Ultrasonographically-guided vaginal oocyte recovery, used to collect oocytes for in vitro fertilization, is a relatively atraumatic method with rare complications. It was first described by Wikland et al. in 1985
. This procedure is fast and easy, and has proved to be efficient with minimal discomfort for patients. It can be performed with local anesthesia. However, the aspiration needle may injure the fine vascular network of blood vessels on the ovarian surface and theca interna layer or damage the adjacent pelvic organs. The subsequent complications are vaginal hemorrhage (8.6 percent), vaginal hemorrhage with loss of more than 100ml of blood (0.8 percent), hemoperitoneum (0.07 percent), punctured iliac vessels (0.04 percent), and post-operative pelvic infection (0.6 percent)
Severe intraperitoneal bleeding was defined as a decrease in hemoglobin level, hematocrit level and blood pressure, and a medium to large volume of pelvic fluid.
Few cases of acute hemoperitoneum have been reported in the literature. To reduce their occurrence and severity, the patient must be kept in the ward for at least four hours post-procedure to control blood pressure, pulse rate, vaginal bleeding, diffuse abdominal pain or vomiting. Overall, most patients tolerate the pain. The pain level increases with the number of oocytes retrieved
Blood loss that should be considered ‘normal’ in the first 24 hours after non-complicated transvaginal oocyte retrieval has been estimated to be approximately 230ml.
The reduction of hemoglobin has been estimated to be 1.6±0.8g/100ml. Several parameters were considered: the number of follicles aspirated, the number of oocytes collected, the pre-ovulatory E2 levels, and the duration of the procedure; this was without correlation with the amount of blood loss
Hemoperitoneum may occur from the ovarian puncture point or from direct damage to pelvic blood vessels or pelvic organs. It may also occur as a result of bleeding of small intra-follicle vessels during the flushing of the follicular bed with solutions containing heparin
. In our patient, no heparin-containing solutions were used for flushing.
Coagulation occurs when a damaged blood vessel interacts with clotting proteins and platelets to form a stable platelet-fibrin plug. Abnormalities of any of these factors may result in clinically significant bleeding. Battaglia et al.
 report a massive hemoperitoneum in a case of coagulation factor XI deficiency and EI-Shawarby et al.
 in a case of thrombocythemia. Leaner patients may be at a much higher risk for acute hemorrhage
[8, 9]. Pregnancy outcome seems not to be affected by intraperitoneal bleeding and subsequent surgery
TachoSil® is a collagen sponge coated with human coagulation factor fibrinogen and thrombin. It is indicated as an adjunct to hemostasis when control of bleeding by standard surgical techniques (such as suture, ligature or cautery) is ineffective or impractical, to promote tissue sealing and for suture support in vascular surgery.
In the literature, a partial resection of ovary or a salpingoophorectomy was often performed because of oozing from the surface of the ovary
Hemostasis can be very difficult to achieve with traditional operative procedures, and the ovary must be preserved whenever possible. Then a topical hemostatic agent can be utilised to avoid oophorectomy.
Finally, in our patient’s case, her ovary was preserved by using an absorbable fibrinogen and thrombin sealant sponge.