|Year : 2021 | Volume
| Issue : 2 | Page : 81-83
Abdominal oocyte pickup in patient with uterine factor infertility: A case report
PM Gopinath, Sahityalakshmi Manoharan
Department of Obstetrics, Gynaecology and IVF, SRM Institutes for Medical Sciences, Chennai, Tamil Nadu, India
|Date of Submission||27-Jul-2022|
|Date of Acceptance||01-Nov-2022|
|Date of Web Publication||30-Dec-2022|
Dr. P M Gopinath
“Divyadeepam”, Plot No. 5102, H Block, 8th Street, 15th Main Road, Anna Nagar, Chennai 600040, Tamil Nadu
Source of Support: None, Conflict of Interest: None
During infertility treatment, ultrasound was required for both diagnostic and therapeutic procedures. Transvaginal route of oocyte retrieval was preferred due to its better visualization, easy accessibility, decreased intestinal trauma, and high pickup rate. Here we have a rare case scenario where abdominal oocyte retrieval was done in a patient with fibroid uterus due to the inaccessibility of both ovaries by the transvaginal method.
Keywords: Abdominal oocyte pick up, fertility preservation, fibroid complicating, oocyte pick up, uterine factor infertility
|How to cite this article:|
Gopinath P M, Manoharan S. Abdominal oocyte pickup in patient with uterine factor infertility: A case report. Onco Fertil J 2021;4:81-3
| Introduction|| |
During infertility treatment, ultrasound was required for both diagnostic and therapeutic procedures. In the early ages of in vitro fertilization (IVF), oocyte pickup was done by a laparoscopic method which carried the burden of anesthesia, admission, and stress of a surgical procedure. Transvaginal route of oocyte retrieval was preferred due to its better visualization, easy accessibility, decreased intestinal trauma, and high pickup rate. However, in some patients, an abdominal route is needed when the ovaries are transposed in cancer patients or enlarged above the pelvic brim. Transabdominal method is rarely used in women with difficult access.
| Case|| |
A 29-year-old, Mrs. DK, was anxious to conceive for 5 years. She is a known case of recurrent multiple large fibroid uterus. She has irregular cycles and heavy flow associated with dysmenorrhoea. Anemia correction was done multiple times. She has undergone myomectomy twice in 2014 and 2016, and uterine artery embolization (UAE) in 2020. However, the fibroids kept recurring. On examination, she had pallor, her uterus was 24 weeks in size, irregularly enlarged, and multiple fibroids were palpable.
| Investigations|| |
- Ultrasound (transvaginal): uterus irregularly enlarged with multiple fibroids. Anterior wall fibroids measuring––7.3 cm x 6.5 cm, 2.6 cm x 1.6 cm, 2.6 cm x 4 cm, 3 cm x 3 cm, 2.5 cm x 1.5 cm. Right lateral wall fibroids measuring––8 cm x 6 cm, 6 cm x 4 cm. Fundo posterior wall fibroid measuring––8 cm x 7 cm. Endometrial cavity cannot be delineated clearly. Bilateral ovaries could not be visualized by the transvaginal route. Abdominal ultrasound shows normal-appearing ovaries.
- Blood parameter: serum thyroid stimulating hormone—1.83 micIU/mL; serum follicular stimulating hormone––4.93 mIU/mL; serum luteinizing hormone––11.53 mIU/mL; prolactin––7.39ng/mL; serum anti-Müllerian hormone––1.56 ng/mL.
- Husband semen analysis––60 mil/mL concentration, 60% total motility, and 4% morphology—normozoospermia.
She planned for assisted reproductive technology-intracytoplasmic sperm injection, embryos cryopreservation based on her response. Ovarian stimulation was done using the Antagonist protocol with highly purified-human menopausal gonadotropin. As follicular monitoring was difficult via transvaginal ultrasound, transabdominal monitoring was done. Recombinant human chorionic gonadotropin trigger was given when follicles reached >20 mm. After anemia correction, abdominal bilateral follicular aspiration with ovarian cortex tissue cryopreservation and total abdominal hysterectomy was done.
Uterus was 24 weeks in size, lobulated with multiple large fibroids [Figure 1]. Both ovaries were enlarged with multiple follicles. Using a 17-G single-lumen needle, follicular aspiration was done from both ovaries [Figure 2]. Fluid was collected in tubes (in warmer); the ovarian cortex was harvested from the left ovary and placed in media [Figure 3]. Both were transferred to the laboratory. Both tubes and ovaries were retained.
|Figure 1: Uterus. A cut section of the removed uterus showing multiple large fibroids|
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|Figure 2: Abdominal oocyte retrieval. A 17-G single-lumen needle was used to directly puncture and retrieve oocytes from the ovary (held by the surgeon)|
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|Figure 3: Ovarian tissue cryopreservation. A sliver of ovarian cortex 0.5 cm x 0.5 cm wcomplex were as harvested from one ovary and placed in a tube containing media and sent over to the laboratory, where it was cryopreserved|
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In the embryology laboratory, six cumulus oocyte complex were retrieved from the follicular fluid, out of which all six were mature Metaphase II oocytes. They were denuded and ICSI was done with good quality sperm from the husband semen sample. On day 3, three 8-cell grade 1 embryos were obtained and were cryopreserved. The patient is enrolled in the surrogacy program, awaiting a suitable candidate.
| Discussion|| |
There are 80% of women affected by fibroids in their reproductive age group associated with pain, stress, heavy menstrual bleeding, and infertility. A study conducted by Wallace et al. compared the quality of life among women who underwent hysterectomy and invasive myomectomy. They concluded that women who underwent hysterectomy had a better quality of life compared with myomectomy. UAE is another option, but the effectiveness of the treatment in women desiring fertility is questionable. Though there is a mild possibility of pregnancy after UAE, the obstetrical complications are more. It also leads to ovarian injury and causes premature menopause hindering time to pregnancy interval in those seeking treatment for infertility.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wallace K, Zhang S, Thomas L, Stewart E, Nicholson WK Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids. Fertil Steril 2022;11:618-26.
Lumsden MA Debate: Embolization versus myomectomy versus hysterectomy. Which is best, when? Human Reprod 2002;17:253-59.
Czuczwar P, Stepniak A, Wrona W, Wozniak S, Milart P, Paszkowski T The influence of uterine artery embolisation on ovarian reserve, fertility, and pregnancy outcomes: A review of literature. Menopause Rev 2016;15:205-9.
[Figure 1], [Figure 2], [Figure 3]