Egg collection IVF - what to expect

Note the obligatory disclaimer: The below is from my personal knowledge and experience of IVF.  The exact advice and processes from your IVF clinic may differ.

How do you collect eggs for IVF?

During IVF, eggs are collected by performing vaginal scanning and needle aspiration of the eggs. It is an odd phrase that I think means sucking the eggs out through the vaginal wall using a long, thin needle.

How long does egg harvesting take during IVF?

The operation for egg collection takes approximately 30 minutes, according to the literature from my IVF clinic. Half an hour is the actual operation time, but if egg collection were a ticketed event it would be a day long extravaganza. Egg collection ‘the event’ involves arriving early at the clinic (hungry), filling in forms, sperm collection, a pre-meet with the anesthetist, an anesthetic injection, an operation to collect the eggs, recovery with the nurses, lunch courtesy of the clinic (although technically you pay for it through the thousands of pounds spent on IVF), a visit from the embryologist, a compulsory wee, a further meeting with the nurse regarding the next set of drugs, and discharge from the clinic mid afternoon.

How painful is egg collection in IVF?

The operation for egg collection is performed under sedation or general anaesthetic, so the procedure should not be painful. My clinic says that egg collection can cause period like cramping, mild bleeding or spotting and some soreness down under following the operation. Luckily, I felt no pain and the only discomfort was the type expected from any operation - the cannula being inserted in to the back of my hand (medical term for this is ‘being a wuss’), a reaction to the general anaesthetic that brought on crippling stiffness in my muscles (I’m fairly confident that is unique to me); a painfully sore throat post operation from the breathing apparatus which makes sipping water feel like an internal throat massage using coarse sandpaper.

Do you need to shave before egg retrieval?

There is no medical reason to shave your legs before egg collection. They could happily perform the operation on Mr Tumnus, if he had ovaries. I am sure it is true that the medical staff are too preoccupied to notice or care if legs are smooth or hairy. But I cared. My preparation for egg collection was identical to a third date – I shaved my legs and wore my poshest pants.  The latter was pointless, as I was asked to remove my posh pants before having a chance to flash them at the staff and replace them with a delightful pair of paper knickers. 

Can you eat before egg collection?

If your operation is performed under general anaesthetic, there will be restrictions on your eating or drinking before the operation. I was not allowed to eat or drink anything other than water from midnight the night before. 

How many days of abstinence before sperm collection for IVF?

In language more appropriate for an invitation to a Royal Garden Party than deterring a man from masterbation, our clinic formally request that the male partner abstain from ejaculation for 2 to 3 days before the collection of the sample, which is undertaken at the clinic on the morning of egg collection. If any problems are anticipated with this, then a sample can be produced beforehand and frozen, thereby taking some of the pressure off.  If an advanced sample has been produced, the clinic can let the man know the quality of the sperm sample. If it is collected the morning of the egg harvesting, then the quality is anyone's guess.

How many eggs is average for IVF retrieval?

The embryologist at my IVF clinic explained that the clinic aims for retrieval in the 8-12 egg range. How many eggs are collected will depend on the medical reason why you require IVF, the IVF drugs you have been taking and your body’s reaction to them. It can be that women with low ovarian reserve produce fewer than this ideal range of eggs and those with PCOS grow more than the ideal. Every case is different.

The literature from my IVF clinic reassured that although very occasionally no eggs are obtained, usually the clinic is aware that there has been poor ovarian response and has discussed this possibility with the patient prior to the egg collection. Therefore, if this happens spontaneously at the point of retrieval, you have experienced what the medical community would term ‘an absolute shocker’.

How many days does it take to recover from egg collection?

It may take 1-2 days to recover from the general anaesthetic used in the egg collection, although the procedure itself may not cause any discomfort. You will be released into the care of a ‘responsible adult’ to drive you home and to check you are not being odder than normal for 24 hours. For me, egg collection was on a Friday so I had the weekend to recover, but I would have felt sufficiently well to return to work the following day, if that had been necessary.

Is egg retrieval the hardest part of IVF?

Egg retrieval is probably the most physically demanding part of IVF, as it is the only stage that requires an operation - although many would argue that weeks of injections are also physically draining. Egg collection feels harder than embryo transfer, which is a quicker procedure which does not require sedation or anaesthetic and is more akin to a SMEAR test.

For me, egg retrieval was not the hardest part of IVF emotionally either, that was the tortious two week wait to take the pregnancy test. 

What is the egg retrieval process really like? A day in the life of someone being harvested.

Egg collection is the time in the IVF process that everything is totally out of your hands and you have to surrender to the IVF consultants. You've done everything that you can and or this one day, what will be, will be. But what will be? Here is a day in the life of a person being harvested.

Arrival at the IVF clinic

All couples being harvested arrive at our clinic for 7:00 am. You can work out the time of egg collection by adding 36 hours to the time of the trigger shot. I’m due under the knife (dramatic expression for such a minor procedure but today calls for hyperbole) at 11 am, yet here I am, at the clinic changing into my paper pants at the break of dawn.

Each couple is led to their private room, one by one, past a delicious looking raffle prize fruitcake, ever more tempting considering I’m denied breakfast (nil by mouth since midnight) and my tummy is all a-rumble.

In our room we are greeted with a fresh, smart but bare space, a bed on wheels, a TV, some medical equipment and a private bathroom. It’s posh. Not hotel posh, but in comparison to NHS hospitals and other medical facilities I’ve experienced, it’s delightful.

On the bed is a spa hotel style brochure with the other services offered, such as gyms, exercise classes, nutritional advice, treatments, other available operations and an extensive and delicious sounding lunch menu.

Sperm collection

Collecting the sperm sample is less than romantic. If a future child ever asks how they were conceived, the following details will not feature in my recanting of the IVF story. As there are 10 couples in the clinic, all queueing up for egg and sperm collection, the sample collection room (AKA the Wank Room) is having a stressful, busy morning.

Joe was therefore given the option of creating his specimen in the comfort of our private hospital bathroom. He leapt at the opportunity with enthusiasm not warranted by the bare and clinical loo in which he would have to perform his duties. The focus during IVF is so much on women and growing eggs that it is easy to forget the pressure on men. And there is pressure. An awkward, embarrassing, critical performance kind of pressure. I indulge in sympathetic feelings, before remembering that one of us is having an orgasim and the other an op, and my empathy somewhat evaporates.

What can make a medically required orgasm more awkward? Well, let’s see. The clinic leave us a Do Not Disturb sign to hang on the door of our room, for use during ‘the moment’, so that everyone (absolutely everyone) who walked past the room knows exactly what was occurring. To provide extra privacy, I turn up the sound on the television to drown out any noise from the bathroom. The unintentional result is dribbling commentary from crap day time TV (A Place in the Sun) penetrating the walls of the bathroom and becoming the un-errotic sound track to sperm collection.

There was no material in the bathroom to use as an aid. In fact, the only material was an informative, if not rather graphically disgusting, poster with illustrations outlining the best way to open your bowels to achieve a class A bowel movement. And a pot, thankfully bigger than previous test posts, which drew complaints from Joe (“Did I get it all, they asked? In that tiny thing? How accurate do they think my aim is?”). When done, the test pot is placed in a brown paper bag, like an alcoholic smuggling an illicit bottle of the hard stuff on to a bus, and walked up to the embryology lab.

How are babies made? Via two loving adults (correct) engaging in a naked cuddle (far from it).

Preparation for general anaesthetic

It’s my first time having a general anaesthetic and I’m panicked. Not about the op, or the affects of the general, but about the insertion of the cannula. I’m not a trypanophobic, but rather what the medical community refers to as a ‘total wuss’. I wonder whether it’s displacement activity, something trivial into which to channel all my stress and anxiety. When the anaesthetist pops by, doing his rounds of the human egg farms on the ward, I ask him if it will hurt. “Well, no. You’ll be completely out of it.” I then explain that I’m not talking about egg retrieval, but about the cannula. His facial expression ends the conversation and he continues on his way in disbelief at the lady in room 3.

The operating theatre

Adorned head to toe in ‘hospital chic’ (imagine a back-to-front and oversized wizard’s outfit with my arse hanging out) and my slippers from home which hospital staff obsessively check are on my feet, I am wheeled down into the pre-ops area.

My transport is a giant hospital bed on wheels. For every moment that I am in motion, all staff hold the doors open for me, everyone I pass smiles and waves, I have my own porter. I feel like royalty, just on weird transport and in terrible clothes.

A nurse smiles and tells me not to be alarmed if I wake up with something in my bottom. This is totally normal, she says. “Is it”, I question, “Is it, though?” Whilst gently stroking my arm, the nurse reassures me that during the operation, when I'm out of it, the consultant may see it necessary to 'pop something in there'. What, was less clear. I assume a medically necessary pessary, but maybe it is a surprise gift, like a raffle. Perhaps an individually wrapped chocolate, some jewellery in cling film or the jackpot, a set of keys for a brand new car waiting for the winner in the clinic car park.

The IVF consultant undertaking the procedure greets me, the porter holds my hand whilst the cannula is inserted (what a supportive sweetie) and then I feel strange as the anaesthetic takes hold. It reminds me of stumbling to the bathroom a couple of tequilas and a bottle of wine past my alcohol tolerance. I count backwards from 10, and similar to an alcohol fueled night out, I don’t make it past 9.

As for me, I look a state.

I watched the Jellie Diaries on myBaba.com of a couple going through IVF at my clinic to better understand what to expect. Post op I assumed that I too would look like the gorgeous and glamorous Ellie after her retrieval, like a model reclining on a sunlounger during a holiday to an exotic island.

Unfortunately, my post procedure appearance is a far cry from glamorous, unless psycho chic is on trend? I keep slurring to Joey “I don’t think that the drugs had any impact. I feel totally normal. Like totally. Do I look completely normal to you?” He simply responds with “Shhh love, Shhh now. Just drink your water.”

The most notable impact from the operation is a painfully dry throat, presumably from the breathing apparatus used during the procedure. Drinking water, which the nurses insist that I continuously do, feels like an internal throat massage using coarse sandpaper and I find it hard to swallow.

Post retrieval recovery - embarrassing myself on drugs

After the procedure, when seeping in and out of consciousness, someone tells me that therapy will be needed, as the egg collection was so poor. At least, I think they did. For half an hour in the recovery room, I try to establish whether this actually occurred. Deciding not to shield my husband from my unstable hold on reality, I share this potentially devastating, but probably didn’t happen, news with Joe on returning to my hospital room. I support him through the inevitable (and wholly avoidable) emotional downturn, as any good wife would.

A short time after egg retrieval the embryologist informs you of your stash, the number of eggs collected. The maturity of the eggs, the quality and the number that fertilise is not known until a phone call the following day. At this stage, it is simply The Number.

One benefit to having PCOS, the only upside to this hair sprouting, spot inducing, infertility rendering, testosterone enhancing condition, is that those with PCOS get enough eggs through IVF to fill Easter. How many eggs did I produce? 9. How is it possible to have more than 22 follicles on a single ovary (the sonographer stopped counting at 22, I assume for clinical reasons rather than sheer boredom) and end up with single figure eggs?

In contrast to me, the embryologist is pleased with the number, explaining that the clinic tries to land people in the 8-12 egg range. She reassures me that it is rare and difficult to get the IVF drugs protocol that spot on for PCOS sufferers. Congrats! All is good. But it feels far from it. When I probe on egg quality, the embryologist admits that PCOS eggs are on the whole crappier than eggs from a ‘normal’ woman (clearly I’m paraphrasing) and therefore there was a chance that the drop off rate would be higher for me than an average woman. The possibility that I may not end up with an embryo to transfer, sinks me into mild depression.

My gloomy thoughts are interrupted by the nurse enquiring, yet again, if I need the toilet, which confirms my suspicion that she has a (poorly concealed) bathroom related fetish.

Discharge from the clinic - Come on lady, do a wee

“Do you need a wee?” the nurse asks. On my polite decline she thrusts a glass of water into my hands. “Drink up”. The nurse smiles at me, expectantly. Waiting. “Drink your water” she keeps saying, so I dutifully sip my liquid sandpaper. After a few minutes of her smiling and nodding and me smiling and slurping, Joe leans in to me and whispers, “She needs you to go for a wee and to get dressed”. The nurse must suspect a standoff, but the reality is that I somehow missed that a wee was my ticket home. Did I mention I’m high on drugs, despite being convinced that I’m totally fine?

The length of time I spend in the bathroom causes coos of concern from the nurse as to whether all was OK. Pulling on a pair of skinny jeans with a cannula in one hand whilst being off your tits on drugs is a slow and laborious task. And I had also paused for a few minutes to read a rather informative poster on how to correctly open your bowels.

Lunch

A room service lunch is provided for both partners. There is an extensive menu, the type you find in one of those coffee shops that smashes avocado onto everything it serves. I chose a chicken sandwich as a celebratory treat, inviting the caterer to comment that most women choose eggs. “Eggs!” he chuckles, shaking his head. “Eggs!” My rational mind knows that he is just enjoying the irony, but my irrational one, which wears the crown most of the time, wonders if he is gluten shaming me.

A visit from the embryologist

The embryologist’s entrance into the room is met with expectant silence, like the curtains opening at the theatre. It is a big moment in our IVF.

Ellie (left) post egg collection and me (right). Oh dear

More IVF drugs and a pregnancy test

It is rare to attend the IVF clinic without being packed off with a bag of drugs and egg collection is no exception. I am on a drug called Cabergoline to help prevent ovarian hyper stimulation syndrome (OHSS). They are the tiny pills, barely visible to the naked eye. Drop one and you have to drop to your hands and knees, sweeping the floor with your hands whilst weeping about messing up your treatment cycle.

Now the nurse gives me progesterone pessaries called Cyclogest, the drug that I am dreading the most. Progesterone support is for after egg collection until either 1) a negative pregnancy test, or 2) for most or all of the first trimester (depending on your clinic’s policies). Progesterone thickens the uterine lining and prepares the body to support the embryo. I am also given a clinic approved pregnancy test with clear instructions on how and when to pee on it.

And now, home. It’s 2:30 pm so we have been at the clinic for 7.5 hours. You are not permitted to drive for 24 hours after a general anaesthetic, so I was discharged into the care of my 'responsible adult' Joe, who is to stay with me overnight to make sure I didn't do anything more peculiar than usual. 

Recovery from egg collection

The nurse warned me that egg collection can cause period-like cramping, mild bleeding or spotting, with some soreness down under. It is not generally known to be painful, but it can be uncomfortable for some women in the days following. Maybe my allotted pain allowance was allocated for my HSG test (horrendous) as ever since the fertility gods have left me in peace. I felt nothing at all, aside from my weird reaction to the general anaesthetic, which brought on crippling stiffness. My whole body felt like a quad muscle after a marathon. I spent a few days moving with the fluidity of an 90 year old, which made me grateful that it was a weekend. I hadn’t told many work colleagues about IVF and their queries as to ‘what the hell has happened to you?’ would have seen me spin an increasingly complex web of lies in which to entangle myself.