Egg Retrieval in IVF
To some, the egg retrieval seems almost anti-climactic. This procedure typically takes thirty minutes or less yet for most couples, they have been preparing weeks, months or even years to achieve. Simple though it may seem, it is a critical step in successfully achieving a pregnancy through IVF.
Egg retrieval is typically performed under anesthesia. The procedure involves the use of a needle, which is passed-under the guidance of ultrasound imaging-along the side of a vaginal probe into the follicles. Each follicle is a small fluid filled space in the ovary that contains an egg. The follicular fluid is aspirated and collected in a test tube, which is promptly delivered to the embryologist for analysis and processing. The procedure itself is rendered painless by the use of anesthesia; but some women experience brief residual postoperative abdominal discomfort and/or cramping. The discomfort, if present, rarely persists for more than a few hours. Following the egg retrieval, the patient is given detailed instructions and discharged within an hour or two.
The biggest disappointment that can occur following the stimulation of a woman’s ovaries is the failure of an egg to be aspirated from each or at least most follicles; a problem that has been named “empty follicle syndrome.” This occurs in about 2-5% of IVF cases and is typically a sporadic event-occurring spontaneously in a patient with previous or subsequent successful cycles. The chance of EFS does increase with age suggesting that it is also related to egg quality. Evidence suggests that a diminished sensitivity to the hCG trigger causes this problem to occur. Once hCG is given, the follicle undergoes final maturation. The egg becomes more loosely bound to the ovary and should easily be aspirated. When this does not happen, even repeated flushing of the follicle can turn up empty. One step that can be taken to minimize this occurrence is to not use reduced hCG trigger doses. We take this one step further and often “step-up” the hCG dose in patients that have more than 15 follicles. Although it has yet to be proven conclusively to be beneficial, early results are encouraging.
Read Dr.Sher’s blog posts about “Empty Follicles” – An IVF Egg Retrieval Mystery Explained and “IVF Egg Retrieval” to learn more about In Vitro Fertilization.