Proficiency in oocyte retrieval: plausible steps before perfection

22 08 2011

To the Editor:

We read with interest the retrospective analysis by Goldman et al (1). The authors attempt to determine the minimum number of procedures required for proficiency in oocyte retrieval (OR). Assessing and classifying the technical competence of a trainee objectively is quite difficult for two reasons: first, there is no clear definition of “competence,” as operative skill is a combination of knowledge, judgment, and technical ability (2). Second, the success of an OR depends on additional parameters, such as patient, nurse and embryologist compliance. We would like to share our thoughts on their work. Read the rest of this entry »

Ovarian hyperstimulation syndrome or massive intraperitoneal hemorrhage?

21 06 2011

To the Editor:

I read with interest a recent paper by Griesinger et al. (1) describing, for the first time in the English literature, a case of severe ovarian hyperstimulation syndrome (OHSS) post-GnRH agonist trigger of ovulation. However, the clinical details of the case cast serious shadow on the correct diagnosis.

The hallmark of severe OHSS is elevated hematocrit (>45%, or >30% increment over baseline values) secondary to hemoconcentration (2). However, the described patient experienced severe intraperitoneal hemorrhage leading to decreasing hematocrit (41% on day of trigger, 37% on day of oocyte retrieval). Blood transfusion was given (no details on amount) due to “drastic decrease of hemoglobin levels to 4.9 mmol/L,” with hematocrit “15,000, oliguria, elevated creatinine, liver dysfunction, anasarca) were not given. Read the rest of this entry »

Proficiency in oocyte retrieval

7 06 2011

To the Editor:

We read with great interest the article by Goldman et al. (1). We would like to make some comments regarding the methodological and statistical issues raised by this work.

First, in our opinion, the outcome measure is not accurate enough to evaluate skill acquisition in oocyte retrieval (OR). A successful OR should be defined by the ability for the trainee to perform the procedure without intervention of the tutor as well as to retrieve the expected number of oocytes. However in this study, cases where more than one provider attempted OR on one ovary were excluded from analysis. What about the cases where the trainees failed to complete OR alone? Were they not taken into account in the learning curve? Read the rest of this entry »