IVF Step by Step: What Actually Happens

If you're considering IVF or about to start a cycle, you probably want to know exactly what to expect - not just the medical overview, but the day-to-day reality. This guide walks you through each phase, from your first injection to your pregnancy test, so nothing catches you by surprise.

Before You Begin: Setting Up for Success

IVF doesn't start the day you get your first injection. There's groundwork to lay first.

Initial Consultation and Testing

Your fertility specialist will want a complete picture before recommending IVF. Expect:

For women:

• Blood tests measuring hormone levels (FSH, LH, AMH, estradiol)
• Transvaginal ultrasound to count antral follicles
• Infectious disease screening

For men:

• Semen analysis
• Infectious disease screening

Based on these results, your doctor will create a personalized protocol-determining which medications you'll use, in what doses, and what timeline to expect.

Getting Medications and Training

IVF requires multiple medications, mostly injectable. Before starting:

• You'll receive your medication package
• A nurse will teach you how to prepare and administer injections
• You'll learn proper storage (many fertility medications need refrigeration)

Phase 1: Ovarian Stimulation (Days 1-12)

This is the most intensive phase. Your goal is to develop multiple eggs instead of the single one your body would normally produce.

What You're Taking

Gonadotropins (FSH injections): These directly stimulate your ovaries. You'll inject these daily, usually in the evening.

GnRH antagonist or agonist: Prevents premature ovulation.

The Monitoring Appointments

During stimulation, you'll visit the clinic every 2-3 days for:

Transvaginal ultrasound: The doctor measures your follicles. They're looking for follicles to reach about 18-22mm before triggering.

Blood tests: Estradiol levels help confirm follicle development and guide medication adjustments.

What You Might Feel

Physical: Bloating, mild discomfort, fatigue, headaches, mood swings from hormone fluctuations.

Emotional: Anticipation and anxiety, hope mixed with fear.

The bloating is real-some women need to wear loose clothing by the end of stimulation. This is normal and resolves after retrieval.

How Long This Phase Lasts

Typically 8-14 days, with most cycles running about 10-12 days.

Phase 2: The Trigger Shot

When your follicles are ready, it's time for the trigger shot-one of the most precisely timed moments in your cycle.

What the Trigger Does

The trigger shot (usually hCG or a GnRH agonist) mimics the natural LH surge that triggers final egg maturation and ovulation.

The Critical Timing

Your clinic will give you a very specific time to take your trigger shot-usually about 36 hours before your scheduled egg retrieval.

Phase 3: Egg Retrieval

Egg retrieval is a minor surgical procedure, but the anticipation can make it feel bigger than it is.

The Day Before

• Stop eating and drinking at the time your clinic specifies
• Plan for someone to drive you home-you'll receive sedation

The Procedure Itself

You won't remember this-the sedation ensures you're comfortable:

1. You're positioned, and the sedation is administered
2. Using transvaginal ultrasound guidance, the doctor inserts a thin needle through the vaginal wall into each ovary
3. The needle punctures each mature follicle and suctions out the fluid (which contains the egg)
4. The entire procedure takes about 20-30 minutes

After the Procedure

Common experiences include:

• Grogginess and sleepiness (the rest of the day)
• Mild to moderate cramping
• Spotting or light bleeding
• Bloating

Before you leave, the embryologist will tell you how many eggs were retrieved.

Phase 4: Fertilization and Embryo Development

Fertilization Day (Day 0)

On retrieval day, the embryologist:

1. Assesses retrieved eggs for maturity
2. Prepares sperm
3. Combines eggs and sperm (conventional IVF) or injects sperm directly into eggs (ICSI)

The Fertilization Report (Day 1)

The next morning, you'll receive a call with results-how many eggs were mature and how many fertilized normally.

Embryo Development (Days 2-6)

Day 2-3: Embryos divide into 4-8 cells.

Day 5-6: Embryos that continue developing reach the blastocyst stage-a hollow ball of about 100-200 cells.

Not all embryos make it to blastocyst. Attrition is normal, though it can be disappointing.

Phase 5: Embryo Transfer

The embryo transfer is the moment everything has been building toward. Unlike retrieval, it's a simple procedure-no sedation required.

Fresh vs. Frozen Transfer

Fresh transfer: Happens 3-6 days after retrieval, during the same cycle.

Frozen transfer (FET): Happens in a later cycle. Increasingly common-allows your body to recover and may have slightly higher success rates.

Transfer Day

1. You arrive with a comfortably full bladder
2. A speculum is placed, and the cervix is cleaned
3. A thin catheter loaded with the embryo(s) is passed into the uterus under ultrasound guidance
4. The embryo(s) are gently deposited

The entire procedure takes about 10-15 minutes. Most women feel only mild discomfort.

How Many Embryos to Transfer

Current guidelines generally recommend:

• Single embryo transfer (SET) for most women under 38 with good-quality embryos
• Sometimes two embryos for women over 38 or with previous failures

Phase 6: The Two-Week Wait

The period between transfer and pregnancy test-typically 10-14 days-is often the hardest part of IVF.

What's Happening Inside

After transfer, the embryo needs to:

1. Hatch out of its outer shell
2. Find a good spot on the uterine lining
3. Implant by burrowing into the lining
4. Begin producing hCG

There's nothing you can do to make implantation happen-it's out of your hands now.

What You Might Experience

The progesterone you're taking causes many symptoms identical to early pregnancy-breast tenderness, fatigue, bloating, mild cramping. This makes symptom-spotting essentially useless for predicting outcomes.

Coping Strategies

• Stay occupied
• Limit symptom-searching
• Avoid home pregnancy tests-wait for the official blood test
• Lean on support
• Be kind to yourself

Phase 7: The Pregnancy Test

About 10-14 days after transfer, you'll take a blood pregnancy test (beta hCG) at your clinic.

Understanding Results

Positive: A positive result means hCG was detected-pregnancy has begun. You'll typically return for follow-up blood tests to confirm hCG is rising appropriately.

Negative: A negative result is devastating, even when you've prepared yourself. Give yourself time to grieve. Your clinic will schedule a follow-up to discuss next steps.

If It's Negative

Many people don't succeed on the first IVF cycle. About 65% of patients who continue treatment will have a baby within three cycles.

The Timeline at a Glance

Frequently Asked Questions

This content is for educational purposes only and should not replace professional medical advice. Your IVF experience may differ based on your protocol and clinic. Always follow your medical team's specific instructions.