SART Fertility Experts - Egg Retrieval: What is it REALLY like?

In this episode of the SART Fertility Experts Podcast, Dr. Susan Nasab and Dr. Dan Williams discuss the egg retrieval process, a key step in IVF and egg freezing. They explain candidate criteria, procedural details, anesthesia, recovery expectations, and potential complications. The conversation highlights the importance of setting realistic expectations, post-op care, and choosing an experienced fertility team. Dr. Williams reassures listeners that egg retrieval is a safe and effective procedure, with most patients achieving successful outcomes through modern fertility treatments.

Hi, welcome to another episode of SART Fertility Experts Podcast. This is Dr. Susan Nasab and I am a Reproductive Endocrinology and Infertility Specialist at Reproductive Fertility Center in Southern California. Today, we will talk about egg retrieval.

So today, before I start about this topic, I want to introduce our wonderful guest speaker, Dr. Dan Williams. Dr. Williams, thank you for accepting our invitation. Thank you.

Happy to be here. Of course. So, talking about Dr. Williams, he has an extensive experience in the field of infertility.

He is a Board Certified Reproductive Endocrinology and Infertility Specialist. He had an extensive experience in the field of academia, and he served as IVF Director in WashU and University of Cincinnati for 17 years. He also served as the Medical Director and Clinical Faculty at the University of Houston in Texas, where I had the pleasure to be his intern.

He also worked as a Medical Director for 14 years in Houston Fertility Institute, and currently, he is working as Medical Director at Reproductive Fertility Center in Southern California, and I also have the pleasure to work with him. He is also the Senior Vice President of Clinical Development at Inception Fertility. Dr. Williams, it's such an honor to have you today.

Thank you very much. Okay, so today, we're going to talk about egg retrieval. Everything that you need to know about egg retrieval, about preparation, who is the candidate, what's going to happen in the day of the OR, or in the operating room when you're asleep, what you need to know about the post-op care.

I know a lot of patients, when they come to our office, they are anxious, they are concerned, they want to do a big surgery, is it a big surgery, they ask, so it's our job to give them information. So first, I'm going to divide this topic in four categories, preparation or pre-op, day of the OR, details of the surgery or complications, and the post-op care. About the preparation, Dr. Williams, who normally is a candidate for egg retrieval? Basically, anyone that wants to do in vitro fertilization or IVF is going to require an egg retrieval.

So, any patient, therefore, that comes to the office and is recommended to have IVF is going to need an egg retrieval. Perfect. So, a simple way, egg retrieval is aspirating the eggs from the ovary.

As he mentioned, IVF is one of the indications. A lot of women, they might just need to do egg freezing, so they just come here and we stimulate their ovary with injectables and take them to the operating room and we retrieve the eggs. It doesn't necessarily need to be inseminated with the sperm.

Other question about preparation, when you see a patient for egg retrieval, either for creating embryo for IVF or egg freezing, what criteria in terms of the patient body habitus, medical history, surgical history, age you look into, do you say yes to all of your patients? Well, I'll sort of clarify that. There are patients that we might have concerns about when they want to go to egg retrieval. So, those would be broadly spaced, as you said, patients with certain medical conditions.

This could be, as you mentioned, obesity. The reason for that is very simple. These procedures are typically not done in a hospital and anesthesia is given.

Therefore, there is a risk with anesthesia. There's also a risk with obesity in terms of accessing the ovaries safely. So, these things have to be assessed prior to moving forward.

There are solutions, by the way. So, if someone is obese, weight loss can be affected quickly with certain injectable medications that are available now and we do consult with other specialties to do that. The other would be, say, someone who had a leukemia that has to preserve their eggs.

Well, they may have low platelets, which are important to keep you from bleeding. So, we would have to work with their oncologist and maybe get a platelet transfusion. The last would be if their ovaries are difficult to assess.

That could be their body habitus. That means we basically can't see their ovaries very well with a vaginal ultrasound. Those patients are in a specific category that would require, actually, abdominal retrieval, but you want to plan ahead of time to make things as safe as possible.

Perfect. So, I'm glad that you mentioned about abdominal and transvaginal. So, normally, egg retrieval is done transvaginally, meaning that the same ultrasound probe that most probably you have seen during your monitoring, we're going to use, and there is a needle hooked to it, and we go vaginally and we're reaching to the ovary.

However, there are some candidates or patients that the ovary has been replaced because of multiple prior surgery or because of the cancer therapy, so it's not accessible. So, normally, we ask the patient to come to clinic before the egg retrieval. We're going to do an ultrasound and abdominal exam, making sure we can reach to that.

And if we're not, we're going to talk about it in case that they need to have a transabdominal, meaning from the top, we go to the hospital normally, and we retrieve or aspirate the eggs from the abdomen. So, we already mentioned who is the candidate and also the route of the surgery. Let's talk about how many egg retrieval is safe, or let's say how many egg retrieval a patient might need.

So, basically, it depends on what their desires are. There's a difference, say, if they're going to freeze eggs for future use versus if they're trying to create embryos. So, for instance, if you're doing IVF where you're going to actually fertilize the eggs, grow them into embryos, and freeze them, you'll know what you have ahead of time.

When you freeze eggs, their potential, but then later when you thaw them and fertilize them and grow them into embryos, you will find out much later, and by then, depending on the situation, it might be more difficult to obtain more eggs. So, usually, we would say between one and three retrievals, sometimes more depending on patients that have, say, poor ovarian reserve, meaning low numbers of eggs, would be required to achieve someone's specific goals. Correct.

I tell my patient, the first cycle is always dancing with the patient. We don't know how the quality of the eggs behave. Well, yes, based on the medical history, age of the patient, ovarian reserve, we can have some guesses.

However, we don't know how they're going to behave until at least one retrieval is done. However, before the egg retrieval during the consultation, we can estimate, of course, the older the patient is, the lower ovarian reserve, the more cycle they might need. Normally, when the egg retrieval is done, the patient will get the period around 10 days after the egg retrieval, and the soonest time that we can start another cycle will be with the upcoming period.

However, there are some exceptions. Dr. Williams, can we start another IVF stimulation just two to three days after the egg retrieval? Well, absolutely. You bring up a very good point.

You can actually start the IVF cycle, if need be, say, for a cancer patient that really needs to move quickly at any time in their cycle. So you do not have to wait for the period to start. You don't have to worry about whether they've ovulated or not.

You can start whenever the patient is ready, if there is a time crunch. The other thing is, if there's a time crunch, you can do back-to-back cycles. So you can start very soon after the retrieval is done.

You simply have to recheck the ovaries to make sure that they are okay for you to start stimulation, but you do not have to wait in those situations. Thank you. Let's dive into the day of the retrieval.

All right, let's say the patient is already stimulated. She got the trigger. She is ready.

She's in the pre-op area, and you walk into the pre-op area. What are you going to talk with the patient before going to the operating room? Just a few things. One is, I'll explain to her what the procedure consists of.

It's the vaginal ultrasound that she's been doing all along, and looking at these dark circles, the follicles grow, but this time, I have a needle guide attached to the ultrasound probe. So I'll simply guide a needle into each dark circle, suck out the fluid. Dark circle collapses.

The fluid then goes into a test tube, and the egg, which is microscopic, goes with the fluid into a test tube, and I give that to our embryologist to find the eggs under the microscope. And then, of course, I tell them time. This takes me maybe 10 minutes to basically aspirate or suck out all the cysts that have grown, the follicles.

She will not feel it because she will receive anesthesia medicine. It basically is deep sedation. She's breathing on her own, but she doesn't feel anything or remember anything, which is very important to patients.

Of course. So what he's talking about, talking in the pre-op area, which I think it's very important, is set up the expectation. I know the patients, when they go to their ultrasound monitoring, they think that all of those round dark circles are going to give them egg.

Well, we always talk with the patients in the pre-op area, show them the last ultrasound, show them the number of the large follicles that most probably 80% of them contain eggs. Expectation always make the life easier. Okay.

Let's talk about a very important topic, and that is pain during the egg retrieval. So we do the egg retrieval on their anesthesia. It is a painless procedure.

Can you please explain a little bit more details? I mean, you mentioned about the anesthesia that the patient is not going to have pain and breathing on their own. Can you walk us through the, what is the experience of the patient regarding the pain during the procedure, after the procedure, and how normally anesthesia talk to the patient about this procedure? Yeah. So you can either use an anesthesiologist or you can use nurses to actually push the medications under the physician's direction.

In my experience over the last 30 years, I found that using an anesthesiologist is better for me because, one, I don't have to worry about how much to give. The anesthesiologist monitors that, and I can actually focus on my task, which is retrieving eggs. And secondly, patients get a small dose of medication, which basically causes amnesia, and then they get the medication, which will sedate them prior to us even starting anything.

So the anesthesiologist is talking to them, and then slowly they drift off. And I think that's much better. The patient really is not aware of anything that we're doing.

And then when they wake up, they're in the recovery room. And before they leave, they're told how many eggs they have, which is key. Exactly.

So I totally agree with Dr. Williams. And also in my experience, in my practice as well, I definitely work with anesthesiologists to do the egg retrieval. The reason is very clear.

They are more expert in pain management than me, and they can also answer all the questions that a patient have during the procedure, after the procedure. They also look carefully of the patient history, any allergy, any type of anesthesia clearance that if the patient wants to have or needs to have that needs to be documented by the primary care doctor, which in this case is a primary REI, and we normally send the patient for anesthesia clearance if we have any concern about the airway or body habitus. So you should not be worried about the pain during the retrieval.

And if anyone has had experience with pain during retrieval, needs to talk with their REI because that shouldn't happen. All right. So he mentioned that we're going to ask for the eggs.

We know exactly how many eggs we got during the procedure. There is an embryologist in the room that actually will get the eggs right away, look at under the microscope and normally count the eggs. The eggs will be fresh at that day.

And if a patient wants to freeze the eggs, of course, they're freezing the eggs. And if they want to inseminate with the sperm, it's going to happen the same day. Okay.

So the patient coming out of the operating room goes to the PACU, which is the post-op recovery area, is going to be on their nursing care. And also we as a REI will go back to the patient to talk to the patient. As Dr. Williams mentioned, the very first thing the patient wants to know as soon as they open the eyes is that how many eggs? So of course, we're going to tell them how many eggs and we will walk them through if there was any complication during surgery.

If there is anything suddenly we found such as endometrioma or a large cyst or something that we didn't, you know, we just saw it during the procedure, they need to know what has happened in the operating room. It is unacceptable that the patient will be left alone in the recovery without talking with the doctor what has happened in the operating room when the patient was under anesthesia. So at minimum, the doctor needs to talk about the number of the eggs was retrieved, if there is any complication that happened during the procedure and the post-op care.

Dr. Williams, can you explain a little bit that how you're going to talk with the patient? I know normally you talk pre-op as well about the post-op care, but what are the post-op care normally the patient needs to focus on? Well, basically pain management. So for instance, if they have any discomfort, they're told what to take. These are oral pain medications in general, things such as Tylenol, in some cases, ibuprofen.

Pretty rarely do we actually even require stronger medicines such as codeine. So that's the first thing. The second thing is as far as what they can eat.

They can eat, by and large, whatever they want. It's generally recommended they don't have spicy foods or extremely greasy foods. But in general, in my experience, patients go to In-N-Out Burger right after.

If that's what they want and they feel comfortable eating it, the anesthesia is really light. So that's really not a problem. And then the third, of course, is ambulation, what they can do.

Now, we want someone to be with them in that immediate time, their partner or a friend or someone. And the main reason for that is simply that they did have a procedure. They did have anesthesia.

They may be a little more unsteady, particularly in the first few hours after the procedure as the anesthesia wears off. So I think those are the three things we talk to them about. Usually their partner is there or whoever's going to pick them up.

I also tell the partner or whoever's with them how many eggs they got, because sometimes with the anesthesia medicine, they tend to forget. So it's very important to give those post-op instructions to someone who hasn't had anesthesia. That's a very good point.

And add on, we always want to make sure that the patient has a right because it was under anesthesia so the patient cannot be released to any driver or share riding. So make sure that you take time off. Other questions that most of the patient they ask before going for egg retrieval is the downtime.

Doctor, can I go back to work? What are my expectations? So it's a minor procedure. Obviously on a day of the egg retrieval, you need to be off regardless of what you're working with because you get anesthesia and you might be a little bit sore. So the expectation is the key.

And I tell the patients that yes, you might get some soreness. Normally the day after the procedure is actually the soreness and the bloating and extension is more. The more egg, the more extension, you know, distensions.

Obviously for, which is, we're talking about egg retrieval today and we can in another episode talk about ovarian hyperstimulation syndrome. But in general, we tell the patients that to ambulate or walk as soon as possible. Try to drink as much as you can.

Electrolyte water is the key. Gatorades or any type of electrolyte containing water next to you. Yes, you have to go into the bathroom and pee all the time.

That's annoying, but that is the key. Pain management. And they might have some spotting or bleeding.

Normally I tell the patient 48 hours not to have intercourse, but some patients, some doctors are more comfortable with one week of pelvic rest. And of course not having a heavy, you know, doing a heavy exercise. Perfect.

So let's talk about when the things doesn't go well. And that is the side effects and complications. Can you tell us what are these risks and complications of egg retrieval? Well, the general risk of any procedure would be infection, bleeding, and the risk of anesthesia, all of which are pretty much 1% or less.

So very low with retrieval. So really what you're dealing with primarily would be patients have large ovaries, in particular those patients that have had a large number of eggs retrieved, such as 20, 30, 40 eggs. And so their ovaries take time to go down and they're going to be uncomfortable for the first week or two.

And then the second thing would be going along with that, there is a risk of hyperstimulation. All patients are hyperstimulated in the sense that we are doing controlled ovarian stimulation to get more eggs. But in this case, hyperstimulation syndrome is where they get fluid in their tummy and other places.

Fortunately, this is very rare. We have ways that we can prevent it, but we tell patients to be on the lookout for, say, shortness of breath, severe pain in their ovaries, things of that sort, which would be sort of symptoms of possible development of hyperstimulation syndrome. Correct.

No procedure is without complications, right? I'm sure that if you go to any doctor appointment and you want to do even a clinic procedure, there are going to be multiple papers that you have to sign. But as he mentioned, the procedure's complication is extremely low, and it really depends on the team that you actually work with. So I highly recommend before you choose your REI doctor, or at least the clinic, the lab, the staff, the nurses, all do your homework, do your research, make sure that they're qualified.

Also, the surgeon expertise, because we are working with close to very vital organs such as vessels, bowels, bladder, and of course, we have to retrieve the eggs from the ovaries. Complication can happen, although this is a very minor surgery, the complication is less than 2-3%. But it can happen and the surgeon needs to have enough expertise to handle the complications.

Perfect. So we're going to go to the last part of the podcast, which I always ask these questions from all of my guest speakers, what is the take home message for patients who are considering egg retrieval, or has done an egg retrieval and they want to do more egg retrieval? What is your recommendation? The recommendation is it's a very safe procedure, and that patients should do the number of procedures required to meet their needs. They would discuss that with their partner, with their physician to determine that.

And that most patients, not all, but most, will ultimately be successful with the technology that we have to be able to have a family. Thank you so much, Dr. Williams again for this wonderful podcast. I really enjoyed.

I hope these podcasts help physician and also patient to make them more comfortable to proceed with egg retrieval. And we'll see you in the next episode of SART Fertility Experts Podcast. The words expressed in this podcast do not necessarily reflect those of ASRM and its affiliates.

These are provided as a source of general information and are not a substitute for consultation with a physician.