Severe hemoperitoneum following transvaginal oocyte retrieval is an extremely rare but potentially life-threatening complication of in vitro fertilization (IVF). We report the case of a 33-year-old woman with long-standing, advanced rheumatoid arthritis (RA), treated with biologic agents and chronic corticosteroids, who presented with an acute abdomen 24 hours after IVF egg retrieval.

 

This case underscores the importance of individualized anesthetic decision-making and demonstrates that regional anesthesia may represent a safe and effective alternative to general anesthesia in selected high-risk gynecologic emergencies, particularly in patients with advanced systemic disease and an anticipated difficult airway.