Beyond the vaginal route: successful oocyte retrieval using a transabdominally adapted transvaginal ultrasound probe in a frozen pelvis: a case report

Abstract

Transvaginal ultrasound-guided follicular aspiration constitutes the gold standard for oocyte retrieval in assisted reproductive technology (ART). However, complex pelvic pathology including severe adhesive disease, adenomyosis, and sequelae of prior pelvic surgery may profoundly distort adnexal anatomy, rendering conventional transvaginal access technically hazardous or anatomically precluded. We present a 38-year-old woman with primary infertility of 12 years’ duration, diminished ovarian reserve (DOR), diffuse uterine adenomyosis, and a complex surgical history encompassing open myomectomy and adenomyomectomy, referred for in vitro fertilization (IVF). Baseline ultrasonography disclosed markedly distorted adnexal anatomy with bilateral ovarian adhesion to adjacent pelvic structures. Following controlled ovarian stimulation (COS) via a clomiphene citrate–GnRH antagonist protocol, bilateral ovarian inaccessibility via the transvaginal route was confirmed intraoperatively. Transabdominal ultrasound-guided oocyte retrieval was therefore performed using a high-frequency transvaginal transducer repositioned and applied abdominally. Five dominant follicles were successfully aspirated without procedural morbidity, yielding five oocytes. Transabdominal oocyte retrieval employing an abdominally applied transvaginal ultrasound transducer is a technically feasible, safe, and clinically effective alternative in patients in whom conventional transvaginal retrieval is anatomically precluded. This approach may avert cycle cancellation and optimise cumulative oocyte yield in poor ovarian responders with complex adnexal anatomy.