Oocyte retrieval during in vitro fertilization (IVF) typically utilizes transvaginal ultrasound to guide the physician through the process of needle aspiration. Overall, the safety record for the procedure is excellent, with bleeding and complications occurring in only a small percentage of patients. However, needle aspiration may injure blood vessels and pelvic organs, causing peritoneal or vaginal bleeding.
How Often Does Vaginal Bleeding Occur?
Research published in Reproductive BioMedicine Online studied 898 IVF patients undergoing oocyte retrieval and estimated that "significant peritoneal bleeding" occurred in approximately 6 percent of cases. Color Doppler vaginal vessel imaging correctly predicted vaginal bleeding in patients who experienced moderate peritoneal bleeding. The incidence of vaginal bleeding was lower than expected when conventional ultrasound technology was used. That said, the study wasn't able to determine whether this was due to the use of Doppler technology or individual technique differences.
The authors wrote that color Doppler ultrasound is an "easily accessible technology" that may enhance the safety of the procedure because it allows physicians to visualize the blood vessels and guide the needle to avoid puncturing a vessel.
3D Color Doppler Ultrasound Improving IVF Safety
In recent years, 3D ultrasound has established itself as a valuable tool that complements two-dimensional imaging of the uterus, ovaries and other structures in the female pelvis. Unlike two-dimensional transvaginal ultrasound, which only reconstructs the axial and sagittal planes, 3D ultrasound shows the coronal plane of the uterus as well — yielding a more complete image that can assist assessments. Today, 3D imaging is the preferred modality for assessing congenital uterine anomalies, IUD localization and the diagnosis of adenomyosis. It has also proven useful for accurate identification and diagnosis of other pathologies such as endometrial polyps and fibroids.
In oocyte retrieval during IVF, the physician can use 3D color Doppler ultrasound to guide the aspiration needle to avoid puncturing blood vessels. This should, in turn, reduce the risk of peritoneal and vaginal bleeding after the procedure. These vascular injuries are rare, but they can cause significant distress and require additional hospital care.
Risks to Using 3D Color Doppler Ultrasound
While there are no additional risks associated with using 3D color Doppler ultrasound in oocyte retrieval during IVF, the authors of the Reproductive BioMedicine Online study note that there are some questions that have yet to be answered about whether it enhances safety. For example, the use of Doppler imaging did not reduce the number of moderate to severe bleeding events, even though the incidence of vaginal bleeding was lower than expected. They noted that physicians may still be unable to avoid smaller blood vessels while retrieving oocytes.
Still, this new technology offers the potential to increase safety for patients during oocyte retrieval and help reduce the incidence of postoperative hemorrhagic bleeding.
