welcome back this week we are continuing on our ivf journey and talking about the egg retrieval
process yeah we're going to be going into what is egg retrieval how does it happen and what can
you do to prepare in case this is your first time meeting us i'm sarah i am a board-certified ob gyn
an ivf doc now doing ivf myself i'm kurt i'm a board-certified pediatrician i'm a first-time
dad and the cheerleader for going through all this process yes and we are the doctors bjorkman
you may have met us two years ago when we were trying to get knocked up with our first
kiddo yeah and during that process we detailed everything about getting pregnant evidence-based
trip through pregnancy and parenting tips and now find ourselves trying for baby number two
yeah so this journey has certainly been different um as we found ourselves faced
with some male factor infertility and now are doing ivf yeah so we've already done
some videos you may have seen about ivf basics some of the medication videos administering those
and what to expect with ivf videos right so this week is all about the egg retrieval you have done
those 8 to 12 days of injectable medications and now your team says those follicles are ready to go
you took your trigger shot and you are wondering what is next
so maybe you can start by saying what is an egg retrieval so an egg retrieval is a minor surgical
procedure where your doctor goes and drains all of those follicles that you have been growing using
a very specialized kind of vacuum suction gotcha okay and is there anything special that you need
to do to prepare for that so first and foremost the most important thing is to make sure that you
take your trigger shot correctly and at the exact time your clinic tells you to yeah the role of
this trigger shot is it causes those follicles to go through their final maturation process
and helps the eggs kind of be released from the wall of that follicle so then they're ready to be
retrieved on retrieval day you then know that ovulation is going to happen about 36 hours
after that and that retrieval time is planned for just before ovulation exactly so the thing about
this medical procedure and egg retrieval that is a little different than any other medical procedure
you may have is that there isn't a set date and time that it's going to happen
your retrieval happens once those eggs are ready and that can vary by a few days um so usually
patients are triggered around day 10 and then your retrieval is always two days after that um trigger
but that trigger shot can vary by a couple days either way yeah and as you can imagine this can be
pretty frustrating and honestly just challenging yes for you as patient just because you're trying
to coordinate with your work schedule child care if you have other kids already um or even
just like life events and having to kind of last minute say like oh the procedure's gonna be today
or it's gonna be tomorrow um can be tricky yeah so something i always try to encourage patients
is to kind of keep a flexible mindset as you are going through all of this
so you take the trigger shot what's next well as we said 36 hours later it is going to be a
retrieval time because this is a minor surgical procedure where you will be getting anesthesia
your team will instruct you not to eat or drink after midnight the night before your procedure
yeah so if you walk in and the anesthesiologist asks you how your breakfast was this is definitely
a trick question as the answer should be like oh i haven't had any breakfast
thanks for asking so again the morning of the retrieval you are gonna need a ride you'll need
someone to bring you um because you need a ride home after getting anesthesia yeah and if you
have a male partner who's participating in the ivf process just as a heads up and a reminder
he's going to be expected to give a fresh sperm sample which is going to be used for insemination
that day often and this generally happens that same day generally also it's recommended for two
to seven days of absence prior to giving that semen sample um so keep that in mind to have
your partner be prepared for that as you're going through the stimulation process yeah
i on that day of i always tell patients that i recommend you come in comfy clothes and your
favorite or lucky socks um as you get there you will change into a hospital gown but often you can
keep your socks on if you want of course after the procedure sometimes you're a little sore
or sleepy and so it's nice to have comfy clothes that are just easy to change into on your way home
so next we're going to talk about what to expect on the actual day of your retrieval um on that day
your team is probably going to ask you to arrive about 45 minutes before your actual retrieval time
this is so that they've got time to get an updated weight vitals they're going to place
an iv that they're going to use for medications and the anesthesia and have you do other things
like changing into a hospital gown putting on a hair net hair cover and then also you're going
to meet the anesthesiology team and the physician team and do other things like reviewing consent
forms verifying your name date of birth and other things pre-procedure like that correct so
as the doc i always see if you have any questions as well as review that last ultrasound you had so
that we can discuss how many eggs we're expecting to get we know that not every follicle has an egg
in it and not all eggs are mature but we hope to find mature eggs and follicles that were greater
than 14 millimeters on your last scan it gives us a pretty good estimate of how many eggs to expect
i also have a motto though no follicle left behind so we drain all of the follicles even the small
ones and then let the embryologists look through that fluid for the eggs
often the smaller ones are immature um but we still try but we do need nice mature eggs
for insemination so we are just getting ready for my retrieval my iv is in and
i've got my little hair net for the the party hat um talk to our nurses talk to
anesthesia talk to the the docs and uh we're ready to rock so we'll know how many eggs soon
then it's time to head back to the procedure room so usually at that time they'll have you empty
your bladder and walk back to that procedure room on your own the anesthesiology team once
you get back there's going to hook you up to their monitor so they can follow your vitals
throughout the procedure and then they're able to give you the medications that put you off to sleep
um and make it so you don't remember anything from the procedure and you really just wake up feeling
like you had a great nap um one thing that's important for you to know is that you almost
never have to put in a breathing tube for this and so you're breathing on your own
during the procedure yes so once you're nice and sleepy we then place the speculum in the vagina
and clean the vagina out really well with saline we know that betadine and other soaps can be
harmful to the eggs so we just use a lot of normal saline a sterile cover then gets placed on that
transvaginal ultrasound probe and a long needle is attached for the beginning that needle just rests
in the needle guide above the ultrasound and then this is when the doctor and physician team
uses that probe placed in the vagina and using the transvaginal ultrasound to identify each ovary
check and make sure the winding of the uterus looks good and then beginning the procedure
so to do the procedure a really long needle as we said is attached to that transvaginal ultrasound
and then the needle is carefully advanced through the back of the vaginal wall into
the ovary once the needle's in a follicle we step on a petal that activates a suction that drains
all of the fluid out of the follicle and we kind of watch it collapse that fluid is then handed off
to our embryology lab and they look for eggs yeah and these eggs are microscopic so the
embryology lab has specialized microscopes to look through the fluid to find those eggs and then
they're actually usually able to give a running tally to the physician team about how many eggs
they're actually finding in the food that's collected yes so after every follicle is
drained on one side we then take the needle out flush that needle and move to the other ovary
after the procedure is the complete we just need to look and check for bleeding so we put
that speculum back in look at those two puncture sites at the back of the vagina again there's only
two puncture sites because you use one to go into the ovary on the left side and one to go into the
ovary on the right side and we just want to make sure those are hemostatic if needed every once
in a while we have to hold pressure for a couple minutes to get that bleeding to stop and rarely
um we have to put a little stitch in the back of the vagina yeah overall this procedure is
pretty quick it only takes about 15 minutes um you're then wheeled back to recovery room and
then it takes you about another 10 minutes or so to wake up from anesthesia sedation
yeah um when you wake up you feel like you've had a nice nap and uh sarah herself felt like she had
the greatest stamp of all time yes in the morning so before you go home we want to make sure that
you can eat and drink a little something that you're not nauseous we want to make sure you
can get up and walk around and pee yeah and then while you're in the recovery room hopefully the
team is going to be able to come and give you the good news with the final egg count of what
they were able to collect with their procedure so from the moment you arrive at the clinic in the
morning till the time you are ready to go home after the procedure is usually around two hours
so i briefly want to mention the complications or possible risks of an egg retrieval
so again an egg retrieval is a minor surgical procedures and all procedures have some risks so
egg retrievals are done using transvaginal ultrasound which is
really cool because this is an ultrasound guided procedure and so we always have our
eyes on your pelvis and what is happening with that needle but the thing that your doc is going
to counsel you about are the risk of bleeding infection damage to surrounding structures
um there are a lot of important things around your ovaries your bowel your blood vessels your bladder
um we're really careful not to poke anything that we aren't supposed to um and sometimes
we will not retrieve an ovary or leave some follicles behind if we can't safely access them
all right so it is the afternoon after my egg retrieval i've kind of just been
napping all afternoon um i felt great right when i woke up from my egg retrieval like
i the nurses had given me these little heat packs and i felt like a million bucks i thought i could
run out of there um afterwards and then sort of as the day has gone gone on i'm feeling
less awesome um just kind of like symptoms of kind of free fluid here in my abdomen which
is normal after a retrieval to have fluid in your abdomen belly's kind of bloated um feel
some a little kind of pain just all through my belly and up here through my shoulder kind of
referred pain again because of that fluid in the abdomen definitely feel like somebody kicked
me in the ovaries um but overall feeling pretty good got some tylenol number three if i need it
already had an ice cream cone um and so now just excited to get things going
then what should you do kind of the day of your procedure and the day after that the
most important thing that you should be doing is rest and recover um again you had a minor surgical
procedure you were under anesthesia don't be doing any making any important decisions that day
don't be driving after the anesthesia go home put your feet up and relax yes um patients are often
a little crampy and uncomfortable after their procedure and so things we usually recommend for
pain are tylenol often your clinic may prescribe something a little stronger if you need it like
tylenol with coding heat pack ice pack whatever feels comfortable or makes you feel better
are things that you can also do to help with some of that crampy pain after your retrieval
after your procedure a lot of the cool and fun stuff is actually happening in the lab
over the next five to seven days embryologists are usually able to keep you updated about how many
eggs are mature how many of those eggs fertilize normally and then how that embryo development is
going after that yeah if you are planning a fresh embryo transfer you do need to start progesterone
on that night of your egg retrieval and if you are planning a frozen embryo transfer then
you will have your retrieval and you will then kind of wait a couple weeks and make a plan with
your clinic of when you will be doing your frozen embryo transfer which is what our next video is
going to be all about the embryo transfer how to prepare what to expect and we will cover that all
next week okay guys so one of our embryologists just texted me that the eggs were going to be
inseminated um with sperm and they're doing that listen to these um using what we call standard
insemination the sperm looked good enough that we could just put the sperm in a dish uh
with the eggs and let them do their thing and so that is great news um a lot of clinics do a lot
of icky and depending on an ixi is just where you're directly injecting a sperm into each egg
whereas the lab here thought the eggs in the sperm looked good enough that they could just kind of
the sperm was good enough that we could just do standard in some which is um
there are pluses and minuses to each which your clinic will talk to you about
um it was just fun to get the report from the text from our embryologists who are
now taking care of our little embryos that are and sperm that are hopefully gonna become
normally and um turn into embryos so tomorrow morning we'll get a fertilization report to know
how many fertilized normally and then kind of continue that journey over five or six
days to become blastocysts that can be frozen or transferred or biopsied and things like that so
good news
we're doctors but not your doctors anything we've
said in this video is for education or entertainment purposes only it is not
medical advice any specific medical questions you have should be directed to your provider