As a nurse at Illume Fertility who has also been a patient here, I know how daunting fertility treatment can be. One of the big milestones in IVF is egg retrieval day - let's talk about what to expect before, during, and after your procedure so you feel as prepared as possible!
In this article:
- My Fertility Journey (As a Nurse)
- Preparing for Your IVF Egg Retrieval
- What to Expect on Egg Retrieval Day
- Before Your Egg Retrieval
- During Your Egg Retrieval
- After Your Egg Retrieval
- Next Steps on Your IVF Journey
- Egg Retrieval FAQs
- The Final Step: Embryo Transfer
- Embryo Transfer FAQs
- Remember: You've Got This!
My Fertility Journey (As a Nurse)
I was honestly both very excited and very nervous to start IVF treatment. I was 26 years old at the time of our IVF consult, and I couldn’t believe that we were having to move onto that next step at such a young age. I never thought it would be as difficult for us to conceive as it had been, so along with the nerves and excitement, there was also some disappointment.
However, I learned throughout the process that it didn’t matter what it took for me to achieve pregnancy – I knew that my husband, loved ones, and I would all love this baby no matter the process.
Becoming a Fertility Patient
The first injections of my IVF cycle were a little nerve wracking for me. I’ve been poking and prodding people my whole nursing career, but doing it to myself was a little scary. Thankfully, it got easier every day. I remember being tired and bloated during the process, but nothing about my IVF medication side effects were unmanageable.
I finally had my egg retrieval after about ten days of fertility medications. I had never been under anesthesia before, so I was very nervous about that (spoiler alert: it was the best nap I’ve ever had).
Everything went off without a hitch – we ended up retrieving 44 eggs and then had 13 embryos to send off for preimplantation genetic testing (PGT).
Note: Those numbers are not typical of every patient - we just got very lucky!
From Egg to Embryo to Ella
Out of those 13 embryos, 10 were chromosomally normal, and our little Ella (who is now nine months old) is the result of our third frozen embryo transfer. My husband and I are so grateful we stuck it out when things got tough so we could meet our beautiful baby girl!
My biggest advice for those going through IVF is to ask questions. Your Care Team is there to help guide you through this complex process of growing your family, so make sure you are utilizing them and their knowledge!
As a nurse working in Illume Fertility's surgical suite since 2021, I've seen (and heard) it all. To help you feel more confident and prepared for your IVF egg retrieval, let's break down the procedure step-by-step and answer all the most common questions about the process.
Preparing for Your IVF Egg Retrieval
After all fertility testing and any necessary surgical procedures are complete, you will come in to the fertility clinic for a baseline ultrasound and blood work to make sure all is "quiet" in your ovaries.
Once you get the green light to start your IVF cycle, you will begin your injections, and these will last for approximately 8-12 days.
You will come in to the office periodically (usually every other day) to have your blood work and ultrasound checks to make sure you are responding appropriately to the medications. We refer to these appointments as "morning monitoring."
The medications your reproductive endocrinologist includes in your IVF protocol are meant to stimulate multiple follicles to grow, which hopefully leads to the development of many eggs to make future embryos with. Once your follicles have grown to their maturity (ideally around 20mm in size), you will be told to take your trigger injection (containing hCG), which prompts your body to ovulate.
Approximately 36 hours after your trigger shot, you will have your egg retrieval.
What are the side effects of IVF medications?
Although the shots aren’t as daunting as one might expect, there are always side effects to every medication.
While on your IVF meds, you can expect to have some bloating (from all those follicles plumping up), headaches from the excess estrogen in your body, and even some occasional nausea from the combination of the two. Some patients also experience fatigue, which is completely normal!
Remember: You’re out of your element right now – it’s completely okay to take time for yourself and to rest! Your body is working in overdrive to prepare you for a successful egg retrieval.
What to Expect on Egg Retrieval Day
It’s okay to be nervous about all the unknowns – how many eggs will I get? Will they be mature? Will I end up with any embryos to test?
Just know that you did all the hard work to prepare, and on the day of your egg retrieval, it’s time for your surgical team to do their part. Remember: you’re in the best hands!
Let's talk about what to expect on the big day.
Before Your Egg Retrieval
Note: Because you will be under anesthesia, you will need someone to accompany you to and from the procedure. You are not allowed to drive for 24 hours after egg retrieval.
When you arrive at Illume Fertility on the day of your egg retrieval, you will first come to the front desk so they can check you in and let our team in the surgical suite know that you have arrived. You will then be greeted and taken back to the surgical suite to get prepped for surgery by one of our surgical suite nurses.
Next up? Signing a host of paperwork, getting your IV inserted, and having your vital signs taken. You will then meet with our anesthesiologist to discuss his part in your care, as well as your surgeon to discuss the plan for the day.
Note: As our team of reproductive endocrinologists rotate through the surgical suite depending on the day of the week, you may or may not see your primary doctor for your egg retrieval. No matter who cares for you, you'll be in excellent hands.
Remember – everyone is on your side and wants to make you feel as comfortable as possible.
If you have any questions, be sure to ask them during your prep!
During Your Egg Retrieval
After you are all prepared and ready to go, one of our medical assistants will escort you to the operating room, where you will be identified by one of our embryologists.
The anesthesiologist will start his anesthetic medications shortly after this step, and you will be off to dreamland while your surgeon gets started. Many patients refer to this as "the best nap" of their lives, and I have to agree!
How does an egg retrieval actually work?
Once you are asleep, your doctor will place an ultrasound probe vaginally and look at your follicles on the monitor. This step is identical to what you've experienced during all those early morning monitoring appointments.
As soon as your follicles are in clear view, the doctor will advance a thin needle through your vaginal wall and into the egg follicle. You can think of the egg follicle as a small water balloon filled with fluid and a single egg.
The doctor will use a machine to apply gentle suction and drain the fluid from the follicle. This fluid is collected in a test tube, then carefully handed over to the embryologist who evaluates it under a microscope and counts any eggs that are collected.
This process of piercing the follicles with needles, draining fluid, and counting eggs, continues until all visible follicles are drained and the procedure is complete.
After Your Egg Retrieval
Congratulations – you’ve made it through your egg retrieval! Now what? You can expect to feel some side effects after your procedure. The most common side effect is post-op bloating, which should reduce after a few days.
Most patients also experience some menstrual-like cramps for about 24 hours following the procedure. Lastly, exhaustion from the anesthesia is completely normal. Take it easy for the next few days – use some PTO, watch some Netflix, and eat some yummy snacks.
Note: If you are in pain or concerned about your symptoms post-egg retrieval, don't hesitate to reach out to your nurse for reassurance or guidance. While severe ovarian hyperstimulation syndrome (OHSS) is unlikely, it's good to be aware of the signs.
Next Steps on Your IVF Journey
After you wake up from your egg retrieval, we will tell you the exact number of eggs retrieved during your surgery. This includes both immature and mature eggs; whatever the doctor sees, they will take. This is technically "day zero" for your eggs since they have not been fertilized yet.
The next day is day 1; on this day, you will find out how many eggs were mature and how many of those mature eggs fertilized. On day 3, you will get a call with an update on how your potential future babies are doing.
On day 5, you will find out how many of those fertilized eggs made it to the blastocyst stage. If you are doing genetic testing on your embryos, you will also get a phone call on day 7 to find out how many of your blastocysts will go off for preimplantation genetic testing (PGT).
The process of fertilization and maturation includes a lot of attrition, which can be difficult to witness. If you're feeling confused or frustrated about this part of IVF, check out Dr. Murdock's explanation of attrition rates, and why it's actually a positive thing that not all eggs turn into embryos.
Note: Scroll down if you want to skip egg retrieval FAQs and jump to the embryo transfer process - arguably the most exciting, nerve-wracking, highly anticipated part of your IVF treatment cycle!
Egg Retrieval FAQs
Now that you know what to expect on the day of your egg retrieval, let's dive into some of the most common questions I hear as a fertility nurse from other patients:
How do you make bloating go away after egg retrieval?
We recommend increasing your intake of electrolytes during this time to help with the bloat (think Gatorade, Pedialyte, coconut water). Avoid foods that cause gas, stay hydrated, and rest and listen to your body. Always contact your nurse if you experience any concerning side effects of egg retrieval.
Does an egg retrieval hurt?
You will feel no pain during your procedure thanks to the wonderful thing that is anesthesia! You will be asleep the entire time for both procedures. Some patients wake up with menstrual-like cramping afterwards, but this is normal and usually can be treated with Tylenol post-operatively.
How long does an egg retrieval take?
The procedure itself is approximately 15-30 minutes, give or take. It depends mostly on the number of follicles and ease of accessibility. On average, patients are in the operating room for 30 minutes and in the recovery room for 30 minutes.
Note: Since you will be asked to arrive an hour before your procedure, you can expect to be at Illume Fertility for a total of about two hours.
Who will be with me during my egg retrieval?
You will have an awesome team with you on the day of your egg retrieval. You will have your surgeon and anesthesiologist as your two main doctors for the day.
Your surgeon may or may not be your primary doctor because all of our doctors rotate in the operating room. However, I can promise you that you’re in the best hands no matter who performs your egg retrieval, as all of our physicians here at Illume are highly experienced.
In addition, you will have your anesthesiologist with you from the second you walk into the operating room. They will make sure you are totally comfortable from start to finish. You will also have one of our awesome nurses with you from start to finish as well.
We have a team of four surgical suite nurses (including me!) who are happy to answer any and all of your questions either pre- or post-op, no matter how crazy you may think they are.
You will of course have one of our brilliant embryologists with you in the operating room to identify you prior to the procedure.
Lastly, you have the glue that holds us all together – our fantastic medical assistants! One of these lovely ladies will accompany you to the operating room and assist the doctor with the procedure.
So, as you can see, you'll have a huge, supportive, compassionate team right by your side rooting for you every step of the way.
What is OHSS? How common is OHSS?
OHSS stands for "Ovarian Hyperstimulation Syndrome." OHSS typically occurs when the patient has an exaggerated response to the injectable medications. We typically see OHSS in patients with many, many follicles.
A very small percentage of our patients will get OHSS, and it’s usually a mild case that is easily treated at home. Those who are at risk for OHSS are typically instructed to increase their intake of electrolytes to help counteract the overload of fluids.
Learn more about OHSS and other side effects to pay attention to from our nurse, Kirsten.
The Final Step of IVF: Embryo Transfer
Making it to the day of your embryo transfer is extremely exciting! Here's a quick crash course in what you can expect:
For an embryo transfer, you are completely awake and your partner is allowed to come back to the surgical suite with you. As most patients will tell you, the hardest part about an embryo transfer is coming with a full bladder!
During the embryo transfer, you are in the exam room with your partner, a medical assistant, and the doctor performing the transfer. The doctor and embryologist will confirm that the right embryo is being placed into the right uterus by asking for your name and date of birth in multiple places. Once that is confirmed, the embryo is loaded into a catheter and transferred right into the thickest part of your uterine lining.
There’s no pain associated with the procedure – only hope and excitement! After the embryo is transferred, you are free to go (with a packet of instructions to follow).
Embryo Transfer FAQs
Will I meet the embryology team on transfer day?
Yes! They play a crucial role in your transfer process from start to finish.
Not only do they make sure your embryos are nice and snuggled in their first home in the lab, but they also do multiple “checks” the day of your transfer to make sure they are transferring the right embryo into the right patient. Once they have identified you multiple times, they will prepare to assist with the transfer of the embryo.
I like to call embryologists our babies’ "first babysitters" since they are the ones carefully monitoring and caring for them in the lab!
What medications will I take post-transfer?
Just when you thought you were done with all the poking and prodding and medications…
The good news is – there are a lot less shots post-embryo transfer! The one shot that may be a part of your protocol is called progesterone in oil (PIO). This is an injectable form of progesterone that is injected into the gluteal muscle (I promise it sounds worse than it really is, though I won't lie and say it's FUN).
In addition to the injectable form of progesterone, you may also be on a medication called Endometrin. This is progesterone in the form of vaginal suppositories. Lastly, you will be on an oral form of estrogen called Estrace or Estradiol. All of these medications play a vital role in supporting your body in hopes that you’ll have a nice sticky embryo!
My embryo transfer was successful, now what?
YAY! Congratulations! You’ve just gotten the phone call that your embryo transfer was successful and you are officially pregnant! What's next? Well, you’ve already had one beta hCG level (via blood work) checked in our office to confirm your successful transfer. Now, you will come back for a second check (yup, you guessed it…more needles).
If your levels are rising appropriately, you will come back in about a week for a very early pregnancy ultrasound. This is the same internal (transvaginal) ultrasound that you had during all your morning monitoring appointments. Five weeks is still too early to hear a heartbeat, but this early ultrasound will confirm that the pregnancy is located in the uterus.
You’ll then come back in about two weeks to hear the first heartbeat. (Such an exciting moment!) Lastly, you will have your third and final ultrasound with us before you are transferred to your OB/GYN or midwife for your prenatal care.
What happens if my embryo transfer is unsuccessful?
It’s really hard to hear that your IVF transfer hasn't been successful. My husband and I went through two very early biochemical pregnancies before we were successful with our third transfer, so I understand this pain on a very personal level.
The good news is this – no matter the results, you have an amazing team in your corner here at Illume, guiding you every step of the way.
If your transfer was unsuccessful, you will be instructed to stop all medications (progesterone and estrogen), in order for your period to start. Once your period starts, you will call the office to schedule an appointment with your primary doctor here at Illume to discuss your next steps.
What happens after I "graduate" from my fertility clinic?
Woohoo! You’ve made it through all of your early appointments with us at Illume, and it’s time for you to "graduate" to the care of your OB/GYN or midwife. I remember taking a huge breath once we finally made it to this point with my daughter, Ella. It's a big deal!
We’ll have you sign a record release that allows us to share all of your information with your OB/GYN, including all of your bloodwork and most recent pregnancy ultrasound.
It's a bittersweet moment when you graduate - you've likely gotten very close to your fertility clinic team, and it can be a big shift going from being monitored constantly to being treated like a "normal" pregnant person.
Remember: You've Got This!
Being both a patient and an employee, I’m so grateful to have been on both sides of this wild journey that is infertility. I was a patient first, so I do understand the feelings that go hand in hand with infertility – disappointment, longing for a "normal" journey to parenthood, stress.
I want others to know that even though these feelings are all incredibly normal and it’s okay to feel every single one of them, you should never, ever give up on your dream. My husband and I had two losses before our third transfer was finally successful. I remember feeling like the good news would never come because we were so used to hearing all the bad.
However, we’re now the parents of an amazing baby girl, and if we had given up, we never would have experienced this joy. I think my biggest take away from being on both sides is this: every single patient, every single diagnosis, and every single fertility journey is different.
And while it’s nearly impossible to compare your journey to someone else’s, I hope it’s comforting to know that you are not alone, and you’ll always be supported throughout your experience here at Illume.
Jamie Dobos is a registered nurse who joined Illume Fertility's Nursing Team in 2021. Her favorite part about her position is being able to use her personal and professional experience with fertility treatment to guide other patients through the most important milestones on their journey.