In IVF/ICSI cycle, there are many unwritten clinical tips that u may get benefit if u consider during performing ovum pickup and embryo transfer

1. Practical tips
In IVF
Hesham Al-Inany, M.D, PhD
kaainih@yahoo.com

2. OPU: preparation
• Test the OPU needle (nurse job)
• Check pressure (120-160mmhg)
• Check tube (fissured or intact : nurse job)

3. OPU: start
• Stretch vaginal wall by ultrasound probe
• Better lateral fornix (rather than posterior
fornix)
• Start at the middle line of the ovary (not the
sides of the ovary)
• Screw the needle (rather than push)

4. OPU : inside the follicle
• Put the echotip of the needle in the CENTER of
follicle
• Twist the needle during collapse of the follicle
• Gradual withdrawal of the needle slowly
(always downwards)
• Stay for few second after collapse of the
follicle and twist the needle (follicular
curettage

5. OPU: moving to another one
• Slight movement downwards (do not exit the
ovary)
• Slight manipulation of the probe to get better
view
• Start from the base (horizontal direction
rather than vertical direction)
• Always Keep the echotip in view

6. OPU: precautions
• Always keep in mind that the echotip is not
the end of the needle: there is still few mm
beyond the echo tip (actual tip)

7. • Start with a good responders)
• Always try to avoid internal iliac artery
• Start with the ovary with less follicles
• Start using double lumen needle (rather than
single lumen)

8. ET: RELAX
• Joyful atmosphere
• Try to be slow and gentle
• Bladder preferred to be semifull or full
• US guided ET is most preferred especially for
beginners

9. ET
• Good light
• Speculum introduced to midvagina
• Gently introducing the catheter
• Either to start with firm catheter : easier
• Or soft catheter : better results
• Never touch the fundus

10. ET
• Rest : minimum for 30 minutes
• Better two hours
• Avoid constipation
• Regular movement

11. Always remember
• Team work : u r not alone
• Failure rate is higher than success
• Success depends on age
• Try to select ur cases at the start
•Try to read more and more

12. How to ?
• Obtain good results:
monitor ur performance