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Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
Oocyte retrival
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Oocyte retrival

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loading this on demand of FOGSI FRIENDS...its a basic presentation , hope you all enjoy this

loading this on demand of FOGSI FRIENDS...its a basic presentation , hope you all enjoy this

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  1. OVUM PICK UP EMBRYO TRANSFER jaideep malhotra narendra malhotra mnmhagra3@gmail.com GLOBAL RAINBOW HEALTH CARE
  2. HISTORY OF OOCYTE RETRIEVAL • initial oocytes were studied by removing ovaries by laparotomy • 1970 steptoe and edwards laparoscopic method (yielded oocytes from one third of follicles) • by 1980 a commercial opu needle and pump was available(teflon needle retrival rates became 90%) • steptoe and goswamy devised the ultrasound guided oocyte retrival
  3. PHYSICS OF OOCYTE RETRIEVAL • a no. of factors affect oocyte collection and damage to ova • pump vacuum flow,velocity,needle lumen size and length,follicular pressure and size,collection techniques COOK MEDICAL TECHNOLOGY STUDY FROM BRISBANE
  4. PHYSICS AND EGG VACUUM APPLIED AFTER NEEDLE ENTRY IN FOLLICLE VACUUM DEACTIVATE BEFORE EXIT FROM FOLLICLE VACUUM ACTIVATED AND DEACTIVATED OUTSIDE FOLLICLE DAMAGE TO OOCYTES VACUUM PRESSURES DAMAGE WITHIN THE NEEDLE/VACUUM LINES DAMAGE WITHIN THE FOLLICLE DAMAGE TO THE CUMULUS
  5. PHYSICS OF OPU • MAINTAINANCE OF SUCTION(IF THIS IS NOT MAINTAINED THE FOLLICULAR FLUID WILL BE LOST AT ENTRY AND EXIT) • MOVEMENT OF THE NEEDLE TIP IN THE FOLLICLE MAY DAMAGE THE OOCYTE PARTICULARLY TO THE CUMULUS • IT IS A COMMON PRACTICE TO SPIN THE NEEDLE TIP AS YOU WILL SEE IN THE SYDNEY IVF VIDEO • ALSO SOME PEOPLE SCRAPE THE FOLLICLE WALLS BY THE EDGE OF THE NEEDLE.. THIS MAY CAUSE SIGNIFICANT DAMAGE TO OOCYTE SPECIALLY IN SMALL FOLLICLES • STUDY IS GOING ON TO COMPARE SPINNING THE NEEDLE TIP AND BLASTOCYST FORMATION (A POSSIBLE SOLUTION FOR MORE RETRIVAL WITHOUT SPINNING IS MAY BE TO USE FLUSHING THE FOLLICLES WITH LOWER SUCTION VACCUMS)
  6. CLINICAL ASPECTS OF OPU • TIMING:34-36 HRS AFTER THE HCG TRIGGER • MORE M2 OOCYTES
  7. OVARIAN ACCESSIBILITY ASSESSMENT • IN DUMMY CYCLE • ON REGISTRATION • DURING STIMULATION MONITORING • VERY HIGH AND VAGINALLY UNAPPROACHABLE OVARIES MAY POSE DIFFICULTY FOR TVS OPU AND MAY NEED LAPAROSCOPY
  8. PRE PICK UP SCAN
  9. EGG PICK UP TECHNIQUE • analgesia(vaginal and cervical blocks) (mild analgesia) • anaesthesia (mild gen anaesthesia propofol/pentothal) • preop counselling and physical check up • it is a low risk surgical procedure hence no need for a detailed preop assessment
  10. ANAESTHETIC PROTOCOL • FENTANYL: 1-2 g/kg i.v.(AVERAGE DOSE 100g) • MIDAZOLAM:0.05-0.1mg/kg i.v.(AVERAGE DOSE 2-5mg) • ADD PROPOFOL IF NEEDED 1-2mg/kg • Monitor oxygen saturation and administer oxygen as indicated • Local anaesthesia • No anaesthesia(only some pain and sedation)(councelling)
  11. OT SETUPS MAMC DELHI MNMH AGRA Rainbow IVF
  12. MATERIAL CHECKLIST FOR OPU • DRY BLOCK HEATER AND WARM BLOCKS • FALCON TESTUBES • GLASS SYRINGE WITH BLUNT NEEDLE(COMES WITH THE NEEDLE) • BEAKERS,PETRIDISHES/FOUR WELL DISHES/PIPETTES/PIPETTE PUMPS ETC • SUCTION PUMP(COOK/ROCKET/INDIAN MAKE:SHIVANI) • NEEDLES(COOK/REPROLINE/OTHER S) • TUBINGS • ULTRASOUND MACHINE : TVS PROBE
  13. TEMPERATURE CONTROL • warm blocks for test tubes • hand held test tube warmer • heated laminar table(integrated table available now made in india)
  14. GETTING READY
  15. GETTING READY
  16. LOCAL ANAESTHETIC INJECTION SHEFALI AND DINESH JAIN CENTRE INDORE
  17. ASPIRATION NEEDLE • 17 GAUZE • SINGLE LUMEN OR DOUBLE LUMEN • DOUBLE LUMEN MAY BE USED IN LESSER FOLLICLE AND WHERE MULTIPLE FOLLICLE FLUSHING IS NEEDED • CONNECTING TEFLON TUBING TO THE BUNGE (SPECIAL DESIGN BUNGES)
  18. TECHNIQUE • clean the vagina and wash off all particulate matter with normal saline • vaginal ultrasound(use of cover and jelly???) • focus and fix the target ovary in the centre of the biopsy line • enter with a sharp jab • enter the follicle at maximum diameter
  19. needle entry
  20. TECHNIQUE CONT… • SUCTION VACUUM APPLIED BEFORE ENTERING THE FOLLICLE TO PREVENT LEAKING • ASPIRATION PRESSURE AROUND 100(NEVER MORE THAN 130) • IF FLUSHING IS BEING DONE IT SHOULD BE AT LOW PRESSURE • AFTER ASPIRATION OF FIRST FOLLICLE IT MAY BE A GOOD PRACTICE TO FLUSH THE NEEDLE OF ANY VAGINAL MUCUS OR TISSUE • THE FOLLICLE SHOULD BE ASPIRATED TILL TOTALLY COLLAPSED • SPINNING ACTION IS NOW DEBATABLE • THE MOBILE OVARY CAN BE NEARED TO THE PROBE TIP AND FIXED BY THE ASSISTANT PUSHING IT DOWN • A CO ORDINATION OF EYE/ HAND AND FOOT PRESSURE IS NEEDED
  21. Eye Hand and Foot Co-ordination
  22. OOCYTE ASPIRATION
  23. FOLLICLE ASPIRATION
  24. LOOSE CAP AND BLOCKED NEEDLE
  25. CHANGING CAPS/PUMP PRESSURE
  26. FLUSHING • value is debatable • only may be used in natural cycle/less eggs/poor responders/small follicle(ivm) • if more than 10 follicles are seen then flushing not required and this may prolong the procedure and discomfort • flushing follicle 6 times may increase the yield by 20% • it is rather better to aspirate completely (as the follicle retrieved in the first aspirate and last aspirate is same)
  27. TUBES AND PETRI DISHES
  28. OOCYTE CUMULUS COMPLEX SCREENING
  29. DIFFICULTIES IN OPU • ovary stuck behind the cervix and uterus (may have to go thru) • endomeriomas • (contamination of the follicle aspiration) • try not to aspirate till opu completed..but if punctured then aspirate completely, flush them and flush the needle many times • bleeding : if ovarian vessel.. just remove the needle and bleeding will stop..if iliac is hit remove needle gently and bleeding may stop,but if there is rapid bleeding,laparotomy may be needed.. • vaginal and cervical bleeding usually stops with pressure , if does not suture
  30. DIFFICULTIES IN OPU • ovary stuck on the fundus • vaginal vessels • thru cervix • endometrioma • too near major blood vessels • hydrosalpinx
  31. COMPLICATIONS VAGINAL BLEEDING 1.4-18.4% IF THE PROBE IS ROTATED WITH NEEDLE INSIDE(CAN TEAR VAGINA,OVARIAN SURFACE AND INTRA ABDOMINAL ORGANS)
  32. INTRAPERITONEAL BLEEDING • RARE • 0-1.3% • INTRAPERITONEAL OR RETROPERITONEAL • IF HAEMODYNAMIC DISTURBANCE.. URGENT LIFE SAVING MEASURES AND LAPAROTOMY OR LAPROSCOPY • RETROPERITONEAL HAEMATOMAS PRESENT AFTER SOME TIME (ABOUT 10 HRS POS OPU)
  33. INFECTION • PID :0.2-0.55 % • BECAUSE THE VAGINAL FLORA IS CARRIED INTO THE PERITONEUM WITH THE NEEDLE PUNCTURE. • PUNCTURE OF INFECTED HYDROSALPINX AND OOPHERITIS • MAY PRESENT AS ACUTE INFECTION AND ENDOTOXEMIA • LOCAL INFLAMMATORY REACTION • ROLE OF PROPHYLACTIC BROAD SPECTRUM ANTIBIOTIC • FOR TREATMENT COVERAGE WITH ANTIBIOTICS AND MONITORING IS NEEDED
  34. TAKE HOME MESSAGE • SIMPLE AND EFFICIENT PROCEDURE • HOWEVER CARE SHOULD BE TAKEN(THE COMPLICATIONS ARE POTENTIALLY DANGEROUS) • HAS A LEARNING CURVE
  35. CONGRATULATIONS ON 35 YEARS OF ART
  36. THANK YOU

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