Transvaginal oocyte retrieval
Encyclopedia
Transvaginal oocyte retrieval (TVOR), also referred to as oocyte retrieval (OCR) or even simply egg collection, is a technique used in in vitro fertilization
(IVF) in order to remove oocyte
s from the ovary
of the female, enabling fertilization outside the body. Transvaginal oocyte retrieval can be called transvaginal ovum retrieval if the oocytes have matured into ova
, as is normally the case in IVF.
. Initially performed using a transvaginal needle guided by transabdominal ultrasonography, TVOR is currently performed with a transvaginal ultrasound
transducer with an attached needle. Once the follicle of the ovary is lined up with the guiding line of the transducer, the needle is advanced through the vaginal wall into the follicle of the ovary. Care is taken not to injure organs located between the vaginal wall and the ovary. Once the follicle is entered, suction is gently applied to aspirate follicular fluid and with it, hopefully, cellular material including the oocyte. 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 Once the ovarian follicles have been aspirated on one ovary, the needle is withdrawn, and the procedure repeated on the contralateral ovary. After completion, the needle is withdrawn, and hemostasis
is achieved. The process takes about 20 minutes and is usually done under procedural sedation or general anesthesia
.
The technique mostly succeeds after ovarian hyperstimulation, where oocytes are pharmacologically stimulated to mature. In addition, oocyte release triggering is usually performed to induce final maturation of oocytes. An agent used for this purpose is human chorionic gonadotropin
(hCG). It would cause ovulation to occur between 38 and 40 hours after injection, but TVOR is typically performed at a time usually between 34 and 36 hours after hCG injection, that is, just prior to the expected rupture of the follicles. hCG injection confers a risk of ovarian hyperstimulation syndrome
.
s. Among lean patients with polycystic ovary syndrome
, ovarian hemorrhage
after ultrasonographically guided transvaginal oocyte retrieval is a potentially catastrophic and not so rare complication.
Anecdotal evidence suggests that certain airborne chemical contaminants and particles, especially volatile organic compound
s (VOC), may be toxic to and impair the growth and development
of embryo
s if present in sufficient concentrations in the ambient atmosphere of an IVF incubator.
, France, in 1984 and introduced into the United States at the Genetics and IVF Institute
in Virginia
in 1985 with the help of Deborah Costakos.
In vitro fertilisation
In vitro fertilisation is a process by which egg cells are fertilised by sperm outside the body: in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed...
(IVF) in order to remove oocyte
Oocyte
An oocyte, ovocyte, or rarely ocyte, is a female gametocyte or germ cell involved in reproduction. In other words, it is an immature ovum, or egg cell. An oocyte is produced in the ovary during female gametogenesis. The female germ cells produce a primordial germ cell which undergoes a mitotic...
s from the ovary
Ovary
The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in anatomically female individuals are analogous to testes in anatomically male individuals, in that they are both gonads and endocrine glands.-Human anatomy:Ovaries...
of the female, enabling fertilization outside the body. Transvaginal oocyte retrieval can be called transvaginal ovum retrieval if the oocytes have matured into ova
Ovum
An ovum is a haploid female reproductive cell or gamete. Both animals and embryophytes have ova. The term ovule is used for the young ovum of an animal, as well as the plant structure that carries the female gametophyte and egg cell and develops into a seed after fertilization...
, as is normally the case in IVF.
Procedure
TVOR is performed in an operating room with the (female) patient in the lithotomy positionLithotomy position
The lithotomy position is a medical term referring to a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth in Western nations...
. Initially performed using a transvaginal needle guided by transabdominal ultrasonography, TVOR is currently performed with a transvaginal ultrasound
Gynecologic ultrasonography
Gynecologic ultrasonography or Gynecologic sonography refers to the application of medical ultrasonography to the female pelvic organs, specifically the uterus, the ovaries, the Fallopian tubes, as well as the bladder, the adnexa, the Pouch of Douglas, and any findings in the pelvis of relevance...
transducer with an attached needle. Once the follicle of the ovary is lined up with the guiding line of the transducer, the needle is advanced through the vaginal wall into the follicle of the ovary. Care is taken not to injure organs located between the vaginal wall and the ovary. Once the follicle is entered, suction is gently applied to aspirate follicular fluid and with it, hopefully, cellular material including the oocyte. 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 contralateral ovary. After completion, the needle is withdrawn, and hemostasis
Hemostasis
Hemostasis or haemostasis is a process which causes bleeding to stop, meaning to keep blood within a damaged blood vessel . Most of the time this includes blood changing from a liquid to a solid state. Intact blood vessels are central to moderating blood's tendency to clot...
is achieved. The process takes about 20 minutes and is usually done under procedural sedation or general anesthesia
General anaesthesia
General anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents...
.
The technique mostly succeeds after ovarian hyperstimulation, where oocytes are pharmacologically stimulated to mature. In addition, oocyte release triggering is usually performed to induce final maturation of oocytes. An agent used for this purpose is human chorionic gonadotropin
Human chorionic gonadotropin
Human chorionic gonadotropin or human chorionic gonadotrophin is a glycoprotein hormone produced during pregnancy that is made by the developing embryo after conception and later by the syncytiotrophoblast .. Some tumors make this hormone; measured elevated levels when the patient is not...
(hCG). It would cause ovulation to occur between 38 and 40 hours after injection, but TVOR is typically performed at a time usually between 34 and 36 hours after hCG injection, that is, just prior to the expected rupture of the follicles. hCG injection confers a risk of ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome
Ovarian hyperstimulation syndrome is a complication from some forms of fertility medication. Most cases are mild, but a small proportion are severe.-Causative medications:...
.
Complications
The retrieval can lead to complication resulting in injury to organs, bleeding, and infection. The aspirates are handed to the laboratory to examine it for oocyteOocyte
An oocyte, ovocyte, or rarely ocyte, is a female gametocyte or germ cell involved in reproduction. In other words, it is an immature ovum, or egg cell. An oocyte is produced in the ovary during female gametogenesis. The female germ cells produce a primordial germ cell which undergoes a mitotic...
s. Among lean patients with polycystic ovary syndrome
Polycystic ovary syndrome
Polycystic ovary syndrome is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease....
, ovarian hemorrhage
Bleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
after ultrasonographically guided transvaginal oocyte retrieval is a potentially catastrophic and not so rare complication.
Anecdotal evidence suggests that certain airborne chemical contaminants and particles, especially volatile organic compound
Volatile organic compound
Volatile organic compounds are organic chemicals that have a high vapor pressure at ordinary, room-temperature conditions. Their high vapor pressure results from a low boiling point, which causes large numbers of molecules to evaporate or sublimate from the liquid or solid form of the compound and...
s (VOC), may be toxic to and impair the growth and development
Embryogenesis
Embryogenesis is the process by which the embryo is formed and develops, until it develops into a fetus.Embryogenesis starts with the fertilization of the ovum by sperm. The fertilized ovum is referred to as a zygote...
of embryo
Embryo
An embryo is a multicellular diploid eukaryote in its earliest stage of development, from the time of first cell division until birth, hatching, or germination...
s 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 StrasbourgStrasbourg
Strasbourg is the capital and principal city of the Alsace region in eastern France and is the official seat of the European Parliament. Located close to the border with Germany, it is the capital of the Bas-Rhin département. The city and the region of Alsace are historically German-speaking,...
, France, in 1984 and introduced into the United States at the Genetics and IVF Institute
Genetics and IVF Institute
The Genetics & IVF Institute is a provider of infertility and genetics services, and also engages in biomedical research in these fields. The Institute was founded in 1984 by Dr. Joseph D. Schulman and associates...
in Virginia
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...
in 1985 with the help of Deborah Costakos.
Further reading
- Bracha, J., Lotan, M. and Zakut, H. (1988) Ovarian abscess following cesarean section. A case report and review of the literature. Clin. Exp. Obstet. Gynecol., 15, 134–136.
- Coroleu, B., Lopez-Mourelle, F., Hereter, L. et al. (1997). Ureteral lesion secondary to vaginal ultrasound follicular puncture for oocyte recovery in in-vitro fertilization. Hum. Reprod., 12, 948–950.
- Dicker, D., Ashkenazi, J., Feldberg, D. et al. (1993) Severe abdominal complications after transvaginal ultrasonographically guided retrieval of oocytes for in vitro fertilization and embryo transfer. Fertil. Steril., 59