To all you cyclists, runners, rock-climbers, and challenge-takers, the hill can be a real beast on the way up. Pushing towards that summit can be exhausting and physically painful. However, once you peak and start the descent it’s a feeling like no other. You did it. Now, enjoy the reward of the downhill. Much the same can be said of the post-retrieval bloat, discomfort, and weight gain. After you reach the peak, it is smooth sailing.

Women are often shocked at how much worse they feel after the retrieval than before. While the swelling, heaviness, and blah feeling are definitely there before the retrieval, they’re about 10 times worse after! When we tell patients this, they’re often shocked. How can that be? You’re taking the eggs out; shouldn’t the symptoms get better? No, in fact, they get worse!

Let’s do a little Bio 101. Eggs are housed in fluid-filled follicles, and follicles live in the ovaries. Many follicles = big ovaries. Seems simple. During the egg retrieval, we drain the follicles of their fluid, and within that fluid comes the eggs. However, after the follicles are drained of fluid they fill with blood. They become corpus lutea (plural for corpus luteum—you learn something new every day!). The CLs (everyone needs a nickname) make a lot of hormones that can make you feel not so hot (#progesterone). Additionally, they often fill with blood. As a result, the ovary stays enlarged, and your belly stays big. This hormone soup keeps the ovaries large, the belly filled with fluid, and you feeling like a balloon at the Macy’s Thanksgiving Day Parade!

Okay, so I am going to feel awful…how long will this go on? The length of the post-retrieval to menses (a.k.a. period) varies based on the trigger shot you were given. Women that get straight HCG or ovidrel will feel the bloat for about 12–14 days. The HCG hormone in both of these formulations is like gas for the ovaries—they keep the ovaries charged and the hormones pumping. And although the symptoms will improve significantly after about seven days, you won’t be back in your skinny jeans until you get a period about 14 days later.

If you were given a Lupron or Lupron +HCG trigger, your period of pain will be protracted (that’s why we give it!). Most women will start to feel better about three to four days after the retrieval and get their period about seven days later. For the majority of women, the blah-blech feeling will steadily increase post-retrieval until you hit the peak about three-ish days later; the summit will be higher and the climb further if your trigger medication was straight-up HCG with no Lupron chaser.

When embryos are transferred back into the uterus during the stimulation cycle and you get pregnant, it’s like you are racing the Tour De France rather than your local 10-miler. The pregnancy will make HCG, and the HCG will make that hill way longer. You won’t recover for several weeks into the pregnancy. It is for this reason, along with new data on the OB benefits of fresh cycles, that we push you to press pause and freeze the embryos. Trust us. Your body, your ovaries, and your brain will thank us.

They say life is about the journey and not the destination. And we mostly agree with that. However, in terms of ovarian stimulation and the aftereffects it’s all about the destination. The climb up will likely not be fun. Keep your eye on the top, and take one step at a time. We’re right there beside you, cheering you on!