This document discusses oocyte pick up and embryo transfer procedures. It describes the equipment, techniques, tips, and potential complications for oocyte pick up, which involves using ultrasound-guided needles to aspirate follicles and retrieve oocytes. It also outlines the timing, catheters, techniques, ultrasound guidance, and factors considered for embryo transfer, which involves placing embryos into the uterine cavity. Mock embryo transfers are recommended to practice catheter placement before the real procedure.

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.