Oocyte retrieval at 140-mmHg negative aspiration pressure: A promising alternative to flushing and aspiration in assisted reproduction in women with low ovarian reserve

Kumaran, Aswathy; Narayan, Pratap Kumar; Pai, Praveena Joglekar; Ramachandran, Amar; Mathews, Basil; Adiga, Satish Kumar

doi:10.4103/0974-1208.158617

“…It is not uncommon to have no oocytes retrieved in women with severe DOR undergoing IVF, especially when there is very little follicular growth (Karande 2003). In these situations, there are usually no oocytes retrieved despite apparently normally growing ovarian follicles with adequate estradiol (E2) concentrations using meticulous repeated follicular aspiration and flushing (Kumaran et al 2015). Patients with poor prognosis also tend to have high cancellation rates, along with lower pregnancy and live birth rates (Reed et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve

Rashtian

¹

,

Zhang

²

2018

Systems Biology in Reproductive Medicine

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“…At present, there is no conclusion on the optimal aspiration pressure level, and a variety of pressures between 100 and 200 mmHg are used, often based on manufacturer’s instructions (Panayotidis, 2017; American Institute of Ultrasound in Medicine, 2017). In a single study, higher pressures (140 mmHg) were not associated with damage to the oocytes (Kumaran et al., 2015). The suction pump should be validated prior to use, and a spare suction pump should be available in case one does not work.A stable pressure should be maintained during the procedure, as changes can induce turbulence.…”

Section: Recommendationsmentioning

confidence: 87%

“…At present, there is no conclusion on the optimal aspiration pressure level, and a variety of pressures between 100 and 200 mmHg are used, often based on manufacturer’s instructions (Panayotidis, 2017; American Institute of Ultrasound in Medicine, 2017). In a single study, higher pressures (140 mmHg) were not associated with damage to the oocytes (Kumaran et al., 2015).…”

Section: Recommendationsmentioning

confidence: 87%

Recommendations for good practice in ultrasound: oocyte pick up†

D’Angelo

¹

,

Panayotidis

²

,

Amso

³

et al. 2019

Human Reproduction Open

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STUDY QUESTION What is good practice in ultrasound (US), and more specifically during the different stages of transvaginal oocyte retrieval, based on evidence in the literature and expert opinion on US practice in ART? SUMMARY ANSWER This document provides good practice recommendations covering technical aspects of US-guided transvaginal oocyte retrieval (oocyte pick up: OPU) formulated by a group of experts after considering the published data, and including the preparatory stage of OPU, the actual procedure and post-procedure care. WHAT IS KNOWN ALREADY US-guided transvaginal OPU is a widely performed procedure, but standards for best practice are not available. STUDY DESIGN, SIZE, DURATION A working group (WG) collaborated on writing recommendations on the practical aspects of transvaginal OPU. A literature search for evidence of the key aspects of the procedure was carried out. Selected papers (n = 190) relevant to the topic were analyzed by the WG. PARTICIPANTS/MATERIALS, SETTING, METHODS The WG members considered the following key points in the papers: whether US practice standards were explained; to what extent the OPU technique was described and whether complications or incidents and how to prevent such events were reported. In the end, only 108 papers could be used to support the recommendations in this document, which focused on transvaginal OPU. Laparoscopic OPU, transabdominal OPU and OPU for IVM were outside the scope of the study. MAIN RESULTS AND THE ROLE OF CHANCE There was a scarcity of studies on the actual procedural OPU technique. The document presents general recommendations for transvaginal OPU, and specific recommendations for its different stages, including prior to, during and after the procedure. Most evidence focussed on comparing different equipment (needles) and on complications and risks, including the risk of infection. For these topics, the recommendations were largely based on the results of the studies. Recommendations are provided on equipment and materials, possible risks and complications, audit and training. One of the major research gaps was training and competence. This paper has also outlined a list of research priorities (including clarification on the value or full blood count, antibiotic prophylaxis and flushing, and the need for training and proficiency). LIMITATIONS, REASONS FOR CAUTION The recommendations of this paper were mostly based on clinical expertise, as at present, only a few clinical trials have focused on the oocyte retrieval techniques, and almost all available data are observational. In addition, studies focusing on OPU were heterogeneous with significant difference in techniques used, which made drafting conclusions and recommendations based on these studies even more challenging. WIDER IMPLICATIONS OF THE FINDINGS These recommendations complement previous guidelines on the management of good laboratory practice in ART. Some useful troubleshooting/checklist recommendations are given for easy implementation in clinical practice. These recommendations aim to contribute to the standardization of a rather common procedure that is still performed with great heterogeneity. STUDY FUNDING/COMPETING INTEREST(S) The meetings of the WG were funded by ESHRE. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER NA. ESHRE Pages content is not externally peer reviewed. The manuscript has been approved by the Executive Committee of ESHRE.

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“…In addition, the oocyte size is smaller than the needle diameter, and due to different shear stresses, the oocyte comlex may be bounced inside the lumen. It was shown that higher pressure and thicker needles can damage the cumulus-oocyte-complex and was suggested to have great effect on oocyte and embryo quality and reduce the blastulation rate [ 16 , 17 , 21 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Degenerated oocyte in the cohort adversely affects IVF outcome

Atzmon

¹

,

Michaeli

²

,

Poltov

³

et al. 2020

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The presence of Degenerated Oocyte (DEG) was mostly described after intracytoplasmic sperm injection (ICSI), with fewer reports on DEG at the time of ovum pick-up (OPU). This study aims to assess morphokinetics of embryos cultured in a time-lapse incubator and compare cohorts with and without DEG at OPU. In a retrospective cohort study from January 1, 2016 until September 31, 2017 a total of 399 IVF/ICSI cycles and 2980 embryos were evaluated. In 81 of 399 cycles at least one DEG oocyte was observed at the time of OPU. The remaining 318 cycles with no DEG oocyte were compared as a control group. In the DEG group, significantly more oocytes were collected per patient (12.9 ± 7.2 vs. 10.1 ± 6.1. P < 0.001). Fertilization rate, pregnancy and clinical pregnancy rates were comparable between the two groups, however, the morphokinetics and developmental scores of the embryos were significantly worse in the DEG group, (KID 3.4 ± 1.6 vs. 3.2 ± 1.6 P = 0.002 and ESHRE 1.5 ± 1.1 vs. 1.4 ± 1.0 P = 0.046). Significantly more patients achieved top-quality embryos in the NON DEG group (58.8% vs. 53.0%, P = 0.03), however, comparable delivery rate was achieved in both groups. In the DEG group, the frequency of DEG oocyte per cycle was negatively correlated with pregnancy rate. GnRH agonist protocol and the 17-20G needle used for OPU were significant predictors for the presence of DEG oocyte at OPU. In conclusions DEG oocyte may negatively affect IVF outcome, however, younger patients, and significantly more oocytes collected in the DEG group compensate for the IVF results.

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Oocyte retrieval at 140-mmHg negative aspiration pressure: A promising alternative to flushing and aspiration in assisted reproduction in women with low ovarian reserve

Cited by 13 publications

References 23 publications

Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve

Luteal-phase ovarian stimulation increases the number of mature oocytes in older women with severe diminished ovarian reserve

Recommendations for good practice in ultrasound: oocyte pick up†

Degenerated oocyte in the cohort adversely affects IVF outcome

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