Transvaginal sonographically controlled ovarian puncture for oocyte retrieval for in vitro fertilization

Two hundred twenty-two patients took part in a trial of follicle puncture via the transvaginal route under sonographic control for the purpose of in vitro fertilization (IVF). Induction protocols were mainly human menopausal gonadotropin (hMG)+human chorionic gonadotropin (hCG) and clomiphene + hMC + hCG. In 79.7% oocyte aspiration could be achieved without difficulty via the transvaginal route. An average number of 4.7 oocytes per attempt was obtained: 10.7% evolutive pregnancies were obtained. No major incident was noted. This technique offers several crucial advantages: it reduces surgical risk, reduces the length of the patient's stay in hospital as well as the overall cost of the procedure, and it also makes possible puncture in some cases hitherto regarded as excluded.     

Ultrasonically guided follicle aspiration for oocyte retrieval in an in vitro fertilization program: further simplification

Transabdominal, transvesical aspiration of oocytes was performed in 58 infertility patients under ultrasound guidance. In contrast to other groups, no particular guiding instruments were used. Wider bore needles and general anesthesia improved the oocyte recovery rate from 44% to 80%, thus approaching the one achieved by laparoscopy.     

Transvaginal ultrasound or laparoscopy for oocyte retrieval (experiences in the Ljubljana IVF program)

At present, the less invasive ultrasound-directed techniques are the methods of choice for oocyte retrieval in most in vitro fertilization and embryo transfer (FIVET) centers. Among the ultrasound-direct techniques, the transvaginal follicle aspiration guided by transvaginal ultrasound for oocyte recovery is gaining popularity in many FIVET centers. This study compare cycles outcome following transvaginal ultrasound oocyte retrieval (105 cycles) to laparoscopic oocyte retrieval (218 cycles); no statistically significant difference could be demonstrated between the groups in all parameters evaluated but better clinical results have been obtained in transvaginal ultrasound group. The Authors conclude that transvaginal oocyte recovery represents an improvement and a simplification of the FIVET procedure.     

Immature oocyte retrieval with in-vitro oocyte maturation.

Early studies of in-vitro fertilization used immature oocytes. The process evolved to retrieving metaphase II oocytes, and was eventually successful. At present, aggressive ovulation induction protocols are the mainstay of assisted reproductive technology programs, but not without increased cost, multiple gestations, morbidity, potential future risks and isolated mortalities. The ability to retrieve each month's cohort of immature oocytes transvaginally opened the door to search for a new option for infertile couples requiring assisted reproductive technology. Immature oocyte retrieval combined with in-vitro oocyte maturation eliminates the stimulation, costs and time that were required to monitor oocytes, along with the short- and long-term complications. The essential components are optimal maturation media and a synchronized endometrium in which the embryos transferred from a truncated follicular phase can implant. The process has been successful in several centers with an acceptable success rate when used in conjunction with a host uterus. Future research with maturation, culture, and endometrial synchronization may allow immature oocyte retrieval with in-vitro oocyte maturation to replace in-vitro fertilization in its present form.     

Transurethral ultrasound-guided oocyte retrieval for in vitro fertilization

Thirty-nine follicular aspirations for in vitro fertilization were performed in 30 patients. Oocyte retrieval was performed by laparoscopy in 21 cases and ultrasound-guided transurethral aspiration in 18 cases. All procedures were performed by the same ovarian stimulation protocol and the same aspirating needle. In the laparoscopy group 150 oocytes were recovered from 177 follicles aspirated (85%). The fertilization rate was 69% (104/150) and cleavage rate, excluding triploidy, was 82% (85/104) for oocytes obtained by laparoscopy. Five clinical pregnancies occurred in the laparoscopy group for a pregnancy rate of 24% per cycle and 25% per transfer. In the transurethral ultrasound-guided group 77 oocytes were recovered from 103 follicles aspirated (75%). The fertilization rate was 79% (61/77) and cleavage rate, excluding triploidy, was 90% (55/61). Three pregnancies occurred for a pregnancy rate of 17% per cycle and 18% per transfer. None of these differences were statistically significant. Transurethral ultrasound-guided oocyte retrieval is a feasible alternative to laparoscopy for in vitro fertilization.     

Endoscopic visualization of oocyte release and oocyte retrieval in humans

Transvaginal hydrolaparoscopy (THL) allows the inspection of the tubo-ovarian structures in their natural position without supplementary manipulation. Saline is used at 37 degrees C as distension medium, which keeps the organs afloat. Using this technique it was possible to visualize and record for the first time the process of oocyte release and capture by the fimbriae in humans. THL was performed in the peri-ovulatory period, in order to collect data that would give a better insight into events at the moment of ovulation.     

Current technology of oocyte retrieval.

Transvaginal follicle puncture under sonographic control has become the method of choice for ovum retrieval worldwide. Because it is the current technology of the 1990s, there are very few reports in the literature on other methods of oocyte retrieval. Furthermore, perhaps because of the simplicity of transvaginal follicle puncture under sonographic control, there are only a few reports on the technique itself in the current literature. This review classifies the papers on hand according to general studies of the subject, appropriate anesthesia, necessity of follicle flushing for oocyte retrieval, vaginal disinfection and the evaluation of the risk following transvaginal oocyte retrieval, and new techniques in connection with the harvesting of oocytes.     

Transmyometrial oocyte retrieval and pregnancy rates

OBJECTIVE: To determine whether transvaginal, ultrasound-guided oocyte retrieval performed through the myometrium has a negative impact on IVF pregnancy rates. DESIGN: Retrospective cohort study. SETTING: Academic hospital and research center. PATIENT(S): A total of 5,115 IVF cycles performed at the Brigham and Women's Hospital between 1998 and 2001 were evaluated. In 85 cycles (1.7%), the oocyte retrieval needle passed through the myometrium because of ovarian position during retrieval. Each of these cases was matched to a control cycle by age, attempt number, and date of retrieval. INTERVENTION(S): Transmyometrial oocyte retrieval. MAIN OUTCOME MEASURE(S): Pregnancy rates. RESULT(S): There were no statistically significant differences in pregnancy rates between cases and controls. Cases were more likely than controls to have underlying tubal disease and adhesions as the primary cause of infertility. The groups did not differ significantly in terms of age, attempt number, estradiol level, follicle number, days stimulated, ampules of gonadotropins administered, number of eggs, number of embryos, or quality of embryos. CONCLUSION(S): Transmyometrial oocyte retrieval is an uncommon event. Clinicians and patients can be reassured that transmyometrial oocyte retrieval does not seem to decrease IVF pregnancy rates; however, a larger study with greater power might reveal a statistically significant difference.     

Transvaginal, ultrasound-guided oocyte retrieval for in vitro fertilization

As compared to laparoscopic oocyte retrieval, the trans-vaginal, ultrasound-guided technique can be performed away from a formal operating room, without general anesthesia and its attendant risks and with a significant reduction in operating time. Performed under paracervical block and minimal analgesia, transvaginal, ultrasound-guided oocyte retrieval results in a fairly easily tolerated level of pain during the procedure and very minimal residual pain postoperatively. The mean number of oocytes retrieved, fertilization and embryo transfer rates, and clinical pregnancy rates are not significantly different between the two procedures. If bleeding occurs from the vaginal puncture site, it is easily controlled with pressure. In this study, postoperative pelvic infection occurred in three patients. The above advantages and associated reduction in cost achieved with the trans-vaginal, ultrasound-guided procedure make it the current method of choice for oocyte retrieval.     

Intraperitoneal bleeding following transvaginal oocyte retrieval

Objective

To investigate the risk factors for intraperitoneal bleeding following transvaginal oocyte retrieval (TVOR).

Methods

Retrospective review of records from patients who underwent TVOR between 2004 and 2008. Patients who had mild and severe intraperitoneal bleeding were compared with the same number of patients without intraperitoneal bleeding (control group) who underwent oocyte retrieval on the same day performed by the same doctor as those who experienced bleeding.

Results

Of 10251 retrieval cycles performed, 22 (0.2%) patients had intraperitoneal bleeding. Five (0.05%) patients with severe bleeding underwent laparotomy or laparoscopy, while 17 patients were managed conservatively for mild bleeding. Among patients with no bleeding, mild bleeding, or severe bleeding, there were significant differences in body mass index (P < 0.02) and number of oocytes retrieved (P < 0.01), while no differences were seen for age and pregnancy rate.

Conclusion

Patients with severe intraperitoneal bleeding had a lower body mass index, a history of surgery, were younger, and had a moderate ovarian response; those with mild bleeding were young and had a high ovarian response.     

Routine ultrasound guided evacuation of first trimester missed abortion versus blind evacuation

BackgroundThe clinical management of miscarriage has changed little over the years and many women undergo surgical uterine evacuation. Surgical evacuation of the uterine contents in missed abortion is a challenge to the obstetrician as it is done blindly. The current study recommends the use of ultrasound guided surgical evacuation. It serves two important advantages; the first is to complete evacuation without the need of additional step. The second is to protect against uterine perforation.Outcome measuresThe primary outcome measures were intraoperative and short-term complications (anesthetic complication, hemorrhage, ongoing pregnancy, cervical trauma, uterine perforation, need for laparoscopy and/or laparotomy, repeat evacuation, and infection). The secondary outcomes were the blood loss, procedure time, and convalescence time.DesignA controlled trial.SettingElbadr Hospital, Benha, Egypt.ParticipantsWomen undergoing STOP (surgical termination of pregnancy) in the first trimester.MethodsTwo hundred cases who refused medical evacuation of proved missed abortion were divided in two groups. Group one (one hundred patients) in whom surgical evacuation was done under sonographic guidance. Group two (one hundred patients) in whom surgical evacuation was done without sonographic guidance.ResultsGroup one cases showed no surgical failure in contrast to 10 cases from group two who failed with contents presented after evacuation (failure rate 10%).ConclusionsSurgical evacuation under sonographic guidance is recommended because there are significant cases with missed abortion which can be incompletely evacuated without the use of the ultrasound guidance.