Proficiency in oocyte retrieval assessed by the learning curve cumulative summation test

Dessolle, Lionel; Leperlier, Florence; Biau, David; Fréour, Thomas; Barrière, P.

doi:10.1016/j.rbmo.2014.03.016

Cited by 9 publications

(11 citation statements)

References 11 publications

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“…However, several studies debated that reduced maturity and fertilization ability for oocytes collected from small follicles and aspiration of those follicles were not recommended [17,18]. One study suggested that oocyte retrieval e ciency should be based on expected number of oocytes collected from follicles sized ≥ 14 mm [11]. Due to the discordant de nition, both methods to determine the oocyte retrieval e ciencies were evaluated in the present study.…”

Section: Discussionmentioning

confidence: 99%

Defining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive CenterDefining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive Center

Cao

You

et al. 2020

Preprint

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Objective: The objective of this study was to determine the novice trainee’s learning curve for oocytes retrieval procedure through assessment of oocytes retrieval efficiency, operative time and other operative characteristics. Methods: This retrospective cohort study included 200 consecutive patients undergoing transvaginal ultrasound guided oocytes retrieval procedure. Those patients underwent oocyte retrieval procedure by a single operator and one experienced supervisor. Their clinical data, including demographic data, ovarian stimulation cycle information, surgical procedure, and laboratory data were collected over 3 months. CUSUM analyses based on the operative time were performed to determine the learning curve. Results: The mean operative time was 10.10 min. Based on the CUSUM plot of operative time, the learning curve can be divided into three separated phases, phase 1 (case 1 to case 49) was learning phase, phase 2 (case 50 to case 130) was acquisition phase, and phase 3 (case 131 to case 200) was proficiency phase. The operative time was significantly shortened from phase 1 to phase 3 (phase 1, 13.37 ± 4.83min; phase 2, 10.21 ± 3.30 min; phase 3, 7.67 ± 3.24 min, P < 0.001). The oocyte retrieval efficiency was also notably improved from phase 1 to phase 3 (78.2% to 100% based on method 1 to determine oocyte retrieval efficiency, and 104.2% to 121.1% based on method 2 to determine oocyte retrieval efficiency). The retrieved oocytes number, the fertilization rate, clinical pregnancy rate among the three phases showed no significant differences. No patients had severe adverse events. As determined by multiple linear regression, learning phase is the only independent predictor of oocyte retrieval efficiency. Conclusion: Trainees practice transvaginal ultrasound guided oocytes retrieval are expected to achieve a stabilized procedure over consecutive training cases, with acquisition of the skills at 49 cases, and proficiency at 130 cases. Cumulative operative experience can improve the operative time and oocytes retrieval efficiency, but showed minimal influence on retrieved oocytes number and reproductive outcomes.

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Section: Discussionmentioning

confidence: 99%

Defining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive CenterDefining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive Center

Cao

You

et al. 2020

Preprint

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“…Nonetheless, the differences in training time indicate that a significant interpersonal variability might be expected even among trainees already proficient in lower complexity ART tasks. The number of trainees, 5, included in the study, is equal or higher than what presented in most ART LC-CUSUM studies [8,11] and should allow for adequate generalizability of results and training expectations.…”

Section: Discussionmentioning

confidence: 99%

“…curves (LC)-CUSUM have been used to evaluate training in ART-related tasks, such as, folliclemetry during ovarian stimulation [7] oocyte retrieval [8], oocyte vitrification [9], and embryo transfer [10,11].…”

Section: Introductionmentioning

confidence: 99%

Are we ready to inject? Individualized LC-CUSUM training in ICSI

Durbán¹,

García

Obradors³

et al. 2016

J Assist Reprod Genet

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Purpose The objective of this prospective, single center study was to develop a personalized training scheme for intracytoplasmic sperm injection (ICSI) through the use of learning curve-cumulative summation (LC-CUSUM), which allows to tailor training to the trainee performance, and to validate it against the performance of experienced embryologists. Methods Five trainees microinjected latex microspheres (LM) into vitro matured oocytes. A microinjection was considered successful when the oocyte did not lyse in the 24 h following the injection. Results Each trainee became proficient at ICSI after a variable number of injections, ranging from 35 to 80. Trainees that achieved proficiency went on to perform ICSI with human gametes in a clinical setting with proficiency comparable to that of experienced embryologists. Conclusions We show that LC-CUSUM based personalized ICSI training is feasible and allows trainees to be as proficient as trained embryologists when treating actual patients.

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“…– For safety reasons, and wherever feasible, the simulator could be the initial part of a structured training for novices who want to perform OPU, enabling them to acquire basic skills and to reach a predefined level of performance in a safe and controlled environment, before applying the procedure to real patients (Soave et al., 2019). Adequate training in OPU includes basic training in IVF US, and at least 30 OPU procedures should be performed under supervision to reach the minimum criteria for competency (but this can vary depending on the type of training, background and progress of trainees) and at least 50 OPUs should be performed independently before the acquirement of the qualification.Proficiency has been defined as retrieving ≥80% of the oocytes compared with a senior operator performing OPU in the contralateral ovary (Dessolle et al., 2014) (see also Fig. 5).…”

Section: Recommendationsmentioning

confidence: 99%

“…Proficiency has been defined as retrieving ≥80% of the oocytes compared with a senior operator performing OPU in the contralateral ovary (Dessolle et al., 2014) (see also Fig. 5).…”

Section: Recommendationsmentioning

confidence: 99%

Recommendations for good practice in ultrasound: oocyte pick up†

D’Angelo

Panayotidis

Amso

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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Proficiency in oocyte retrieval assessed by the learning curve cumulative summation test

Cited by 9 publications

References 11 publications

Defining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive CenterDefining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive Center

Defining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive CenterDefining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive Center

Are we ready to inject? Individualized LC-CUSUM training in ICSI

Recommendations for good practice in ultrasound: oocyte pick up†

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