Ultrasound standards for transvaginal oocyte pickup (OPU) have never been formally assessed. The literature review for this chapter showed only a few papers evaluating OPU concerning in vitro fertilization (IVF) protocols. This chapter explores what is currently considered to be the best clinical practice for OPU. This clinical practice should be aimed at having maximum results (high oocyte yield) and as few as possible complications. Factors (ultrasound quality and settings) that influence these aims together with operator efficiency are of paramount importance in order to maintain a high OPU standard of practice.