Oocyte retrieval

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Oocyte retrieval
Prof. Aboubakr Elnashar
Benha University Hospital, EGYPT
Delta (Mansura) Benha Fertility Centers E-mail
elnashar53_at_hotmail.com
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Introduction Transvaginal follicle puncture under
sonographic control has become the method of
choice for ovum retrieval worldwide. Our
objective was to review the up-to-date RCT
meta-analyses concerning oocyte retrieval
(OR). Materials methods An electronic search of
the Cochrane library, Pub Med for RCT
meta-analyses concerning OR from 1990 to 2005.
Results One chochrane systematic review, one
meta-analyses 21 RCT were reviewed as regard
the optimal time for OR, administration of
progesterone, routine anxiolytic premedication,
analgesia, anesthesia, aspirating needle, vaginal
disinfection follicular flushing.
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1. Time of retrieval hCG can be administered at
any time 34 to 38 hr before OR without affecting
the results of IVF (Bjerecke et al ,2000) 2.
Administration of progesterone before
OR Administration of 25 mg IM progesterone 12
hours before OR is associated with a lower PR
than the administration of progesterone after OR
(Sohn et al,1999). Vaginal progesterone started
on the day of OR did not increase implantation or
PR when compared to the same dose started on the
day of ET (Baruffi et al ,2003) .
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3. Administration of beta 2 adrenergic agonists
on the day of OR Administration of 10 mg of
terbutaline or 20 mg of ritodrine daily for 15
days starting on the day of OR was not associated
with significant improvement in pregnancy,
implantation or miscarriage rates (Pinheiro et
al,2003). 3. Premedication Routine use of
anxiolytic premedication (50 mg pethidine 25 mg
promethazine) prevented an increase of
preoperative anxiety level, reduced pain levels
during OR but was associated with a higher
percentage of moderate/severe drowsiness in the
postoperative period (Ng et al, 2002).
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• 4. Analgesia
• a. Paracervical block
• Paracervical block compared with placebo
  injection was associated with lower pain scores
  (Corson et al,1994).
• b. Electro-acupuncture
• Conventional medical analgesia plus paracervical
  block Vs electro-acupuncture plus paracervical
  block. No significant differences in clinical
  pregnancy rates per woman and patient
  satisfaction (Kwan et al Cochrane library,
  2005). For intra-operative pain score, there was
  a significant difference, favouring conventional
  medical analgesia plus paracervical block . There
  was a significant difference in intra-operative
  pain between patient-controlled sedation and
  physician-administered sedation.

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5. General anesthesia The sedative combination of
midzolam ketamine for OR may serve as an
alternative for general anesthesia (Benshlomo et
al,1999). 6. The aspirating needle a. Collection
using smaller diameter needles had no significant
effect on the number of oocytes collected per
follicle aspirated, or on the subsequent
fertilizing capacity of those oocytes (Aziz et
al,1993). There was a significant reduction in
pain perceived by the patient when the smaller
needle was used during the collection.
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b. Comparison of single- and double-lumen needles
No differences between the two needles in the
number of oocytes provided for IVF(Scott et
al,1989). The double-lumen needle was more
flexible and frequently deviated from the
projected path as observed by ultrasound. The
single-lumen needle may be preferable because it
is technically easier to use. 7. Vaginal
disinfection No differences in the fertilization
cleavage rates were found in the betadine
normal saline groups (van Os et al,1992). However
PR was significantly higher in the normal saline
group (17.2 Vs 30.3).
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8. Follicular flushing No significant difference
in the number of oocytes retrieved, fertilization
rate, PR. Significant shortening of operating
time in the aspiration time in the aspiration
only group (Kinsland et al,1991).. 10.
Intravaginal administration of probiotics
immediately after oocyte retrieval did not
affect the prevalence of lactobacilli during ET
or PR. No effect on vaginal colonization or PR in
IVF cycles (Gilbao et al, 2005).
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• Conclusions
• HCG can be administered at any time within the
  interval of 34 to 38 hr before OR
• Administration of progesterone before OR is
  associated with a lower PR
• There is insufficient evidence to determine the
  best method of pain relief for OR.
• The single-lumen needle may be preferable because
  it is technically easier to use.
• PR was significantly higher when normal saline
  rather than betadine is used for vaginal
  disinfection.