If you’re reading this, you may be considering in vitro fertilization (IVF) or preparing to begin the process. Perhaps other fertility treatments haven’t worked as hoped, or maybe IVF is your first step due to specific medical conditions. Whatever your path, it’s important to recognize that while the journey can be challenging both emotionally and physically, IVF has helped millions of people worldwide achieve their dreams of parenthood
This guide aims to walk you through the IVF process in straightforward terms, helping you understand what to expect and how to prepare. While the medical aspects are important, we’ll also discuss the emotional journey and practical strategies for navigating this experience.
What Is IVF?
In vitro fertilization (IVF) is a type of assisted reproductive technology where eggs (oocytes) are retrieved from the ovaries and fertilized with sperm in a laboratory setting. The resulting embryos are then transferred into the uterus with the goal of achieving pregnancy.
IVF was initially developed to help women with blocked or damaged fallopian tubes, but today it’s used to overcome various fertility challenges, including:
- Male factor infertility
- Diminished ovarian reserve
- Unexplained infertility
- Endometriosis
- Genetic disorders (when combined with preimplantation genetic testing)
- Same-sex family building and single parent family building
- Fertility preservation
The core premise of IVF is simple—it brings eggs and sperm together outside the body, bypassing certain obstacles to natural conception. However, the process involves multiple steps that unfold over weeks or months.
Your Initial Evaluation
Before beginning IVF, you’ll undergo a comprehensive fertility evaluation, which typically includes:
For the Egg Provider:
- Ovarian reserve testing: Blood tests measuring hormones like anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH), along with an ultrasound to count antral follicles. These tests help predict how your ovaries might respond to stimulation medications.
- Uterine assessment: Such as a hysterosalpingogram (HSG), sonohysterogram, or hysteroscopy to evaluate the uterine cavity.
- General health screening: Including infectious disease testing and often a general physical exam.
For the Sperm Provider:
- Semen analysis: Evaluating sperm count, motility (movement), and morphology (shape).
- Infectious disease testing: Similar to those for the egg provider.
This evaluation helps your fertility specialist design a treatment protocol tailored to your specific needs and circumstances.
The IVF Process: Step by Step
1. Ovarian Stimulation (Approximately 8-14 days)
The first phase of IVF involves stimulating the ovaries to produce multiple eggs. In a natural menstrual cycle, usually only one egg matures each month. With IVF, the goal is to retrieve multiple mature eggs to increase the chances of developing healthy embryos.
What to expect:
- You’ll take hormone medications (gonadotropins) via subcutaneous injections, typically for 8-14 days.
- Regular monitoring through blood tests and ultrasounds (every 2-3 days) to track follicle development and adjust medication doses if needed.
- As your follicles grow and estrogen levels rise, you may experience symptoms like bloating, mild abdominal discomfort, or mood changes.
Types of protocols:
- Antagonist Protocol: The most common approach, using FSH/LH medications with the addition of a GnRH antagonist later in the cycle to prevent premature ovulation.
- Long (Lupron) Protocol: Begins with suppression using a GnRH agonist before stimulation starts.
- Minimal Stimulation Protocol: Using lower doses of medications, sometimes combined with oral medications like Clomid.
Your doctor will recommend a protocol based on your age, ovarian reserve, previous responses to medication (if applicable), and other factors specific to your situation.
2. Trigger Shot and Egg Retrieval Preparation
When your follicles reach the right size (typically 17-22mm), you’ll take a “trigger shot” of human chorionic gonadotropin (hCG) or a GnRH agonist like Lupron to finalize egg maturation and prepare for retrieval. The timing of this shot is crucial—egg retrieval is precisely scheduled for 34-36 hours afterward.
What to expect:
- Specific instructions about when to take the trigger shot (often in the evening).
- Details about when to stop eating and drinking before your procedure.
- Information about what to bring and wear on the day of retrieval.
3. Egg Retrieval (Day 0)
Egg retrieval is a minor surgical procedure performed under sedation, typically taking 15-30 minutes.
What to expect:
- You’ll receive intravenous sedation, so you’ll be asleep or very relaxed.
- Using ultrasound guidance, your doctor will insert a thin needle through the vaginal wall into each ovarian follicle to aspirate (remove) the eggs.
- After the procedure, you’ll rest in a recovery area for 1-2 hours.
- You’ll need someone to drive you home.
- Some discomfort, bloating, and light spotting are normal afterward.
4. Sperm Collection and Fertilization (Day 0)
On the day of egg retrieval, fresh sperm is collected, or previously frozen sperm is thawed. The sperm is then processed to select the healthiest specimens.
Fertilization methods:
- Conventional insemination: Eggs and sperm are placed together in a culture dish, allowing natural fertilization to occur.
- Intracytoplasmic sperm injection (ICSI): A single sperm is directly injected into each mature egg. This method is often used for male factor infertility or when previous conventional insemination has been unsuccessful.
5. Embryo Development (Days 1-6)
After fertilization, the embryology team monitors embryo development daily.
Development milestones:
- Day 1: Check for fertilization (presence of two pronuclei).
- Days 2-3: Cell division begins, creating a cleavage-stage embryo with 4-8 cells.
- Days 5-6: Further development to blastocyst stage, containing 60-120 cells with differentiation into inner cell mass (future baby) and trophectoderm (future placenta).
6. Embryo Testing (Optional)
Some patients choose to have their embryos tested for genetic abnormalities through preimplantation genetic testing for aneuploidy (PGT-A). This involves:
- Biopsy of a few cells from the trophectoderm of blastocyst-stage embryos
- Freezing all biopsied embryos
- Testing the cells for chromosomal abnormalities
- Transferring only embryos determined to be euploid (having the correct number of chromosomes)
While PGT-A adds cost and time to the process, it may help select embryos with higher implantation potential and lower miscarriage risk, particularly for those of advanced maternal age or with recurrent pregnancy loss.
7. Embryo Transfer (3-7 days after retrieval or in a later cycle)
Embryo transfer is a quick, usually painless procedure that doesn’t require anesthesia.
What to expect:
- The embryo(s) are loaded into a thin, soft catheter.
- Using ultrasound guidance, your doctor will pass the catheter through your cervix and place the embryo(s) in your uterus.
- You may be asked to have a moderately full bladder to aid ultrasound visualization.
- The procedure typically takes 5-10 minutes.
- Some clinics recommend brief rest afterward, though research shows immediate activity restrictions aren’t necessary.
Fresh vs. Frozen Transfer:
- Fresh transfer: Embryos are transferred 3-5 days after egg retrieval.
- Frozen transfer: All embryos are frozen after development, and transfer occurs in a subsequent cycle. This approach has become increasingly common due to potentially higher success rates and lower risks of ovarian hyperstimulation syndrome.
8. The Two-Week Wait and Pregnancy Test
After embryo transfer, you’ll begin progesterone supplementation to support the uterine lining and early pregnancy. Approximately 9-14 days after transfer, you’ll have a blood test to check for pregnancy.
What to expect:
- Progesterone may be administered as vaginal suppositories, gel, or injections.
- Common side effects include breast tenderness, mood changes, and fatigue.
- The waiting period can be emotionally challenging—having support systems in place is important.
How to Prepare for an Embryo Transfer
Preparing for an embryo transfer is an important step in your fertility journey. Here are some tips from Dr. Lora Shahine, a reproductive endocrinologist with over 15 years of experience.
Follow Medication Instructions Carefully
- Be meticulous about taking all prescribed medications (typically estrogen and progesterone)
- Review your medication calendar multiple times
- Ensure you have adequate supplies and refills
- Consider using reminders on your phone or enlist your partner’s help
- Ask your clinic to clarify any medication instructions you don’t understand
Plan Logistics for Transfer Day
- Confirm the exact clinic location and transfer time
- Research parking options in advance
- Account for traffic and travel time
- Consider staying near the clinic if you live far away
- Some patients make a mini-vacation out of it to reduce stress
Understand the Procedure Details
- Ask who will be in the room (typically the doctor, embryologist, and ultrasonographer)
- Confirm if your partner or support person can attend
- Inquire about clinic policies regarding photos or videos
- Ask if you’ll receive a picture of your embryo
Follow Pre-Transfer Instructions
- Read and re-read all instructions from your clinic
- Come with a full bladder – this is crucial as it:
- Helps position the uterus for an easier transfer
- Improves ultrasound visualization during the procedure
- Follow guidelines on how much water to drink and when
Plan for Post-Transfer Self-Care
- Schedule a relaxing evening after the transfer
- Consider ordering takeout food
- Plan to watch a favorite movie or engage in calming activities
- Avoid work obligations or deadlines
- Take time to reflect on this significant milestone
Remember that the embryo transfer is an exciting step in your fertility journey. Being well-prepared can help reduce anxiety and create a more positive experience on this important day.
Success Rates and Expectations
IVF success rates vary widely based on multiple factors, most significantly:
- Age of the egg provider: The most important factor, with success rates declining after age 35 and more significantly after 40.
- Ovarian reserve: How many eggs are retrieved impacts the chances of having embryos suitable for transfer.
- Reason for infertility: Some conditions have higher success rates than others.
- Previous pregnancy history: Those who have had successful pregnancies in the past often have better outcomes.
- Clinic expertise: Success rates can vary between clinics.
According to the Society for Assisted Reproductive Technology (SART), the approximate live birth rates per embryo transfer for women using their own eggs are:
- Under 35 years: 55-60%
- 35-37 years: 40-45%
- 38-40 years: 30-35%
- 41-42 years: 15-20%
- Over 42 years: 5-10%
These rates are for reference only—your personal chances may be higher or lower based on your individual circumstances. Your fertility specialist can provide a more personalized assessment of your prognosis.
Physical and Emotional Well-Being During IVF
Managing Physical Side Effects
IVF medications and procedures can cause various side effects:
- Injection site reactions: Redness, mild swelling, or bruising.
- Hormonal symptoms: Mood swings, headaches, bloating, breast tenderness.
- Ovarian hyperstimulation syndrome (OHSS): In rare cases, ovaries become painfully swollen with fluid buildup in the abdomen. Severe cases may require hospitalization.
Tips for physical comfort:
- Apply ice before injections to numb the area
- Rotate injection sites
- Stay well-hydrated
- Wear comfortable clothing with waistbands that don’t press on your abdomen
- Get plenty of rest
- Contact your clinic immediately if you experience severe pain, rapid weight gain, severe bloating, or difficulty breathing
Emotional Support and Coping Strategies
The emotional aspects of IVF can be as challenging as the physical ones. Common feelings include:
- Anxiety and uncertainty
- Mood fluctuations (partially hormone-related)
- Relationship strain
- Isolation or feelings that others don’t understand
Helpful coping strategies:
- Seek support: Consider counseling with a therapist who specializes in fertility issues, join support groups (in-person or online), or connect with others who have gone through IVF.
- Practice stress management: Follow along with Mindful Conception and the Pearls of WellBeing. Techniques like gentle yoga, walking, or journaling can also help.
- Communicate with your partner: Open communication about expectations, concerns, and feelings can strengthen your relationship during this challenging time.
- Set boundaries: It’s okay to limit exposure to baby showers, child-centered events, or even well-meaning but insensitive comments if they cause distress.
- Take breaks when needed: If you need to step away from fertility treatments temporarily for your mental health, discuss this option with your doctor.
Practical Tips for IVF Success
preparing for your cycle
3-6 months before starting:
- Take a prenatal vitamin with at least 400mcg of folic acid.
- Maintain a balanced diet rich in fruits, vegetables, and lean proteins.
- Consider reducing or eliminating alcohol, caffeine, and tobacco.
- Aim for a healthy weight—both underweight and overweight conditions can affect IVF outcomes.
- Discuss any medications you’re taking with your fertility specialist.
- Find ways to reduce stress and incorporate regular, moderate exercise.
Leading up to your cycle:
- Organize your medication supplies (alcohol wipes, sharps container, etc.).
- Create a medication schedule or use a tracking app.
- Arrange for time off work for procedures and recovery if needed.
- Plan for support during key appointments like egg retrieval.
Financial Planning
IVF is a significant financial investment, with costs varying widely by region and specific treatment needs. The average cost for one cycle in the US ranges from $12,000 to $25,000, including medications.
Financial strategies:
- Check if your insurance offers any fertility coverage.
- Research clinic-specific financing programs.
- Explore grants from organizations like the Baby Quest Foundation or the Cade Foundation.
- Ask about medication discount programs.
- Some employers offer fertility benefits—check with your HR department.
- Consider joining clinical trials if appropriate.
When the Journey Continues
Not everyone is successful with their first IVF cycle. If your cycle doesn’t result in pregnancy, your doctor will review what was learned and may suggest modifications for future attempts, such as:
- Adjusting medication protocols
- Adding additional treatments or testing
- Considering donor gametes if appropriate
- Exploring gestational surrogacy in certain cases
Remember that each cycle provides valuable information, and success rates can improve with subsequent attempts.
Final Thoughts
IVF is a remarkable technological advancement that has helped create millions of families worldwide. While the process can be demanding, understanding what to expect and preparing accordingly can help you navigate the journey with greater confidence and resilience.
Throughout your IVF experience, remember:
- You’re not alone—many others have walked this path before you.
- It’s okay to feel a range of emotions throughout the process.
- Success often requires patience and persistence.
- The support of knowledgeable medical professionals, understanding loved ones, and others who have experienced infertility can be invaluable.
- Take care of your whole self—mind, body, and heart—throughout your fertility journey.
Whether your path to parenthood is straightforward or involves unexpected turns, approaching IVF with knowledge, support, and self-compassion will help you navigate whatever lies ahead.
Sources
American Society for Reproductive Medicine. Assisted reproductive technologies: A guide for patients.
Zegers-Hochschild F, Adamson GD, Dyer S, et al. The International Glossary on Infertility and Fertility Care, 2017. Human Reproduction.
Society for Assisted Reproductive Technology. National Summary Report.
Practice Committee of the American Society for Reproductive Medicine. Guidance regarding gamete and embryo donation. Fertility and Sterility.
Practice Committee of American Society for Reproductive Medicine. Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility. Fertility and Sterility.
Crawford N, Salem W. Evidence-based approaches to IVF success. Contemporary OB/GYN.
Pandey S, Shetty A, Hamilton M, et al. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Human Reproduction Update.
Glujovsky D, Farquhar C, Quinteiro Retamar AM, et al. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database of Systematic Reviews.
Paulson RJ, Sauer MV, Lobo RA. Factors affecting embryo implantation after human in vitro fertilization. American Journal of Obstetrics and Gynecology.
Devine K, Richter KS, Jahandideh S, et al. Intramuscular progesterone optimizes live birth from programmed frozen embryo transfer: a randomized clinical trial. Fertility and Sterility.
Shahine, Lora. “How To Prepare For Your Embryo Transfer.” YouTube, accessed 2 Apr. 2025
Shahine, Lora. “Advice and Tips to Maximize Success for IVF.” YouTube, accessed 2 Apr. 2025,