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.
