Does size matter (needle size that is)?

We just received follow up from one of our young patients who recently had an egg retrieval. She was one of our Egg Donors, a young woman who donates her eggs to another patient who is having difficulty conceiving because of poor egg quality. Our donor is feeling great! She has had minimal to no discomfort. She had undergone an egg retrieval at another center in the past and she said that this was a definite improvement.

So what was so different at Hanabusa IVF that made it so much better for her?

Could it be the medication protocol?

That isn’t it. Because the patient was donating her eggs and had a good response elsewhere, I basically repeated the same protocol (for those of you that are curious and well-versed, it was a “Short” protocol).

Could it be the anesthesia?

Because donors tend to produce more eggs, I still encourage General Anesthesia with these patients (although I have retrieved as many as 30 eggs under local anesthesia). I do tend to ask my Anesthesiologist to use more expensive, shorter acting medications that may reduce the nauseous, hung-over feeling associated with less expensive medications, but this does not explain the decrease in pain.

Could it be skill and technique?

Most of the IVF doctors out there are well-trained and highly experienced so we have to give them the benefit of the doubt.

Could it be the equipment/tools?

This is where it becomes interesting. Most IVF centers in the United States use a 17 gauge catheter for egg retrievals (yes, it is a needle, but I tend to avoid the term to try minimize any squeamishness).

A 17 gauge catheter measures 1.473 mm in diameter.

To put this in perspective, an intravenous (IV) catheter used for fluid and medication is often 18 gauge (1.270 mm) and the needle used for drawing blood is often a 22 gauge (0.717 mm).

The catheter I used for our Donor Egg retrieval was a Japanese (designed and made) 19 gauge (1.067 mm) catheter which is 28% smaller than what is typically used in the USA. For patients who have been treated with minimal stimulation or natural IVF, I will mostly use 20 gauge (0.908 mm) or even 21 gauge (0.819 mm) catheters which are 38% and 44% (respectively) smaller than the catheter typically used at most other IVF centers. A smaller catheter creates less trauma. Less trauma means less risk of injury and complication. Also, it means less pain.

So why do most IVF centers continue to use such a large catheter?

Here are some possible explanations …

1. Habit. Old habits die young. I guess the argument is that “The patient is asleep for the procedure anyway, so why bother changing.”
2. Time. The larger the catheter, the faster the retrieval, the less time under anesthesia. Even I wouldn’t try to retrieve 20 eggs with a 21 gauge catheter. A patient would spend too much time under anesthesia which increases the risk of anesthesia complication.
3. Access to Technology. American companies have no interest or are unable to produce smaller retrieval catheters. I’ve tried American prototypes of 19 gauge and 20 gauge catheters and in both instances they fell far behind the quality and sophistication of their Japanese counterparts.

Fortunately, at Hanabusa IVF,

• I believe in using new technology if it is beneficial, cost-effective and safe. A smaller gauge catheter creates less trauma which results in less pain, during and after. For someone who is making a sacrifice to help someone else have a child, the least we can do is make her experience as pain free as possible. For someone who would like to avoid the potential complications associated with intravenous sedation, technology in the form of smaller retrieval catheters makes that possible.
• I have not noticed a significant difference in retrieval time between a 19 gauge and 17 gauge catheter. If there is no significant difference in time under anesthesia, why bother with a larger catheter.
• I have now worked with two Japanese affiliated institutions. Because of this, I have been fortunate enough to have access to Japanese technology which has allowed me to become familiar and comfortable with this technology.

So, in the end, size does matter and, in this case, smaller is better!