Transvaginal recovery of oocytes for in vitro fertilization using vaginal ultrasound

Aspiration of bovine oocytes during transvaginal ultrasound scanning of the ovaries

A technique for the repeated collection of bovine oocytes using transvaginal ultrasound guided aspiration is described. Cows were used during their normal estrous cycle and after stimulation of the ovaries with pregnant mare serum gonadotrophin (PMSG). The sedation of the animals and the puncturing of follicles appears not to have traumatized the animals and plasma progesterone measurements suggested that the cyclicity was not interrupted. A total of 36 transvaginal aspiration procedures were performed, during which 54 oocytes were recovered from 197 follicles. These experiments indicate that the repeated aspiration of bovine oocytes during transvaginal ultrasound scanning is possible. However, more research is needed to establish optimal methods for improving the recovery rate of oocytes before this method can be used as an alternative route for the supply of oocytes for in vitro maturation and in vitro fertilization.

Ovarian function and morphology in the mare after multiple follicular punctures

REASONS FOR PERFORMING STUDY

In the mare, ultrasound-guided transvaginal oocyte recovery and transfer might offer a way to circumvent the demanding procedures of in vitro embryo production. Before clinical application, the possible consequences for subsequent fertility have to be considered.

OBJECTIVES

To examine ovarian function and morphology in mares after repeated follicular punctures.

METHODS

A total of 14-26 follicular puncture sessions were conducted on each of 4 Norwegian pony mares over a period of 8 years. The ovaries of these mares were recovered by bilateral ovariectomy or at post mortem and subjected to macroscopic inspection and histology. For comparison, ovaries were collected from 7 nonaspirated control mares and processed for histology.

RESULTS

In all experimental mares, ovarian function, defined as the ability regularly to ovulate preovulatory follicles and develop corpora lutea, remained normal during their last breeding season. Gross examination and histology showed that normal follicular and corpus luteum development was accompanied by the formation of condensed reparative fibrosis and normal local haemosiderosis of the ovarian stroma in all experimental mares. In one mare, an ovary contained several foci of chronic apostematous oophoritis, while a cystic structure lined with a single layer of epithelial-like cells and surrounded by a cartilaginous capsule was present in the other ovary.

CONCLUSIONS AND POTENTIAL RELEVANCE

Repeated follicular aspirations do not hamper future folliculogenesis, ovulation and corpus luteum formation. However, ovarian puncture induces reparative fibrosis in the ovarian stroma and involves a risk of inducing abscess formation within the ovarian tissue which may impair fertility.

Collection of oocytes from cattle via follicular aspiration aided by ultrasound with or without gonadotropin pretreatment and in different reproductive stages

Ultrasound-guided follicular aspiration was performed on 29 Holstein-Friesian cows/heifers twice weekly at 3- to 4-d intervals over a period of 2 consecutive estrous cycles (total 42 d). For visualization of the ovaries and guidance of the aspiration needle, a 6.5 MHz fingertip probe on a 62 cm probe carrier was inserted into the vagina. The disposable aspiration needle was connected to a permanent rinse tubing system, thus ensuring minimum death of oocytes in the aspiration processs. After penetration of the vaginal wall, the needle was inserted into a follicle of the rectally fixed ovary. Cumulus oocyte complexes (COC) were aspirated at a pressure of 100 mm Hg. In the first experiment, the effect of an additional gonadotropin treatment 4 d prior to aspiration was investigated in 8 lactating cows. Following FSH-treatment, the number of aspirated follicles was higher (P < 0.05) than in the nontreated animals (10.6 +/- 0.7 vs 8.9 +/- 0.5). The number of recovered COC (7.0 +/- 0.6 vs 5.8 +/- 0.5), the recovery rate (COC per aspirated follicle) (66.6% vs 65.4%), the percentage of viable COC (56.8% vs 52.1%), the cleavage rate upon in vitro maturation and in vitro fertilization (56.7% vs 59.8%) as well as the rate of morula/blastocyst formation (3.8% vs 2.9%) were similar in both groups. In the second experiment, follicles were aspirated in 4 lactating cows, 6 dry cows, 4 pregnant cows (first 35 d of pregnancy), and 4 heifers. The average number of aspirated follicles and recovered COC was higher (P < 0.05) in the first 2 groups (10.6 +/- 0.6 and 9.3 +/- 0.7 follicles; 7.2 +/- 0.5 and 6.9 +/- 0.7 oocytes) than in trie 2 other treatment groups (7.3 +/- 0.5 and 8.1 +/- 0.5 follicles; 5.0 +/- 0.4 and 5.7 +/- 0.5 oocytes). The percentage of viable COC was higher (P < 0.05; 68.3%) in lactating animals than in all the other groups (49.7, 52.5 and 57.4%, respectively). Similarly, upon in vitro fertilization, cleavage rate was higher (P < 0.05; 63.4%) in lactating cows than in the other groups (43.7, 50.5, 55.1%, respectively). A total of 21.5, 22.7, 11.9 and 13.5%, respectively, in the 4 groups of the in vitro fertilized oocytes reached the morula and blastocyst stages. After transfer of a total of 48 embryos 22 pregnancies (45.8%) were established as detected on Day 65. We conclude that 1) repeated aspiration of viable COC at short intervals is possible, 2) additional FSH-treatment does not increase oocyte yields, and 3) viable blastocysts can be produced from cattle at various reproductive phases irrespective of the reproductive phase.

Quantitative three-dimensional sonographic assessment of pelvic blood after transvaginal ultrasound-guided oocyte aspiration: factors predicting risk

OBJECTIVES

To evaluate the fluid volume in the pelvis immediately and 3-5 days after transvaginal ultrasound-guided oocyte aspiration (TOAS) and to identify predictive factors for intraperitoneal bleeding.

METHODS

This was a prospective study of 83 infertile women undergoing controlled ovarian hyperstimulation followed by TOAS and embryo transfer (ET). Pelvic blood volume was measured by three-dimensional (3D) ultrasound examination 3-5 h after TOAS (post-TOAS), and prior to ET (2-3 days after TOAS; pre-ET). Pelvic blood volume was then correlated with the following procedure-related variables: day of hCG administration: number and diameter of ovarian follicles, endometrial thickness, serum estradiol levels; day of TOAS: number of retrieved oocytes, patient's perceived pain (Likert scale), duration of TOAS, diameters (using two-dimensional (2D) ultrasound) and 3D volume of pelvic fluid; day of ET: 2D diameters and 3D volume of pelvic fluid, perceived pain; pregnancy rate.

RESULTS

The mean +/- SD volume of blood measured by 3D ultrasound after TOAS and before ET was 12.94 +/- 16.88 (range, 0-98.00) mL and 19.13 +/- 17.84 (range, 0-70.20) mL, respectively. Blood volume in the pelvis correlated most strongly with number of oocytes retrieved (post-TOAS: P < 0.01; pre-ET: P < 0.05), followed by pain level (post-TOAS: P < 0.01), number of follicles (post-TOAS: P < 0.05) and endometrial thickness (post-TOAS: P < 0.05). When all study variables were held constant, the number of oocytes and serum estradiol level proved to be significant predictors of the amount of fluid in the pelvis (post-TOAS/pre-ET: P < 0.01). If 2D ultrasound was used, the best predictor of fluid volume after TOAS was the width of the fluid scanned in the pelvis (P < 0.001).

CONCLUSIONS

The amount of blood in the pelvis following TOAS in the present series was within acceptable clinical limits. The number of retrieved oocytes and pain after TOAS were found to be indicators of patients at risk of excessive bleeding. These findings have important implications for the improvement of postprocedural care.

Transvaginal aspiration

This article describes in detail the procedures for collection of equine oocytes using a transvaginal ultrasound probe. Success in obtaining oocytes from humans, bovines, and horses are presented. The effect of repeated follicular aspiration of both cattle and horses is reviewed.

Evaluation of transvaginal ultrasound-guided follicle puncture to collect oocytes and follicular fluids at consecutive times relative to the preovulatory LH surge in eCG/PG-treated cows

Holstein-Friesian cows (n=56) were synchronized with Syncro-Mate B, and those cows (n=47) developing a normal progesterone pattern were further treated im with 3,000 I.U. eCG at Day 10 and 22.5 mg PGF2alpha 48 h later. Blood samples were collected every hour from 30 until 49 h after PG administration. Cows (n=17, 36.2%) with fewer than 8 follicles larger than 8 mm in diameter at 28 to 30 h after PG treatment and animals without an LH peak (n=7, 23%) were excluded from the study. Transvaginal ultrasound-guided puncture of the follicles was carried out two times per cow, at 30 h after PG injection (4 to 5 follicles) and again at 1 to 5 (n=6), 12 (n=8) or 22 h (n=9) after the LH peak. No differences in the concentrations of progesterone and LH were observed among the 3 groups. An average of 18 follicles per cow was punctured (total of 415 punctures, n=23); 116 cumulus-oocyte-complexes and 370 follicular fluid samples were obtained producing average recovery rates of 28.0% and 89.2%. The number of cumulus-oocyte-complexes varied between puncture times; shortly before ovulation, at 22 h after the LH peak, the recovery rate was significantly 5 times higher than immediately after the LH peak. Overall, in 75 punctures the cumulus-oocyte-complex was accompanied by a pure follicular fluid sample (3.3 per cow). In conclusion, the transvaginal ultrasound-guided puncture of preovulatory-size follicles can be used to collect follicular fluids to study changes in the microenvironment of maturing oocytes upon superovulation. However, further research is required in order to obtain an equivalent number of accompanying cumulus-oocyte-complexes.

Intrauterine fertilization capsules--a clinical trial

Treatment of 26 women with tubal infertility was attempted using intrauterine capsules loaded with oocytes and spermatozoa. The stimulation protocol was as used for in vitro fertilization and embryo transfer and consisted of short-term use of Buserelin, human menopausal gonadotropin, and human chorionic gonadotropin. Oocytes were collected by ultrasonically guided transvaginal aspiration, and spermatozoa were prepared by swim-up technique. The gametes were placed in agar capsules 4 hr after oocyte collection, and the capsules were introduced to the uterine fundus using an insertion tube and piston from an intrauterine device. Six complete capsules and parts of two other capsules were expelled. None of the women became pregnant, compared with a pregnancy rate of 21% per aspiration following in vitro fertilization and embryo transfer during the same period.

A controlled study of gonadotropin-releasing hormone agonist (buserelin acetate) for folliculogenesis in routine in vitro fertilization patients

STUDY OBJECTIVE

To determine if gonadotropin-releasing hormone agonist (GnRH-a) and gonadotropin therapy could improve folliculogenesis and pregnancy rates (PRs) in women with a previously satisfactory response to clomiphene citrate and human menopausal gonadotropin (hMG).

DESIGN

Randomized prospective study.

SETTING

Assisted reproduction clinic.

PATIENTS

One hundred fifty-seven women were randomized to receive either hMG alone or the GnRH-a buserelin acetate 600 microgram/d or buserelin acetate 1,200 microgram/d plus hMG.

RESULTS

Compared with hMG alone, pretreatment with buserelin acetate significantly increased the PR per cycle started by preventing a premature luteinizing hormone rise and thereby reducing the number of abandoned cycles. There was, however, no difference between the number of follicles aspirated, oocytes obtained, or fertilization rates between groups. Furthermore, agonist therapy significantly increased both the dose of hMG required and the duration of stimulation.

CONCLUSION

The routine use of GnRH-a in in vitro fertilization programs must be questioned.

A comparison of vaginal ultrasonic-guided and laparoscopic retrieval of oocytes for in vitro fertilization

A retrospective analysis was undertaken to compare the less invasive technique of vaginal ultrasonic-guided oocyte retrieval with the standard laparoscopic technique. We have shown that the outcome of the transvaginal technique with respect to oocytes harvested, fertilization rate, and pregnancy rate is comparable with the laparoscopy technique. We have also shown that 9 clinicians with little previous expertise in ultrasound have been able to incorporate this technique into a busy and successful in vitro fertilization unit.

Comparison between laparoscopically and ultrasonographically guided transvaginal follicular aspiration methods in an in vitro fertilization program in the same patients using the same stimulation protocol

Oocyte recovery from 43 patients undergoing ultrasound-guided transvaginal oocyte retrieval was compared to a previous laparoscopic oocyte retrieval cycle from the same patient. Gonadotropin stimulation in both cycles was performed using the same protocol. There were no statistically significant differences in the mean day of oocyte retrieval or the mean daily estradiol level up to the day of oocyte retrieval between laparoscopic and transvaginal cycles. The total number of follicles aspirated per cycle, preovulatory oocytes aspirated per cycle, and number of concepti of preovulatory origin transferred per cycle were not statistically different. The number of immature oocytes aspirated per cycle was statistically decreased in transvaginal retrieval cycles, which resulted in an increased total number of concepti transferred per transfer in laparoscopic retrieval cycles. Twelve pregnancies resulted from the transvaginal retrieval cycles (27.9%), seven of which are ongoing or delivered. Ultrasound-guided transvaginal follicular aspiration yields results comparable to laparoscopic retrieval in the same patients and should be the method of choice for oocyte pickup because of its many advantages.

Ultrasound-guided fallopian tube catheterization per vaginum: a feasibility study with the use of laparoscopic control

The fallopian tube can be cannulated per vaginum under ultrasound control. The sensation and ultrasound appearance of smooth passage without visible kinking are accurate predictors of success. The average time taken for each cannulation was 7.2 minutes. Adequate practice in non treatment cycles is essential before proceeding to cell transfer, while further modification of the catheters used may improve overall success.

Nonsurgical management of unruptured tubal pregnancy with intra-amniotic methotrexate: preliminary report of two cases

Two cases of unruptured tubal pregnancy were managed conservatively by the aspiration and injection of 50 mg methotrexate into the amniotic sac with the use of a vaginal ultrasound transducer under local anesthesia. Both women experienced no pain or side effects and went home within 12 hours. Spontaneous menstruation began in both cases within 6 weeks of the procedure.

Follicular aspiration: a comparison of an ultrasonic endovaginal transducer with fixed needle guide and other retrieval methods

Ultrasonic techniques have been developed as alternatives to conventional laparoscopic aspiration for oocyte retrieval for in vitro fertilization (IVF). Given the advantages (less risk, lower cost, and greater patient acceptance) of these alternative techniques, it is appropriate to assess their efficacy compared with traditional laparoscopic retrieval. This article examines the recovery rate of oocytes and their subsequent fertilization rate with the use of an ultrasonic endovaginal transducer with fixed needle guide and compares these results with other retrieval methods. Comparisons were made between laparoscopic harvesting (n = 71, group I), ultrasonic transabdominal transvesical (n = 21, group II), and ultrasonic vaginal transducer (n = 76, group III). The data demonstrate comparable success using an ultrasonic endovaginal transducer with fixed needle guide. The authors believe this technique to be the procedure of choice for all routine oocyte retrievals during IVF treatment.

Transfundal transfer of embryos using ultrasound

Ultrasonically guided transfer of embryos was performed transabdominally in 10 patients. The uterus was punctured by a 16-gauge needle with a stylet through a full urinary bladder. When the needle tip was in the uterine cavity the stylette was removed and a transfer catheter loaded with the embryos was inserted. No complications or technical difficulties were experienced. None of the patients became pregnant.