Transabdominal retrieval of oocytes when transvaginal access is not an option: mastering an egg-cellent technique

OBJECTIVE: To demonstrate the step-by-step technique for performing a transabdominal oocyte retrieval (TAOR) with a vaginal transducer in patients where transvaginal access is not an option. DESIGN: Video article. SETTING: Academic fertility center. SUBJECT(S): The first patient is a 38-year-old G0 woman with prior midline laparotomy for myomectomy and endometriosis resection. In vitro fertilization (IVF) was recommended after unsuccessful natural conception attempts. Her baseline anti-Mullerian hormone (AMH) was 17 pmol/L (2.38 ng/mL). The second patient is a 26-year-old G0 woman with history of multiple abdominal and pelvic surgeries due to congenital vaginal and anal atresia. She presented with locally advanced cancer of the neovagina. Her baseline AMH was 24 pmol/L (3.36 ng/mL). The patients included gave consent for publication and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. INTERVENTION: Both patients underwent controlled ovarian stimulation using a gonadotropin-releasing hormone antagonist (GnRH-ant) protocol. Oocyte retrievals were performed transabdominally using a 7 MHz vaginal transducer fitted with a disposable needle guide and a 17 gauge, 25-cm single lumen aspiration needle. Follicular aspiration was performed with a pedal-activated vacuum pump with suction pressures ranging between 105-140 mm of Hg. MAIN OUTCOME MEASURES: Oocyte yield after TAOR. RESULTS: The first patient's IVF cycle yielded 12 oocytes, of which 8 fertilized with conventional insemination; four blastocysts were cryopreserved. A frozen embryo transfer is planned imminently. Twenty-one oocytes were retrieved in the second patient, of which 12 mature oocytes were cryopreserved for future use. She is currently undergoing radiation therapy. CONCLUSION: TAOR using a vaginal transducer is a safe, effective, and feasible method of oocyte retrieval in select patients where ovaries are not accessible transvaginally. This technique may be more easily adopted where abdominal transducer needle guides and adapters are not readily accessible, offering a practical alternative for oocyte retrieval in patients with complex pelvic anatomy or pathology.