The eggs are microscopic, contained in dense ovarian tissue, buried deep inside the female pelvis. How could you possibly capture them in a 15 min procedure with an intravenous sedative? Most women wake up and say “Are you sure you got my eggs? I just fell asleep!”
The success of every procedure relies heavily on how you set it up. Before scheduling an egg retrieval, the patient needs to complete a 2-week hormonal injection regimen called ovulation induction. Generally, it involves the hormones FSH and LH that we all make, but in higher doses than normal to fool the ovaries to develop a group of eggs to maturity in that cycle. As each egg matures, there are cells around the egg that replicate and secrete fluid that gets trapped in a sac around the maturing egg. Ultrasound can visualize the fluid sac (or follicle) even though it cannot visualize the microscopic egg.
Then there is the issue of timing. We have a 2-hour window in which to complete an egg retrieval; this 2-hour window represents the time that most of the eggs have achieved maturation and have not yet ovulated. It takes a village! So, we have a daily dedicated egg retrieval team, in collaboration with the NYU Fertility Center, such that egg retrievals can be provided 7 days a week, and specifically when the group of eggs are mature for any given patient. Dr. Moomjy provides monitoring (estrogen and ultrasound checks) 7 days a week, to customize the ovarian stimulation process and timing for each patient.
The last injection in this preparation is called the trigger shot. It is often 2 hormones that will complete the final egg maturation and release of the eggs at 36 hours. Egg retrieval is precisely timed at 35 hours. And it is amazing!
Most importantly, the patient receives an intravenous sedative upon arrival to the egg retrieval operating room. Once she is snoring, we do a sterile prep, and egg retrieval starts. Using a special ultrasound that has a thin needle attached to it, each follicle is visualized with the ultrasound then punctured and drained. There is a vacuum system and test tubes attached to the needle that causes the follicle to drain in seconds with the follicular fluid captured in test tubes. Where are the Eggs? We still cannot see them. The embryologist has to take the fluid from each test tube and transfer it to a Petrie Dish, then look in a very systematic fashion through all of the fluid to locate, and isolate each egg, and then transfer each egg to a droplet of culture media (nutrients), and then transfer to the incubator. Eventually, the eggs will either be fertilized or frozen depending on the patient’s plan. At the end of the egg retrieval procedure, the patient is still asleep and a speculum is placed and the tiny puncture in the upper left and right corner of the vagina are provided cotton and pressure to cause a tiny clot to form; sometimes a tiny stitch is needed. The patient is observed in the recovery room and often able to go home in an hour, to rest for the remainder of the day, while the embryologists continue their highly skilled work.