Hemoperitoneum after oocyte retrieval in women undergoing ART: A 2017-2022 retrospective cohort study with a historical comparison to 1996-2016.

PURPOSE: To estimate the incidence and predictors of severity-defined hemoperitoneum after oocyte retrieval in a contemporary 2017-2022 cohort, and to place these findings in context with the center's previously published 1996-2016 experience.

METHODS

Retrospective cohort study including all 13,192 oocyte retrieval procedures performed at a single fertility center from January 2017 to December 2022 in 9,346 women. The primary endpoint was documented hemoperitoneum associated with hemoglobin decrease ≥ 2 g/dL and/or hospital admission, surgery or blood transfusion. The 1996-2016 cohort was retained only as an aggregate historical comparator. Predictors were estimated with robust Poisson regression clustered by patient identifier.

RESULTS

Severity-defined hemoperitoneum was identified among 50 retrievals (0.379 %), including 46 cases with hemoglobin decrease ≥ 2 g/dL, 44 admissions, 20 surgical procedures and 12 transfusions. The contemporary primary endpoint was recorded more frequently than the historical aggregate hemorrhagic comparator (RR 1.67, 95 % CI 1.14-2.46, p = 0.010), whereas surgery did not differ significantly (RR 1.81, 95 % CI 0.97-3.36, p = 0.069). In the primary contemporary model, lower BMI (RR 0.80 per kg/m2, 95 % CI 0.73-0.88, p < 0.001), higher AMH (RR 1.08, 95 % CI 1.02-1.14, p = 0.010) and longer total retrieval time (RR 1.03 per minute, 95 % CI 1.00-1.06, p = 0.044) were associated with severity-defined hemoperitoneum.

CONCLUSIONS

Hemoperitoneum after oocyte retrieval was rare, but associated with substantial morbidity when it occurred. Lower BMI and higher AMH were the main patient-level risk markers. Total retrieval time remained modestly associated with the risk, and should be interpreted as a marker of ovarian response and procedural complexity. The higher rate observed in the contemporary cohort should be interpreted cautiously, as surgery did not increase significantly.

TRIAL REGISTRATION NUMBER: NCT05895227, May 31st, 2023.