In Vitro Fertilization Process: Egg Retrieval

Oocyte (egg) retrieval is a procedure for removing the oocytes, or eggs, from the ovarian follicles using an ultrasound guided needle.

Release

The monitoring phase of the treatment cycle continues until the follicles reach the appropriate size for release. On average, the mean follicular size needs to be larger than 14.5 to 15 mm with a lead follicle (the largest one) around 18 to 20 mm.

The follicles are allowed to grow a little bit larger for patients undergoing Intracytoplasmic sperm injection (ICSI) (this facilitates the removal of the granulosa cells surrounding the oocyte). When the follicles have reached the appropriate size, instructions will be given to prepare you for the oocyte retrieval.

Specific written instructions will be given to you on the day you are to take human chorionic gonadotropin (HCG). Here is an overview of these instructions.

Prior to visiting the monitoring clinic you will have taken your daily dose of Lupron. This does not change for the day you are to take HCG. The written instructions will direct you to stop taking your gonadotropin medication.

Instead of the evening dose of gonadotropin you will be instructed to take 5,000 units of HCG at a given time (usually 9 p.m. to 9:30 p.m. for weekday retrievals and 6 p.m. for weekend retrievals). Intercourse is usually recommended on the day of release.

The following day you will not take Lupron, gonadotropins, or HCG. There are no instructions for this day other than to avoid any food or drink after midnight. This is designed to ensure you have an empty stomach on the actual day of retrieval.

You may also take a sleeping aid if needed. Medications containing diphenhydramine (Benadryl) are usually enough. Patients who have had retrievals in the past may have directions discussing the use of oral Valium. Due to a change in our sedation protocols, you will not need to take any sedatives prior to the procedure unless specifically prescribed for the current retrieval.

The day of the retrieval is a very exciting time. Remember not to eat or drink anything when you wake up. Refer to your suggested arrival time on the written instructions (usually 8 a.m. for weekday retrievals and 6 a.m. for weekend retrievals).

Patients who are using donor sperm or are oocyte donors can usually arrive a little later during the week. Please arrive at the time written on your instruction sheet to keep the process running as smoothly as possible. Semen specimens will be collected on arrival and sent to the lab for processing.

Recovery

The next stop in retrieval process is the recovery and observation area. You will meet the recovery nurse who will help you prepare for the retrieval, insert an IV for fluids, and give an initial dose of sedation.

You will not receive any sedation until the physicians are ready to take you to the procedure room due to the fast onset of action of the medications we are currently using. Partners and family members will not be permitted to attend the retrieval process.

The Retrieval

You will be taken into the procedure room which is adjacent to the recovery area. After you have been situated comfortably on the procedure table the process begins.

The nurse will connect monitors used to evaluate your pulse, blood pressure, and oxygen saturation during the procedure. Additional medications can be administered safely as needed. A cleansing solution and speculum will be used to wash the labia and vagina to remove bacteria. Once the cleaning preparation and equipment set up is complete, the retrieval takes place.

An ultrasound probe fitted with a special needle guide is used to align the probe, needle, and follicle. Just like in the clinic, the follicle will be centered on the screen and instead of measuring the follicle, the needle will be inserted into the follicle.

This allows for precision aspiration of each of the follicles which will hopefully each contain an oocyte. As the oocytes are aspirated into the needle they are drawn into a test tube. This tube is then passed into the incubator. From here the embryologist will identify the oocytes and count them as they are found.

After the retrieval is complete you will be taken back to the recovery area. You or your partner will be told the final oocyte count prior to leaving the clinic. Recovery takes one to two hours on average. Prior to discharge you will be given discharge instructions including directions for supplemental HCG. Oocyte donors do not need supplemental HCG.

Things to Remember

The medications may impair your memory and ability to make decisions. Some patients do not even remember having had the procedure. You should not return to work or drive for the remainder of the day.

Do not get discouraged if the number of oocytes retrieved seems less than the number of follicles seen on ultrasound. Each follicle may not yield an oocyte for a variety of reasons.

Fertilization results are called by phone the following day before 1 p.m. Calls can sometimes be made sooner and are almost always called as soon as possible. Please be patient while waiting for the results. Also be sure to give us a number where you can be reached with the results.

The medications used for sedation will make you drowsy and less anxious but will not make you unconscious. You will not undergo general anesthesia. You may still feel sensations such as movement, pressure, and occasionally slight discomfort. The initial insertion of the needle is often a sharp "pinch" which can not be overcome by the medication. Fortunately, the needle is felt only once for each ovary in most cases.