Ovarian puncture is the process of collecting the contents of a follicle or cyst. The procedure is performed for various pathologies of the gonads, as well as in preparation for in vitro fertilization. Puncture intervention allows you to obtain material for IVF, as well as make an accurate diagnosis for ovarian diseases. In modern gynecology, the procedure is performed under ultrasound control, which makes it possible to minimize risks and avoid the development of complications.
What is ovarian puncture in gynecology, and why is it needed?
In gynecology, ovarian puncture is prescribed in the following situations:
- Before IVF. In preparation for in vitro fertilization, obstetricians puncture the ovary to collect eggs and conceive a child in a test tube.
- For the diagnosis of ovarian formations. By puncturing the cyst, the doctor can obtain material for histological examination and determine the nature of the pathology.
- For the treatment of ovarian diseases. The puncture is used to reduce the size of the cyst.
Question to the expert
The date for the ovarian puncture was set, and I had a question: is it possible to go to work immediately after the procedure?
After puncturing, it is recommended not to overexert yourself for two hours. You can spend this time in bed. In the future, if you feel well, you can go to work, but it is better to take that day off and not expose your body to unnecessary stress.
How to increase your chances of fertilization
To avoid the formation of ovarian hyperstimulation and for more productive sampling, doctors recommend following the following rules:
- Take all hormonal medications according to the prescribed regimen (if IVF is done in a natural cycle, then the medications are not taken).
- Before starting the protocol, undergo a full medical examination.
- It is advisable to start following a diet a month before your appointment - exclude fatty, unhealthy and heavy foods from the diet, include easily digestible protein, carbohydrates and healthy fats in the menu.
- Take only those hormonal medications prescribed by your doctor.
- Follow a daily routine, lead a healthy lifestyle, get enough sleep and rest.
- Avoid overexertion, stress, and anxiety.
The video will show you in detail how the puncture is performed.
How is an ovarian puncture taken? Procedure technology
During ovarian puncture, the patient is positioned in a gynecological chair. The entire procedure in modern clinics is carried out under ultrasound control. This approach allows you to accurately determine the location of the needle insertion and reduces the risk of complications.
Stages of ovarian puncture:
- Search for the ovary using an ultrasound machine.
- Determining the location of needle insertion.
- Puncture of the vaginal wall with a special needle under ultrasound guidance.
- Inserting a needle into the ovarian tissue or cyst cavity.
- Collection of material: follicles or fluid from the cystic cavity.
- Removing the needle.
Depending on the indications for ovarian puncture, the preparation and procedure for performing the procedure may differ.
Question to the expert
Why drink a lot of water after ovarian puncture during IVF? The doctor told me to drink up to 1.5 liters a day, but I can’t. Is this necessary?
Drinking plenty of fluids is prescribed to all women after ovarian puncture. This tactic allows you to reduce the risk of developing hyperstimulation syndrome, one of the common complications of puncture. Follow your doctor's recommendations! Drink as much as possible, in small portions throughout the day.
Types of cysts
Cysts are divided based on the type of their formation.
- Dermoid cyst
A mucous structure, the size of which does not exceed 5 cm. It may contain fluid, mucus, fat and even hair. - Yellow cyst
This type of cyst has thickened walls. It is formed at the site of a burst follicle, where the “corpus luteum”, which produces progesterone to support conception, has not resolved. - Hemorrhagic cyst
Appears due to hemorrhage of a yellow cyst or follicular cyst. - Serous cyst
A benign formation containing a light-colored fluid. - Follicular cyst
If the follicle cannot rupture, the mature egg does not leave the ovary. Ovulation does not occur. An unruptured follicle fills with fluid, resulting in the formation of a follicular cyst. At the initial stages, this type of cyst does not manifest itself in any way, so the same thing may happen again during the next menstrual cycles. As a result, multiple small cysts are formed on the surface of the ovaries, sonographically resembling “grape seeds”. This pathology of the reproductive system is called polycystic ovary syndrome.
Transvaginal ovarian puncture during IVF: how does it happen?
Puncture of the ovaries during IVF is preceded by a preparatory stage:
- Stimulation of ovulation. Drugs are used to promote follicle maturation. During stimulation, it is usually possible to obtain several full-fledged eggs, which significantly increases a woman’s chances of becoming pregnant. Injections of drugs are performed in a clinic, but in some cases a woman can give injections on her own after simple training.
- Monitoring follicle growth using ultrasound. For successful in vitro fertilization, you need to obtain follicles with a diameter of at least 16 mm. The thickness of the endometrium (the mucous layer of the uterus) must be at least 8 mm. A good option is the growth of 8-10 full-fledged follicles.
- Administration of human chorionic gonadotropin (hCG) for final maturation of the egg.
Question to the expert
After puncture of the ovaries, bleeding began. They took me to the hospital and prescribed an IV. Tell me, can bleeding affect the course of pregnancy?
Unfortunately, it is impossible to predict for sure. It is necessary to do an ultrasound and assess the viability of the embryo so that we can talk about the prognosis and further tactics.
How is ovarian puncture done during IVF?
On the day of the procedure, you must take a hygienic shower. Immediately before puncture, you should empty your bladder. The procedure is carried out in a specially equipped room. The patient changes into a sterile shirt and then takes a comfortable position in the gynecological chair.
Transvaginal puncture of the ovary is prescribed 24-36 hours after the administration of hCG. Follicles are taken according to the scheme indicated above. There is no need to be afraid of this procedure - it is quick and does not hurt. The entire puncture takes no more than 15 minutes, after which the patient is transferred to the ward and remains under the supervision of a doctor for some time.
Question to the expert
Last year I had surgery to remove an ovarian cyst. After the anesthesia, I couldn’t come to my senses for a long time, then I had a severe headache and felt sick. Now there is an ovarian puncture coming up, and the doctor says that I will just sleep through the entire procedure. I'm afraid: what if it gets bad again? Is ovarian puncture performed without anesthesia?
Ovarian puncture can be performed under local anesthesia, but this tactic is not recommended. It is better when the patient sleeps peacefully during the puncture, and the doctor can do all the necessary manipulations. Modern clinics use high-quality anesthesia, from which recovery occurs without complications. Check with your anesthesiologist which drug will be used and whether the mildest anesthetic agent can be selected based on your situation.
On what day of the cycle is ovarian puncture performed during IVF?
When stimulating ovulation, the procedure is performed on the 13-15th day of the menstrual cycle. The puncture is done one day after the administration of hCG. It is important not to waste time, since there is no point in doing puncture 36 hours after the injection.
In the natural cycle, follicle maturation is regularly monitored. An ultrasound is performed from the 8th day of the cycle until the onset of ovulation. On average, the maturation of the egg occurs on the 12-14th day after the start of menstruation.
Fertilization of the obtained eggs is carried out on the day of puncture. The embryos are transferred into the uterine cavity on the 3-5th day. Some embryos can be frozen and used in the future. This scheme is practiced when obtaining a large number of embryos (more than three) or in a situation where a woman undergoes radiation therapy (irradiation of the ovaries) for a malignant tumor.
Anesthesia
The method of pain relief during follicular puncture is selected for each patient individually. In this case, the patient’s psycho-emotional state, her individual characteristics, and the level of pain threshold are taken into account. If there is increased anxiety or fear on the eve of a puncture, it is recommended to take tranquilizers - drugs that balance the functioning of the central nervous system.
When puncturing follicles, the following types of anesthesia are used:
- General anesthesia. The drugs are administered intravenously or inhaled. Under their influence, a woman loses sensitivity to pain, relaxes and temporarily loses consciousness.
- Sedation is the introduction of a woman into a shallow sleep. There is no discomfort or pain.
- Local anesthesia is used only if there are contraindications to general anesthesia. In most cases, an anesthetic is injected into the cervix, which numbs the posterior vaginal vault, the area where the piercing will be done.
- Combined - simultaneous use of local and intravenous anesthesia.
When the ovarian puncture is carried out in a natural cycle, that is, the contents of one follicle need to be taken, then anesthesia is not required.
Ovarian cyst puncture: features of the procedure
In modern gynecology, puncture of an ovarian cyst is rarely performed, and there are explanations for this:
- During puncturing, the capsule of the formation is opened. If the tumor turns out to be malignant, it spreads to surrounding tissues. This procedure significantly worsens the prognosis and increases the likelihood of an undesirable outcome.
- Theoretically, puncture when a cyst is detected allows you to obtain fluid for analysis and determine the nature of the pathology. In practice, if a malignant tumor is suspected, it is better to remove the cyst than to open its capsule and expose the woman to unnecessary risk. Examination of the cyst tissue is performed after its removal.
Puncture of an ovarian cyst can also be performed for therapeutic purposes. Alcohol is injected into the cavity, the walls stick together, and the formation decreases in size. Today such tactics are practically not used. Puncture followed by the administration of alcohol during surgery is allowed. Once the cyst has decreased in size, it can be easily removed during laparoscopy.
Ovarian cyst puncture before IVF
Stimulation of ovulation with medications leads not only to the growth of follicles, but also to the appearance of cysts. These formations are functional and usually go away on their own within 3 months, but it is not always possible to wait this period. It is also impossible to plan a pregnancy against the background of such a cyst. Any voluminous formation of the ovaries during gestation may begin to grow rapidly. The development of complications – torsion of the leg or rupture of the capsule with hemorrhage – is also possible. All these arguments suggest that the cyst must be removed, and this must be done before conceiving a child.
Question to the expert
After a long examination, a diagnosis was made, and the doctor referred me to IVF. I know that the procedure is long and will require ovarian puncture. I would like to know what kind of anesthesia is used during ovarian puncture during IVF - local or general, and which is better?
Ovarian puncture is usually performed under general anesthesia. This way the doctor can perform all the necessary manipulations, and the patient will not feel pain.
Puncture of the cyst is one of the methods to solve the problem. Immediately after collecting mature follicles, the doctor inserts a needle into the formation and pours in a certain amount of alcohol. The walls of the cyst stick together and it stops growing. Ovarian function is not impaired. This tactic allows the doctor to remove a potentially dangerous formation and increase the chances of a favorable IVF outcome.
Question to the expert
I am an egg donor. The puncture was performed a week ago, after which my husband and I had sex a day later. Is it possible to get pregnant after ovarian puncture on your own or were all follicles taken during the puncture?
Spontaneous pregnancy after puncture is possible. Not all mature follicles are taken during the procedure. If at least one egg remains, it is possible to conceive a child. Take a blood test for hCG after 10 days to find out for sure if you are pregnant.
Preparing for the procedure: tips and tricks
Despite the short duration of the procedure, it requires careful preparation. Preparation for follicle puncture during IVF
is as follows:
- You must try to lead a healthy lifestyle. This refers to the ban on smoking and alcohol, abuse of spicy and fatty foods. It is advisable to limit excessive physical activity.
- Try to avoid viral and infectious diseases, and prevent exacerbation of chronic processes, if any.
- Do not take medications without the knowledge of a fertility specialist.
- Food should be rich in vitamins and minerals.
Let us repeat, during the stimulation process, when the follicles reach a certain size (about 18 mm), the reproductologist prescribes a so-called trigger, which ensures the final maturation of the eggs. For this purpose, human chorionic gonadotropin is used, which is administered 34-36 hours before the procedure. Strict adherence to the doctor’s instructions in the stimulation protocol, especially the time of trigger introduction, is one of the most important conditions for successful egg retrieval.
Consequences of ovarian puncture
After completion of the procedure, the patient remains under the supervision of a doctor. The state of health is disturbed, the appearance of complaints is noted:
- Drowsiness for 1-2 hours after puncture.
- Marked weakness.
- Nagging pain in the lower abdomen.
- Bloating.
- Short-term constipation.
- Increase in body temperature to 37-38 degrees.
- Bloody vaginal discharge is scanty or moderate. There should not be a lot of blood after the puncture. The discharge persists for 2-3 days, gradually decreases and disappears.
Such symptoms are considered normal and do not require special treatment. Short-term use of anti-inflammatory drugs is allowed for pain in the lower abdomen after puncture.
Possible complications of puncture:
- Intra-abdominal bleeding. Occurs when the ovary is injured during puncture. Accompanied by increased pain and the appearance of copious vaginal discharge. Nausea and vomiting, decreased blood pressure, and loss of consciousness are possible.
- Infection. It develops when the puncture technique is not followed, as well as against the background of concomitant inflammatory processes in the genital tract. Leads to an increase in body temperature and severe pain in the lower abdomen.
- Cyst rupture. A specific complication that occurs during puncture of space-occupying lesions. Leads to excessive bleeding. Accompanied by the appearance of sharp pain and a significant deterioration in well-being.
The development of undesirable consequences can be avoided by following the rules for performing a puncture and assessing all risk factors.
Pashkova Alla Valerievna
Obstetrician-gynecologist, candidate of medical sciences.
Ask a Question
If your general condition worsens and unpleasant symptoms increase, you should consult a doctor as soon as possible.
Question to the expert
Three days ago I had an ovarian cyst punctured. At first everything was fine, I was discharged home. The ovaries did not hurt too much, the temperature was not high. Today the pain intensified sharply, the temperature rose to 39 degrees. Why did the temperature increase after ovarian puncture and what should I do now?
An increase in body temperature is an alarming sign. Complications may develop after puncture: rupture of the cyst, infection of the ovary. Be sure to consult a doctor - you need to find the cause of this condition and begin treatment.
