Complications of transvaginal ultrasound-directed follicle aspiration: A review of 2670 consecutive procedures

Stephen Bennett, John Waterstone, Wei Chen Cheng, J. A. Parsons
In: Journal of Assisted Reproduction and Genetics · 1993 · vol. 10(1) , pp. 72–77 · doi:10.1007/bf01204444 · PMID:8499683 · W2051976349
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-12 ⓘ

This study monitored complications from 2670 transvaginal ultrasound-directed follicle aspirations, finding vaginal hemorrhage in 8.6%, significant blood loss in 0.8%, and pelvic infection in 0.6%.

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This paper is a prospective review of complications from 2670 consecutive transvaginal ultrasound-directed follicle aspiration procedures over 4 years, reporting incidence and outcomes of adverse events. Vaginal hemorrhage occurred in 8.6% of cases, with >100 ml blood loss in 0.8%, and postoperative pelvic infection occurred in 0.6%, including 9 severe infections with pelvic abscess; microbiology suggested direct inoculation of vaginal organisms into the peritoneal cavity via the needle as a likely route. Major but rare events included two cases of ovarian hemorrhage with hemoperitoneum (one requiring emergency laparotomy) and one iliac-vessel puncture hematoma that resolved without intervention. The authors conclude the low pelvic infection incidence questions prophylactic antibiotics and note no increased infection risk with preexisting peritoneal damage, but the study does not provide an explicit control for antibiotic use beyond this observational inference. 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

PurposeComplications following transvaginal ultrasound-directed follicle aspiration are rare, making it difficult to assess their true incidence. During a 4-year prospective study the complications arising from a series of 2670 consecutive procedures were monitored.ResultsVaginal hemorrhage occurred in 229 (8.6%) of the cases, with a significant loss (> 100 ml) in 22 (0.8%). Postoperative pelvic infection occurred in 18 (0.6%) of the cases. Hemorrhage from the ovary with hemoperitoneum formation was seen on two occasions and necessitated emergency laparotomy in one instance. A single case of pelvic haematoma formation from a punctured iliac vessel was also recorded; this settled without intervention. Of the 18 cases with infection, 9 were severe with pelvic abscess formation; microbiological examination of the pus from these cases suggests that the most common route of infection in such cases is probably by direct inoculation of vaginal organisms into the peritoneal cavity by the collecting needle.ConclusionThe low incidence of pelvic infection questions the value of using prophylactic antibiotics. No increased risk of infection was demonstrated in cases with preexisting peritoneal damage.
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Results

Vaginal hemorrhage occurred in 229 (8.6%) of the cases, with a significant loss (>100 ml) in 22 (0.8%). Postoperative pelvic infection occurred in 18 (0.6%) of the cases. Hemorrhage from the ovary with hemoperitoneum formation was seen on two occasions and necessitated emergency laparotomy in one instance. A single case of pelvic haematoma formation from a punctured iliac vessel was also recorded; this settled without intervention. Of the 18 cases with infection, 9 were severe with pelvic abscess formation; microbiological examination of the pus from these cases suggests that the most common route of infection in such cases is probably by direct inoculation of vaginal organisms into the peritoneal cavity by the collecting needle.

Conclusion

The low incidence of pelvic infection questions the value of using prophylactic antibiotics. No increased risk of infection was demonstrated in cases with preexisting peritoneal damage. Similar content being viewed by others

References

Wickland M, Lennart E, Hamberger L: Transvesical and transvaginal approaches for the aspiration of follicles by the use of ultrasound. Ann NY Acad Sci 1985;442:184 Evers JLH, Larsen JF, Gnany GG, Sieck UV: Complications and problems in transvaginal sector scan-guided follicle aspiration. Fertil Steril 1988;49:278–272 Cohen J, Debache C, Pez JP, Junca AM, Cohen-Bacrie P: Transvaginal sonographically controlled ovarian puncture for oocyte retrieval for in vitro fertilisation. J Vitro Fert Embryo Transfer 1986;3:309–313 Feichtinger W, Kemeter P: Laparoscopic or ultrasonically guided follicle aspiration for in vitro fertilisation. J Vitro Fert Embryo Transfer 1984;1:244–249 Riddle AF, Sharma V, Mason BA, Ford NT, Pampiglione JS, Parsons J, Campbell S: Two years' experience of ultrasound-directed oocyte retrieval. Fertil Steril 1987;48:454–458 Jones WR, Haines CJ, Matthews CD, Kirby CA: Traumatic ureteric obstruction secondary to oocyte recovery for in vitro fertilisation: A case report. J Vitro Fert Embryo Transfer 1985;6:185–187 Flood JT, Muasher SJ, Simonetti S, Kreiner D, Acosta AA, Rosenwaks Z: Comparison between laparoscopically and ultrasonographically guided transvaginal follicular aspiration methods in an in vitro fertilisation program in the same patients using the same stimulation protocol. J Vitro Fert Embryo Transfer 1989;6:180–185 Howe RS, Wheeler C, Mastroianni L, Blasco L, Tureck R: Pelvic infection after transvaginal ultrasound-guided ovum retrieval. Fertil Steril 1988;49:726–728 Meldrum DR: Antibiotics for vaginal oocyte aspiration. J Vitro Fert Embryo Transfer 1989;6:1–2 Ashkenazi J, David MB, Feldberg D, Shelef M, Dicker D, Goldman JA: Abdominal complications following ultrasonically guided percutaneous transvesical collection of oocytes for in vitro fertilisation. J Vitro Fert Embryo Transfer 1987;4:316–318 Author information Authors and Affiliations Rights and permissions About this article Cite this article Bennett, S.J., Waterstone, J.J., Cheng, W.C. et al. Complications of transvaginal ultrasound-directed follicle aspiration: A review of 2670 consecutive procedures. J Assist Reprod Genet 10, 72–77 (1993). https://doi.org/10.1007/BF01204444 Received: Accepted: Issue date: DOI: https://doi.org/10.1007/BF01204444

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