This chapter gives a detailed practical description of the transvaginal oocyte retrieval (TVOR) process. Patient preparation should include informed consents and proper timing of ovulation trigger. A robust patient identification system with gamete traceability is a crucial part of the process. Transvaginal ultrasound-guided retrieval is a low-risk method, but care should be taken to avoid significant vessel and organ injury. Endometriomas should not be drained, unless they impede access to ovarian follicles. Antibiotic prophylaxis is recommended in high-risk cases. Follicle flushing is unlikely to increase pregnancy rates and therefore the routine use of double-channel needle is not advised. Temperature fluctuation and turbulent flow must be avoided by applying careful technique in order to minimise damage to the cumulus–oocyte complex. If the ovary is difficult to access transvaginally, retrieval options include a transmyometrial, transabdomial or laparoscopic approach. Bleeding can usually be managed conservatively, but vaginal suture and access to facilities for emergency laparoscopy should be available.