Oocyte Pick-up Procedure Research Articles

P-466 The effect of Virtual Reality technology (VR) during oocyte pick up (OPU) in 100 IVF/ICSI patients - A randomised controlled trial (RCT)

Abstract Study question Does VR technology improve patient experience in terms of nervousness, nausea, pain, and total experience as well as consumption of painkillers during the OPU procedure? Summary answer The use of VR technology seems to have a positive influence on patient experience during OPU. No effect was seen regarding consumption of painkillers. What is known already In recent years, the VR technology has received increasing attention for its suggested calming and pain-relieving effect during medical procedures. Thus, a previous study using VR technology in women undergoing hysteroscopy showed a significant difference in anxiety compared to women not using VR. We previously performed a small pilot study in patients undergoing OPU. That study suggested that VR technology had a positive effect on patients before OPU in terms of level of relaxation and stress. Importantly, in the pilot project patients solely used the VR technology before the OPU procedure. Study design, size, duration This RCT included a cohort of 100 IVF/ICSI patients undergoing OPU. Patients were computer randomized into two groups: an intervention group (VR) and a control group (no VR) during OPU. Randomization was performed on the day of ovulation induction. The study was conducted from April 2023 to December 2023 in a public university affiliated fertility clinic. Participants/materials, setting, methods 10 minutes before the OPU procedure the VR headset was placed and remained in place during OPU in the intervention group. The control group was treated according to the standard procedure of the unit. Both groups answered a questionnaire, including 14 questions using VAS (Visual Analog Scale) before and after OPU regarding nervousness, nausea, pain and total experience. Moreover, blood pressure, heart rate, saturation, and consumption of medication was recorded. Main results and the role of chance The study showed that the use of VR technology in women undergoing OPU significantly (P = 0.01) lowered the patient’s systolic blood pressure before the procedure. Moreover, the study showed a trend towards a reduction in nervousness and consumption of painkillers. The comments of the patients regarding their total experience of the effect of VR were in favour of VR usage and several patients would choose VR technology for a possible future OPU. Limitations, reasons for caution The patient experience might have differed if the same nurse participated during all the OPUs. To find a possible significant effect of VR usage as regards nervousness and consumption of painkillers a future larger sample size is required. Wider implications of the findings The use of VR technology during OPU might be considered as a supplement for patients during OPU. Trial registration number NCT05826938

P-785 Validation for effectiveness of the virtual reality based simulator for training of Neophyte on oocyte retrieval/ovum pickup

Abstract Study question To evaluate and measure the clinicians’ performance in oocyte pick-up procedures by using a VR based Simulator before they perform procedure on real patients Summary answer Clinicians’ oocyte pick-up performance significantly improved with the virtual reality simulator—evidenced by heightened accuracy, enhanced hand-eye coordination, and reduced procedure time. What is known already Virtual reality simulators hold immense potential in transforming medical training, providing a secure space for neophyte practitioners to repetitively practice procedures without the involvement of live subjects. However, despite their promise, there is a lack of rigorous evaluation regarding the translation of skills acquired on these platforms into improved clinical outcomes, such as oocyte retrieval. A critical need for comprehensive assessments to determine the effectiveness of virtual reality simulators in enhancing real-world clinical skills and ensuring their impact on patient care. Study design, size, duration The study utilized a quasi-experimental design, incorporating a 60-minute theoretical and 45-minute simulator training program for oocyte retrieval. A total of 40 participants were split into two groups, each consisting of 20 individuals, experiencing a 4-hour and 8-hour simulation session. Following the allocated training hours, participants completed questionnaires covering demographics, first impressions of the VR simulator, and its perceived usefulness. Participant performance was subsequently scored after completion of training. Participants/materials, setting, methods Forty neophyte participants, with master’s in Obstetrics- Gynecology, were divided into two groups for simulation training on oocyte pick-up using a virtual reality-based simulator. Performance parameters assessed included the total number of times the vaginal and ovary walls were pierced, the total number of aspirated follicles, remaining follicles, compromised follicles, blood aspiration count, and aspiration efficiency. These metrics aimed to comprehensively evaluate and measure participants’ proficiency in oocyte pick-up procedures using the virtual reality simulator. Main results and the role of chance The results show that training with the virtual reality-based simulator significantly enhanced clinician performance when performing oocyte pick-up. In the second group, there was a significant increase in the percentage of correctly aspirated follicles (77% vs. In the first group, 60% of patients (p < 0.05), while accompanied by a significant decrease in aspirating follicles time (26 s vs. 38 s, p < 0.05). This translated into improved accuracy of performance on the whole (2.77% vs 1.56%, p < 0.05). Furthermore, those in the second group significantly improved their performance time-wise (20s vs. 35s, p < 0.05), although the level of aspirated follicles remained about the same mean number. These improvements are unlikely to be attributed to chance, as the differences observed between the two groups are statistically significant. These findings are also supported by the study design itself, which divided participants according to two teams undergoing various durations of simulation training. The fact that the trends of improvement in speed and accuracy across sessions support the argument against chance also provides additional evidence, suggesting that use of a virtual reality-based simulator has consistent meaningful impact on clinician performance during oocyte retrieval procedures. Limitations, reasons for caution The study’s limitations include a small sample size, a focus on Neophyte participants without expert group involvement, and the absence of more complicated ultrasound cases in oocyte pickup scenarios. Considering, these outcomes are relatively small and highly sensitive to their groups, further research of larger and diverse group is warranted. Wider implications of the findings virtual reality simulators’ has a transformative impact on enhancing clinical competency in oocyte pick-up. The observed improvements in accuracy and efficacy in simulations imply practical implications for real clinical practice. Requirement of extensive studies with diverse participants are crucial, confirming initial positive results and unveiling enduring effects in clinical settings. Trial registration number not applicable

What should be the strategy in case of a big follicle at the start of the cycle? Shall we start the stimulation or postpone it to the next cycle?

This study facilitates decision-making when an antral follicle diameter >15 mm is detected at the beginning of the menstrual cycle in poor responder (POR) patients. Eighty-three POR patients with at least one leading follicle with a diameter of 15 to 24 mm on the 2nd-4th days of the menstrual cycle were assessed. The mean age of females was 40.1±4.8 (26-45), and the mean partners' age was 42.1±7.8 (26-65). Fifty-one (61.4%) women underwent an oocyte pick-up procedure 36 h after the first ultrasonographic examination on the 2nd-4th days of the menstrual cycle. Gonadotrophin stimulation was initiated in 32 (38.6%) patients. Among women in whom oocyte retrieval was performed, an oocyte was obtained in 49 (59.75%) patients. In 13 of 49 patients (26.5%), no mature oocytes were obtained. Fertilized 2pn embryos were obtained in 18 of 33 patients (54.5%). Among the fertilized embryos, 12 were good, six were moderate, and two were of poor quality. Following the frozen embryo transfer procedure, one of the two patients experienced a clinical pregnancy. Patients with POR are still difficult to manage both clinically and therapeutically. Since every oocyte is valuable and important, patients should be carefully followed up. Our research will be directed by the need to rule out a physiological ovarian cyst when large antral follicles appear at the beginning of the cycle. The clinician should give them a chance.

Status of maternal serum B vitamins and pregnancy outcomes: New insights from in vitro fertilization and embryo transfer (IVF-ET) treatment.

The influence of B vitamins on human fertility and infertility treatments remains elusive. Therefore, this study investigated the association of most B vitamins with IVF-ET outcomes. A total of 216 subjects aged <35 year in their first oocyte retrieval cycle were recruited. Blood samples from the participants were collected before the oocyte pick-up procedure, and serum levels of riboflavin, niacin, pantothenic acid, vitamin B6 (including PA and PLP), folate, and methylmalonic acid (MMA) were detected using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Endpoints were classified into three groups according to tertiles (lower, middle, and upper) of each vitamin index, and the association of the serum vitamin status with intermediate and clinical outcomes was analyzed using a generalized estimating equation model. Higher riboflavin levels were associated with elevated probabilities of high-quality embryos, as well as clinical pregnancy after embryo transfer. A greater likelihood of transferable embryos was found in the middle tertile of serum folate. Similarly, a negative correlation of serum MMA, a marker of vitamin B12 deficiency, with high-quality embryos was identified. No significance was observed for other vitamins in terms of all endpoints. Therefore, sufficient levels of pre-conception riboflavin, folate, and vitamin B12 are recommended for successful infertility treatment and pregnancy planning; further evidence is needed to confirm our conclusion.

P-569 Reduction of gonadotropin-dosage towards the end of ovarian stimulation for IVF/ICSI improves ART-outcome in a subgroup of patients

Abstract Study question To identify in an unselected patient population those patients, who would benefit from a gonadotropin stepdown towards the end of ovarian stimulation in IVF/ICSI-treatment Summary answer Reduction of gonadotropin-dosage during ovarian stimulation for IVF/ICSI is beneficial in FSH-stimulated patients, aged 26-30 years, and in HMG-stimulated patients, aged 36-40 years of age What is known already Ovarian stimulation with gonadotropins for multi-follicular growth is a crucial part of IVF/ICSI-treatment. Intensive administration of gonadotropins might lead to progesterone elevation (PE) in the late follicular phase, impacting negatively the endometrial receptivity and possibly the embryo quality. During follicular growth, the number of FSH- and LH-receptors shift from predominantly FSH-receptors in the early to predominantly LH-receptors in the late follicular phase, reducing susceptibility of the follicle towards systemic FSH-levels. In a good prognosis population, it was shown that lower systemic FSH-levels on the trigger-day lead to significantly lower progesterone levels without reducing the number of retrieved/mature oocytes. Study design, size, duration Retrospective analysis of 1276 ovarian stimulation cycles, performed as GnRH (Gonadotropin-Releasing-Hormone)-antagonist protocol in an unselected patient population, between January 2018 and December 2020 at ART Fertility Clinic, Abu Dhabi, UAE. Ovarian stimulation cycles were split according to the stimulation medication used (either only recombinant FSH (rFSH) or only human menopausal gonadotropin (HP-HMG)) and whether stimulation-dosage was reduced (reduction group, RG) during the stimulation course or not (non-RG). Furthermore, patients were stratified into age-groups. Participants/materials, setting, methods Couples with primary / secondary infertility and an indication for ovarian stimulation for IVF/ICSI were included, independent of their age or ovarian reserve parameters. Only GnRH antagonist cycles, with either rFSH or HP-HMG as sole medication for ovarian stimulation and available data on Antral Follicle Count (AFC), gonadotropin-dosage at stimulation-start and -end, oocyte yield (number of retrieved / mature) and hormonal parameters of estradiol, progesterone and FSH were included. Main results and the role of chance A total of 1276 ovarian stimulation cycles were included, 495 (38.79%) with rFSH and 781 (61.21%) with HP-HMG as stimulation medication. In the FSH-group, 295 patients reduced (reduction-group=RG) and 200 did not reduce (=non-RG) FSH-dosage during stimulation. In all age-categories (&amp;lt;25; 26-≤30; 31-≤35; 36-≤40; 41-45years), FSH-end-dosage was significantly lower in the RGs compared to the non-RGs (p &amp;lt; 0.001, respectively). Despite not significantly different patient characteristics (AFC, BMI (Body Mass Index), mean age, FSH-starting dosage), in patients aged 26-≤30years, a significantly higher number of oocytes (retrieved/mature) were obtained in the RG (16.0±7.1 vs 20.4±8.3;p&amp;lt;0.001 / 12.6±6.5 vs 15.8±7.0;p=0.004, respectively) without an increase in progesterone-levels (1.0±1.3 vs 0.9±0.6ng/ml;p=0.95). The HP-HMG group was composed of 437 patients in the RG and 344 patients in the non-RG-group. In all age-categories (&amp;lt;25; 26-≤30; 31-≤35; 36-≤40; 41-52years), HP-HMG-end-dosage was significantly lower in the RGs (p &amp;lt; 0.001, respectively). The age-group 36-≤40 showed no significant differences in AFC, BMI, age and HP-HMG-starting-dosage, and still, a significantly higher number of oocytes (retrieved/mature) were obtained in the RG-group (7.2±5.61 vs 9.8±6.13;p&amp;lt;0.001 / 5.7±4.7 vs 7.8±5.0;p&amp;lt;0.001, respectively). The progesterone-levels on trigger day in the nRG-group was 0.5±0.3ng/ml and 0.6±0.4ng/ml in the RG group, which is significantly different (p &amp;lt; 0.001), however, clinically insignificant. Limitations, reasons for caution The retrospective design is a limitation to this study as well as the exclusion of ovarian stimulation cycles, which were cancelled and no oocyte pick-up procedure was performed. Furthermore, in some age-categories, patients in RG and non-RG were different regarding their basic characteristics. Wider implications of the findings This analysis demonstrates, that in specific patient populations, gonadotropin-dosage can be reduced without impacting the oocyte yield and preventing progesterone-elevation despite higher oocyte yield. Furthermore, reduction of gonadotropins towards the end of the follicular phase results in a more physiologic course of the gonadotropin-levels during ovarian stimulation. Trial registration number not applicable

P-650 Partial premature ovulation detection during follicular aspiration compromises the quantity but not the quality of the retrieved oocytes in stimulated fresh IVF cycles

Abstract Study question Is partial premature ovulation (PPO) detection during the oocyte pick-up (OPU) a sign of poor prognosis in in vitro fertilization (IVF) cycles with own oocytes? Summary answer PPO halves the number of metaphase II oocytes available for an IVF treatment without reducing their quality, demonstrated by unaltered fertilization and top-quality blastocyst rates. What is known already PPO detected during the OPU procedure has not been extensively studied in the literature. This phenomenon may result in a reduction in the number and/or competence of the oocytes retrieved, due to the potential loss of the already expelled oocytes, as well as the likely dominance exerted by the ruptured follicle/s in the rest of the cohort. Despite this, several authors have demonstrated that competent oocytes can be retrieved from these already ruptured follicles, suggesting that oocyte extrusion frequently does not occur after follicle rupture. The potential negative effect exerted in the rest of sibling oocytes remains unknown. Study design, size, duration Retrospective cohort analysis performed in IVIRMA Valencia (Spain), including 8994 cycles of controlled ovarian stimulation (COS) for an IVF treatment with fresh own oocytes, between January 2016 and May 2021. OPU procedures for oocyte cryopreservation, as well as mixed cycles with both fresh and frozen oocytes, were discarded. PPO diagnosis was based on ultrasound visualization of any already formed corpus luteum structure/s, a lower follicular count than expected, and/or free fluid. Participants/materials, setting, methods Female patients undergoing OPU after COS for a fresh IVF treatment. Cycles in which PPO has been detected will be compared with a random, and of the same size, sample without PPO. Mean number of oocytes, metaphase II, fertilized oocytes and top-quality embryos, as well as IVF success rates, will be compared between both groups. Patients’ basal characteristics and COS parameters will be analyzed in order to detect any potential early indicator of PPO. Main results and the role of chance PPO was detected in 123 of the 8994 cycles (1.37%) performed. A random control group of 123 cycles without PPO was selected. Patients’ mean age was 37.6±3.6, with a BMI of 23.3±4.1 kg/m2 and an anti-mullerian hormone of 1.62±1.3 ng/mL. Patient’s basal characteristics and COS parameters were statistically comparable among groups (p &amp;gt; 0.05), except for lower serum estradiol levels (2037.64 vs. 1582.24 pg/mL; p = 0.004) in the PPO group on the last ultrasound prior to OPU. Patients with PPO showed lower aspiration rates (88.95% vs. 55.78% in the PPO gr.), as well as a reduced mean number of oocytes (10.69 vs. 5.68 in the PPO gr.), metaphase II (8.41 vs. 4.33 in the PPO gr.), fertilized oocytes (6.23 vs. 3.26 in the PPO gr.) and top-quality blastocysts (2.77 vs. 1.35 in the PPO gr.) (p = 0.000). In contrast, maturation (80.72% vs. 76.57% in the PPO gr.), fertilization (73.52% vs. 75.18% in the PPO gr.) and top-quality blastocyst rates (44.03% vs. 38.68% in the PPO gr.) were statistically similar between both groups (p &amp;gt; 0.05). Limitations, reasons for caution The main limitations of the present study are its retrospective design and its small sample size, derived from the low frequency of the PPO phenomenon in our clinic. Larger prospective studies should be proposed in order to accurately define the negative impact of PPO in IVF success rates. Wider implications of the findings PPO clearly reduces the number of oocytes available for an IVF treatment, although it does not seem to impair the competence of the remaining cohort. Once PPO is detected, cycle cancellation may not be worth the associated loss of money, time and morale, especially given its low prevalence (around 1%). Trial registration number Not applicable

Comparison of complication rates after transvaginal ultrasound-guided oocyte pick-up procedures with respect to ovarian response.

ObjectiveThe aim of this study was to compare the complication rates of oocyte pick-up (OPU) procedures via transvaginal ultrasonography in patients with different levels of ovarian reserve. MethodsIn total, 789 patients who underwent OPU procedures for in vitro fertilization (IVF) were included in the study.ResultsIndividuals with normal ovarian reserve had a 2.947-fold higher risk of complications in OPU procedures than individuals with low ovarian reserve, and individuals with high ovarian reserve had a 7.448-fold higher risk of complications than individuals with low ovarian reserve. In addition, a higher number of IVF trials was associated with an increased risk of complications.ConclusionThe results of this study show that OPU has a higher risk of complications, particularly severe pain, in patients with high ovarian reserve. It is thought that complications can be reduced by preferring mild stimulation in patients with high ovarian reserve. Collecting fewer oocytes is also associated with a lower risk of complications from OPU. Even if a patient’s reserve is very good, fewer and higher-quality oocytes should be targeted with the use of the lowest possible dose of drugs.

What is the optimum number of follicular flushes in mono-follicular in-vitro fertilization cycles in a poor responder population?

Objective:Assessment of the optimal number of follicular flushes on retrieval rate and quality of oocytes in mono-follicular in-vitro fertilization (IVF) cycles.Material and Methods:A retrospective analysis of 246 oocyte pick-up procedures in mono-follicular IVF cycles of 226 poor responder women was performed. The primary endpoint was oocyte retrieval rate in the initial aspirate versus subsequent flushing episodes. The secondary endpoints were oocyte maturity, fertilization rates and embryo cleavage.Results:The procedure was successful in 187 cycles (76%), of which 160 metaphase-II oocytes were retrieved. Retrieval rates were similar for natural and modified natural cycles (p=0.595). The initial aspirate provided 54% of the total yield and the rest was obtained from up to four episodes of flushing. Follicular flushing increased oocyte recovery rate from 41.1% to 76%. None of the oocytes retrieved after three flushes fertilized. Oocyte maturity, fertilization and embryo cleavage rates were comparable for oocytes from the initial aspirate and one or two episodes of flushing. Oocytes obtained after the third flushing episode developed into poor quality embryos.Conclusion:Flushing confers a benefit for oocyte recover rates in mono-follicular IVF cycles in poor responder women. However, more than three attempts at flushing were not associated with good outcome.

Dydrogestérone vs progestérone vaginale micronisée dans le soutien de la phase lutéale après transfert frais d’embryons

ObjectivesThe objective of the study was to compare the live birth rate and miscarriage rate after fresh embryo transfer (Fresh ET) when patients are treated either with oral dydrogesterone or micronized vaginal progesterone (MVP) as luteal phase support (LPS). The vaginal route is still preferred, despite the discomfort for the patients and recent RCTs showing similar results for dydrogesterone and MVP. MethodsAll 556 consecutive Fresh ET after autologous IVF procedure, from December 2011 to March 2013 in one centre in France were included. Patients were treated either with dydrogesterone 10mg every 12hours (n=267) or MVP 200mg every 12hours (n=289), the physician's arbitrary choice on the day of the oocyte aspiration procedure. ResultsThe groups were comparable regarding the demographic data and stimulation protocols, except for the rank of the oocyte pickup procedure [1.54±0.80 vs. 1.74±0.96, (P=0.01)], with no significant difference in live birth rates (22.4% vs. 23.8%, P=0.77) and miscarriage rates (4.1% vs. 5.5%, P=0.55) for dydrogesterone vs. MVP respectively. The results were similar in a good prognosis patients’ subgroup. ConclusionsLPS with either dydrogesterone or MVP after Fresh ET showed similar live birth rates and miscarriage rates. The benefits of the oral over vaginal route might be higher tolerance and possibly better compliance. Dydrogesterone seems to be a safe treatment, but its long-term innocuity needs to be further proven.

What is the optimum number of follicular flushing in mono-follicular IVF cycles in poor responder women population?

Assessment of the optimal number of follicular flushes on retrieval rate and quality of oocytes in mono-follicular in-vitro fertilization (IVF) cycles. A retrospective analysis of 246 oocyte pick-up procedures in mono-follicular IVF cycles of 226 poor responder women was performed. The primary endpoint was oocyte retrieval rate in the initial aspirate versus subsequent flushing episodes. The secondary endpoints were oocyte maturity, fertilization rates and embryo cleavage. The procedure was successful in 187 cycles (76%), of which 160 metaphase-II oocytes were retrieved. Retrieval rates were similar for natural and modified natural cycles (p=0.595). The initial aspirate provided 54% of the total yield and the rest was obtained from up to four episodes of flushing. Follicular flushing increased oocyte recovery rate from 41.1% to 76%. None of the oocytes retrieved after three flushes fertilized. Oocyte maturity, fertilization and embryo cleavage rates were comparable for oocytes from the initial aspirate and one or two episodes of flushing. Oocytes obtained after the third flushing episode developed into poor quality embryos. Flushing confers a benefit for oocyte recover rates in mono-follicular IVF cycles in poor responder women. However, more than three attempts at flushing were not associated with good outcome.

Impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup

ObjectiveTo assess the impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup (OPU).DesignRetrospective cohort study.SettingHospital-based fertility clinic.Patient(s)All women undergoing OPU procedures during autologous in vitro fertilization (IVF) and oocyte banking cycles, grouped by patient body mass index (BMI: <25, 25–29.9, 30–34.9, 35–39.9, ≥40 kg/m2).Intervention(s)Transvaginal OPU under conscious sedation.Main Outcome Measure(s)Sedation and procedure-related parameters and complications.Result(s)A total of 2,141 OPU procedures in 1,579 patients were analyzed, including 121 OPU procedures in 94 patients with BMI ≥40 kg/m2. There was a statistically significant increase in total fentanyl and midazolam doses and procedure duration as BMI increased. Compared with patients with BMI <25 kg/m2, those with BMI ≥40 kg/m2 were more likely to require additional sedation during the procedure (adjusted odds ratio [aOR] 1.99; 95% confidence interval [CI], 1.14–3.49). The rate of difficult access was 28.9% for procedures with BMI ≥40 kg/m2 compared with 5.2% with BMI <25 kg/m2 (aOR 7.57; 95% CI, 4.66–12.29). The OPU was incomplete due to inaccessible follicles through a transvaginal approach in 18.2% of procedures with BMI ≥40 kg/m2 compared with 1.3% with BMI <25 kg/m2 (aOR 16.94; 95% CI, 8.24–34.84). The rates of sedation and procedure-related complications were low, and none occurred in patients with BMI ≥40 kg/m2.Conclusion(s)There was no increased risk of complications for women with class III obesity undergoing OPU with conscious sedation. However, the operator was more likely to encounter difficult access and to incompletely aspirate follicles through a transvaginal approach.

High-resolution 1H-NMR spectroscopy indicates variations in metabolomics profile of follicular fluid from women with advanced maternal age.

To reveal whether there are differences in follicular fluid metabolomics profile of women with advanced maternal age (AMA). The group with advanced maternal age includes 23 patients above the age of 40, and the control group includes 31 patients aged between 25 and 35years and AMH values above 1.1ng/mL with no low ovarian response history. A single follicular fluid sample from a MII oocyte obtained during the oocyte pick-up procedure was analyzed with high-resolution 1H-NMR (nuclear magnetic resonance) spectroscopy. The results were evaluated using advanced bioinformatics analysis methods. Statistical analysis of the NMR spectroscopy data from two groups showed that α-glucose and β-glucose levels of follicular fluid were decreased in the patients with AMA, while in contrast, lactate and trimethylamine N-oxide (TMAO) levels were increased in these patients compared with the controls. In addition to these, there was an increase in alanine levels and a decrease in acetoacetate levels in patients with AMA. However, these changes were not statistically significant. Obtained results suggest that the follicular cell metabolism of patients with AMA is different from controls. These environmental changes could be associated with the low success rates of IVF treatment seen in these patients.

About “Efficacy of bispectral index monitoring for prevention of anesthetic awareness and complications during oocyte pick-up procedure”

About “Efficacy of bispectral index monitoring for prevention of anesthetic awareness and complications during oocyte pick-up procedure”

Efficacy of bispectral index monitoring for prevention of anestheticawareness and complications during oocyte pick-up procedure

Background/aim: This study was planned by considering that the use of bispectral index (BIS) monitoring ensures sufficient depth of anesthesia and avoids anesthetic awareness and patient movement in the oocyte pick-up (OPU) procedure.Materials and methods: Ninety-eight patients undergoing OPU were randomly divided into 2 groups as the control group (n = 48) and BIS group (n = 50). After propofol and remifentanil induction, the control group was given additional propofol according to reaction response, while the BIS group was given propofol at BIS values of 60 and above with the aim that BIS values be 40?60. Total procedure time, recovery time, patient movement, additional propofol consumption, total number of oocytes, and awareness during anesthesia were recorded. Results: Demographic data were similar in the two groups (P > 0.05 for all). The recovery time in the BIS group was significantly shorter compared to the control group (P < 0.001) while additional propofol consumption was found to be significantly lower (P < 0.001). Baseline BIS values fell compared to all other times after induction significantly (P < 0.001). No patient had anesthesia awareness.Conclusion: During the OPU procedure BIS monitoring is considered to prevent anesthesia awareness, intraoperative movement, and complications caused by insufficient anesthetic use as it ensures optimal doses of anesthetic agents used and early recovery.

An Endometriosis Patient Presented with Gross Hematuria as a Complication of the Oocyte Pick-Up Procedure

Purpose To report a case of a 34-year-old female with endometriosis and a complication presented with gross hematuria due to bladder injury after transvaginal oocyte retrieval for in vitro fertilization. Case Report A 34-year-old woman with endometriosis presented with gross hematuria 4 days after oocyte retrieval and was conservatively followed up. Results As an uncommon emerging situation after oocyte retrieval for in vitro fertilization procedure, gross hematuria is pointed as a complication with an endometriosis patient. Conclusions Although a transvaginal approach is accepted as a safe and simpler technique for oocyte retrieval, complications like adjacent organ injury should be kept in mind. Especially in patients with endometriosis, in whom pelvic anatomy is distorted due to adhesions, oocyte pick-up procedure should be carried out more carefully.

Effect of Anesthetics During Oocyte Pick-Up Procedure on Oocyte Quality and Pregnancy

Effect of Anesthetics During Oocyte Pick-Up Procedure on Oocyte Quality and Pregnancy

Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment.

The aim of this study was to evaluate long-term embryo cryopreservation, utilization, and success rate in patients subjected to gonadotoxic treatments in the context of cancer. This is a retrospective study on patients (n = 54) undergoing ovarian stimulation and IVF for fertility preservation between January 1997 and June 2014. Embryos were slow-frozen and stored until the women were cured and able to undergo embryo transfer. Fifty-four women underwent 66 oocyte pick-up procedures in total, and embryos were obtained from 52 of the 54 patients. Four patients died before their frozen embryos could be thawed. Of the remaining 48, 9 women returned to use their embryos, resulting in 6 pregnancies (66% cumulative pregnancy rate), two of which ended in miscarriage. The live birth rate per patient was thus 44% (4/9). The true come-back rate, calculated after applicable exclusions, was found to be 23%. IVF followed by embryo freezing is a widely established technique for fertility preservation, but little has been published on the outcomes in cancer patients. While we found the number of good-quality embryos to be lower than in a normal population, the cumulative live birth rate was similar to that achieved with fresh embryos in non-cancer patients. The utilization rate of this fertility preservation method can be considered high.

Follicular fluid and serum vascular endothelial growth factor, interleukin (IL)-1β and glycodelin concentrations: comparison between long-gonadotropin-releasing hormone (GnRH)-agonist and GnRH-antagonist cycles: a randomized controlled trial

In this randomized controlled trial, we aimed to examine whether differences exist among patients who underwent assisted reproductive technology treatment with a long-GnRH-agonist compared to a GnRH-antagonist protocol in terms of levels of follicular fluid (FF) and serum concentrations of vascular endothelial growth factor (VEGF), glycodelin and interleukin (IL)-1β on the day of oocyte pick-up (OPU). In 80 infertile couple with male factor or unexplained infertility, 40 women stimulated with GnRH-antagonist protocol and 40 women with the long-GnRH-agonist protocol. FF and blood serum samples were obtained simultaneously from 80 women during the OPU procedure and the concentrations of VEGF, IL-1β and glycodelin were measured with commercially available kits. Concentrations of FF VEGF, IL-1β and glycodelin were not significantly different in the long-GnRH-agonist and GnRH-antagonist groups, and neither were serum concentrations of VEGF, IL-1β and glycodelin. According to our results in at least, we can say that minor differences between these protocols in terms of clinical pregnancy do not depend on VEGF, glycodelin or IL-1β.

Comparison of complication rates and pain scores after transvaginal ultrasound–guided oocyte pickup procedures for in vitro maturation and in vitro fertilization cycles

To compare complication rates and pain scores after oocyte pickup (OPU) in in vitro maturation (IVM) and IVF cycles. Retrospective cohort study. University-affiliated ART center. One hundred eighty-eight IVM and 188 IVF OPUs. IVM OPUs were done using a 19-gauge single-lumen needle, and IVF OPUs were done using a 17-gauge single- or 16-gauge double-lumen needles. Duration of OPU, complication rates, and pain scores during the OPU procedure. IVM OPU took significantly more time than IVF OPU (22 vs. 15 minutes). Two women in the IVM and four in the IVF group experienced bleeding from the vaginal wall or ovary. None of them required hospitalization, transfusion, or an operative intervention. One patient in each group had pelvic infection. Severe post-OPU abdominal pain occurred in one patient in the IVM group and five patients in the IVF group. No differences were found between pain scores in the IVF and IVM groups (3.4 vs. 3.8). Although IVM OPU requires more punctures per ovary, it is well tolerated and does not seem to be associated with a higher complication rate than IVF OPU.

Low or high aspiration vacuum pressure to yield oocytes for poor responder in oocyte pick-up procedure

Low or high aspiration vacuum pressure to yield oocytes for poor responder in oocyte pick-up procedure