The IVF Process: A Step-by-Step Guide

Eran Amir

CEO and Founder of GoStork

On 25 July 1978, Louise Joy Brown, the first baby conceived via in vitro fertilization (IVF) was born in Manchester, England. Since then, technology has continued to evolve, allowing many to conceive despite struggling with infertility. IVF has also made it possible for same sex couples and individuals to achieve parenthood. 

This article offers a step-by-step guide to the IVF process, providing all you need to know as you, too, embark on this journey!

But first:

What is IVF?

IVF is a medical infertility procedure which involves the combination of an egg with sperm in a laboratory setting. The egg and sperm can come from the intended parents themselves, or donors. The fertilized eggs (embryos) are then transferred into the intended parent’s or a gestational carrier‘s uterus, where it will hopefully implant in the uterine lining and continue to develop. Excess embryos may be frozen for future use.

Since IVF bypasses the fallopian tubes, this treatment option is ideal for women with blocked, damaged or absent fallopian tubes, or in cases where endometriosis is preventing conception. It’s also a solution in case of male factor infertility and where no explanation has been found for a couple’s infertility.

IVF is also utilised when donor egg or donor sperm are needed, and when the pregnancy will be carried by a gestational carrier.

The IVF process

The IVF process may vary from clinic to clinic but it generally follows these steps:

1. Suppressing the Natural Menstrual Cycle

You or the donor will be given injectable medication to suppress the normal menstrual cycle. This helps the next treatment stage be more effective.

Time Span: two weeks

2. Ovarian Stimulation

Medications, commonly known as ‘fertility drugs’, are prescribed to boost egg supply. A study undertaken by the University of Birmingham found that for a woman under 34, the ideal number of eggs is 15: at this number, the live birth rate stood at 40%. 

The medication comes in the form of an injectable follicle stimulating hormone (FSH) that should be self-injected for 10-12 days. During treatment, the ovaries are evaluated via ultrasound to see that the ovarian follicles are developing – at this point, a blood test is also done to measure response to ovarian stimulation medication. This determines if the follicles are ready for egg retrieval. A final hormone injection is given to help the eggs mature: the eggs are then collected after 34 – 36 hours.

20% of IVF cycles end up cancelled at this stage due to poor medication response and an insufficient amount of follicles. The chance of an IVF cycle being cancelled increases with age.

Time Span: 10 – 12 days

3. Egg Retrieval

A light sedative is used during the egg retrieval procedure to help you relax and not feel pain. Using ultrasound for guidance, a needle is passed through the vagina and into each ovary. This minor procedure is performed in the physician’s office or an outpatient center, and takes around 30 minutes. Most women find the procedure straightforward, with minimal to no pain. Some report lower abdominal cramping and light spotting but recovery is swift.

Time Span: 30-minute procedure, followed by 5-10 minutes to come out of sedation and an additional 30 minutes for recovery. You may be able to work the next day, but give yourself some leeway for an extra day off should you require it. 

4. Insemination and Fertilization

Following retrieval, the eggs are examined for maturity and quality. Mature eggs are mixed with the partner’s or donor sperm and left to fertilize for the next 16-20 hours.

Around 60% of ART cycles utilize intracytoplasmic sperm injection (ICSI). In this procedure, a single sperm is directly injected into a mature egg. ICSI is performed in cases of poor sperm quality and failed fertilization in a previous IVF cycle. ICSI is also a must when donor frozen eggs are used: the freezing and thawing process makes the shell surrounding the egg hard for the sperm to penetrate on its own. Read more about this in The Egg Question: Fresh vs Frozen Donor Eggs?

The fertilized eggs are then allowed to grow in the laboratory for up to 6 days.

Time Span: About 6 days

5. Embryo Culture

The embryo is monitored to ensure it’s growing well. At this stage, a number of tests may be offered:

  • Preimplantation Genetic Testing for Aneuploidies (PGT-A) – which provides information on the embryo’s genetic health, specifically the number of chromosomes
  • Preimplantation Genetic Testing for Monogenic disorders (PGT-M) – which tests for inherited disorders caused by mutations in a single gene.
  • Embryo Gender Selection – to choose the gender of the baby, either to balance out the family or to prevent gender-specific disorders. 

For couples who are carriers of genetic diseases, these tests help reduce the risk of having an affected child.

The best embryo(s) are then chosen for transfer. In the meantime, the mother or gestational carrier is given medication to help prepare the lining of the womb for the embryo transfer. This medication comes in the form of a pessary, an injection or gel.

Time Span: embryo transfer takes place approximately 6 days following egg retrieval

6. Embryo Transfer

The embryo is transferred into the womb using a thin catheter. The procedure is more straightforward than egg retrieval: no sedative is necessary and many liken it to a pap smear. The reproductive endocrinologist or embryologist will discuss the number of embryos that should be transferred – the decision will be based on the mother’s or gestational carrier’s age, and specific patient and embryo characteristics. 

The American Society for Reproductive Medicine (ASRM) provides guidelines for the number of embryos to be transferred. These can be viewed here.

The Centers for Disease Control and Prevention (CDC), too, have their own recommendations when it comes to embryo transfer: “for women who are good candidates for single embryo transfer, transferring one fresh embryo followed by one frozen embryo, if a second transfer is needed, offers the best chance of having a baby without increasing the chance for twins.” The reason why the CDC recommends the transfer of only one embryo is because twin pregnancies are more risky, for both mother and babies.

The remaining embryos can be frozen (cryopreserved) for future transfers. This makes future IVF cycles less expensive and less invasive.

Time Span: The embryo transfer procedure itself takes around 20-30 minutes – considering checking in and rest time, you may be at the fertility clinic for around 2 hours. 

The IVF cycle can be longer when using a gestational carrier. If you’re doing embryo testing, and in between contracts, travel, screening and medications, the process can take around 4 months.

7. The Wait

Once the embryo(s) are transferred, what’s commonly known as ‘the two-week wait’ ensues. It can be a difficult time for you and your partner: you may feel a roller coaster of emotions, from hope, to fear to exhaustion. This is normal and the National Infertility Association RESOLVE offers some emotional coping strategies to help see you through this time. 

A number of clinics suggest a regular at-home pregnancy test two weeks after the embryo transfer, while others request you to go in for a more accurate blood test. 

If the IVF cycle has been successful, ultrasound scans will be carried out in the following weeks, after which you’ll follow regular antenatal care.

IVF success rates vary according to age, the specific case in question, and from one clinic to another. Unfortunately, not all cycles are successful so you should prepare yourself also for this possibility. Make sure you have a good support system around you to help deal with any eventuality – counseling or fertility support groups are helpful during this time.

Time Span: two weeks

In Conclusion

Recent advances in reproductive technology have made it possible for many couples and single persons to experience parenthood. IVF is one such option. The process requires patience and determination and can sometimes be gruelling. But, with a positive attitude, preparedness for any eventuality and good knowledge on the process and the clinic you choose to work with, it is manageable. 

At GoStork, we’re working to help simplify the search for your ideal IVF clinic. Once the service is launched (coming very soon!), you will be able to view comprehensive information for the top IVF clinics across the US, with an easy search, filter and scheduling system similar to what we already offer for surrogacy agencies. Each clinic’s profile will include success rates, clear cost breakdowns, a list of the services offered, and much more.
If you’d like to be alerted when our free IVF platform launches, please let us know here!