One of the most controversial topics in the in vitro fertilization procedure is follicle puncture. Although it is an integral and indispensable step in the implementation of the program, many women who first entered the protocol experience real fear of this medical intervention.

The fault lies with online forums for IVF mothers, which often present personal experiences as objective information. What actually is a puncture during IVF and should you be afraid of it?

In the IVF protocol, this means a minor surgical intervention in which, using a special hollow needle, the mature follicles in the ovaries are punctured and the follicular fluid containing the egg is collected.

Expectant mothers who are just planning to enter into the protocol often ask whether it is necessary to puncture the follicles during IVF or can another method be used? The answer to this question lies in understanding the entire process of in vitro fertilization.

In a healthy female body, in each menstrual cycle (with the exception of rare anovulatory cycles), 1, rarely 2, dominant follicles mature. They are bubbles filled with liquid in which the egg floats.

On the days of ovulation, under the influence of female sex hormones, the wall of the follicle becomes thinner, ruptures and the egg leaves the ovary. It is then captured by the fimbriae (jellyfish-like tentacle-like processes) of the ampulla of the fallopian tube and placed into its lumen.

In the fallopian tube, the egg and sperm meet, and the process of fertilization occurs. The resulting embryo moves along the tube towards the uterus, where it is subsequently attached (implanted).

With IVF, the fertilization process occurs in a laboratory (“in vitro”), so the doctor needs to remove the egg from the mature follicle before it leaves it on its own. It is for this purpose that follicle puncture is used during IVF.

The puncture can be performed:

• without the use of general anesthesia (without anesthesia);
• under general intravenous anesthesia (controlled anesthesia).

The indication for puncture during IVF without general anesthesia is in vitro fertilization in a natural cycle or during stimulation, when the total number of mature follicles does not exceed 5 and they are located in one ovary (this number is not an officially established indicator and is based on the practical experience of reproductologists).

If there are a larger number of eggs that need to be collected or if they are located in 2 ovaries at once, general intravenous anesthesia is used.

A number of foreign IVF clinics have regulations prohibiting the use of anesthesia during IVF. On the territory of the Russian Federation, reproduction centers leave the choice to the patients, and if desired, they can perform or refuse anesthesia, regardless of the number of follicles and their location.

How to prepare for a puncture

Preparation for puncture of follicles during IVF is carried out simultaneously by the married couple and by the reproductive specialist conducting the protocol.

Preparing the expectant mother

The puncture, although small, is still an operation, so it is necessary to prepare for it according to all the rules for surgical patients:

• 4-5 days before the puncture, do not enter into intimate relationships;
• on the day before the procedure, do not eat after 6 pm;
• on the day of the puncture, do not eat or drink in the morning;
• arrive at the clinic strictly at the appointed time (exactly 34-36 hours should pass from the moment the trigger dose of hCG is injected);
• Bring a clean nightgown and slippers with you.

Preparing the future dad

The day of puncture during IVF is a crucial moment not only for the woman, but also for the future father (if you plan to use your own sperm). Preparation for it is as follows:

• throughout the IVF protocol, you should completely abstain from alcohol and smoking, and not take medications without prior approval from a reproductologist;
• 4-5 days before the puncture of the follicles, it is necessary to observe sexual abstinence, not to visit baths, saunas, beaches, solariums, and not to overwork physically (if the work involves heavy physical labor, then it is better to take a day off);
• arrive at the clinic exactly at the appointed time.

Doctor training

The reproductive specialist also carefully prepares for the day of follicle puncture during IVF. Carrying out daily monitoring of the size of the follicles in the patient’s ovaries, the doctor waits for the moment when their size reaches 18-22 mm. If the required value is reached, the woman is given a trigger dose of hCG and exactly 34-36 hours later (depending on the specifics of the protocol), a puncture is prescribed.

The doctor pays special attention to the prevention of the development of ovarian hyperstimulation, which can begin after puncture during IVF. If a woman undergoing ovarian stimulation is at risk for developing hyperstimulation syndrome, then the following preventive measures can be taken for her:

• using gonadotropin-releasing hormone agonists rather than hCG drugs as an ovulation trigger;
• delayed administration of hCG if a decision is made to stimulate ovulation with this drug;
• complete refusal to administer trigger drugs.

How is the procedure performed?

On the day of follicle puncture for IVF, a married couple arrives at the reproduction clinic exactly at the appointed time. The expectant mother empties her bladder, she is given an enema if she has not cleansed the intestines at home with drugs like Fortrans (this issue is discussed in advance with the attending physician). The woman takes off her underwear, puts on a nightgown and is taken to the operating room.

If follicle puncture is performed without the use of anesthesia, then it is discussed in advance to take a painkiller in the form of a tablet (capsule) 1 hour before the procedure or an intramuscular injection is prescribed upon arrival at the clinic.

If it is decided to use anesthesia during a puncture during IVF, then the woman is placed on a gynecological operating table, a butterfly catheter (flexule) is installed in a vein in the arm, through which the drug is supplied in a strictly calculated dose. The procedure begins only after the patient has completely fallen asleep, this happens after about 30 seconds.

The duration of the puncture is on average from 5 to 15 minutes, depending on the number of eggs that need to be collected. The procedure is carried out using a special hollow thin needle, which is attached to a special ultrasonic sensor. Thus, the doctor sees everything that is in front of the needle tip and can accurately control any of its movements.

Access to the ovaries is achieved through a puncture of the vaginal wall. A special pump is connected to the needle, which allows you to carefully suck out all the follicular fluid with the egg in it without causing any harm to it. An experienced doctor can puncture both ovaries at once through one vaginal puncture.

The resulting follicular fluid is sent to the embryology laboratory before the operation is completed.

During follicle puncture during IVF, preventive measures are also taken to prevent the development of superovulation syndrome: aspiration of all follicles in both ovaries with maximum sampling of all follicular fluid.

After the doctor has finished puncturing and removed the needle from the vaginal wall, the anesthesiologist stops the intravenous administration of the anesthesia. The woman wakes up after about 1-2 minutes.

If the IVF protocol plans to use the husband’s (partner’s) own sperm, then while the expectant mother undergoes the puncture procedure, the future father donates sperm.

All women who decide to have a puncture without using anesthesia are concerned about the only question: does it hurt? It is impossible to give a definite answer, since everything depends on the following factors:

• pain threshold;
• doctor's experience;
• number and location of follicles.

After the puncture

After follicle puncture during IVF, the expectant mother is under the supervision of clinic doctors for about 2 hours, and then can be sent home.

The following are considered normal phenomena after puncture:

• aching pain in the lower abdomen, which is easily relieved by taking painkillers (paracetamol) and/or antispasmodics (no-spa);
• slight dizziness, weakness as a reaction to the anesthetic drug and nervous tension;
• pinkish vaginal discharge;
• rise in body temperature no higher than 37.5 degrees.

Follicular puncture during IVF can be complicated by the following conditions:

• development of ovarian hyperstimulation syndrome;
• internal bleeding;
• inflammation.

The expectant mother should urgently seek medical advice from the following symptoms that develop after the puncture:

1. Dizziness, pale skin, fainting, sharp abdominal pain (suspicion of internal bleeding).
2. Nausea, vomiting, drop in blood pressure, pain in the lumbar region, in the abdomen, not relieved by conventional painkillers, difficulty breathing (suspicion of ovarian hyperstimulation syndrome).

Puncture of follicles during IVF is one of the important stages on the complex path of in vitro fertilization. This is the name given to the process of “removal” of mature eggs located inside stimulated follicles.

Puncture is a minimally invasive surgical intervention. Therefore, women, exhausted by hormonal stimulation, worry about how the operation is going, how painful it is and whether unpleasant consequences are possible after it.

In vitro fertilization is an artificial conception, the stages of which are as close as possible to a naturally occurring pregnancy. One of these stages is ovulation, which occurs in a healthy woman every month approximately in the middle of the cycle. During ovulation days, the “birth” of one or two eggs occurs, which are ready to meet with sperm for further fertilization.

Eggs are born and grow in follicles. This is the name given to small vesicles on the ovaries, which every month “grow” and “release” female reproductive cells into the fallopian tubes. Before ovulation occurs, the eggs are reliably protected from external influences by the walls of the follicle and a special liquid.

Approaching day “X”, the follicle, or rather its shell, becomes much thinner, thinning enough by the time of ovulation to release the egg “in free swimming”.

Once in the lumen of the fallopian tube, the egg moves towards the sperm, and after fertilization it continues on its way to securely attach to the uterine cavity. After successful implantation, pregnancy begins to develop.

In the IVF process, fertilization of an egg with a sperm occurs in a laboratory setting. To carry it out, the doctor needs to collect a cluster of mature oocytes and “remove” them from the female ovaries. For this purpose, transvaginal puncture of the follicles is performed.

The process of follicle maturation is carefully monitored using ultrasound diagnostics: it is important for doctors to prevent ovulation from occurring naturally. After all, thanks to hormonal stimulation, not one or two eggs can mature, but as many as 20!

After the follicles reach 17-18 cm, the woman is given a trigger (a drug based on human chorionic gonadotropin) to help the oocytes finally mature. 36 hours after the injection, follicle collection begins. This cannot be done earlier or later. If eggs are collected prematurely, they will be immature, and delay threatens ovulation. And then the puncture will no longer be possible.

It is impossible to say for sure on what day of the cycle the procedure will take place: it all depends on the individual characteristics of the women and the specifics of the chosen protocol.

After puncture, the resulting embryos are placed in a special environment and grown there for several days, preparing for “relocation” into the uterine cavity.

How to prepare for a puncture

Preparing for follicle puncture is a simple procedure. In addition, couples who decide to conceive a baby, in most cases, already lead a healthy lifestyle, adhering to a balanced diet. However, there are several rules that both parents must follow in order for the procedure to be as successful as possible. Here are some general recommendations for married couples:

• Eat nutritiously, excluding foods with artificial additives from your diet;
• Avoid crowded places and contact with patients who are sick with viral infections to avoid contracting infectious diseases;
• Take medications and vitamins prescribed by your doctor in the dosage indicated by him;
• Drink at least 2.5 liters of pure still water daily.
• Give up bad habits: smoking, drinking alcohol;
• Reduce consumption of strong tea and coffee;
• Do not get involved in sports that involve heavy physical activity.

Preparing the expectant mother

Ovarian puncture during IVF is a surgical intervention, albeit a minor one. Therefore, a woman must first prepare for it. To do this, when preparing for the procedure, she needs to follow the following rules:

• A week before the puncture, the basis of the menu should be a protein diet;
• You cannot have sex, visit bathhouses, solariums, beaches, gyms 4 days before the procedure;
• If a puncture is scheduled for tomorrow, in the evening after 18.00 food intake should be limited;
• Since the procedure involves the use of general anesthesia, you should not eat or drink in the morning before the puncture;
• If spontaneous bowel movement does not occur, a cleansing enema should be performed;
• The last hCG injection involves collecting follicles after a specific period of time, so the woman needs to come to the medical facility strictly at the time prescribed by the doctor;
• Take a clean shirt and slippers with you.

Preparing the future dad

In the case where the husband’s seminal fluid is used for fertilization, he must also seriously prepare for the procedure. Preparation consists of the following actions:

• During the entire course of the protocol, alcohol, nicotine and narcotic drugs must be prohibited;
• It is prohibited to use medications without first consulting a doctor;
• Maintain a daily routine, correctly alternating hours of rest and exercise;
• You cannot have sex, visit bathhouses, solariums, beaches, or gyms 4 days before the procedure.

How does follicle puncture occur?

Puncture of follicles during IVF is carried out by puncturing the vaginal vault with a special needle, at the end of which there is a sensor. If a woman has specific structural features of the organs of the reproductive system, the egg puncture is performed through laparoscopy.

The patient, who is located in the gynecological chair, is given general anesthesia. After she falls asleep, the doctor uses a special needle to place a sensor connected to an ultrasound machine through the vaginal vault to the ovaries. Looking at the monitor, the doctor carefully “collects” the contents of the follicles through a special pump connected to the needle.

Depending on the size of the follicles and their number, the surgical intervention can last from 5 to 10 minutes. This time is enough for an experienced physician to use a single puncture to collect follicular fluid filled with eggs from both ovaries. At the same time, the sampling is carried out very carefully to minimize risks. The contents of the puncture devices have a special treatment that does not allow the egg to be damaged during the procedure. And at the tip of the needle there is a tiny air bubble, which helps to clearly see the contents of the cavity.

As soon as the necessary biological fluid is obtained, it is sent to the laboratory to identify the most viable eggs and further grow them in an optimal environment for them. After the collection of follicular fluid is completed, the anesthesia is stopped, and after 2-3 minutes the patient comes to her senses.

Immediately after the procedure, the woman cannot go home: she must spend 1-2 hours in a medical facility under the supervision of doctors. She is also prescribed a broad-spectrum antibiotic to prevent infection.

Does it hurt or not?

How much pain will a woman experience during surgery if she wants to refuse anesthesia? It is impossible to answer this question unambiguously, since the degree of pain depends on the following factors:

• Individual sensitivity to pain;
• Experience and professionalism of the physician who performed the surgery;
• Number and location of follicles.

Despite this, in Russia, during follicle puncture, anesthesia is a mandatory part of the procedure. However, the doctor may not use anesthesia at the woman's request.

However, if there are a lot of mature follicles on the ovaries, it is better to use short-acting intravenous anesthesia. Domestic reproductive specialists believe that modern medications will not harm either the woman’s health or the integrity of the extracted eggs.

You can do without anesthesia if no more than five mature follicles are found on the ovaries, which are located on one ovary. Also, anesthesia may not be used if the puncture is performed in a natural cycle.

It should be noted that some foreign experts prohibit the use of anesthesia during puncture, suggesting that it may negatively affect the quality of the extracted egg. In Russia, the right to choose remains with the patient.

Well-being and warning symptoms after puncture

Regardless of whether anesthesia was used during the removal of follicular fluid, the sensations after puncture of the follicles cannot be called pleasant. True, most of them are a natural reaction of the body to surgery, because it is an interference in its natural work. A good doctor will definitely have a conversation with the patient: he will talk about the quantity and quality of the biological material obtained, as well as the manifestation of possible unpleasant symptoms after the procedure.

Let's look at the symptoms that are normal after a puncture for IVF:

• A temperature after follicle puncture at 37-37.5 is considered normal. You cannot take medications to reduce it;
• Uncomfortable pulling and painful sensations in the lower abdomen. The pain increases with palpation;
• Weakness, slight dizziness;
• A small volume of bloody vaginal discharge.

Most often, these signs disappear 1-3 days after the procedure. Although some women claim that discomfort accompanied them for about a month. In this case, the duration of the recovery stage after the procedure is very individual.

Despite the fact that the listed symptoms are a natural reaction of the body to outside interference, one should be wary of the fact that its manifestations will intensify significantly.

Immediately consult your doctor or call an emergency team if your temperature rises sharply, your stomach hurts unbearably after follicular puncture, and the spotting turns into bleeding. After all, taking follicular fluid can be accompanied by complications:

• Ovarian hyperstimulation;
• Internal bleeding;
• Inflammatory process.

A complication called hyperstimulation requires special attention. It appears a few days after the procedure. Severe bloating after puncture, pain, constipation or diarrhea, nausea accompanied by vomiting are all signs of ovarian hyperstimulation. Not a single patient is immune from such pathological manifestations. However, all women can reduce the risk of developing hyperstimulation to a minimum, while significantly improving their overall well-being. To do this, you must follow the following rules:

• Limit sexual activity;
• Ensure complete psychological and physical rest;
• Balance your diet.

You should know that a woman should pay special attention to the quality and quantity of food during this period. You need to continue to monitor the sufficient amount of protein in your diet, minimally reducing the amount of salt consumed. Drinking plenty of fluids will help you quickly cope with the signs of hyperstimulation, and eliminating foods that increase gas formation from the menu will reduce their manifestations.

If ovarian hyperstimulation manifests itself very clearly, accompanied by a feverish state and profuse vaginal bleeding, treatment is carried out only in a hospital.

“Collecting” follicles is a necessary procedure, without which all hormonal therapy performed will be meaningless. You should not be afraid of it, since in most patients the puncture is almost painless. You need to gain strength and patience, because in just a few days the final stage of IVF will occur - embryo transfer.

When the egg and sperm cannot fuse into one in natural conditions, they can be helped to do this in a laboratory, and then a ready-made embryo can be implanted into the uterus. But to do this, the couple's genetic material must be extracted somehow. And if with a man there are usually no problems in this regard - he just needs to bring his sperm to the clinic at the appointed time, then with his wife things are a little different. It is no longer possible to obtain her eggs naturally after ovulation. The only way out is to act proactively, that is, while ovulation has not yet occurred and the follicle has not yet burst, extract it from it using a special thin needle. This is follicle puncture during IVF.

The puncture is always preceded by hormonal stimulation. responsible for the maturation of eggs (human chorionic gonadotropin). The amount of hormone secreted by the female body is sufficient for the maturation of one egg. For pregnancy to occur under natural circumstances, this is enough, but if we are talking about IVF, then one oocyte may not be enough. There are many circumstances that can prevent successful in vitro fertilization, so genetic material should always be in stock.

Taking this into account, the standard IVF protocol always begins with ovulation induction - developing a schedule for taking hormonal drugs that force the ovaries to work harder and produce not just one or two, but 5-7 (in some cases 15-20) eggs in one cycle. . On the eve of the puncture, the woman is given an injection with an additional dose of hCG, which should help the follicles finally mature. After 34 (maximum 36) hours after this, it is necessary to extract the oocytes from them.

Important! On what day to puncture the follicles during IVF and at what time is decided by the doctor. By being late to the clinic and missing the appointed hour, a woman can ruin all her efforts. If the eggs are not retrieved in time, ovulation will occur and they will enter the cavity of the fallopian tube. It will no longer be possible to find them and get them out of there.

Follicle puncture during IVF is a transvaginal operation. It is carried out using a special ultrasound probe, which is inserted into the vagina. All manipulations are visible on the monitor screen. According to the woman’s feelings, this procedure is not much different from a standard transvaginal ultrasound. After examining the internal organs and making sure that everything is in order, the doctor proceeds directly to the puncture. To do this, he pierces each follicle and sucks out the fluid containing the oocyte.

There is no need to be afraid of this procedure - there is no pain or threat to health. Of course, the doctor manipulates a thin needle, which can touch other organs, but the risk of this is minimized. Firstly, all actions are controlled on the screen of an ultrasound machine, on which you can clearly see the follicle. Secondly, the sensor with the needle is also equipped with a special beacon that highlights the dotted line of the puncture.

Puncture under anesthesia

As for the fear of painful sensations, it is completely unfounded. No one will perform follicular puncture without anesthesia in domestic clinics. Some institutions use full anesthesia, others use only local anesthesia, but in any case, the woman will not feel pain from the puncture.

It is interesting that more and more often women themselves insist on puncture of follicles without anesthesia, and foreign clinics are increasingly willing to accommodate them. Especially if there are few follicles that have matured, and the physiological location of the ovaries allows easy and quick access to them. Refusal to take pain medication is usually triggered by concerns about the quality of the eggs obtained. And I must say that they are not so groundless. Some reproductive specialists actually believe that the effect of anesthetics can negatively affect the quality of the obtained genetic material, and therefore jeopardize the likelihood of a successful pregnancy.

Considering all the risks, most clinics today offer so-called “controlled anesthesia.” It begins to act almost instantly - 30-40 seconds after injection into a vein, and stops pumping it into the blood immediately a minute or two after all manipulations are completed. In this way, the effect of anesthetics on both the woman’s brain and her eggs can be minimized. Within 1-2 minutes the patient will come to her senses, and after two hours she will be able to leave the clinic without any problems. There will be no nausea, dizziness and weakness that are usually present after waking up from anesthesia.

How long does it last

Puncture of follicles during IVF does not last long. For everything about everything, a maximum of 10-15 minutes. It happens that the operation is delayed, but most often this is caused by a large number of mature follicles. The liquid obtained from the follicles in a special container is transferred to the laboratory. Now an embryologist will have to work with her. Only he will be able to determine how many eggs were actually obtained during the puncture. It is impossible to examine the oocyte on an ultrasound monitor; when a reproductologist makes a puncture, he sees only the follicle, which, by the way, may turn out to be empty.

You will be able to find out the results of the puncture and the date of the next visit, during which the embryo will be transferred into the uterine cavity, a few hours after the procedure. As a rule, by the time a woman finally comes to her senses and is ready to go home, her attending physician is ready to provide all the necessary information.

Important! Due to the intervention, the quality of the patient’s reaction to what is happening around her slows down significantly for some time. You can't drive in this condition. On the way home from the hospital, a woman must certainly be accompanied by someone.

Puncture of follicles using laparoscopy

This is exactly how eggs were obtained at the dawn of the development of IVF techniques. The first oocyte retrieval operations, carried out in the 80s of the last century, were carried out exclusively by the laparoscopic method, under general anesthesia.

Three small punctures, no more than a centimeter in diameter, were made in the patient’s anterior abdominal wall. A special mini-tool was inserted into each hole. One of them served simultaneously as a flashlight and a video camera - it illuminated the abdominal cavity and displayed the image on the screen in the operating room. With the other two, the fertility specialist made a puncture and pulled out the oocytes from the follicles. Once completed, the manipulators were removed and the remaining holes were stitched or glued.

Due to the traumatic nature of the method, it was soon abandoned and the technology of transvaginal puncture was developed. But nevertheless, even today, circumstances arise in which it is either very difficult or even impossible to extract eggs through the vagina. For example, due to the structural features of the pelvic organs and the difficulty of access to the ovaries. In such rare cases, egg retrieval using laparoscopy is possible.

Important! Puncture is not just for women. In some forms of male infertility, the partner may also need a similar operation. In particular, we are talking about a situation where sperm are produced in the male body, but due to problems with the ejaculatory ducts they do not enter the seminal fluid. A few years ago, such circumstances forced couples to contact. Today, azoospermia is not a reason to refuse the opportunity to have a biologically natural child, thanks to doctors who have mastered the technology of testicular puncture.

Regardless of the method used to puncture the follicles - transvaginal or laparoscopic - after it, the attending physician will certainly prescribe the patient to take hormonal medications. Their task is to prepare the uterine endometrium for future embryo transfer. The main role in this process is played by progesterone, which is sold in the form of drugs called "", "", "Iprozhin". In some cases, you may also need an additional dose of estrogens - "", "", "Estrogen".

Preparation for follicle puncture

So that all efforts and surgical interventions are not in vain, a woman must be aware that her future motherhood is in her own hands. Much indeed depends on the reproductive specialist who collects the eggs, and on the embryologist who combines them with the husband’s sperm, but, alas, not everything.

Before meeting in the same test tube, oocytes and sperm undergo thorough genetic screening. Only the best of the best will be selected. So, in order for the eggs obtained during puncture to be suitable for fertilization, a woman should follow some recommendations.

1. Do not take any medications without a doctor's prescription.
2. Avoid food additives, canned food, and any other food containing chemicals.
3. If possible, limit contact with strangers in order to protect yourself from other people's viruses and infections.
4. Take folic acid and a vitamin complex prescribed by your doctor.
5. Eat nutritiously, eat nuts, vegetable oils and fermented milk products. Eliminate from your diet too salty, spicy and fatty foods, refined carbohydrates, as well as any foods that cause increased gas formation. Drink more fluids.
6. Categorically give up smoking and alcohol, and, preferably, also caffeine.
7. For a while, forget about baths, saunas and solariums. Locked in applies to any extreme heat, even home hot baths. Massage of the lumbar area is also not advisable.
8. The month before the puncture is not the best time for intensive training in the gym or any form of heavy physical labor.
9. You should abstain from sexual intercourse for the last 3-4 days before egg retrieval.
10. The evening before the procedure, have a light dinner, and in the morning completely cleanse the bladder and intestines (using an enema is allowed). You should avoid eating and drinking on the day of the puncture.

By and large, a man should follow these same recommendations. The number and activity of the resulting sperm directly depends on his lifestyle. By joining forces, it will be easier for the couple to overcome the restrictions of the preparatory period.

Consequences of follicle puncture during IVF

After puncture of the follicles, a woman may still feel the side effects of anesthetics (dizziness, drowsiness, weakness) for some time, but it all depends on the general tolerance of the body and the quality of anesthesia. Modern medications practically do not provide such effects. But what you cannot avoid is nagging pain in the lower abdomen and scanty bleeding.

The fact is that it is, in principle, impossible to pierce the vagina and ovarian wall without touching a single blood vessel. The cavity of the follicle, from which all the liquid along with the egg is sucked out through a needle, will inevitably fill with blood and a small hematoma will form. Normally, the pain should be tolerable and completely subside 1-2 days after the puncture. Normal tissue restoration will be facilitated by bed rest - the less physical activity, the less likely there is bleeding.

Important! To help the patient relieve nagging pain, the doctor may prescribe antispasmodics or nonsteroidal anti-inflammatory drugs. Most often, regular paracetamol is sufficient. But you should never take aspirin - it can increase bleeding.

A slight increase in body temperature is also normal. 32.4 – 32.7°C is the usual thermometer reading after any surgical intervention. If the temperature rises above 38°C, then this is a good reason for hospitalization.

It is important to understand that the puncture itself rarely causes any complications. Most often, the cause of intense pain lies elsewhere - in ovarian hyperstimulation syndrome (OHSS). It is provoked not by a puncture, but by taking hormonal drugs on the eve of oocyte collection. Moreover, the more eggs matured in one stimulating cycle, the higher the likelihood of this complication. In addition to severe nagging pain, it can be recognized by a severely swollen abdomen. Even to the touch it becomes noticeably harder.

This occurs due to the significant volume of liquid blood that leaks into the abdominal cavity. It increases and begins to put pressure on the internal organs. In this case, the woman feels not only pain, but also a strong heaviness in the lower abdomen. A mild form of hyperstimulation is usually accompanied by intestinal problems - flatulence, diarrhea or constipation.

Painful sensations after puncture

The more fluid leaks into the abdominal cavity, the worse the patient will feel. Severe forms of hyperstimulation manifest themselves:

• nausea;
• vomiting;
• discomfort when urinating;
• severe increasing pain in the lower abdomen and back;
• profuse bleeding.

Any of these symptoms is a reason to immediately seek medical help, as it can cause severe internal bleeding and cost a woman her life.

Although you shouldn’t worry too much and set yourself up for negativity in advance. Severe forms of OHSS are not common. According to various statistics, the frequency of complications does not exceed 10% of the total number of punctures performed.

Puncture of follicles behind. What to expect?

After both partners have successfully donated the genetic material, they can rest for the next few days - now the embryologists get down to business. The best time to fertilize an egg is 4-6 hours after puncture. A suitable oocyte and some seminal fluid are placed in a special medium and waited until the most active sperm breaks through the protective layers surrounding the egg.

After this happens, a few more days are needed to observe the resulting embryos in the laboratory and select the best of the best for transfer. On days 2-3 or 5-6 (it all depends on the individual IVF plan), the woman will need to come to the clinic again. This time so that a fertility specialist could transfer fertilized eggs from a test tube to her uterus. Now all that remains is to wait. Whether the embryos have taken root in the maternal endometrium or not can be found out no earlier than in one and a half to two weeks by taking a blood test for hCG levels.

All this time, the woman is advised to try to remain calm and limit any stress - both psycho-emotional and physical. Leisurely walks in the fresh air are useful, but it is better to avoid overly active activities. Just like from sexual intercourse, hot baths, baths and saunas.

If the long-awaited pregnancy occurs, the gynecologist will give all subsequent recommendations. If the result is negative, hormonal medications are usually discontinued, and the next appointment with the attending physician is scheduled immediately after the end of the next menstruation. Stimulation and subsequent puncture of the ovaries is a serious stress for the body, after which it will need some time to recover. The first 2-3 menstrual cycles may occur with significant delays and disruptions - this is a variant of the norm. In some cases, it may be necessary to take estrogen-progestin drugs as compensatory therapy.

Regardless of the diversity of modern families, most of them cannot imagine their life without children. Just 10-20 years ago, the diagnosis of “childlessness” was a lifelong sentence, and there was no way out of it. The possibilities of modern medicine and IVF technology now allow a woman to give birth to her own baby in most different pathologies. Egg puncture is a mandatory procedure for in vitro fertilization. We invite you to learn more about how egg puncture occurs during IVF and all the most important things about its implementation.

Before ovarian puncture, the stimulation stage is mandatory. Normally, one (less often two) eggs mature in the ovaries of each woman every month. And with stimulation, the number of maturing follicles increases to 21 (superovulation).

Hyperovulation will increase the number of mature follicles, which will significantly increase the chances of successful IVF.

A large number of eggs will make it possible to obtain many embryos, which will bring the woman as close as possible to her intended goal of having a child.

A follicle with a diameter of 16-18 mm is considered mature. To cause artificial hyperstimulation, a woman is usually prescribed hormonal medications during the 1-3 days of the menstrual cycle. Then, within 34-36 hours, the long-awaited process of ovulation occurs in the ovaries.

Superovulation can be carried out according to various schemes. Previously, it was carried out by administering HMG (human menopausal gonadotropin) and clomiphene citrate. However, recently combinations of gonadotropin analogues have been used. The administration of these drugs can be carried out according to two main schemes: long and short.

With a “long” regimen, several hormonal drugs are administered on days 2 and 20-21 of the cycle.

The “short” regimen consists of parallel administration of hormones (or a hormone-releasing hormone antagonist) from the 2nd day of the cycle. Other options for schemes or combinations of using hormonal drugs for hyperstimulation are also possible. All this is determined by the woman’s attending physician.

After stimulation, the doctor monitors the process of follicle maturation. Usually a woman comes for an appointment every other day so that the reproductive specialist can accurately determine the moment of full maturation and completion.

In order to keep follicle development under control, the doctor records the most important parameters:

• follicle size (using transvaginal ultrasound monitoring);
• level of hormones in the blood (,);
• condition of cervical mucus.

The main goal is to perform a puncture before the oocytes ovulate inside the follicle. It is during this period that follicular puncture (retrieval of mature eggs) is prescribed.

Preparatory stage

The preparation stage for egg retrieval is especially important with IVF technology.

Any one is a huge burden on women's health. That is why it is important to reduce these attempts to a minimum and collect follicles the first time.

For a successful IVF procedure, both partners (female and male donor) must prepare and follow important recommendations for several months.

In order for the sex gametes to be as healthy and complete as possible by the time of IVF, it is important to observe the following restrictions:

• abolition or significant limitation of all medications;
• a complete diet;
• quitting smoking and alcohol;
• avoiding drinks containing caffeine;
• refusal of all kinds of “steam rooms”, saunas, baths, hot baths;
• abstinence from sexual contact 3-4 days before puncture;
• exclusion of strong physical activity;
• excluding men from wearing tight and thick underwear;
• absence of illness in the last 2-3 months.

But the woman’s behavior on the day of the puncture is especially important.

Preparation for women

Before ovarian puncture, the anesthesiologist must talk with the patient to clarify the following important details:

• height, weight, blood pressure;
• presence of allergies to drugs;
• previous operations;
• existing chronic diseases.

A woman should not be afraid and “observe” a particularly strict regime on the day of embryo transfer. Later in the day she will be allowed to both drink and eat. However, the patient will still need to comply with several restrictions.

Usually the puncture is performed in the morning. The day before, a woman is prohibited from eating later than 18-00. You can still drink the liquid. In the morning, a woman should neither eat nor drink. The fasting period should be at least 6 hours.

It is advisable for the patient to arrive at the clinic 30-60 minutes before the operation. It is better for her to have an accompanying person with her so that she has someone to take her home after the manipulation. Sometimes after this people are disoriented in time and space.

Before egg puncture, a woman must:

• shave the bikini area (especially the entrance to the vagina);
• take items of clothing (nightgown, clean socks);
• Avoid wearing makeup.

Training for men

It is important for the male partner to be in the clinic with the woman on the day of the procedure. 3 months before sperm donation, a man is prescribed a course of multivitamins. The partner must donate sperm at the time of puncture (through masturbation).

A man must also observe the following:

• 3 days before the puncture, refrain from alcohol, visiting a bath or sauna, and from sexual intercourse;
• wash the genitals with soap (preferably baby soap) before donating sperm;
• empty your bladder and bowels.

Before donating genetic material, a man should thoroughly wash his hands and penis. The sperm is collected in a sterile container without touching its internal surfaces. The donor's name must be indicated on the container. If part of the sperm could not be collected, this is reported to the attending physician.

Follicular puncture surgery

What is the operation of egg puncture or the procedure for removing mature eggs from a woman’s body? Such manipulation is not considered difficult. Usually 20 minutes is enough for her.

The procedure is performed with a special hollow needle using suction (aspiration) through the vagina.

This surgical intervention is performed under anesthesia with mandatory monitoring of an ultrasound sensor.

The ultimate goal of the manipulation is to extract fully mature eggs from the woman’s ovaries.

The procedure is performed by a gynecologist, assisted by an anesthesiologist, embryologist, and operating room nurse.

During the puncture, the woman falls into a light medicated sleep. This allows you to maintain the patient’s comfort and the effect of “not being present” in the operating room (to minimize stress).

Before the puncture, an ultrasound is performed to determine the size of the follicles. The material is collected when the ovaries contain at least 3 follicles, the size of which is about 18-20 mm.

Egg puncture during eco - sequence of actions

• The woman sits in the gynecological chair, her arms and legs are fixed. Special sensors are connected to the patient to monitor her condition.
• A drug for anesthesia is injected intravenously. The anesthesiologist monitors the woman's condition.
• The gynecologist opens the cervical canal of the cervix with special dilators. An ultrasound sensor is inserted into the cervix, under the control of which a hollow needle is inserted.
• A specialist, under the control of a monitor, finds and pierces the follicles. The eggs, along with the follicular fluid, are aspirated and collected in test tubes. Occasionally, it is impossible to find eggs in the follicles; they remain empty. This happens with incorrectly selected hormonal therapy. In this case, the woman is recommended to take a 3-month rest and make adjustments in hormonal treatment.

In laboratory conditions, mature oocytes are selected by an embryologist and prepared for fertilization. In this case, the stage of puncturing passes into the stage of fertilization and selection of blastocysts. The eggs obtained after puncture are placed in the necessary nutrient medium in a special sterile container (plate or Petri dish) and placed in an incubator. All dishes containing the material are marked with the number of eggs and the data of the married couple.

It is especially important to perform a puncture at the optimal period, preventing the release of eggs from the follicles (natural ovulation) into the abdominal cavity. If you miss this moment, the follicles will become unavailable for removal.

In special medical situations, a method of obtaining a woman's eggs by laparoscopy (through an incision in the abdominal cavity) is used.

How to behave after a puncture

Slight discomfort or bloody “spotting” is possible after the puncture and this is quite normal.

It is appropriate for a woman to lie down and rest. Patients often experience pain in the ovaries for a month after the puncture. Therefore, in most clinics, at this and subsequent stages, the patient is given a sick leave certificate.

Complications after puncture

In general, serious complications after egg puncture are rare (less than 1%). However, the possibility of damage to the pelvic organs with infection and bleeding still exists.

Therefore, in some cases, seeing a doctor is simply necessary. Such situations are:

• temperature above 38 degrees;
• the appearance of severe abdominal pain;
• discharge is copious or has an unpleasant odor;
• shortness of breath, nausea or vomiting;
• dizziness, paleness, fog, or loss of consciousness.

You should not be afraid of the egg puncture procedure during IVF. Complications are extremely rare, and modern medical capabilities make this procedure painless and quick. This stage is extremely important for realizing the dream of having a wonderful baby in the family.

Follicular puncture is a procedure in which mature eggs are removed and then fertilized in vitro.

Preparation for follicle puncture

In 5 days	The day before	On the day of the puncture
		What to do	Why
maintain sexual rest	light dinner no later than 17:30	do not eat, not to drink, don't chew chewing gum	for the anesthesia to work well
stop drinking alcohol	do not drink liquids after 24:00	leave your jewelry at home (sometimes you are allowed to leave your wedding ring on)	During the procedure, the doctor will monitor your well-being. At any moment he can examine the pupils of the eyes, the pulse on the wrists and neck, the color of the lips, face, fingers under the nail plates
give up spicy and smoked foods	remove nail polish	do not wear contact lenses
cancel visits to baths, saunas, and hot baths		don't wear makeup
		don't paint your nails

You must arrive for the procedure 30 minutes before your scheduled time. Be sure to stick to the times indicated on the card! The doctor accurately calculates the time from the injection of the hormone hCG (human chorionic gonadotropin) to the puncture. It should be no more than 34-36 hours. Otherwise, ovulation may occur, the eggs will be released from the follicles, and it will no longer be possible to get them.
The woman always comes with her husband, who donates sperm at the same time.

Should I be afraid of follicular puncture?

We answer unequivocally: “No need.”
Of course, the follicles are located inside - in the ovaries, which means you need to “make a hole”, you can touch something, damage it... Yes, all these concerns can occur if you are not familiar with the puncture technique. This is what we will do now.

Methodology for transvaginal puncture of follicles

A familiar ultrasound awaits you, only slightly modified. An ultrasound sensor with a puncture device is inserted through the vagina (“transvaginal” means through the vagina). Everything that happens inside you is displayed on a computer monitor and is under the strict supervision of a doctor.

Ultrasound examination of organs

First, nearby organs are examined to determine your individual anatomical features. This will make the procedure as safe as possible. The doctor then examines the ovaries directly. He will move the sensor until he clearly sees the liquid formation with the egg.

Puncture safety indicator

A special guide line is displayed on the monitor, which allows you to assess whether the puncture needle will enter the follicle. Only when the doctor is sure that everything is under control, the needle is pulled out and inserted. She pierces the vaginal wall and follicle.

How are the contents of the follicle collected?

The procedure is similar to drawing blood from a vein. In approximately the same way, the contents of the follicle along with the egg are absorbed from the follicle into the device. The needle is retracted into the device and the ultrasound transducer is withdrawn.

The sensor is inserted into the vagina, the needle pierces its wall and is inserted into the follicle. The contents with the egg are extracted from the follicle and placed in a test tube. Then a microbiologist will examine this liquid under a microscope. And the follicle puncture procedure is repeated until all the eggs are extracted.

Is follicular puncture painful?

For the patient, it is absolutely painless, because it is performed under general or local anesthesia. When using local anesthesia, a woman may experience a state of discomfort. But it is connected, rather, with a psychological factor. Just as a woman experiences discomfort at an appointment with a gynecologist, so it is here. In addition, the patient may be very worried about the outcome of the procedure, which will also cause discomfort.

What is the duration of follicle puncture?

The procedure is very quick and takes only 10-15 minutes. In some cases, for example, when many follicles have matured, the puncture can last up to 40 minutes.

What should the follicle size be?

The optimal size for puncture is considered to be 18-22 mm. Even if they are not mature enough, there is no need to worry. Follicles can be from 10 to 22 mm. Moreover, their size is absolutely not an indicator of the presence of an egg. On the contrary, small ones can be with an egg, and large ones can be without it.

On what day of the cycle is puncture performed during IVF?

Doctors try to perform a puncture as close as possible to natural ovulation. But it should be remembered that with IVF the so-called. stimulation of superovulation. That is, injections of hormonal drugs are given that help the follicles mature.

Why is superovulation necessary?

If normally one or two follicles mature per month, then during superovulation there can be up to ten. This allows for maximum egg retrieval because:

• some may be immature, that is, unsuitable for IVF;
• not everyone will be fertilized by sperm;
• an even smaller number will take root in the uterus.

The maturation of follicles is necessarily monitored by ultrasound.

Another guideline for timing is as follows: follicle puncture is carried out 34-36 hours after injection of the drug containing.

How do you feel after the puncture?

The patients' health is usually satisfactory. The norm is the appearance of:

1. slight weakness
2. drowsiness
3. slight nagging pain in the lower abdomen
4. light bleeding

Why does my stomach hurt after the procedure?

Pain in the pelvic area and light discharge are the consequences of a mini-operation, which is a puncture. Normally, the pain will be tolerable and the discharge will be scanty. The color of the discharge can vary from red to dark brown.

How to help with stomach pain?

For such symptoms, paracetamol is usually prescribed, and all phenomena quickly disappear. It should be remembered that aspirin and its analogues should not be taken, as this drug can increase bleeding.
Each body is individual, so before the puncture, discuss these points with your doctor.

Can there be negative consequences of follicle puncture?

Theoretically, yes. A large vessel that runs near the ovary may be damaged. But on ultrasound, the difference between the vessel and the ovary is very clearly visible by the characteristic pulsation. Therefore, a competent specialist will never make such an oversight.

When do you need a doctor's help?

There are symptoms that require you to see a doctor. They are caused not by puncture, but by taking hormonal drugs. This is the so-called ovarian hyperstimulation syndrome (OHSS). So, its signs:

• increase in body temperature above 37°
• severe or unusual pain in the lower abdomen
• backache
• heavy bleeding
• nausea
• vomit
• difficulty urinating
• diarrhea (diarrhea)
• abdominal enlargement.

If any of these symptoms appear, you should consult your doctor. These signs can appear within 24 hours after the puncture, or after a few days or already at the stage of pregnancy. Therefore, you need to remember them and contact your doctor in time.

How dangerous is OHSS?

The condition may be quite serious and require hospitalization in the department. With all this, there is no need to be scared and set yourself up for negativity in advance. The incidence of OHSS is only 0.08-10%. This is quite small. Moreover, timely assistance provided normalizes the patient’s condition.

When are they discharged from the department?

2 hours after the puncture you go home. You must have an accompanying person with you, because after anesthesia you cannot drive. Ideally, a loving husband who will support and help.

How to behave at home after a puncture?

For the rest of the day, try not to overload yourself physically, don’t look for a way out of difficult situations - rest. You can eat and drink at any time and in any reasonable quantities. Take your medications as prescribed.

When will there be news about the results?

Demonstration of the follicle puncture procedure: from registration to discharge from the clinic

The doctor's story about the nuances of puncture: the non-traumatic nature of needles and the safety of anesthesia.

Believe in yourself and you will succeed!