Clinical Complications in Oocyte Retrievals: A brief look into a recent retrospective study

by Kallie Fell, CBC Research Associate on July 7, 2019

illustrated collage of women's faces in a range of skin tones and hairstyles

A year ago this month, Fertility and Sterility published an article that assessed complications arising from oocyte retrievals. More specifically, researchers performed a retrospective analysis of ultrasound-guided transvaginal oocyte retrieval procedures and the ensuing complications that occurred between 1996 to 2016 at the Fertility Center Humanitas Research Hospital in Italy. A total of 23,827 consecutive oocyte retrieval procedures in 12,615 patients were analyzed for complications. 

First, it is important to understand what oocyte retrieval is. If you know what this is, skip this paragraph and keep reading below. Egg donation, surrogacy, and IVF all require oocyte retrieval. ‘Oocyte’ is just a fancy word for egg. To create an embryo (or baby) you have to have an egg (from a female) and a sperm (from a male). Oocyte retrieval is a procedure where doctors remove an egg from a woman’s body. The gold standard way to remove an egg from a woman’s body is the ultrasound-guided transvaginal (US-TV) route. It is less invasive than other methods and was first performed only 36 years ago.  

Secondly, I would like to point out that studies like this are important because they help potential egg donors or women undergoing IVF understand the risks associated with procedures like egg donation. Studies like this form the basis of informed consent. The authors of this study agree. They write, “the risks associated with US-TV should not be underestimated because some complications, although rare, may be life-threatening.” Authors go on to state:

“In general, the rates of complications associated with oocyte retrieval procedures are not easily available unless individual programs collect these data as indicators for their own quality performance. Most ART registries focus on cycle outcomes in terms of pregnancy and live births, but neglect to collect information about the rate of complications during oocyte retrieval procedures. In addition, as complications often occur days to weeks after the oocyte retrieval procedure, the reporting of these complications to the registry may be suboptimal.” (emphasis added)

How can an egg donor give informed consent if fertility clinics fail to track the risks and report the complications and negative outcomes? How can a young donor know what she is risking if doctors and researchers don’t know either? 

In this study, surprisingly, only 96 complications related to oocyte retrieval procedures were encountered.  It is important to note that the authors defined “complication” as one that required hospitalization or outpatient medical management.  Complications in this study included:

  • peritoneal bleeding (bleeding into the abdominal cavity) 
  • infection: severe sepsis and septic shock, ovarian abscess, pelvic peritonitis (inflammation of the pelvic area)
  • vaginal wall lacerations and bleeding
  • bladder trauma
  • pelvic pain
  • anesthetic complications: circulatory shock, nausea, atrial fibrillation cardiorespiratory insufficiency 

Of the 96 complications, hospital admission was necessary for 71 of them. Twenty-four patients required surgical intervention, 19 of these cases were from peritoneal bleeding – the most common complication in this study. 

You might be thinking that 96 out of 23,827 seems pretty insignificant. I agree, it does. Then I think, would I take the chance? Would I risk it? Would you? Would you want your college age daughter to take that risk? The women featured in Eggsploitation regret their lack of being informed of the risks and they live each day with the long-term effects of damage to their health. Additionally, although the risk for complications seems low, this study did not include any complications or consequences associated with hormonal stimulation such as ovarian hyperstimulation syndrome. This study was also not able to follow, track, or record the long-term health outcomes of these patients. Medical procedures do have the potential to carry risks throughout a women’s lifetime. 

Remarkably, this study revealed that patients experiencing complications tended to be younger, thinner, and had a higher number of oocytes retrieved. Sound like any population you know? Egg donors tend to be younger (fertility clinic advertisements are often targeted at women in college) and egg donors often donate large numbers of eggs at one time. It is also documented in the literature that young women are more at risk for OHSS because the ovaries of a younger woman are more responsive to gonadotropins due to a higher density of gonadotropins receptors (or a larger number of follicles able to respond). 

We are grateful for studies like this that help illuminate the risks involved with egg donation so that women can make more informed decisions about their reproductive health. May the scientific community continue to explore the consequences of artificial reproductive techniques. We at the CBC will be here, watching, waiting, and reporting.

Graphic by Vecteezy

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