Transvaginal oocyte retrieval, also referred to as oocyte retrieval, is a technique used in in vitro fertilization in order to remove oocytes from the ovary of a woman, enabling fertilizationoutside the body. Transvaginal oocyte retrieval is more properly referred to as transvaginal ovum retrieval when the oocytes have matured into ova, as is normally the case in IVF.
Procedure
Under ultrasound guidance, the operator inserts a needle through the vaginal wall and into an ovarian follicle, taking care not to injure organs located between the vaginal wall and the ovary. The other end of the needle is attached to a suction device. Once the follicle is entered, suction is gently applied to aspirate follicular fluid and with it, hopefully, cellular material including the oocyte. The follicular fluid is delivered to a technician in the IVF laboratory to identify and quantify the ova. Next, other follicles are aspirated. Once the ovarian follicles have been aspirated on one ovary, the needle is withdrawn, and the procedure repeated on the other ovary. It is not unusual to remove 20 oocytes as women are generally hyperstimulated in advance of this procedure. After completion, the needle is withdrawn, and hemostasis is achieved. The procedure usually lasts 2060 minutes. Initially performed using transabdominal ultrasonography, TVOR is currently performed with a transvaginal ultrasound transducer with an attached needle. TVOR is performed in an operating room or a physician's office, with the subject in the lithotomy position. TVOR is usually performed under procedural sedation, general anesthesia, paracervical block, or sometimes spinal anesthesia. Local anesthesia is not typically used because local anesthetic agents interfere with follicular cleavage and the technique requires multiple needle punctures.
Injection of hCG as a trigger for ovulation confers a risk of ovarian hyperstimulation syndrome, especially in women with polycystic ovary syndrome who have been hyperstimulated during previous assisted reproduction cycles. Complications of TVOR include injury to pelvic organs, hemorrhage, and infection. Occurring more often in lean patients with polycystic ovary syndrome, ovarian hemorrhage after TVOR is a potentially catastrophic and not so rare complication. Additional complications may result from the administration of intravenous sedation or general anesthesia. These include asphyxia caused by airway obstruction, apnea, hypotension, and pulmonary aspiration of stomach contents. Propofol-based anesthetic techniques result in significant concentrations of propofol in follicular fluid. As propofol has been shown to have deleterious effects on oocyte fertilization, some authors have suggested that the dose of propofol administered during anesthesia should be limited, and also that the retrieved oocytes should be washed free of propofol. Anecdotal evidence suggests that certain airborne chemical contaminants and particles, especially volatile organic compounds, may be toxic to and impair the growth and development of embryos if present in sufficient concentrations in the ambient atmosphere of an IVF incubator.
History
This technique was first developed by Pierre Dellenbach and colleagues in Strasbourg, France, and reported in 1984. Steptoe and Edwards used laparoscopy to recover oocytes when IVF was introduced, and laparoscopy was the major method of oocyte recovery until TVOR was introduced.
