The IVF Process Part II: Egg Retrieval and the Hunger Games
By Alina Avery
At the end of your stim phase, you’re given a different medication called a “trigger shot”. This is administered exactly 36 hours before your egg retrieval is scheduled and lets your ovaries know that it’s time to mature the eggs and prepare them for release. Before they are actually released, the procedure is performed to aspirate each of the eggs out of their follicles. The follicles have grown to be about 20mm at the largest, and usually at least 14mm if they are containing a mature egg, and they’ll continue to grow after the trigger shot, but the eggs themselves are still microscopic. Essentially what they do for the surgery is administer a general anesthesia and go in and suck out the fluid from each follicle, including the egg, and then observe the fluid under a microscope to see how many eggs they were able to collect. So roughly, the number of follicles correlates to the number of eggs you can expect, but some eggs get stuck to the side of the follicle, some follicles are empty, some eggs are released sooner than expected, and some immature follicles will mature by retrieval time, so it’s not exactly 1-to-1.
At the time of my trigger shot, my left ovary had 5 follicles measuring (in mm) 19.6, 19.1, 18.9, 18.4, 17.2, and my right ovary had 18, measuring from 21mm to 11mm. It’s pretty normal to have one ovary more active than the other, and it varies from cycle to cycle. During a natural cycle, only one ovary matures and releases an egg, so logically to me it seems like that side might have a leg up, but I haven’t had that confirmed by a doctor or anything.
The day of the surgery, I arrived about an hour before my scheduled retrieval time. I was told not to eat or drink anything after midnight, no makeup or perfume or contact lenses, and no jewelry. I was given a gown to change into and a warm blanket and some socks. A nurse administered an IV and that was the most uncomfortable part of the whole day. I met the anesthesiologist and the fellow who would be performing my retrieval, and they went over what I could expect, how long the operation would take, things like that. I might have signed a consent form but I don’t really remember. I was pretty nervous, even though at that point, everything was out of my control. I was mostly paranoid that I had ovulated all of my eggs already and they’d go in and find nothing left. That was not the case, and is very rare, although it does happen.
Matt left me on my own for a few minutes to go produce his sample that they would use for fertilization and when he was back with me, it was time to go into the operating room. I used the rest room (awkwardly as I had an IV in my arm and a fluid bag with me), and walked into the room and got up onto the table myself. They had me get into position while I was still awake so that I would be comfortable and not pinch any nerves or lose circulation, and then they replaced the IV fluid with whatever drugs they used for the anesthesia and the next thing I knew I was being wheeled into the recovery area about 25 minutes later.
The anesthesia can sometimes make you nauseated, so they give you some crackers and ginger ale while you wake up, and a nurse comes by with a little slip of paper to tell you how many eggs they were able to retrieve and give you some post op instructions. Basically, no driving, no strenuous exercise, call if you notice anything unusual. Once I felt strong enough to use the bathroom by myself, I could change back into my street clothes and be on my way. I did need to have a ride home as I couldn’t drive, and a nurse actually walked me out to the car, probably to make sure I didn’t fall and also to make sure I wasn’t driving.
We got 24 eggs, from what seemed like 23 mature follicles two days before, so pretty much what was expected. Generally, this is a lot of eggs for an IVF patient. The “sweet spot” is around 15 eggs to balance quality and quantity, but a lot of patients who are older get fewer, and patients who are younger without any ovarian issues get more. We went home and spent the rest of the day on the couch essentially, watching movies and napping. My recovery was very easy, which isn’t always the case. I had a very easy go of it and I’m very thankful. I was back at work the next day and did not have any lingering nausea, pain, or side effects from the anesthesia. I consider myself very lucky.
Then, the hardest part of all of this started. The waiting. No one prepares you for how much waiting you have to do, and this was just the start. Twenty-four hours after the surgery, the clinic will call you to let you know how many of the retrieved eggs fertilize naturally. We opted to do something called ICSI, where instead of just putting the sperm and eggs together in a dish, they inject a single sperm cell into each egg, which helps with fertilization rates. Waiting for that phone call was nerve wracking, but I was happy to hear that we had 16 eggs fertilize. Generally, you’ll lose 25-30% of your starting egg count with each stage of growth, which is very normal and mostly due to chromosomal issues with the cells or something along those lines. IVF message boards and support groups sometimes refer to this as the Hunger Games, as it is kind of a survival test of strength for microscopic groups of cells. Some clinics will give you an update on the growth of your embryos on day 3, but many will prefer to leave them undisturbed until day 5, when most patients will have a “fresh” (as opposed to “frozen”) embryo transfer. So we went from day 0, retrieval and 24 eggs, to day 1, fertilization and 16 embryos, and then we wouldn’t hear anything more about our embryos until day 5, transfer day. Those four days feel like an eternity, but it was really just the beginning of all of the waiting we’d be doing throughout this process.
