The Egg Retrieval Process Starts with an HCG Injection
When Dr Sharara decides that the follicles are ready to be aspirated (to remove the eggs), the patient will be given instructions to take an HCG injection 35 hours prior to the Egg Retrieval. This medication is crucial. It will “push” the eggs through their final stages of maturation and will release them from their attachments to the walls of the follicles to float inside the follicular fluid. If HCG is not taken correctly and at the exact time specified, the eggs will not be mature and will not be able to be aspirated.
The patient will be given written instructions on how and when to administer this medication. She will also be given a instruction sheet on how to mix and administer the HCG injection under the skin, as well as the time the patient has to report for Egg Retrieval two days later. Since HCG injections are given at night (usually between 9 PM and 11 PM), the Egg Retrieval is scheduled 35 hours after the injection, which falls two days later in the morning between 8 AM and 10 AM.
- The day before egg retrieval, DO NOT EAT OR DRINK ANYTHING after midnight. You can brush your teeth the morning of egg retrieval.
- Do not wear any jewelry OR ANY PERFUME. Notify the anesthesiologist if you are wearing any dentures.
- Wear comfortable clothing.
- Make sure to be at VCRM at least 20-30 minutes before your appointment.
- A fresh sperm sample will be needed if your partner’s sperm is to be used, unless otherwise noted.
- Expect to be at VCRM for at least one hour. You will need someone to drive you home.
- Call us with any questions at (703) 437-7722.
When the size of the leading follicles reaches 17 to 20 mm in average diameter and the estradiol hormone level is appropriately elevated, then it is time for the eggs to be “harvested”. The HCG injection (described in the previous section) will be administered in the evening usually between 9 PM and 11 PM. The egg retrieval will be scheduled 35 hours after the HCG injection. For instance, if the HCG is given on a Monday at 9 PM, then the egg retrieval will be performed on Wednesday at 8 AM.
The couple or individual needs to be at VCRM at least 30 minutes prior to the scheduled time of Egg Retrieval (ER). The patient should not eat or drink anything after midnight, the night before the ER day. (Please see Pre-Retrieval Instructions).
The ER is performed under “general anesthesia” but without intubation (using Propofol, which causes a twilight sleep). The patient will not feel any discomfort during the procedure and will wake up immediatly after the procedure. Depending on the number of follicles present, the ER will usually last 10 to 15 minutes.
The ER is performed under ultrasound guidance similar to the vaginal ultrasound examination that the patient has during follicular monitoring. A needle guide is attached to the ultrasound probe, a long needle is introduced through the guide, and under direct visualization each follicle is punctured and the fluid (along with the egg floating in it) is aspirated. The fluid is then immediately sent to the laboratory where the embryologist searches for the eggs, isolates them and place them in incubators. At the completion of the ER, the patient is taken to the recovery area where she will stay for about an hour. Pain medications might be administered at this time as needed. Some discomfort is expected for a few hours following ER and Tylenol can be taken by the patient at home as needed every 4 hours (please avoid Motrin/Alleve/Ibuprofen). Occasionally, some nausea might also occur which usually dissipates within a few hours.
After about 20-30 minutes when the patient is fully awake and relatively pain-free, instructions are given by the recovery nurse and the patient is discharged home. The patient must be accompanied by someone who can drive them home and should not be left alone for the rest of the day.
After the egg retrieval, the partner is asked to provide us with a semen sample. The semen is then washed and prepared to inseminate the eggs 3-4 hours later.
In cases where the male partner has to undergo the testicular biopsy (TESE) procedure for sperm recovery, he will be the operating room and the urologist will perform the needle biopsy under local anesthesia. This procedure will usually last 15-30 minutes and the patient will be discharged home with an ice pack placed over the testicles to prevent swelling. Sperms are identified, separeted from the testicular tissue, cultured, and then frozen for later use. We rarely perform the TESE and the egg retrieval on the same day.
When you get home following egg retrieval, you should rest. Mild abdominal discomfort is very common. This will subside over several hours. You can and should use the restroom as needed.
- Eat or drink anything you would like as tolerated. Some nausea is common for a few hours.
- You can shower the night of egg retrieval and thereafter. You might be a little lightheaded, so be careful standing up!
- Expect some vaginal spotting.
- No heavy lifting
- No intercourse
- No hot tubs or baths, showers only
- No heavy or impact exercises
Call your physician immediately if you have any of the following symptoms:
- Fever (>101 F or 38.0 C).
- Bleeding (i.e, soaking a pad every 1-2 hours).
- Severe abdominal pain and tenderness.
- Difficulty breathing.