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.