Under ultrasound guidance, the operator inserts a needle through the vaginal wall and into an ovarian follicle, taking care not to injure organs located between the vaginal wall and the ovary. The other end of the needle is attached to a suction device, which should has a temperature around 37 °C. Once the follicle is entered, suction is gently applied to aspirate follicular fluid with a pressure of -140 mmHg, which is the necessary to aspirate rapidly, but not enough to break the follicles; and with it, hopefully, cellular material including the<unk> . The follicular fluid is delivered to a technician in the IVF laboratory to identify and quantify the ova. Next, other follicles are aspirated. Once the ovarian follicles have been aspirated on one ovary, the needle is withdrawn, and the procedure repeated on the other ovary. It is not unusual to remove 20<unk> s as women are generally hyperstimulated in advance of this procedure. After completion, the needle is withdrawn, and hemostasis is achieved. The procedure usually lasts 2060 minutes. Once the extraction is done, the sample is analyzed in the microscope to select and carry out the<unk>  decumulation, a process where the granulosa cells surrounding the<unk>  are removed. Initially performed using transabdominal ultrasonography, TVOR is currently performed with a<unk>  ultrasound transducer with an attached needle. TVOR is performed in an operating room or a physician's office, with the (female) subject in the lithotomy position. TVOR is usually performed under procedural sedation, general anesthesia, paracervical block, or sometimes spinal anesthesia. Local anesthesia is not typically used because local anesthetic agents interfere with follicular cleavage and the technique requires multiple needle punctures. This technique must be done very delicately, without stimulating the uterus, so that contractions do not occur. It is also necessary that the environment is relaxing so that the women does not stress. Adjunctive procedures Follicular flushing has not been found to increase pregnancy rates, nor result in an increase in<unk>  yield. On the other hand, it requires a significantly longer operative time and more analgesia. Seminal fluid contains several proteins that interact with epithelial cells of the cervix and uterus, inducing active gestational immune tolerance. There are significantly improved outcomes when women are exposed to seminal plasma around the time of<unk><unk> , with statistical significance for clinical pregnancy, but not for ongoing pregnancy or live birth rates with the limited data available.
Transvaginal oocyte retrieval
Posthumous sperm retrieval
Menstrual extraction
Ovarian tissue cryopreservation
Ovarian drilling
Ovarian stimulation
Artificial insemination
Embryo transfer