Fellowship in Embryology in India: Oocyte Retrieval

Fellowship in Embryology in India: Oocyte Retrieval

Blog Article

In this article, we shall discuss oocyte retrieval under the following headings, the definition, history, route of choice, prerequisites, preparation, equipment, steps in oocyte retrieval, post procedure care, complications, associated pathologies, and oocyte retrieval troubleshooting. For practicing IVF doctors in Bangalore, it is important to be through with the concept and the training in oocyte retrieval. Now the definition would be that ultrasound guided technique in which oocytes are aspirated using a needle connected to a suction pump. That would be oocyte retrieval means the removal of oocytes either by the abdominal or the vaginal roots in order to get the oocytes out from the abdomen to be able to fertilize that and make embryos. The first oocyte retrieval was through the laparoscope by Morgenstern and Supart in 1972.

And then by laparoscopy, Patrick Steptoe and Bob Edwards resulted in the birth of Louise Brown in 1978, and since then, laparoscopy became a routine. However, transvaginal ultrasound guided technique by Susan Lentz and Wilfred Feitinger resulted in abandoning of laparoscopy and the adoption of the transvaginal technique. Transvaginal ultrasound retrieval is the gold standard for rocyte aspiration in assisted reproductive technology and became the method of choice and a simple procedure. What has been the advantages of the transvaginal root is because it's reduced recovery time, it is an outpatient procedure, There's good visualization and access and avoids trauma to the bladder and the urethra. There is no skin incision or a scar.

What are the alternative routes that one can actually use is a transmiometrial route and a transabdominal route. And the indications in these cases could be where the abnormal placement of the ovary and also with tubal adhesions. What are the prerequisites?

• We must ensure that the patient has taken her HCG injection and that at the scheduled time only.


• We must inform the anaesthetist and surgeon, embryologist, and the OT staff well in advance. Checking the equipment beforehand, example, that the suction, pedal, or handheld suction device is working, all connections of tubing are tightly connected, tube is not kinked or damaged, and the ultrasound machine is functioning appropriately.


• Now what would be the patient checklist? The name, the hospital ID number, the most recent ultrasound report, the most recent hormone levels, if done. The consent form has to be checked, documented, signature appropriate, the medical history of the patient, of any allergies that she may have had, any vaginal infections, any appropriate antibiotics she's taking, and, of course, the details of stimulation and the planned procedure of IVF XE, fresh or frozen embryo transfers.


• The equipment check should make sure that the ultrasound machine works, the needle guide, and check the orientation of the images. Check the tubes connected to the needle and the suction pump.


• Specify if it's a single or a double lumen needle, and test that the suction is working and adjust the pressure by aspirating some culture media into the tube. Fill the collection tube with the media. There is no airlock in the tube.

Now, the preparation part of it is that the first part, the ovarian stimulation. Now, oocyte retrieval to be performed thirty four to thirty six hours after trigger. Look for the stimulation protocol and the trigger prescribed. Confirm that the patient has taken the trigger at the prescribed time. In the agonist trigger cycles, baseline LH levels to be measured on the day of the trigger.

As far as the patient preparation is concerned, the patient must be fasting for six hours for food and two hours for clear fluids. The peripheral IV line must be established and normal saline started. Patients must have an empty bladder immediately prior to oocyte retrieval. Empty bladder decreases the posterior enhancement and improves the image quality.

Sperm collection is done on the day of oocyte retrieval. A backup sample should always be kept as a frozen sample in case the patient is unable to produce on the day of the pickup. A specular examination of the vagina and cervical examination should be performed before to check for present with the procedure.

What about local anesthesia? A parasaivolic block in addition to sedation. Sometimes, if we have an anxious patient, general anesthesia has also been given. The Cochrane database and a systematic review on pain relief for women undergoing oocyte retrieval for assisted reproduction has not shown any difference of whether which medicine or pain relief given has a better outcome.

So it is again on the individual, preference of the patient. And so, it is between the patient and the physician.

 

Steps in oocyte retrieval

• Patient asked to empty the bladder, put in lithotomy position, adequate anesthesia administered. Cleansing of vagina with normal saline. Elbow support should be given while holding the vaginal probe. Adequate pressure to be maintained on the probe.


• Focus the maximum diameter of the follicle after inserting the probe. Insert the needle into the center of maximum diameter of the follicle with the needle into the middle of the follicle.


• Suction petal to be switched on just before entry into the follicle. Follicle collapse occurs focus of the eye and not the drops in the tube. Keep the needle surrounded by the fluid at all times.


• If needed, gentle movement of the probe should be utilized. Follicular fluid should be collected heated block calibrated at 37 degrees. Follicular curating at the end of complete follicular collapse.


• Do not deactivate the suction pump while the needle is still inside as the follicle can result in a backflow towards the follicle. Needle should be gently withdrawn without negative suction pressure to avoid the sudden flow of follicular fluid into the collection tube.


• And once all adequately grown follicles present in both ovaries are aspirated, then one must reach the pouch of Douglas and both adnexa should be checked to rule out any blood collection.


• Flush the needle between the two ovaries to avoid any potential blockage caused by blood clots. Avoid repetitive punctures or ovarian penetrations because this can increase the incidence of infections or bleeding.


• Prefer to maintain the needle within the ovary.


• Recommended to access as many follicles as is safely possible through the same ovarian cortex puncture, as this will reduce the amount of bleeding when the needle is taken out.

Follicle flushing It is proposed to increase the number of retrieved oocytes. What do you mean by closed flushing? Every follicle is rinsed three to four times. Tubes passed on to the laboratory when all follicles are punctured Recommended for patients with more than six follicles.

What does that mean? You can puncture at least more than six follicles when you can puncture multiple follicles and collect that follicular fluid into the test tube and send it across to the embryologist who then checks that in a petri dish, and you may be able to collect four to six oocytes in the petri dish as you go along because this saves time, and you don't have to wait for more than half an hour to be able to collect about 20 oocytes. This is called closed flushing.

The open flushing is with direct communication between the laboratory staff and the operator. Here, the follicle is rinsed until an oocyte is detected in the laboratory or until no cell material is detected. And this is recommended when the number of follicles available for puncture are less than six. So follicular flushing during oocyte retrieval in assisted reproductive techniques has the conclusion that follicular flushing probably has little or no effect on live birth rates compared with aspiration alone. Live birth rate is approximately forty one percent with aspiration alone.

What are the complications? Most common postoperative complications could be haemorrhage from the ovarian surface or injury to uterine, vaginal, ovarian, or even iliac vessels. It has been proposed that use of Doppler ultrasound may guide the needy and prevent injury to pelvic organs and blood vessels. However, trauma to pelvic structures are also noted, and pelvic infection, tubal ovarian, and pelvic abscess have already been seen usually one to six weeks after aspiration. Risk is increased if there is a puncture of an endometrioma or previous history of pelvic infection.

Medline Academics is a leading online infertility education service provider that provides niche healthcare specialty medical services to IVF Doctors in Bangalore. In a bid to develop the capacity of practitioners in high indexing disciplines such as the Reproductive Medicine, Fellowship in Embryology, Medline Academics has constructed an online training portal that offers accredited, comprehensive, and solely practitioner-centred programs that integrate theory and practice. The courses are delivered by industry-wise experts and professionals so that the students get to hear and learn more of what is latest in the field. The course that a student takes at Medline Academics is accredited by prominent medical associations to enable students advance their careers and practice pretty much anywhere in the world.

Dr. Kamini Rao Hospitals is one of the premier IVF centres in Bangalore. Started by Padma Shri Prof. Dr. Kamini A. Rao one of the pioneers in reproductive medicine the hospital is known for the kind treatment they give to their patients, the right procedures in treatment and the right patient-centred approach to fertility and women’s health. Procedures included are IVF, ICSI, IUI and Egg/Sperm Donation, at Dr. Kamini Rao Hospitals focus is made on the fact that it offers expert services in fertility to every patient. The hospital has first-rate infrastructure and provides state of art technology in terms of IVF and embryology to get good success rates in assisted reproduction. With the application of innovation, research and efficient treatment procedures Kamini Rao Hospitals ensure high success rates in infertility.

Report this page