Dados do Trabalho

Title

The presence of endometriomas is associated with post-oocyte retrieval complications in patients undergoing IVF treatment

Objective

This review aims to evaluate whether the presence of endometriomas is a risk factor for post-oocyte retrieval complications, such as pelvic infections, vaginal or peritoneal bleeding, and pelvic pain in women undergoing in vitro fertilization (IVF) treatment for infertility.

Methods

This literature review covers 55 original articles, case reports and reviews in English published on Pubmed between January 1983 and December 2022. The MESH terms used for the search were: endometriosis, endometrioma, oocyte retrieval, hemoperitoneum, pelvic infection, pelvic inflammatory disease, vaginal bleeding, peritoneum injuries, and postoperative complications.

Results

Anatomical distortion may impair oocyte retrieval in patients with endometriomas. In one of the studies included it was found that incomplete aspiration of the follicles occurred in 14% of women as a result of limited needle access to the ovaries. Pelvic pain in women with endometriomas is one of the most common complications after the oocyte pick-up. In another study, the percentage of women with pain that needed to go to hospital was 7%.
Endometriosis and the presence of an endometrioma are associated with a higher risk of post-oocyte retrieval pelvic infection, as a consequence of various factors: immunological changes, the fact that endometriomas are an excellent culture medium, the frequency of endometrioma puncture and pelvic adhesions. Most critically, endometrioma puncture during the oocyte retrieval is the risk factor more associated with pelvic infection post-egg retrieval. In this context, endometriomas larger than 27 mm were inadvertently punctured in 22% of cases, and in patients with previous laparoscopic approaches, this percentage increased to 24%. Pelvic infection after transvaginal oocyte retrieval occurred in 0.2-0.5% of the cases. In 14 endometrioma infections cases in the literature, 11 of them received antibiotic therapy after the procedure, as prophylaxis, and 7 had the endometrioma accidentally punctured during the retrieval. Vaginal bleeding is one of the most common complications after oocyte retrieval, mild cases could occur in 18.8% and be solved with local compression. Its main risk is associated with the intensity of pressure exerted by the endovaginal ultrasound probe. Peritoneal bleeding occurs less frequently, just in 0.2/1000 to 0.5/1000 of the oocyte retrievals. Therefore, the presence of endometriomas was not associated with vaginal and/or peritoneal bleeding. Previous laparoscopic procedures could be a risk factor for hemoperitoneum in women with endometriosis, together with ovarian scars. In a case series report that included 54 patients with post-oocyte retrieval pelvic bleeding, 33.33% reported having had laparoscopic surgery before the IVF treatment.

Conclusion

Therefore, endometriosis and the presence of endometriomas are risk factors for pelvic infection after ultrasound-guided oocyte retrieval, but the literature does not suggest they are risk factors for peritoneal and vaginal bleeding.

Keywords

endometriosis; endometrioma; pelvic infection; oocyte retrieval complication.