Transrectal approach to oocyte retrieval in a patient with vaginal cancer
Related Experiment Video
Updated: Nov 1, 2026
Laparoscopic Oocyte Retrieval and Cryopreservation during Vaginoplasty for Treatment of Mayer-Rokitansky-Kuster-Hauser Syndrome
Published on: May 10, 2022
Sahra Nathoo1, Bridget Lu2, Kelsey Zhao2
1Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada; Mount Sinai Fertility, ON, Canada.
Objective:
To describe the pre-procedural planning and demonstrate the intra-procedural technique of transrectal ultrasound-guided oocyte retrieval (TROR) in a patient with vaginal cancer.
Design:
Video article.
Setting:
University-affiliated fertility center.
Subject(S):
A 19-year-old virginal female with primary clear cell cancer of the vagina presented for fertility preservation. She was unable to tolerate a pelvic examination or transvaginal ultrasonography (TVUS) due to significant pain and bleeding. Her antral follicle count (AFC) and anti-mullerian hormone (AMH) was 37 and 67 pmol/L (9.38 ng/mL), respectively. Controlled ovarian stimulation (COS) was initiated with 150 units of recombinant follicle stimulating hormone (FSH) in a gonadotropin-releasing hormone (GnRH) antagonist protocol. Transabdominal ultrasonography (TAUS) on the 10th day of COS revealed 11 follicles measuring 17 mm or larger in both ovaries. TAUS also demonstrated access to only the lateral portion of the right ovary; access to the left ovary was limited significantly by the uterus and intervening vasculature. Given the short notice, a laparoscopic oocyte retrieval was not possible, and both transabdominal and transrectal retrieval of oocytes was proactively discussed. Bowel preparation was implemented the day before the retrieval. The patient gave consent for publication and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites.
Intervention:
TROR 36 hours after ovulatory trigger.
Main Outcome Measures:
Total and mature oocyte yield after TROR.
Results:
A 7 mHz vaginal transducer with diameter of 23.8 mm, covered with a sterile cover, and copious lubrication was gently introduced into the rectum. Both ovaries were visualized easily. A 17 G, 25-cm single lumen needle was used for follicular aspiration. Twenty nine oocytes were retrieved, of which 28 mature oocytes were cryopreserved. The patient was prescribed oral levofloxacin and metronidazole for 5 days post-TROR. She had an uneventful postoperative course and began her oncologic treatment shortly after.
Conclusion:
TROR is a viable alternative to the transabdominal and/or laparoscopic approach in patients with vaginal or cervical cancer. Despite its novelty, TROR should be performed only when transvaginal, transabdominal or laparoscopic oocyte retrieval is not safe or feasible.
