Ovogene Egg Bank offers full support along every step of the way to all partner clinics, from quality management to laboratory standardization and through to medical processes.
Ovogene Egg Bank will monitor all procedures throughout the donor programme with collaborating partner clinics.
In accordance with our audit system:
- Laboratory quality management, SOPs, air quality and standardization will be controlled.
- Laboratory team will be trained by our experts and all protocols will be shared with partner clinic’s.
- Warming (thawing) and embryo culture system will be checked by our experts and we will share our experiences with partner clinics.
- Each IVF outcome throughout the donor egg programmes will be closely followed by our experts.
- Online consultation will always be available between our experts and partner clinic’s laboratory team.
The critical steps in oocyte retrieval:
- Identify the preparations prior to oocyte retrieval.
- Describe the techniques of oocyte retrieval.
- Evaluate the methods for assessing functioning of equipment and personnel involved in oocyte retrieval, that may impact the quality of the oocytes retrieved.
- Document the outcome of oocyte retrieval.
- Quality control measures that must be performed prior to the retrieval to be certain that equipment is functioning as intended.
- Tasks that should be completed prior to the retrieval.
- Principles that should be adhered to during the retrieval.
- Communication between the laboratory and the clinician during the retrieval.
- Documentation of the retrieval results.
- Quality assurance measures that may be helpful in assessing the performance of the retrieval.
Facilities and Equipment
The procedure room should be designed to provide comfort and privacy to the patient when undergoing the procedure, while maintaining the patient in a position that allows for the physician to complete their job with ease. In addition, the space should maintain an optimal environment for the collection of oocytes and preserving their viability from aspiration until the oocytes are in the embryology laboratory. Most programmes perform oocyte retrieval while the patient is consciously sedated. However, should there be an emergent need for laparotomy or laparoscopy, means of anesthesia should be available, either onsite, or within a short transportable distance.
Retrievals involve the insertion of an aspiration needles into the peritoneal cavity, usually through the vaginal wall, but occasionally through the abdominal wall.
With repeated insertion of the aspiration needle, there can be bleeding and haemostasis is commonly required after completion of oocyte collection. The room should provide the means to accomplish this. Aspiration of follicular fluid requires the insertion of an aspiration needle into the Graafian follicles of a woman's ovaries and application of suction to draw the follicular fluid out of each follicle and deposit it into a tube for examination. The suction may be provided by a vacuum pump or a syringe and the suction method must be available in the room at the time of the procedure.
Some programmes prefer to flush fluid into the follicles after aspiration. This fluid is typically culture medium or a simple isotonic salt solution. There should be a mechanism in the procedure room throughout the duration of oocyte retrieval to maintain the flushing medium at the appropriate pH, by equilibration with CO2 if necessary, and at body temperature.
The embryology laboratory should be temperature and humidity controlled so that temperature-sensitive controlled devices, such as incubators and warming surfaces, do not undergo fluctuations or unusual offsets due to the ambient conditions in the lab. The room should be located conveniently near to the operating room or procedure room, to minimize exposure of follicular aspirates to uncontrolled environmental conditions during transit to the laboratory. Many programmes locate the embryology laboratory immediately adjacent to the procedure room. Other programmes prefer to use a re-engineered paediatric incubators with a temperature, humidity, and CO2-controlled interior, and fitted with a dissecting microscope.
This incubator may be wheeled into the procedure room, and the laboratory portion of oocyte retrieval can be performed by a technician working with the follicular aspirates and identified oocytes, while they are maintained in the incubator's controlled conditions.
The embryology laboratory, where oocytes will ultimately reside, should be equipped with incubators that have undergone quality control to assure that their temperature, gas concentrations, and humidity are within tolerable ranges specified by the laboratory. Whereas appropriate pH and osmolality of the media have been documented and targets for these values are well known, the ideal temperature for embryo culture has not yet been established (McCulloh, 2012). Generally, laboratories rely upon the notion that the ideal culture temperature is one that mimics body temperature - 37.0⁰C. Temperature is considered quite important, due to the temperature sensitivity of the meiotic spindles (Meng et al., 2001).
The embryology laboratory should have sufficient equipment to perform the embryology tasks anticipated, such as dissecting microscope(s) for examination of cumulus masses, corona radiata, and oocytes, and warmed surfaces (stage of microscope, tube warmers, large surfaces for dishes in which follicular aspirates are examined). All equipment should be maintained and checked frequently as a quality-control exercise.
Air quality in the laboratory has been the subject of great concern during recent decades (Cohen et al., 1987). It is notable that gametes and embryos in culture do not have the advantage of organ systems in the body to help detoxify their environment (e.g. the immune system, lungs to limit exposure to environmental gases, liver to remove toxins from the body fluids). Therefore, similar systems should be employed to limit the gametes' and embryos' exposure to airborne agents while maintained in vitro.
Systems such as HEPA and carbon filtration have been created to remove particulates and minimize the presence of volatile organic compounds. Minimization of redox reagents using potassium permanganate is another technique. Systems like these should be considered, especially in the typical urban setting of an IVF facility.
Preparation for the Retrieval
Physician's orders should be written unambiguously so that the laboratory knows what procedures must be performed with the oocytes retrieved. Written orders may be maintained on paper or electronically and are generally expected to be provided on requisitions furnished by the laboratory. Not knowing the orders prior to the retrieval may lead to confusion and delays in processing or even inappropriate treatments of the oocytes.
The orders should include the intent of oocyte retrieval for oocyte freezing or for fertilization; whether insemination will be via standard co-incubation of the oocytes with sperm or via intracytoplasmic sperm injection (ICSI) or whether some oocytes will have standard insemination and some ICSI; whether the patient is intending to undergo transfer (replacement) of fresh embryos from this retrieval or whether the embryos are all intended for cryopreservation; and at what stage should cryopreservation be performed. Finally, it is extremely helpful for the technician performing the retrieval to have some idea of the number of oocytes anticipated.
It allows the technician to be emotionally prepared for a long retrieval with many oocytes or for a short retrieval with few oocytes and possibly more extensive examination to find the small number(s) of oocytes expected.