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If you’re only just starting to consider in-vitro fertilization (IVF) as an option, the very concept can be intimidating. The term “IVF” is thrown around so often in fertility circles that some people automatically assume it’s a necessary step for getting pregnant with infertility. Sometimes it is, but sometimes it isn’t.
“Don't assume just because you're struggling to get pregnant that you need IVF,” says Deanna Brasile, DO, a fertility specialist at Main Line Fertility. “The majority of patients can get pregnant through means that are less aggressive and less expensive than IVF.”
There are, however, numerous reasons why doctors recommend IVF for patients who are trying to conceive: Blocked, tied, or missing fallopian tubes. Severe sperm problems (a count of less than 5 million, according to Dr. Brasile). Advanced maternal age. Genetic conditions. Recurrent miscarriage. Endometriosis. Three failed IUIs.
So, what can you expect during the IVF process, from shots to egg retrieval?
Even though IVF is one of the most common fertility treatments available, it’s important for potential patients to be armed with all the facts, including answers to pressing questions like, “Is egg retrieval painful?” We’re here to walk you through every step of the process, so you can make an informed decision regarding whether or not IVF is the best option for you.
Initial consultation, follicle observation, and ovarian stimulation
An IVF protocol usually begins with an initial consultation with your fertility specialist, followed by an orientation with the doctor’s team. Then, the patient will begin medication to help stimulate the ovaries to produce multiple eggs (as opposed to the usual single egg). These medications, according to Dr. Brasile, begin when the woman’s period starts, with the woman taking the medication daily for about two weeks.
Dr. Brasile says patients should prepare for about four or five office visits for blood work and ultrasounds during those two weeks. “You're going to be watched really closely for the follicle development,” she says. Once the eggs reach a mature size (“which we gauge by ultrasound”), then it’s time for the all-important “trigger shot.” This hormone injection “will make the eggs ripe,” says Dr. Brasile. Thirty-six hours later, it will be time for the next step, which is egg retrieval.
Is egg retrieval painful?
Retrieving eggs during an IVF protocol does consist of a surgical procedure, but according to Dr. Brasile, it’s a painless experience. “It's just a small puncture that closes up on its own,” she says. “Then we go into the ovary and we get all of the eggs out through suction – and there are no cuts in your skin or stitches afterward.” The good news is, the procedure is performed in an operating room with anesthesia, and Dr. Brasile promises the patient won’t feel any discomfort because “you’re asleep.” The recovery time is also minimal, with Dr. Brasile remarking that most patients are back at work the following day.
While the eggs are being retrieved, this is usually around the same time the male partner produces a fresh sperm sample – or donor or thawed sperm is made available.
Fertilization to blastocyst
The sperm and egg then undergo conventional insemination, where they’re mixed and incubated overnight. Or, as Dr. Brasile refers to this process: “an arranged marriage.” These embryos, she says, “are permitted to grow out to what's called a blastocyst, which is day five, six, or sometimes day seven of development.”
Fresh vs. Frozen embryo transfer
If the patient's IVF protocol includes a "fresh" embryo transfer, the embryo is transferred into the woman’s uterus on either the fifth, sixth, or seventh day of blastocyst development. This is done via an in-office or in-clinic procedure where one embryo is typically transferred using a speculum inserted into the vagina, followed by a catheter, which is inserted into the cervix and uterus. The embryo transfer is non-invasive and may feel like a Pap smear, with light cramping or discomfort. Although the patient isn’t under anesthesia for the embryo transfer, Dr. Brasile says this procedure isn’t painful. “The egg retrieval itself would be painful if you were awake,” she says, “but you’re not.”
The transfer is considered successful if the embryo implants in the lining of the uterus, which is confirmed by an hCG blood pregnancy test about 9 to 10 days after egg retrieval.
It's important to note that not all patients will be ready for an embryo transfer immediately following an egg retrieval. In these cases, a frozen embryo transfer is typically recommended during the subsequent cycle.
What else to consider before IVF
Aside from learning the basics behind an IVF protocol, Dr. Brasile recommends that patients also consider genetic testing of their embryos. This occurs before a frozen embryo transfer, and it helps determine possible abnormalities. “[Genetic testing] is definitely advised for over age 35,” she says. “But even if you're young, it's a really good piece of information to have.” By having the embryos tested prior to implantation, both the patient – and their fertility team – will know if they’re working with normal or abnormal embryos. “I advise it for all my patients,” says Dr. Brasile.
She also stresses the importance of comfort and good communication with your fertility team. “Make sure you feel as though your doctor looks at you as an individual and has tailored your approach – and isn’t just using a cookie-cutter approach,” advises Dr. Brasile. “If [a clinic] has the same protocol for every single person that walks through the door, you're going to have some patients who won’t be appropriate for that protocol and it's just not going to work. So make sure that you have a comfort level with your doctor, and feel as though they're taking an individualized approach.”
Remember, if that means you need to shop around for the right doctor and the right clinic, that’s totally fine! When it comes to your fertility journey, open lines of communication and feeling at ease with your care team are paramount.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.