How Is Egg Retrieval Performed? Is It Painful? How Long Do Injection Days Last?

Short Answer

Egg retrieval is performed under sedation, transvaginally with ultrasound guidance, by emptying the follicles in the ovaries with a thin needle, and it usually takes 15-20 minutes. The procedure itself is painless thanks to sedation; the injection days before it, with daily hormone injections, last 9-12 days on average.

Key Takeaways

• Injection days consist of daily hormone injections that make the ovaries produce more than one follicle and last 9-12 days on average.
• The injections are usually given under the skin of the abdomen with thin, short needles; most patients can administer them at home themselves.
• Because retrieval is performed under sedation, the patient does not feel pain.
• The procedure takes 15-20 minutes; the total time spent at the clinic, including preparation and observation, is around 2-3 hours.
• Mild cramping, bloating and spotting after the procedure are normal.
• It is recommended not to drive on the same day and to have a companion with you.
• Excessive bloating, shortness of breath or severe pain may be signs of OHSS and should be reported to the doctor.

What Are Injection Days? Why Are They Necessary?

In a natural menstrual cycle, the ovaries usually mature a single egg. In IVF treatment, the aim is to mature and retrieve more than one egg at a time to increase the chance of obtaining a healthy embryo. For this, the ovaries are stimulated with daily hormone injections; in everyday language this period is called injection days. The type and dose of medication used are personalized according to the patient's age, ovarian reserve and response to previous treatment.

Is There a Difference Between Injection Protocols?

Antagonist Protocol

It is one of the most commonly used approaches today. Stimulation injections are started on an early day of the cycle, and when the follicles reach a certain size, a medication that prevents premature ovulation is added. It is usually shorter and may help reduce the risk of OHSS.

Agonist (Long) Protocol

It requires a longer preparation that starts from the previous cycle. In some patients, especially in certain gynecological conditions, this protocol may be preferred.

Which Protocol Is Used for Whom?

Protocol selection is personalized according to age, ovarian reserve (AMH, AFC), response to previous treatment and accompanying gynecological conditions. No single protocol is suitable for every patient.

How Are the Injections Given? Are They Painful?

The injections are usually given under the skin of the abdominal area with very fine-tipped pens or small syringes. The sensation is usually similar to a mild needle prick, and most patients get used to the routine within a few days. Some patients may have mild redness or bruising at the injection site; this is usually harmless. The clinic shows the first injection to the patient or their partner so that it can be done at home; nurse support is also available for patients who want it.

How Many Injections Are Given?

The total number of injections varies according to the length of treatment and the protocol used; one or sometimes two injections a day may be given for 9-12 days on average. This number is not a fixed rule; the clinic may extend or shorten the treatment depending on how fast the follicles grow.

What Happens in the Body During Injection Days?

Bloating and a Feeling of Fullness in the Abdomen

Because many follicles develop in the ovaries at the same time, a feeling of fullness, mild bloating and pressure in the lower abdomen is common. This is an expected effect of the treatment.

Mood Changes

Because of the hormone doses used, some patients may experience mood swings, irritability or fatigue. This is temporary and returns to normal when treatment ends.

Mild Pain or Tightness

As the ovaries enlarge, a mild pulling or tight sensation may be felt on both sides of the abdomen; this is usually not severe enough to interfere with daily activities.

Can You Exercise During Injection Days?

Apart from light walking, intense cardio, jumping movements or exercises that strain the abdominal area are not recommended during this period. Because the ovaries are enlarged, the risk of ovarian torsion (the ovary twisting on itself) may increase with sudden movements, although this is rare. Patients who want to maintain their exercise habits are advised to discuss this with the clinic.

Is Sexual Intercourse Safe During Injection Days?

Because of the enlarging ovaries, clinics usually recommend taking a break from sexual intercourse during this period, since the risk of the rare complication of ovarian torsion is theoretically slightly higher at this time. Because the exact rule may vary from clinic to clinic, it is best to consult the physician managing the treatment directly on this matter.

How Is Monitoring Done During Injection Days?

Throughout the injection days, the clinic monitors the number and size of the follicles and hormone levels with ultrasound at regular intervals (usually every 2-3 days) and sometimes with blood tests. This monitoring serves two purposes: to see whether the follicles have reached sufficient maturity and to detect the risk of an excessive response early. Based on the monitoring results, the clinic may update the medication dose.

When Is the Trigger Shot Given?

When the follicles reach sufficient size, a trigger shot is given so that the eggs complete their final stage of maturation. The time at which this shot is given is very important; egg retrieval is scheduled exactly a set number of hours after this shot. A trigger shot not given on time can adversely affect the timing of retrieval.

How Does Egg Retrieval Day Work? Hour by Hour

Arrival at the Clinic and Preparation

Fasting may be required on the day of the procedure because sedation will be given; the clinic provides information about this in advance. After admission, the patient is prepared and an IV line is placed.

Sedation

The procedure is performed under light sedation so that the patient does not feel pain. Sedation is managed by an anesthesiologist, and the patient is unconscious throughout the procedure.

The Retrieval Procedure Itself

Guided by a thin ultrasound probe inserted through the vagina, the fluid in the ovarian follicles is aspirated with a thin needle. The eggs in this fluid are separated in the embryology laboratory. The procedure usually takes 15-20 minutes.

Waking Up and Observation

After the procedure, the patient is kept under observation for a while, usually 1-2 hours, and rests until the effect of sedation wears off. At the end of this period, the patient is discharged together with a companion.

Is Sedation or General Anesthesia Used?

The method preferred in most clinics is a short-acting sedation given while the patient continues to breathe on their own; this is not full general anesthesia. Sedation is administered by an anesthesiologist while the patient's heart rate and oxygen level are monitored. Rarely, a different anesthesia approach may be preferred depending on the patient's medical history; this decision is made together with the anesthesiologist.

Do You Need to Fast on Retrieval Day?

Because sedation will be given, you will be asked to fast for a few hours before the procedure; this is to reduce the risk of stomach contents entering the airway during sedation. The exact duration is communicated by the clinic, and following this instruction is important for safety.

How Long Does Retrieval Day Take in Total?

Although the procedure itself is short, when preparation, sedation, the procedure and post-waking observation are included, the patient spends a total of about 2-3 hours at the clinic. This duration may vary from clinic to clinic and according to how quickly the patient wakes from sedation.

How Many Eggs Are Retrieved?

The number of eggs retrieved varies greatly depending on the patient's age, ovarian reserve and response to medication. It is not guaranteed that every retrieved egg will be fertilized and become an embryo; egg and embryo quality are as decisive as the number. For more information on this, you can read our article on ovarian reserve.

What Happens If Fewer Eggs Are Retrieved Than Expected?

In some patients, the response to medication may be lower than expected and only a small number of follicles may develop. In this case, the clinic may consider changing the medication dose or protocol in the next attempt. Retrieving a small number of eggs does not mean there is no chance of pregnancy; a healthy pregnancy can be achieved even from a single good-quality egg.

Is Pain Felt During the Procedure?

No. Because sedation is given, the patient is not conscious during the procedure and does not feel pain. Some patients say they remember nothing, while others say they felt nothing other than mild dizziness or drowsiness.

What Is Felt After the Procedure? Is It Normal?

Mild Cramping and Bloating

Mild cramping, fullness and bloating lasting a few days after the procedure are common and normal.

Spotting

Light vaginal bleeding in the form of spotting may occur; this usually decreases on its own within a few days.

Fatigue

Due to the effects of sedation and hormonal changes, feeling tired on the day of the procedure and the following day is common.

What Should You Pay Attention To After the Procedure?

• You should not drive on the day of the procedure and should not travel alone before the effect of sedation has fully worn off.
• Heavy physical activity and sports should be postponed for a few days.
• Apart from the pain reliever recommended by the clinic, consult the doctor before using any medication.
• If severe pain, fever or heavy bleeding occurs, contact the clinic without delay.

When Can Sexual Intercourse Be Resumed After the Procedure?

Because the ovaries may still be enlarged for a few days after retrieval, most clinics recommend a break from sexual intercourse for at least a few days, sometimes until the next menstrual period. This duration may vary according to the number of eggs retrieved and how quickly the ovaries recover; the physician managing the treatment should be consulted for the exact duration.

When Can Normal Activities Be Resumed?

Most patients can return to light daily activities the next day; however, work requiring intense physical exertion or sports is usually postponed for a few days, sometimes a week. This duration is assessed individually according to the number of eggs retrieved and how enlarged the ovaries are.

Is There a Risk of OHSS (Ovarian Hyperstimulation Syndrome)?

An excessive response to injection treatment can rarely lead to excessive enlargement of the ovaries and fluid accumulation in the abdomen. While mild cases are limited to bloating and mild discomfort, severe cases may involve symptoms such as shortness of breath, severe abdominal pain and rapid weight gain. When these symptoms are noticed, the clinic should be contacted without delay.

Is Embryo Transfer Done Right After Retrieval?

This varies according to the clinic protocol and the patient's condition. In some patients embryo transfer is done within a few days after retrieval (fresh transfer), while in others the embryos are frozen and transferred after the uterus is prepared in a more suitable cycle (frozen embryo transfer). Factors that determine this decision include OHSS risk, endometrial thickness and hormone levels.

Can the Retrieval Procedure Be Repeated?

If a sufficient number or quality of eggs cannot be obtained in the first attempt, a new stimulation cycle can be planned after a rest period. There is no strict limit on how many times it can be repeated; the decision is evaluated together with the clinic according to the patient's ovarian reserve, general health and treatment history.

Can You Continue Working During Injection Days?

Most patients can continue their normal working life during injection days; the injections are usually given at a convenient time of day, most often at home. Because of frequent ultrasound checks, short time off may be needed on some days. As fatigue or bloating becomes more noticeable, especially in the last days of the cycle, this flexibility is usually possible for patients who want to reduce their work pace.

Should the Injections Be Stored in the Refrigerator?

Some of the medications used can be stored at room temperature, while others must be stored in the refrigerator; this depends on the type of medication. Following the storage instructions given with the prescription is important to preserve the medication's effectiveness. If the medications need to be carried while traveling, using a suitable carrying bag is recommended so that the cold chain is not broken.

What Happens If an Air Bubble Remains When Injecting?

A small air bubble remaining in the syringe usually does not cause a serious problem, because the injection is given under the skin and the volume given is small. Still, removing bubbles as much as possible by following the technique shown at the clinic both ensures the correct dose is given and reassures the patient. When in doubt, the clinic nurse is always a support resource reachable by phone.

What Happens If a Dose Is Forgotten or Given Late?

If a dose is forgotten or given a few hours late, the clinic should be contacted as soon as it is noticed; depending on the type of medication, it may be recommended to give it immediately or to wait until the next dose. Giving two doses at once or changing the schedule on your own is not recommended. Timing errors can usually be made up for; what matters is sharing the situation with the clinic.

Do Alcohol and Smoking Have an Effect During Injection Days?

Alcohol and smoking are among the factors that can adversely affect the response to treatment and overall reproductive health. Staying away from these substances throughout the treatment cycle is recommended for both egg quality and the process as a whole. If there are habits that could not be given up before treatment, sharing this openly with the doctor helps plan the process more realistically.

Can You Fly During Injection Days?

Short trips usually do not cause problems, but regular ultrasound monitoring must not be interrupted. Therefore, if a long trip is planned during injection days, how the appointment schedule will be affected should be discussed with the clinic in advance. Travel close to retrieval day is especially not recommended, because it is critical that the trigger shot is given on time and that retrieval takes place on the planned day.

Who Needs to Be With Me on Retrieval Day?

Because sedation is given, it is not safe for the patient to drive or return home alone after the procedure. For this reason, a companion is asked to be present at the clinic on the day of the procedure and to take the patient home. The companion can also provide support in case of any discomfort by staying with the patient during the first hours after the procedure.

Can Pain Relievers Be Used After Retrieval?

A pain reliever recommended by the clinic that is compatible with a possible pregnancy is usually sufficient for mild to moderate cramps. Using a different pain reliever or a high dose without consulting the doctor is not recommended, because some pain relievers are not preferred in early pregnancy. If the pain cannot be controlled despite the recommended medication, this should be reported to the clinic.

How Does the Number of Eggs Retrieved Change With Age?

As a general trend, because ovarian reserve decreases with advancing age, the number of eggs retrieved also tends to fall on average. However, this is not a strict rule; there may be young patients with low reserve as well as older patients who respond relatively well. For this reason, the expected number of eggs is estimated based on the patient's own AMH and AFC values rather than age.

Can Retrieval Be Done With a Single Ovary?

Yes. In patients whose one ovary has been surgically removed or is not functioning, the procedure is performed by retrieving follicles from the single remaining ovary. In this case the number of eggs retrieved may naturally be more limited, but there are many cases where a single ovary is sufficient to obtain a good-quality embryo.

When Does the First Period Come After Retrieval?

The first period after retrieval usually starts within one to two weeks, but this timing may vary according to the hormonal status and treatment protocol. If no fresh transfer was done and the embryos were frozen, this period can be used as the starting point for planning the next transfer. If the period does not come for longer than expected, contacting the clinic is recommended.

When Should You See a Doctor?

After retrieval, contact the clinic without waiting if the following symptoms appear:

• Severe, steadily increasing abdominal pain
• Shortness of breath
• Rapid bloating or weight gain
• Vaginal bleeding that lasts more than 24 hours or is heavy
• High fever

Common Mistakes

"I can't give the injections myself; they must be done at the hospital."

Most patients quickly learn to give the injections at home themselves or with their partner's help; the clinic demonstrates the first injection.

"Egg retrieval is very painful."

Because the procedure is performed under sedation, no pain is felt; mild cramping after the procedure is normal, severe pain is not.

"The more eggs retrieved, the better."

Egg and embryo quality matter as much as the number; because a very high number can sometimes increase the risk of OHSS, the clinic aims for balance.

"I can return to my normal life right after the procedure."

You should not drive until the effect of sedation wears off, and heavy exertion should be postponed for a few days.

"Mild bleeding and cramping are a dangerous sign."

Mild cramping and spotting after the procedure are expected; severe pain or heavy bleeding are different and should be evaluated.

Assoc. Prof. Dr. Nurettin Türktekin's Assessment

Injection days are one of the periods my patients worry about most; yet with the right information the process becomes quite manageable. The injections themselves are usually less uncomfortable than expected; the main points to pay attention to are adherence to regular monitoring and giving the trigger shot on time. The use of sedation during retrieval is important for patient comfort; most complaints after the procedure resolve on their own within a few days. I especially explain this to my patients from whom few eggs are retrieved: the number alone is not decisive, and sometimes even a single good egg can be enough to obtain a good-quality embryo.

Conclusion

The egg retrieval process consists of two stages: the injection days, when daily hormone injections stimulate the ovaries (9-12 days on average), and the retrieval procedure itself, which takes 15-20 minutes under sedation. No pain is felt during the procedure, and mild cramping and bloating afterwards are expected. Regular ultrasound monitoring, giving the trigger shot at the right time and taking care to rest for a few days after the procedure are the keys to a comfortable process. When symptoms such as severe pain, shortness of breath or heavy bleeding appear, the clinic should be contacted without delay.