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

AbstractObjective 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.Keywords: Adenomyosisin vitro fertilizationIntracytoplasmic sperm injectionOocyte retrievalTransabdominal TransparencyDeclaration of fundingThis work was supported by National Key R&D Program "Fertility Health and Health Security for Women and Children": Clinical Cohort and Intervention Study on Genetic Problems in Assisted Reproduction Offspring (2021YFC2700602).Declaration of financial/other relationshipsThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.Author contributionsZhen Li: conception and design of the manuscript, data collection; Ruolin Jia: conception and design of the manuscript, drafting of the article; Yichun Guan: review and guidance of thesis manuscript; Wen Zhang: data collection; Kexin Wang: design of manuscript; Zhuolin Yao: assistance in drafting the article.AcknowledgementsAuthors acknowledge the patient who participated in this study (Informed consent was obtained from the patient). They also thank American Journal Experts for their professional manuscript editing services.Data availability statement The original contributions of the study are included in the article and supplementary material. Further inquiries can be directed to the corresponding authors.Ethical statementStudies involving human participants were reviewed and approved by the Ethics Committee of the Third Affiliated Hospital of Zhengzhou University. Written informed consent for participation was required for this study, following national legislation and institutional requirements.