Oocyte retrieval is done under spinal anesthesia or intravenous sedation using fentanyl and midazolam (1-2 mg). Intravenous fentanyl is administered at intervals of 15-20 min up to a total dose of 150-200 mg. Local infiltration of bupivacaine 0.5% in the vagina reduces the discomfort of multiple needle punctures. Retrieval is performed under ultrasound guidance with a 19-G, single-lumen aspiration needle. The aspiration pressure is reduced to 7.5 kPa. The follicular fluid is collected in culture tubes containing 0.9% saline with 2U/mL of heparin. Because immature oocytes are enclosed in tightly packed cumulus cells, curettage of the follicle wall will dislodge the cumulus oocyte complex. In an immature oocyte collection, multiple needle punctures are needed. Because the aspiration pressure is low and a small-gauged needle is used, the bloodstained aspirate may often block the needle. Therefore, the needle is withdrawn from the vagina after aspirating a few follicles to flush and clear any blockage. The procedure is repeated until all follicles seen are aspirated.
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