High rates of perforation are found in endovaginal ultrasound probe covers before and after oocyte retrieval forin vitro fertilization-embryo transfer

To study perforation rates of sterile transvaginal ultrasound probe covers before and after oocyte retrieval (OPU) in an IVF-ET program. Transvaginal ultrasound probe sheaths from two different manufacturers were studied, Cook Innoray (Cook-Canada #TTUPS-100) and Swemed Lab (Frolunda Sweden #715). After controlled ovarian stimulation, OPU was done using the needle guide of a sterile sheathed 5-MHz transvaginal ultrasound transducer (ATL Bothell, Washington, USA). A newer designed Cook probe cover supplied by the manufacturer was also tested after the company was made aware of our initial perforation results. Following each OPU, probe covers were examined for perforations by filling them with water and checking for leaks. If perforations were found, the vaginal transducer was disinfected by soaking for 20 min in 2% gluteraldehyde (Formac ®).Twenty unused sterile probe covers from each manufacturer were also tested for perforations. After OPU we found 10/13 (75%) old Cook, and 35/43 (81%) Swemed probe covers to be perforated (NS). Only 5/20 (25%) of the new design Cook probe covers were perforated post OPU (P =0.000005). Analysis of unused probe covers revealed 13/20 (65%) Cook, and 5/20 (25%) Swemed probe covers to be perforated (P =0.02). None of 10 new design unused Cook probe covers were perforated before use. Sterile transvaginal ultrasound probe covers have a very high rate of perforation even before use. It is important to examine probe covers for perforations after OPU procedures and to disinfect them as necessary to avoid the risk of sexually transmitted disease. Quality control between brands seems to vary and efforts should be made to develop a cooperative relationship with manufacturers to improve design and quality control in production of ultrasound probe covers used for IVF procedures.