This Medical Video: To record the sequence, Stephan Gordts and Ivo Brosens of the Leuven
Institute for Fertility Embryology in Belgium performed
transvaginal laparoscopy, which involves making a small cut in the
vaginal wall and observing the ovary with an endoscope.
This
allows us direct access to and observation of the tubo-ovarian
structures without manipulation using forceps, says Gordts.
For
the photos of ovulation, which only accidentally captured the
critical moment, Jacques Donnez at the Catholic University of
Louvain (UCL) in Brussels, Belgium, used gas to distend the organs
for photography. However, Gordts and Brosens planned the procedure
to coincide with ovulation and used saline solution to float the
structures.
Perfect timing
Observation was timed for the day of
the peak of the patients luteal hormone cycle. Ovulation was
predicted to occur on the evening of the day of the LH peak, and the
endoscope introduced at 6 pm.
A small amount of saline was used
to float the opening of the fallopian tube, its fimbriae (the
fingers that sweep the egg into the tube) and the ovary itself. This
gives a more natural appearance than gas, says Gordts.
In the
video, the fimbriae can be seen sweeping in time with the patients
heartbeat. A mucus plug can be seen protruding from the ovary –
this contains the egg.
The ovum is not captured naked, says
Gordts. There is no eruption like a volcano.
Gordts says that in
clinical practice it is not easy to organise the observation of
ovulation. We were probably lucky to be successful at our first
attempt, he says.