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While exploring fertility treatment, the egg retrieval process is a common topic of discussion, as it is often one of the big steps toward pregnancy for many families. As with any major step, there can be an abundance of questions about the process and what is necessary to yield the best results. This article is aimed at answering many of those questions, as well as providing a general overview of what to expect throughout the entire egg retreival process.
An Egg Retrieval procedure is a necessary element when it comes to In Vitro Fertilization (IVF). Whether the eggs are from an intended mother or donor, they are an essential part of the family-building equation. IVF is the process of the extraction of eggs from the ovaries via egg retrieval, fertilization in a laboratory with sperm, and subsequently, transfer of the embryo(s) into the uterus.
Egg retrieval procedures are also used for patients seeking fertility preservation. For those undergoing cancer treatment, gender transitions, looking to have kids later in life, or considering fertility preservation for other reasons, these people will also need to understand the implications of an egg retrieval procedure.
Preparation is key when embarking on the egg retrieval process. Understanding the steps involved, from pre-cycle labs to fertilization, is crucial for a successful outcome. Below are the main steps of the egg retrieval process:
Below we breakdown the steps listed above in detail to help you better understand what to expect from the egg retrieval process every step of the way.
Being well-prepared and informed is key to navigating the egg retrieval process successfully. Your fertility doctor should provide you with specific instructions pertaining to your treatment. Many patients can expect the following events when preparing for an egg retrieval.
Optimizing health for the scheduled fertility window is crucial when preparing for an egg retrieval procedure. Egg quality and ovarian function take time. Many fertility specialists would recommend to plan ahead of time and consider the following a few months before treatment:
At Pacific Fertility Center Los Angeles (PFCLA), our physicians typically order blood tests to check female patients’ ovarian reserve and look for any abnormalities. Male patients will also go through blood tests, and a semen evaluation is usually required prior to starting IVF treatment. These pre-cycle tests can be done at our clinic or a local facility to reduce travel if the patient does not live in the Los Angeles area. Patients can also expect a baseline ultrasound. After initial tests are reviewed, a physician will assign you with a treatment plan that best fits your goals.
Ovarian stimulation is a crucial step in the egg retrieval process. Stimulating the ovaries encourages the ovaries to produce multiple eggs. This is typically achieved through hormonal injections, which help mature more eggs than the body would naturally prepare in a regular cycle. The goal is to maximize the number of viable eggs for retrieval, increasing the chances of successful fertilization.
Understanding how long an IVF cycle is from start to finish can help create an expectation for a treatment timeline. A detailed review of the treatment calendar of events will be emailed and reviewed over the phone with you, so you know exactly the series of events pertaining to treatment.
Your clinical coordinator will order fertility medications from a specialty pharmacy, the medications can be delivered to you prior to the cycle starting. After receiving the medications, demonstrative videos will be emailed, and you will be guided in person, over the phone, or via virtual call on how to administer each medication. This is usually done close to the time of starting medications.
Fertility hormonal medications are usually started on the second or third day of your period. We order all the necessary medications for you ahead of time. We use different types of hormones such as Gonal-f, Follistim, or Menopur. These medications will stimulate the ovaries to produce multiple eggs. The response to these medications varies according to the patient’s age, ovarian reserve, and the amount of dosage given. The dosage will be clearly indicated on the treatment calendar. These drugs are given once (usually in the evening) or twice daily (morning and evening). These hormones are usually taken for an average of 10 to 14 days. Some patients might need a longer time to have a successful stimulation.
A vaginal ultrasound examination will be performed about one week after the start of these medications. The purpose of this ultrasound is to visualize the ovaries and count the number of follicles present. A follicle is a fluid-filled sac that contains the egg. Each follicle usually contains one egg.
By counting the follicles, we can determine how well the patient has responded to the fertility drugs. We will also measure the follicles. The size of the follicle gives a good idea about the egg's maturity. As the patient continues to take the medications, these follicles will grow (about 3 mm in 2 days); and at a certain point in time, they will be ready to be retrieved. We usually like to retrieve the eggs when the majority of the follicles are around 18 mm in size.
Occasionally a blood test for the hormone Estradiol is also checked during the stimulation cycle. As the follicles mature, the eggs secrete the Estradiol hormone. Therefore, measuring the level of this hormone in the blood often gives us a good idea as to how the ovaries are responding to the medications. The level increases as the eggs are maturing and the follicles grow. The more eggs or follicles a woman has the higher the Estradiol level.
Following the initial visit, the patient will be given an updated calendar with specific instructions on the next steps. They will be told what medications to continue taking and when to come back for another ultrasound appointment. Usually, another appointment will be made 2-4 days after the first ultrasound. During this follow-up visit, an ultrasound, and a possible blood test to evaluate the growth of the follicles will be performed. The patient will again be given further instructions on what to do daily. On average, two to four visits are required prior to the egg retrieval procedure.
When the physician decides that the follicles are ready to be aspirated, the patient will be given instructions to take an HCG Trigger injection 36 hours prior to the egg retrieval procedure. This medication is crucial and needs to be at an exact time. It will release the eggs from their attachments to the walls of the follicles to float inside the follicular fluid. If the HCG Trigger shot is not taken correctly and at the exact time specified, the eggs will not be mature and will not be able to be aspirated.
The patient will be given verbal and written instructions on how and when to administer this trigger medication.
The HCG Trigger injection is usually given at night; the egg retrieval procedure is scheduled 36 hours after this injection, which falls two days later in the morning.
When the size of most follicles reaches 18 to 20 mm in average diameter and the estradiol hormone level is appropriately elevated, then it is time for the eggs to be retrieved.
The patient needs to be at our clinic at least 30 minutes prior to the scheduled time for the egg retrieval procedure. The patient should not eat or drink anything after midnight, the night before the egg retrieval date. Your fertility team should provide you with procedure guidelines.
The egg retrieval procedure is performed under “general anesthesia” but without intubation. The patient will not feel any discomfort during the procedure and will wake up within 10 to 15 minutes of the end of the procedure. Depending on the number of follicles present, the procedure will usually last 10 to 30 minutes.
The procedure is performed under ultrasound guidance similar to the vaginal ultrasound examination that the patient has during the stimulation cycle. A needle guide is attached to the ultrasound probe, a long needle is introduced through the guide, and under direct visualization, each follicle is punctured and the fluid (along with the egg floating in it) is aspirated. The fluid is then immediately sent to our IVF lab where the embryologists search for the eggs, isolate them, and place them in incubators. At the completion of the egg retrieval, the patient is taken to the recovery area where she will stay for about an hour. Pain medications might be administered at this time as needed. Some discomfort is expected for a few hours following the procedure and Tylenol can be taken by the patient at home as needed every 4 hours. Occasionally, some nausea might also occur which usually dissipates within a few hours.
Lab Analysis & FertilizationOnce the eggs are retrieved and cleaned in the laboratory, they are either frozen through cryopreservation, incubated with sperm overnight or sperm is directly injected into each egg to fertilize them. Depending on the case, your fertility doctor may recommend intracytoplasmic sperm injection (ICSI) to assist in fertilization. The next day after insemination, the embryologist will check on the status of the fertilized eggs.
A fertilized egg is called an embryo. An embryo goes through stages of development. Embryos will be cryopreserved for the intent to use at a later time. Embryos can be frozen indefinitely. Our technique of freezing and thawing has improved significantly over the years.
After about an hour when the patient is fully awake and relatively pain-free, instructions are given by the recovery nurse and the patient is discharged home. The patient must be accompanied by someone who can drive them home and should not be left alone for the rest of the day.
Many patients can plan to go back to work the next day, while others may need an additional day or two to rest and recover from the procedure. It is important to protect your ovaries and avoid heavy exercise and high impact activities following an egg retrieval, walking and light activities are usually okay. Make sure to review your post operation guidelines carefully for a successful recovery.
Egg Retrieval, while generally safe, can come with a range of side effects. Some women may experience mild to moderate discomfort, fatigue, including bloating, cramping, and abdominal pain, similar to menstrual symptoms. Bruising or soreness at the injection sites and mood swings due to hormone fluctuations are also common. In rare cases, more serious complications like ovarian hyperstimulation syndrome (OHSS) can occur, leading to more severe pain, nausea, and fluid retention. It's important for women to closely monitor their symptoms and maintain open communication with their healthcare provider throughout the process.
There is no one size fits all treatment and it's important to work closely with a fertility specialist to determine the most effective course of action per your situation. At Pacific Fertility Center Los Angeles (PFCLA), we offer a range of personalized treatment options. Our team of experienced fertility specialists utilizes the latest techniques and technologies to help our patients achieve their dream of starting or growing their families.
We understand that treatment can be a difficult and emotional experience, and we strive to make the process as comfortable and stress-free as possible. If you have any additional questions or concerns regarding the egg retrieval process, we encourage you to contact us today. 
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