Follicular puncture to extract the mature eggs

By (embryologist) and (babygest staff).
Last Update: 01/18/2017

Egg retrieval, also known as follicular puncture or ovum pick-up, is the surgical intervention in which the eggs are collected for use in an in vitro fertilization (IVF) procedure. This is a simple surgery, with few side effects and no pain, as it is performed under mild anesthesia or sedation.

Ovum Pick-Up step by step

Follicular puncture consists of inserting a needle through the vagina to get into the follicles and aspirate the follicular fluid (FF) contained within. Follicles are the structures where eggs mature in the ovary.

Subsequently, the collected follicular fluid is analysed in search of mature eggs that can be fertilized in the laboratory and give rise to viable embryos.

These are the steps of intervention:

  • The anesthesiologist gives the woman a minimal dose of anesthesia (sedation). This way, the woman does not feel pain during the operation, which lasts about 20-30 minutes.
  • The doctor inserts the ultrasound through the vagina in order to visualize the ovaries, as it is the case with transvaginal ultrasound. However, in this case, the ultrasound machine incorporates an aspiration needle, with which each follicle will be punctured and the fluid it contains will be aspirated.
  • The fluid obtained is collected in test tubes that maintain the temperature of the ovary (37°C). This is the optimum temperature so as not to alter the integrity and viability of the extracted eggs, so it is essential to maintain it throughout the process.
  • The test tubes go to the laboratory, where specialists analyze the fluid they contain and retrieve the eggs they find.

After this process, the woman wakes up and waits a few hours in the clinic room.

After this time of rest and after verifying that you have recovered well from the anesthesia, you will be able to return home on your own feet and follow your daily routines. It is important not to make great efforts during the same day of the intervention and perhaps also the next day.

Schedule the day of the follicular puncture

It is important to keep in mind that, before the ovarian puncture, the woman receives an ovarian stimulation treatment to favour the development and maturation of a greater number of oocytes. This process also helps to control the ovarian cycle and accurately program the ideal time to perform the puncture.

If you want to read detailed information about this treatment, I recommend this article: What Is Controlled Ovarian Stimulation?

During the time that the woman is self-administrating the hormonal medication for stimulation, approximately 10 days, the doctor performs continuous transvaginal ultrasounds and blood tests to control follicular growth and the increase in the level of estrogens in the blood. It is known as ovarian stimulation follow-up.

When several follicles have reached the right size (about 16-18 mm) and estradiol levels are about 200 pg/ml for each mature follicle, the woman receives an injection of hCG hormone to trigger ovulation (exit of the egg from the follicle).

36 to 48 hours after the administration of this hormone, natural ovulation will occur. Follicular puncture must be performed before this occurs, otherwise the eggs will be loose and puncture empty follicles.

Potential Risks and Side Effects

The operation to extract the eggs is a simple and short surgery, so the possible complications are few and of low gravity.

The main problems that can occur refer to the use of anesthesia, which, although mild, is not without risks.

To avoid possible side effects, it is essential that the woman is on absolute fasting for at least 6 hours before the puncture.

As we have commented, after a few hours of rest in the centre, the woman will be able to return home and continue with her daily routines. It is possible, however, that during that day and perhaps the next, she may experience slight bleeding, dizziness or minor discomfort as a result of the operation itself and the anaesthesia.

The likelihood of infection is low, so it is not usually a common side effect of this intervention.

IVF Process in surrogacy

In most cases, the surrogacy process is carried out through an in vitro fertilization process. That is why it is called as gestational surrogacy or complete surrogacy.

Ovarian stimulation and follicular puncture are preferably performed on the mother-to-be. However, there are cases in which this can not be submitted to treatment, either by not being able to receive hormonal medication, not being able to undergo surgery, not having an ovary or having a low ovarian reserve, among other reasons.

In that case, it will be an egg donor, and not the surrogate who undergoes the entire procedure to obtain the eggs.

FAQs from users

Can eggs be retrieved without a uterus?

By Andrea Rodrigo (embryologist).

Yes, if the woman has an ovary and it is functional, i.e. it has eggs and responds to medication, it is possible to perform the ovarian puncture. The extracted eggs must be fertilized in the laboratory and, subsequently, the embryos obtained, transferred to the uterus of a surrogate.

This means that, although it is possible to obtain the eggs, it will be necessary to carry out a surrogacy due to the absence of the uterus.

Is it normal to have gas and bleeding after ovarian puncture?

By Andrea Rodrigo (embryologist).

Yes, some women have symptoms such as bleeding, gas, dizziness or abdominal pain, due to the medication prior to the puncture and the operation itself.

Can the egg retrieval be done under local anesthesia or without anesthesia?

By Andrea Rodrigo (embryologist).

Yes, it can be done with local anesthesia or without anesthesia, but it is not recommended. Doing the puncture without anesthesia implies pain, quite strong in the case of a high number of follicles. In addition, it is more uncomfortable for the specialist and, therefore, the intervention can be prolonged and lead to greater complications.

With regard to the use of local anaesthesia, such as epidural anaesthesia, the recovery time is longer and is therefore not usually used.

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References

Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
Adapted into english by:
 Marie Tusseau
Marie Tusseau
Babygest Staff
Editorial Director of Babygest magazine in French and English. More information about Marie Tusseau

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