Transrectal vs. transvaginal oocyte retrieval in patients requesting egg freezing for fertility preservation: a...

Oocyte freezing can be performed for up to ten years, with regulations regarding storage duration and age limits varying by country, including a maximum age of up to 50 years in some regions. The standard method for oocyte retrieval is transvaginal ultrasound; however, it is not suitable for patients with an intact hymen, particularly in regions with cultural and religious considerations, such as the Middle East. For these patients, transrectal ultrasound-assisted retrieval represents a safe alternative. This study evaluates transrectal oocyte retrieval and compares it with conventional ultrasound-guided transvaginal aspiration.

This prospective observational study involved 120 patients undergoing oocyte cryopreservation, divided into two groups: transrectal oocyte retrieval (TROR) for patients with intact hymens, and transvaginal oocyte retrieval (TVOR) for those without. The study compared follicle and oocyte retrieval counts between these groups, using regression analyses to evaluate the impact of variables such as age, body mass index (BMI), anti-Müllerian hormone (AMH), anesthesia duration, procedural time, and peak estradiol (E2) on the triggering day.

Number of oocytes correlated negatively with age in TROR and TVOR groups (r = -0.10, -0.55, P = 0.22, P < 0.001, respectively). It also correlated negatively with BMI in both groups (r = -0.20, -0.12, P = 0.03, P = 0.19, respectively). Number of oocytes showed a significant strong positive correlation with AMH level, anesthesia time, surgery time, peak E2 on triggering day, and number of follicles in the TROR group (r = 0.80, 0.56, 0.55, 0.81, 0.69, P < 0.001). Similarly, it showed significant moderate correlation with AMH (r = 0.40, P < 0.01) and strong correlation with anesthesia time, surgery time, peak E2 on triggering day, and number of follicles in the TVOR group (r = 0.73, 0.74, 0.80, 0.85, P < 0.001).

Transvaginal oocyte collection is the standard and easiest method for oocyte retrieval. However, for patients with an intact hymen particularly in regions with cultural and religious considerations, trans-rectal oocyte collection is also regarded as a safe and simple alternative.