ABSTRACT
Once oocyte maturation is achieved, patients receive 5000 to 10,000 IU of human chorionic gonadotropin in order to mimic an endogenous LH surge. Retrieval is performed 34 to 36 hours after human chorionic gonadotropin administration, at which time the oocyte resumes meiosis, approaching completion of its reduction division.1 Historically, laparotomy had been briefly used and abandoned because the morbidity associated with the procedure precluded its widespread use.1 Steptoe and his group2 achieved the first IVF success harvesting the oocytes laparoscopically. Laparoscopy became the standard procedure for oocyte retrieval and was universally employed by IVF/ET programs. As the peripheral follicles are aspirated, it is difficult to delineate and selectively aspirate follicles well within the stroma of the ovaries. Generally, these “internal” oocytes are aspirated blindly. Its major advantage is related to the clear view of the pelvic organs during the aspiration process. However, this is an invasive technique, requiring general anesthesia and it is also associated with significant postoperative patient discomfort, some morbidity and, rarely, mortality. An increased risk and mortality rate may be associated with repeated laparoscopies in patients with previous abdominal operations. Furthermore, in 5 to 10 percent of the patients admitted for IVF/ET, it is impossible to perform a laparoscopic guided oocyte retrieval because of severe pelvic adhesions.3 Although the effects of general anesthesia and CO2 pneumoperitoneum on the oocyte have not been fully investigated, it has been demonstrated that prolonged exposure of the oocyte to the anesthetic agents and the potential lowering of follicular pH associated with CO2 pneumoperitoneum, may have a deleterious effect.4 Laparoscopic oocyte retrieval is currently reserved only for gamete intrafallopian transfer (GIFT), but there are increasing attempts to carry out GIFT completely under ultrasonographic control, especially as newly developed transcervical-transuterine tubal cannulation techniques have become widely available.5 The ideal method of oocyte recovery should allow easy access to the largest number of available follicles and be simple to perform, and be associated with low morbidity and cost. In addition, the method of retrieval should not adversely affect the recovered oocytes.
