Complicated Clinical Course and Poor Reproductive Outcomes of Women with Tuboovarian Abscess Following Fertility Treatments

Intrudction: There is limited data regarding the clinical course, treatment and reproductive outcome of women with tuboovarian abscess (TOA) following fertility treatment.

Aim: To assess the clinical course, surgical and fertility outcomes of patients diagnosed with TOA following fertility treatment.

Materials&Methods: Retrospective cohort study over 10 consecutive years was performed in a tertiary hospital. Electronic medical records were used to identify patients who were diagnosed with fertility treatment associated TOA. Fertility unit charts and phone survey were used to assess patient clinical course, surgical and reproductive outcomes.

Results: Thirty-seven women who were diagnosed with TOA following fertility treatments were compared with 313 women who were diagnosed with TOA not associated with fertility treatments during the same time period. Women with TOA following fertility treatments had significantly higher inflammatory markers upon admission. In addition, women with TOA following fertility treatments were associated with significantly higher surgical intervention rate and a more complicated clinical course as was shown by shorter time interval from admission to surgery (2.1 days vs. 3.2 days, p=0.01), higher rates of antibiotic failure, higher conversion rate from laparoscopy to laparotomy (14.2% vs. 3.2%, p=0.005), increased perioperative complications rate (25.0% vs. 3.8%, p=0.0001) and a longer hospitalization period (7.2 days vs. 4.8 days, p=0.01). Clinical pregnancy rate per cycle in women with TOA following fertility treatments was 9%. one case of live births was recorded.

Conclusions: TOA following fertility treatment has a substantial effect on the clinical course, surgical and fertility outcome. Prophylactic antibiotic treatment and embryo transfer cancellation should be considered in patients at risk for infection.