The puncture procedure takes about half a day and requires the presence of both spouses in the clinic.
The purpose of this stage is to obtain eggs from the follicles of stimulated ovaries by puncturing them with a cannula (puncture). This intervention is performed under operating conditions, under intravenous anesthesia, under ultrasound guidance. The contents of the follicle (follicular fluid with eggs) are transported to the embryology laboratory in special sterile disposable plastic containers made of non-toxic polymer. The whole procedure of follicle puncture lasts, on average, 15 -20 minutes.
The time of puncture is scheduled by the doctor in advance and according to the standard scheme: 35-36 hours after administration of hCG. The date and time of the intended puncture are recorded in the patient’s appointment list.
On the day of the puncture, both spouses must arrive at the appointed time (usually punctures are carried out in the morning) to the clinic. If necessary, documents are drawn up and the rest of the IVF procedure is paid for.
Then the patient is invited to a special room (usually a comfortable room for several beds) for changing clothes: she measures her body temperature, blood pressure, she finds out her general well-being, she is offered to completely empty her bladder. She is escorted to the operating room, where they prepare for the puncture: they help to lie down in the gynecological chair, they process the external genitalia. An anesthesiologist and a doctor are invited to the operating room. After the introduction of drugs for anesthesia (that is when you fall asleep), the procedure itself is carried out.
After the puncture, you are under the supervision of the medical staff of the clinic for 1.5-2 hours. After the anesthesiologist is satisfied that you are in satisfactory condition and well-being, you will be allowed to stand.
The spouse at the time of completion of the puncture must pass the sperm for its subsequent analysis, special processing and fertilization of the eggs obtained.
After the entire procedure, you will again meet with your doctor, who will tell you how the puncture was done, how many eggs are received, and also prescribe you drugs that you will take according to the schedule up to the pregnancy test.
After the follicular fluid enters the laboratory, the embryologist conducts a “search” for the eggs, which are then placed in the incubator. Fertilization is carried out by concentrated sperm 4-6 hours after receiving the eggs. For normal fertilization, approximately 50 thousand spermatozoa are used per egg cell. If the sperm parameters do not meet the requirements of standard IVF or previous IVF attempts were unsuccessful, the question of further treatment tactics (possibly ICSI or IVF using donor sperm) is discussed. The ICSI technique is used for the fertilization of mature eggs in case of insufficient spermograms of a spouse.
If it is difficult to obtain sperm on the day of puncture or no sperm in the ejaculate, a special procedure is provided – testicular biopsy.
Puncture day is considered the zero-day of embryo cultivation; the first day of cultivation is the day following the puncture. It is on this day that most of the eggs appear the first signs of fertilization. They are already noticeable in 16 – 18 hours after the connection of eggs with spermatozoa (insemination). Re-assessment of fertilization is carried out in 24-26 hours after insemination. Control of fertilization is carried out by the embryologist when viewing cups of cultured cells under a microscope.