Fertility outcomes in patients with tubo-ovarian abscesses after an oocyte retrieval: a longitudinal cohort analysis

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This study compared IVF cycles with and without tubo-ovarian abscess (TOA) after oocyte retrieval, finding TOA reduced oocyte yield and fertilization rates with near-zero pregnancy rates.

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This retrospective longitudinal cohort study assessed ovarian response to stimulation and pregnancy outcomes in 15 women who developed tubo-ovarian abscess (TOA) after oocyte retrieval during an IVF cycle, comparing their first TOA-complicated treatment cycle with the subsequent IVF cycle within one year. The mean number of retrieved oocytes was higher in the first cycle than the second (8.1 ± 3.2 vs 5.4 ± 2.5), indicating about a 30% reduction in ovarian response to gonadotropin stimulation, and fertilization rates were lower in the second cycle. Embryo transfer occurred in most patients in both cycles (80% vs 93.3%), but no clinical pregnancies were seen after the first cycle and only 1 patient (6.6%) achieved a clinical pregnancy after the second cycle. The authors explicitly note that current data are insufficient to recommend deferring fertility treatment after a TOA episode. The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

PurposeTo determine the impact of pelvic inflammation caused by tubo-ovarian abscess (TOA) on ovarian response to stimulation.MethodsThis retrospective longitudinal cohort analysis that was carried out in a tertiary university-affiliated medical center included 15 women with TOA during in vitro fertilization (IVF) cycles. The ovarian response to stimulation and the pregnancy rate were compared in two subsequent cycles, the initial IVF cycle that was complicated by TOA after oocyte retrieval (first treatment cycle) and the following IVF treatment (second treatment cycle) that occurred within a period of a year from the first cycle.ResultsThe mean number of retrieved oocytes was significantly higher in the first IVF cycle compared to the second cycle (8.1 ± 3.2 vs. 5.4 ± 2.5, P = .003], corresponding to a 30% reduction in ovarian response to gonadotropin stimulation. Fertilization rates were significantly lower in the second cycle (4.1 ± 2.9 vs. 2.9 ± 1.7, P = .015). Twelve women (80%) reached embryo transfer in the first cycle compared to 14 women (93.3%) in the second cycle. The mean number of transferred embryos was similar between the two cycles. There were no clinical pregnancies following the first cycle, and only one patient (6.6%) had a clinical pregnancy in the second treatment cycle.ConclusionsTOA following fertility treatment has a detrimental effect on ovarian function. The pregnancy rate in the immediate period following TOA is poor. Current data for recommending the deferral of fertility treatment following a TOA episode are insufficient, calling for more studies to address these issues.
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Abstract

Purpose To determine the impact of pelvic inflammation caused by tubo-ovarian abscess (TOA) on ovarian response to stimulation.

Methods

This retrospective longitudinal cohort analysis that was carried out in a tertiary university-affiliated medical center included 15 women with TOA during in vitro fertilization (IVF) cycles. The ovarian response to stimulation and the pregnancy rate were compared in two subsequent cycles, the initial IVF cycle that was complicated by TOA after oocyte retrieval (first treatment cycle) and the following IVF treatment (second treatment cycle) that occurred within a period of a year from the first cycle.

Results

The mean number of retrieved oocytes was significantly higher in the first IVF cycle compared to the second cycle (8.1 ± 3.2 vs. 5.4 ± 2.5, P = .003], corresponding to a 30% reduction in ovarian response to gonadotropin stimulation. Fertilization rates were significantly lower in the second cycle (4.1 ± 2.9 vs. 2.9 ± 1.7, P = .015). Twelve women (80%) reached embryo transfer in the first cycle compared to 14 women (93.3%) in the second cycle. The mean number of transferred embryos was similar between the two cycles. There were no clinical pregnancies following the first cycle, and only one patient (6.6%) had a clinical pregnancy in the second treatment cycle.

Conclusions

TOA following fertility treatment has a detrimental effect on ovarian function. The pregnancy rate in the immediate period following TOA is poor. Current data for recommending the deferral of fertility treatment following a TOA episode are insufficient, calling for more studies to address these issues. Similar content being viewed by others

References

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Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004635.pub2 Author information Authors and Affiliations Contributions YF: protocol/project development, data collection or management, manuscript writing/editing, and data analysis. YC: data management, manuscript writing/editing, and data analysis. IL: manuscript writing/editing and data analysis. AM: protocol/project development and manuscript writing/editing. FA: manuscript writing/editing. AC: protocol/project development, manuscript writing/editing, and data analysis. Corresponding author Ethics declarations Conflict of interest All the authors report no conflict of interest and that this research was non-funded. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Fouks, Y., Azem, F., Many, A. et al. Fertility outcomes in patients with tubo-ovarian abscesses after an oocyte retrieval: a longitudinal cohort analysis. Arch Gynecol Obstet 300, 763–769 (2019). https://doi.org/10.1007/s00404-019-05230-9 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-019-05230-9

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