The IVF egg retrieval
IVF is quickly becoming the most frequently used fertility treatment in the world. Whether IVF is used for the classic reason of infertility or to freeze eggs, to do genetic testing of embryos, or to have extra embryos stored for future use, IVF offers many advantages over conventional, less aggressive fertility measures.
However, in addition to the daily injections, frequent monitoring, and hormonal side effects, the egg retrieval procedure is always a big concern for patients. In addition to being the big day when the eggs are removed, it is a mini-surgery, and patients worry about what exactly happens in the operating room during this procedure.
Common questions are:
- “What is the egg retrieval procedure like?”
- “Will it hurt?”
- “What kind of anesthesia will I get?”
- “Do I need to take the day off work?”
Let’s go through a few common questions and concerns that many of our patients have, along with some information to put your mind at ease before the big day!
“What is egg retrieval?”
Also known as the oocyte pick-up, or OPU, egg retrieval is the process by which eggs, or oocytes, are removed from the ovary after stimulation during IVF. After you take fertility injections to grow multiple ovarian follicles, which house the eggs, and once they reach the target size, ovulation is triggered and the eggs are removed through the vagina during this “mini-surgery.” Using an ultrasound much like the ones you see during monitoring, we remove the eggs using a needle guide that is attached to the ultrasound probe. You will be well sedated for the procedure, so you will feel minimal discomfort. The fluid is taken out of each follicle and placed in test tubes and handed to the laboratory for the embryologists to look for eggs.
“What will happen when I go into the operating room?”
Patients walk into the operating room themselves before any medication is given by the nurse. Egg retrieval usually happens in the clinic, in a separate area from where monitoring happens, but sometimes it happens in a hospital, depending on the clinic’s facilities.
Before you go to sleep, the operating room staff and laboratory staff will confirm your name and date of birth. You might feel this is overkill — and often, the embryologist, nurse and doctor will all ask for your name and date of birth — but this is very important because we definitely want to confirm you are who you say you are; and in our fertility clinics, we take patient identification very seriously to protect our eggs and embryos and to eliminate identification errors.
Sometimes your partner or a close friend or family member can accompany you in the procedure. Once you are given the anesthesia medication and are sedated, the procedure will start.
“Will it hurt? What kind of anesthesia will I get?”
This is probably the most common question we hear as fertility doctors. Patients worry about any kind of procedure, with due reason! What I tell patients is that, on the scale of surgeries, this is a very minor one, with less than a 1% risk of complication. A small intravenous catheter will be put in your arm or hand upon your arrival in the office on the day of your egg retrieval, and then you will be given medications through the IV to go to sleep. Most patients sleep through it, but some are semi-awake and pain-free. This isn’t a general anesthesia, so you will still be breathing on your own. Sometimes a breathing mask is used to give you extra oxygen, and you might hear the OR staff ask you to take deep breaths on occasion. No incisions are made; everything is done through the vagina.
Initially, a speculum is placed in the vagina so that the area can be cleaned, which you might feel mildly. You will feel some pressure from the ultrasound during extraction of the eggs, but not pain. Some patients are semi-awake but feel no pain and even talk with the nurse during the procedure! The anesthesia meds are short-acting; they last for the entire procedure, which is approximately 30 minutes, and they wear off within an hour, but we do tell patients to take the day off and not to drive or do strenuous activity that day. Most likely, you will go home and sleep the rest of the day.
Eat only light meals after the procedure. Usually, we say not to eat anything heavy the night before or on the morning of the procedure.
“What happens next, after the retrieval?”
Once the eggs are removed and the procedure is complete, you will rest in the recovery room for about an hour, to make sure the anesthesia medication wears off and you can stand up, walk and use the washroom. Mild nausea is common, and often you will get medication in the IV to prevent this.
Typically, you will go home and sleep most of the rest of the day, and you should be fine by the next day to resume normal activities.
The eggs go to the laboratory to be prepared for freezing or for fertilization with sperm to create embryos. Don’t worry: They are safe and sound!
Depending on the number of eggs retrieved and the plan after retrieval, you could possibly be asked to return to the clinic for an evaluation the next day or to come in for a fresh transfer in the next few days. If your embryos are being frozen, then you would come back in the next cycle to start a frozen embryo transfer.
“What symptoms can I expect after the egg retrieval?”
Patients often wonder about symptoms once the eggs are taken out. Mostly, they ask if they will feel less bloated and hormonal! Yes, you should, but not all of the symptoms will disappear right away, because your hormone levels are elevated even after the eggs are removed. Usually these symptoms will resolve in three to five days after the egg retrieval and are gone by the next menses.
Patients who make more than 20 eggs or have very high hormone levels should especially watch for ovarian hyperstimulation syndrome (OHSS); your doctor might give you extra medication or monitor you closely after egg retrieval if this is a concern. Usually, this involves a few visits after the retrieval and a few extra ultrasounds and bloodwork. This scenario, however, is rare these days, occuring in fewer than 10% of cases due to newer trigger medications and protocols to avoid OHSS.
The clinic will update you likely the next day and in subsequent days about the number of eggs frozen, in the case of egg freezing cycles, or on day 1 (fertilization day) and day 3 and day 5 or 6 regarding your embryos.
As always, contact the clinic with any unusual symptoms, such as fevers, chills, increasing abdominal pain or bloating.
Overall, egg retrieval is a very safe procedure. Many clinics perform up to 10 retrievals per day without issues. As always, speak to your fertility doctor about any concerns you have about egg retrieval. Happy egg harvesting!