Ovarian Pexy- A Simple Procedure to Help Improve Egg Retrieval Outcomes
We posted a video of Dr. Miller discussing a recent surgical procedure he performed called an Ovarian Pexy that helps improve egg retrieval outcomes. We figured this was a procedure many were unfamiliar with, so we asked Dr. Miller for more information. Get ready to understand how this simple procedure can make a big difference on your road to becoming a parent.
Q: What is an Ovarian Pexy?
Dr. Miller: A laparoscopic procedure to move the ovaries closer into the pelvis so that the follicles can be more easily identifiable.
Q: How do you know if you are a good candidate for Ovarian Pexy?
Dr. Miller: The procedure would be performed on someone whose ovaries are out of position. A woman can be born with her ovaries misplaced, making IVF difficult. Additionally, another potential cause is adhesive disease – whether from infection, endometriosis or prior surgery, the ovaries are simply pulled away from the pelvis.
However, keep in mind that you don’t know whether or not there is room for improvement until you look at the anatomy. If I cannot see the ovary, I will not take the patient to stimulation. Generally, we have indications that the ovary is not in the right place and see this while the patient is undergoing transvaginal ultrasound or when I perform a saline infused sonogram. At that point, I recommend surgery. Pexy of the ovaries is ultimately a game time decision at the time of surgery, when the anatomy can be seen.
Q: Why does this procedure improve your chances for a more successful egg retrieval?
Dr. Miller: It gets the ovaries to a place where they can be easily visualized via ultrasound and thus, makes egg retrieval easier.
Q: What is the recovery time and how soon can you do an egg retrieval after the procedure?
Dr. Miller: The recovery time is 5-7 days at home and the patient can start preparing for an egg retrieval with her next cycle.
Q: How common is an Ovarian Pexy?
Dr. Miller: Since most reproductive endocrinologists do not perform surgery, this procedure is not routinely performed. Instead, patients settle for a lesser amount of eggs. Oftentimes, Dr. Miller sees patients who have gone through cycles with other physicians and have not had eggs retrieved on one side because of the ovary position. After the ovarian pexy procedure, patients can go from not being able to retrieve eggs to having a comparable number of eggs retrieved from either ovary.
Interested in scheduling a consultation with Dr. Miller? Call 630-428-2229 to set up an appointment or request a consultation online.
Her Own View: A Patient’s Journey Through IVF (Day 26)- Final Preparations and Waiting for Transfer Day
As you might recall from my last post, I had 30 eggs collected, and 10 made it to Preimplantation Genetic Screening (PGS). Out of those 10, five were considered genetically normal. They do know the genders of the normal embryos, but we’ve decided we don’t want to know. We have asked for the best quality embryo to be implanted during our Frozen Embryo Transfer (FET). To be honest, I’m a little surprised that we only had five come back genetically viable. As a 31-year-old, I expected a greater ratio to come back normal. Don’t get me wrong, I’m very, very grateful for having five healthy embryos. I’m also glad I did the test to up my chances of a successful pregnancy. Dr. Miller says that even in your 20s and 30s, a large percentage of eggs are genetically abnormal. Add to this, the fact that sperm can also be abnormal, it is not surprising that only 50% of the embryos were tested to be normal. He said to have five embryos tested and healthy is really very good.
This week, I went in for my FET consultation where they went over my schedule in detail. An FET is great because I now have a pretty solidified schedule for the next month and a half, so I can plan my life. The schedule was based on my ovulation, but unfortunately, I did not ovulate naturally this cycle yet. This happens sometimes because of all the stimulants in my system from my retrieval and hormones can sometimes throw off your cycle. Because of this, I was instructed to inject 3ml of Progesterone in Oil (PIO) intramuscularly to induce my period. I should have my period in the next 7-10 days and they will be able to better control my cycle once that happens. I found the PIO shot to not be as bad as people made it out to be, but again, this was my first one! I used a heating pad before/ after and massaged the contents of the shot into my bum. I was also instructed to start my Lupron injections on Friday.
After that, I start taking Estrace which helps build the lining to allow a successful implantation, Progesterone to help nourish the lining to maintain implantation and a few other things in preparation for my FET on August 28th! I do have to go in for a few more blood/ultrasound tests in the next week, but transfer day is coming up fast! I’m a little nervous that I won’t get my period, which could delay things, but it’s completely out of my hands! I’m just going to focus on self-care for the next month, and make sure I’m doing everything I can to keep myself healthy and happy!
-Katie
Her Own View: A Patient’s Journey Through IVF (Day 12-25) Adventures in Egg Retrieval
Hi everyone!
I’ve had loads of activity since the last time I updated! Since my last post, I had a third and fourth ultrasound, an egg retrieval and had my embryos shipped to the lab for genetic testing! Yes, a lot can happen in just a few days! Let me break it down…
During my third ultrasound, they saw 12 follicles in my left ovary and 14 follicles in my right ovary. I’ve included a picture so you can see they were still small that day. The size is in the “mean d mm” column. For a follicle to be considered mature, they must be between 16-22mm.
Dr. Miller requested I come back the next day after he increased my Menopur and Follistim to see if I was ready to pull the Human Chorionic Gonadotropin (HCG) trigger. The HCG trigger shot gives your follicles one last push before the egg retrieval. The shot happens exactly 35 hours before the retrieval. The next day, I had an ultrasound, and I was ready to pull the trigger at exactly 8:30 PM because I was scheduled for my egg retrieval 35 hours later at 7:30 AM. The shots during this time period were not too bad, but by the end, I was very bloated, which is a normal side effect of the medications. Yoga pants, loose tops and layers were my wardrobe staples!
So here we are, the day of the retrieval! I had to be at the office at 7 AM, for my 7:30 AM egg retrieval procedure. The staff took me in at exactly 7 AM, where they had me change into a hospital gown and gave me discharge instructions. The Anesthetist then hooked up what she needed to, and told me what to expect. The Embryologist also came in and went over the plan (egg retrieval/ freezing embryos, and Preimplantation Genetic Screening (PGS). She mentioned that there would be one update the next day, and we would not get another update until 5 days after that. The staff then took me into the procedure room where I was injected with the anesthesia. The next thing I knew, I was up and with Dan! I think the actual procedure only took 15 minutes. The first thing I heard was, “they got 30 eggs!” The staff was extremely attentive during recovery (about an hour) and Dr. Miller paid me a visit and said he was very pleased with the retrieval. After the procedure, I took it very easy and napped the rest of the day. I did take a drive with Dan that night to run an errand, which did not go well. I threw up when I got home, probably from the anesthesia and motion sickness from the car! And that is why it’s important to have a driver the day of the retrieval! The procedure was on a Sunday, and I managed to go to work on Monday, although I had to leave early. I felt uncomfortable for the next few days, but that is a normal side effect.
The next day, I received a call saying, out of the 30 eggs, 26 were mature, and 22 fertilized with ICSI (Intracytoplasmic Sperm Injection). Since I had so many eggs, Dr. Miller put me on a few medications to minimize the risk of Ovarian Hyperstimulation Syndrome (OHSS).
Often times once the retrieval takes place a transfer can be done on Day 3 or Day 5 after the embryos have matured under the care of the embryologist. This is called a fresh cycle because the embryos are “fresh out of the oven.”
However, because we chose to do the PGS testing our transfer turnaround time is a little longer. On Day 5, the lab was happy to report that I had 10 normally developed embryos that could go on to be tested for genetic normalcy. Those results should be back any day and we will then know how many viable embryos we have. After that, we will also be going through a frozen cycle. This means the embryo(s) will be thawed and then placed into their new home (aka my uterus).
To be honest, I’m enjoying this time where everything is basically out of my control. Let’s see what happens. Stay tuned!
-Katie