Process of oocyte release and capture in the human
Gynecological Surgery ,
May 2009
Stephan Gordts , Rudi Campo , Patrick Puttemans , Marion Valkenburg , Sylvie Gordts , Ivo Brosens
A PDF file should load here. If you do not see its contents
the file may be temporarily unavailable at the journal website
or you do not have a PDF plug-in installed and enabled in your browser.
Alternatively, you can download the file locally and open with any standalone PDF reader:
http://link.springer.com/content/pdf/10.1007%2Fs10397-008-0439-1.pdf
Process of oocyte release and capture in the human
Stephan Gordts
Rudi Campo
Patrick Puttemans
Marion Valkenburg
Sylvie Gordts
Ivo Brosens
-
In transvaginal hydrolaparoscopy (THL), access to the
pelvis is gained through a needle-puncture technique of the
pouch of Douglas with the patient in a dorsal lithotomy
position [1, 2]. As distension medium, a continuous flow of
pre-warmed solution of Ringer lactate is used during the
entire procedure. The watery distension medium keeps the
organs afloat. The major advantage of the transvaginal
access procedure is the possibility of inspection of the
tuboovarian structures in their natural position without
manipulation. Performed midcycle, it offers the possibility to
inspect the events at the moment of ovulation [3].
A 25-year-old patient came to see us because of primary
infertility for 2 years. There was no history of previous
interventions and, at clinical examination and vaginal
ultrasound, there were no clinical abnormalities. Patient
had regular cycles of 28 days and no dysmenorrhea.
As part of the fertility investigation, a THL was scheduled at
midcycle. The patient was asked to monitor her cycle by using
daily urinary LH assays starting on day 11 of the cycle. The LH
assay was positive on the morning of the 13th day of the cycle,
and an appointment for THL was made for 6.30 p.m. on the
same day for further exploration. A vaginal ultrasound
examination showed the presence of a 20-mm follicle in the left ovary.
The THL was performed under local anaesthesia. The
patient was conscious and could follow the entire procedure.
The ovulation stigma was identified on the caudal pole of
the left ovary. The fimbriae were in close contact embracing
the caudal pole of the ovary. Due to vasocongestion, the
fimbrial vessels were engorged and the fimbrial ends erected.
In a pulsatile way, they were sweeping the surface of the
ovulation ostium. At closer inspection, a mucinous structure
was seen protruding from the ovulation ostium and stretched
between the fimbrial ends and the ostium. The pulsatile
movements of the fimbriae, synchronous with the patients
heartbeat, slowly pulled the cumulusoocyte complex free
from the ostium of the ruptured follicle. During the
observation, follicular fluid could be seen leaking from the ostium.
The total duration of the observation lasted for 15 min.
The technique of THL allowed us, for the first time, to record
the events at the moment of oocyte release in humans. Our
observation shows that the release of the cumulus oophorus is a
slow process and is assisted by the pulsating fimbrial activity.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which
permits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
(...truncated)
This is a preview of a remote PDF: http://link.springer.com/content/pdf/10.1007%2Fs10397-008-0439-1.pdf
Stephan Gordts, Rudi Campo, Patrick Puttemans, Marion Valkenburg, Sylvie Gordts, Ivo Brosens.
Process of oocyte release and capture in the human ,
Gynecological Surgery,
2009, pp. 159, Volume 6, Issue 2, DOI: 10.1007/s10397-008-0439-1