Embarking on the In Vitro Fertilization (IVF) journey can often be filled with hope and uncertainties. One phenomenon that might catch IVF patients by surprise is the Sticky Egg Syndrome. Dr. Aniruddha Malpani, an IVF expert with three decades of experience, delves into this lesser-known aspect, offering valuable insights to help patients navigate their path to parenthood with better understanding and expectations.
The Basics of Egg Retrieval in IVF
Expected Vs. Actual Egg Yield
During the IVF process, an ultrasound scan prior to egg collection provides an estimate of the number of follicles, and the number of eggs the doctor expects to retrieve. For instance, if the scan shows around 12 follicles, and the estradiol level is about 2500 pg/ml , the expectation is to collect approximately 10 eggs. However, there are cases where the actual number of eggs retrieved is significantly less than anticipated.
Zero eggs – Empty Follicle Syndrome
Sometimes, the doctor is not able to collect even one egg. This is called Empty Follicle Syndrome, and is usually due to the improper administration of the hCG injection, which is crucial for egg maturation. Read more about empty follicle syndrome at https://www.drmalpani.com/knowledge-center/articles/efs-a-guide-for-ivf-doctors
Few Eggs Retrieved
More commonly observed is a scenario where, despite a good number of follicles and a high estrogen level indicating a good ovarian response, only 2 or 3 eggs are retrieved from 10-12 follicles. This situation, without a clear explanation from the doctor, can cause distress and disappointment for patients who had different expectations. This poor retrieval rate causes the IVF success rate to drop dramatically, because the number of embryos we can get is directly proportional to the number of eggs sent to the embryologist.
Identifying the Causes Behind Reduced Egg Retrieval
Technical and Human Factors
Several factors could account for the reduced number of eggs retrieved:
- Undue haste in performing egg collections, because the doctor is in a hurry to do as many cases as possible . This means he fails to collect many of the eggs from the follicles, because he does not spend enough time doing thorough and meticulous surgery
- Using a single puncture needle. While this allows the doctor to complete the egg collection faster, it often means that the doctor cannot check each follicle for an egg, because he needs to puncture, aspirate, and then move on to the next follicle
- Technical challenges, such as the positioning of the ovaries because of adhesions
- Surgeon’s experience and skill in egg collection
- Inadequate anesthesia leading to patient movement, thus hindering access to the follicles
- No real-time embryologist support. Ideally, during the egg collection, the embryologist should be scanning the follicular fluid for the presence of the egg. This gives the IVF doctor instant feedback, and if the embryologist does not find an egg in the follicle, the doctor can flush the follicle, until the embryologist identifies the egg. This takes time and patience, but many IVF clinics do not have this support. The doctor completes the entire egg collection in a few minutes, and the embryologist then scans all the fluid from all the follicles at one time. If he does not get as many eggs as expected, there is nothing which can be done, because the surgery is over, and no corrective action can be taken.
Sticky Egg Syndrome: An Insight
A specific condition contributing to this issue is the Sticky Egg Syndrome, where eggs remain adherent to the inside of the follicle wall. These sticky eggs are not released into the aspirated follicular fluid during the initial suction. This is not common, but does affect a significant proportion of patients. This means that though the egg is present inside the follicle, the doctor fails to retrieve it because he does not flush the follicle to dislodge the egg from the follicular wall.
Addressing Sticky Egg Syndrome: Improving Egg Retrieval Rates
The Role of Technical Adjustments
A simple yet effective approach to combating Sticky Egg Syndrome involves the use of a double puncture needle , along with the thorough flushing of each follicle. This technique significantly improves the egg retrieval rate, potentially leading to one egg per follicle. Such adjustments can dramatically increase a patient’s chances of pregnancy. This requires a skilled doctor , who is willing to be patient , and who makes sure that they wait until they get the egg from the follicle , before moving on to the next follicle. It also requires real time embryology support , because only the embryologist can tell the doctor whether they have been able to identify an egg in the follicular fluid or not. Only after he has done so does the doctor advance the needle into the next follicle.
The Impact on IVF Success
By understanding and addressing the Sticky Egg Syndrome, IVF clinics can enhance the efficiency of egg retrieval, thus improving the overall success rates of IVF treatments. Patients are encouraged to discuss these aspects with their IVF specialist to ensure a tailored approach to their treatment.
Conclusion: Navigating IVF with Expert Guidance
Dr. Aniruddha Malpani highlights the importance of understanding the nuances of IVF treatments, including the Sticky Egg Syndrome. By being informed and working closely with a skilled IVF specialist, patients can navigate their IVF journey with realistic expectations and improved outcomes.
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