Egg collection is the time in the IVF process that everything is totally out of your hands and you have to surrender to the consultants. You've done everything that you can and for this one day, what will be will be. But what will be? This article sets out a day in the life of a person being harvested.
Can you eat before egg retrieval? Preparation for the BIG op
Other than engaging in mild trepidation, I didn't do anything special to prepare for egg collection. Because the operation was being performed under general anaesthetic, I wasn't allowed to eat or drink from midnight the proceeding evening. It may be different for those (brave souls in my book) undergoing a sedation rather than a general. So all my preparation entailed was wearing my poshest pants, I have no idea why as I had to take them off early doors and don a fetching paper of paper pants, and enduring a hungry morning.
Arriving at the clinic for my harvesting
All couples having their eggs collected arrive at the clinic at 7:00 am. On our special harvesting day it was 10 pairs of anxious people. Why so early? WHY? You sign in at reception and then anxiously wait to be called through. We were the last couple (of course, Sod’s Law) with an operation at 11:00am. The time you are due to go under the knife (dramatic expression for such a minor procedure) can be worked out by adding 36 hours to the time you took your trigger shot. If you jabbed at 11pm then the op will be at 11:00am two days later.
Each couple were led to their private room one by one until we were the only ones in the waiting room, salivating over a delicious looking raffle prize fruitcake, ever more tempting given I had been denied breakfast and my tummy was all a-rumble. You are told not to eat before the general anaesthetic so I had been ‘nil by mouth’ since midnight.
We were finally led through to our room and greeting us was a fresh, smart but bare space with a bed on wheels, a TV, some medical equipment and a private bathroom. It was posh, I thought. Not hotel standards of posh, let’s be clear, but in comparison to NHS hospitals and other medical facilities that I’ve been in it was a league above. On the bed was a spa hotel style brochure with the services offered by Nuffield, such as gyms, nutrition advice, treatments, operations (OK, there are less operations in a spa hotel) and an extensive and delicious sounding lunch menu.
The male contribution - It's sperm sample time
Our clinic formally request that the male partner abstain from ejaculation for 2 to 3 days before the collection of the sample, which is undertaken on site the morning of the egg collection. If any problems are anticipated with this then a sample can be produced beforehand and frozen, taking some of the pressure off. If it is the case that an advanced sample has been produced, the clinic let the man know the quality of the sperm sample. If it is collected the morning of the egg harvesting, then the quality is anyone's guess.
Collecting the sperm sample was less than romantic. If a future child ever asks how they were conceived, the following details will not feature in my recanting of the IVF story. So, given there were 10 couples all queueing up for egg and sperm collection, the sample collection room (AKA the Wank Room) was having a stressfully busy morning. Joe was therefore given the option of creating his specimen in the comfort of our private hospital bathroom. He leapt at the opportunity with enthusiasm not warranted by the rather bare and clinical loo in which he would have to perform his duties. The focus is so much on the females and growing eggs that it is easy to forget the pressure on the men. And there is pressure. An awkward, embarrassing, critical performance style of pressure which I have luckily never had to experience.
What can make a medically required orgasm more awkward? Well, let’s see. We were left a Do Not Disturb sign to hang on the door of our room, for use during ‘the moment’, so that everyone (absolutely everyone) who walked past the room knew what was occurring. To provide extra privacy I turned up the sound on the television in order that any noises from the bathroom would be drowned out. The unintentional result was that dribbling commentary from crap day time TV (A Place in the Sun) penetrated the walls of the bathroom and became the un-errotic sound track to the sperm collection. There was no material in the bathroom to use as an aid. In fact, the only material was an informative (if not rather graphically disgusting) information poster with illustrations outlining the best way to open your bowels and achieve a class A movement. And a pot, thankfully bigger than some test posts previously used (‘Did I get it all?! In that tiny thing? How accurate do they think my aim is?’) which when filled was to be placed in a brown paper bag, like an alcoholic smuggling an illicit bottle of the hard stuff on to a bus, and walked up to the embryology lab. How are babies made? Via two loving adults (correct) engaging in a naked cuddle (far from correct).
Is egg retrieval painful? Anaesthetic and that dreaded cannula
It was the first time of having a general anaesthetic and I was panicked. Not about the op, or the effects of the general, but about the insertion of the cannula. I’m not trypanophobic by any stretch (yep, I looked up the technical term), but I’m what the medical community would refer to as a ‘total wuss’. It seems silly now and I wonder whether it was displacement activity, something ridiculously trivial into which to channel all my stress and anxiety. When the anaesthetist popped by, doing his rounds of the human egg farms on the ward, I asked him if it would hurt. “Well, no. You’ll be completely out of it.” When I explained that I wasn’t talking about the procedure but about the cannula, the look on his face was shock (or possibly awe) that someone would focus on something so basic. “It depends on your pain threshold”. Oh dear, not comforting. I can confirm that having a cannula inserted was no worse than a blood draw which made my stressing a total waste of energy.
The big egg harvest
In my beautiful hospital edition garments, that were far too big and made me look like a wizard, and my slippers from home (the hospital were very insistant on slippers and kept checking that I had them on my feet) I was wheeled down into the pre-ops area. My transport was a giant hospital bed on wheels, and for the time I was on it all staff held the doors open for me, everyone I passed smiled and waved, I had my own porter. I felt like royalty, just on a giant bed and in terrible clothing.
I was greeted by the consultant who was undertaking the procedure. It could have been any of the 4 consultants at the clinic but by chance it was mine, Dr Curtis, smiling away in his usual supportive way. The Porter held my hand whilst the cannula was inserted (what a sweetie) and it turned out to be a non-event (Was that it? Seriously?). I then felt really strange as the anaesthic took hold, like stumbling to the bathroom a couple of tequilas and a bottle of wine past my alcohol tolerance point. I counted backwards from 10, making it to 9 before passing out.
How long does egg retrieval take? How do they extract eggs from a woman for IVF?
What does the egg collection procedure entail? Well, according to the official literature from the clinic the operation time is about 30 minutes in which the eggs will be collected by performing vaginal scanning and needle aspiration of the eggs (which is a funny term that I think means sucking them out) through the vagina. Sounds pleasant doesn't it? The literature reassures that although very occasionally no eggs are obtained, usually the clinic is aware that there has been poor ovarian response and has discussed this possibility with the patient prior to the egg collection. Therefore, if that happens spontaneously then you have had an absolute shocker.
I was told before being taken down into theatre not to be alarmed if I woke up with something in my bottom. This is totally normal, they said. Is it though? Is it? The smiling nurse reassured me that during the operation when I'm out of it the clinician may see it necessary to 'pop something in there'. What was less clear was what it would be. I assumed it would be a medically necessary pessary, but maybe it was a surprise, with each lucky lady receiving a different gift? An individually wrapped Roses chocolate, a dashing pair of earrings wrapped in cling film (ouch) or the jackpot, a set of keys for a brand new car waiting for the winner in the clinic car park. I was intrigued, and very hopefully. But alas, nothing graced by bottom that day.
Post op recovery - embarrassing myself on drugs
During the op I dreamt that someone had said therapy would be needed as the egg collection was so poor. I then spent my 30 minutes in the recovery room trying to establish whether that actually occurred. I’m pretty sure now that it didn’t, but I scared the crap out of Joe by sharing it with him on my return to our room. The most notable after effect of the operation is a painfully dry and sore throat, presumably from the breathing apparatus. Drinking water, which the nurses insist that you do, feels like an internal throat massage using coarse sandpaper.
I looked a state. I watched the Jellie Diaries on Baba.com of a couple going through IVF at Nuffield Woking to gain an understanding of what to expect. I assumed that I too would look like the gorgeous and glamorous Ellie after her retrieval, like a model reclining on a sunbed during a holiday to an exotic island. Unfortunately, my post procedure appearance was a far cry from glamorous, unless psycho chic is on trend? I kept slurring to Joey “I don’t think that the drugs had any impact. I feel totally normal. Like totally. Do I look completely normal to you?”. He just responded with “Shhh love, Shhh now. Just drink your water.”
A room service lunch was provided for both partners, self-selected from an extensive and smart looking menu. I chose a chicken sandwich as a celebratory treat, sparking the caterer delivering the food to comment that most women choose eggs. “Eggs!” he chuckled to himself, shaking his head “eggs! Ha ha!”. I knew I should have chosen more protein. Was he gluten shaming me? Actually I think he was just enjoying the irony of eggs.
Visit from the embryologist
Then you wait tensely for a visit from the embryologist to hear about your stash. We didn't find out the maturity or the quality of the eggs until the first hair raising call from the embryologist the following morning on fertilisation rates. But they do tell you the number collected, which in my case was 9. 9?! Surely PCOS promises me at least double figures? How is it possible to have more than 22 follicles on a single ovary (the sonographer stopped counting at 22, I assume for clinical reasons rather than sheer boredom) and end up with single figure eggs? I understand that for those suffering with low AMH 9 eggs sounds like a good crop and my intention is not to be insensitive. But the one and only benefit to PCOS (after struggling with insulin resistance, long cycles, no proper ovulation and hairiness) is that you get a high number of eggs. But not me. Nope. The embryologist seemed pleased with the number, explaining that the clinic tries to land people in the 8-12 egg range and that it is difficult and rare for the drugs protocol for PCOS suffers to be that spot on. Congrats! All is good. But it didn’t feel good. It is hard not to compare yourself to others in similar situations and most PCOSers have more, possibly double my numbers plus. But as my mother in law would say, comparisons are odious, and she is absolutely right.
I probed the embryologist about likely quality of the eggs. It is impossible to tell by looking at them straight after collection how they are going to fare, instead you have to wait until fertilisation and development to have a proper indication of quality. But the embryologist admitted that PCOS eggs on the whole are crappier then eggs from a ‘normal’ woman (I’m paraphrasing) and therefore there was a chance that the drop off rate would be higher for me than an average woman. Not music to my ears. More like A Place in the Sun commentary to my ears. The possibility that I would not make it to a 5 day transfer, or that I may not have any embryos to transfer at all, washed over me and sank me into mild depression for the remainder of the day.
Discharge (from the clinic - NOT the type that involves oversharing)
Please note, you need to do a wee before they will let you go home. Why is anyone’s guess, but those are the rules. The nurse was smiling at me, expectantly. Waiting. “Drink your water” she kept saying so I dutifully sipped at my liquid sandpaper. After a few minutes of her smiling and nodding and me smiling and slurping, Joey lent in a hoarsely whispered “She needs you to go for a wee and to get dressed”. Ohhh. I hadn’t realised. She must have thought it was a standoff but in reality I’d somehow missed that instruction. Did I mention I was high on drugs, despite being convinced that I was totally fine? So I plodded off to the bathroom clear on the fact that a nice wee was my ticket home. The amount of time I spent in the loo caused chirrups of concern from the other room as to whether all was OK. Pulling on a pair of jeans with a cannula in one hand whilst being off your tits on drugs is a slow and laborious task. And I had also paused for a minute or two to read a rather helpful and information poster on how to correctly open your bowels.
It is rare to attend the IVF clinic without being packed off with a bag of drugs, and egg collection is no exception. I was already on a drug called Cabergoline to help prevent ovarian hyper stimulation syndrome (OHSS) which were the tiniest 6 pills I had ever experienced. Drop one of those bad boys and you'd spend the rest of the day feeling around the floor on your hands and knees as they were barely visible to the naked eye. Post sandwiches and post embryologist we were visited by a fertility nurse who talked us through the next set of drugs and the pregnancy test. I was provided with progesterone pessaries called Cyclogest, the drug that I was dreading the most (more on this next week) and a clinic approved pregnancy test with clear instructions on how and when to pee on it. Then I was allowed to go home. You are not permitted to drive for 24 hours after a general anaesthetic, so I was discharged into the care of my 'responsible adult' (they obviously don't know Joey) who was to stay with me overnight to make sure I didn't do anything more peculiar than usual.
Is it painful after egg retrieval? Post operation recovery and all over body aches
Egg collection can cause period like cramping, mild bleeding or spotting and some soreness down under. It is not generally known to be hugely painful but can be uncomfortable for some women during the following days. For me, I was one of the lucky ones and felt nothing adverse at all. Maybe my pain had all been allocated for my HSG test (horrendous) as the fertility gods have left me alone ever since. What I did experience, which I was not expecting, were pretty severe all over body aches as the general anaesthetic left my muscles. Talking to medics afterwards, this happens to some people. Luck of the draw (or unluck of the draw) I suppose. On the plus side, it was hilarious. For anyone who has ever endured long distance running, my whole body was feeling the pain usually reserved for my quad muscles following a hard long run. Joey helped me out of bed, levering me up like I was chronically obese, a kind stranger helped me reach a box of tea on the top shelve at a supermarket when my grimace and contorted body position indicated I was an invalid, and my cat Roger sat on me whilst I relaxed in front of the TV (this didn’t help at all, to be honest, but the kind intentions were there). Other than spending a few days not being able to move with more fluidity than a 80 year old, I felt fine following egg retrieval, for which I am very grateful.
I also didn't change my diet and lifestyle, other expanding to the size of a small retirement bungalow due to bloating. I maintained my attempts at nutrient rich healthy eating, tried to stay calm and hoped for the best.
If you are wanting specific tips on what to eat at each stage of IVF to get your temple of a body in fighting form then the book Zita West's The IVF Diet has a chapter on suggested food to eat for egg collection, with recipes. She lists particularly good foods for egg retrieval to be foods rich in vitamin C, magnesium, zinc, omega 3, vitamin E and vitamin D - so basically you need lots of everything.
And that's the day in the life of an egg collectee. It was an unsettling, nerve wracking and hungry day, but there is nothing one can do other than surrender to the process. In some ways it was nice to finally have something that was totally out of my hands. The most stressful part of the IVF process for me was yet to come. The calls from the embryologist, the progesterone pessaries and the two week wait were just around the corner. Crumpets.
Coming next in the IVF Series...
Egg Transfer and Progesterone Pessaries - Could IVF be any more fun? - Sunday 1 April
Books Review: Get A Life, His and Hers Survival Guide to IVF - Sunday 8 April