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 hear from the TTC (trying to conceive) community is understanding ovarian reserve health and knowing what to expect during the egg retrieval process.

So today, we’re teaming up with leading US fertility clinic ORM Fertility to find out more.

Board-certified specialist with ORM Fertility Dr. Jamie Massie explains how to understand your ovarian reserve and hormone level testing, shares tips for supporting your reproductive health holistically, and talks you through what to expect during egg retrieval and ultrasound.

Over to Dr. Jamie Massie.

Your fertility potential

Uncertainty is all around us. 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 specialised fertility treatment, not being able to plan or foresee the future can feel unbearable.

As a reproductive endocrinologist (fertility specialist), it’s crucial to me that my patients feel as prepared as possible before embarking on their fertility journey.

When you begin trying to conceive, it’s completely understandable to have lots of questions and 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?

From the get-go, it’s not only important to understand what your fertility treatment process could look like, but also to understand your fertility potential. Doing so can help ease anxieties, set realistic expectations about your possible outcomes and give you a clearer understanding of what we mean when we talk about ovarian reserve.

Let’s walk through what we look for when assessing ovarian reserve and ovarian health at ORM Fertility, as well as what you can expect during the egg retrieval process once you have a better understanding of your fertility health.

What is ovarian health?

To get a better understanding of your fertility potential, we first look at your ovarian health. Ovarian health is a broad term that refers, in part, to the number and quality of eggs within your ovaries. The more specific term used to describe the number of eggs remaining is ovarian reserve.

Your ovarian reserve is influenced not only by age, but also by your individual genetic timeline from puberty through to menopause.

Some women maintain a healthy ovarian reserve well into their early 40s, while others experience a significant decline in egg quantity and quality by their early 20s. Every woman is different, and understanding your ovarian reserve through testing can help you determine where you fall on this spectrum.

There isn’t one single test that can accurately measure your ovarian reserve, so two complementary assessments are typically used to build a clearer picture: hormone level testing and an ultrasound examination.

Hormone level testing

The first assessment is a blood test that measures two key hormones: Anti-Müllerian Hormone (AMH) and Follicle Stimulating Hormone (FSH).

AMH is produced by the cells surrounding immature eggs. Because this hormone is made by the cells supporting developing eggs, higher AMH levels are generally associated with a healthier ovarian reserve. One advantage of AMH testing is that it can be carried out at any point during your menstrual cycle, even if you are using hormonal birth control.

FSH works a little differently. This hormone is released by the brain to stimulate and support egg development.

Healthy ovaries typically require only a small amount of FSH to mature eggs. However, when egg numbers are lower, the ovaries need much more stimulation to encourage egg development. As a result, higher FSH levels can be a sign of a lower ovarian reserve.

Unlike AMH, FSH testing is more time-sensitive and should be carried out between the second and fourth days of your menstrual cycle to provide the most accurate assessment.

Decision making

Once you have a clearer understanding of your ovarian reserve and overall ovarian health, you’re in a much better position to make informed decisions about your reproductive future.

If you’re hoping to grow your family in the near term, in vitro fertilisation (IVF) can increase your chances of pregnancy, even if you have a lower ovarian reserve.

If you’re not ready to start a family, egg freezing offers an opportunity to preserve your eggs, so you have more options when circumstances shift.

Whichever path you choose, egg retrieval may be a key milestone to prepare for. The good news is that it’s a routine procedure and, for most patients, much easier than they initially expect.

That said, I understand that giving yourself injections at home and not knowing exactly how your body will respond can feel daunting. So, let’s walk through the process.

The egg retrieval process

IVF injections and the trigger shot

Whether you’re pursuing egg freezing or IVF, both treatment pathways involve injectable forms of the hormones FSH (Follicle Stimulating Hormone) and LH (Luteinising Hormone). These medications stimulate your ovaries to develop multiple eggs during a single treatment cycle.

The injections are given using very small needles into the skin of your abdomen. I know that probably sounds daunting, but after their first injection, many of my patients tell me it wasn’t nearly as bad as they’d feared. Every shot is different though, and some people will experience discomfort – either way, it should all be quick and gentle.

The injections are typically taken for around 8-14 days. During this time, your fertility clinic will closely monitor how your ovaries are responding with ultrasound scans and blood tests every 2-4 days.

If you’re still feeling nervous about giving yourself injections at home, you’re certainly not alone. Here are a few tips that may help make the process feel more manageable.

IVF injection tips

Be your own advocate. If you’re anxious about injections or needles, tell your fertility team. Many clinics can provide one-to-one teaching and guidance to help you feel confident before you start.

Find the technique that works for you. There isn’t one “right” way to give yourself IVF injections. You may find it easier sitting down, standing up or lying down. Some people feel more comfortable asking a partner, friend or family member to help.

Prepare in advance. Give yourself 15-30 minutes before your injection. Make sure you have everything you need from the pharmacy and organize a clean, comfortable space. Feeling prepared can help you feel calmer and more in control.

Breathe. Your breath is one of the most powerful tools for easing anxiety. Before your injection, spend 30 seconds to one minute taking slow, deep breaths through your nose. Deep breathing can help lower blood pressure, relax your nervous system and create a greater sense of calm before you begin.

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.