Purpose: The purpose of the article is to know how to progress ovum pick up (OPU) in cases where the ovaries are superiorly placed and are difficult to approach vaginally.
Material and methods: We performed OPU in cases where the ovaries are superiorly placed and are difficult to approach vaginally. This is a case study of eight patients where the ovaries were not approachable: four cases of Mayer–Rokitansky–Küster– Hauser (MRKH) syndrome, three cases of endometriosis, and one case of pelvic inflammatory disease (PID) over a period of 2 years from December 2014 till December 2016. There were four cases of MRKH syndrome out of which in two the vagina was only about 2 to 3 cm in depth. It was very difficult to even insert the vaginal probe. In two cases of MRKH syndrome the ovaries were superiorly placed and were not approachable by the routine OPU needle through the guide of transvaginal probe; in two cases of endometriosis, endometrioma was 4 to 5 cm in size. There was one case of endometriosis and one case of PID.
Discussion: A laparoscopic approach for OPU may be the answer in cases of superiorly placed ovaries in cases of MRKH syndrome going in for surrogacy and also in some cases of severe endometriosis and PID where it may be difficult to approach the ovaries. In all these cases, OPU could be completed with the transvaginal ultrasound probe kept suprapubically and the OPU needle was guided through the guide and all the follicles could be aspirated without the need for laparoscopy
Limitations, reasons for caution: The procedure should be carefully done in very obese women. The anatomical location of the inferior epigastric vessels should also be known to avoid any bleeding from these vessels at the time of the procedure.
Wider implications of the findings: Can be done by a routine in vitro fertilization specialist. It removes the need of calling a laparoscopic surgeon in such difficult cases.
Results: It is noninvasive with just a needle puncture on the lower abdomen and all the follicles can be retrieved.
Conclusion: This novel method of using the transvaginal probe abdominally for OPU in cases of superiorly placed ovaries can avoid
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