Your guide to a successful egg collection

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What is egg collection?

Egg collection (also referred to as ‘egg retrieval’ or ‘egg pickup’) is the process by which we collect eggs from your ovaries. The eggs collected can then be frozen and stored, or used in the next step of an IVF cycle. Usually, we will be able to collect around 8–12 eggs but this is dependent on multiple factors, including your age.

Sometimes, you may need to undergo more than one egg collection, so we have a good quantity of eggs available (in the double digits is ideal). The number of eggs is important, whether you are freezing your eggs for potential use in later life, or whether you are moving on to the next step in the IVF process straightaway.

How do I prepare for my egg collection?

Two weeks before your egg collection

You will require regular hormone injections for around 8–14 days before your egg retrieval. This varies based on how your body is responding to the fertility medications and which regimen your fertility specialist decides is best for you. These injections encourage the maturation of eggs that would otherwise deteriorate. This is important as only mature eggs are capable of fertilisation when combined with sperm (an egg and sperm must successfully unite in order for an embryo to form).

While injections can sound painful and daunting, the needles are very small and easy to use. We will teach you (or a partner or another preferred person) how to give the injections at home.

You can read more about how we stimulate the ovaries to produce mature eggs here.

The week prior to egg collection

An ultrasound image showing the number of follicles within a woman's ovary
Ultrasound imaging is used during fertility treatment to track the development of ovarian follicles.

About a week after you start these medications, you will have a vaginal ultrasound so we can view your ovaries and count the number of follicles present. Usually, each follicle will contain one egg. The number of follicles gives us a good idea of how well you are responding to the fertility medications, while the size of the follicles is a good indicator of egg maturity. Unfortunately, small follicles usually contain immature eggs, which can be difficult to retrieve – they tend to stick to the follicle wall during collection. Thus, we may need to adjust your fertility medications to encourage more growth.

Ultrasound and blood tests also help us to determine the best time to collect your eggs. As such, these tests will be performed over the course of this week with the exact timing of your egg collection updated in line with your results. This change in schedule can sometimes be frustrating for patients, particularly in the midst of work commitments, but it ensures we are collecting your eggs at the optimal time in terms of both egg quantity and quality – the more mature eggs, the better!

1–2 days before your egg collection

Around 35–36 hours before your scheduled egg collection, you will have a ‘trigger injection’. This is a different hormone medication and will trigger ovulation (the release of eggs from your ovaries).

We will also ask you to fast from 6 hours before the time of your scheduled procedure (this reduces the risk of nausea and vomiting later).

Morning of your egg collection

On the morning of your egg collection, you may feel both excited and nervous – and hungry (!) from fasting. There are just a few things we need you to remember:

  • Continue to eat and drink nothing. Small sips of clear fluids are okay up to 2 hours before your procedure
  • Brush your teeth – we understand the last thing you want to do is to break our ‘nothing to drink’ rule but it’s okay to brush your teeth!
  • Wear loose fitting, comfortable clothing
  • Do not wear any makeup or jewellery, and
  • Confirm the availability of the person you have organised to drive you home after your procedure and to ideally spend the rest of the day with you while your sedation wears off.

What will happen when I arrive for my egg collection?

On arrival, please make your way to our Ground Floor reception to complete your admissions paperwork. We will then guide you through to a waiting area where you can change into a hospital gown. There will usually be a period of waiting at this point, as we schedule your admission time an hour before your procedure. We recommend bringing a good book or podcast along.

Next, we will discuss the procedure with you, check when you took your trigger injection, answer any last-minute questions you may have, and ensure you understand and feel comfortable with what will happen next.

When it’s time for your procedure, we will guide you through to the procedure room and give you some light sedation. Once the sedation has kicked in (you will feel drowsy and relaxed), we will insert an ultrasound probe into your vagina. This provides a clear view of your ovaries and the follicles inside them (the eggs are located inside these follicles). We will then guide a fine needle attached to the probe into each of the follicles, one at a time. A suction device attached to the needle drives the fluid inside the follicle up the needle and into a heated test tube. This entire process takes around 20–30 minutes.

An image of oocyte-containing fluid collected from an egg retrieval procedure
During the egg retrieval procedure, fluid is collected from ovarian follicles, which contain eggs (the dark, circular spots).

The fluid collected is taken straight through to our lab for examination by one of our embryologists. Under a microscope, they can carefully identify the eggs and discard the fluid. Our lab is directly adjacent to our day surgery so your eggs don’t have very far to travel!

If your egg collection is for the purposes of egg freezing, any mature eggs we find will be frozen and stored within a few hours of your procedure. If your egg collection is part of an IVF cycle, we may also freeze the mature eggs for use at a later date. Alternatively, we may proceed to the next step of the IVF process straightaway, placing your eggs with specially-prepared sperm from your partner or donor (this is called ‘insemination’).

Depending on how many eggs were collected and the volume of sperm available, 1–2 eggs will each be placed in a petri dish with a concentrated sperm sample containing around 100,000 sperm! Ideally, each egg will be fertilised by a single sperm, with every normally fertilised egg having the potential to grow and develop further into an embryo. However, it’s important to note that not every egg we collect will be mature, and not every mature egg placed with sperm will be fertilised. Hence, by collecting multiple eggs, we increase the chances of success at this step in the IVF process. You can read more about fertilisation and what impacts its success here.

What happens after my egg retrieval?

Around 90 minutes after your procedure, your designated person can take you home. Before you leave, let us know if you need a medical certificate. We recommend taking it easy for the rest of the day.

If you are planning to freeze your eggs, we will generally call you later that day to tell you how many mature eggs were collected. If we are proceeding with insemination, we will usually call you the next day instead, so we can also tell you how many of these eggs were successfully fertilised overnight. Any fertilised eggs will be placed in an incubator in our lab. Here, their development will be monitored closely with the hope that they continue to grow into healthy embryos, ready for the next step in the IVF process – embryo transfer.

How can I best support my recovery after an egg collection?

Most women will experience some mild pain or discomfort after an egg collection and it may take weeks for this discomfort to ease completely. To help support your recovery, we recommend:

  • Placing a heat pack over your belly and resting if you’re experiencing any cramping or discomfort. If your pain continues, take some paracetamol. Note: do not take any antihistamines, ibuprofen, aspirin or non-steroidal anti-inflammatory medications if you are planning to have an embryo transfer
  • Consuming clear fluids if you are nauseous until you feel better
  • Looking out for any vaginal bleeding (but don’t worry if you notice some light spotting or bleeding for a few days – this is completely normal)
  • Avoiding vaginal creams, lubricants or spermicides (aside from the progesterone cream we may have given you)
  • Avoiding all heavy lifting or vigorous exercise such as running or cycling for a few weeks
  • Staying away from hot tubs and Jacuzzis
  • Limiting your caffeine and alcohol intake
  • Avoiding intercourse for a few days or until you feel comfortable. Engaging in intercourse around this time can result in natural conception; however, it’s important to listen to your body and only do what it feels physically ready for.

Are there any symptoms I should watch out for?

There are a few symptoms to watch out for after this procedure, including fever; pain, nausea or vomiting that’s not improving; heavy vaginal bleeding; feeling overly weak, faint or dizzy; shortness of breath; pain in your shoulder area; severe stomach bloating; rapid weight gain; or little to no urination despite drinking plenty of water.

If you are concerned or worried about anything you are experiencing, please call our clinic for advice on (03) 8080 8933. Alternatively, you can contact your fertility specialist. After-hours, you should visit your closest emergency department.

Still got questions?

If you have an upcoming egg collection booked and still have questions, don’t hesitate to give us a call on (03) 8080 8933. If you’re interested in learning more about egg freezing or IVF, check out the rest of our website for further information. For personalised advice, you can also book an appointment with one of our fertility specialists.

Understanding ovarian reserve: will I really run out of eggs?

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What is ‘ovarian reserve’?

‘Ovarian reserve’ refers to the pool of eggs left in your ovaries with reproductive potential. Because women are unable to make new eggs, your egg supply (and fertility) naturally declines with age until menopause when you no longer ovulate at all.

A bit of biology

Your ovaries are oval shaped, around 3–5 cm long and found on either side of your uterus (womb). Ovaries contain follicles which act like a nest for immature eggs. Each month, your hormones stimulate many of these follicles, triggering the eggs inside them to mature. Even though a number of follicles are activated (often referred to as the ‘cohort’), the ovary will usually only release one dominant egg each month (‘ovulation’), leaving the other eggs to deteriorate. If the mature egg released from the ovary meets and unites with any sperm present in your reproductive tract (‘fertilisation’), pregnancy results (as long as the fertilised egg continues to develop and successfully implants in the wall of the uterus). This is why sexual intercourse is recommended around the time of ovulation.

Egg numbers change as we age

Even though women start with 1–2 million eggs, by the time you reach puberty only about 300,000–400,000 of the eggs you were born with remain. The monthly cycle described above then continues throughout a woman’s life until there are no eggs left. You will have around 27,000 eggs remaining in your late 30s and around 1000 at the onset of menopause. As the total number of remaining eggs decreases, so does the size of the monthly ‘cohort’. This means there are fewer follicles from which the ovary is able to select an egg for release each month and fewer potential eggs available for pick-up when an older woman undergoes egg collection for IVF or egg freezing. In total, your ovaries will release around 500 mature eggs throughout your fertile years (puberty to menopause).

It’s not hard to see why age plays such a major role in a woman’s potential to fall pregnant. Generally, the most fertile period of a woman’s life is between her 20s and early 30s – when egg quantity and quality are at their best. Women will typically find it more difficult to fall pregnant after the age of 35, when there is a sudden, sharp decline in egg count, along with a reduction in egg quality.

Counting eggs

There are two tests commonly used by fertility specialists to check a woman’s ovarian reserve. The first is the AMH (anti-Mullerian hormone) test, more colloquially known as the ‘Egg-timer test’. AMH is a hormone secreted by the follicles in the ovaries. However, as a woman matures, AMH levels naturally decrease. By measuring AMH levels in the blood, we can gauge how many eggs remain in your ovaries – high AMH levels are a strong indicator of a high number of eggs. Dr Chris Russell discusses the AMH test in more detail in this video.

The second test we use is called an ‘antral follicle count’. This test involves viewing your ovaries via an ultrasound scan (typically in the first week after a period). This enables us to count the number of egg-containing follicles in your ovaries.

It’s important to note that although both these tests provide valuable information about egg quantity, neither is able to assess egg quality.

Can I improve my ovarian reserve?

While there aren’t any proven ways to hold onto your eggs for longer, certain lifestyle factors have been shown to accelerate egg loss. For example, cigarette smoking may lead to the premature deterioration of your eggs. Thus, avoiding smoking is one of the simplest ways to preserve your fertility.

Are there other reasons my ovarian reserve may be low?

While a low (or diminished) ovarian reserve is a normal part of every woman’s biological clock, egg loss can occur earlier than expected for some women. Besides smoking, common causes of diminished ovarian reserve include various genetic conditions (e.g. Fragile X), ovarian surgery (e.g. for endometriosis or ovarian cysts) and some cancer treatments (e.g. certain chemotherapies and radiation therapy).

What role does egg freezing play in fertility preservation?

It is now very common for women who expect to start a family later in life (when they know their natural reserve of eggs will be lower) to consider freezing some of their eggs. Freezing your eggs is a safe and effective form of fertility preservation that can help limit the impact of expected age-related fertility decline. The best time to freeze your eggs is in your 20s and early 30s (when you are most fertile and you have a lot of good-quality eggs).

An embryologist pouring liquid nitrogen into a liquid nitrogen container storing frozen eggs and embryos.
Egg freezing is a common way to preserve a woman’s fertility.

Egg freezing involves four steps:

  • Ovarian stimulation: We stimulate the ovaries with hormone injections to promote the development of egg-containing ovarian follicles
  • Monitoring: We monitor the developing follicles via ultrasound to help guide the timing of egg collection
  • Egg collection: Under light anaesthesia, we collect around 15–20 eggs (but this number is highly dependent on the ‘cohort’ size)
  • Storage: We identify and freeze any mature eggs, which can then be stored for up to 10 years.

If a woman encounters difficulty falling pregnant when she is ready to start a family, she then has the option of thawing her frozen eggs and trying for a baby via IVF.

Falling pregnant when egg numbers are already low

Women with a low ovarian reserve may still be able to have children with the help of assisted reproductive techniques like IVF. However, IVF success is reduced in women with low ovarian reserve and the risk of miscarriage is higher due to lower egg quality. If a woman’s ‘cohort’ size (i.e. the number of ovarian follicles activated each month) is significantly reduced, even very high doses of stimulating hormone will only produce one or two poor-quality eggs for collection during the IVF cycle. In this case, using donor eggs instead may be an option for some women.

Discussing your options

If you would like to learn more about low ovarian reserve or understand if your egg supply could be affecting your fertility, you can make an appointment with one of our fertility specialists by calling (03) 8080 8933 or by booking online.

Is egg freezing right for you?

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In principle, egg freezing sounds simple enough – have some eggs collected, freeze them for storage, then thaw them when you’re ready to undergo fertility treatment – providing you with a chance to store your eggs while you’re still young and beat the biological clock. But what exactly does egg freezing involve and are you an appropriate candidate?

Why freeze your eggs?

You may want to consider freezing your eggs if you’re worried about your fertility declining but your life circumstances mean that you’re simply not ready to start a family. Alternatively, you may have a medical condition or be receiving medical treatment that could affect your fertility. If you’re a female transitioning to a male, you may wish to preserve your fertility before starting reconstructive or hormonal therapy, which can lead to a loss of your fertility.

What does the egg freezing process involve?

The first stage of egg freezing is ovarian stimulation, which involves 10–14 days of hormone injections to stimulate your ovaries to produce multiple eggs. There are various techniques used for stimulation and your fertility specialist will decide, together with you, which is most suitable for you. The developing follicles, which contain your eggs, are monitored by ultrasound and sometimes by blood hormone levels to determine when they are ready to be collected.

When mature, your eggs are collected (usually while you’re under sedation rather than general anaesthetic), frozen and put into storage. In most cases, frozen eggs can be stored for up to 10 years.

When you’re ready to have a baby, the eggs are then thawed and used in IVF treatment. This involves fertilising your eggs with sperm using a method called intracytoplasmic sperm injection (ICSI), whereby sperm is injected directly into the egg. The embryos are then grown in the lab for up to 6 days and then transferred to your uterus (womb).

Factors to consider when deciding whether to freeze your eggs

1. Success rates

Egg freezing is an established procedure. It has now been two decades since the world’s first pregnancy using frozen eggs and over this time, there have been notable improvements in the technology and processes we use. High rates of success can now be expected when circumstances are optimal. A 2017 study showed that freezing 20 eggs before the age of 35 gives a 90% chance of having a baby.1

When considering these statistics, it is important to note that the number of women who actually go on to use their frozen eggs is still quite low. In 2017–18, less than 1% of IVF cycles in Victoria involved the use of a woman’s own thawed eggs.2  The data on egg freezing success rates are challenging to compile because many women choose not to use their eggs for many years after freezing and some may not use them at all. Furthermore, current figures may not reflect advances in egg freezing technology because the results are from a period when clinics were using different ‘slow freezing’ techniques.

In terms of understanding the success rates for frozen eggs compared to ‘fresh’ (recently retrieved) eggs, a study published in the Journal of Human Reproduction in 2010 examined the success of IVF in 600 women, half of whom were assigned ‘fresh’ eggs while the other half were given frozen and thawed eggs.3 The study found no significant difference in pregnancy rates between the two groups of women, concluding that freezing eggs and thawing them for later use has no effects on success rates. According to these findings, the likelihood that your eggs will result in a pregnancy will be the same whether you choose to freeze and use them later or use them straightaway.

2. Age

The age at which you choose to freeze your eggs is key to your chances of having a baby – the younger you are, the better. Egg quality declines more rapidly after the age of 35, so the best time to freeze your eggs is in your 20s and early 30s.4 Unfortunately, eggs collected from older women are less likely to form viable embryos and are also less likely to successfully implant in the wall of the womb. Thus, if you decide to freeze your eggs when you are older, we typically need to collect more eggs to ensure at least one egg is of suitable quality to result in a baby. However, as women age, they also have fewer eggs, so only a small number of eggs may be available for collection and freezing. If this is the case, you may need more than one treatment cycle to collect an adequate number of eggs for storage.

Both the number and quality of eggs available for freezing are important, because at each step in the freezing and subsequent IVF process, there is a risk that some are lost. Of the eggs that are collected, some may not be appropriate for freezing, some may not survive the thawing process, and some may not be fertilised or successfully develop into embryos.

3. Costs

In Australia, fertility treatment is only covered by Medicare and other government subsidies when there is a medical need for the treatment. If you freeze your eggs for non-medical reasons (i.e. ‘elective egg freezing’), you won’t be eligible for Medicare assistance.

For detailed information about the costs associated with egg freezing, please visit our fees page.

*Does not include hospital fees; †Does not include medications or hospital fees.

What are the alternative options?

If freezing your eggs is not a suitable option for you, other potential options include:

When considering your fertility and the options for extending it, there is no one-size-fits-all approach. As with all aspects of fertility care, the best decision for you is the one that is personalised to your individual situation.

Learn more information about Newlife IVF’s egg freezing services. If you would like to discuss your options with one of our fertility specialists, please call Newlife IVF on (03) 8080 8933. Alternatively, you can book online via our appointments page.

References

  1. Munné S et al. Human Reprod 2017; 32(4):743–749.
  2. Victorian Assisted Reproductive Treatment Authority. Annual Report 2018.
  3. Cobo A et al. Human Reprod 2010; 25(9):2239–2246.
  4. Saumet J et al. J Obstet Gynaeocol Can 2018; 40(3):356–368.