STIMULATION AND
RETRIEVAL PROCEDURE
STIMULATION
In order to improve the efficiency of the
cryopreservation procedure, it is necessary to effect the
production of multiple eggs from the ovary. In a normal
unstimulated cycle a woman generally produces one egg each month.
By increasing the stimulation to the ovary through the use of
gonadotropin medications (follicle stimulating hormone and
lutenizing hormone) it is possible to cause multiple eggs to
develop. This involves the injection of these hormone medications
on a daily basis for typically ten to fourteen days. While our goal
is to retrieve multiple eggs, we do not want too many eggs in that
this can predispose to a serious complication known as ovarian
hyperstimulation syndrome. In order to prevent this, monitoring is
required while taking these medications. Monitoring consists of a
vaginal ultrasound performed every second to third day, along with
a blood estrogen level. If there is concern that an individual is
at risk for developing ovarian hyperstimulation syndrome, the cycle
can be cancelled and re-started using lower doses. (Individuals
generally do not develop ovarian hyperstimulation syndrome unless
they take a final egg maturation medication known as human
chorionic gonadotropin). It is for this reason that we would like
to coordinate care with a Reproductive Endocrinologist, a physician
who specializes in the use of these medications and understands the
risks of ovarian hyperstimulation syndrome. It may be necessary to
have follow-up care for ovarian hyperstimulation syndrome with a
Reproductive Endocrinologist following egg retrieval. In general
the incidence of severe complications associated with this syndrome
are rare, but can require hospitalization, removal of fluid from
the abdomen and lungs, and possibly removal of one or both ovaries.
These more serious consequences should occur in less than ½% of
individuals. Mild symptoms may occur in up to 10% of patients
including mild bloating and tenderness from ovarian distention.
Other minor risks associated with the procedure include those
associated with a blood draw, i.e. local redness and possible
hematoma formation. Similar problems can be associated with the
local injection of medications. Instruction regarding the injection
of medications can be obtained through your local Reproductive
Endocrinologist if the injections are going to be done at home, or
alternatively the injections can be given directly by your local
physician.
RETRIEVAL
When follicle development is close to reaching the point of
maturity, we will ask you to be in Jacksonville so that final
triggering of egg maturation can be done under the supervision of
our physicians. It is critical that this final medication known as
human chorionic gonadotropin be given when the majority of
follicles are in their optimal mature stage of development.
Thirty-five hours after this medication is given, egg retrieval
will be performed. This is done under anesthesia known as IV
sedation. If an individual has had a history of problems with
anesthesia or any particular anesthetic medication, it is
imperative that this be discussed prior to coming to the
Jacksonville area.
In most cases alternative strategies
for anesthesia can be worked out. At the time of egg retrieval you
will meet with our anesthetist and a full history regarding prior
anesthetic administration will be elicited. It will be necessary
that you come in the day of retrieval with an empty stomach. You
will be asked not to eat or drink anything after midnight. An IV
will be administered. You will be given anesthetic medications
through your IV which will make you very sleepy and prevent you
from feeling pain. Typically the retrieval procedure takes anywhere
from 15-30 minutes, depending on the number of eggs produced.
Removal of the eggs involves the aspiration of eggs through the
wall of the vagina using a vaginal ultrasound probe and a fine
gauge needle. Risks of the aspiration procedure include bleeding
from the vaginal wall and ovary. Generally this is very mild and
controlled with direct pressure. Following retrieval you will be
watched in the recovery area for an hour and will continue to get
IV fluids during this time. Prior to being dismissed from the
clinic that day you will be given a complete report of the number
of eggs obtained. We would prefer patients to stay in the
Jacksonville area that day. We would like you to check in with us
the next morning before leaving town. If any follow-up care is
recommended our physicians and IVF egg coordinators will instruct
you as to what would be asked of you. You will be sent written
confirmation of the number of eggs cryopreserved.
STORAGE
Your eggs will be stored in special holding tanks filled with
liquid nitrogen. Based on data from cryopreserved fertilized eggs,
we do not believe there is a "shelf life" for the cryopreserved
eggs, but until we have established pregnancies with eggs frozen
for very long periods, we cannot absolutely assert this. The
longest eggs have currently been frozen for resulting in pregnancy
through the program is 6-1/2 years. We would encourage patients to
use their eggs as soon as it is feasible.
