There are a bunch of valid reasons why you may need or want to pluck a few eggs out of your ovaries: Maybe you’re putting those puppies on ice (so to speak) for use at a later point, or you need a few to pair up with sperm outside of your body as part of the in-vitro fertilization (IVF) process. Or perhaps you’re donating a fresh dozen. Different things will happen to the eggs in each scenario—but what all three have in common is the egg retrieval process and procedure.
The word “procedure” alone might sow some fear. After all, gynecology doesn’t exactly have the best reputation for pain management. You may have also heard that you’ll need to give yourself shots to administer hormone meds for several days beforehand…which does mean getting acquainted with needles. It’s totally valid to feel anxious for these reasons or any other, but it’s also important to know that the egg retrieval process today is minimally invasive and low-risk. The prep period and the days just after the procedure can bring uncomfortable symptoms as a result of cranking up your hormone levels (more on that below). But ICYWW: You’ll generally be sedated for the surgery so you won’t feel a thing.
“Back in the day, egg retrieval would be done laparoscopically, meaning they’d [make an incision in] your abdomen,” Asima Ahmad, MD, MPH, FACOG, a Chicago-based board-certified reproductive endocrinologist, and cofounder and chief medical officer at Carrot Fertility, tells SELF. “But nowadays, we’ll place a probe in the vagina with a small needle attached to it to access each ovary internally.” So you won’t be left with any scars.
Knowing exactly what to expect can make it a lot less daunting—which is a great thing, because there are already enough barriers to fertility care (like the high cost and, increasingly, access-limiting legislation) without factoring in medical fears and misconceptions. Read on to learn what happens in your body at every stage of the egg retrieval process, from the preparation to the procedure itself to the recovery period.
How the egg retrieval process actually works
You may have heard that people with a vagina are born with all the eggs they’ll ever have—which is true, but they’re not all available for pregnancy at any time, Tia Jackson-Bey, MD, MPH, a board certified reproductive endocrinologist and infertility specialist at RMA of New York, tells SELF. They start out as immature eggs housed inside follicles, which are tiny fluid-filled sacs in your ovaries. Each month, when your brain releases follicle stimulating hormone (FSH) during the first half of your menstrual cycle, your ovaries spring into action, preparing an “allowance” of these mini eggs for ovulation, she explains. But ultimately, just one will mature completely and be released (to potentially join with a sperm), and the others in the running that month will be lost, Dr. Ahmad says.
With an egg retrieval cycle, the goal is to prompt your body to fully grow all of that month’s available eggs versus letting nature take its course and leave you with just the one, Dr. Ahmad explains. This allows you to capture the mature version of the eggs that would otherwise never completely develop (and would be sacrificed that cycle)—so you’re not depleting your total supply (or ovarian reserve) or impacting your future fertility in any way.
As Dr. Jackson-Bey explains, in order to get your ovaries to grow that month’s full cohort of eggs, you need more key hormones like FSH pumping through your system—which is where the pre-procedure shots come into play. These medications mimic the hormones in your body involved in egg development, but at a much higher level, so all of your eligible eggs that month have a shot at maturing. Your surgery will be scheduled strategically—right before your ovaries would typically release these adult eggs into your fallopian tubes—so your doctor can pluck them at their peak.
Before your egg retrieval: You inject shots for a couple weeks to get your follicles growing.
The longest chunk of the egg retrieval process happens before your procedure, when you’re self-administering meds to stimulate your ovaries. Your doctor will determine your particular mix of drugs as well as your dosage and injection schedule based on things like your age, health, ovarian reserve, and the goal of the retrieval, Dr. Ahmad says. Generally, you’ll kick off the shots around the third day of your period and will do daily injections for about 10 to 14 days. Throughout that journey, you’ll also have regular appointments with your doctor, during which they’ll do bloodwork and ultrasounds to assess how your eggs are developing and determine when they’ll be ripe for the picking.
As noted above, what you’re injecting are meds that resemble hormones your body naturally makes, like FSH and luteinizing hormone (LH), which is another chemical that’s key for follicle development. You’ll use a small needle to insert the medication into the fatty tissue just beneath your skin, commonly in your belly area, Nicole Yoder, MD, FACOG, a board certified reproductive endocrinologist and infertility specialist at Spring Fertility, in New York City, tells SELF. It will likely sting or pinch—like any needle piercing your skin would—but it usually doesn’t cause much pain beyond that.
The first few days tend to be pretty easy going as your hormones are ramping up. “Most people feel nothing, but sometimes you can have vague symptoms, like headaches, dizziness when you stand up quickly, fatigue, or nausea,” Dr. Jackson-Bey says. Over time, you may gain what she calls ovarian awareness, or start to feel unusual sensations in this area of your body. (It’s important to remember that different people can have pretty distinct responses here, so if you feel nothing, that doesn’t mean something is wrong.)
Things can take a turn on the fifth or sixth day of your injection protocol, once a bunch of follicles are growing. “One of the biggest things that people experience is bloating, partially because your ovaries just physically take up more space,” Dr. Yoder says. Each developing egg also produces estrogen, which, in low amounts, can boost your energy levels and libido and clear up your skin, but at the high quantities created by a bunch of maturing follicles, can also worsen fluid retention and bloating, Dr. Jackson-Bey explains. With each passing day, as your estrogen level ratchets up, everything can get puffier and more tender (yes, including your boobs), and mood swings could be on the docket. Your doctor may suggest you pause any high-impact exercise as you get further into your protocol, too, as the vigorous movement, paired with the enlarged size of your ovaries, may up your risk of ovarian torsion (when your ovary twists on itself, cutting off blood supply).
Also around the midpoint of your prep process, you’ll likely add in shots of a gonadotropin-releasing hormone (GnRH) antagonist, which tells your ovaries to hold the phone on ovulating, or releasing the mature eggs as they naturally would. You want all of those eggs to stay put in your ovaries so that it’s possible to retrieve them, Dr. Ahmad explains.
A few days later, once your doctor determines that your follicles have reached their max size, you’ll do one last injection known as the “trigger shot,” which flips your ovulation reflex back on, mimicking your body’s natural surge of LH at this stage. This allows your eggs to take their final steps toward maturation, and “instead of being stuck to the edges [of the follicles] like Velcro, they become suspended in the follicle fluid, so we can actually retrieve them,” Dr. Jackson-Bey explains. All the while, you’re likely to continue feeling bloated, and you could experience cramping too, as more of your eggs start to peel off from their follicle walls, Dr. Yoder says.
To be sure those eggs don’t fully ovulate (and pop out of your ovaries) before your doctor can retrieve them, your surgery will usually be scheduled for just about 35 to 36 hours after your trigger shot—so your eggs are completely mature but also still easily accessible.
During the procedure: Your doctor removes your eggs by inserting a tiny needle into your ovaries.
It’s worth repeating: You’re most likely going to be sedated during the retrieval itself, Dr. Jackson-Bey says, “which, to most people, will feel like taking a nap.” It’s basically a light anesthesia, so you’ll be asleep but can continue to breathe on your own (unlike general anesthesia used for major surgeries). You’ll also typically receive a drug like fentanyl to prevent any pain during or right after the surgery. (Given the fogginess of the anesthesia can linger a bit, you’ll probably be asked to coordinate with a friend or family member who can escort you home post-procedure.)
As Dr. Ahmad explains, your doctor will insert an ultrasound probe into your vagina to see inside your ovaries—just like in your monitoring visits—but this time, there will also be a needle guide attached to it, which allows them to pass a small needle through the side walls of your vagina and into each of your ovaries. From there, they’ll essentially poke and suction out the contents of each follicle, which includes fluid and the egg, Dr. Jackson-Bey says. The whole shebang takes anywhere from 15 to 30 minutes or longer depending on how many mature follicles need to be prodded, per Dr. Ahmad.
As your doctor suctions the contents of each follicle into a little tube, they’ll typically pass it right to an embryologist, who will start counting the eggs, Dr. Ahmad says. So shortly after, you’ll get an idea of how many full-grown eggs were successfully retrieved.
After the surgery: Your ovaries heal and shrink back to their normal size.
When you first wake up, you’ll likely feel groggy and have some abdominal discomfort, Dr. Jackson-Bey says. Certain pain meds can leave you nauseated too, which is something that your doctor can give you medication for, she adds. Some spotting and cramping is also common, Dr. Yoder says; after all, your ovaries “just got several little pokes with a needle.” (Your doctor may choose to prescribe a short course of oral antibiotics to lower your chances of infection, especially if you’re at an increased risk.) Within an hour or so, once you’re feeling totally awake and any pain and nausea is under control, you’ll be able to head home. It’s a good idea to give yourself the rest of that day off work at minimum, Dr. Jackson-Bey says.
Keep in mind that any symptoms you felt during the pre-procedure injection phase could stick around for a bit. According to Dr. Yoder, most people feel pretty bloated, swollen, and fatigued for a few days post-op. “Your hormone levels are still high, your ovaries are still bigger than usual, and you haven’t really gotten rid of that extra fluid yet,” she says. That’s also why your doctor may suggest you hold off on intense exercise for another week or so.
Each of the places from which an egg was retrieved also turns into “a little progesterone factory,” Dr. Jackson-Bey says. The subsequent spike in that hormone can cause you to retain more fluid (leading you to feel puffier all over) and trigger a variety of blegh symptoms, like mood disturbances, fatigue, breast tenderness, and bloating. Because progesterone can slow the movements of your gut, it’s also possible to have some constipation, Dr. Yoder adds. Generally speaking, the more eggs you just had removed, the more of these symptoms you can expect to feel, Dr. Ahmad says.
By around day three or four after the retrieval, “people usually turn a corner and start to feel more like their normal selves,” Dr. Yoder says. As your ovaries go back down in size, bloating typically subsides, and you may find you have to pee more often as your body flushes out excess liquid.
Though it’s very rare (and increasingly less common than it used to be), it’s possible to develop a condition called ovarian hyperstimulation syndrome (OHSS) as a complication of the egg retrieval process, in which your ovaries have an exaggerated response to the hormone meds and get very swollen, potentially leaking fluid into your belly or chest cavity; it affects an estimated 5 in 1,000 IVF cycles. It typically occurs about a week after the procedure, Dr. Ahmad says, and you’ll want to be on the lookout for the symptoms: decreased urination, dark or tea-colored pee, shortness of breath, bloating that only gets worse or just won’t quit, nausea, vomiting, and swelling. Reach out to your doctor STAT if you notice any of the above, as OHSS can put you at risk for blood clots, ovarian torsion, and even kidney failure if it progresses.
When your next period rolls around, Dr. Jackson-Bey says it could be a little heavier or crampier than normal. The influx in estrogen from the growth of those extra eggs also stimulates the thickening of your uterine lining, meaning more tissue then has to come out. By the time it’s over, though, any egg-retrieval-related symptoms will have typically let up.
Though there aren’t any clearly defined long-term health risks associated with egg retrieval, the American Society of Reproductive Medicine suggests doing no more than six egg donor cycles (and the ob-gyns SELF spoke with cited the same cap for egg retrievals for any reason) because each retrieval process still adds to your overall potential risk of side effects and uncommon complications such as OHSS. There’s also research to suggest that ovulating more, over the course of your lifetime, puts you at increased risk for ovarian cancer, Dr. Ahmad says, and with egg retrieval, you’re essentially replicating the ovulation process with multiple eggs.
But again, with any one retrieval, it’s important to remember that symptoms are short-term—two to three weeks out of your life, Dr. Jackson-Bey says. And for your ovaries, it’s usually little more than a blip as well. Even the regular ovulation process is pretty “violent,” she says, requiring an egg to “burst out,” so “the ovaries are very capable of mending themselves” relatively quickly when it’s all over. And then, Dr. Jackson-Bey says, they’re back to their regularly scheduled programming for next month.
Related:
- What Black Women Need to Know Before Seeking Fertility Treatment
- So, Let’s Talk About That Whole Fertility and Age 35 Thing
- 8 Things I’ve Learned From 4 Failed IVF Cycles
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