How the IVF Process Works Step by Step

Understanding each phase of the IVF process helps reduce anxiety and ensures you're prepared for the journey ahead. The process typically begins with extensive preparation and baseline testing before moving through the active treatment phases.

Pre-cycle preparation usually begins 4-6 weeks before starting IVF medications. This phase includes comprehensive medical history review, physical examination, baseline blood tests, and ultrasound assessment. You may also need to complete infectious disease screening, genetic counseling, and psychological consultation. Birth control pills are often prescribed to synchronize your cycle and allow for precise timing of the IVF start.

Cycle synchronization and medication start typically occur on day 2-3 of your menstrual cycle. Baseline blood tests check hormone levels, and a transvaginal ultrasound confirms that no cysts are present that might interfere with treatment. Once cleared, you begin daily injections of gonadotropin medications (FSH/LH) to stimulate multiple egg development.

Stimulation monitoring begins 4-5 days after starting medications and continues every 1-2 days thereafter. Blood tests measure estradiol levels (reflecting egg development), while transvaginal ultrasounds track follicle growth and count. Your medication dose may be adjusted based on your response, and additional medications may be added to prevent premature ovulation.

Trigger shot timing is critical and occurs when most follicles reach 18-20mm in diameter. The trigger shot (usually hCG or Lupron) causes final egg maturation and precisely times ovulation for optimal egg retrieval timing. The egg retrieval is scheduled exactly 35-36 hours after the trigger shot to capture eggs at peak maturity.

Egg retrieval day begins with arrival at the clinic 1-2 hours before your procedure for preparation and IV placement. The procedure is performed under conscious sedation for comfort, with continuous monitoring of vital signs. Using transvaginal ultrasound guidance, your doctor aspirates eggs from each visible follicle. The entire procedure typically takes 15-30 minutes.

Fertilization occurs 4-6 hours after egg retrieval, once the eggs have been assessed for maturity. Mature eggs are either mixed with prepared sperm (conventional IVF) or injected with individual sperm (ICSI). Fertilization is assessed 16-18 hours later, with normally fertilized embryos continuing in culture for further development.

Embryo development is monitored daily, with embryologists assessing cell division, fragmentation, and overall quality. Day 3 embryos typically contain 6-8 cells, while day 5 blastocysts have developed into complex structures with inner cell mass and trophectoderm. Many clinics now culture embryos to the blastocyst stage for better selection.

Embryo transfer typically occurs 3-5 days after egg retrieval, depending on your clinic's protocols and embryo development. The procedure is performed in a sterile procedure room, with you positioned similarly to a Pap smear. A thin catheter containing the selected embryo(s) is guided through the cervix into the uterus using ultrasound guidance. The procedure takes 5-10 minutes and typically causes minimal discomfort.

Luteal phase support begins immediately after embryo transfer with progesterone medications to maintain the uterine lining. You may also receive estrogen supplements and other medications depending on your protocol. This phase continues for approximately 10-12 weeks if pregnancy occurs, gradually tapering as the placenta takes over hormone production.

The pregnancy test occurs 9-12 days after embryo transfer, depending on the stage at which embryos were transferred. Beta hCG blood tests provide quantitative results and are typically repeated 2-3 times to confirm appropriate doubling patterns. If positive, you'll continue luteal support while transitioning to obstetric care.