Transabdominal and transvaginal egg retrieval guided by a vaginal ultrasound probe in an adenomyosis patient: a case report

OBJECTIVE: To explore a non-routine method of oocyte retrieval in patients with difficulty in obtaining oocytes via the vagina during a cycle of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-embryo transfer (ET). METHODS: We report the clinical data of one case of combined transabdominal and transvaginal egg retrieval with a vaginal ultrasound probe in a patient with adenomyosis undergoing IVF/ICSI for fertilization. RESULTS: A patient with infertility due to adenomyosis desired fertility. During vaginal ultrasound monitoring before ovulation induction, it was found that most of the pelvic cavity was occupied by the uterus. The uterus was (116 mm + 30 mm) × 110 mm × 108 mm and the right ovary was extremely high. The right ovary was not clear on transvaginal ultrasound but it could be displayed by abdominal ultrasound. The Cancer antigen 125(CA125) before starting the fertility cycle was 532.5 U/mL. On the 7th day of the cycle, she complained of mild pain and discomfort in the abdomen, and the size of the uterus was found to be (128 mm + 30 mm) × 125 mm × 110 mm, and her Cancer antigen 125(CA125) was 1109 U/mL. After a total of 13 days of stimulation, the eggs were retrieved. The ovum retrieval procedure used a vaginal ultrasound probe to guide retrieval of the eggs via puncture through the abdomen. A total of 12 and 9 mature eggs were obtained from the left and right ovaries, respectively, and 1 embryo and 9 blastocysts were frozen after insemination. The patient was undergoing treatment for adenomyosis, and no embryos had been transferred. CONCLUSION: Transabdominal ovum retrieval guided by a vaginal ultrasound probe is a feasible, effective, and safe method for obtaining oocytes for patients who cannot retrieve eggs vaginally. In the clinical work of IVF/ICSI fertility, it is necessary to obtain a thorough medical history and assess the patient's condition before the cycle and conduct multidisciplinary consultation on difficult cases to improve the likelihood of pregnancy.