Egg retrieval is a fairly rapid procedure. Obviously the length of the procedure depends on how many follicles are present. Also the accessibility of the ovaries will determine how long the procedure will take. Accessibility means how easy is it to reach the ovaries with the ultrasound probe, whether they have a tendency to move away from the probe and so on. The typical egg retrieval will take from 20-30 minutes.

We do our egg retrievals under anesthesia so the patient is asleep for the procedure. Our anesthesiologists use medications which heavily sedate the patient so she is “asleep” however, she is not anesthetized so that breathing tubes are not necessary. The beauty of this approach is that the patient feels absolutely nothing, remembers absolutely nothing, and has few if any of the typical side effects of anesthesia such as nausea and vomiting.

The data we have available tells us that it does not. There have been many women who have undergone multiple egg retrievals. The fact that they have responded to stimulation on subsequent occasions and gotten eggs and pregnancies on these occasions implies that the ovaries are OK after egg retrieval. There have been some limited studies looking at the appearance of the ovaries in women who have had egg retrievals and subsequent laparoscopic surgery. In those patients, the findings were normal. Of course we simply have no data as to long term outcomes because IVF and egg retrievals have only been done since 1978, however our opinion, and that of the medical community, is that egg retrieval is a safe procedure where the benefits outweigh the risks.

Vaginal bleeding is not uncommon after an egg retrieval. Usually this bleeding is from the needle puncture sites in the vaginal wall. It is usually minor (spotting).

Not necessarily. Although we will usually get an egg from most mature sized follicles, most women will have a mixed group of follicles after ovulation induction. Some of those follicles will have immature eggs or post mature eggs which may not be identifiable so they will seem to have been “empty” follicles.

The embryo transfer does not require any anesthesia. It is performed using a speculum that allows the doctor to see the cervix, (like a Pap smear) and is very similar in technique to an intrauterine insemination (IUI). Usually the woman feels only the speculum and nothing else.

It is really not necessary from the conception point of view. In nature, the embryo floats freely in the endometrial cavity for a number of days before implantation and it will do the same in an IVF cycle. We do recommend that our patients take it easy following transfer, but routine work activities are certainly reasonable. If there is an increased risk of Ovarian Hyperstimulation, we will recommend prophylactic bed rest.

When the above criteria are followed, approximately 25-30% of pregnancies are multiple. The vast majority of these are twin pregnancies. The rate of triplets is approximately 5% and that of quadruplets is much less than 1% when the above criteria are followed. These odds are related to the number of transferred embryos.

Ultimately the answer is no. If an embryo is of poor quality because it is genetically abnormal, there is nothing that can be done to salvage it. However, there are procedures which we do that can improve the chances of a borderline embryo. These include carrying aspiration of fragments as well as assisted hatching. It has been shown that procedures such as these can increase implantation rates in couples with a poor prognosis.

Since we only do day 5 (or blastocyst) transfers we perform assisted hatching routinely in most cases. Assisted hatching is also performed routinely in PGS and PGD cases.

Embryos which progress to the blastocyst stage and are good quality can then be cryopreserved, if that is the couple’s wishes. If couples do not elect to freeze the extra embryos for later use, they can donate their embryos for research, for stem cells research, to another couple, to an embryo adoption agency, or simply discard them.