03 Jun Egg retrieval – 10 tips to improve the outcome
Egg retrieval – a key moment in your IVF cycle. Your eggs, specifically their quality and quantity, affect your chances of getting, and staying, pregnant. So what should you do to make your egg retrieval a success? Based on our experience, that of our patients and the best medical research, read our 10 tips to improve the outcome of your egg retrieval.
1. Get the right protocol.
The right treatment protocol matters when it comes to a successful egg retrieval. Your clinic should carefully assess the level and brand of stimulating medication it gives you (e.g. Menopur, Gonal-f). Too high a dose pushes your follicles too fast: this affects egg quality. Too low, and quantity nosedives.
Make it easy for your clinic. Have an up-to-date blood hormone profile just before your treatment. Those scores are the building blocks of an accurate, finely-tuned protocol. Your egg retrieval depends on it.
For patients having donor eggs, donor embryos or an FET, a full hormone profile isn’t essential. But TSH and Prolactin are always worth checking. Press your clinic for its recommendation on any other pre-treatment tests, such as haemotology, immunology and genetic testing.
Interestingly, a 2019 study on AMH levels and IVF found that younger women with low AMH levels had better pregnancy prospects than older women with the same low levels. But older patients (over 35) responded better to IVF medication, which narrowed the gap.
2. Scan well before – and avoid the gimmicks.
Egg retrieval is all about your ovaries. Before treatment, get them examined by a good sonographer. A detailed trans-vaginal scan of your reproductive organs can rule out obstacles like polyps, cysts and fibroids.
You don’t have to use your IVF clinic for the pre-treatment scan. A reputable local scanning clinic, ideally headed up by an infertility specialist or consultant, may be cheaper and better. Scanning skills vary. Don’t do it on the cheap. Don’t spend a fortune either. Avoid gimmicky clinics offering 3D and 4D scans – they’re aimed at the general pregnancy market.
if you’ve had repeat miscarriages or implantation problems, consider a hysteroscopy. It’s the best way to check everything is in order prior to egg retrieval or embryo transfer. A hysteroscopy sees things a scan can’t.
3. Consider minimal stimulation.
Egg retrieval following minimal stimulation produce fewer, but better-quality eggs. If you’ve got low ovarian reserve, blasting your follicles with high doses of FSH medication isn’t the answer. Quality is paramount. Two mature eggs are better than four no-hopers.
The mantra is: gently does it. This softly-softly approach might pay dividends on egg retrieval day. You’ll save a fortune on expensive fertility injections. And patients in their late 30s and early 40s do particularly well on mild IVF cycles.
It’s also a safer bet for over-responders. A 2016 study on minimal stimulation found that it virtually eliminated the chance of OHSS. Live birth rates were lower. But that’s the trade-off: safety comes first.
4. Improve your egg quality.
We all know that egg quality declines with age. But lifestyle factors may play a part in egg production and quality. Schedule your egg retrieval in six months. Then start a health campaign. Don’t go crazy, but take steps to improve your IVF diet. Take moderate exercise. Avoid stress. Get your BMI in the normal range.
A 2018 study into the effects of conezyme Q10 found it boosted ovarian response in younger women with low ovarian reserve. Another supplement, DHEA, is more controversial, but a second 2018 study concluded it may boost poor ovarian reserve. Talk to your clinic.
5. Freeze while you’re ahead.
Savvy patients, often single women, are opting for egg-retrieval-only cycles, or egg freezing. So-called social egg freezing is a way to plan for the future, but it’s not risk-free. Critics say it gives false hope – an insurance policy without a guaranteed pay out.
But a 2016 study on egg freezing recommended, surprisingly, that all women should freeze their eggs by a certain age. Tread with care. Egg freezing is not as successful as embryo freezing. But eggs from women with no fertility issues, in their 20s or early 30s, can make for the best egg retrievals of all.
6. Sort out his sperm.
A successful egg retrieval is meaningless without good sperm. A pre-treatment sperm analysis is essential. Make sure all parameters are tested: volume, concentration, motility, progressive motility and morphology. Clinics sometimes skimp.
Male partners are rarely given lifestyle advice on sperm nurturing. Here’s ours. Take a multivitamin, including selenium and zinc, for at least these months prior to egg retrieval/sperm collection. Get in shape. Eat well. Stop smoking. Ditch alcohol. And cut down on your caffeine intake.
Male partners should practise regular masturbation. In the run-up to sperm collection on egg retrieval day, time the last ejaculation 48 to 72 hours before the big day. Sperm quality will then be at its best by the morning of your egg retrieval.
7. Fertilise and freeze – the new IVF trend.
An option gaining momentum is egg retrieval, fertilisation, then embryo freezing. Transfer happens at a later date. Why do it? Because ovarian stimulation can affect uterine receptivity. And the risk of OHSS is reduced (relevant to patients with PCOS).
Faced with low egg quality, some clinics now propose double egg retrieval. That’s two retrievals, separated by two menstrual bleeds, but sometimes done consecutively. The objective is a larger crop of embryos. Two egg retrievals is an expensive route. But the greater egg yield gives embryologists room for manoeuvre. Here’s one new study on dual egg retrieval.
Delaying embryo transfer is also needed if your embryos are genetically tested. A biopsy is taken, the samples are sent to the lab for PGS testing, and your embryos are frozen. A successful egg retrieval, enhanced by a healthy lifestyle, make blastocysts more likely. That means PGS can take place. For more on PGS and IVF, we recommend reading this 2017 study.
8. Be PCOS aware.
PCOS patients pose a significant risk in the build-up to egg retrieval. IVF patients with PCOS should be extra vigilant, as should their clinics. Pre-treatment checks, including a super-accurate hormone profile and a detailed scan, are a must.
OHSS monitoring during treatment is, of course, paramount. An alternative trigger shot (e.g. Decapeptyl 0.1 or Buserelin 0.5) is often a good idea. As mentioned above, freezing of embryos for a later FET might also be necessary.
PCOS patients can be proactive. Six months before your estimated egg retrieval day, start your health binge. A good diet (more vegetables, pulses and seeds, and less processed food), combined with regular exercise, can help. The goal is an egg retrieval that’s successful and safe.
9. Time that trigger.
Egg retrieval can only happen after a trigger shot. And a trigger shot’s timing requires clinic expertise and patient vigilance. As you get nearer to your egg retrieval day, your clinic will monitor your follicular development closely. Then it’s time to trigger.
Since egg retrievals usually happen in the morning, you’ll be applying your trigger shot two evenings earlier. Inject at exactly the right time. If you’re flying abroad for treatment, check the time difference. Store your Ovitrelle or Pregnyl correctly.
10. Take time off and tell your friends.
The run-up to egg retrieval can be an anxious time. Your journey to IVF treatment has probably been a tough one. So be good to yourself. Take a week off before egg retrieval, and a few days more after your transfer.
And don’t keep it to yourself. Tell your friends and family what you’re up to. Ask for their support. There’s too much silence in IVF: sharing your concerns will make you feel better and more prepared.
Hope you enjoyed our 10 tips to improve the outcome of your egg retrieval. Now read how to make your embryo transfer a success.