When going through an IVF cycle, knowing what to expect and how to prepare for your egg retrieval is an important part of the journey. Many patients focus so hard on the preparation (time, shots, and appointments) leading up to this point that they often forget to learn about what to expect on the actual day of the retrieval. But preparation decreases worry and makes the day better all around.
Preparing for the Egg Retrieval
It’s never too early to prepare for the egg retrieval. The procedure is usually done in the morning, and you should not plan to work or have any responsibilities afterward – instead, you should plan for pampering. This means preparing for a day off of work – free of appointments, childcare responsibilities, etc.
One really tough reality is that that day is up to your ovaries – not you, not the medications, and not the doctor. You can get a guess of about 2-3 days you are most likely to have your retrieval, but every person and every cycle is different, so be prepared to be flexible. You will get updates with the ultrasounds and blood tests through the stimulation phase of IVF, and your team can tell you their best guess of the day each time they see you. You will definitely have 2 days’ notice, because patients do one last shot (the trigger shot that signals the final maturation of the eggs) about 36 hours before the retrieval. So, if you are ready for a trigger on a Monday, your retrieval will be on a Wednesday. As soon as you get your calendar from your clinic, look at the week around the estimated date of retrieval and lighten your schedule, limit commitments, and think ahead.
The timing of the egg retrieval is critical, and being late to the procedure can result in ovulation, which means having to start all over again. If you live far away from your clinic or you live in an area with lots of traffic, plan ahead. This can mean leaving extra early or staying in a hotel close to the clinic the night before the procedure.
Closer to the day of the retrieval, prepare to have a relaxing day. Get a book recommendation, line up shows or movies you’d like to watch, plan ahead for meals – if you have a partner or dear friend, ask for help and make sure they have made their schedule flexible too, because it’s good to have someone when you need them.
The Day of the Egg Retrieval
Review the process with your clinic and ask questions ahead of time. Each clinic has slightly different protocols and expectations, but most are similar. Here are some things to expect:
Expect to be told not to eat or drink anything the morning of the procedure. If you take medication, ask your clinic whether you should take or skip your morning dose(s).
Check in on time – a 9:00AM procedure usually means the start time of the procedure, and it takes time to get ready – your clinic will usually tell you both a check in time and a start time for the procedure. Be on time (or early), but do not be late.
You’ll change into a gown and meet your team.
The procedure room is an operating room, so expect to see people in scrubs, medical equipment, lights, and a procedure table – it feels a little strange to be in a room like that as a patient but remember that everyone in the room is there to help you, and do not be afraid to ask questions.
Expect to lie down on the table (ask for warm blankets if you’re cold). You’ll get an IV for medication and go to sleep soon.
Take a moment to pause the morning of the retrieval or on the table as you are drifting off to sleep. Be mindful of all the work you’ve done to get to this point and all the hurdles you’ve overcome to make it to that day!
I reassure patients before they go off to sleep that we are here to take care of them and that they are going to have a lovely nap. I also remind them that at this point, their work is done – all the shots, appointments, and logistics of preparing are complete. It’s like the moment right before an exam – all the studying is done, so be in that moment knowing you've done all you can, mindful of your goals. Then we visualize their favorite place, their happy place – Maui is often the front runner. “Close your eyes, imagine warm sun, sand, hear the waves, and enjoy that fruity drink with a tiny umbrella."
The procedure itself takes about 10-15 minutes, but expect to be in the clinic for about 2 hours total. Most patients are asleep for the procedure; sedation medication is given through an IV, and the patient does not feel anything while they sleep. Most patients are not intubated, meaning they are breathing on their own but in deep sleep.
Eggs are inside pockets of fluid called follicles resting in the ovaries. A transvaginal ultrasound is used to see the follicles in the ovaries, and a needle is placed through the upper wall of the vagina into each follicle in the ovary. Each follicle is drained, and the follicular fluid (with the egg) goes into a test tube (that’s where the term test tube baby comes from).
The embryologist looks through the fluid and isolates the eggs and takes them back to the lab.
Immediately After the Egg Retrieval
You will usually wake up in the recovery room and rest until you can eat a little, drink a little, and go to the bathroom before leaving the clinic. You’ll leave the clinic knowing how many eggs were retrieved that day (more on egg number and expectations below).
You should have someone drive you home from the egg retrieval. That day, expect a little cramping and spotting. Make sure you know how to get in touch with a provider if you have concerns, more pain than expected, or questions.
Recovery After the Egg Retrieval
Recovery from the egg retrieval procedure is minimal for many patients. Plan ahead for a relaxing afternoon and evening the day of the procedure, and expect some light bleeding and cramping that day. You may be able to work the following day, but be flexible – you may need one more day at home.
Patients with a high response to stimulation (lots of eggs retrieved or high estrogen levels in the cycle) can take longer to recover. Ovarian hyperstimulation syndrome is a risk of IVF and can involve enlarged ovaries, fluid buildup in the pelvis and abdomen, and bloating. Patients with ovarian hyperstimulation syndrome can be caught off guard if they assume all their symptoms will resolve with ‘getting the eggs out,’ so contact your clinic if you are having significant bloating, weight gain, or discomfort after the retrieval. If you are planning a fresh transfer, follow your instructions for starting the supporting medications.
If you’re not planning a fresh transfer, expect a period about 7-10 days after the retrieval, and warning: this period may be heavier and more crampy than normal since your hormone levels are higher and your uterine lining usually gets thicker in a stimulation cycle compared to a natural menstrual cycle.
Ask your clinic about communication after the egg retrieval:
How will you get updates on the eggs and embryos?
What medications will you need?
Will you have a follow up visit with your provider?
An important note about the number of eggs retrieved. Before the retrieval, your doctor will make a prediction of how many eggs they may retrieve based on the number of follicles on ultrasound and the estrogen level on the day of the trigger shot. This is an estimate, and rarely do we as doctors guess exactly right. We do not always get an egg from every follicle, and you can wake up and get a report that fewer than expected eggs were retrieved.
This can be incredibly disappointing and cause worry. When we do not get an egg from a follicle, we feel that either there was not an egg in the follicle or that the egg was immature, poor quality, and did not release from the wall of the follicle as it should. When we get more eggs than expected, then we assume we underestimated the number of follicles or perhaps that some follicles had 2 eggs.
But the number of eggs is not the end of the journey – there are other hurdles, since each egg retrieved is an opportunity, but not every egg will be mature – only mature eggs can fertilize with sperm to become embryos, and not every embryo can become a baby. Some patients will have 20 eggs retrieved and 5 embryos and other women will have 5 eggs retrieved and 5 embryos. Be patient, even though it’s incredibly tough waiting for those updates from the clinic after the retrieval. As you’re waiting it can be tempting to look online, social media outlets, and talk to friends about their experiences with IVF. Reminder: Every person is different and this is not a time for comparison – other women will have more or fewer eggs, but we can all become mothers one way or another.
Best wishes if you are preparing for your own egg retrieval!
Learn more about infertility and miscarriage with more blog posts at drlorashahine.com.