Egg Retrieval and Embryo Transfer

Preparing for Egg Retrieval

The decision regarding the timing of the third injectable medication (Ovidrel, or HCG) is determined by a combination of events that include size and number of the leading (largest) ovarian follicles observed on ultrasound and blood level of ovarian hormone/s.  The timing of the Ovidrel/HCG injections is critically important as your egg retrieval procedure is scheduled at a specified hour following this injection.You will be provided with clear instructions regarding the timing for this injection. You must not eat or drink anything past midnight the night before the egg retrieval.

Male Partners: The day your partner is instructed to take the Ovidrel or HCG injection, it is recommended that you ejaculate in order to have a fresh sample with healthier sperm available on the day of egg retrieval (unless you are instructed otherwise).

Egg Retrieval

Please note that your partner must accompany you to provide his sperm specimen at the time of your scheduled egg retrieval.  Also note that arrangements must be made for you to be driven back home after the procedure. You will meet with our expert IVF nursing staff on your arrival for the scheduled egg retrieval procedure. Please feel free to mention any concerns or questions you may have before the procedure. You will be asked to change into a surgical gown and will be provided with a locker for your personal belongings. After your paperwork is reviewed, including consents, and after all your questions are addressed, an IV will be placed in one of your arm veins for administration of medications during the egg retrieval procedure. You will then be chaperoned to our procedure room for the egg retrieval that takes approximately 30 minutes (depending on the individual patient’s ovarian response – as retrieval of eggs from a larger number of ovarian follicles may take a few extra minutes).

The egg retrieval involves a transvaginal ultrasound almost identical to the scans performed during the monitoring process. We use a combination of intravenous sedatives and local anesthetic to keep you comfortable during the egg retrieval procedure. A needle guide is attached to the side of the vaginal ultrasound probe, to accommodate the egg retrieval needle; under ultrasound guidance, the needle is passed along the ultrasound guide through the wall of the vagina into the ovary and the fluid within the visible follicles is aspirated; this fluid contains the egg surrounded by cells. The aspirated fluid is passed on to the embryologist who identifies the egg from each aspirate.

Embryo Transfer

Embryo transfer is a simple, painless procedure that is performed under abdominal ultrasound guidance.

When to transfer embryos:

The timing of embryo transfer is dependent on the number and quality of available embryos and on individual patient related circumstances. Embryos are almost exclusively transferred on Day 3 (cleaving embryos) or Day 5 (blastocyst stage embryos).

How does one decide on the number of embryos to transfer:

The decision on how many embryos to transfer is based on a number of factors including the age of the female partner, her prior reproductive history and health profile (placing in perspective risks of multiple pregnancy for the woman), the number and quality of the available embryos, and couple’s acceptability of selective reduction in the event of a high order multiple pregnancy (more than twins) resulting from embryo transfer. Couples are encouraged to discuss these considerations and communicate their concerns and preferences at any and all times through the IVF process. Your infertility specialist will review your embryo status including fertilization, embryo development and the quality of embryos on the day of embryo transfer. The embryology team and your infertility specialist will identify the most optimal of the embryos available for transfer. The number of embryo/s to transfer will be decided only after you have reviewed the “track record” of your embryos, and are satisfied with the discussion and recommendations of your fertility specialist and embryologist.

Procedure of Embryo Transfer:

You will be asked to come in with a full bladder, change into a procedure gown and will be taken to the procedure room; your partner is welcome to accompany you for this highly meaningful event in your life! For patients who have previously undergone an insemination, embryo transfer is a similar procedure. With you lying down, one of our trained staff members will perform an abdominal ultrasound scan (which requires a full bladder to allow optimal visualization), while your fertility specialist gently cleanses the cervix with the fluid your embryo/s are bathed in. The pre-selected embryo/s will be “loaded” into an embryo transfer catheter; the catheter is passed on to the fertility specialist who performs a trans-cervical embryo transfer under the guidance of abdominal ultrasound. For the majority, the procedure of embryo transfer takes just a few minutes. You should not feel any discomfort during the embryo transfer procedure, and will be asked to remain reclining for an additional 15 minutes.

No. Your embryos are placed within the uterine cavity and do not “drop” out of the uterus. In the event that you experience any pink-tinged vaginal discharge, be assured that this is the fluid used to cleanse your cervix before the embryo transfer.

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There is no need for you to be bed-bound following embryo transfer. Remember, for the majority of couples conceiving spontaneously, they have NO idea what they were doing around the time of embryo implantation (attachment to the uterine lining). Extremes of physical activity and psychological stress however should be avoided over the next few days.

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Patients are advised to avoid pain medications such as Motrin, Ibuprofen, Aleve and Aspirin. Tylenol is the preferred agent for pain control. If in need of remedies for symptoms of cold, avoid medications with added “decongestant”.

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After the best of the available embryos are transferred, the remaining embryos are cultured to day #6 to determine if any of them make it to the next stage of development. Blastocyst embryos that are deemed as being of excellent quality on day 6 should be considered for cryopreservation (freezing). Our embryology team calls the patient to apprise them of the embryo’s status on day 6 and convey their recommendation for freezing consideration. Couples are strongly advised to consider freezing embryos that make it to day#6 and are considerd of excellent quality as these embryos have declared themselves to be the fit and their potential for success if transferred in a future cycle is high. Please refer to the Financial Section regarding cost of Cryopreservation.

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