. An egg retrieval is a surgical procedure done to remove the egg(s) from a woman’s ovaries undergoing Egg Freezing or In Vitro Fertilization (IVF). Surgery is a big and scary word, but the procedure is done in a minimally invasive way, meaning it usually has no scars, stitches, and a short recovery time.
. It takes place approximately 10-12 days after the start of hormone-based stimulation medications taken to make the ovaries develop numerous eggs.
. The procedure generally lasts only 10-15 minutes from the administration of anesthesia to completion of the egg retrieval procedure.
. Egg retrieval recovery is generally minimal due to the type of anesthesia used (MAC) and the minimally invasive nature of the surgery (can be thought of as a blood draw through the vaginal wall).
. Risks for an egg retrieval procedure itself are relatively minimal due to the relatively mild nature of the surgery compared to other medical procedures. Still, some risks include bleeding, infection, as well as damage to the bowels and or bladder.
. Following the egg retrieval procedure, the eggs will be taken to an embryology lab where they will either be frozen, fertilized and developed for 3-7 days inside the lab, or in a relatively rare case, loaded into an INVOcell device for fertilization and development.
. If doing IVF, an embryo transfer is the next step following the egg retrieval that involves the intended parents.
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The egg retrieval process is most often put in motion by the start of stimulation medications for an IVF or Egg Freezing treatment. These medications are usually started on days 2-4 of a woman’s natural menstrual cycle and taken for approximately ten days. In the case of a woman who does not have regular or any cycle, the process can usually be started at any time following a baseline appointment to measure the starting hormone, follicular, and endometrial levels.
The exact amount of time the medications are taken and thus the day of the egg retrieval is based upon follicular and egg development. Follicular development is measured at each monitoring appointment which uses ultrasound and bloodwork to measure a number of key factors including follicle size, endometrial lining, and hormone levels.
The egg retrieval itself is always 35 hours after the administration of the first trigger shot (Lupron or HCG) which stimulates the final maturation of the eggs and triggers ovulation; of course, with egg freezing or in vitro fertilization, it is important to remove the eggs before they are truly ovulated. At ovulation, a follicle ruptures and expels the egg from the follicular sac, after which the egg travels through the fallopian tube toward the uterus. The egg retrieval is timed to catch the eggs shortly before they would start this journey, at a point where they are ready for fertilization but are still within their follicles and can easily be found. It is, therefore, critical that the trigger shot is taken at the exact time as instructed by your fertility care team (set 4 alarms in your phone!!).
It’s also important to understand that the “trigger day” can be either pushed up or back depending on the follicular development seen in the monitoring appointments. If it is pushed backward, one would simple continue FSH and an antagonist medication (Antagon: under the brand names of Cetrotide, Ganirelix) until the follicles reach the appropriate size for trigger. Because of this, it’s important to maintain a flexible mindset during the stimulation phase of IVF.
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No two women are alike, so each may experience different post-retrieval symptoms. The major side effects of egg retrieval include constipation, bloating and cramping, breast tenderness, discharge, infection, and OHSS. Risks associated with anesthesia are usually very minimal.
. Constipation: One of the most common side effects women report after egg retrieval surgery is constipation. Take a stool softener if necessary, and be sure to stay hydrated.
. Bloating & Cramping: Because your ovaries become enlarged after embryo transfer, it’s not uncommon to feel mild to moderate cramping after you return home. Hormones can create bloating too. Increasing consumption of protein can be very helpful.
. Breast Tenderness: Rapidly changing hormone levels can create sore or tender breasts, similar to what some women experience during PMS. After your procedure, be sure to wear a supportive bra to avoid putting any unnecessary strain on your chest and take OTC pain medication if necessary.
. Vaginal Discharge: It’s not uncommon to pass small amounts of watery fluid. Because the cervix is swabbed before egg retrieval, some discharge can get left behind, which is later passed. While it’s often clear, patients may experience bloody discharge as well. It’s important not to strain following surgery—either while using the toilet or through heavy lifting or activity. Excessive straining can further irritate the cervix.
. Infection: During any surgical procedure, infection is always a risk. The use of an aspirating needle to collect eggs can potentially cause bleeding, infection, or damage to the bowel, bladder, or a blood vessel.
. Ovarian Hyperstimulation Syndrome: symptoms can range from mild symptoms of mild to moderate abdominal pain, abdominal bloating or increased waist size, nausea, vomiting, diarrhea, and tenderness near the ovaries, to severe symptoms like rapid weight gain (more than 2.2 pounds in 24 hours), severe abdominal pain, persistent and severe nausea and vomiting, blood clots, decreased urination, shortness of breath, and a tight or enlarged abdomen. Severe symptoms should be addressed with your provider as soon as possible and may require treatment. As mentioned previously, acupuncture and increased protein consumption can greatly reduce the symptoms of OHSS.
Most of the “do’s” and “don’ts” that will help improve the number and quality of eggs retrieved need to happen 30-90+ days prior to your retrieval. So, while the night before is certainly important, it’s really what you do three months prior that has the most impact on your success. A healthy body is a fertile body: acupuncture, a high-fat fertility diet, and vitamins are important.
The day of, relax, stay positive, and give yourself enough time to get to your doctor’s office ahead of time without needing to rush.
That said, the egg retrieval is a surgery and it’s important you follow the instructions given by your healthcare team carefully. It’s likely you will be asked to follow a number of instructions or precautions in preparation for your egg retrieval procedure.
. to wear comfortable, easy to remove clothing
. arrive early, usually an hour before the intended retrieval
. make sure you have a ride home – it’s usually recommended that family or a close friend accompany you to your egg retrieval, but other ride arrangements may be made. You will not be allowed to drive home yourself.
. to not eat or drink anything after midnight on the day of your procedure.
. to not wear perfumes or fragrances other than deodorant the day of the egg retrieval procedure.
After you check-in, you’ll likely change into a robe or hospital gown and be taken to one of the surgical suites. Once in the surgical suite, you’ll have blood drawn, complete some paperwork, consult with the nurse, anesthesiologist, surgeon performing the procedure, and a member of the embryology team.
The nurse will then hook you up to several monitors so that your vital signs can be closely monitored before, during and after the procedure.
The Egg retrieval procedure begins with the anesthesiologist administering light intravenous sedation for your comfort. During egg retrievals, anesthesiologists use MAC (monitored anesthesia care) as opposed to general anesthesia, while general anesthesia requires you to be intubated with an endotracheal tube so you can breathe during surgery, MAC offers deep sedation with no tube and a much faster recovery time.
Once you are sedated, your surgeon will then use ultrasound with a probe to locate the ovarian follicles. Then, using a tiny hollow needle with suction capabilities, your surgeon will guide the needle attached to a catheter through the vaginal wall and drain the fluid from the follicles which contain the developed eggs.
The follicular fluid which contains the eggs is drawn using light suction and collected in test tubes labeled with your name and patient I.D.
Once collected, eggs are immediately transported to the IVF lab, where one of the embryologists will locate, isolate, and place your eggs in media where they will continue to develop for a few hours prior to freezing or fertilization.
The actual time it takes to locate and retrieve eggs is only about 5-15 minutes. There are no incisions or stitches. During the egg retrieval itself, you shouldn’t feel or remember a thing thanks to the anesthesia.
Once the retrieval is complete, the anesthesiologist will gently bring you out of sedation and you will be transferred to a recovery room where you’ll continue to be monitored. It usually takes 5-10 minutes to come out of sedation, and about 30 minutes to recover, after which point, you are free to go home.
Before you go, one of the clinical team members will tell you how many eggs were retrieved. If you have additional questions or require pain medication, you will be taken care of before being discharged.
We encourage those having an egg retrieval to take it easy on the day of the procedure. Rest and relax at home and catch up on your favorite series or watch a movie. You’re clear to return to work the following day, barring any complications.
You can expect to experience some pain after egg retrieval, including bloating, mild soreness in the vaginal area, slight abdominal cramping, or some spotting, which can last a couple of days. Over-the-counter pain relievers such as Tylenol or ibuprofen, will help. Most women feel back to normal by the next day.
You probably won’t need a follow-up appointment, but your team will be available should you need anything. If at any time you’re excessively bloated, throwing up, in a lot of pain, or otherwise feeling bad, give your healthcare team a call. Women taking injectable fertility medications are at risk for developing ovarian hyperstimulation syndrome (OHSS), which causes the ovaries to swell and become painful.
Mild OHSS can include abdominal pain, nausea, vomiting, and diarrhea, as well as tenderness near your ovaries. If OHSS is suspected, it is recommended to follow a high protein “keto” diet with 150-200g of protein along with acupuncture. OHSS symptoms usually subside after several days to a week. But if your symptoms are severe, you may require medical attention. OHSS usually happens within a week after your trigger shot. This is why close monitoring is necessary throughout your IVF cycle. By regularly checking the development of your follicles, your doctor can adjust your medication dose or prescribe other medications that can help prevent hyperstimulation if it looks like you are at higher risk. Electing to freeze embryos and have an FET later when your body has had a chance to recover may also be encouraged should you be at risk for or having OHSS.
To prevent constipation, be sure to hydrate and add in a stool softener if you are having difficulties moving your bowels.
Immediately after retrieval, your eggs are transported to the embryology lab by the embryologists attending your egg retrieval. The embryology team will then locate, count, and place your eggs in nourishing media that mimics the environment of your fallopian tubes. The eggs are then placed in an incubator labeled with your full name and medical record number.
At this point, if you’re freezing eggs, they can be flash-frozen via vitrification. Once cooled, the eggs are kept in liquid nitrogen cryotanks for preservation.
If you are freezing embryos or planning a IVF embryo transfer, the eggs will be fertilized approximately 4 hours after the retrieval and placed back in the incubator. After this, the eggs are checked regularly for several days until the embryos reach a cleavage or blastocyst stage, at which point they will be frozen or transferred back into the carrier’s uterus.
. Day Zero: Egg Retrieval & Fertilization
. Day One: Fertilization Check – About 14-16 hours after ICSI, an embryologist will check all eggs to confirm fertilization.
. Day Two: Embryos divide. Most labs do not look at embryos on this day.
. Day Three (aka Cleavage Stage): Embryo Grading & Potential Transfer. Embryos are graded based on their number of cells and a grade of 1 through 4. The number of cells refers to the number of cells present in the embryo when observed under a microscope. Typically, a healthy day three embryo will contain between 6 and 10 cells. Several studies confirm that an embryo with 6-10 cells is more likely to grow into viable blastocyst than an embryo with fewer cells. The embryo grade refers to how the cells in the embryos look. In a grade 1 embryo, all of the cells are the same size, and there is no fragmentation in the embryo.
. Day Four: Cleavage to Blastocyst Transformation. Most labs do not look at embryos this day. Embryos are transitioning from cleavage to blastocyst stage.
. Day Five (aka Blastocyst Stage): Blastocyst Grading & Transfer or Freezing. If embryos are being carried out to Day 5, they will be checked again.
. Days 6 & 7: If an embryo hasn’t reached blastocyst stage by day five they will usually be checked on both day 6 and 7. Embryos that have developed to blastocyst can either be transferred or frozen. Embryos that have not progressed to the blastocyst stage are not considered viable and usually discarded at this point.
What comes after the egg retrieval is dependent upon a number of things:
. Are you doing egg freezing or IVF?
. Are you planning a fresh or frozen transfer?
If you’re doing egg freezing the process is complete until you decide later to thaw, fertilize and transfer the embryos made from your frozen eggs.
If you are planning on doing an embryo transfer, the decision to take you embryos to clevage or blastocysts stage is usually done after seeing the number of fertilized embryos. If there are 4 or more fertilized eggs (now embryos) we usually recommend taking the embryos to blastocyst. If less, we usually recommend preparing for a day three transfer or freeze. You will typically be contacted the day after the retrieval and be informed how many were fertilized.
If planning on taking your embryos to blastocyst, you will not be contacted until day 5. If planning on taking the embryos to clevage stage, you should be contacted on day three.
If you’re planning to have a fresh embryo transfer, you will likely start taking estrogen and progesterone the day after your retrieval to help prepare the lining of your uterus for implantation. If planning a frozen embryo transfer, you will likely rest until the start of your next cycle, in which you will take estrogen and progesterone to prepare the uterus for implantation.
So, how many eggs should you expect to retrieve? It will vary from person to person and cycle to cycle for the same person., but experts generally regard 10-15 mature eggs as being an optimal number of eggs.
Researchers analyzed more than 400,000 IVF cycles in the United Kingdom. They found there was a strong association between the number of eggs retrieved in one IVF cycle and live birth rates. The likelihood of success rose with each additional egg retrieved, up to about 15 eggs. Outcomes leveled off when 15-20 eggs were retrieved, and then steadily declined beyond 20 eggs.
Quality is always more important than quantity, and IVF success requires only one normal embryo, but patient outcomes improve when a reasonable number of eggs are retrieved, typically between 10-15 mature eggs.
Younger women under the age of 35 tend to produce more eggs than older women. Women who respond better to ovarian stimulation will produce more eggs than women who are low responders. Women who produce 20 or more eggs are usually young females with no fertility problems.
IVF only targets the final developmental phase of egg production taking place in the last 10-14 days. To improve egg retrieval outcomes, women need to be sure they’re doing everything possible to improve the quality of their eggs for the full 90 days prior to retrieval. Egg quality is a major factor impacting IVF success, and something you have the power to change. We recommend women eat a high fat, moderate protein, low carbohydrate (AKA ketogenic) diet, take high-quality supplements that can improve egg quality, and prescription medications (if necessary) to reduce inflammation, improve implantation, and regulate the immune system. Similarly, acupuncture can be helpful.
Especially if you’ve had repeat miscarriages or implantation problems, consider a laparoscopy and hysteroscopy. It’s the best way to check everything is in order prior to egg retrieval or embryo transfer. There are also various procedures, such as PRP-Therapy and ERA, along with yoga, massage, and acupuncture, that CNY Fertility providers recommend as part of a protocol to boost female fertility.
Patients with PCOS are at higher risk for developing OHSS. An alternate trigger shot is frequently a good idea and freezing embryos for FET to give the body time to recover. It’s critical that patients with PCOS begin preparing for egg retrieval from 90 days up to 6-months in advance, to reduce BMI and inflammation, and maximize health so that retrieval can be successful and safe. A high fat, moderate protein, low carb diet is critical for getting pregnant with PCOS.
Egg retrievals happen in the morning, so you’ll be administering your trigger shot two evenings earlier. Inject at exactly the time you’ve been instructed. If you’re traveling for treatment, check the time difference. And be sure to store your injectables correctly. Remember to set an alarm!
The time before, during, and immediately after an IVF cycle can be very stressful. Make sure you are reaching out for the necessary support you need to handle the stress and anxiety. Support groups are a tremendous resource for emotional support. Mentors who have been in your shoes offer a caring ear and great advice. If you’re more comfortable one on one, go that route. Just be sure you reach out and don’t internalize your stress.