Beyond the vaginal route: successful oocyte retrieval using a transabdominally adapted transvaginal ultrasound probe in a frozen pelvis: a case report

Beyond the vaginal route: successful oocyte retrieval using a transabdominally adapted transvaginal ultrasound probe in a frozen pelvis: a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20262582Keywords: Transabdominal oocyte retrieval, Transvaginal ultrasound probe, In vitro fertilization, Inaccessible ovaries, Pelvic adhesions, Diminished ovarian reserve, Assisted reproductive technologyAbstract Transvaginal ultrasound-guided follicular aspiration constitutes the gold standard for oocyte retrieval in assisted reproductive technology (ART). However, complex pelvic pathology including severe adhesive disease, adenomyosis, and sequelae of prior pelvic surgery may profoundly distort adnexal anatomy, rendering conventional transvaginal access technically hazardous or anatomically precluded. We present a 38-year-old woman with primary infertility of 12 years’ duration, diminished ovarian reserve (DOR), diffuse uterine adenomyosis, and a complex surgical history encompassing open myomectomy and adenomyomectomy, referred for in vitro fertilization (IVF). Baseline ultrasonography disclosed markedly distorted adnexal anatomy with bilateral ovarian adhesion to adjacent pelvic structures. Following controlled ovarian stimulation (COS) via a clomiphene citrate–GnRH antagonist protocol, bilateral ovarian inaccessibility via the transvaginal route was confirmed intraoperatively. Transabdominal ultrasound-guided oocyte retrieval was therefore performed using a high-frequency transvaginal transducer repositioned and applied abdominally. Five dominant follicles were successfully aspirated without procedural morbidity, yielding five oocytes. Transabdominal oocyte retrieval employing an abdominally applied transvaginal ultrasound transducer is a technically feasible, safe, and clinically effective alternative in patients in whom conventional transvaginal retrieval is anatomically precluded. This approach may avert cycle cancellation and optimise cumulative oocyte yield in poor ovarian responders with complex adnexal anatomy. Metrics References Wikland M, Enk L, Hammarberg K, Nilsson L. Use of a vaginal transducer for oocyte retrieval in an IVF/ET program. J Clin Ultrasound. 1987;15(4):245-51. DOI: https://doi.org/10.1002/jcu.1870150405 Barton SE, Politch JA, Benson CB, Ginsburg ES, Gargiulo AR. Transabdominal follicular aspiration for oocyte retrieval in patients with ovaries inaccessible by transvaginal ultrasound. Fertil Steril. 2011;95(5):1773-6. DOI: https://doi.org/10.1016/j.fertnstert.2011.01.006 Ferraretti AP, La Marca A, Fauser BC, Tarlatzis B, Nargund G, Gianaroli L. ESHRE Working Group on Poor Ovarian Response Definition. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod. 2011;26(7):1616-24. DOI: https://doi.org/10.1093/humrep/der092 Drakopoulos P, Bardhi E, Boudry L, Vaiarelli A, Makrigiannakis A, Esteves SC, et al. Update on the management of poor ovarian response in IVF: the shift from Bologna criteria to the Poseidon concept. Ther Adv Reprod Health. 2020;14:2633494120941480. DOI: https://doi.org/10.1177/2633494120941480 Melado L, Lawrenz B, Fatemi H. Rethinking the route of oocyte retrieval: when one procedure does not fit all. Reprod Biomed Online. 2026;53(2):105739. DOI: https://doi.org/10.1016/j.rbmo.2026.105739 Sönmezer M, Saçıntı KG, Gülümser Ç, Özkavukçu S, Atabekoğlu C, Şükür YE, et al. Transabdominal ultrasound-guided oocyte retrieval for oocyte cryopreservation using a vaginal probe: a comparison of applicability, effectiveness, and safety with conventional transvaginal approach. J Assist Reprod Genet. 2023;40(2):399-405. DOI: https://doi.org/10.1007/s10815-022-02705-8 Jia R, Li Z, Guan Y, Zhang W, Wang K, Yao Z. Transabdominal and transvaginal egg retrieval guided by a vaginal ultrasound probe in an adenomyosis patient: a case report. Curr Med Res Opin. 2023;39(5):797-801. DOI: https://doi.org/10.1080/03007995.2023.2192609 Yang G, Wang S, Lin H, Yuan P, Zhang Q, Chen H. Modified transabdominal oocyte retrieval guided by vaginal ultrasound probe: a case report and literature review. Case Rep Obstet Gynecol. 2025;2025:5530041. DOI: https://doi.org/10.1155/crog/5530041 Vercellini P, Consonni D, Dridi D, Bracco B, Frattaruolo MP, Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29(5):964-77. DOI: https://doi.org/10.1093/humrep/deu041 Cozzolino M, Tartaglia S, Pellegrini L, Troiano G, Rizzo G, Petraglia F, et al. The effect of uterine adenomyosis on IVF outcomes: a systematic review and meta-analysis. Reprod Sci. 2022;29(11):3177-93. DOI: https://doi.org/10.1007/s43032-021-00818-6