SlideShare a Scribd company logo
1 of 24
.
OOCYTE PICKUP
ESHRE 2019
Prof. ABOUBAKR ELNASHAR
Benha university, Egypt
ABOUBAKR ELNASHAR
CONTENTS
1. BASIC PRINCIPLES OF THE OPU TECHNIQUE
2. PRIOR TO OPU CHECK LIST
3. TROUBLESHOOTING DURING OPU
4. AFTER OPU CHECKLIST
5. COMPLICATIONS
6. ASSESSING COMPTENCY
7. FUTURE DEVELOPMENTS
ABOUBAKR ELNASHAR
1. BASIC PRINCIPLES OF THE OPU TECHNIQUE
1. The pivot movement of the transvaginal transducer is
easier when
 patient places her buttocks at the edge of the
gynaecological couch
 operator is standing or sitting in between the
patient’s abducted and supported legs.
ABOUBAKR ELNASHAR
2. Holding the transvaginal transducer in a correct way is
advisable
{allow better vision of the proximity of the different
tissues and organs on the monitor}.
 Placing the transducer parallel to the hand of the
operator:
 better tactile perception
{the transducer becomes an extension of the
operator’s fingers}.
ABOUBAKR ELNASHAR
3. The left side of the patient is often represented at the
right part of the monitor.
 The probe is represented at
 the top or
 the bottom of the monitor depending on the
operator's preference.
ABOUBAKR ELNASHAR
4. Avoid contaminating the needle tip of the probe when
introducing it in the vagina, by
keeping the needle inside the needle guide until
ready to pierce the vagina.
5. The ovary should be lined up to the most accessible
position on the screen.
ABOUBAKR ELNASHAR
6. The transducer should be against the ovary (through
the vaginal wall).
Carefully insert the needle inside the follicle.
7. Ideally the needle should be inserted in the middle of
the ovary
{prevent the ovary from moving and needle to cause
injury to adjacent organs}.
ABOUBAKR ELNASHAR
8. The echogenic tip of the needle should be identified
during all manoeuvres.
The needle guide seen on the monitor can facilitate
safer insertion as it projects where the needle tip will
progress.
9. It is advised to keep the needle in the centre of the
follicle during aspiration and observe the follicle walls to
collapse around the tip.
ABOUBAKR ELNASHAR
10. The needle tip markers must be
 observed at all times as it is manoeuvred within
the ovaries and into each follicle
 never be advanced if not visible.
11. Aspirate the follicular fluid containing the
oocyte/cumulus complex by application of suction.
ABOUBAKR ELNASHAR
12. The walls of the follicle collapse as the fluid is
aspirated; before moving the needle to the next follicle,
the operator should ensure that all the follicular fluid is
withdrawn.
13. The needle can be
 advanced into an adjacent follicle or
 withdrawn to the edge of the ovary;
 realignment is needed to advance into another
follicle.
 Minimize as far as possible repetitive puncture
through the vaginal wall.
ABOUBAKR ELNASHAR
14. Avoid lateral movements of the needle to reduce the
risk of vascular damage.
15. Do not move the transducer with the needle in the
advanced position.
16. Puncture all follicles, especially if there is a high risk
of OHSS.
17. Flush the needle between the two ovaries to avoid
any potential blockage caused by blood clots.
ABOUBAKR ELNASHAR
2. BEFORE OPU-CHECKLIST
✓ The entire system is tested by aspirating some culture
medium (Null Aspiration).
✓ Make sure that the
 suction pump is turned on and
 suction pedal is functioning
 (many aspiration pumps have a light flashed, and
some have audible signals, when the pump is
activated).
ABOUBAKR ELNASHAR
✓ Check the setting of the suction pressure taking into
account the maximum pressure limit of the suction
pump.
✓ Check the needle connection with the tubing system
and ensure that they are tightly connected with no air
leakage
ABOUBAKR ELNASHAR
✓ Ensure that the suction tubing system is
 new, or
 undamaged (when the system is re-used)
✓ Exclude any cracks in the aspiration test tube.
✓ Ensure that the collection tubing is not kinked or
damaged.
ABOUBAKR ELNASHAR
✓Check the needle and the connection of the needle
with the tubing system.
✓ Ensure that the needle guide is
 appropriately placed on the ultrasound probe with
no gaps
 the protective probe sheath is not on the way of
the needle projection.
✓ Ensure that the needle guide is well applied on the
probe and not loose.
ABOUBAKR ELNASHAR
3. TROUBLESHOOTING DURING OPU
 What to do when the needle tip is not visualized?
 Withdraw the needle
 ensure that the needle director/gauge is in place
allowing the needle to move in the same sector as
the ultrasound beam
ABOUBAKR ELNASHAR
 What to do when suction fails?
 Rotate the needle within the follicle to ensure that
it is not blocked by follicular wall tissue.
 If there is still no suction, remove the needle and
perform a “retrograde flush” to clear any blockage.
 Before re-inserting the needle, re-check by
aspirating some culture medium.
 In case of a double-lumen needle, the needle can
be flushed without taking it out of the ovary
ABOUBAKR ELNASHAR
 What to do when no oocytes are retrieved?
 When no oocytes are discovered, or if the fluid
collected is very clear and devoid of (granulosa
and cumulus) cells after aspiration of the first
follicles, suspicion may be raised that the patient
has not had her trigger.
In case of hCG trigger
 Before follicles from the second ovary are
aspirated,
 a urinary pregnancy test or beta-hCG serum
test can be performed.
 Alternatively, follicular fluid can be tested with a
urinary pregnancy test strip
(Enien et al., 1995).
ABOUBAKR ELNASHAR
 In case of agonist trigger (triptorelin).
✓ An ovulation test can be performed.
✓ The serum LH levels can be checked.
- If the test shows that the patient did not receive the
trigger:
- a new dose may be administered and the OPU
repeated after 36 h. If the time interval since OPU
was too short, OPU can be delayed.
- If premature ovulation is suspected,
- peritoneal fluid can be aspirated to recover some
oocytes.
ABOUBAKR ELNASHAR
 In case of agonist trigger (triptorelin).
✓ An ovulation test can be performed.
✓ The serum LH levels can be checked.
- If the test shows that the patient did not receive the
trigger:
- a new dose may be administered and the OPU
repeated after 36 h. If the time interval since OPU
was too short, OPU can be delayed.
 If premature ovulation is suspected,
- peritoneal fluid can be aspirated to recover some
oocytes.
ABOUBAKR ELNASHAR
4. AFTER OPU CHECKLIST
 Monitor general status
 be alert for complications.
 Provide patients with a leaflet with
 written information and
 a 24 h emergency number.
ABOUBAKR ELNASHAR
5. COMPLICATIONS
ABOUBAKR ELNASHAR
6. ASSESSING COMPETENCY
(Dessolle et al., 2014, Panayotidis, 2017)
1. the number of oocytes collected
2. the number of ovarian punctures
3. the ratio of number of oocytes retrieved to the
number of follicles aspirated
4. any complications from the procedure, in the short or
long term
5. the duration of the OPU procedure
ABOUBAKR ELNASHAR
7. FUTURE RESEARCH IN OPU
✓ Value of FBC or any additional test (microbiology)
before OPU for prevention of complications
✓ Value of antibiotic prophylaxis in low-risk patients
✓ Value of flushing to increase number of eggs
retrieved
✓ Effect of different aspiration pressures on oocyte yield
✓ Number of OPUs necessary for proficiency and for
maintaining skills
✓ Complications rates related to the OPU performance
under sedation versus general anaesthesia
ABOUBAKR ELNASHAR

More Related Content

What's hot

NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...Lifecare Centre
 
Controlled ovarian stimulation in IVF
Controlled ovarian stimulation in IVFControlled ovarian stimulation in IVF
Controlled ovarian stimulation in IVFAboubakr Elnashar
 
Ovarian Stimulation Protocols
Ovarian Stimulation ProtocolsOvarian Stimulation Protocols
Ovarian Stimulation ProtocolsHesham Gaber
 
ICSI Lab procedures for gynecologist
ICSI Lab procedures for gynecologist ICSI Lab procedures for gynecologist
ICSI Lab procedures for gynecologist Aboubakr Elnashar
 
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESAboubakr Elnashar
 
Monitoring of IVF Cycle - Dr Dhorepatil Bharati
Monitoring of IVF Cycle - Dr Dhorepatil BharatiMonitoring of IVF Cycle - Dr Dhorepatil Bharati
Monitoring of IVF Cycle - Dr Dhorepatil BharatiBharati Dhorepatil
 
SPERM SELECTION IN ICSI
SPERM SELECTION IN ICSISPERM SELECTION IN ICSI
SPERM SELECTION IN ICSIRahul Sen
 
Recent Trends In Art (2)
Recent Trends In Art (2)Recent Trends In Art (2)
Recent Trends In Art (2)guest7f0a3a
 
Setting up of art lab by Dr. Renukadevi
Setting up of art lab by Dr. RenukadeviSetting up of art lab by Dr. Renukadevi
Setting up of art lab by Dr. RenukadeviMorris Jawahar
 
Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018 Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018 Lifecare Centre
 
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT?
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT?
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? Rahul Sen
 
Hysteroscopy pre IVF is it neccessary ??
Hysteroscopy pre IVF is it neccessary ??Hysteroscopy pre IVF is it neccessary ??
Hysteroscopy pre IVF is it neccessary ??NARENDRA MALHOTRA
 
Oocyte Morphology assessment
Oocyte Morphology assessment Oocyte Morphology assessment
Oocyte Morphology assessment Yasminmagdi
 
Repeated Implantation failure
Repeated Implantation failureRepeated Implantation failure
Repeated Implantation failureAhmad Saber
 

What's hot (20)

NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...
NICE Guidelines 2013, in relation to IUI & IVF Dr. Jyoti Agarwal,Dr. Sharda J...
 
Controlled ovarian stimulation in IVF
Controlled ovarian stimulation in IVFControlled ovarian stimulation in IVF
Controlled ovarian stimulation in IVF
 
Optimizing IUI Outcome
Optimizing IUI OutcomeOptimizing IUI Outcome
Optimizing IUI Outcome
 
Ovarian Stimulation Protocols
Ovarian Stimulation ProtocolsOvarian Stimulation Protocols
Ovarian Stimulation Protocols
 
ICSI Lab procedures for gynecologist
ICSI Lab procedures for gynecologist ICSI Lab procedures for gynecologist
ICSI Lab procedures for gynecologist
 
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
 
ICSI for all
ICSI for allICSI for all
ICSI for all
 
Monitoring of IVF Cycle - Dr Dhorepatil Bharati
Monitoring of IVF Cycle - Dr Dhorepatil BharatiMonitoring of IVF Cycle - Dr Dhorepatil Bharati
Monitoring of IVF Cycle - Dr Dhorepatil Bharati
 
SPERM SELECTION IN ICSI
SPERM SELECTION IN ICSISPERM SELECTION IN ICSI
SPERM SELECTION IN ICSI
 
Recent Trends In Art (2)
Recent Trends In Art (2)Recent Trends In Art (2)
Recent Trends In Art (2)
 
Setting up of art lab by Dr. Renukadevi
Setting up of art lab by Dr. RenukadeviSetting up of art lab by Dr. Renukadevi
Setting up of art lab by Dr. Renukadevi
 
Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018 Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018
 
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT?
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT? EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT?
EMBRYO QUALITY ASSESSMENT, WHICH TO SELECT?
 
Intra uterine insemination for unexplained infertility
Intra uterine insemination for unexplained infertilityIntra uterine insemination for unexplained infertility
Intra uterine insemination for unexplained infertility
 
Hysteroscopy pre IVF is it neccessary ??
Hysteroscopy pre IVF is it neccessary ??Hysteroscopy pre IVF is it neccessary ??
Hysteroscopy pre IVF is it neccessary ??
 
Oocyte Morphology assessment
Oocyte Morphology assessment Oocyte Morphology assessment
Oocyte Morphology assessment
 
EMPTY FOLLICLE SYNDROME
EMPTY FOLLICLE SYNDROMEEMPTY FOLLICLE SYNDROME
EMPTY FOLLICLE SYNDROME
 
IMSI
IMSIIMSI
IMSI
 
Embryo transfer
Embryo transferEmbryo transfer
Embryo transfer
 
Repeated Implantation failure
Repeated Implantation failureRepeated Implantation failure
Repeated Implantation failure
 

Similar to oocyte pickup ESHRE2019

PERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHY
PERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHYPERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHY
PERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHYSharmaRajan4
 
Instruments Gynecological/ obstetrics/ Compilation / Ziauddin Hospital
Instruments Gynecological/ obstetrics/ Compilation / Ziauddin HospitalInstruments Gynecological/ obstetrics/ Compilation / Ziauddin Hospital
Instruments Gynecological/ obstetrics/ Compilation / Ziauddin HospitalDr. Darayus P. Gazder
 
THIRD AND FOURTH DEGREE TEARS
THIRD AND FOURTH DEGREE TEARSTHIRD AND FOURTH DEGREE TEARS
THIRD AND FOURTH DEGREE TEARSAboubakr Elnashar
 
Seminar presentation 14october 2020 (1)
Seminar presentation 14october 2020 (1)Seminar presentation 14october 2020 (1)
Seminar presentation 14october 2020 (1)SumaiyaShams
 
Optimising IVF results with good OPU and ET techniques
Optimising IVF results with good OPU and ET techniquesOptimising IVF results with good OPU and ET techniques
Optimising IVF results with good OPU and ET techniquesMangalaDevi9
 
Anatomy Review and S.A.L.T.™ OveRview
Anatomy Review and S.A.L.T.™ OveRviewAnatomy Review and S.A.L.T.™ OveRview
Anatomy Review and S.A.L.T.™ OveRviewTonia A. Dousay
 
Anatomy Review and S.A.L.T.™ OveRvieW
Anatomy Review and S.A.L.T.™ OveRvieWAnatomy Review and S.A.L.T.™ OveRvieW
Anatomy Review and S.A.L.T.™ OveRvieWTonia A. Dousay
 
Anatomy Review and S.A.L.T.™ OvervieW
Anatomy Review and S.A.L.T.™ OvervieWAnatomy Review and S.A.L.T.™ OvervieW
Anatomy Review and S.A.L.T.™ OvervieWTonia A. Dousay
 
Experience of improvised esophageal stethoscope over precordial stethoscope a...
Experience of improvised esophageal stethoscope over precordial stethoscope a...Experience of improvised esophageal stethoscope over precordial stethoscope a...
Experience of improvised esophageal stethoscope over precordial stethoscope a...Azad Abul Kalam
 
Specimen collection 130319145806-phpapp02
Specimen collection 130319145806-phpapp02Specimen collection 130319145806-phpapp02
Specimen collection 130319145806-phpapp02Javad Gafoor
 
Git j club EUS FNA or cb.
Git j club EUS FNA or cb.Git j club EUS FNA or cb.
Git j club EUS FNA or cb.Shaikhani.
 
Laparoscopic surgery in dogs an overview
Laparoscopic surgery in dogs an overviewLaparoscopic surgery in dogs an overview
Laparoscopic surgery in dogs an overviewBhubaneswarSahoo
 

Similar to oocyte pickup ESHRE2019 (20)

Laparoscopy
LaparoscopyLaparoscopy
Laparoscopy
 
Laparoscopic Sterilization
Laparoscopic SterilizationLaparoscopic Sterilization
Laparoscopic Sterilization
 
PERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHY
PERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHYPERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHY
PERCITANEOUS NEPHROSTOMY and HYSTEROSALPIONGOGRAPHY
 
Instruments Gynecological/ obstetrics/ Compilation / Ziauddin Hospital
Instruments Gynecological/ obstetrics/ Compilation / Ziauddin HospitalInstruments Gynecological/ obstetrics/ Compilation / Ziauddin Hospital
Instruments Gynecological/ obstetrics/ Compilation / Ziauddin Hospital
 
Pediatric laparoscopy
Pediatric laparoscopyPediatric laparoscopy
Pediatric laparoscopy
 
THIRD AND FOURTH DEGREE TEARS
THIRD AND FOURTH DEGREE TEARSTHIRD AND FOURTH DEGREE TEARS
THIRD AND FOURTH DEGREE TEARS
 
Git j club eus liver biopsy22
Git j club eus liver biopsy22Git j club eus liver biopsy22
Git j club eus liver biopsy22
 
Git j club eus liver biopsy22
Git j club eus liver biopsy22Git j club eus liver biopsy22
Git j club eus liver biopsy22
 
Seminar presentation 14october 2020 (1)
Seminar presentation 14october 2020 (1)Seminar presentation 14october 2020 (1)
Seminar presentation 14october 2020 (1)
 
IUCD: Uterine perforation
IUCD: Uterine perforationIUCD: Uterine perforation
IUCD: Uterine perforation
 
Optimising IVF results with good OPU and ET techniques
Optimising IVF results with good OPU and ET techniquesOptimising IVF results with good OPU and ET techniques
Optimising IVF results with good OPU and ET techniques
 
Airway management final
Airway management finalAirway management final
Airway management final
 
Anatomy Review and S.A.L.T.™ OveRview
Anatomy Review and S.A.L.T.™ OveRviewAnatomy Review and S.A.L.T.™ OveRview
Anatomy Review and S.A.L.T.™ OveRview
 
Anatomy Review and S.A.L.T.™ OveRvieW
Anatomy Review and S.A.L.T.™ OveRvieWAnatomy Review and S.A.L.T.™ OveRvieW
Anatomy Review and S.A.L.T.™ OveRvieW
 
Anatomy Review and S.A.L.T.™ OvervieW
Anatomy Review and S.A.L.T.™ OvervieWAnatomy Review and S.A.L.T.™ OvervieW
Anatomy Review and S.A.L.T.™ OvervieW
 
Hysteroscopy overview
Hysteroscopy overviewHysteroscopy overview
Hysteroscopy overview
 
Experience of improvised esophageal stethoscope over precordial stethoscope a...
Experience of improvised esophageal stethoscope over precordial stethoscope a...Experience of improvised esophageal stethoscope over precordial stethoscope a...
Experience of improvised esophageal stethoscope over precordial stethoscope a...
 
Specimen collection 130319145806-phpapp02
Specimen collection 130319145806-phpapp02Specimen collection 130319145806-phpapp02
Specimen collection 130319145806-phpapp02
 
Git j club EUS FNA or cb.
Git j club EUS FNA or cb.Git j club EUS FNA or cb.
Git j club EUS FNA or cb.
 
Laparoscopic surgery in dogs an overview
Laparoscopic surgery in dogs an overviewLaparoscopic surgery in dogs an overview
Laparoscopic surgery in dogs an overview
 

More from Aboubakr Elnashar

WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTWHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTAboubakr Elnashar
 
Adenomyosis associated infertility
Adenomyosis associated  infertilityAdenomyosis associated  infertility
Adenomyosis associated infertilityAboubakr Elnashar
 
Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022Aboubakr Elnashar
 
Aesthetic gynecology controversy
Aesthetic gynecology controversyAesthetic gynecology controversy
Aesthetic gynecology controversyAboubakr Elnashar
 
Hormonal assay in clinical gyn
Hormonal assay in clinical gynHormonal assay in clinical gyn
Hormonal assay in clinical gynAboubakr Elnashar
 
Unnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicineUnnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicineAboubakr Elnashar
 
Individualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulationIndividualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulationAboubakr Elnashar
 
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA Aboubakr Elnashar
 
cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021  cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021 Aboubakr Elnashar
 
Management of pregnancy of unknown location
Management of pregnancy of unknown locationManagement of pregnancy of unknown location
Management of pregnancy of unknown locationAboubakr Elnashar
 
COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021Aboubakr Elnashar
 

More from Aboubakr Elnashar (20)

WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTWHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
 
hepatitis B.pdf
hepatitis B.pdfhepatitis B.pdf
hepatitis B.pdf
 
hepatitis c2022.pdf
hepatitis c2022.pdfhepatitis c2022.pdf
hepatitis c2022.pdf
 
Adenomyosis associated infertility
Adenomyosis associated  infertilityAdenomyosis associated  infertility
Adenomyosis associated infertility
 
Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022Endometriosis associated infertility: ESHRE2022
Endometriosis associated infertility: ESHRE2022
 
Adenxal mass guidelines2020
Adenxal mass guidelines2020Adenxal mass guidelines2020
Adenxal mass guidelines2020
 
Aesthetic gynecology controversy
Aesthetic gynecology controversyAesthetic gynecology controversy
Aesthetic gynecology controversy
 
Hormonal assay in clinical gyn
Hormonal assay in clinical gynHormonal assay in clinical gyn
Hormonal assay in clinical gyn
 
FIRST TRIMESTER ANC OF IVF
FIRST TRIMESTER ANC OF IVFFIRST TRIMESTER ANC OF IVF
FIRST TRIMESTER ANC OF IVF
 
Unnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicineUnnecessary investigations in reproductive medicine
Unnecessary investigations in reproductive medicine
 
Infertility prevention
Infertility prevention Infertility prevention
Infertility prevention
 
Individualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulationIndividualisation of controlled ovarian stimulation
Individualisation of controlled ovarian stimulation
 
Female infertility
Female infertility Female infertility
Female infertility
 
Maternal near miss
Maternal near missMaternal near miss
Maternal near miss
 
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
 
cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021  cesarean birth: procedural aspects: NICE2021
cesarean birth: procedural aspects: NICE2021
 
CAESAREAN SCAR DEFECT
CAESAREAN SCAR DEFECT  CAESAREAN SCAR DEFECT
CAESAREAN SCAR DEFECT
 
Management of pregnancy of unknown location
Management of pregnancy of unknown locationManagement of pregnancy of unknown location
Management of pregnancy of unknown location
 
Aerobic Vaginitis
Aerobic Vaginitis Aerobic Vaginitis
Aerobic Vaginitis
 
COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021COVID 19 infection and pregnancy RCOG2021
COVID 19 infection and pregnancy RCOG2021
 

Recently uploaded

Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?Ryan Addison
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisNilofarRasheed1
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingAnonymous
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 

Recently uploaded (20)

Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?
 
Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid Arthritis
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_Wellbeing
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 

oocyte pickup ESHRE2019

  • 1. . OOCYTE PICKUP ESHRE 2019 Prof. ABOUBAKR ELNASHAR Benha university, Egypt ABOUBAKR ELNASHAR
  • 2. CONTENTS 1. BASIC PRINCIPLES OF THE OPU TECHNIQUE 2. PRIOR TO OPU CHECK LIST 3. TROUBLESHOOTING DURING OPU 4. AFTER OPU CHECKLIST 5. COMPLICATIONS 6. ASSESSING COMPTENCY 7. FUTURE DEVELOPMENTS ABOUBAKR ELNASHAR
  • 3. 1. BASIC PRINCIPLES OF THE OPU TECHNIQUE 1. The pivot movement of the transvaginal transducer is easier when  patient places her buttocks at the edge of the gynaecological couch  operator is standing or sitting in between the patient’s abducted and supported legs. ABOUBAKR ELNASHAR
  • 4. 2. Holding the transvaginal transducer in a correct way is advisable {allow better vision of the proximity of the different tissues and organs on the monitor}.  Placing the transducer parallel to the hand of the operator:  better tactile perception {the transducer becomes an extension of the operator’s fingers}. ABOUBAKR ELNASHAR
  • 5. 3. The left side of the patient is often represented at the right part of the monitor.  The probe is represented at  the top or  the bottom of the monitor depending on the operator's preference. ABOUBAKR ELNASHAR
  • 6. 4. Avoid contaminating the needle tip of the probe when introducing it in the vagina, by keeping the needle inside the needle guide until ready to pierce the vagina. 5. The ovary should be lined up to the most accessible position on the screen. ABOUBAKR ELNASHAR
  • 7. 6. The transducer should be against the ovary (through the vaginal wall). Carefully insert the needle inside the follicle. 7. Ideally the needle should be inserted in the middle of the ovary {prevent the ovary from moving and needle to cause injury to adjacent organs}. ABOUBAKR ELNASHAR
  • 8. 8. The echogenic tip of the needle should be identified during all manoeuvres. The needle guide seen on the monitor can facilitate safer insertion as it projects where the needle tip will progress. 9. It is advised to keep the needle in the centre of the follicle during aspiration and observe the follicle walls to collapse around the tip. ABOUBAKR ELNASHAR
  • 9. 10. The needle tip markers must be  observed at all times as it is manoeuvred within the ovaries and into each follicle  never be advanced if not visible. 11. Aspirate the follicular fluid containing the oocyte/cumulus complex by application of suction. ABOUBAKR ELNASHAR
  • 10. 12. The walls of the follicle collapse as the fluid is aspirated; before moving the needle to the next follicle, the operator should ensure that all the follicular fluid is withdrawn. 13. The needle can be  advanced into an adjacent follicle or  withdrawn to the edge of the ovary;  realignment is needed to advance into another follicle.  Minimize as far as possible repetitive puncture through the vaginal wall. ABOUBAKR ELNASHAR
  • 11. 14. Avoid lateral movements of the needle to reduce the risk of vascular damage. 15. Do not move the transducer with the needle in the advanced position. 16. Puncture all follicles, especially if there is a high risk of OHSS. 17. Flush the needle between the two ovaries to avoid any potential blockage caused by blood clots. ABOUBAKR ELNASHAR
  • 12. 2. BEFORE OPU-CHECKLIST ✓ The entire system is tested by aspirating some culture medium (Null Aspiration). ✓ Make sure that the  suction pump is turned on and  suction pedal is functioning  (many aspiration pumps have a light flashed, and some have audible signals, when the pump is activated). ABOUBAKR ELNASHAR
  • 13. ✓ Check the setting of the suction pressure taking into account the maximum pressure limit of the suction pump. ✓ Check the needle connection with the tubing system and ensure that they are tightly connected with no air leakage ABOUBAKR ELNASHAR
  • 14. ✓ Ensure that the suction tubing system is  new, or  undamaged (when the system is re-used) ✓ Exclude any cracks in the aspiration test tube. ✓ Ensure that the collection tubing is not kinked or damaged. ABOUBAKR ELNASHAR
  • 15. ✓Check the needle and the connection of the needle with the tubing system. ✓ Ensure that the needle guide is  appropriately placed on the ultrasound probe with no gaps  the protective probe sheath is not on the way of the needle projection. ✓ Ensure that the needle guide is well applied on the probe and not loose. ABOUBAKR ELNASHAR
  • 16. 3. TROUBLESHOOTING DURING OPU  What to do when the needle tip is not visualized?  Withdraw the needle  ensure that the needle director/gauge is in place allowing the needle to move in the same sector as the ultrasound beam ABOUBAKR ELNASHAR
  • 17.  What to do when suction fails?  Rotate the needle within the follicle to ensure that it is not blocked by follicular wall tissue.  If there is still no suction, remove the needle and perform a “retrograde flush” to clear any blockage.  Before re-inserting the needle, re-check by aspirating some culture medium.  In case of a double-lumen needle, the needle can be flushed without taking it out of the ovary ABOUBAKR ELNASHAR
  • 18.  What to do when no oocytes are retrieved?  When no oocytes are discovered, or if the fluid collected is very clear and devoid of (granulosa and cumulus) cells after aspiration of the first follicles, suspicion may be raised that the patient has not had her trigger. In case of hCG trigger  Before follicles from the second ovary are aspirated,  a urinary pregnancy test or beta-hCG serum test can be performed.  Alternatively, follicular fluid can be tested with a urinary pregnancy test strip (Enien et al., 1995). ABOUBAKR ELNASHAR
  • 19.  In case of agonist trigger (triptorelin). ✓ An ovulation test can be performed. ✓ The serum LH levels can be checked. - If the test shows that the patient did not receive the trigger: - a new dose may be administered and the OPU repeated after 36 h. If the time interval since OPU was too short, OPU can be delayed. - If premature ovulation is suspected, - peritoneal fluid can be aspirated to recover some oocytes. ABOUBAKR ELNASHAR
  • 20.  In case of agonist trigger (triptorelin). ✓ An ovulation test can be performed. ✓ The serum LH levels can be checked. - If the test shows that the patient did not receive the trigger: - a new dose may be administered and the OPU repeated after 36 h. If the time interval since OPU was too short, OPU can be delayed.  If premature ovulation is suspected, - peritoneal fluid can be aspirated to recover some oocytes. ABOUBAKR ELNASHAR
  • 21. 4. AFTER OPU CHECKLIST  Monitor general status  be alert for complications.  Provide patients with a leaflet with  written information and  a 24 h emergency number. ABOUBAKR ELNASHAR
  • 23. 6. ASSESSING COMPETENCY (Dessolle et al., 2014, Panayotidis, 2017) 1. the number of oocytes collected 2. the number of ovarian punctures 3. the ratio of number of oocytes retrieved to the number of follicles aspirated 4. any complications from the procedure, in the short or long term 5. the duration of the OPU procedure ABOUBAKR ELNASHAR
  • 24. 7. FUTURE RESEARCH IN OPU ✓ Value of FBC or any additional test (microbiology) before OPU for prevention of complications ✓ Value of antibiotic prophylaxis in low-risk patients ✓ Value of flushing to increase number of eggs retrieved ✓ Effect of different aspiration pressures on oocyte yield ✓ Number of OPUs necessary for proficiency and for maintaining skills ✓ Complications rates related to the OPU performance under sedation versus general anaesthesia ABOUBAKR ELNASHAR