By Cristina Mestre Ferrer BSc, MSc (embryologist).
Last Update: 11/24/2015

Follicular puncture is one of the steps involved in the in vitro fertilization process. This procedure allows egg retrieval from inside the ovarian follicles of a woman. Once retrieved, the eggs will be manipulated in the laboratory to carry out either a conventional IVF or an ICSI, depending on the assisted reproductive technology required.

We visited the fertility clinic Reproducción Bilbao, located in the Basque Country, Spain, where Dr Gorka Barrenetxea and embryologist María De Las Heras explain what follicular puncture is all about:

Every fertility treatment can be divided into 4 phases: firstly, ovarian stimulation, preceded by egg retrieval via follicular puncture. Thirdly, the retrieved oocytes are used in the in vitro fertilization laboratory, and the last step is the embryo transfer.

Ovarian stimulation

The first step towards follicular puncture is ovarian stimulation, which can be done using stimulation of ovarian function medications. This process is what we call controlled ovarian stimulation, often abbreviated as COS. Through COS, multiple ovarian follicles will grow and develop till they reach the adequate size.

Previously, the ovarian stimulation phase usually took a month; now, thanks to updated ovarian stimulation protocols, it takes no longer than 10-15 days and turns out to be safer than before. Thus, during the period of time in which the woman has to self-administer hormone injections, she will be monitored through ultrasound scan and blood tests to evaluate follicle growth and development.

Once the optimal follicular size is acquired, oocyte retrieval is scheduled.

Follicular puncture step by step

As mentioned hereunder, once the ovarian follicles reach the appropriate size, follicular puncture is performed in the operating room. It is a simple surgical intervention in which the grown eggs are retrieved.

While local anesthesia can be used as well, usually it is performed under sedation; therefore, the patient is in state of unconsciousness and cannot feel any pain. However, although some discomfort may be felt after oocyte retrieval, generally it is not painful.

When the woman is under sedation, each follicle is punctured with an ultrasound-guided needle for oocyte retrieval. The fluid removed from inside the ovarian follicle will be placed in a test tube and taken to the IVF laboratory.

There, the embryology team will search for the presence of oocytes within the follicle fluid and these oocytes will be the ones selected and used to perform either a conventional IVF or an intracytoplasmic sperm injection (ICSI).

How long the follicular puncture procedure takes will depend on the number of eggs the patient has produced. Anyhow, it usually takes around 20-30 minutes. After this process, the woman will rest for an hour or less at the rest suite. It won’t be until anesthesia is proved to have disappeared when the woman will be allowed to leave the clinic and return home on her own.

Even though the patient feels good after follicular puncture, due to sedation, she must be accompanied that day. Besides, rest following the invervention for the rest of the day is strongly advisable, mainly because feeling some nuisances is not uncommon. Afterwards, the medical team will give you precise indications as to how the IVF cycle will develop from now on.

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Authors and contributors

 Cristina Mestre Ferrer
BSc, MSc
Embryologist
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information
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7 comments

    1. Aurora

      Thank you very much!

    2. Aurora

      Hi! Thanks for this info.

      In addition I wanted to know: if the eggs can’t be grown more than 4 mm, even with 10 days of stimulation (puregon and menopur). Can you get them and grow in laboratory and later fertilize them outside the body?

      • Sandra FernándezBA, MA

        Hello Aurora,

        I’m so sorry I don’t quite understand your comment, because there is no possible way an egg measures 4 mm. Are you talking about your follicles? In any case, follicles usually measure between 18-20 mm, so I still don’t manage to get your concern. Can you explain yourself a little bit more?

        Thank you very much

        • Aurora

          Hi again!

          My follicles are 4 mm, although I took Puregon and Menopur for 10 days (stimulation). Can you fertilize them outside my body? Growing them I mean…

          • Sandra FernándezBA, MA

            Hi again Aurora,

            thanks for clarifying it 😉 Now I understand what you mean… Well, I’m afraid your follicles are too small even for in vitro maturation (IVM). The most common in cases like yours is canceling the cycle and start over again another stimulation cycle with a greater dosage.

            I hope I have been able to help,

            Regards

    3. amanda22

      Okay, but the question remains… is egg retrieval painful? Because I have fear of needles and if besides it is painful, I don’t think I will be able to stand it. Please, help me!

      • Sandra FernándezBA, MA

        Hello amanda22,

        As mentioned in this post, it is done under sedation, therefore you will be in a state of unconsciousness and therefore unable to feel any pain. However, maybe you feel some discomfort around your ovaries following the intervention, but it is tolerable, so don’t panic 😉