Consensus has been reached on requirements for safe and standardised oocyte pick-up under ultrasound guidance. Dr Arianna D’Angelo presented the highlights from the most recent recommendations document, which was developed by ESHRE's SIG Safety & Quality in ART.
ESHRE has been developing evidence-based guidelines in reproductive medicine and embryology since 2010. They follow a structured methodology and provide valuable guidance based on best quality evidence. However, some relevant topics lack the back-up of thorough research and the evidence-based approach is not feasible for answering key questions.
Broad variations in practice exist between countries and even between clinics of the same country in processes that lack adequate evidence. ESHRE has addressed this by developing a new manual for the development of consensus-based recommendations for good practice. Topics for recommendations are different and more practically orientated than those for evidence-based guidelines.
To highlight such inconsistencies in oocyte pick-up processes worldwide, D’Angelo began her presentation with four definitions aiming to describe the same process: transvaginal oocyte retrieval (TVOR), egg retrieval (ER), oocyte collection (OC) and follicle aspiration. After defining the outline and performing data collection from 108 relevant studies, recommendations have now been grouped under ten domains involving expert opinion.
The domain prior to oocyte pick-up reunites agreements related to planning the procedure in terms of assessing potential difficulties - by performing a baseline ultrasound four to six month before, screening for potential vaginal infections, following local protocols and preventing possible complications by taking actions based on individual and accurate histories. An equipment and consumables domain follows to provide more technical recommendations - such as the frequency for the transducer, image optimisation tools, types of aspiration needles to be used and aspiration pressures based on manufacturer’s advice.
The preparation domain follows chronologically and sets up the recommendations closer to the day of pick-up. These include timing the procedure 34-38 hours from the trigger, having a team of at least one operator and one assistant, completing the WHO safety checklist and ensuring the practicalities (such as fasting, emptying the bladder and positioning the patient).
The fourth domain covers important aspects of the procedure itself: the use of flushing using double lumen needles, aspirating the peritoneal fluid in case of premature ovulation and performing trans-abdominal ultrasound in case of suspected abdominal bleeding.
Domains five to seven address post-procedure care, associated pathologies and cautions, and complications and risks following oocyte pick-up. In a field that is evolving continuously, the future developments domain includes expected advances with artificial intelligence and predictor tools for the growth of the follicles.
The final two domains address the need for adequate training and competence to assure quality and performance. These include minimum standards to be achieved in order to gain and maintain competency.
In addition to direct recommendations, the document includes troubleshooting boxes and checklists for critical situations - such as not retrieving any oocytes, or when the tip of the needle is not visualised or the suction system fails.
For details about each of the domains covered, the full recommendations may be downloaded from ESHRE’s website (https://www.eshre.eu/Guidelines-and-Legal
* A Campus meeting on Quality Management in ART: new and practical insights from old concepts will take place 24-26 October 2019 in Palermo, Italy.