The egg retrieval process during IVF is a key part of this the overall in vitro fertilization process. What happens during egg retrieval, and how do you prepare for a successful procedure? What happens to the eggs once they are retrieved? Find out these details, and more, in our comprehensive guide to IVF egg retrieval.
An Introduction to IVF Treatment and IVF Egg Retrieval
IVF, or In Vitro Fertilization, is a common type of assisted reproductive technology (ART). When a couple is unable to conceive a child naturally, they can turn to a fertility doctor to help them get pregnant. IVF can also be used to help single individuals and LGBTQ couples have children.
IVF has been used in the United States since the early 1980s and is by far the most common form of ART. Doctors have been perfecting the procedure for decades, which makes this an attractive option for those who need an alternative path to family building.
What Is In Vitro Fertilization?
In Vitro Fertilization is a medical procedure that combines male and female sex cells in a lab. And egg and sperm are carefully placed in a laboratory dish, then monitored and stored for optimal development. The goal is for the cells to combine and form into the earliest stages of an embryo, which is then implanted into the woman’s uterus.
For more details, check out our comprehensive article: Understanding the Basics of IVF.
What Is Egg Retrieval?
IVF egg retrieval is a minor surgical procedure to extract egg from a woman’s ovaries. It is minimally invasive, meaning there are no incisions made, no scarring, and it’s done as an outpatient procedure, usually in a fertility clinic. The procedure itself doesn’t take much time, about 10-15 minutes, but it takes a lot of preparation to get ready for egg retrieval.
IVF Egg Retrieval Timeline
The timeline for IVF is calculated around a woman’s menstrual cycle, which is typically 28 days long. Egg retrieval usually occurs on day 10-12 of that cycle. The doctor will use bloodwork and other tests to determine the optimal time to schedule the retrieval.
Here is a brief overview of an entire IVF cycle:
- On the first day of menstruation, the clinic is notified and baseline blood work and ultrasound is completed.
- Medication to stimulate ovulation begins.
- Sometime during week 2, the trigger shot is administered. This helps the eggs mature quickly and is scheduled 36 hours prior to egg retrieval.
- Around day 12, egg retrieval takes place.
- Patients typically take other hormonal medication following egg retrieval in order to increase the chance of implantation and pregnancy.
- Approximately two weeks after egg retrieval, the patient will start her period if pregnancy is not achieved, or she will receive an initial positive pregnancy test.
Preparatory Stage
There are a few steps to take before beginning IVF treatment that are important to know about. Your doctor will want to know how to predict your cycle so he or she knows when ovulation is expected to occur. If you have regular cycles, you may be asked to chart your temperature or to detect when ovulation begins.
Some doctors may ask you to start birth control pills during the cycle before treatment. This may sound counterintuitive for someone trying to become pregnant, but it can improve your odds of success and decrease your risk of ovarian hyperstimulation syndrome.
The key to this stage prior to beginning treatment is that your doctor needs to establish control over when you ovulate. After you ovulate, your doctor will start you on medications to stimulate ovulation.
Your treatment cycle officially starts on the first day of your period after beginning medications. At this point, it’s time for your baseline bloodwork and baseline ultrasound. On day two of your period, your doctor will conduct a blood test and a transvaginal ultrasound to check the size of your ovaries and your estrogen levels and to look for any ovarian cysts that might be present. If everything looks okay, your doctor will clear you to proceed!
Once the doctor has given you the green light to proceed, you will begin taking medications to increase your egg production. Normally, your body releases one egg each cycle. With IVF, your chances of success increase when you have multiple eggs to choose from. Not every egg will be viable, which is why you’ll need to take medications to signal your body to produce more.
During this stage, your doctor will monitor how your body responds to the medication and will make adjustments as needed. He or she will need to monitor how your ovarian follicles are developing so your medication dosages can be increased or decreased accordingly. You will likely be making daily trips to your IVF clinic to complete this monitoring for bloodwork and ultrasounds.
Now that your body is producing several eggs, or oocytes, you’ll need to make sure they reach a proper level of maturation. Your doctor needs to be sure that the eggs are fully ready to be retrieved, so you’ll be given what’s called a trigger shot to self-inject at a precise time.
The trigger shot contains human chorionic gonadotropin (hCG) which gives your eggs a boost to reach full maturity. The timing of this shot is super important! If you are off by a little as an hour, your eggs may be too immature or too over-developed to fertilize successfully.
Determining Egg Counts
In the weeks leading up to your IVF egg retrieval, you’ll be monitored at your fertility clinic at least every few days. Your doctor will perform ultrasounds to check how well the medication is working.
To determine egg counts, your doctor looks at both the ovarian follicle count and the follicle size. (Read More: What are Ovarian Follicles?) They will also be checking your hormone levels to make sure everything is progressing as expected. They may decide to adjust the dosage of your medication to promote better development.
Raising The Egg Count Through Injection
In the days leading up to your egg retrieval, you need to give yourself daily hormone injections of gondatropins. This type of drug mimics the hormone FSH which is typically produced by the pituitary gland. For people who struggle with infertility, gondatropins can signal the body to produce multiple ovarian follicles. Each follicle contains one oocyte, or egg, so the more follicles that develop, the higher the egg count.
Some women worry about the discomfort of giving themselves daily injections, but we often hear that the anticipation is worse than the actual shot! These injections are a necessary part of the IVF process. They are the key to preparing for a successful egg retrieval and should cause no more discomfort than your average vaccine.
Next, your clinic will give you a precise time to administer what’s called the “trigger shot.” Your doctor needs to be sure that the eggs are fully ready to be retrieved, and this shot is designed to cause rapid maturation.
The trigger shot contains human chorionic gonadotropin (hCG) which gives your eggs a boost to reach full maturity. The timing of this shot is super important! If you are off by a little as an hour, your eggs may be too immature or too over-developed to fertilize successfully.
Some women experience mild side effects from these hormonal medications, including fluid retention, bloating, mild headaches, mood swings, or breast tenderness. If you’ve taken hormonal birth control before, these symptoms may sound familiar.
Egg Retrieval Procedure
Roughly 36 hours after your trigger shot, your doctor will perform the egg retrieval procedure at your clinic. The actual egg retrieval process takes only 20 minutes (though you should plan to be at the office for around three hours that day), and takes place in their ambulatory surgery center.
You’ll be given mild IV sedation (not general anesthesia), so you won’t feel anything during the procedure. You may feel crampy the day after, and most women choose to take 1–2 narcotic painkillers the day of the egg retrieval, possibly one more the next day, and then ibuprofen if anything, the day after.
It’s best to rest and relax at home for a day or two, but most women are back to their daily routine after a few short days. You’ll need to have someone who can drive you home following the procedure, so plan to bring a friend or family member.
Once you are comfortable, the doctor will use a transvaginal ultrasound probe to guide a needle to your ovaries. Then, the follicle is aspirated to gently remove the egg from the follicle. This is repeated for each follicle, with the doctor carefully removing each egg to be transferred to the embryology lab for the next step. On average, about 8 to 15 eggs are retrieved during this procedure.
Following the procedure, clinic staff will monitor you for an hour or so to make sure no complications arise. It’s recommended that you spend a day or two resting at home, so use this time to catch up on Netflix!
Before The Surgery
To prepare for the egg retrieval procedure, you’ll of course want to follow all of your clinic’s medical advice closely. It’s also important to be prepared, both mentally and physically.
Some patients choose to talk through the process with a mental health professional. Any infertility treatment can be emotionally charged, so we think it’s always a good idea to talk about it with a professional.
In the days leading up to the procedure, do what you can to relax and stay positive. The day of, make plans to arrive early. Wear comfortable, loose-fitting clothing, and don’t forget to bring a friend or family member! You won’t be able to drive yourself home, so that last step is a must.
A couple more tips to keep in mind before your egg retrieval procedure: you won’t be able to eat or drink anything prior to the surgery. Most clinics tell you to fast after midnight before your scheduled procedure, but be sure to check with your doctor in particular. They’ll also tell you to avoid perfumes or other cosmetics the day of the egg retrieval.
During The Surgery
When you arrive for your egg retrieval, you’ll need to change into a hospital gown and head to the surgical suite. You’ll have your blood drawn, some initial paperwork to complete, and then the anesthesiologist will start you on IV sedatives. You’ll be asleep but able to breathe on your own, and you’ll be closely monitored by the anesthesiologist to make sure everything goes smoothly. And of course, you won’t feel anything during the actual procedure.
The surgeon locates your ovarian follicles using a transvaginal ultrasound, and then he or she will insert a thin catheter with a small, hollow needle attached to it. The needle is able to suction the follicular fluid that contains the eggs, and then that fluid is placed into test tubes to be transported to the embryology lab.
The anesthesiologist and medical team will continue to monitor you as you come out of sedation. All told, the retrieval process takes less than 20 minutes. You’ll spend more time in the recovery room (about an hour) than you will undergoing the procedure.
Recovering From The Procedure
Once the procedure is over, it will take you a few minutes to come out of sedation, but you’ll probably feel a little groggy for an hour or two. Your medical team will update you about how it went, letting you know how many eggs were retrieved.
Most of the time, you’ll be cleared to return to work the next day, although we like to suggest taking it easy for a couple of days whenever possible. You’ll be a little sore, and you may experience bloating, mild abdominal cramping, or spotting after the procedure. Most people say these symptoms are short-lived, only lasting a day or two. If you experience symptoms that are more severe or last longer than a couple of days, be sure to contact your medical team.
What Happens To The Eggs After Retrieval?
Once removed, your eggs are carefully collected into test tubes and transported to the embryology team in the lab. The eggs are located, counted, and put into a culture medium that mimics the environment of an ovarian follicle. They are then placed into an incubator to prepare for fertilization, or they are flash frozen to be cryopreserved for future use.
If your eggs will be used for an IVF transfer, or if you are creating embryos to be frozen, they’ll be fertilized with sperm in the culture dish about four hours after the retrieval and then put back into the incubator. They are then checked daily to see how the embryos are developing. The embryology team monitors progress as follows:
- Day Zero: Egg retrieval and fertilization
- Day One: Fertilization is confirmed
- Day Two: The embryos begin to divide.
- Day Three: The cleavage stage. The team checks the embryos and grades them based on the number of cells present and the general appearance of the embryos.
- Day Four: Embryos move from the cleavage stage to form blastocysts.
- Day Five: The blastocysts are examined and graded, then they may be transferred or frozen.
- Days Six and Seven: Any embryos that haven’t transitioned into blasocysts are rechecked on days six and seven. If all looks well, they’re then transferred or frozen. If an embryo doesn’t move to the blastocyst stage by this point, it’s not viable and is usually discarded.
Preparing For The Next Stage
Once you have viable embryos, it’s time for the next stage! There are a few ways you might proceed depending on the treatment plan you and your medical team have landed on.
If you are moving forward with an IVF transfer, then the embryologist will determine which embryos are the most likely to be viable. You’ll prepare for the embryo transfer procedure in much the same way as you did for the egg retrieval. You’ll need to have someone to drive you home, and you will be given a light sedative. Your doctor will pass a catheter (a thin tube) through your cervix in order to insert the embryos and a small amount of fluid into your uterus.
After the transfer, you will need to lie down for a few hours before heading home. Clinic staff will check in on you regularly to make sure you’re feeling okay and there are no signs of complications. Following the procedure, you may experience cramping, spotting, or mild discomfort.
If you are having your embryos frozen, then they will be cryopreserved and stored until a later date.
Risks And Side Effects Of Egg Retrieval
As with any medical procedure, there are some risks involved with egg retrieval. Minor risks include infection, discomfort, and swelling. In rare cases, there is a slight risk of injury to the bowel, bladder, uterus, ovaries, or major blood vessels.
The most concerning risk to watch for is OHSS, or Ovarian Hyperstimulation Syndrome. Ovarian hyperstimulation syndrome is an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. Ovarian hyperstimulation syndrome (OHSS) causes the ovaries to swell and become painful. Talk to your health team about your likelihood of experiencing OHSS and what to do if you have symptoms that concern you post-procedure.
Frequently Asked Questions About Egg Retrieval
It’s important that you understand each aspect of the egg retrieval process. Here are our answers to some frequently asked questions about the procedure.
Is fertility injection painful?
As with any vaccination or blood draw, you’ll feel a slight pinch when inserting the needle. You may experience some bruising at the injection site. While these injections are self-administered, your clinic staff will give you detailed instructions about how to minimize discomfort. Usually a little bit of ice and maybe some over-the-counter pain medication will help ease any discomfort at the injection site.
Any specific food to eat before egg retrieval?
There isn’t a particular diet you need to follow. We recommend nutritious foods and plenty of water! Remember, you’ll need to avoid any food or drink the day of the procedure, usually from midnight on.
Would the whole process of egg retrieval hurt?
You will be sedated during the egg retrieval procedure, so you won’t feel any discomfort during the process. Afterward, you can expect some mild cramping and slight pain in your vaginal and abdominal areas. Most women say over-the-counter pain medications do the trick!
What can I expect from egg retrieval?
The egg retrieval process is a minor and very quick procedure. You can expect to spend a day or two resting at home, but most people say they are back to normal by the second day.
I have PCOS, what can I do?
Women with PCOS can have very successful egg retrievals. Speak to your doctor about your particular situation.
Any advice for fellow women that are preparing for egg retrieval?
Our best advice is to make sure you feel informed and empowered every step of the way! If something is unclear, reach out to your medical team. It can also be helpful to find a community of people who have gone through the process before. There are many online support communities for people going through the IVF egg retrieval process.
When will I know the result of the process?
Your doctor should be able to tell you how many eggs were retrieved the same day of your procedure, usually while you are in the recovery room.
Improving The Outcome
There are a few things you can consider trying to improve the odds of a successful egg retrieval.
- Take care of your health in the 90 days leading up to your egg retrieval. Some doctors suggest trying a high fat, high protein, lower carb diet similar to the ketogenic diet. Others may recommend certain medications, supplements, or acupuncture treatments in order to improve egg quality.
- Discuss surgical interventions with your doctor. Sometimes, your doctor may want to perform a laparoscopy or hysteroscopy to get a better idea of how to proceed.
- Be sure to manage your stress and anxiety. Seek out support and counseling, and practice relaxation techniques such as yoga or meditation.
A Core Step In IVF
Egg retrieval is a core step in the overall lVF process. IVF is a wonderful option for people who need the assistance of reproductive technology in order to have a baby of their own.
You can learn more about the IVF process in this article, Understanding the Basics of the In Vitro Fertilization Process.
