Case Report: Ultrasound-guided continuous catheter drainage to facilitate ovarian access before in vitro fertilization in a patient with large pelvic cystic lesions

Severe pelvic adhesive disease and large pelvic cystic lesions may markedly distort pelvic anatomy and compromise ovarian visualization and accessibility during in vitro fertilization (IVF). We report a 35-year-old woman with secondary infertility, bilateral tubal occlusion, severe pelvic adhesive disease, and large multiloculated pelvic cystic lesions that obscured the left ovary and displaced the right ovary superiorly. The lesions were clinically considered to represent chronic inflammatory pelvic sequelae, although their precise etiology remained uncertain. Before ovarian stimulation, transabdominal ultrasound-guided continuous drainage using a 12-Fr pigtail catheter was performed primarily to restore ovarian access. Approximately 450 mL of clear, odorless fluid was drained over approximately 10 days, reducing the dominant lesion from 18.40 cm × 8.82 cm × 11.80 cm to approximately 3 cm × 2 cm. Following drainage, the number of sonographically visualized antral follicles in the ovary increased from two to eight, reflecting improved visualization rather than increased ovarian reserve, and the previously obscured left ovary became accessible. Five metaphase II oocytes were retrieved, four from the left ovary and one from the right ovary; four high-quality blastocysts were vitrified, and a live birth followed a single frozen-thawed blastocyst transfer. In this patient, continuous catheter drainage provided temporary mechanical decompression that facilitated ovarian access and IVF treatment. This single case cannot establish the efficacy, safety, or generalizability of this strategy.