Overcoming challenges in ovarian visualization: a case report of a magnetic resonance imaging-guided oocyte retrieval resulting in live birth.

Objective: To report a successful case of magnetic resonance imaging (MRI)-guided oocyte retrieval in a patient with challenging pelvic anatomy, extensive adhesive disease, and diminished ovarian reserve, necessitated by the inability to visualize the ovaries using transvaginal or transabdominal ultrasound. Design: Case report. Subject: A 33-year-old nulligravid woman with a history of ulcerative colitis, multiple pelvic and abdominal surgeries, and significant pelvic adhesive disease. Exposure: Controlled ovarian stimulation was initiated using a gonadotropin-releasing hormone antagonist protocol, followed by sequential MRI and MRI-guided oocyte retrieval due to challenges in visualizing and accessing the ovaries. Main Outcome Measures: Successful oocyte retrieval under MRI guidance. Results: Two oocytes were retrieved from 5 aspirated follicles using MRI guidance. Both underwent intracytoplasmic sperm injection, resulting in the development of a single blastocyst, which led to a live birth via embryo transfer to a gestational carrier. Conclusion: Magnetic resonance imaging-guided oocyte retrieval represents a potential technique for patients with complex pelvic anatomy or extensive adhesive disease, where traditional ultrasound-guided approaches may be inadequate. Interdisciplinary collaboration and individualized care are crucial in optimizing outcomes for patients undergoing assisted reproduction, particularly those with challenging medical histories. Further studies comparing MRI-guided and traditional ultrasound-guided oocyte retrieval in challenging cases are warranted to determine the optimal approach for these patients.