Understanding your ovarian reserve & and the egg retrieval process – a fertility doctor’s Q&A

Here at The Ribbon Box, one of the biggest concerns we see in the TTC (trying to conceive) community is about knowing your ovarian reserve health and knowing what will happen during the ever-daunting egg retrieval process.

That’s why we have teamed up with leading US fertility clinic, ORM Fertility to find out more.

Read on as we hear from Dr. Jamie Massie at ORM Fertility about how to understand your ovarian reserve and tips for supporting your reproductive health holistically, what to expect during egg retrieval, as well as important information on hormone level testing and ultrasounds.

Over to Dr Jamie Massie

Understanding your ovarian reserve

Uncertainty. It’s all around us, especially in the year 2020. We’ve developed a new normal where we must anticipate that things might not turn out the way we expected. This state of uncertainty is uncomfortable and when it comes to specialized fertility treatment, not being able to plan and foresee the future can feel unbearable.

It’s incredibly important for myself as a reproductive endocrinologist (fertility specialist) that my patients feel as prepared as possible before embarking on this fertility journey.

As you start your trying to conceive journey, it’s completely understandable to have a lot of questions and some feelings of anxiety. What are my treatment options? Do I REALLY have to give myself a shot, more than once? How will this affect my body?

Your questions and feelings of anxiety are understandable. Fertility treatment is an intricate process, but we’re here to empower you to start your fertility journey, ready to take on anything!

When you’re getting started, it’s not only important to understand what your fertility treatment process could look like, but also to understand your fertility potential. This can help ease anxieties and set expectations of what your outcome might be, and help you to gain a better understanding of what we mean.

Let’s walk through what we look for in terms of ovarian reserve and health at ORM Fertility and what to expect during the egg retrieval process, once you understand your fertility health.

What is ovarian health?

To get a better idea of fertility potential, we take a look at ovarian health. Ovarian health is a general term referring, in part, to the number and quality of eggs within the ovaries. The more specific term for the number of eggs within the ovaries is “ovarian reserve”. Ovarian reserve is influenced not only by our age, but also by our own genetically determined course from puberty to menopause.

There are women who have a healthy ovarian reserve well into their early 40’s, while other women have very low quality ovarian reserve by the time they reach their early 20’s. It truly is unique to every individual and understanding your ovarian reserve with testing, can help you determine where you fall on this spectrum.

Here’s a bit of good news – ovarian reserve testing is quite simple! Because there is no single perfect test for egg supply, two tests are usually taken to give you a better picture of your ovarian health: hormone level testing and ultrasound testing.

Hormone level testing

The first test is a blood test that looks at two different hormones: Antimullerian Hormone (AMH) and Follicle Stimulating Hormone (FSH).

AMH is a hormone that’s produced by cells surrounding the immature eggs. Because AMH is made by the cells that are working with the eggs, high levels of AMH are a sign of healthy egg supply. AMH can be drawn at any time of the menstrual cycle, even when you are using birth control.

FSH is a little different. This hormone gets sent by the brain to encourage and support egg growth.

While healthy ovaries only need a little stimulation from FSH in order to grow mature eggs, ovaries with low egg counts need a lot more encouragement from FSH to develop. As a result, high levels of FSH are a sign of low quality egg supply. FSH is a little more particular when it comes to testing and needs to be drawn between the second and fourth days of your cycle.

Now I understand my ovarian health, what’s next?

With a better idea of your ovarian reserve and health, there are multiple options for making an informed decision about your reproductive future.

For women hoping to grow their family in the immediate future, In Vitro Fertilization (IVF) is a highly successful option to increase your chances of pregnancy, even with low ovarian reserve.

For women who might not be ready to start their family yet, egg freezing is a great approach to taking your fertility future into your own hands, so you can start your family when the time is right for you.

Either way, the next logical step can often be an intimidating one: the egg retrieval. Don’t worry, the process is actually quite routine and it’s typically a lot easier than my patients initially think.

But I recognize that at-home shots and the uncertainty of how this will affect your body can be unnerving, so let’s walk through this together.

The egg retrieval process

IVF injections & trigger shot

Whether you are pursuing egg freezing or IVF, both use injectable forms of the hormones FSH and Luteinizing hormone (LH). These hormone injections stimulate your ovaries to grow multiple eggs in a single cycle. They are injected with tiny needles into the skin of the abdomen. I know, it sounds horrifying but most women’s reaction after their first injection is “Hey, that wasn’t so bad!” 

These IVF injections are administered for about 8-14 days during which time your fertility clinic will be monitoring your ovarian response to the medication with ultrasound and blood work every 2-4 days. If you’re still nervous about at-home injections, our team has compiled a few tips to try and help you through the process.

IVF injection tips

1. Be an advocate for yourself – If you have fears around injections or needles, you’re not alone! Let your provider know and they can offer 1-on-1 teaching to help set you up for success.

2. Know your techniques – There are a few different ways to give yourself IVF injections. It can make a big difference whether you are sitting down, standing up or lying down and if you have a partner or someone there who can help you.

3. Prepare – Give yourself 15-30 minutes before your injection. Take that time to make sure you have your supplies in order from the pharmacy and your space is clean and organized. This will help you feel ready and in control.

4. Breathe – Your breath is your greatest tool to ease your anxiety and fear. Practice deep breathing through the nose for 30 seconds to 1 minute before you are ready to start the injections process. Deep breathing helps lower blood pressure, relaxes your nervous system and gives you a sense of calmness to take on the challenge.

IVF Trigger Shot

Once the ovaries are ready, an IVF “trigger” injection is given to time the release of the eggs. This prepares your ovaries for the egg retrieval, which takes place 34-36 hours after the trigger shot.

At ORM Fertility, this medication is given in the same way as your prior injections, so nothing new or scary. However, the IVF trigger shot method may differ depending on fertility clinic.

The egg retrieval

In order to retrieve the eggs your body has been working so hard to grow, you’ll undergo a trans-vaginonal oocyte collection procedure.

For this, you’ll receive sedation medication through an IV line, so you won’t feel a thing. It’s a quick, same-day procedure where a needle is passed through the wall of the vagina and into the ovaries to collect fluid that contains the eggs.

The fertility specialist then passes the fluid to the embryologist, who identifies and collects the mature eggs in preparation for fertilization.

After egg retrieval procedure

Following the procedure, you’ll want to rest for a day or two, as many women experience abdominal bloating and mild cramping for a few days after the egg collection.

At this point, two things can happen:

1. IVF – Those who are ready to build their family can have their eggs fertilized and grown into blastocysts. The resulting embryos can be transferred fresh into the uterus or frozen and stored for use in the future.

2. Egg Freezing – Freezing eggs without fertilizing them is an excellent option for those who are not planning on having children for a while, or are in the process of finding a sperm donor.  Frozen eggs can be stored for years, allowing you the opportunity to build your family in the future.  When you are ready, the eggs can be thawed and inseminated with sperm from your partner or donor.

The incredible thing about both of these options is that frozen eggs and embryos don’t “age”. The chance of achieving a pregnancy using your frozen eggs/embryos will be the same in five years as on the day that they were made.  For women who are later in their reproductive years, or those who anticipate that their family building will be delayed, these treatment options offer the opportunity to create a family using your own eggs that may not exist if you wait for the time to be right.

We know this process can seem overwhelming, but just remember you have The Ribbon Box Community, physicians and a support system to help you along the way! Do what you can to educate yourself, ask tons of questions, and pick a path forward that feels right for YOU!

Whether you’re about to go through ovarian testing or you’re looking to undergo testing in the future, you can take steps to help improve the chance that your body will be ready when you are. For now, here are a few tips from our team at ORM Fertility that you can do to help support your fertility potential.

How to prepare for your fertility treatment

Here are some positive steps you can take to support your reproductive health and to prepare for your fertility treatment:

1. Don’t smoke – Seriously. Smoking is really bad for your ovaries and can prematurely decrease your egg supply.

2. Sleep – Try to get more than 6 hours of sleep per night, preferably 8.  Skip those nighttime Netflix binges that eat away at your hours of beauty sleep!

3. Drink less – While there is no need to give up that occasional glass of wine, drinking more than 4 alcoholic beverages per week can negatively impact your reproductive health.

4. Eat well – Although there is no magical “fertility diet,” eating a Mediterranean-type diet has been shown to have some benefits.

5. Get your BMI in normal range – Having a BMI (body mass index) of <18 or >25 has been associated with poorer outcomes in women undergoing fertility treatment.

6. Don’t leave it too long to see a doctor – Get your Pap smear, check your blood pressure. Do the preventative things that can help to ensure you have a safe and healthy pregnancy once you conceive.

We hope this fertility blog has provided you with a deeper understanding of how to help your ovarian health and the importance of getting your ovarian reserve checked. We’re always keen to empower you with great information on how to holistically prepare for fertility treatment and IVF.

If you’re struggling to conceive and want some help, then don’t hesitate to reach out to the wonderful team at ORM Fertility and they will be more than happy to offer you specialist help with your fertility journey.