Practical tips

In IVF

Hesham Al-Inany, M.D, PhDkaainih@yahoo.com

OPU: preparation

• Test the OPU needle (nurse job)• Check pressure (120-160mmhg)• Check tube (fissured or intact : nurse job)

OPU: start

• Stretch vaginal wall by ultrasound probe• Better lateral fornix (rather than posterior

fornix)• Start at the middle line of the ovary (not the

sides of the ovary)• Screw the needle (rather than push)

OPU : inside the follicle

• Put the echotip of the needle in the CENTER of follicle

• Twist the needle during collapse of the follicle• Gradual withdrawal of the needle slowly (always downwards)• Stay for few second after collapse of the

follicle and twist the needle (follicular curettage

OPU: moving to another one

• Slight movement downwards (do not exit the ovary)

• Slight manipulation of the probe to get better view

• Start from the base (horizontal direction rather than vertical direction)

• Always Keep the echotip in view

OPU: precautions

• Always keep in mind that the echotip is not the end of the needle: there is still few mm beyond the echo tip (actual tip)

• Start with a good responders)• Always try to avoid internal iliac artery• Start with the ovary with less follicles• Start using double lumen needle (rather than

single lumen)

ET: RELAX

• Joyful atmosphere• Try to be slow and gentle • Bladder preferred to be semifull or full• US guided ET is most preferred especially for

beginners

ET

• Good light• Speculum introduced to midvagina• Gently introducing the catheter• Either to start with firm catheter : easier• Or soft catheter : better results• Never touch the fundus

ET

• Rest : minimum for 30 minutes• Better two hours• Avoid constipation• Regular movement

Always remember

• Team work : u r not alone• Failure rate is higher than success• Success depends on age• Try to select ur cases at the start

• Try to read more and more

How to ?

•Obtain good results:

monitor ur performance