Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome

Objective To report the first case series of ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration (TVOA). Design Retrospective analysis. Setting In vitro fertilization unit of a tertiary university hospital. Patient(s) Patients who underwent TVOA during a 6-year period. Intervention(s) Surgical intervention due to active bleeding from the ovary. Main Outcome Measure(s) Prevalence and risk factors. Result(s) Among 3,241 patients undergoing TVOA, 7 were diagnosed as having ovarian hemorrhage afterward. All patients were thin, with a body mass index of 19–21 kg/m2 , and 4 had polycystic ovary syndrome (PCOS). The prevalence of ovarian bleeding among lean patients with PCOS was 4.5%. The odds ratio for bleeding in lean patients with PCOS vs. all other patients was 50 (95% confidence interval 11–250). The interval between the TVOA and surgical intervention ranged from 5 to 18 hours (mean ± SD, 11.4 ± 5 hours). The Δ decrease in hemoglobin levels was 3.2–9 g/dL (mean 6.1 ± 1.8). In 6 of the 7 patients, laparoscopically guided electrocoagulation was sufficient to achieve hemorrhagic control. Conclusion(s) Although acute hemorrhage is a rare event after TVOA, lean patients with PCOS specifically are at much higher risk for this complication.