Deciding to start IVF can be exciting and nerve-wracking. Yes, you’re one step closer to having a baby, but it is also a major emotional, physical, and financial commitment.
The next steps
If you’ve gone through fertility treatments like IUI or timed intercourse before, you’re likely familiar with the beginning steps of an IVF cycle. IVF cycles start with a monitoring appointment. During these appointments your fertility specialist will perform a transvaginal ultrasound to count your ovarian follicles, tiny fluid-filled sacs in the ovary that contain one egg each. Repeat ultrasounds throughout the cycle will monitor the growth of these follicles, giving you an estimate of how many eggs you might retrieve. You will also have blood drawn to make sure your hormone levels correspond with the growing follicles. The closer you get to the day of your egg retrieval, the more frequent monitoring appointments become.
During a typical menstrual cycle, multiple eggs grow but only one egg reaches the point of ovulation. IVF uses medication to develop all of the eggs because the goal is to collect as many eggs as possible in one round. Most of the medications you’ll use during IVF are injections. Some injections are subcutaneous, or under the skin, while others are intramuscular, and go into the muscle. With practice, it’s easy to do the under the skin injections in your lower abdomen by yourself. The intramuscular ones are a bit harder to do and may require help from a partner, friend, or nurse. Most people find the injections get easier the more they do them. Your clinic nurse will have plenty of tips to make things easier if you’re having challenges.
The medications you take, and their dosages, change throughout the cycle. The first medications are stimulation medications, or “stim meds” as they’re more commonly known. These injections help multiple follicles grow. Research suggests that 9-11 days of stim meds produces the best outcomes. However, your cycle may be longer or shorter depending on how your body responds. As your follicles grow, you may feel some bloating, soreness, and heaviness in your lower abdomen. Some bloating and discomfort is normal, but if it becomes excessive and painful to the touch, let your doctor or nurse know right away.
Once your follicles grow large enough, it’s time to trigger ovulation. Some trigger shots, like stim meds, are done under the skin while others need to go into the muscle. Follicles ranging from 12–19 mm on the day of the trigger shot are most likely to be mature and fertilize. You must take your trigger shot at the exact time provided by your fertility clinic, typically 36 hours before your scheduled egg retrieval. Your clinic will also monitor estrogen levels at this critical point in time.
Egg retrievals usually occur under light sedation, so you will be asleep for the procedure. Most retrievals are performed vaginally, the doctor uses a probe similar to the wand used for transvaginal ultrasounds, except this wand has a place to slide a hollow needle through. The needle goes through the wall of the vagina and into the follicle to retrieve the egg. Your fertility specialist will let you know how many eggs they retrieved when you wake up from the procedure. You may have some cramping and bleeding following the procedure, but these symptoms usually go away within a day or so. It is also common to feel very fatigued, so planning a day or two of recovery is ideal when possible.
After the egg retrieval, your fertility clinic’s embryologist will use your partner’s sperm, or donor sperm, to fertilize your eggs. From there, the newly formed embryos grow either three or five days before being transferred to your uterus and/or frozen. The number of embryos that make it to day three or five will be less than the number of eggs retrieved. Typically, 80% of the eggs retrieved are mature and 80% fertilize, but only 30-50% of embryos make it to day five. While this is often disappointing, it’s totally normal! At this stage most embryos will undergo testing for quality and genetics. This is an optional, but often highly recommended step, based on your personal history.
One of the biggest moments on your journey to conceive is the day of embryo transfer. Unlike the egg retrieval, you will be awake for the embryo transfer. Most clinics will let your partner join you. Some clinics even have on-site acupuncture, and all clinics will recommend a plan for your care the day after transfer — sometimes recommending rest or bedrest. If you’re working, coordinating time off can cause some added stress.
The 10 day wait
While the shots, blood draws, and procedures, may seem like the hardest part, having to wait 10 days to two weeks to take a pregnancy test tends to be the most trying. While most people don’t get pregnant on the first try, which can be very challenging, your odds increase with subsequent cycles.
Reviewed by the Ovia Health Clinical Team
- Abbara, Ali, et al. “Follicle size on day of trigger most likely to yield a mature oocyte.” Frontiers in endocrinology 9:193. April 2018. https://www.frontiersin.org/articles/10.3389/fendo.2018.00193/full
- Murdock, Cynthia. “IVF Attrition Rate: Why Don’t All Eggs Create Embryos?” Reproductive Medicine Associates. April 2020. https://www.rmact.com/fertility-blog/ivf-attrition-rate
- Sarkar, P., et al. “Duration of gonadotropin stimulation is predictive of IVF outcome.” Fertility and Sterility 108.3:e231. October 2017. https://www.fertstert.org/article/S0015-0282(17)31218-9/pdf
- Smith, Andrew DAC, et al. “Live-birth rate associated with repeat in vitro fertilization treatment cycles.” JAMA. 314.24. 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934614/