In the world of In Vitro Fertilization (IVF), the Egg Retrieval process is a common topic of discussion, as it is often one of the big steps toward pregnancy. As with any major step, there can be a flurry 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 process.
Preparation for Cycle
At 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.
Medications Injection Instructions:
A clinical coordinator will order the medications from a specialty pharmacy, the medications can be delivered to the patient prior to the cycle starting. After receiving the medications, demonstrative videos will be emailed, and the patient 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.
A detailed review of the treatment calendar of events will be emailed and reviewed over the phone with the patient, so they know exactly the series of events pertaining to their treatment.
The Role of Egg Retrieval During In Vitro Fertilization (IVF)
IVF is the process of the extraction of eggs from the ovaries, fertilization in the laboratory with sperm, and subsequently, transfer of the embryo(s) into the uterus.
Fertility hormonal medications are usually started on the second or third day of a woman's period, in some cases, we will require a baseline blood test or ultrasound examination to rule out cysts. We order all the necessary medications for the patient 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. She 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. 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.
Egg Retrieval Procedure
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.
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.
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 her home and should not be left alone for the rest of the day.
Once the eggs are retrieved and cleaned in the laboratory, they are either incubated with sperm overnight or sperm is directly injected into each egg to fertilize them.
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.
If you have any additional questions or concerns regarding the egg retrieval process, please reach out to us!
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