Egg retrieval during the IVF cycle – the climax of the superovulation process

The finale of the clinical superovulation part of the IVF cycle is egg retrieval( egg collection), where the doctor collects eggs from the mature follicles in the ovaries. It’s important that patients understand the importance of the egg retrieval process because the quality of the embryos is only going to be as good as the eggs! After all, it’s the egg quality that determines how good your embryos are.

Egg quality will depend on how well the doctor superovulates you ( the protocol used, the dose of drugs, and the brand used), as well as the skills of the doctor involved in the actual egg retrieval process. Sadly, not only do most patients not understand much about the egg retrieval process, but it's actually quite depressing to see how casually IVF doctors take this as well.

You need to be proactive, to make sure the doctor does a good job – after all, each egg is a potential baby. Now this doesn’t mean that you need to learn how to do the egg retrieval yourself – it just means you need to know what questions to ask to make sure everything is proceeding according to plan, so there are no unexpected shocks later on.

When the doctor gives you the HCG trigger, you need to know exactly how many follicles the doctor can see on the ultrasound scan, what their sizes are, and what your blood estradiol ( E2) level is. This will allow you to predict approximately how many eggs you're going to get. Sadly, most doctors don’t bother to share this information, which means patients are often completely clueless about what to expect.

Thus, even when there are 12 mature follicles, doctors will end up getting only 5 or 6 eggs, partly because they don't take the time to do the procedure properly and don’t take the time, trouble, and energy to retrieve each and every egg from each and every follicle. This is either because they're in a hurry to do the next case, or because they don't have the expertise to do this properly. This is especially an issue when the egg collection is not done under general anesthesia, because if the patient has pain, she will start moving, and the doctor is then worried that the tip of the needle may enter a blood vessel, as a result of which they will often abandon the procedure halfway.

It's also important that the doctor devote enough time to the procedure, and that it be done by someone who has enough expertise. While a simple egg collection is easy to do (for young women with lots of follicles), some patients are technically challenging. This is especially true for obese patients; for patients whose ovaries are not easily accessible; and for patients who have a poor ovarian response - they only have two or three follicles. You then need a doctor who will make sure that they get each and every egg from each and every follicle. But unfortunately, not all doctors are equally passionate or committed to maximizing your chances of getting pregnant. This is especially true in corporate IVF chains, which treat patients on an assembly-line basis because the doctor who does the egg collection is not the one who does the consultation, the ultrasound scanning, or the monitoring, which means no one takes overall responsibility, and the patient falls between the cracks because of a lack of coordination. Often the doctor who does the egg collection behaves as a technician whose only job is to stick a needle into each follicle, hand over the follicular fluid to the embryologist, and then leave the OT and move on to the next egg collection, without even checking how many eggs the embryologist has identified. Sadly, not all doctors are conscientious, and this is especially a problem when IVF clinics batch patients because they end up doing so many egg collections in one day that they don't have more than 10 or 15 minutes to do the retrieval for each patient.

In our clinic, Dr Anjali aspirates ( sucks) each and every follicle, and sends the follicular fluid from each follicle to the embryologist, until he gets an egg from that follicle. She may need to do multiple flushes, and will use a double-lumen egg collection needle, in order to make sure that each and every egg is retrieved! Very few doctors are that skilled or that devoted to their patients.

This is why you need to be proactive and understand exactly what's happening during the eff collection process so that you are confident that your doctor does a good job with the egg collection. If he doesn't get all your eggs, your chances of getting pregnant are going to go down dramatically.

The problem is that when the doctor doesn't get enough eggs, even though there are lots of follicles, the doctor will often end up blaming the patient for having poor-quality eggs - and this is just adding insult to injury, and is extremely unfair. To ensure this doesn’t happen to you, you need to ask the doctor questions both before the egg pickup ( your scan images and measurements, your blood estradiol level, and the number of eggs he expects to collect); and after the egg pickup as well. Accurate medical documentation will ensure that you're not being taken for a ride.

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.