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Imaging of complications following treatment with assisted reproductive technology: keep on your radar at each step

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Abstract

Since the advent of assisted reproductive technology (ART), the utilization of ART procedures has become increasingly popular among women seeking to establish pregnancy. Radiologists are therefore likely to encounter the various complications of ART therapy. The most common is ovarian hyperstimulation syndrome; others are multiple, ectopic, and heterotopic pregnancies. Ultrasonography is considered the initial modality to investigate ART complications, However, nonspecific symptoms might need the use of an additional imaging modality, such as computed tomography or magnetic resonance imaging, as a problem-solving tool. This article briefly discusses the steps involved in assisted reproduction. Its aim is to help radiologists become familiarized with the multimodality imaging features of the spectrum of ART-related complications. Their key imaging features and differential considerations are emphasized. This will facilitate the provision of precise and timely diagnoses, and aid the avoidance of fatal consequences.

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References

  1. Kawwass J, Badell M. Maternal and feral risk associated with assisted reproductive technology. Obstet Gynecol 2018; 132(3): 763–72

    Article  PubMed  Google Scholar 

  2. Gelbaya TA. Short and long-term risks to women who conceive through in vitro fertilization. Hum Fertil (Camb) 2010;13(1):19–27.

    Article  Google Scholar 

  3. Sunderam S, Kissin D, Crawford S. Assisted reproductive technology surveillance—United States. MMWR Fertil Steril Summ 2018; 67:1–28.

    Google Scholar 

  4. Balen A, Morley L, Misso M. The management of anovulatory infertility in women with polycystic ovarian syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod 2016;22(6):687–708.

    Google Scholar 

  5. Kawwass J, Kissin D, Kulkarni A, Creanga AA, Session DR, Callaghan WM, Jamieson DJ, National ART Surveillance System (NASS) Group (2015) Safety of assisted reproductive technology in the United States, 2000–2011. JAMA;2015 313:88–90.

    Article  PubMed  Google Scholar 

  6. Singh AK, Desai H, Novelline RA. Emergency MRI of acute pelvic pain: MR protocol with no oral contrast. Emerg Radiol 2009; 16:133–41.

    Article  PubMed  Google Scholar 

  7. Dohke M, Watanabe Y, Okumura A, Amoh Y, Hayashi T, Yoshizako T, et al. Comprehensive MR Imaging of Acute Gynecologic Diseases. Radiographics 2000;2:1551–66.

    Article  Google Scholar 

  8. Klemetti R, Sevón T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod 2005;20(12):3293–300.

    Article  PubMed  Google Scholar 

  9. Zivi E, Simon A, Laufer N. Ovarian hyperstimulation syndrome: definition, incidence, and classification. Semin Reprod Med 2010;28(6):441–7.

    Article  CAS  PubMed  Google Scholar 

  10. Kashyap S, Parker K, Cedars M, Rosenwaks Z Ovarian hyperstimulation syndrome prevention strategies: reducing the human chorionic trigger dose. Semin Reprod Med 2010; 28:475–85

    Article  CAS  PubMed  Google Scholar 

  11. Tandulwadkar SR, Lodha PA, Mangeshikar NT. Obstetric complications in women with IVF conceived pregnancies and polycystic ovarian syndrome. J Hum Reprod Sci 2014; 7:13–18

    Article  PubMed  PubMed Central  Google Scholar 

  12. Schenker J. Prevention and treatment of ovarian hyperstimulation syndrome. Hum Reprod 1993;8:653–9.

    Article  CAS  PubMed  Google Scholar 

  13. Lyons CA, Wheeler CA, Frishman GN, Hackett RJ, Seifer DB, Haning RV Jr. Early and late presentation of the ovarian hyperstimulation syndrome: two distinct entities with different risk factors. Hum Reprod 1994; 9(5):792–9.

    Article  CAS  PubMed  Google Scholar 

  14. Gat I, Shlush E, Quach K, Librach CL. Librach. The continuum of high ovarian response: a rational approach to the management of high responder patient subgroup. Syst Biol Reprod Med 2015;61(6):336–44

    Article  PubMed  Google Scholar 

  15. Humaidan P, Nelson SM, Devroey P, Coddington CC, Schwartz LB, Gordon K, et al. Ovarian hyperstimulation syndrome: review and new classification criteria for reporting in clinical trials. Human Reproduction 2016 31(9):1997–2004

    Article  CAS  Google Scholar 

  16. Saha PK. Ovarian Hyperstimulation Syndrome (OHSS) Presented as Massive Hydrothorax. J Clin Diagn Res 2013; 7(12):2996–7.

    PubMed  PubMed Central  Google Scholar 

  17. Jung SE, Byun JY, Lee JM. MR imaging of maternal diseases in pregnancy. AJR Am J Roentgenol 2001;177(6):1293–300.

    Article  CAS  PubMed  Google Scholar 

  18. Jung BG, Kim H. Severe spontaneous ovarian hyperstimulation syndrome with MR findings. J Comput Assist Tomogr 2001;25(2):215–7.

    Article  CAS  PubMed  Google Scholar 

  19. Bennett GL, Slywotzky CM, Giovanniello G. Gynecologic causes of acute pelvic pain: spectrum of CT findings. RadioGraphics 2002;22(4):785–801.

    Article  PubMed  Google Scholar 

  20. Maxwell K, Cholst I, Rosenwaks Z. The incidence of both serious and minor complications in young women undergoing oocyte donation. Fertil Steril 2008;90(6):2165–71.

    Article  PubMed  Google Scholar 

  21. Cerrillo M, Pacheco A, Rodriguez S. Effect of GnRH agonist and hCG treatment on VEGF, angiopoietin-2, and VE-cadherin: trying to explain the link to ovarian hyperstimulation syndrome. Fertil Steril 2011;95:2517–9.

    Article  CAS  PubMed  Google Scholar 

  22. Badeeb A, Brook A, Lee KS. Dark cortical rim: an MRI feature of polycystic ovarian syndrome. Abdominal Radiology 2021;46:1148–56.

    Article  Google Scholar 

  23. Castelo-Branco C, del Pino M, Valladares E. Ovarian hyperstimulation, hyperprolactinaemia and LH gonadotroph adenoma. Reprod Biomed Online. 2009;19(2):153–5.

    Article  CAS  PubMed  Google Scholar 

  24. Emami MHH, Langroudi RM. Ovarian hyperstimulation syndrome and autoimmune primary hypothyroidism in two members of a family. J Clin Case Reports. 2012;02(04):2–4.

    Article  Google Scholar 

  25. Delbaere A, Smits G, De Leener A. Understanding ovarian hyperstimulation syndrome. Endocrine. 2005;26(3):285–90.

    Article  CAS  PubMed  Google Scholar 

  26. Mittal K, Koticha R, Dey AK, Anandpara K, Agrawal R, Sarvothaman MP, Thakkar H. Radiological Illustration of Spontaneous Ovarian Hyperstimulation Syndrome. Pol J Radiol 2015; 80:217–27.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril 1990;53(1):76–80.

    Article  CAS  PubMed  Google Scholar 

  28. Wilkinson C, Sanderson A. Adnexal torsion—a multimodality imaging review. Clin Radiol 2012;67(5):476–483

    Article  CAS  PubMed  Google Scholar 

  29. Arena S, Canonico S, Luzi G, Epicoco G, Brusco GF, Affronti G. Ovarian torsion in in vitro fertilization-induced twin pregnancy: combination of Doppler ultrasound and laparoscopy in diagnosis and treatment can quickly solve the case. Fertil Steril 2009;92(4):1496.e9–13.

    Article  Google Scholar 

  30. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. RadioGraphics 2008; 28(5):1355–68.

    Article  PubMed  Google Scholar 

  31. Huchon C, Fauconnier A. Adnexal Torsion: A Literature Review. Journal of Obstetrics & Gynecology and Reproductive Biology 2010; 150, 8–12.

    Article  Google Scholar 

  32. Roest J, Mous HV, Zeilmaker GH, Verhoeff A. The incidence of major clinical complications in a Dutch transport IVF programme. Hum Reprod Update 1996;2(4):345–53.

    Article  CAS  PubMed  Google Scholar 

  33. Kim IY, Lee BH. Ovarian hyperstimulation syndrome: US and CT appearances. Clin Imaging 1997;21(4):284–6.

    Article  CAS  PubMed  Google Scholar 

  34. Graif M, Shalev J, Strauss S, Engelberg S, Mashiach S, Itzchak Y. Torsion of the ovary: sonographic features. AJR Am J Roentgenol 1984;143(6): 1331–4.

    Article  CAS  PubMed  Google Scholar 

  35. Bar-On S, Mashiach R, Stockheim D. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Fertil Steril 2010;93(6): 2012–5.

    Article  PubMed  Google Scholar 

  36. Fleischer AC, Stein SM, Cullinan JA, Warner MA. Color Doppler sonography of adnexal torsion. J Ultrasound Med. 1995 Jul; 14(7): 523–8.

    Article  CAS  PubMed  Google Scholar 

  37. Bennett SJ, Waterstone JJ, Cheng WC, Parsons J. Complications of transvaginal ultrasound-directed follicle aspiration: a review of 2670 consecutive procedures. J Assist Reprod Genet 1993;10(1):72–7.

    Article  CAS  PubMed  Google Scholar 

  38. Sarhan A, Muasher SJ. Surgical complications of in vitro fertilization. Middle East Fertil Soc J 2007;12(1) 1–7.

    Google Scholar 

  39. Azem F, Wolf Y, Botchan A, Amit A, Lessing J B, Kluger Y. Massive retroperitoneal bleeding: a complication of transvaginal ultrasonography-guided oocyte retrieval for IVF-ET. Fertility and Sterility 2000; 74, 405–6.

    Article  CAS  PubMed  Google Scholar 

  40. Bennett S. J, Waterstone J. J, Cheng W. C, Parsons J. Complications of transvaginal ultrasound-directed follicle aspiration: a review of 2670 consecutive procedures. Journal of Assisted Reproduction and Genetics 1993;10, 772–8.

    Google Scholar 

  41. Dicker D, Ashkenazi J, Feldberg D, Levy T, Dekel A, Ben-Rafael Z. Severe abdominal complications after transvaginal ultrasonographically guided retrieval of oocytes for IVF & ET. Fertility and Sterility 1993;59, 1313–5.

    Article  CAS  PubMed  Google Scholar 

  42. Jones, W. R., Haines, C. J., Matthews, C. D., & Kirby, C. A Traumatic ureteric obstruction secondary to oocyte recovery for IVF: a case report. Journal of In Vitro Fertilization and Embryo Transfer 1985; 6, 185–7.

    Article  Google Scholar 

  43. Salem A El-Shawarby, Raul A Margara, Geoffrey H Trew & Stuart A Lavery. A review of complications following transvaginal oocyte retrieval for in-vitro fertilization, Human Fertility 2004; 7:2, 127–33.

    Article  Google Scholar 

  44. Evers JLH, Larsen JF, Gnany GG, Seick UV. Complications and problems in transvaginal sector scan-guided follicle aspiration. Fertil Steril 1988;49:278–82

    Article  CAS  PubMed  Google Scholar 

  45. Anuradha Rao. Potential imaging findings following assisted reproduction: complications and clinical implications. Emerg Radiol 2018; 25:73–86.

    Article  PubMed  Google Scholar 

  46. Fernandez H, Gervaise A. Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update 2004; 10:503–13.

    Article  PubMed  Google Scholar 

  47. Chang H, Suh C. Ectopic pregnancy after assisted reproductive technology: what are the risk factors? Curr Opin Obstet Gynecol 2010;22:202–7.

    Article  PubMed  Google Scholar 

  48. Farquhar C. Ectopic pregnancy. Lancet 2005;366:583–91.

    Article  PubMed  Google Scholar 

  49. Clayton H, Schieve L, Peterson H. Ectopic pregnancy risk with assisted reproductive technology procedures. Obstet Gynecol 2006;107:595–604.

    Article  PubMed  Google Scholar 

  50. Perkins K, Boulet S, Kissin D, Jamieson DJ. National ART Surveillance (NASS) Group. Risk of ectopic pregnancy associated with assisted reproductive technology in the United States; 2001–2011. Obstet Gynecol 2015;125(1):70–8.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Dor J, Seidman D, Levran D. The incidence of combined intrauterine and extrauterine pregnancy after in vitro fertilization and embryo transfer. Fertil Steril 1991;55:833–4.

    Article  CAS  PubMed  Google Scholar 

  52. Levine D. Ectopic pregnancy. Radiology 2007;245(2):385–97.

    Article  PubMed  Google Scholar 

  53. Brown D, Doubilet P.Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics. J Ultrasound Med 1994; 13(4):259–66.

    Article  CAS  PubMed  Google Scholar 

  54. Kao LY, Scheinfeld MH, Chernyak V, Rozenblit AM, Oh S, Dym RJ. Beyond ultrasound: CT and MRI of ectopic pregnancy. AJR Am J Roentgenol 2014; 202:904–11.

    Article  PubMed  Google Scholar 

  55. Kanal E, Shellock FG. Safety manual on magnetic resonance imaging contrast agents. Cedar Knolls, NJ: Lippincott-Raven Healthcare, 1996.

    Google Scholar 

  56. Shellock FG, Kanal E. Safety of magnetic resonance imaging contrast agents. J Magn Reson Imaging 1999;10(3):477–84.

    Article  CAS  PubMed  Google Scholar 

  57. E. Mausner Geffen , C. Slywotzky, G. Bennett. Pitfalls and tips in the diagnosis of ectopic pregnancy. Abdom Radiol 2017;42:1524–42

    Article  CAS  Google Scholar 

  58. Greenberg JA. Bilateral ectopic pregnancy. Rev Obstet Gynecol 2008;1(2):48.

    PubMed  PubMed Central  Google Scholar 

  59. Kasum M, Grizelj V, Simunic V. Simultaneous bilateral tubal pregnancy following in-vitro fertilization and embryo transfer. Hum Reprod 1998;13(2): 465–7.

    Article  CAS  PubMed  Google Scholar 

  60. De Los Ríos JF, Castañeda JD, Miryam A. Bilateral ectopic pregnancy. J Minim Invasive Gynecol 2007; 14(4):419–27.

    Article  PubMed  Google Scholar 

  61. Rojansky N, Schenker J. Heterotopic pregnancy and assisted reproduction: an update. J Assist Reprod Genet 1996; 13(7):594–601.

    Article  CAS  PubMed  Google Scholar 

  62. Elizabeth H. Dibble, Ana P. Lourenco. Imaging Unusual Pregnancy Implantations: Rare Ectopic Pregnancies and More AJR 2016; 207:1380–92.

    Article  PubMed  Google Scholar 

  63. Talbot K, Simpson R, Price N, Jackson SR. Heterotopic pregnancy. J Obstet Gynaecol 2011; 31:7–12.

    Article  CAS  PubMed  Google Scholar 

  64. Benjamin Hirshberg, Matthew Rheinboldt. Multimodality imaging of acute locoregional and systemic complications in the setting of assisted reproduction. Emergency Radiology 2019;26:205–19.

    Article  PubMed  Google Scholar 

  65. O. Dundar, L Tutuncu, E. Mungen, M. Muhcu, Y. Z. Yergok: Heterotopic pregnancy: tubal ectopic pregnancy and monochorionic mono-amniotic twin pregnancy: a case report, Perinatal journal. 2006; 14:96–100.

    Google Scholar 

  66. Sitthipong Srisajjakul, Patcharin Prapaisilp, Sirikan Bangchokdee. Magnetic resonance imaging in tubal and nontubal ectopic pregnancy. European Journal of Radiology 2017; 93:76–89.

    Article  PubMed  Google Scholar 

  67. Chan W, Dixon M. The ‘ART’ of thromboembolism: a review of assisted reproductive technology and thromboembolic complications. Thromb Res 2008;121:713–26.

    Article  CAS  PubMed  Google Scholar 

  68. Chan W, Ginserg J. A review of upper extremity deep vein thrombosis in pregnancy: unmasking the ‘ART’ behind the clot. J Thromb Haemost 2006;4:1673–7.

    Article  PubMed  Google Scholar 

  69. Grandone E, Villani M. Assisted reproductive technologies and thrombosis. Thrombosis Res 2015;135:S34–S45.

    Article  CAS  Google Scholar 

  70. Serour G, Aboulghar M, Mansour R. Complications of medically assisted conception in 3500 cycles. Fertil Steril 1998;70:638–42.

    Article  CAS  PubMed  Google Scholar 

  71. Bauersachs R, Manolopoulos K, Hoppe I. More on: the “ART” behind the clot: solving the mystery. J Thrmb Haemost 2007;5(2):438–9.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang road Bangkoknoi, Bangkok, 10700, Thailand

    Sitthipong Srisajjakul & Patcharin Prapaisilp

  2. Department of Internal Medicine, Pratumtani Hospital, 7 Ladlumkaew Muang District, Pratumtani, 12000, Thailand

    Sirikan Bangchokdee

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  1. Sitthipong Srisajjakul
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Correspondence to Sitthipong Srisajjakul.

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Srisajjakul, S., Prapaisilp, P. & Bangchokdee, S. Imaging of complications following treatment with assisted reproductive technology: keep on your radar at each step. Abdom Radiol 47, 328–340 (2022). https://doi.org/10.1007/s00261-021-03245-y

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