Ultrasonographic Transvaginal Oocyte Retrieval

Anesthesia Implications

Position: Lithotomy
Time: 5-30 min (very short)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

High stimulation/pain – When needle is passed through the vaginal fornix and ovary. Ensure a deep MAC – This is the most stimulating time. The first ovarian follicles may be easy, therefore quick to retrieve. The second may be more difficult, slower and more stimulating. The patient must remain motionless during the procedure to avoid damage to the oocytes or surrounding tissues/structures.

Avoid Lidocaine – This can affect oocyte quality

This procedure is done ~36 hours after a patient has undergone human chorionic gonadotropin (HCG) injections to induce oocyte maturation. If any more than 36 hours have passed since the injections, oocytes may have already been matured and ovulated into the fallopian tubes making retrieval no longer be possible.

An ultrasound probe with a 16 or 17 gauge needle is passed into the vagina. Once an ovary is identified, the needle is passed through the vaginal fornix and into the ovary. The ovarian follicles are then aspirated. This procedure is performed on both ovaries. After the needle and probe are removed, the vagina is inspected to ensure minimal/no bleeding. With bleeding, there will be pressure applied for 3-5 minutes.

Metoclopramide rapidly induces hyperprolactinemia, which will impair ovaian follical maturation and the function of the corpus luteum. While documented as acceptable to give immediately before oocyte retrieval, uterine receptivity to the embryo may be negatively affected if it is given routinely after retrieval.