Follicular puncture to extract the mature eggs

By (embryologist) and (babygest staff).
Last Update: 11/06/2020

Egg retrieval, also known as follicular puncture or ovum pick up, is the surgical intervention in which eggs are obtained for use in an in vitro fertilization (IVF) procedure.

It is a simple surgery, with few side effects and that does not generate pain, since it is performed under mild anesthesia or sedation. However, the ovarian puncture is still an operation, so there may be complications.

How are eggs retrieved?

The follicular puncture is one of the essential steps of an in vitro fertilization (IVF) treatment. Its purpose is to obtain the woman's eggs, which will later be fertilized in the laboratory with the sperm of the male partner or a sperm donor.

The patient is given sedation for this surgery, so she does not feel any pain. In addition, the follicular puncture doesn’t last long, about half an hour.

This step in IVF is carried out before ovulation occurs; otherwise, it would be difficult to locate the eggs outside the ovary. It is therefore essential that the patient is monitored at all times to avoid spontaneous ovulation, which would result in the cancellation of the ovarian puncture.

Schedule the day of the follicular puncture

In order to obtain a greater number of eggs, the patient receives ovarian stimulation treatment through subcutaneous administration of hormonal medication. This process also allows the control of the ovarian cycle and the exact programming of the ideal moment to perform the puncture.

The woman must take hormonal medication for approximately 10 days. During this period of time, the physician performs continuous transvaginal ultrasounds and blood tests to monitor follicular growth and increased blood estrogen levels. This phase of the process is known as ovarian stimulation follow-up.

When several ovarian follicles have reached the right size (about 16-18 mm), and the blood estradiol levels are correct, the woman receives the injection of hCG hormone to trigger ovulation.

Once 36-48 hours have passed since the administration of this hormone, natural ovulation will occur. For this reason, the follicular puncture must be performed before this happens; otherwise, all the eggs will be lost.

Read more about this treatment here: What is ovarian stimulation?

Ovarian Puncture step by step

Basically, follicular puncture consists of puncturing the ovarian follicles with a needle and aspirating the fluid from the inside. The follicles are the structures where the eggs mature in the ovary.

Below, we will describe the procedure step by step:

  • The anesthesiologist gives the woman a minimal dose of anesthesia (sedation). In doing so, the woman does not feel pain during the follicular puncture.
  • The doctor inserts the ultrasound machine through the vaginal opening so that the ovaries can be visualized, just like with transvaginal ultrasound. However, in this case, the ultrasound machine has a built-in aspiration needle, with which each ovarian follicle will be punctured and the fluid inside will be aspirated.
  • The liquid 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 are then taken to the laboratory, where specialists analyze the follicular fluid and retrieve the eggs found in it.

Recovery

Once the follicular puncture is over, the woman wakes up in the recovery room and waits a few hours for everything to return to normal.

After resting and after checking that the patient has recovered well from the anesthesia, she will be able to go home on her own and follow her daily routines. It is important not to make great efforts on the day of the intervention and perhaps also the next day.

Potential Risks and side effects

The operation to extract the eggs is a simple and short surgery, so possible complications are few and not severe.

The main problems that can occur are related to the use of anesthesia, which, although mild, is not without risk.

As we have mentioned, after a few hours of rest in the clinic, the patient can go back home and continue with her daily routines. However, it is possible that during that day and perhaps the next, she may suffer slight bleeding, dizziness, or little discomfort as a result of the operation itself and the anesthesia.

The probability of infection after an ovarian puncture is low, so it is not usually a common side effect of this intervention.

Tips for puncture

Generally, specialists recommend that women fast for 6 hours before the puncture. This will reduce the possibility of side effects and make the intervention go smoothly.

It is also advisable for the patient to be accompanied to the ovarian puncture since after the operation and the anesthesia the woman may feel somewhat dizzy and confused.

On the other hand, if the patient feels any discomfort after the puncture, she should contact the clinic. They will be in charge of assessing the protocol to be followed to avoid any complications.

IVF process in surrogacy

In most cases, surrogacy is carried out through in vitro fertilization. This is known as gestational or full surrogacy.

Surrogacy is probably the most confusing of all infertility treatments. Transparency is a key value for us when it comes to recommending a clinic or agency for intended parents. You can now use this tool to receive a detailed report that will solve any question you may have, and most importantly, to help you avoid potential frauds.

Ovarian stimulation and follicular puncture will be performed preferably on the future mother. However, there are cases in which the latter cannot undergo the treatment, either because they cannot receive hormonal medication, cannot undergo an operation, do not have an ovary, or have a low ovarian reserve, among other reasons.

In that case, it will be an egg donor and not the gestational carrier (also known as a surrogate mother) who will undergo 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.

Suggested for you

Once the eggs are obtained in the laboratory and fertilized, it is necessary to wait a few days until the embryos develop. These embryos will be transferred to the woman's or the surrogate’s uterus. If you would like more information about this step in IVF, you can visit the following article: How are embryos transferred into the gestational carrier?

On the other hand, the fertilization of the eggs can be done in a conventional way or by intracytoplasmic sperm injection. If you want to know the difference between these two methods of fertilization, have a look at the following post: What is the difference between classic FIV and ICSI?

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References

Author

 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:
 Romina Packan
Romina Packan
Babygest Staff
Editor and translator for the Babygest magazine in English and German. More information about Romina Packan

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