Infertility/Fertility/Egg retrieval


Dear dr
I am 30 years old undergoing ivf. I am fit and healthy, my results are all normal and  I have been pregnant before. I have completed the long protocol and responded well to the drugs, 12 follicles at least. We are having ivf because my husband has abnormal sperm counts. I took my hcg shot 2330 on Saturday night. My last scan was Thursday and they were considering doing egg collection Saturday but decided that Monday would be best. I had no scan or bloods between Thursday and Monday. I took all the drugs correctly. On Monday I turned up for my egg collection early, I ended up going to theatre over 40 minutes late  as they were running late. I woke up from the procedure to find they only retrieved 2 eggs. A blood test showed I had already ovulated. This was our only chance on the NHs and I feel that this should not have happened. Not only was the egg collection delayed but i was not monitored between Thursday and Monday. I would really appreciate some advice on this matter as I feel we should not have to now pay for another cycle .

Hello CJ from the UK,

In terms of not having to pay, that question would be best put to an attorney (solicitor).

In terms of the medical aspect of your story, the usual protocol is to retrieve 35-36 hours after the HCG injection.  In most cases, ovulation will not have occurred.  However, premature ovulation has occurred to most of us that do IVF and is unpredictable.  Did your doctor/clinic use some type of medication to prevent your body from mounting an LH surge?  If you used the long protocol, that would have been Lupron and you would have taken it up to the day of HCG.  If it was stopped earlier than that point, it is possible that your body mounted a natural LH surge and the timing of ovulation was thrown off.

It is a little unusual that here was no monitoring done between Thursday and Saturday.  Usually monitoring occurs on a daily basis when you are close to reaching the appropriate follicular size, to determine when to give the HCG.  In your case, it sounds like your doctor just designated a day without knowing if the follicles were ready or not, which I might say is a little unusual but is not necessarily wrong.  Maybe that is the protocol your doctor uses based on his/her knowledge and training?  Maybe it's to save cost and eliminate two visits and ultrasounds?  It certainly is something I think your doctor needs to sit down and explain to you.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate  


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Edward Joseph Ramirez, MD, FACOG


I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.


I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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