HOW TO INCORPORATE ASSISTED REPRODUCTIVE TECHNOLOGIES


battery-powered systems are more reliable at main- taining temperature but come with a higher cost of initial investment (Table 1).


Incubator


An incubator to maintain the temperature of fluids used for the aspiration procedure, filters or flasks (Table 1).


Staff


A brief overview of the oocyte aspiration procedure to highlight staffing requirements for this proce- dure. During the aspiration the mare will be heav- ily sedated and kept at this plane of anesthesia during the oocyte aspiration procedure. During the oocyte aspiration procedure, the veterinarian will position the ovary transrectally in alignment with the aspiration probe in the vaginal vault. The nee- dle will be advanced into the follicle, the follicular fluid removed, and the follicular wall will be scraped and then rinsed. Depending on the training either the veterinarian will manipulate the needle to scrape the follicular wall or an assistant will manip- ulate the needle and rinse the follicle. In either situation a second assistant is necessary, in addition to the person maintaining sedation, to rinse the follicle regardless to who manipulates the needle. While most reproductive procedures do not re-


quire personnel with significant training, it is ideal in the authors’ opinion to have at least 2 trained personnel to assist with oocyte aspirations. At least 1 trained person is necessary to continue main- taining the level of sedation/analgesia in the mare, helping to assist in positioning the mare. It is ex- pected from setting up to final cleaning after the aspiration to allocate 90 to 120 minutes per session. A trained assistant can prove invaluable simply set- ting up the equipment and media for the procedure. A second person is strongly recommended to flush


media into the follicle as the follicular wall is scraped with the needle. This allows one staff member to assist the veterinarian while performing the aspiration and one staff member to maintain sedation and position the mare. This person’s ex- perience level will depend if the veterinarian is po- sitioning the ovary and spinning the needle or if the assistant is spinning the needle while the veterinar- ian positions the ovary. In the authors’ clinical program a technician is available to help keep the mare positioned and to administer sedation as required per the veterinari- an’s instruction. A second veterinarian assists during the procedure by spinning the needle and flushing the follicle. In the authors’ program, this arrangement of one veterinarian positioning the ovary against the transducer and a second veteri- narian handling the needle to puncture the follicle, scrape the follicular wall, and rinse the follicle has led to the highest oocyte recovery rate in the au- thors’ program. This may be due to the veterinar- ian expertise in visualizing the ultrasound screen


376 2019  Vol. 65  AAEP PROCEEDINGS


and ability to better assess positioning of the needle within the follicle. Additionally, by having another staff veterinarian assist with the procedure, it pre- vents the practice from having to have additional technicians on the payroll for a limited number of procedures each year. Each practice will have to evaluate their individual needs and staffing to eco- nomically justify adding more staff members.


Training


Most practices interested in adding oocyte aspira- tion services will require some training in the oocyte aspiration technique. This should be performed through a combination of continuing education courses, working with the ICSI lab that the clinic plans to ship the majority of the oocytes and prac- ticing on nonclient mares (Table 1). When the authors’ practice started an oocyte as- piration program, the combined team for oocyte as- piration had a good understanding of the procedure but had not aspirated many mares together. The entire aspiration team traveled to an ICSI facility for training. This allowed all aspects of the proce- dure to be covered for each specific team member. In addition to training in the aspiration, oocyte searching, and packing procedures, additional as- pects such as items that were required in inventory, facilities, and set up for the procedure, and cleaning as well as maintenance of equipment after the pro- cedure is performed. After initial training, approx- imately 12 practice sessions were performed before performing a client mare aspiration (Table 1). To keep the aspiration team in sync for performing aspirations a mare is aspirated (client or practice owned) every 2 weeks at a minimum. This sched- ule allowed for streamlining the process and prepa- ration for any client aspirations that presented. At the end of the 12 practice sessions, the recov-


ered oocytes were sent to the ICSI lab to confirm that blastocyst rates were within the expected range. This final confirmation allows the practitio- ner to feel confident that clients are receiving the appropriate level of service with this new clinical technique.


Disposable Items


There are numerous disposable items utilized dur- ing the aspiration procedure. This paper will not discuss the cost individually of disposable items in context of this manuscript. In 2018, the average cost of an oocyte aspiration in the authors’ practice was approximately $220 (labor not included). This includes the cost of sedation, antibiotics and non- steroidal anti-inflammatory drugs (NSAIDs), media, fluid lines, a new aspiration needle, search dishes, and pipettes. This figure represents the entire cost for the procedure to place the oocytes into a shipping container for transport to an ICSI lab. While some facilities will have better purchasing power or will sterilize some of the disposable items for addi-


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