Egg Retrieval

After the start of your IVF cycle, when your follicles are ready, you will be told the exact time (usually between 10 p.m. and 3 a.m.) to take your intramuscular injection of human Chorionic Gonadotropin (hCG). The hCG mimics the surge of luteinizing hormone (LH) during a natural cycle and helps the eggs separate from the follicle wall and float in the follicular fluid, ready for retrieval. It is extremely important that you take this medication at the exact time, and in the exact dosage instructed, or your retrieval may have to be cancelled. It also is important that you eat a low fat meal on the night you take your hCG. After midnight, you may have only juice, water, decaffeinated coffee or tea with skim milk.

Your blood will be drawn in the morning at the Atkins Kent Building, and the serum will be used as a supplement to the culture media in which your embryos will grow. Next, you will report to our office for an ultrasound and to check with the nurse that all of your paperwork is complete. You may resume your normal diet after the blood draw and you will not take any injections on this day. Do not eat or drink anything after midnight and when it is time to get ready for your retrieval, refrain from wearing jewelry, contact lenses or fragrances (including hair spray, perfume and deodorant).

The retrieval is scheduled 34.5 to 39 hours after the hCG injection. You and your partner should report to the fifth floor of Atkins Kent, so that you may prepare for your procedure while your partner provides a semen specimen. Even though the retrieval takes only about 30 minutes, you will spend several hours with us.

Once you have received intravenous sedation from an anesthesiologist, an IVF team physician will use an ultrasound probe to visualize your follicles. He or she will insert a needle through the vaginal wall, reaching the follicles and drawing out the fluid containing the oocytes. The eggs are transferred immediately to the embryology laboratory and you will be sent to the recovery for about an hour.

You will be instructed to begin taking a prescribed antibiotic to reduce the chance of infection following oocyte aspiration. Medrol, a steroid taken orally, will suppress your immune function until implantation. You also will begin progesterone, taken orally, by intramuscular injection or vaginal suppository, to aid in implantation of the fertilized embryo. This medication protocol will continue until your pregnancy test, 11 days after the transfer, and for six or seven weeks beyond that if the test is positive.

You will be allowed to leave with an escort, as it is unsafe to operate a motor vehicle or machinery following intravenous sedation. You also will be instructed to rest, resume your normal diet and drink plenty of fluids. You should avoid aerobic activity for the remainder of the day, and it is extremely important that you take the antibiotics prescribed to you. You may experience cramping, slight abdominal pressure or pain, or light vaginal spotting. Two to four Tylenol, every 4-6 hours, should alleviate these symptoms. If you develop severe pain or fever, call the office to speak with a nurse – someone is always on duty in the event of an emergency.

 

Fertilization

Once your oocytes are collected, they are taken to the laboratory for fertilization. The male’s sperm is collected and joined with the eggs in a special medium, encouraging fertilization and development. In cases of male factor infertility caused by conditions such as azoospermia, tubal blockage and genetic anomalies, sperm is not available in the seminal fluid and surgical techniques may be required to extract specimens from the testes or scrotum. In cases where they are few in number or likely to have problems penetrating the outer shell of the egg, fertilization can be assisted by intracytoplasmic sperm injection (ICSI). A micromanipulation technique, ICSI involves injection of a single sperm directly through the zona, or outer shell of the egg, into the cytoplasm it protects.

It takes just a few hours for the eggs to be fertilized unless there is a problem with them or the sperm that precludes this from happening. We will call you the afternoon of your retrieval with fertilization results. The embryos will begin to develop and healthy ones will grow for several days before transfer. In most cases, this will occur on Day 3, when the zygote (which includes the nucleus from the egg and sperm) has developed into an 8-celled embryo. In other instances, and depending on factors related to embryo quality, they may be allowed to develop until Day 5, when they have reached the blastocyst stage and contain more than 100 cells.

You will not hear from us between the day of transfer and retrieval unless there is a problem with your embryos. Immediately prior to transfer, the physician will review the laboratory results and recommendations with you.

 

Embryo Transfer

The embryo transfer takes place 3-5 days after oocyte retrieval and you must be prepared to stop all usual activities and report to the Atkins Kent building on relatively short notice. The embryo transfer is a simple, painless technique and anesthesia is not required; however, some patients require medication to relax their muscles. You may eat prior to the procedure, but please don’t wear fragrances, including hair spray, perfume and deodorant.

During the 10-to15-minute procedure, the embryos and a small amount of fluid are placed in a long, thin catheter. Once the catheter passes through the cervix, they are released into the uterus, an environment that has been prepared for implantation.

This procedure is very similar to an intrauterine insemination and the discomfort is not unlike that experienced during a PAP smear. Please urinate before leaving home or work and bring a bottle of water to sip after you arrive. The procedure usually is performed with ultrasound guidance and a bladder that is ¹/₂ to ³/₄ full not only allows the physician to visualize the uterus, but it also straightens out the cervix, helping the transfer to go smoothly. Recovery takes 20 to 30 minutes and you are allowed to drive following the procedure.

On the day of transfer, the physician will discuss the number and quality of embryos being transferred. Although the exact number will depend on several factors that vary between individual couples, IRMS employs certain age- and diagnosis-related guidelines to help avoid multiple pregnancies. Very generally, these include two embryos for patients under age 35, three for patients age 35 to 39 and four to patients over 39. These numbers are adjusted either up or down when there is pertinent previous medical and or embryologic data available. In all cases, the patient couple is consulted prior to determining the exact number to be transferred.

Following the embryo transfer, you will be instructed to limit certain activities for the rest of the day and continue taking your pre-natal vitamin, antiobiotics and Medrol. In five days, you will visit us for a blood test to monitor your hormone levels. The protocol of estrogen and progesterone will continue until your pregnancy test, 11 days after the transfer, and for six or seven weeks beyond that if the test is positive. If you are pregnant, we will continue to monitor you for 4 to 5 weeks (or until you are approximately 8 to 9 weeks pregnant). At that time, your care will be transferred to your obstetrician. If the cycle is not successful, we will schedule a follow-up visit with your physician to discuss your options.

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