Ep 295: Egg retrieval

 Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. For many patients, egg retrieval feels like the biggest unknown of the IVF journey. In this episode, your Fertility Docs take you behind the scenes to show exactly what happens on retrieval day. From the moment you arrive, you’ll meet the team working to make your procedure smooth and safe—the recovery room nurse, circulating nurse, anesthesia provider, and the embryologist who will care for your eggs after retrieval. Of course, your doctor also plays a vital role, and we’ll explain what she does during the procedure itself. We’ll walk you through how long the procedure typically lasts, what you can expect to feel afterward, and the important milestones you'll need to meet before you’re cleared to head home. You’ll learn why egg retrieval is a carefully orchestrated team effort, and how every member of your care team is focused on your comfort and success. Whether you’re preparing for your own retrieval or simply curious, this episode offers a reassuring, inside look. This podcast was sponsored by IVF Florida. 

Transcript

Susan Hudson (00:01)

You're listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

Carrie Bedient MD (00:22)

Hello and welcome to another episode of Fertility Docs Uncensored. I am one of your co-hosts, Dr. Carrie Bedient from the Fertility Center of Las Vegas, joined by my two trusty, tireless, tenacious, partners, Dr. Susan Hudson from Texas Fertility Center and Dr. Abby Eblen from Nashville Fertility Center.

Susan Hudson MD (00:37)

Hello.

Abby Eblen MD (00:41)

Hey everybody.

Carrie Bedient MD (00:43)

Okay, I need advice, please and thank you, because you are both far better shoppers than I am, and all three of us are going to this function where we have to dress up and look like fancy adults. And so I would like to know what do you look for in dresses when you are shopping that is kind of the giveaway, like, yes, I know this is very likely to look good, whether it's color or shape or cut or fabric or any of those things. Give me your secrets.

Abby Eblen MD (01:11)

Mine is not applicable to either of yours because I'm the five foot one in the room. So my first thought is I've got to have something that's the right length. And it's just my waist is really short. So it has to be petite because otherwise the waist comes where my hips are and it looks terrible. You guys are long and lean. You have a lot more ability to choose a lot of different stuff. But that in color are the two things. I want something that's bright. I don't want dark colors. I want bright colors.

Susan Hudson MD (01:35)

Colors? I think for me, there's definitely colors I stay away from being a redhead. Obviously, there's no oranges, there's no yellows. There generally is no pinks. It has to be a blue-red if it's a red. There's all those types of things. But I think it's true. It's true. Julia Roberts, Pretty Woman, that dress was amazing because it was a blue-red.

Styles I like right now are I like anything that has the the ruching ⁓ in the waist because it just form fits and no matter what you're doing it fits great and honestly I like dresses that have built-in bras in them because having to wear something that's stuck on me or that logistically is not supporting what needs to be supported, you're paying enough for those dresses that they need to just hold up the girls.

Abby Eblen MD (02:31)

Yeah.

That's right, I agree with that.

Carrie Bedient MD (02:37)

I have yet to find a dress, even with something built in, that effectively holds up the girls.

Susan Hudson MD (02:42)

Well, your girls are different than my girls though.

Abby Eblen MD (02:45)

Haha.

Carrie Bedient MD (02:45)

Yeah, that very well may be true. ⁓

Yeah, gravity is a law that mine follow with just precision every day all the gravity. And so if I don't have little forklifts and cranes, it's not gonna look good So one of the things that I always look for is can I wear a reasonable bra of some sort because strapless bras are Satan's work. ⁓

Abby Eblen MD (02:57)

Yeah, they don't. They're not too great.

Carrie Bedient MD (03:13)

They're not okay. No matter how good they look in the first five minutes, it never stays that way. And then I spend the rest of the night like pulling at my boobs and doing the shimmy. And this is not that kind of function. It is not in Las Vegas. I can't be wiggling like that. It is inappropriate. And so, yeah, I always look for something where I can actually wear a legit bra of some version so that gravity is not, maybe not my friend, but at least not my enemy.

Susan Hudson MD (03:19)

Do the shimmy.

Abby Eblen MD (03:24)

Yeah.

So Carrie, you had your colors done. What colors are you looking for?

Carrie Bedient MD (03:44)

So, jewel tones always work very well for me because I'm very high contrast of team pasty white girl with dark hair, dark eyes, dark brows, like all the rest of the features are pretty dark. And so, I usually go for all the jewel tones, the sapphires, the emeralds, the rubies, the pure blacks, the pure whites, all of those types of things are what I go for.

I like color too, I've got a great one, I've got a default one that's a red dress that is really pretty if I can't find anything else that I'll go for. But I just found a-

Abby Eblen MD (04:16)

So where are you gonna look? Where you looking?

Carrie Bedient MD (04:19)

White House Black Market is one of my defaults. So I have to look like an adult. And then, I mean, a couple of years ago when we did this for the same thing, I just got it off of Amazon for, I don't know, $39.99 or whatever. And so, so I don't know, But this time I probably can't wear sequins head to toe like we were all able to last time. And so I don't know what I'm going to do this time. Yeah. Yeah. Where do you guys look?

Susan Hudson MD (04:49)

I like Dillard's, but I didn't have a lot of luck going there this time. I think I'm going to we have a lot of outlet malls down here. We have a really great one in San Marcos. And so the last like fancy fancy dress I bought, I bought at the Saks that was there. And so I got something that was like crazy expensive, but it wasn't crazy expensive when I bought it. I'm all about finding that kind of deal. So I think I want to go there. I really want one of the the ones that are has the one shoulder thing. That's what I really, really want for this party, but we'll have to see if I can find it. There's a lot of options out there. I just haven't found the right.

Abby Eblen MD (05:18)

Yeah, that'd be pretty. That'd look great.

Yeah.

Carrie Bedient MD (05:27)

Excellent, marvelous. Okay, well, now that we know everything about dresses, do we have any questions? We can answer legitimate fertility questions as opposed to how do I dress myself questions.

Abby Eblen MD (05:38)

Ha ha ha!

Susan Hudson MD (05:38)

We do, we do.

Susan Hudson MD (05:39)

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Susan Hudson MD (06:42)

All right, our question for today. I'm curious about the medication I've been prescribed for my upcoming egg retrieval. My wife, 35, went through a retrieval a few months ago and took Follistim, Menopur, and Ganirelix. She got eight eggs, all of which were mature and fertilized, and we ended up with six PGT-A normal embryos, which we are thrilled about. I, 31, have been prescribed only Follistim and oral provera.

My REI said this protocol has been used for egg donors for a while and had good results. I'm happy about less shots, but worried it won't work as well. We want to have at least two kids, one from each of our eggs and chose IVF due to limited donor sperm availability and wanting me to carry both pregnancies. Thoughts on this protocol. Thanks for all you do. This is a great subject because it is kind of a new thing.

Carrie Bedient MD (07:33)

It is. And this is gonna dovetail into our episode as a whole, which is egg retrieval, so it's fabulous. So did she say how old her partner was? 35. Okay, and she's 35. All right, so what do you guys think about the difference of Menopur versus No-Menapur and Ganerelix versus Provera? Because the Follistim part, that's the same.

Susan Hudson MD (07:42)

35. So I personally typically do split protocols on everybody, whether they're good responders or not good responders. However,

Abby Eblen MD (08:02)

And by split protocol, what do you mean by split protocol? With Menopur?

Susan Hudson MD (08:06)

I mean doing Menopur plus either Gonal F or Follistim in pretty much almost everyone. Now I do think that there's some information that if you are using an antagonist specifically using something like Menopur helps improve outcomes. And that's probably why this doctor has taken the Menopur away from the provera cycle.

I would also say that when I look at this, generally Provera works really good for really good responders, but in anybody that you're concerned about diminished ovarian reserve, their brain's working a little bit harder than all of us think it is, and they can tend to ovulate through. And so that's probably looking at what your wife went through. She probably had a touch of diminished ovarian reserve. And so you ended up with great outcomes in the end, but you didn't have a ton of eggs, whereas with egg donors, we tend to get a ton of eggs.

Abby Eblen MD (09:09)

I don't usually start out with everybody on Menopur. I'm of the school where a few years ago we thought that there could be Menopur overload and that LH wouldn't necessarily all good in everybody. So I don't routinely just start out with it. I use it a lot though. If it's an older patient, I certainly will. And 35 is not that much older, I don't think. But a lot of times I'll use HCG every day or HCG every other day to get a little bit of that same kind of maturity potential.

I don't ever use Provera, I always use Ganerilix and everybody, or Cetrotide.

Susan Hudson MD (09:44)

We've started using it probably a year and a half ago or so in our donors and had really good luck. And I've recently started in my good responders using it and it works well. 10 milligrams daily starting on the first day of stim.

Carrie Bedient MD (10:00)

Yeah, we've used Provera quite a lot in the past, again, with the good responders, not a great med for the poor responders because like Susan said, they're a little bit harder to control and having a stronger med is helpful. But I tend to use Menopur on everybody for pretty similar reasons. But yeah, I would agree with both of your answers all the way through. For this listener, I would not worry about your medication protocol because the one thing that that medication protocol does tell us is that you are very likely to be a good responder. So I don't think you've got a whole lot to worry about. I very much hope that you get pregnant with whosoever baby you're planning on carrying first. And that I'm glad that you both aren't going through at the exact same time, because that seems like it would be a very challenging month to go through two people going through a retrieval at the same time. So I'm glad you guys kind of know what to expect, and I think you're probably going to do great.

Alright, so talking about egg retrievals, let's go through the egg retrieval process for our listeners as they're thinking about it and as they're starting all this process. So first of all, when we talk about an egg retrieval, what are we talking about?

Abby Eblen MD (11:06)

We're talking about the actual process where we put a needle through the vaginal wall, and I always tell everybody, you're asleep when we do this. We go into the ovary with a needle and we go into the follicle. And the follicles, the fluid filled sac around the egg. We can't see the egg, the egg is only one cell big, but we put our needle in the follicle. We aspirate the fluid through suction. The fluid goes through the tubing into a test tube. And then we hand that off to our embryologist who's right there close by in the room or in very next room over. And they look and tell us whether or not we've gotten the egg.

Carrie Bedient MD (11:34)

So egg retrieval is getting the egg out as a whole. Now let's back up just a little bit. And I was going to say, let's start the morning of the egg retrieval, but let's actually start two days before that. Prior to the egg retrieval, you've gone in for your monitoring visit and gotten your blood drawn, gotten your ultrasound done. And then what happens when your coordinators let you know

Abby Eblen MD (11:46)

wow.

Carrie Bedient MD (12:01)

We're ready to trigger, this is what's gonna happen.

Susan Hudson MD (12:02)

So you will probably be notified sometime the afternoon of your trigger, your actual trigger time, and what time your retrieval is going to be and the timing of any labs that will need to be drawn. The reason why they generally can't tell you all of that specific information if you're there in the morning is because they're are potentially lots of other doctors in the practice, other people who are going through IVF and there's a certain order of things that have to happen that morning. And so they'll generally give you the general idea of all the instructions for the injections and that type of thing. But then you'll get a phone call with the absolute times. And this is the one time that being on time is super, super important. So if you're a person who runs late, please set every alarm you could possibly imagine for all of these things, because these things matter. And if for some reason something happens and you can't take your trigger shot or you don't take your trigger shot when you were instructed to, please, please, please call your clinic as soon as possible so that they can figure out what needs to happen from there.

Abby Eblen MD (13:20)

Yeah, that's really important. Just as a side note, I had a patient sometime this year who took her medicine at a time she thought she was supposed to take it, but she wasn't sure. As it turned out, I was there and our team was there at 5.30 in the morning doing her egg retrieval. So, has that happened to you too, Carrie?

Carrie Bedient MD (13:36)

Yeah, she got the a.m. p.m. wrong. And so instead of doing her retrieval at 11 a.m., we did her retrieval at 11 p.m. on a Friday.

Abby Eblen MD (13:45)

Wow. Haven't had that happen. Mine was just really early.

Carrie Bedient MD (13:49)

Yeah, she just was not clicking, like just did not read closely. And so this was our Friday night date night is at the retrieval, at the surgery center doing the retrieval.

Abby Eblen MD (14:00)

Well, and the bigger issue there too is if you give your shot at the wrong time, then if you give it and too much time goes by, we worry that you may release all the eggs before we go in to get them. And that's really of all the things that could happen. That's worst case scenario basically.

Carrie Bedient MD (14:14)

Yeah, there's no recovering from that within that cycle. That's a scratch it and start again. So why are we so particular about this timing?

Susan Hudson MD (14:23)

We are so particular about this timing because when you receive your trigger shot, whether that is a leuprolide injection, some form of HCG or a combination thereof, we know that within about 34 to 37 hours after that injection, your eggs are going to be at the correct maturity and it's the window that they're mature before they're released out into the pelvis because once they get released out into the pelvis, it's almost impossible for us to salvage anything. Sometimes we do, but not a lot. So it really is a sweet spot in timing.

Abby Eblen MD (15:06)

And one side note on that too is if you live in a different time zone, I don't know if your states are like this, but Tennessee is divided right in the middle. And so the people from East Tennessee that come over, just remember there's a difference in our time versus your time. We're central, you're Eastern.

Susan Hudson MD (15:19)

Another side note that I just thought of, I personally am not a fan of people taking medicines for ADD or ADHD during their IVF stimulations because those medicines speed up the metabolism of medications. I've actually had IVF cycles messed up from those medications. So anything that can change the metabolism of those medications should ideally be avoided during that time frame.

Carrie Bedient MD (15:48)

So we're super particular about the time of the trigger, which means we're also super meticulous about the time of the retrieval. And so The morning of the retrieval, what's gonna happen?

Susan Hudson MD (15:59)

You're going to have nothing to eat or drink after midnight is the first thing that's going to happen.

Carrie Bedient MD (16:05)

or not happen as the case may be.

Abby Eblen MD (16:07)

Yeah.

Susan Hudson MD (16:08)

Exactly. And then they're going to give you an arrival time, which will be somewhere between one to two hours before your egg retrieval because there's prep stuff to do.

Abby Eblen MD (16:19)

So there's things like IVs to put in. You talk to the anesthesiologist or nurse anesthesist, whoever's gonna be giving your medicine to put you to sleep. You've got consents and you may have signed some of those ahead of time, but there may be some other consents just specifically for the surgery center that you sign on that day. All that has to take place before your retrieving doctor comes in to talk to you. So you just wanna make sure you have plenty of time. You don't wanna be rushed. We don't want your blood pressure being...160 over 100 because you had to come through traffic and you're running late, we want you to be calm and relaxed and have the best experience possible.

Carrie Bedient MD (16:52)

And your anesthesiologist is going to ask you a question of, what did you have for breakfast this morning? That is a trick question. The only correct answer to that question is nothing. And I had no coffee on my way in. I did not stop at McDonald's and get a cup of juice or whatever. And there was no water and there was no nothing. When we mean nothing after midnight, we mean nothing after midnight. Now, there's one or two exceptions to this. And what are those exceptions?

Susan Hudson MD (16:52)

On that note.

Abby Eblen MD (17:02)

Nothing.

Antihypertensive medications. We typically let you take medicines with a sip of water, that's okay, but just not a cup of water or a huge cup of water.

Carrie Bedient MD (17:27)

Yeah, that's the big one. We wanna make sure that your blood pressure's under control. If you are a diabetic that requires insulin, that's something with talk to your clinic ahead of time because they will probably want to schedule you first thing in the morning so that your eating does not throw off a whole lot. And they may want you to touch base with your endocrinologist to see if there's something different you need to do with your insulin, particularly if you are on a pump and make sure you're bringing in whatever controller devices you might have. At this point it's usually on your phone, but make sure your phone stays unlocked so that if we need to access it during the procedure we can do that.

Susan Hudson MD (18:02)

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Susan Hudson MD (18:41)

So one thing I did want to mention, we talked about the timing of things. If your egg retrieval is happening at a time of the year that you may be having bad weather, or if you're in a city that has ridiculously bad traffic, you may want to consider staying close to your IVF center the night before. The last thing you want to be doing is worrying about going over an icy bridge or you can't see in the rain or there's a wreck on this major thoroughfare that's the only way for you to get from point A to point B because there's nothing we can do about those natural disasters. I can tell you that, at our clinic, we sometimes even have doctors who spend the night when we know that those bad storms are coming in so that we will have somebody there for you, but you got to be there too.

Abby Eblen MD (19:28)

The snow is coming.

I had a patient one time that walked a mile from the interstate to our office to get her egg retrieval done. We had tornadoes in Nashville that day and traffic was so terrible. Her partner dropped her off and she walked a mile to our office and she was successful. She ended up ultimately getting pregnant.

Carrie Bedient MD (19:48)

We had a patient once who there was such a bad snowstorm she could not get across town and so her IVF center called us and we did the retrieval because she was close enough to get to us and then we just packaged everything up and once things cleared send it over to her her center. Make sure you stay in communication because this community is small and everybody knows each other. We will do absolutely everything if you are stuck somewhere, but it's a lot easier if nobody's stuck.

So when you come in that morning after you have not had anything to eat or drink and you talk to your anesthetist and you've signed all of your consent forms and you have your blood drawn if it is protocol in your clinic for that day and you have your IV placed, they start to give you some happy juice through your IV. They're the best cocktails that you will ever get before noon. And you head back to the room. You roll back to the room. Now, what happens if you are scheduled for a retrieval on the hour and it's like the half hour or the 45 minutes or maybe it's even an hour or a little bit more later. To what level do you freak out?

Abby Eblen MD (20:50)

As a doctor, I don't freak out too much. We want it to run on time, but we have a little bit of a wiggle room there, but we don't want much more wiggle room than that, though.

Carrie Bedient MD (20:58)

Exactly. So don't worry about it too much because every clinic knows how to schedule within how they usually run. And so whatever time you've been given, they know full well what kind of day they're going to have and typically build in whatever wiggle room is needed, depending on what they think is going to happen. Now, once you get back to the room, what happens then?

Susan Hudson MD (21:18)

Well, they are going to hook you up to even more happy juice that is going to help you relax a little bit more. They're going to identify you. They're going to look at your little wristband, check all the things with all the people, make sure everybody's in the right place. And then they will usually give you medicine that's going to let you drift off to sleep. So the rest of what we're going to talk about are things that are going to happen while you're having a really good dream about Hawaii.

Abby Eblen MD (21:48)

But the worst thing that usually happens is right as you're telling us some really critical thing about something that just happened. Then you go to sleep and we don't hear the rest of the story. And I even included that in the book because that seems to happen all the time. Somebody would be telling me something. I'm like, wait, wait. And she falls asleep.

Carrie Bedient MD (21:57)

Yeah.

Mm-hmm and all of the things that you see like the various YouTube and Instagram and tik-tok videos about people talking crazy after anesthesia. That doesn't really happen after the type of anesthesia that we tend to give. Not anymore. You just you fall asleep and there's nothing interesting that you're you're saying that's wild and crazy and then you wake up and you tend to be fairly clear fairly quickly. So don't worry about saying anything because we're not We listen Believe me, we listen because if there's something that's funny you're saying, we want to be able to tell you what you said afterwards. But it doesn't happen hardly at all.

Susan Hudson MD (22:36)

So while you're falling asleep, you're usually breathing some oxygen. So sometimes it's through a little nasal cannulas or a little plastic tube that's putting oxygen into your nose. Sometimes it's a mask over your face. It may smell plasticky. That's normal. You'll be okay. And then as you're asleep, then we put your legs up in stirrups. So kind of like what you do in the...exam room, but these stirrups actually support your legs. So it's not like you're having to balance yourself while you're asleep. We put you in these little boots that are secured to the bed and your legs are nice and stable so that we can get where we need to be.

Abby Eblen MD (23:18)

And we also monitor your heart rate so we know that your heart's beating the way it's supposed to.

Carrie Bedient MD (23:22)

Now, who is in the room when all of this happens?

Abby Eblen MD (23:26)

There's a bevy of people in there. There's the anesthesia person, there's the physician, there's an OR nurse that hands instruments to us, our scrub nurse, and then there's also a circulating nurse, and she's the one that will take the little test tube and hand it over to the embryologist. So the embryologist is also in the room with us as well.

Carrie Bedient MD (23:44)

And then once you're asleep and once you're comfy and your your doc is in the room, what happens next?

Susan Hudson MD (23:53)

We will again identify everybody to make sure everybody's in the right place because we do this like five different times it feels like. And then we'll place a speculum so that we can see your cervix. We will clean your vaginal canal usually with some saline, some salt water. Just make sure everything's nice and clean. We can't use soap or anything like that because that's not really egg friendly. But the motto you had in chemistry where the solution to pollution is dilution, it works. And then we will remove the speculum and place the ultrasound transducer so we can take a look at those big, beautiful ovaries.

Carrie Bedient MD (24:37)

And so once we have the transducer in, typically what do we see?

Abby Eblen MD (24:41)

We typically see hopefully an ovary that has several black circles. And those black circles are the follicle, the part that contains the egg, the fluid-filled sac that contains the egg. But as I was saying earlier, you can't see the egg, unfortunately. So we literally take our needle and put it in that sac. That sac is the target. And it's attached to suction. So when we put our needle in there, the suction will immediately remove the fluid from the sac.

Sometimes we're lucky and we get the egg in that way, but a lot of times we have to work at it and we do something called curetting where we turn the needle and help, gently scrape or abrade the sidewall to get the egg to release. And then sometimes we can even put fluid back in again if we need to to try and open the follicle back up to get the egg out if we didn't get it the first time around.

Carrie Bedient MD (25:26)

Now does every one of those black circles have an egg in it?

Susan Hudson MD (25:29)

No, well, theoretically they each have an egg in it. That doesn't mean we're gonna get an egg out of each of those black circles.

Abby Eblen MD (25:36)

Size matters.

Carrie Bedient MD (25:38)

Size always matters. Once the egg is out, it's traveled through our needle, through the tubing, and is into the test tube. What happens next to it?

Susan Hudson MD (25:46)

The test tube is removed from the section tubing. Another little lid is placed on that test tube. And then that is handed to the embryologist who is either in that room or in the next room over. And then they take that little test tube, dump out the fluid into a Petri dish, which is a little plastic dish. And they start looking in that fluid for your egg or eggs.

Carrie Bedient MD (26:13)

All right, and then once we are done going through as many of those black circles, as many of those follicles as we can get, what happens next? Now, how long does that usually take?

Abby Eblen MD (26:26)

45 minutes or so, give or take a little bit.

Susan Hudson MD (26:29)

It depends on how many follicles you have. If you have two or three follicles versus you have 40 follicles, those are very different situations.

Abby Eblen MD (26:31)

Yeah, and how easy they come out too. Sometimes even people that have a reasonable number of eggs, sometimes they just don't want to come out so easily.

Carrie Bedient MD (26:43)

Once we have all of those eggs out and we are done and we have taken out our needle and our ultrasound, what happens next?

Abby Eblen MD (26:51)

We wake you up. Once we wake you up, and it happens pretty quickly, because the medicine that we use is called propofol, or most centers probably do. And it's really great because you go to sleep really quickly, and when it's gone, you wake up really quickly. And so at that point, we move you to the bed that you're going to be in, in the recovery area, off the surgery table, essentially. You go to the recovery area, and then we hook you up to monitors there to make sure heart rate, blood pressure, and all those things are appropriate.

Carrie Bedient MD (27:18)

And where is your partner during all of this? Are they allowed to be in the room with you?

Susan Hudson MD (27:23)

So no, your partner is not in the room with you. This is an operating room. So we work under the same rules as if you were having a surgery in a hospital or an outpatient surgical center, because this essentially is an outpatient surgical center. If you have a male partner during this timeframe is usually when he goes back to the collection room to do his thing.

Carrie Bedient MD (27:46)

Once you are out in the recovery room and we've got you hooked up to all of our bells and whistles and you have started to wake up, we usually bring your partner back and so you guys can sit together and then the docs gonna come in and talk to you next and what kind of information do they usually have to give you at that point?

Abby Eblen MD (28:04)

So Initially it takes a little while for the embryologist to look through all the fluids and all the stuff we've given them from the suction. And a lot of times they don't know exactly at that point how many eggs that you have. A lot of times the doctor will come out and just say, everything went great. We didn't have problems, et cetera, et cetera. Just any info, if we know roughly how many eggs you may have gotten, sometimes I'll give that information as well. But ultimately the embryologist will have the last say on how many eggs were actually retrieved.

Carrie Bedient MD (28:29)

Once we know everything is good, you're able to, your pain's controlled, you're able to sit up, you're able to stand up, go to the bathroom, those types of things, and we give you the all clear to leave. What can you do that day?

Susan Hudson MD (28:40)

First of all, the things that you can't do.

Abby Eblen MD (28:42)

It's more kind of what you can't do than what you can do.

Susan Hudson MD (28:45)

So you can't leave with Uber or Lyft or some other driving service that is not a medical driving service. Okay, so If you are going through this by yourself or your partner is not with you, you need to have a friend, family member, somebody trusted to get you home. Number two, you are probably going to have to leave in a wheelchair and that is just for precautionary reasons.

It's not that you can't walk, it's that we don't want you walking out and tripping out of the surgery center because that would be really bad.

Other things you should not sign any legal documents, you should not go to work, you should not do anything that seriously requires any level of higher reasoning.

Susan Hudson MD (29:42)

You should not drink alcohol that day. Alcohol and anesthesia are not a good mix.

Abby Eblen MD (29:48)

Don't go to the gym in the afternoon or even the next morning because your ovaries are really big. And what we worry about with really large ovaries is that they can twist and they can cut off the blood supply to the ovary. That's called a torsion and that's a surgical emergency. So it's just not worth it. I mean, a lot of our patients really value exercise and it really helps them release stress. And I get that, but this is one of the times when it's really not safe to exercise. We do not want you to have a torsion. That's a big deal.

Susan Hudson MD (30:16)

Do not have sex. This is not the time to be intimate. I mean, for people who have gone through it, you're like, why would you ever? But believe me, there are people who think about this. Number one, it's not gonna feel good. Number two, we don't necessarily get all the eggs. And if you do ovulate some of those, you could get pregnant and you could get pregnant with more than we would want you to get pregnant with. So just lay low on that until you start your period.

Abby Eblen MD (30:47)

particularly if you're an egg donor.

Carrie Bedient MD (30:49)

Absolutely, absolutely. We have a couple of additional instructions that I always give my patients. No going down to the strip, no gambling, no dancing on table. That is a standard instruction. And then the other two that we have learned over experience is no going to pet stores unattended. We've had two puppies come back to visit us as a result of pet store visits over the course of the years. And then the other thing is

Abby Eblen MD (30:56)

Yeah.

Carrie Bedient MD (31:13)

No online shopping without supervision. Because we have also gotten stories of all of these packages arriving unexpectedly a couple days after a retrieval. And she was really quite irritated at us. yeah.

Abby Eblen MD (31:28)

Or if you do make sure you get them from Amazon, because they're easier to return.

Carrie Bedient MD (31:31)

100%

Susan Hudson MD (31:33)

This is actually a very good point for partners. Just because your partner who went through the egg retrieval is awake talking to you seems completely normal. Do not think that they are actually going to remember what they're saying or doing. I'm gonna give a very real situation that happened to me. Not with my egg retrieval, but I had a procedure one time which was a fancy type of ultrasound of my heart that I had to go under the same type of anesthesia.

I am not kidding. I fell asleep in the hospital gown about to undergo the procedure. I woke up at home in my clothes. Like I have to this day, I have no memory of waking up, getting in the car, getting home, getting back in bed, none of that.

Abby Eblen MD (32:12)

Wow.

Susan Hudson MD (32:22)

Just because your partner seems very alert and with it, that they may not remember the doctor talking to them. They may not remember anything. So that's just something to be aware of because you don't know how different people metabolize these meds.

Abby Eblen MD (32:37)

Yeah. Good point.

Carrie Bedient MD (32:38)

And some people will remember a lot of this stuff afterwards, not during, of course, but afterwards. But Susan's right, you can't depend on it. And so nothing important, they can't drive, they can't make important decisions in any way, shape, or form. And this is a good time to go home and binge watch whatever you have stored on your Netflix that you haven't had a chance to watch. Read trashy magazines.

Whatever low key event you want, no sex, no gym, no running around, no bouncing around, lay low. Usually ibuprofen and heat are very helpful for pain control. Some clinics will give a small dose of narcotics too, particularly if you have a lot of eggs. There will occasionally be other medications that they send home with you if you have quite a lot of eggs.

And they're worried about potential for hyperstimulation. A lot of times they'll just give you the preventative meds just in case because they tend to be pretty well tolerated and we'd rather have you go through that than not.

Abby Eblen MD (33:37)

And one other important thing is when to call your doctor. And this is actually in our IVF book. And in fact, everything we're talking about today is in our IVF book. But the times that you want to call are when you have symptoms that you don't expect. Severe pain, not relieved by the pain medicine. If you're really dizzy, lightheaded, passing out, if you're vomiting, any other unusual symptoms. Fevers would be really unusual, particularly pretty early after the egg retrieval. But a day or two later, if you had fevers, that would be something we would want to know about as well.

Susan Hudson MD (34:05)

If you can't urinate, that's important.

Carrie Bedient MD (34:09)

Yes, definitely. Alright, anything else that all of our peeps need to know about what happens on the day of retrieval?

Susan Hudson MD (34:17)

It's really important to remember when you're speaking with your anesthesiologist and they're asking about medications and habits and these habits that I'm referring to are taking any type of pain medications or marijuana use or maybe a little bit more than average alcohol use or things like that. This is the time to be brutally honest because we're going to give you enough medicine for you to be asleep and comfortable. However, if an anesthesia doctor or anesthetist knows that you're going to need more, they can be a little bit more prepared than being like, I have no idea why this 120 pound woman is needing more than the average medicine.

And that tends to make them concerned versus if you have told them about something in your history that may give you a little more tolerance to those types of medications, it helps them rest more assured. like, this is why it's happening.

Carrie Bedient MD (35:22)

Exactly, and if you have any fevers or chills or anything like that going into this procedure, we want to know about it upfront, especially if it's any respiratory symptoms because we need to give something to you to help dry out your snotty nose or your phlegmy throat or whatever it may be. We want to do that upfront and take a few more precautions than we otherwise would need to.

Abby Eblen MD (35:30)

And I just thought of one more thing, and we've said this before, but GLP-1 inhibitors, those need to be stopped at least two weeks before your egg retrieval. We had a couple of episodes with patients who didn't tell us that they were on them and they actually aspirated, vomited during the egg retrieval, and that can be really dangerous. So make sure your clinic knows about it, but stop them two weeks ahead of time.

Carrie Bedient MD (36:04)

We're very good at not judging. We're also very good at fixing things that go wrong. We would far rather not have to because all of us tend to be very over-prepared and we will make whatever adjustments we need to, but we want to keep you safe first and foremost throughout all of this. All right. Well, hopefully this is a really helpful episode for you and your partner or your friends or whoever's picking you up from your appointment on Monday.

Abby Eblen MD (36:29)

Not your Uber driver.

Carrie Bedient MD (36:32)

To our audience, thank you so much for listening and subscribe to Apple Podcasts to have the next Tuesday's episode pop up automatically for you. Be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

Susan Hudson MD (36:45)

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Abby Eblen MD (37:02)

As always, this podcast is intended for entertainment and it's not a substitute for medical advice from your own physician. Subscribe, sign up for emails and we'll talk to you soon.