What happens during the IVF egg retrieval process?

    Published 11 August 2022
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    Medically reviewed by Dr. Allison Rodgers, Reproductive endocrinologist, obstetrician, and gynecologist, Fertility Centers of Illinois, Illinois, US
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    The egg retrieval process can be a nerve-racking part of IVF. Here, a fertility specialist talks through what to expect and how many eggs you’ll ideally produce.

    Egg retrieval day (also known as egg collection) is a pivotal moment in in vitro fertilization (IVF) treatment and can also be used in egg freezing too. After 10 days of medication and perhaps months of anticipation, it’s finally time to discover how many eggs your ovaries have been busy producing. 

    The results of the egg retrieval process will ultimately determine how many embryos you have to choose from for transfer day. It’s understandable, then, that this can feel like a tense part of an already emotionally charged process. With so much riding on the procedure, you may feel under pressure, which is completely natural. But the more information you have, the better you’ll know what to expect and the calmer you might feel. So read on as a fertility expert takes you through exactly what happens during the IVF egg retrieval process and what the outcome might mean for your fertility journey.

    When is egg retrieval done?

    There are several steps in the average IVF journey, and egg retrieval comes about halfway through. One cycle of IVF can take three to six weeks, and the stages typically involve:

    • Synchronizing eggs, typically with hormones (either oral or injectable), so they grow together
    • Stimulating the ovaries to produce as many eggs as possible (also injecting a tailored prescription of fertility drugs) 
    • Injecting the trigger shot
    • Egg retrieval at the clinic
    • Fertilization in the lab
    • Embryo transfer

    Leading up to egg retrieval procedure, your menstrual cycle needs to be suppressed, either by self-administered daily injections or with birth control pills or estrogen patches. This allows the doctor to control your cycle more effectively, so your body produces a more predictable response to the egg stimulation medication. 

    You’ll start taking a follicle-stimulating hormone (FSH), luteinizing hormone (LH), or a combination of both to increase the number of eggs that the follicles in your ovaries produce. The idea is that the more eggs that are collected and fertilized, the greater chance you will have of finding a healthy egg that could go on to produce a baby. This is especially important because not every follicle will produce an egg.

    During this part of the process, which usually takes around one to two weeks, you’ll be called into the clinic regularly for scans on your ovaries to make sure the drugs are working. Your sonographer will document how big the follicles are at the scans. Then the date of your egg collection will be calculated based on how well your body is responding.

    Just before egg retrieval day, you’ll be given a “trigger shot.” This is a shot of a hormone that helps your eggs to mature in the ovaries. The egg retrieval process then takes place at your fertility clinic approximately 36 hours later.

    How long does egg retrieval take?

    IVF egg retrieval is a fairly quick process, taking just 20 minutes. But how does it work?

    First, sedation or anesthesia will be used to make sure you don’t feel any pain. A specially trained health care professional will then perform the procedure by placing a needle through the vagina into each ovary, using ultrasound as a guide. They will then retrieve multiple eggs from your ovarian follicles via a suction device.

    While you’re in the recovery room taking it easy before heading home, your doctor will let you know how many eggs they’ve retrieved. What happens next depends on what kind of IVF treatment you’re having (fresh or frozen). 

    In both cases, the clinic will mix the eggs with sperm in the lab, and some will fertilize (they’ll keep you updated on how many have fertilized over the next few days — not every egg will survive, and that’s normal). Then, the fertilized eggs (now called embryos) will be graded based on quality. In a fresh transfer, your fertility doctor will transfer one or two embryos (depending on your fertility plan) into your uterus around 2 to 5 days after egg collection. In a frozen IVF cycle, the embryos will be graded and then frozen around days 5 to 7, ready to be thawed when you want to use them.

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    Is egg retrieval painful?

    If the thought of egg retrieval makes you wince, you’ll be glad to know that the procedure is carried out under sedation or a general anesthetic. Tiffanny Jones, MD, a practicing endocrinologist and fertility specialist, explains: “Most egg retrievals are done under anesthesia. Since they are usually done when you are asleep, you will not feel any pain.”

    Nutritionist Charlotte Grand has experienced egg retrieval herself. Reflecting on how she felt at the time, Charlotte recalls finding her first IVF egg retrieval “nerve-racking” but says she was pleasantly surprised by the process. “I was concerned that I would be aware of what was going on and feel it. I think this is something that concerns most women,” she explains. “But you are sedated for retrieval, and the sedation for me was exactly like a general anesthetic, so I wasn’t aware of anything.”

    How many eggs do you get from egg retrieval?

    Until egg retrieval day arrives, there’s no way of knowing exactly how many eggs you will produce. Although some parts of the IVF process can involve lots of nervous waiting, thankfully, this isn’t the case with egg retrieval — you should find out how many have been collected before you leave the clinic.

    Your age and ovarian reserve (the total number of healthy, unmatured eggs you have in your ovaries) will play a part in the number of eggs you produce, explains Dr. Jones. But there’s an ongoing debate among experts about how many eggs are the ideal number to produce in IVF egg retrieval. “The optimal number of eggs [is] age dependent. The older someone is, the more eggs they would need to have for a reasonable chance of having a live birth,” Dr. Jones adds.

    According to one big study from Guy’s and St Thomas’ Foundation Trust in London, the average number of eggs collected from IVF egg retrieval is 9, with 15 eggs maximizing the chance of a live birth. But this varies from person to person. 

    It might be hard, but try not to fixate too much on the number of eggs your doctor retrieves. While more eggs (up to a point) may increase your chances of a healthy pregnancy and a live birth, other research shows that (depending on your age) you can still have a decent chance of conceiving via IVF with a lower number of eggs. 

    One such study carried out by the Quebec government showed that women under the age of 35 who produced between 1 and 4 eggs at retrieval still had a 30.8% chance of getting pregnant following IVF.

    "Try not to fixate too much on the number of eggs your doctor retrieves"

    It’s also worth knowing that there is some risk attached to having too many eggs retrieved at this stage of IVF. Dr. Jones explains that anyone who produces more than 24 eggs during an egg retrieval procedure is at a higher risk of ovarian hyperstimulation syndrome (OHSS), a condition that needs to be closely monitored by a doctor. However, this is quite a rare occurrence, with severe OHSS only occurring in 0.5% to 5% of IVF patients. Symptoms can include abdominal pain, nausea, vomiting, diarrhea, bloating, shortness of breath, and tenderness in the area of your ovaries, so seek medical help immediately if you have recently undergone IVF egg retrieval and you notice any of these.

    Sadly, despite the very best preparation ahead of egg retrieval day — and through absolutely no fault of your own — sometimes no eggs are retrieved at all. This is known as empty follicle syndrome and thankfully isn’t all that common, affecting just 1.7% of egg retrievals.

    “The reason can be that the patient doesn’t respond to the trigger shot,” says Dr. Jones, explaining that the trigger shot helps the egg detach from the follicle side wall. “Another reason could be that a person may [have] ovulated prematurely. The retrieval is timed to occur before the eggs release from the follicle. When they release, they free float into the body and cannot be found in most cases.”

    Unfortunately, if you have experienced empty follicle syndrome once, you are at a slightly elevated risk of it happening again. However, this risk also increases with age, regardless of whether you’ve had it before or not.

    Empty follicle syndrome can be an understandably disappointing outcome to experience, so be kind to yourself if you find yourself in this position, and reach out to loved ones or professional support networks such as Resolve in the US or Fertility Network UK if you need to. Your clinic should also do a full debrief with you, which will allow you to ask any questions. Make sure to take advantage of this so you come away feeling like you understand everything you can.

    How long does it take to recover from egg retrieval?

    Although it may feel like there’s a lot riding on it, egg retrieval is a fairly straightforward part of the IVF process and is therefore quite quick to recover from. “It is an outpatient procedure, meaning you go home after a short recovery period after waking up from anesthesia,” explains Dr. Jones. “Most people are able to go to work or school the next day.”

    However, your recovery may be slightly delayed if you suffer from any of the common egg retrieval side effects. These can include bloating, cramping, breast tenderness, constipation, and vaginal discharge. They all vary from person to person, and you may not experience all or any of them. Even with side effects such as these, most people feel back to normal within 1 to 2 weeks.

    Jewelry designer Jenny Guertin knows firsthand what egg retrieval side effects can feel like after her procedure resulted in 25 eggs, which put her at a heightened risk of OHSS. “I had a little bit of cramping, but it wasn’t too painful. My stomach was very bloated, probably because they retrieved a lot of eggs,” she recalls.

    “I was worried about OHSS as I had read a lot about it, and my stomach was very large,” Jenny says, adding: “I was absolutely fine though, and over the next few days and weeks, the bloating subsided, and I felt a lot more comfortable.”

    Although she felt anxious ahead of the procedure, which is to be expected, Jenny tried to prepare herself for her egg retrieval the best she could. “I was really nervous on egg collection day, but I felt prepared. I had done a lot of research, so I knew what to expect with the procedure,” she explains.

    Happily, Jenny went on to welcome a baby girl after having a frozen embryo transfer (FET) using an embryo created from one of her 25 collected eggs.

    Charlotte, who underwent three retrievals resulting in 9, 17, and 14 eggs, respectively, had a very different experience from Jenny. “I was lucky and didn’t experience any side effects,” she recalls. “I had minimal bleeding after retrieval and experienced some minor bloating, which is to be expected.”

    Charlotte went on to have two children following her first and third egg retrieval.

    Egg retrieval complications

    As with any medical procedure, egg retrieval surgery isn’t completely without risk. As well as OHSS, there is also a very small risk of ovarian torsion (a twisted ovary), infection, and bleeding or damage to the bowel, bladder, or blood vessels. If you notice ongoing pain in your pelvic area following egg retrieval, make sure to see a health care professional right away.

    However, it’s important to remember that these are rare complications, and egg retrieval is generally a safe and straightforward minor procedure. Don’t be afraid to talk to your health care provider if you have any concerns.

    Egg retrieval: The takeaway

    Although it may sound daunting, egg retrieval is a quick, usually painless procedure and is hopefully just another step to take on your journey to parenthood. It’s important not to be too hard on yourself if your treatment results in fewer eggs than you’d hoped, as you still have a chance to get pregnant.

    Jenny says focussing on the end goal helped her to get through this stage of IVF treatment. “I know people like to prepare for things in different ways, but for me knowing as much about what would happen as possible really helped,” she says. “I had my ‘eyes on the prize’ and felt like this was just one of a number of difficult but necessary procedures I had to go through to get what I so desperately wanted.”

    References

    Choe, Jennifer, et al. “In Vitro Fertilization.” StatPearls, StatPearls Publishing, 2022.

    Deepika, K., et al. “Empty Follicle Syndrome: Successful Pregnancy Following Dual Trigger.” Journal of Human Reproductive Sciences, Jul.–Sep. 2015, Vol. 8, No. 3, pp. 170–174. www.ncbi.nlm.nih.gov/pmc/articles/PMC4601177/ 

    Delvigne, Annick, and Serge Rozenberg. “Epidemiology and Prevention of Ovarian Hyperstimulation Syndrome (OHSS): A Review.” Human Reproduction Update, Volume 8, Issue 6, 1 November 2002, pp. 559–577. Oxford University Press, academic.oup.com/humupd/article/8/6/559/718653

    Huang, Ci, et al. “A Review of Ovary Torsion.” National Center for Biotechnology Information, www.ncbi.nlm.nih.gov/pmc/articles/PMC5615993/

    “In Vitro Fertilization (IVF).” Mayo Clinic, www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716

    “IVF Egg Retrieval: Process, Procedure, Recovery, Risks, and More.” CNY Fertility, www.cnyfertility.com/ivf-egg-retrieval/#

    “IVF: What Happens.” National Health Service, www.nhs.uk/conditions/ivf/what-happens/

    Madani, Tahereh, and Nadia Jahangiri. “Empty Follicle Syndrome: The Possible Cause of Occurrence.” Oman Medical Journal, Nov. 2015, Vol. 30, No. 6, pp. 417–420. National Center for Biotechnology Information, www.ncbi.nlm.nih.gov/pmc/articles/PMC4678451/#

    “NCI Dictionary of Cancer Terms.” National Cancer Institute, 2 Feb. 2011, www.cancer.gov/publications/dictionaries/cancer-terms/def/ovarian-reserve.

    Ouhilal, S., et al. “What Is the Optimal Number of Eggs at Oocyte Retrieval?” Fertility and Sterility, vol. 100, no. 3, Sept. 2013, p. S262.

    “Ovarian Hyperstimulation Syndrome.” Mayo Clinic, www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697.

    “Ovarian Stimulation for IVF/ICSI.” European Society of Human Reproduction and Embryology, www.eshre.eu/Guidelines-and-Legal/Guidelines/Ovarian-Stimulation-in-IVF-ICSI. Accessed 6 July 2022.

    “Ovarian Torsion.” Yale Medicine, 13 July 2021, www.yalemedicine.org/conditions/ovarian-torsion.

    Raju, Gottumukkala Achyuta Rama, et al. “Luteinizing Hormone and Follicle Stimulating Hormone Synergy: A Review of Role in Controlled Ovarian Hyper-Stimulation.” Journal of Human Reproductive Sciences, vol. 6, no. 4, Oct. 2013, pp. 227–34.

    Sunkara, Sesh Kamal, et al. “Association between the Number of Eggs and Live Birth in IVF Treatment: An Analysis of 400 135 Treatment Cycles.” pubmed.ncbi.nlm.nih.gov/21558332/

    “What Is the Trigger Shot?” Fertility Center of Dallas, fertilitycenterofdallas.com/blog/trigger-shot/ 

    History of updates

    Current version (11 August 2022)

    Medically reviewed by Dr. Allison Rodgers, Reproductive endocrinologist, obstetrician, and gynecologist, Fertility Centers of Illinois, Illinois, US

    Published (11 August 2022)

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