What lies behind the word "puncture“?

This is a stage at which we "collect" the mature eggs from a woman's body via an ultrasound probe needle.

Under ultrasound monitoring the needle passes through the back wall of the vagina and reaches the ovary. The follicular fluid, in which oocytes "swim" and which fills the follicle, is aspirated and collected into tubes or syringes.

Immediately thereafter the collected fluid is passed to a biologist whose task is to "discover" the eggs under a microscope, to wash and place them in an appropriate, pre-warmed to 37 degrees medium.

An assessment of the quality of the obtained eggs is carried out in order to be defined whether the eggs are mature, and if so, appropriate conditions for their fertilization are provided.

Meanwhile, the sperm produced by your partner are prepared in the Andrology ward. A spermogram / semen analysis/ is carried out, then the sperm are processed by various methods, purified and finally they are activated.

Before the puncture – practical advice

Make sure that you read carefully, fill in together with your partner (if you do not have a partner – do it by yourself) the whole package of documents provided in the Manipulation room at MC "Nadezhda“- Reproductive Sofia": your informed consent for the upcoming procedure, anesthesiology questionnaire, your informed consent for embryos/ ova to be frozen, in which to express your will for such a procedure in case that after the transfer there are fit embryos / eggs for cryonization.

  • To bring all your tests - AIDS, Wasserman, Hepatitis B, C (valid for 3 months prior to the procedure (for both partners)
  • PKK coagulation (carried out not later than six days before your puncture)

On the day before the puncture:

  • You should stop eating any food at 17:00 pm and drinking liquids at 22:00 pm. In the morning on the day of your procedure you must be "hungry and thirsty."
  • Take care of your intimate toilet (remove the intimate hair). Avoid any use of cosmetic products such as gels and body lotions, strong perfumes and nail polish.

The day of the puncture

In MC "Nadezhda-Reproductive- Sofia" punctures are carried out in the morning.

It is recommended that you be at the hospital at least 15 minutes before your scheduled time for the puncture in order some administrative procedures to be finalized if necessary.
At the Registration Desk you will receive the necessary instructions where to wait and when your partner will be called to the Andrology laboratory.
If the procedure is on the basis of spontaneous cycle, in the morning before having the puncture, you will have an additional ultrasound examination, which will establish whether there is a presence of follicles and whether your spontaneous ovulation has occurred.

Where are the punctures carried out?

The punctures are carried out in three separate specialized facilities (manipulation rooms), located on the first floor in Nadezhda Hospital.
Embryological laboratory is located close to the manipulation rooms.

Before you are taken to the room, where along with the other patients you will be waiting for your turn, you will have to leave your personal belongings and clothes (including underwear, shoes) in an individual wardrobe locker.

In the surgery room you will be wearing disposable booties, cap and gown.

It is not necessary you to bring anything from home.
Before the procedure your bladder should be empty.

The room where you will be waiting for the puncture has a bathroom.

During the puncture

The team that will be with you during the procedure:

  • an obstetrician-gynecologist who will perform the puncture;
  • an anesthesiologist-resuscitator who will apply the anesthesia and observe your vital signs;
  • an obstetrician and an anesthesiology nurse ;
  • an embryologist: In the embryological facility, directly connected to the manipulation room, will be waiting a biologist, who will take the tubes with the aspirated follicular fluid and then establish the presence / absence of an egg and take further care of the egg.

Before the procedure you will have an abbocath applied (a plastic disposable cannula, designed to grip the peripheral vein, through which the anesthesia is introduced and if necessary – some medications). You will have a vaginal wash.

The manipulation is performed under short intravenous anesthesia for about 10-15 minutes.
You will not feel any pain. In some cases, when only one or two eggs are available (for example, In vitro spontaneous cycle), the anesthesia can be skipped, but it depends on what decision your physician will take and your own preference whether to have the puncture without anesthesia.

After the procedure

After the procedure you are supposed to remain in hospital for observation for about two to four hours. You may have slight bleeding, feel heavy and have some pain, similar to your menstruation pain.
At the time while you are waiting for the effects of the anesthesia to go away, the specialists from the embryological laboratory will prepare information on your case -how many eggs have been removed and how many of them are suitable for fertilization.
After a meeting with your physician, you will receive detailed instructions on what medications you have to take till the time of the transfer.

Before you leave the hospital, please provide your personal data at the Registration Desk so that you can receive a sick leave document, starting from the day of your puncture.
It is recommended that after you had the puncture done you do not go to work on the same day and avoid driving.

Between the time of the puncture and the time of the transfer our embryologists will keep in touch with you and inform you about the development of your embryos.

Side effects


The puncture of the follicle is a minimally invasive procedure; however, it carries its own risks. These risks are stated in the informed consent, and you must become familiar with it before having the procedure.

It is very important to watch for some side effects after you had the puncture and let us know about them in due time.

If after the puncture you experience:

  • strong pain
  • profuse bleeding
  • vomiting
  • dizziness or fainting

Immediately contact us at the emergency number provided to you by your physician’s office or the manipulation surgery, or come to the hospital.
You should always let us know promptly if some worrying symptoms occur.

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