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Egg Collection and Embryo Transfer Techniques

Dear Friends and Colleagues.
There are various techniques to aspirate eggs and replace embryos. There is still much debate and controversies regarding these techniques.
In order to learn from the experience of the IVF units worldwide, the below survey was suggested and conducted by Drs. Tongtis Tongyai, Thailand, Abha Majumdar, India, Peng Cheang Wong, Singapore, Dan Levin, Israel .

In your clinic, hCG is given when the leading follicle is usually reached a diameter of:
  • 16 to 18 mm in diameter
  • 19 to 20 mm in diameter
  • 21 to 22 mm in diameter
  • 23 to 24 mm in diameter
  • More than 24 mm in diameter and more
  • None of the above

 

hCG is (usually) given when the below number of follicles reaches the optimum diameter as described above:
  • At least 1 follicle
  • At least 2 follicles
  • At least 3 follicles
  • Four or more follicles

 

The routine dose of hCG administered in your unit is?
  • One ampoule of Ovitrelle (250 mcg of recombinant hCG) equal to 6600 IU hCG
  • One and half ampoulws of Ovitrelle (375 mcg of Ovitrelle) equal to 10,000 IU hCG
  • Two ampoules of Ovitrelle (500 mcg of recombinant hCG) equal to 13,200 IU hCG
  • One ampoule of 5000 IU of Urinary hCG (i.e. Chorigon, or Pregnyl)
  • Two ampoules of Urinary hCG (10,000 IU hCG)
  • None of the above

 

When treating patients with GnRH antagonist during the stimulation protocol, what do you routinely use for the final stage of oocyte maturation?
  • hCG
  • GnRH agonist
  • None of the above

 

Do you monitor the patient again after giving the hCG and before egg retrieval?
  • Yes
  • No
  • Only in special cases

 

If you monitor the patient again, after hCG administration, on a routine basis, what do you look for?
  • Follicle size and number
  • Estrogen levels
  • Progesterone levels
  • All of the above
  • I do not monitor the patient on a routine basis

 

What is usually the time interval between hCG administration and egg collection:
  • 30-34 hours after hCG administration
  • 34-37 hours after hCG administration
  • 37-40 hours after hCG administration
  • In between 30-40 hours after hCG administration
  • None of the above

 

Is the time interval between hCG or GnRH agonists administration and egg retrieval the same?
  • Yes
  • No, it is shorter after the administration of GnRH agonist
  • No, it is longer after the administration of GnRH agonist
  • I do not give GnRH agonists for final stage of oocyte maturation

 

As part of a natural IVI cycle: Do you administer hCG or GnRH agonist for the final stage of oocyte maturation?
  • hCG
  • GnRH agonist
  • I use both drug for this purpose
  • I do not perform natural cycle IVF
  • None of the above

 

What is your preferred method of analgesia/anesthesia in most cases of oocyte aspiration?
  • Light anesthesia
  • Mild sedation (Like diazepam given I.M. or I.V.)
  • Regional anesthesia (Spinal block)
  • Local anesthesia (Para-cervical block)
  • In most of the cases with no any anesthesia
  • None of the above

 

What is your preference in cleansing of the vagina prior to aspiration?
  • Saline or sterile water only
  • With antiseptic fluid and sterile water after this
  • I use iodine or polydine
  • None of the above

 

Which aspiration needle do you prefer to use in stimulated IVF cycles?
  • Single lumen – in most cases
  • Double lumen to allow follicle flushes – in most cases
  • None of the above

 

Do you give antibiotics following egg collection?
  • Yes
  • No
  • Only if there is an additional indication (like heart disease, previous PID, etc)

 

If you give antibiotics for egg collection, usually it is being given:
  • As a single IV dose during aspiration
  • As a single IM dose during aspiration
  • Per Os for a short period of time after egg collection
  • I do not give antibiotics
  • None of the above

 

How many hours do you keep the patient under surveillance after Egg Collection?
  • Less than an hour
  • Less than 2 hours
  • Less than 4 hours
  • Less than 6 hours
  • For one day
  • None of the above

 

Before you discharge the patient form your clinic do you routinely perform?
  • A pelvic ultrasound scan
  • A hemoglobin analysis
  • Both
  • Other tests
  • None of the above

 

Who discharges patients from your clinic after egg collection?
  • A physician
  • A nurse
  • None of the above

 

Before transferring the embryo(s) what do you cleanse the uterine cervix with?
  • Sterile water (external os)
  • Medium (external os)
  • We wash the cervical canal up to the internal os in order to remove the cervical mucus
  • None of the above

 

Do you usually use a Mock catheter to assess the cervical canal and uterine cavity before transferring the embryos?
  • Yes
  • No

 

Do you usually perform ultrasound guided embryo transfer?
  • Yes
  • No
  • Only in difficult cases

 

Where do you place the embryos in the uterine cavity?
  • The lower half part of the uterus
  • The middle of the endometrial cavity - half way between the internal os of the cervix and the uterine fundus
  • The top part of the uterine cavity
  • I do not monitor the place
  • It is not so important
  • None of the above

 

In cases of difficult embryo transfer what measures do you take?
  • Utilization of a tenaculum to enable traction on the cervix
  • Freeze the embryos and postpone E.T.
  • Utilization of a malleable stylette catheter
  • Performing a transmyometrial transfer
  • None of the above

 

In the event that an E.T. was difficult we will try to solve it by:
  • Performing cervical dilatation a month prior to the E.T.
  • Dilating the cervix by inserting Laminaria in the cervix a month prior to the E.T.
  • Try again without doing anything special
  • None of the above

 

While transferring the embryo(s) we do the followings?
  • Leave the catheter in the uterus for a few seconds
  • Rotate the catheter after injecting the embryos?
  • Both
  • Inject the embryos and pull out the catheter
  • None of the above

 

How long do you keep the patients in bed after E.T. ?
  • None, the patients are ambulated imminently after E.T.
  • I keep the patients in the supine position up to 30 minutes
  • I keep the patients in the supine position up to 60 minutes
  • I keep the patients in the supine position up to 2 hours
  • I keep the patients in the supine position more than 2 hours
  • None of the above

 

Would you recommend some physical restriction following E.T. ?
  • No
  • For the same day only
  • For a few days
  • Until b-hCG test is being performed
  • None of the above

 

While doing IUI, do you keep the patients in a supine position?
  • My patients do not remain supine after IUI and are ambulated immediately
  • For 15 Minutes
  • More than 15 minutes
  • I do not perform IUI

 

In Ovulation induction cycles I perform IUI:
  • Usually once
  • Usually twice
  • Twice only if in case of Oligoteratoastenospermia (OTA)
  • I am not involved in IUI