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Fifty patients scheduled to undergo IVF received a standard anesthetic of fentanyl and propofol for induction, followed by propofol infusion, with Bispectral index values and modified Ramsey sedation scores recorded at 5-minute intervals for the duration of anesthesia care. Moderate sedation was found only transiently during the first 5–10 minutes of the oocyte retrieval, but thereafter the level of sedation increased, with deep sedation and general anesthesia measured in all patients as determined by both the Bispectral index scores and lack of response to painful stimulation. [Copyright &y& Elsevier]

To present the first report of massive hemoperitoneum in a case of essential thrombocythemia after transvaginal oocyte retrieval for IVF and review the relevant literature related to the management of patients with this condition.Case report.Assisted conception unit of a tertiary care university hospital in the United Kingdom.A 37-year-old woman with essential thrombocythemia who developed massive intra-abdominal bleeding after transvaginal oocyte retrieval for IVF.Emergency laparotomy and right salpingoophorectomy.Resuscitation of the patient.Overall management of the patient is discussed.The management of patients with essential thrombocythemia at the childbearing period poses a difficult problem. Fertility may be reduced, and an adverse outcome of pregnancy due to thrombotic or bleeding complications is a matter of concern. A multidisciplinary approach with close and early cooperation with the hematologists before initiation of IVF therapy for patients with essential thrombocythemia is essential. Efforts should be made to reduce the platelet count and assess the platelet function before embarking on IVF, keeping in mind the double jeopardy from bleeding and thrombosis in these cases. [Copyright &y& Elsevier]

We report the complications observed after transvaginal oocyte retrieval guided by ultrasound in 7,098 IVF cycles. The frequency of severe complications in our patients was 0.08%, of which four cases were intraperitoneal bleeding (0.06%) and two were cases of ovarian abscess (0.003%). [Copyright &y& Elsevier]

Objective: To report a case of ureterovaginal fistula secondary to transvaginal oocyte retrieval (TVOR). Design: Case report. Setting: IVF Center IN a private hospital. Patient(s): A 31-year-old woman presented immediately after TVOR with right lower abdominal pain with irradiation to the suprapubic area and vaginal discharge. Intervention(s): Vaginal examination, creatinine dosage in plasma and vaginal discharge, excretory urography. A double-J catheter was inserted under general anesthesia. Main Outcome Measure(s): Clinical follow-up. Result(s): Vaginal leakage ceased a few hours after catheter insertion. Transfer of two embryos was performed 3 days after TVOR, but no pregnancy occurred. The double-J catheter was removed 21 days after its placement. Imaging studies done 6 weeks later demonstrated a normal urinary tract morphology. Conclusion(s): Given the elective nature of TVOR and IVF, patients should be informed about all potential complications, including ureterovaginal fistula. [ABSTRACT FROM AUTHOR]

Objective: To describe an ovarian abscess presenting very late after oocyte retrieval for IVF with several unusual clinical features. Design: Case report. Setting: Academic medical center. Patient(s): A 35-year-old nulliparous woman underwent IVF with uncomplicated transvaginal oocyte retrieval (TVOR), resulting in a dizygotic twin pregnancy. At 13 weeks of pregnancy she presented with vaginal discharge, but was otherwise constitutionally well. At 30 weeks she developed a low-grade fever, and the diagnosis of ovarian abscess was made. She received broad-spectrum antibiotics, and the abscess was drained percutaneously after cesarean delivery of twins. Intervention(s): Antimicrobial therapy; cesarean section; postpartum percutaneous drainage. Main Outcome Measure(s): Clinical and radiologic resolution of infection. Result(s): Complete resolution of the abscess; delivery of healthy twins. Conclusion(s): Infectious complications of TVOR and other surgical procedures usually occur within days of the intervention. Our case illustrates the possibility of infectious complications of TVOR presenting months after the procedure. Our patient did not become acutely ill due to the formation of a spontaneous vaginal fistula, which allowed the abscess to drain. The optimal management of this complication is unclear, but final resolution of any pelvic abscess generally requires drainage. [Copyright &y& Elsevier]