OVUM PICK UP

EMBRYO TRANSFER

jaideep malhotra
narendra malhotra
mnmhagra3@gmail.com
GLOBAL RAINBOW HEALTH CARE
HISTORY OF OOCYTE RETRIEVAL

• initial oocytes were studied by

removing ovaries by laparotomy
• 1970 steptoe and edwards
laparoscopic method (yielded
oocytes from one third of follicles)
• by 1980 a commercial opu needle
and pump was available(teflon
needle retrival rates became 90%)
• steptoe and goswamy devised the
ultrasound guided oocyte retrival
 PHYSICS OF OOCYTE RETRIEVAL
• a no. of factors affect
oocyte collection and
damage to ova
• pump vacuum
flow,velocity,needle lumen
size and length,follicular
pressure and
size,collection techniques

COOK MEDICAL TECHNOLOGY STUDY FROM

BRISBANE
 PHYSICS AND EGG
VACUUM APPLIED AFTER NEEDLE ENTRY IN
FOLLICLE
VACUUM DEACTIVATE BEFORE EXIT FROM
FOLLICLE
VACUUM ACTIVATED AND DEACTIVATED
OUTSIDE FOLLICLE
DAMAGE TO OOCYTES
VACUUM PRESSURES
DAMAGE WITHIN THE NEEDLE/VACUUM
LINES
DAMAGE WITHIN THE FOLLICLE
DAMAGE TO THE CUMULUS
 PHYSICS OF OPU
• MAINTAINANCE OF SUCTION(IF THIS IS NOT MAINTAINED
THE FOLLICULAR FLUID WILL BE LOST AT ENTRY AND EXIT)

• MOVEMENT OF THE NEEDLE TIP IN THE FOLLICLE MAY

DAMAGE THE OOCYTE PARTICULARLY TO THE CUMULUS

• IT IS A COMMON PRACTICE TO SPIN THE NEEDLE TIP AS YOU

WILL SEE IN THE SYDNEY IVF VIDEO

• ALSO SOME PEOPLE SCRAPE THE FOLLICLE WALLS BY THE

EDGE OF THE NEEDLE.. THIS MAY CAUSE SIGNIFICANT
DAMAGE TO OOCYTE SPECIALLY IN SMALL FOLLICLES

• STUDY IS GOING ON TO COMPARE SPINNING THE NEEDLE

TIP AND BLASTOCYST FORMATION (A POSSIBLE SOLUTION
FOR MORE RETRIVAL WITHOUT SPINNING IS MAY BE TO USE
FLUSHING THE FOLLICLES WITH LOWER SUCTION
VACCUMS)
CLINICAL ASPECTS OF OPU
• TIMING:34-36 HRS
AFTER THE HCG
TRIGGER
• MORE M2 OOCYTES
 OVARIAN ACCESSIBILITY
ASSESSMENT
• IN DUMMY CYCLE
• ON REGISTRATION
• DURING STIMULATION
MONITORING
• VERY HIGH AND
VAGINALLY
UNAPPROACHABLE
OVARIES MAY POSE
DIFFICULTY FOR TVS OPU
AND MAY NEED
LAPAROSCOPY
PRE PICK UP SCAN
 EGG PICK UP TECHNIQUE

• analgesia(vaginal and cervical blocks)

(mild analgesia)
• anaesthesia (mild gen anaesthesia
propofol/pentothal)
• preop counselling and physical check
up
• it is a low risk surgical procedure
hence no need for a detailed preop
assessment
 ANAESTHETIC PROTOCOL
• FENTANYL: 1-2 g/kg i.v.(AVERAGE DOSE
100g)
• MIDAZOLAM:0.05-0.1mg/kg i.v.(AVERAGE
DOSE 2-5mg)
• ADD PROPOFOL IF NEEDED 1-2mg/kg
• Monitor oxygen saturation and administer
oxygen as indicated
• Local anaesthesia
• No anaesthesia(only some pain and
sedation)(councelling)
 OT SETUPS

Rainbow IVF

MAMC DELHI

MNMH AGRA
 MATERIAL CHECKLIST FOR
OPU
• DRY BLOCK HEATER AND WARM
BLOCKS
• FALCON TESTUBES
• GLASS SYRINGE WITH BLUNT
NEEDLE(COMES WITH THE NEEDLE)
• BEAKERS,PETRIDISHES/FOUR WELL
DISHES/PIPETTES/PIPETTE PUMPS
ETC
• SUCTION
PUMP(COOK/ROCKET/INDIAN
MAKE:SHIVANI)
• NEEDLES(COOK/REPROLINE/OTHER
S)
• TUBINGS
• ULTRASOUND MACHINE : TVS
PROBE
 TEMPERATURE CONTROL
• warm blocks for test
tubes
• hand held test tube
warmer
• heated laminar
table(integrated table
available now made in
india)
GETTING READY
GETTING READY
LOCAL ANAESTHETIC
INJECTION
SHEFALI AND DINESH JAIN CENTRE INDORE
 ASPIRATION NEEDLE

• 17 GAUZE
• SINGLE LUMEN OR
DOUBLE LUMEN
• DOUBLE LUMEN MAY BE
USED IN LESSER FOLLICLE
AND WHERE MULTIPLE
FOLLICLE FLUSHING IS
NEEDED
• CONNECTING TEFLON
TUBING TO THE BUNGE
(SPECIAL DESIGN BUNGES)
 TECHNIQUE
• clean the vagina and
wash off all particulate
matter with normal saline
• vaginal ultrasound(use of
cover and jelly???)
• focus and fix the target
ovary in the centre of the
biopsy line
• enter with a sharp jab
• enter the follicle at
maximum diameter
needle entry
TECHNIQUE CONT…

• SUCTION VACUUM APPLIED BEFORE ENTERING THE FOLLICLE TO

PREVENT LEAKING
• ASPIRATION PRESSURE AROUND 100(NEVER MORE THAN 130)
• IF FLUSHING IS BEING DONE IT SHOULD BE AT LOW PRESSURE
• AFTER ASPIRATION OF FIRST FOLLICLE IT MAY BE A GOOD
PRACTICE TO FLUSH THE NEEDLE OF ANY VAGINAL MUCUS OR
TISSUE
• THE FOLLICLE SHOULD BE ASPIRATED TILL TOTALLY COLLAPSED
• SPINNING ACTION IS NOW DEBATABLE
• THE MOBILE OVARY CAN BE NEARED TO THE PROBE TIP AND
FIXED BY THE ASSISTANT PUSHING IT DOWN
• A CO ORDINATION OF EYE/ HAND AND FOOT PRESSURE IS
NEEDED
Eye Hand and Foot
Co-ordination
OOCYTE ASPIRATION
FOLLICLE ASPIRATION
LOOSE CAP AND BLOCKED NEEDLE
CHANGING CAPS/PUMP PRESSURE
 FLUSHING
• value is debatable
• only may be used in natural
cycle/less eggs/poor
responders/small follicle(ivm)
• if more than 10 follicles are
seen then flushing not required
and this may prolong the
procedure and discomfort
• flushing follicle 6 times may
increase the yield by 20%
• it is rather better to aspirate
completely (as the follicle
retrieved in the first aspirate
and last aspirate is same)
TUBES AND PETRI DISHES
OOCYTE CUMULUS COMPLEX
SCREENING
 DIFFICULTIES IN OPU

• ovary stuck behind the cervix and uterus (may have

to go thru)
• endomeriomas
• (contamination of the follicle aspiration)
• try not to aspirate till opu completed..but if
punctured then aspirate completely, flush them and
flush the needle many times
• bleeding : if ovarian vessel.. just remove the needle
and bleeding will stop..if iliac is hit remove needle
gently and bleeding may stop,but if there is rapid
bleeding,laparotomy may be needed..
• vaginal and cervical bleeding usually stops with
pressure , if does not suture
 DIFFICULTIES IN OPU

• ovary stuck on the

fundus
• vaginal vessels
• thru cervix
• endometrioma
• too near major blood
vessels
• hydrosalpinx
 COMPLICATIONS
VAGINAL BLEEDING
1.4-18.4%
IF THE PROBE IS
ROTATED WITH NEEDLE
INSIDE(CAN TEAR
VAGINA,OVARIAN
SURFACE AND INTRA
ABDOMINAL ORGANS)
 INTRAPERITONEAL BLEEDING

• RARE
• 0-1.3%
• INTRAPERITONEAL OR RETROPERITONEAL
• IF HAEMODYNAMIC DISTURBANCE.. URGENT LIFE
SAVING MEASURES AND LAPAROTOMY OR
LAPROSCOPY
• RETROPERITONEAL HAEMATOMAS PRESENT
AFTER SOME TIME (ABOUT 10 HRS POS OPU)
 INFECTION

• PID :0.2-0.55 %
• BECAUSE THE VAGINAL FLORA IS CARRIED
INTO THE PERITONEUM WITH THE NEEDLE
PUNCTURE.
• PUNCTURE OF INFECTED HYDROSALPINX
AND OOPHERITIS
• MAY PRESENT AS ACUTE INFECTION AND
ENDOTOXEMIA
• LOCAL INFLAMMATORY REACTION
• ROLE OF PROPHYLACTIC BROAD
SPECTRUM ANTIBIOTIC
• FOR TREATMENT COVERAGE WITH
ANTIBIOTICS AND MONITORING IS NEEDED
 TAKE HOME MESSAGE

• SIMPLE AND EFFICIENT PROCEDURE

• HOWEVER CARE SHOULD BE TAKEN(THE
COMPLICATIONS ARE POTENTIALLY
DANGEROUS)
• HAS A LEARNING CURVE
CONGRATULATIONS ON 35
YEARS OF ART
THANK YOU