Ureteral injury after transvaginal ultrasound-guided oocyte retrieval: a complication of in vitro fertilization-embryo transfer that may lurk undetected in women presenting with severe ovarian hyperstimulation syndrome

Abstract

Objective: To report a case of ureteral injury after transvaginal ultrasound-guided oocyte retrieval, initially misdiagnosed as an ovarian hyperstimulation syndrome (OHSS).

Design: Case report.

Setting: University hospital.

Patient(s): A 26-year-old patient with a history of primary infertility due to polycystic ovary syndrome (PCOS) presented with acute pelvic pain after transvaginal ultrasound-guided oocyte retrieval for in vitro fertilization-embryo transfer.

Intervention(s): Initial clinical presentation, context, and imaging results were consistent with the diagnosis of mild OHSS. Recurrence of the pelvic pain with radiation to the right lumbar region suggested the possibility of a urinary complication.

Main outcome measure(s): Successful detection and management of unilateral ureteral injury in a patient with PCOS.

Result(s): Uro-computed tomography scan helped with the diagnosis of right pelvic-ureter lesion. Patient underwent cystoscopy with uncomplicated right ureteral stent placement and delivered a healthy baby at term.

Conclusion(s): Although ureteral injury after transvaginal ultrasound-guided oocyte retrieval is a rare complication of IVF-ET, it could have serious sequelae such as fistula formation and renal dysfunction if untreated. Clinicians must be aware that it may lurk undetected in women presenting OHSS.