On the day of your retrieval your husband/partner will need to come in during morning clinic to give a semen specimen. You will be given a specific time for this collection, usually between 7:00 and 7:45am. The embryologists will prepare the sperm to fertilize the eggs once they have been retrieved. If you are using donor sperm, make sure it is in our office at least 2 days prior to your retrieval.
You will be given a specific time to check in for your retrieval. This will be one hour prior to your retrieval time. Timing is vital during this process so plan accordingly. Make sure you have NOTHING TO EAT OR DRINK AFTER MIDNIGHT THE NIGHT BEFORE YOUR RETRIEVAL. This, too, is very important. You may use a sip of water to take any oral medications, but nothing more. Do not use any scented lotions, hair products, make-up or perfume the day of the retrieval. Odors can be toxic to embryos so they are not allowed in the operating room. Wear comfortable clothing to your appointment. You will likely experience some cramping and discomfort after your procedure. Be prepared for some spotting, this is normal.
Once you check in for your retrieval you will be taken to an exam room where you will change in to a gown and have in IV started. Your vitals will be taken and a nurse will go over instructions with you, sign consents and answer any questions you may have. An anesthesiologist will come in and talk to you about your retrieval, medications used, and take a brief medical history. We will then escort you to the OR, making a stop at the restroom so you can empty your bladder. Once in the OR, an embryologist will come in to confirm your ID and you will be asked to view a monitor on the wall where your Petri dish with your name on it will appear. This is where your eggs will be placed and fertilized after the retrieval. Once you have identified your dish, you will go to sleep for approximately 20-30 minutes.
A speculum is placed so Dr. Robins can clean the vaginal area with warm saline. Then a vaginal ultrasound probe is used to identify the ovaries. An aspiration needle attached to the probe is used to penetrate the vaginal wall and enter the ovaries to remove the egg and follicular fluid from each of the follicles. Dr. Robins first aspirates one ovary, then moves on to the next. The length of this process depends on how many follicles are in each ovary. This process typically takes 5-10 minutes. Once all the follicles have been aspirated, the vaginal area is cleaned, the speculum is removed and the procedure is complete.
From the OR you will go to the recovery area. You will wake up from the anesthesia within 5-10 minutes after the surgery. Some patients feel nauseated and this is normal. If you experience nausea, please tell your recovery nurse immediately so we can give you some medication in your IV to alleviate the nausea. Abdominal cramping is normal and to be expected. As soon as you are awake and can eat a small snack you will be offered some pain medication. Your husband/partner will be able to come back to join you in recovery once you are awake and ready for a visitor. You will spend about an hour in recovery. We want to make sure your pain is minimal and you have had plenty of fluids by the time you are discharged. You will need to arrange for transportation after your retrieval as you are not allowed to drive yourself home. You need to go straight home/hotel to finish recovering. It will take several hours for the anesthesia to completely wear off. You will be tired and should be resting for the remainder of the day. You will receive a prescription for Tylenol #3 with codeine for pain. Be sure to eat a small meal or snack before taking pain medication. Narcotics can make you very nauseous if taken on an empty stomach. Expect abdominal cramping and bloating for up to a week after your retrieval. The severity of symptoms can vary greatly between patients. It may take a couple weeks for your ovaries to return to normal size. If bloating and discomfort increases over the 7-10 days after your retrieval, let your nurse coordinator know.
You are able to resume normal activity the day after your procedure as tolerated. Abstain from intercourse until after your pregnancy test if you have a transfer, or 1 week following retrieval if you don’t have a transfer. Avoid high-impact activities until your ovaries have returned to normal size. DO NOT USE ANTIHISTAMINES, IBUPROFEN/ADVIL, ALEVE, ASPIRIN OR OTHER NON-STEROIDAL ANTI-INFLAMMATORY MEDICATIONS. These will block prostaglandin production which is involved in the implantation process. Tylenol is safe and may be taken for pain relief if needed.
If you are expecting a transfer 5 days after your retrieval, you will begin taking your Medrol and Progesterone this evening. You will be given medication instructions prior to the procedure and it should also be on your calendar. It doesn’t matter what time you take your Progesterone, just keep it consistent. Do whatever works best for you and the person giving you the injection. Progesterone is an IM (intramuscular) injection and can be difficult to give yourself.
FERTILIZATION
On the day of the retrieval you will be told how many eggs were retrieved. The next day, Day 1, you will receive a call from a nurse telling you how many eggs were mature and how many fertilized. The next update of your embryos’ progress will be on Day 3. On Day 5 you will receive an update on your embryos. If you are expecting to have a transfer this day, be up and showered, waiting for a call from the clinic telling you if your embryos are ready. If you live out of town, you may want to come to Spokane on Day 4 in anticipation of your transfer. Otherwise, you’ll need to be in Spokane as early as 8:30 am for your transfer. We won’t be able to give you a transfer time until that morning. Again, our schedules are dependent on your embryo development and cannot be guaranteed ahead of time.
If your embryos are not blastocysts by Day 5, your embryos will be given another day to reach that stage. On Day 6, any embryos that developed to a blastocyst will then be vitrified until we prepare your uterus for a transfer in another cycle. This allows for better synchrony between the embryos and your endometrium. If the embryos are not blastocysts by Day 6 they will arrest, or stop growing. Transferring your embryos in a non-stimulated cycle once they have been vitrified is called a WARMED EMBRYO TRANSFER. This has shown to have far better for on-going pregnancy rates than doing a fresh Day 6 transfer.