Lennart Enk

Transvesical and Transvaginal Approaches for the Aspiration of Follicles by Use of Ultrasound

The use of ultrasound to study follicular growth in both normal and stimulated cycles is well established.’-’ The technique is today probably utilized in all in vitro fertilization and embryo replacement (IVF/ER) programs as a complement to hormone analyses for prediction of the optimal time of oocyte c~l lec t ion .~’ Oocytes have, hitherto, mainly been recovered by means of laparo~copy.*-’~ However, radiologists and ultrasonographers have used ultrasound for many years to guide the needle for percutaneous puncture of intra-abdominal structures.” One of the advantages of using this technique is that it is less invasive than other methods if the only purpose is to empty, as with cysts, or to retrieve cells for cytological evaluation, for example. Analogous with this principle, the preovulatory follicle is a cystic structure and the goal in this case is to retrieve intrafollicular cell material for culture purposes. Thus, ultrasound in this connection seems to be a self-evident alternative to use of laparoscopy. Although human IVF/ER has been established clinically since the end of the 1970s for treatment of certain types of female and male infertility, ultrasound-guided follicle aspiration has not been utilized for more than 3 years.’6s” However, the vast increase in experience with this method during the last 2 years indicates that the technique is here to stay as an alternative or complement to laparoscopy.’” This paper will deal with the ultrasound-guided method for oocyte retrieval as it has been developed and utilized in the IVF/ER programs in Sweden. Future possible developments within the technique will also be discussed.

Fertilization and embryo development of oocytes obtained transvaginally under ultrasound guidance

The widespread use of ultrasound for follicle development assessment and ovum pickup has raised concerns about the theoretical possibility of adverse effects on oocyte function. Studies in other species do not demonstrate any adverse effects when using sonic energies as those presently used in diagnostic ultrasound. However, no data are available concerning the effects of diagnostic ultrasound on human preovulatory oocytes. This study was conducted to determine whether there were any adverse effects on the reproductive function of oocytes using transvaginal ultrasonography. No effect on fertilization and subsequent cleavage of oocytes was demonstrated. This method can, therefore, be recommended for follicle assessment and as a better alternative to laparoscopy for oocyte retrieval.