Egg Collection

So on the Friday (what would have been day 11 of stims) I had what is known as "oocyte capture" or "ovum retrieval" - egg collection in layman's terms!

The consultant retrieves the artificially stimulated eggs by passing a fine needle through the vaginal wall and into each follicle in turn. Some UK clinics perform this under general anaesthetic but most under sedation. It also varies as to whether this procedure is performed in theatre or not, I believe.

At Care, egg collection is performed under sedation in theatre. We were booked in to start at 8:30am and needed to arrive at 8:00am to prepare. I didn't get a wink of sleep the night before; I felt physically sick with nerves, it was horrible. So much of our chance of success at IVF depended on the outcome of this procedure and how many and what good quality eggs were removed. At 4am I gave up trying to sleep and came to watch TV downstairs with the dog!

Our clinic ask the patient not to wear perfume, not to eat after midnight, and not to drink after 5am. I was asked to bring a dressing gown and socks as theatre can get cold. I think the dressing gown is more to protect the ladies' modesty as it is removed in theatre and a blanket is given instead.

Hubby and I arrived early and had an identity card produced - with cheesy mugshots! - that allows us onto the ward area. We were shown into a small private room containing a small cupboard and two chairs and I was asked to change into a hospital gown. I've never worn a hospital gown before, it was quite exciting (despite the nerves)! A nurse went through various questions - what I am allergic to and so on - and then collected me and we walked into theatre. Hubby was left behind and collected to produce his 'sample' once egg collection was underway.

The next bit is a bit of a lovely blur due to the sedation... I lay down and was arranged on the bed.  The various members of staff - nurse, ODP, embryologist, anaesthetist, and consultant (who was the only consultant at the clinic we already knew, thank goodness - I had prayed specifically for her). The anaesthetist then inserted a canular into my hand, he was a very nice man. He explained to me about the medication and said I might fall asleep or fall in and out of sleep, and that if I had any discomfort, to let him know and he'd increase the dose. He then said, 'You will start to feel sleepy over the next couple of minutes.' I looked around, and that is the last thing I remember before waking up in recovery.

I was vey nervous about the idea of sedation and had prayed I would sleep through the whole thing... Praise God this happened; I slept deeply according to the nurse and was not best pleased when she woke me up! I think my lack of sleep the previous two nights helped achieve this :D. Waking up was the worst part (in fact the only uncomfortable part of the whole thing); I was in a lot of pain. The nurse said, "Do you want to know how many? You've had 23 eggs removed!!" I was overjoyed. She then explained that this is why I was in so much pain - the higher the number of eggs, the more the pain. Paracetamol had already been given through the canular while I was asleep but she said they could give me more drugs and to let her know when I wanted them. She was the nicest nurse (the same nurse who saw me through the whole thing and then again through embryo transfer).

I was wheeled on the bed back to the little private room and there was my lovely hubby. He was very tender and protective of me, it was really sweet. The nurse left us alone and I told him how many eggs, he was amazed too and we shared our joy! Another nurse then returned (equally lovely) and offered me a choice of Codeine or a painkiller that goes in a pessary up the bum (sorry TMI and I forget the name). Anyway she recommended the latter so I went for that and it worked like a dream, in about 20 minutes all the pain had gone. I had low blood pressure from the sedation and couldn't go to the loo for about an hour; this was not good as I was immediately given lots of sweet tea and water by the lovely nurses!!! Had a scary moment when I first tried to go to the loo - the room span and I felt sick - but half an hour later it was ok and I was able to relieve myself.

Both the embryologist and the consultant who performed the procedure visited us in our private room after egg collection. The embryologist told us that hubby's sperm sample was great! The consultant said I would feel very sore as she had not only retrieved 23 eggs, but also 'popped' all my smaller follies not containing eggs in order to prevent OHSS. She also said that due to my large number of follies, she felt unsure as to whether we should go ahead with transfer this cycle or freeze the embryos for transfer at a later date, but she said she was happy to monitor me over the next few days and see how things go before making any decisions. She said that during EC my ovaries had shown no signs of OHSS (i.e. there was not excess fluid), despite the large number of follies. (I had a nurse phone every day between EC and ET to check how I was doing with OHSS symptoms. Luckily I never had any more than very, very mild symptoms - a small amount of bloating, abdominal discomfort, and nausea... And we were able to do the transfer this cycle.)

We drove home and I rested on the sofa the rest of the day. Pain wasn't too bad at all and although we had bought some Co-Codomol in preparation, I didn't need to take more than Paracetamol once I got home, and I took Paracetamol for four days following egg collection. I felt pretty nauseous so treated myself to some favourite foods. It was quite sore to wee, but I didn't have any bleeding or spotting after I left the hospital (there was quite a bit of bleeding immediately after egg collection that went onto the clinic pad, I think they're called Chux pads). And I still haven't had any bleeding or spotting from egg collection and this is now 3dp5dt.

So that was it, my egg collection experience... It was an amazing experience full of answer to prayer - I had prayed for sleeping through the procedure and no signs of OHSS. Next came the really hard part - waiting.

Stimulation Injections and Monitoring Scans

Stimulation Injections

My protocol for this cycle was Menopur 150iu daily and Cetrotide O.25mg daily (Cetrotide started on day 5 and is to help prevent ovulation).

Through this cycle I have discovered that I much prefer injections in the leg to injections in the tummy :). Didn't mind the leg ones at all; something creeps me out about having a needle pointed at the stomach though, it's such delicate and tender skin. Everyone's different, some people prefer the tummy.

First Monitoring Scan

On day 6 of the stimulation injections we had our first early morning scan and blood test. The scans are done internally - ie vaginally. At the first scan, 17 follicles measuring between 8-12mm were counted and I was over the moon! Hubby and I went to a local country park to walk the dog afterwards, I wasn't feeling too uncomfortable at that point and just had a stitch-like feeling from the follies growing. It was a beautiful day and full of peace, we just floated around all over the place!!! The clinic called at 2pm and told us to continue medication as before (my blood test results were normal - the clinic are looking for risk of OHSS) and to come back for another scan in two days.

Second Monitoring Scan

On day 8 of the stimulation injections we had our second monitoring scan and blood test. It's not normal to have so many blood tests, but due to having PCOS, being under 35 and slim, and having lots of follies responding I am a high OHSS risk.

At this scan I had 19 follies over 8mm, but I was quite disappointed as they didn't seem to have grown much in size, and one was miles ahead of the others in size at 16mm. It was at this point that I learned that clinics look for 3 follicles of 17-22mm in size for egg collection, and I felt really disheartened as we seemed miles away from that (little did I know!).

The clinic called in the afternoon and told me to drop the Menopur from 150iu to 112.5iu that night. Cetrotide stayed the same. Blood work was normal.

I was very sore this day; it was the sorest day. I could physically feel the follies stretching and growing inside, it felt like a burning. Walking began to hurt. I had a training day for new job and it was very unpleasant!

Third Monitoring Scan

On day 9 of the stims we had third scan and blood test. Felt relieved and overjoyed when my lovely original follies had grown lots and lots more, an incredible amount (guess that's what the pain was!). I had 30 follies over 8mm and we had two ready for egg collection at this point. Blood work had increased fairly dramatically but not enough to worry them. After this scan, a lovely nurse (all the staff at Care Nottingham have been so lovely) took us into a private room and told us that our egg collection was likely to be Friday and that my trigger shot would likely be changed from Gonasi (containing HcG) to Buserilin (which doesn't contain HcG). The reason for this is that HcG triggers OHSS.

I was not so sore this day, although this scan was the first to hurt (I guess as my ovaries were taking up a lot more room!). Hubby and I were 'intimate' this night in preparation for EC (sorry TMI!); we were told to be intimate 2-5 days before egg collection, and it was quite sore for me.

When the clinic phoned us in the afternoon, they told us to drop the Menopur from 150iu to 75iu that night. I became very anxious as I was worried that we wouldn't have very many follies ready for collection by Friday, and I couldn't feel them stretching and growing any more.

Fourth Monitoring Scan

On day 10 of stims (our trigger shot day) we had our fourth and final monitoring scan and blood test. The blood work determined whether egg collection would be Friday or Saturday - if it showed me to be at risk of ovulation it would be Friday, but otherwise they would leave it 'til Saturday to give the little follies time to grow. At this scan I was again thrilled and overjoyed as the follies had grown lots and lots.

We saw a nurse after scan and blood test who taught us how to do the Buserilin trigger and prescribed me some Cabergoline to prevent OHSS. She warned me that this would likely make me feel very poorly - in her words, 'not many ladies tolerate it'. This made me feel very nervous - what was I letting myself in for? She predicted that if we did egg collection on Friday I would have 17 eggs and I was OVER THE MOON!!! It felt like God specifically and personally addressing my concerns.

That afternoon the clinic phoned and confirmed that egg collection would be Friday and I should do trigger shot and start Cabergoline that night. I didn't have Cabergoline side effects that night (phew!!) but Buserilin gave me heart palpitations and hot flushes and I only slept about two hours that night.

Luckily I had no warning signs of OHSS - the clinic said that my blood work was at the higher end but not abnormal or dangerous, and my stomach was no more bloated than before a period. However, I spent most of this week on the sofa as walking was sore, and the clinic told me to rest as an OHSS preventative measure.