Lecture By Prof . Emad Darwish

1. Oocyte pick up and
Embryo transfer
Emad Darwish MD
Professor of Obstetrics and Gynecology
Integrated Fertility Centre
Alexandria

2. Oocyte Pick up
• Equipments
• Technique
• Complications
• Approaches

3. Equipments
• Ultrasound Machine with trans-vaginal probe.
• Needle guide to be attached to the trans-vaginal probe.
• Aspiration needle: single lumen or double lumen.
• Follicle aspiration set.( ready made needle with tubing and collection
tube) ready to be attached to suction pump.
• Suction pump. ( can be replaced by 10 ml syringes).

4. Technique
• General anaesthesia. Most common.
• Aspiration of the follicles:
Push needle through needle guide on the guide line.
Push needle tip inside follicle and aspirate.
All follicles to be aspirated.
• Flushing of follicles:
When no. of follicles less than 6-8.
Up to 8 times till oocyte is retrieved.

5. Important tips
• Tip of the needle should be seen all the times
• Do not move probe side to side while needle inside ovaray.
• Try to aspirate more than one follicle with single puncture in the
vagina or the ovary.
• Do not aspirate chocolate cysts and avoid to puncture it.
• If bleeding from vaginal punctures, usually controlled easily by
pressure and rarely needs diathermy.
• Rotate needle when blocked by follicle wall.

6. Complications
• Bleeding :
Vaginal
Intr-Abdominal
• Infection
• Pain
• No oocytes

7. Approaches
• Laparoscopic.
• U/S guided: Trans-vaginal or Trans-abdomonal

10. Embryo Transfer
• Timing
• Catheters
• Technique
• Ultrasound guided
• Bed rest after ET
• Number of replaced embryos
• Mock ET

11. Timing
• Day 2-3
• Day 5-6

12. Catheters
• Soft
• Hard
• Two steps

13. Technique
• No need of anaesthesia. Very rare.
• Clean cervix with saline.
• Remove mucus from cervical canal. Not important
• Flush cervix and cervical canal with culture media
• Gentle manipulation
• Tip of outer catheter just above internal os
• Advance inner catheter to about 1-2 cm below upper end of cavity
• Push piston and keep pressure for about 5-10 seconds
• Withdraw catheter while keeping pressure

14. If difficult to pass internal os, shift to 2 steps transfer.
• Use outer sheath with stellate and pass it from internal os.
• Remove stellate
• Advance inner catheter with embryos till 1-2 cm below fundus and
replace embryos

15. Ultrasound
• ET under U/S guidance improves pregnancy rate.
• Full bladder for TAS
• Very important for begginers
• Needs expert assistant

16. Bed Rest
• No evidence to support bed rest after ET .

17. Numbers of replaced embryos
• Depends on many factors
Age, history, embryo quality
• 2-3 usual number.
• Problem of multiple pregnancy
• Fetal reduction
• Freezing program
• Cumulative pregnancy rate

18. Mock embryo transfer
• On day of retrieval
• Just before real ET
• Before starting stimulation
• eg 4+3 at 3 oclock
shoulder of outer catheter at 4 cm, inner catheter pushed for 3 cm
and introduction of catheter direction is at 3 oclock.