Individualized Periprocedural Management of Congenital Dysfibrinogenemia during Transvaginal Oocyte Retrieval: A Case...

Congenital dysfibrinogenemia is a qualitative fibrinogen disorder with phenotypes ranging from isolated laboratory abnormalities to bleeding or thrombosis. Transvaginal ultrasound-guided oocyte retrieval is minimally invasive but may cause pelvic bleeding, and peri-procedural management in patients with congenital dysfibrinogenemia is not standardized. We report a 34-year-old woman with tubal-factor infertility and persistently low functional fibrinogen who pursued in vitro fertilization. Targeted sequencing of coagulation-related genes identified a heterozygous fibrinogen gamma chain gene (FGG) variant (NM_021870.3:c.902G>A, p.Arg301His), which was considered potentially contributory to the laboratory phenotype. She had no personal history of abnormal bleeding or thrombosis and had previously tolerated laparoscopic salpingotomy without transfusion or fibrinogen supplementation. A multidisciplinary team involving reproductive medicine, anesthesia, laboratory medicine, transfusion medicine, and internal medicine implemented a conservative, trigger-based plan without routine prophylactic transfusion, with prearranged availability of fibrinogen-containing products and predefined escalation criteria based on symptoms, hemodynamics, hemoglobin trends, and ultrasound findings. Controlled ovarian stimulation was performed using a gonadotropin-releasing hormone antagonist protocol, and oocyte retrieval was completed under standard intravenous sedation by an experienced operator. Ten oocytes were retrieved with an estimated blood loss of <5 mL. Postprocedure monitoring with serial vital signs, complete blood counts, coagulation tests, and transvaginal ultrasound showed hemodynamic stability and no clinically significant hemoperitoneum. This case illustrates the feasibility of transvaginal oocyte retrieval in a carefully selected, low-risk patient with congenital dysfibrinogenemia and provides a practical framework for individualized, risk-stratified peri-procedural management.