An egg retrieval procedure is a 10-30 minute procedure to remove eggs from your ovaries so they can be fertilized through in vitro fertilization (IVF). However, it’s helpful to know what happens before the procedure and afterward. To understand how egg retrieval fits into the IVF process, read on.

6 Second Snapshot

• Before egg retrieval, you will use medications to stimulate your ovaries to produce more egg-containing follicles than they would during your usual menstrual cycle, in a process known as ovarian stimulation.
• During egg retrieval, you will be lightly sedated and your RE will insert a thin needle through the vaginal wall to withdraw fluid from each of your follicles.
• That follicular fluid will contain your eggs!
• After the egg retrieval procedure, an embryologist will check each egg to make sure it is mature and can proceed to the next step: fertilization.

What Happens Before Egg Retrieval

Before beginning the IVF process, you will have baseline fertility tests and an ultrasound conducted to ensure that IVF is the right fertility treatment for you. These tests will also give your reproductive endocrinologist (RE) a sense of how many eggs are in your ovaries (ovarian reserve) and help you set realistic expectations for the process.

To prepare for egg retrieval, you will undergo ovarian stimulation, during which your RE will prescribe a protocol of hormone medications. These medications will help develop a greater number of egg-containing follicles in your ovaries during your menstrual cycle as well as suppress ovulation so that your RE can retrieve those eggs from your ovaries.

As you undergo ovarian stimulation, you will periodically head back to your fertility clinic so your RE can conduct blood work to check your hormone levels and monitor the size of your ovaries’ egg-containing follicles through an ultrasound. When several of your follicles have reached a certain size, about 18-22 mm, your RE will carefully schedule your "trigger shot" (which “triggers” your eggs to mature) to occur 34-36 hours before your egg retrieval procedure.

Because you will be lightly sedated during the egg retrieval (usually with IV anesthesia), you should plan to have your partner, a loved one, or a friend accompany you to your appointment and take you home afterward. On the day of your procedure, plan to dress comfortably and be sure to arrive on time, since timing is critical toward the success of the procedure.

What Happens During Egg Retrieval

Before the retrieval begins, you will be put under light sedation, so you will not feel anything during the procedure itself. During the egg retrieval process, which can take anywhere from ten minutes to a half hour, your RE will use a transvaginal ultrasound to insert a thin needle through the vaginal wall to withdraw fluid from each of your follicles. That follicular fluid will contain your eggs! Afterward, you will be taken to a recovery room to be monitored as you recover from the sedation.

During egg retrieval recovery, it's very common to feel side effects such as discomfort and cramping similar to your period or PMS cramps. It is important to minimize activity after the egg retrieval for a day or two as you recover. Your RE may suggest that you take an over-the-counter pain medication such as tylenol to help with the discomfort. They may also prescribe an antibiotic to prevent infection from the procedure.

Your RE will likely be able to tell you how many eggs they retrieved before you leave the clinic or later that day. To find out how many of those eggs were mature, you may need to wait until the next day.

What Happens After Egg Retrieval

Immediately after your eggs are retrieved, the fluid is taken to a laboratory where an embryologist will check each egg for maturity. The next steps your fertility care team will take are dependent on your goals.

• Egg Freezing - Your mature eggs will be frozen using a process called "vitrification" (1). This fast-freeze method minimizes damage to your eggs as they freeze. They are then stored for later use.

• Fresh Embryo Transfer - Your eggs will be fertilized with your partner’s or a donor’s sperm, then monitored in a lab as they grow into embryos. During this time, you may start to take progesterone supplements to prepare your body for the transfer. The embryos that reach the blastocyst stage will be graded by an embryologist to determine which ones would be best suited for transfer. If you have more than one embryo, one will be transferred to your uterus, and the others will be frozen.

• Frozen Embryo Transfer - Your embryos will undergo the same process as they would during a fresh embryo transfer. However, once the embryos have been graded, they will be frozen for later use. If you decide to do preimplantation genetic testing (PGT), your embryos will be frozen while you wait for the results.

The day of your egg retrieval procedure, you should plan to rest as you recover from the sedation. You may continue to feel cramping, soreness, and discomfort for a few days during your egg retrieval recovery. If you developed a large number of follicles during ovarian stimulation (more than 20) and/or had high estrogen levels before the trigger shot was administered, you may experience more uncomfortable symptoms, which may be a sign of ovarian hyperstimulation syndrome (OHSS).

The symptoms of OHSS include bloating, constipation, reduced urinary output, and abdominal pain. If you suspect that you are experiencing OHSS, you should contact your clinic. However, if you notice that you are experiencing rapid weight gain (more than 2.2 pounds in one day), nausea and/or vomiting, severe abdominal pain, and/or shortness of breath, you should go to the emergency room for care.

To manage mild OHSS, your RE may recommend a high protein diet, plenty of electrolytes and fluids, and an over-the-counter stool softener.

Can I Predict How Many Eggs My RE Will Retrieve?

In short, yes! From the start of your IVF cycle, your RE will have a sense of how many eggs they might retrieve from your baseline fertility tests and ultrasound. They will get a more clear picture by taking periodic ultrasounds during your ovarian stimulation process as they monitor the size and number of your follicles.

While doctors and researchers used to believe that the optimal number of eggs you could retrieve during a cycle was 6-15, new research shows that your overall chance of success will be better if you retrieve as many as is safely possible for your body. Each egg retrieved increases your chance of success with IVF, since each egg increases the possibility of a high quality embryo for transfer.

It’s important to note that the number of eggs your RE retrieves will most likely not be the same as the number of embryos you will have from your IVF cycle. This is because some eggs and embryos are lost at each step of the IVF process. To get a sense of how many eggs and embryos are average for your age, it may help to look at the chart below and to read more about what’s known as the "IVF funnel." This chart begins with the average number of follicles before egg retrieval and ends with the cumulative live birth rate (CLBR) for non-canceled cycles, which is the percentage of IVF cycles that result in at least one live birth after all embryo transfers associated with that retrieval.

While it's understandable to be nervous about your egg retrieval procedure, remember that you have a team of experts who are there to support you, as well as resources, reproductive technology, and your patient advocacy skills to help you along the way!