Anesthesiology

Egg Retrieval Q&A: Why Should It Matter to Anesthesiologists and other Healthcare Professionals?

Egg Retrieval Q&A: Why Should It Matter to Anesthesiologists and other Healthcare Professionals? 

Written By Theodora Wingert, MD 

Assistive reproductive technologies have advanced tremendously in the past 20 years, providing support and possibilities for parenthood for many populations who have previously struggled. One current technology in more frequent use is egg retrieval. This process involves ovarian stimulation and subsequent egg procurement for fertility preservation. It can also be helpful for people undergoing cancer treatment or gender transitions. 

Women in medicine are poised to have significant potential benefit from support and workplace flexibility for such procedures. Although women’s representation in medicine has grown immensely, gender disparities continue to be observed in speed of promotion, achievement of academic rank, and appointment to leadership positions, with minimal improvement of this gap over time.1-3 

Women physicians report that career-related pressures influenced the timing of childbearing and led to significant alterations in professional trajectories to accommodate family building and parenthood.4 Medicine historically mandates training during peak reproductive years, which can make family decisions incredibly difficult.5 And female anesthesiologists have specifically been shown to face challenges surrounding childbearing.6-7 Studies have shown female anesthesiologists to report discouragement and a negative stigma related to having children during training.7 And for women who delayed training or board certification for childbearing reasons, these delays affected their pursuit of fellowships, jobs, and seniority.8 In order to promote women’s advancement in medicine, it may be beneficial to support the journey to parenthood for those who wish to pursue it.  

There are many logistical components to egg retrieval that should be considered. Cost and time investment can be prohibitive for many. There are many visits, laboratory studies, and injections, and the ultimate procedure typically must be scheduled with only a few days notice. Many insurance policies now offer some benefit coverage for these services. This is critical, as the cost of these technologies may be prohibitive for many trainees or other professionals. One cycle of egg retrieval, for example, often ranges from $10,000 to $20,000.  

It is important to build awareness and understanding of what these technologies offer (and don’t offer in some cases), what is involved, and what trainees, colleagues, and supervisors can expect.  

The following is a Q&A of a resident physician in our department who underwent egg retrieval. Please note that this represents one individual experience. We are so grateful for her bravery in sharing her story. And we hope sharing this individual’s experience is informative and fosters dialogue about this technology and people’s experiences.  

Question: How did you find out about egg retrieval? 

Answer: Oddly enough—the summer before 5th grade. A new classmate joining my class told us she was a "test tube" baby, and that's why she didn't have a dad. She's now a proud mom of her own two boys. 

Fast-forward just shy of two decades, a colleague was sharing how she was planning to pursue egg retrieval. Before that conversation, I always assumed egg retrieval was reserved for (1) those with accumulated wealth and/or fertility issues, or 2) those for whom egg retrieval was a “Hail Mary” type of situation.  

Question: What made you decide to pursue egg retrieval at the time you did? 

Answer: Once I started asking around, it turned out a lot of women that I knew and respected had already undergone or were also considering egg retrieval. During my training, I was able to receive fertility benefits, which meant I would be receiving egg preservation therapy at a heavily discounted rate. Multiple women even told me, “If you can do it more than once, you should!” They were so nonchalant and encouraging, I felt less fearful of the procedure. 

Ultimately, my motivation was fueled by the idea that "you never know what will happen"—as in, I may personally face infertility issues, may not have an ideal partner to start a family with at an "ideal" time, or perhaps preserving these half-baked, 30-year-old cells might be a potential medical therapy for myself or my family in the future.  

Question: What were the challenges you faced in going through this as a resident? 

Answer: I felt like there was never a right time to “not inconvenience anyone” on a resident work schedule. Some friends suggested one rotation as the ideal time to pursue this, but I had already finished that rotation. I happened to have a flexible rotation later in the year, so I ended up pursuing this procedure then.  

Although my initial evaluation said that I had 14 follicles, during my next menstrual cycle, I only had 8 follicles before we started medical therapy. Before the trigger shot, 6 follicles looked promising. After I woke up from the procedure, I learned I had only retrieved 1 mature egg and 4 immature eggs. I was very saddened by the results. At this time, I had already spent over half of my benefits. I was faced with a quandary. If I were to pursue a second cycle, some of the costs would be out of pocket.  

There were also several times in the process when I felt like I saw the business side of healthcare. In hindsight, I realize how critically important it is as a patient to speak up, ask questions, trust your gut, and advocate strongly for yourself. 

Question: How long did the process take from start to finish? 

Answer: The time from the initial appointment to the egg retrieval was a little over 4 weeks. Recovery took about a week for me. 

Question: Is there anything you wish you had known? 

Answer:

  • The treatment starts coinciding with your menstrual cycle. Your menstrual cycles and your response to the medications will determine when you can start the treatment and when you can retrieve the eggs--you do not have much say in the timing or date. 
  • Recovery is variable. Some people feel back to normal very shortly after. I personally could not walk quickly or go over speed bumps in the car for about a week and a half after the procedure.  
  • Multiple cycles cannot be done on back-to-back months  
  • The shots go straight to the derriere! 
  • There are some great websites specific to fertility centers out there with reviews and other helpful information. 
  • Results are highly variable. I had an acquaintance who spent 24k on a single cycle, and the results were so poor the physician called it a “fluke cycle.” Another acquaintance had excellent results and retrieved 20 eggs in a single cycle. During the process, I spoke with someone undergoing their fourth cycle. The bottom line is that many women need more than one cycle to achieve a sufficient number of eggs. 
  • Exercise is prohibited during the hormonal injections and for some time after the egg retrieval. 
  • Prices are not standardized and are frequently negotiable.  
  • I personally was surprised at how emotional the entire process was. 
  • Costs included the: (1) initial evaluation, consultation fee, and ultrasound fee, (2) medication fees, (3) procedure fee, (4) all other visits including the ultrasound and procedure day. Each of these were billed separately. 

Question: Anything you would tell someone who is thinking of undergoing this? 

Answer:

  • Know that you are buying a "maybe" at the end of the day. You can do everything right, but you may never see any results from your pain or money spent 10 years down the line. 
  • Take time to do research about the fertility clinic you select. If things don’t feel right, and you have questions for your doctor, ask the questions, speak up. There were times I wish I had said to the doctor, "Can you come back after I've dressed and explain what you saw to me?”   

Question: How would you support a friend or colleague undergoing this procedure? 

Answer:

  • Check on her, listen, and reassure. I cried after I heard the retrieval results. My partner was very supportive, and my close friend reassured me that they told her she had poor ovarian reserve, but she conceived within 2 months after that news. Multiple friends checked on me throughout the process, and I felt very seen and supported by them. 
  • If you're brave enough, help her with the derriere shot. Offer to ice it. A good friend came over to help me with that shot when my partner was unavailable. She even checked to make sure I didn't have foot drop after the injection.   

References: 

  1. Silver JK, Ghalib R, Poorman JA, et al. Analysis of gender equity in leadership of physician-focused medical specialty societies, 2008-2017. JAMA Intern Med. 2019;179:433–435. 
  2. Bissing MA, Lange E, Davila WF, et al. Status of women in academic anesthesiology: a 10-year update. Anesth Analg. 2019;128:137143. 
  3. Bakkensen JB, Smith KS, Cheung EO, Moreno PI, Goldman KN, Lawson AK, Feinberg EC. Childbearing, Infertility, and Career Trajectories Among Women in Medicine. JAMA Netw Open. 2023 Jul 3;6(7):e2326192.
  4. Adesoye T, Mangurian C, Choo EK, et al. Perceived discrimination experienced by physician mothers and desired workplace changes: a cross-sectional survey. JAMA Intern Med. 2017;177(7):1033-6. 
  5. Li RD, Janczewski LM, Eng JS, Foote DC, Wu C, Johnson JK, Easter SR, Kim E, Buyske J, Turner PL, Nasca TJ, Bilimoria KY, Hu YY, Rangel EL. Pregnancy and Parenthood Among US Surgical Residents. JAMA Surg. 2024 Jul 17:e242399. 
  6. Kraus MB, Dexter F, Patel PV, Dodd SE, Thomson HM, Girardo ME, Hertzberg LB, Pearson ACS. Motherhood and Anesthesiology: A Survey of the American Society of Anesthesiologists. Anesth Analg. 2020 May;130(5):1296-1302. 
  7. Kraus MB, Thomson HM, Dexter F, Patel PV, Dodd SE, Girardo ME, Hertzberg LB, Pearson ACS. Pregnancy and Motherhood for Trainees in Anesthesiology: A Survey of the American Society of Anesthesiologists. J Educ Perioper Med. 2021 Jan 1;23(1):E656. 
  8. Pearson ACS, Dodd SE, Kraus MB, Ondecko Ligda KM, Hertzberg LB, Patel PV, Chandrabose RK. Pilot Survey of Female Anesthesiologists' Childbearing and Parental Leave Experiences. Anesth Analg. 2019 Jun;128(6):e109-e112.