What is the IVF process really like? A fertility doctor explains

Once you make the life-changing decision to have a baby with the help of in vitro fertilization (IVF), it’s natural to wonder about what it will be like to actually go through fertility treatment. While discussions of in vitro fertilization (IVF) are becoming more commonplace, the intricacies of this incredible (yet complex) family-building option are rarely depicted in the media.  

To help make the IVF process a little less intimidating, let’s break down each step of the journey from beginning to end. Before we dive in, let’s talk about some actionable steps you can take right now to help prepare for fertility treatment. 

What to do before starting IVF

As any fertility patient will tell you, getting ready to begin a treatment cycle takes time. Lots of communication, consultations, phone calls and big decisions will happen well before you do your first injection. 

Here are 5 ways to set yourself up for success: 

• Schedule an initial consultation with a board-certified reproductive endocrinologist (aka a fertility specialist) and bring a list of questions to your appointment 
• Meet with a nutritionist to learn how nutrition and lifestyle habits can impact your chances of IVF success 
• Meet with a counselor familiar with fertility treatment who can help you emotionally prepare for the journey ahead
• Join a fertility support group (your fertility clinic may offer them, or you can locate virtual and in-person groups through organizations such as RESOLVE) 
• Follow a preconception checklist to reset your body and mind before beginning IVF

How long will my IVF cycle take?

The IVF cycle itself takes around four weeks—the length of a normal ovulation cycle. However, various factors can add to that timeline. Your IVF cycle can only begin after initial fertility testing is completed. These tests often include assessing your ovarian reserve, egg quality, uterus, fallopian tubes and a semen analysis (for male partners).

Uncovering any potential issues before beginning the IVF process will not only save you time and money, but peace of mind, as you’ll feel confident you’ve done all you can to be successful. This often involves a medical evaluation that assesses everything from your thyroid and blood sugar levels to genetic carrier screening. Certain medical conditions may warrant medication or lifestyle modifications that will make it easier for you to conceive.

When including the time it takes to complete fertility testing and a preconception health regimen, the IVF process can take up to four months.

Why should I focus on my preconception health?

Put simply, a healthy body has the best chance of success! Even small changes in nutrition and lifestyle in the months leading up to IVF can improve your odds of a healthy pregnancy. For this reason, the ideal time to start focusing on your preconception health is three months before the start of an IVF cycle.

During this time, you should consult with your physician and create a plan, which will likely include starting prenatal vitamins, increasing your water intake, improving sleep habits, and eating a more balanced and nutritious diet. Limiting alcohol and caffeine, ceasing smoking, and incorporating low-impact exercise will also prepare your body for the rigors of fertility treatment and pregnancy.

Now is also an excellent time to set up your emotional support network and confirm your insurance benefits (your fertility clinic’s finance department should assist with the latter). 

What to know about pre-treatment testing 

Around 30 days before your IVF cycle, your physician will conduct important tests, such as a comprehensive blood work panel, a saline sonogram to ensure your uterine cavity is healthy for embryo transfer, transvaginal ultrasounds, infectious disease screening and male fertility testing. 

Male fertility issues account for up to 40% of infertility problems. Assessing male fertility includes a semen analysis, where the quantity and quality of the sperm are evaluated. The sperm supply is typically “replenished” every 64 days, which means that preconception health matters for the male partner as well. 

The 4 stages of IVF

Once diagnostic testing is complete, your IVF cycle will begin. 

Stage 1: Oral contraceptives

Although it may sound counterintuitive, IVF patients must take oral contraceptives for 10 to 14 days before starting fertility medications. When taken before ovarian stimulation, studies have shown that oral contraceptives can increase the number of eggs available for retrieval, ensure follicles grow as a cohesive group, and support ovarian health throughout IVF.

Stage 2: Ovarian stimulation

After completing a course of oral contraceptives, you will begin injections of fertility medication for approximately 9 to 11 days. These fertility medications consist of naturally-occurring hormones that help develop and mature your follicles (eggs are housed within the follicles).

The number of follicles (and their size) help provide a glimpse into how many mature eggs will be available for retrieval. During this stage of IVF, you can expect to visit your fertility clinic’s office approximately every other day for monitoring (which will include a vaginal ultrasound and blood work.

Stage 3: Egg retrieval

An egg retrieval is a short, outpatient procedure during which eggs are extracted from the ovarian follicles while you are under anesthesia, then fertilized with sperm in the IVF lab at your fertility clinic. The fertilized eggs then begin to rapidly divide and develop into embryos. 

An embryologist closely monitors the embryos for five days, at which point they transition from the “zygote” stage to the “blastocyst” stage of development. 

Stage 4: Embryo transfer

Around day five of development, one of the embryos will be transferred into the uterus of the intended parent (or a gestational surrogate). The embryo transfer is a short procedure that should take approximately 20 to 30 minutes.

You will be awake for this painless procedure, and it will not require any anesthesia. Following your transfer, there will be a waiting period of 9 to 10 days to see if the embryo successfully implants in the uterus, resulting in a pregnancy. Depending on the maturity of the embryo, it can take between 1 to 5 days for an embryo to implant after the transfer.

When will I know if I’m pregnant?

Waiting to find out whether your embryo transfer resulted in pregnancy can be the hardest part of IVF. While it may be tempting, your physician will advise against taking an at-home pregnancy test prior to your official blood work at the clinic. To reliably detect human chorionic gonadotropin (hCG), the hormone produced by the placenta after implantation, a blood test must be performed.

What might make my IVF cycle take longer?

Reason #1: Poor ovarian response

Sometimes the ovaries don’t respond as expected to IVF medications, which can delay or cancel your IVF cycle. For example, there might be a delay or cancellation if a lower number of follicles develop in the ovaries than expected, meaning fewer eggs were produced.

Reason #2: Suboptimal hormone levels

If hormone levels are not ideal for continuing an IVF cycle, delaying the egg retrieval can lead to better chances of success. Although this can be difficult news to receive, every cycle is diagnostic as well as therapeutic. Your fertility specialist will gain knowledge throughout each cycle, increasing your chances of success for the next cycle.

Keep in mind: a suboptimal hormonal response from this round of IVF does not mean you’ll have the same fate should you decide to continue with treatment. Sometimes, it just takes a little time to figure out the right protocol for your body. 

Reason #3: Embryo screening

If you choose to have your embryos screened for abnormalities via preimplantation genetic testing (PGT), this will take some additional time (typically around 4 to 5 weeks). Embryo screening can decrease miscarriage rates, reduce the risk of genetic disorders, and provide other valuable insights. PGT is especially useful for hopeful parents who are known carriers of a disorder or at higher risk for passing on genetic diseases. 

Your IVF experience will be unique

While much of the fertility treatment process is standardized, your fertility clinic team should always consider your medical history, family-building goals, and other factors to create a personalized treatment protocol that offers you the highest chances of success.  

Whether you’re feeling anxious or confident about starting IVF treatment, learning more about the process can only help you feel more empowered and informed about the journey ahead of you.