Speaker- Bettina Toth

Oocyte pickup and embryo transfer, including ovarian stimulation, can involve potential mishaps influenced by risk factors such as body mass index (BMI), thrombophilic disorders, and congenital disabilities. A PubMed search identified 65 instances of complications, including vaginal bleeding and abdominal injuries. Data from European and German registries highlight the necessity of understanding these issues and implementing preventive models, underscoring the importance of patient awareness and comprehension of potential risks in endometrial diagnostics.

The European In vitro Fertilisation (IVF) monitoring consortium has 44 members, and 39 have provided data on over 700,000 cycles. Complications were reported in 0.16% of cycles, mainly bleeding, followed by other complications and infection. The German registry reported 66,219 Oocyte pickups in 2023, with only 0.9% of cycles having no information. A large observational study with 23,800 side pickups in a single center had an overall incidence of 0.4 percent, and a Cochrane meter analysis showed a low complication rate of 0.72%. However, there is a significant gap in reported numbers regarding vaginal bleeding, possibly due to the variation in definition. Risk factors for vaginal bleeding include previous surgery, coagulation disorders, pelvic organ injuries, pelvic infection, and severe pain requiring hospitalization. 

The study reveals that a significant number of patients experienced severe abdominal complications after cute pickup, with 8 out of 14 patients requiring surgery due to the complication. Additionally, 9 of 14 patients had specimens cultured with bacteria in their specimens. Seven out of 14 patients had a history of pelvic inflammatory disease. The study also found that enlarged ovaries and small hints of oocyte pickup were observed during fertility surgery. Most reports are case reports, and the study highlights the importance of understanding these complications. 

Staff training, patient characteristics, and procedure duration influence complications during oocyte pickup. A study found that higher BMIs result in more frequent Polycystic Ovary Syndrome (PCOS) and increased sedative needs, and the duration of oocyte pickup increases with BMI. However, overweight patients had a rare complication rate, and there was no increased risk of sedation or procedure-related complications, even in women with class three obesity. The study underscores the growing obesity problem and the need for improved treatment options. 

A Turkish study compared complications with ovarian response in nearly 800 patients who underwent oocyte pickup. The study found significant differences between poor and high responders in pain, with the highest pain occurring in the high responder group. Other complications were rare, with severe pain more common in patients with high ovarian response. The study suggests that patients at risk for complications during oocyte pickup include those with obesity, pelvic inflammatory disease, and high ovarian reserve. The findings highlight the importance of understanding the ovarian response in determining the risk of complications during oocyte pickup. 

The embryo transfer complications include channel infections, cervical stenosis, and stick reactions. They also discuss extra uterine pregnancies, maternal age, and endometriosis. Ectopic pregnancy risk is higher in ART cycles, increased in women with tubal fractures, and decreased through blastocyst and single embryo transfers. Extrauterine pregnancies have declined over the years, with 2% in IVF cycles, 1% in Intracytoplasmic sperm injection (ICSI) cycles, and the lowest rate in frozen embryo transfers. 

Maternal age is a significant risk factor for Antiretroviral therapy (ART), with an increase in both women and men over the last 30 years. A new subgroup of women with advanced maternal age, between 45 and 49 years, is also increasing due to egg donation. A study by the Sauer Group showed growing maternal mortality rates, particularly in patients aged 35 and older, due to medical and obstetric adverse events during delivery. Identifying and addressing these complications through thorough risk selection is crucial for preventing complications in this patient group. 

PCOS patients are highly vulnerable, especially in the high-response group, and face risks such as overstimulation syndrome, miscarriage, pregnancy-induced hypertension, preeclampsia, gestational diabetes, premature birth, and large for gestational age babies. Endometriosis is a significant burden on women's quality of life, with an increase in fertility treatment. Patients with endometriosis undergoing ART face more risks, including spontaneous hemoperitoneum, rupture or necrosis of endometriotic lesions during pregnancy, ovarian endometriosis, and bowel endometriosis. After surgery, intra-abdominal bleeding due to adhesions between the rectum and ovaries or uterus increases, and heavy uterine manipulation during cesarean section is advised.

Structured quality management, organized training, and emergency training are crucial to preventing complications in ART. Patients at risk should be identified and treated before ART, and fertility surgery skills should be consulted. Tranexamic acid can prevent complications during oocyte pickup. Communication and witness systems can ensure understanding. Simulation tools and online reporting systems can help prevent complications. 

In conclusion, complications in human immunodeficiency viruses (HIV) treatment are crucial and should be discussed, and it's essential not to feel ashamed or unqualified. More information is needed, and prevention and skillset development are vital. Identifying HIV-positive women before ART is necessary. 

European Society of Human Reproduction and Embryology, July 7-10, Amsterdam, The Netherland