IVF Step by Step: What to Expect During the IVF Process
If you’re considering IVF, one of the biggest challenges can be simply understanding what to expect.
Many people start the IVF process feeling overwhelmed by unfamiliar terms, medications, testing, and procedures. In this guide, we’ll walk through the IVF process step by step so you can better understand how treatment works, what happens at each stage, and the questions you should ask before getting started.
IVF Procedure Step-by-Step: What to Expect During IVF
Timestamps:
00:00 What to Expect During IVF Step by Step
01:00 How to Prepare for IVF
01:55 Does IVF Make You Run Out of Eggs Faster?
03:30 Fertility Testing Before IVF (AMH, AFC & Semen Analysis)
04:20 How IVF Protocols Are Chosen
04:55 IVF Suppression vs Stimulation Explained
06:35 IVF Monitoring Appointments and Bloodwork
07:05 What Is the IVF Trigger Shot?
08:40 Egg Retrieval Procedure: What to Expect
09:40 IVF Fertilization: Conventional IVF vs ICSI
10:25 How Sperm Selection Works
10:40 IVF Attrition: From Eggs to Blastocysts
11:20 Fresh Embryo Transfer vs Frozen Embryo Transfer (FET)
12:00 PGT-A Genetic Testing Explained
12:30 How Age Affects Embryo Quality
12:45 Questions to Ask Before Starting IVF
13:10 IVF Success Rates by Embryo Transfer
13:50 IVF Cycles vs Frozen Embryo Transfer (FET)
IVF Doesn’t Replace Healthy Habits
One common misconception is that once you begin IVF, lifestyle factors no longer matter.
The reality is that IVF can only work with the eggs and sperm available. While IVF can help overcome certain fertility challenges, egg quality and sperm quality still play an important role.
According to Dr. Natalie Crawford, the life cycle of sperm is about 90 days. Eggs remain in the body throughout a woman’s lifetime, but the 60 to 90 days before they mature are an important window when they are sensitive to the environment around them.
Because of this, making healthy lifestyle choices before and during treatment may positively impact both egg quality and sperm quality.
Does IVF Make You Run Out of Eggs Faster?
One fear many patients have is that IVF will deplete their egg supply.
Dr. Crawford explains this using her “vault” analogy.
Imagine your ovaries contain a vault where all of your eggs are stored. Each month, a group of eggs comes out of the vault. In a natural cycle, one egg typically matures and ovulates while the rest are lost.
During IVF, doctors can only work with the eggs that have already come out of the vault that month. The goal is to help more of those eggs mature instead of allowing only one to develop.
Because IVF does not access additional eggs inside the vault, it does not make you run out of eggs faster. It simply gives more of that month’s eggs an opportunity to mature.
Step 1: Fertility Testing Before IVF
Before beginning IVF, proper evaluation is essential.
Testing typically includes:
Antral Follicle Count (AFC) through ultrasound
Anti-Müllerian Hormone (AMH) blood testing
Semen analysis
AFC and AMH help estimate ovarian reserve, while a semen analysis evaluates sperm quantity and quality.
These results help determine which IVF protocol may be most appropriate.
Step 2: Choosing an IVF Protocol
IVF protocols should be personalized.
According to Dr. Crawford, it is important to understand that not every patient should receive the same protocol. Factors such as ovarian reserve, endometriosis, PCOS, autoimmune conditions, and medical history can all influence treatment decisions.
She describes IVF protocols as having two primary phases:
Suppression
The goal of suppression is to prevent the brain from sending out its normal hormone signals so that follicles can begin treatment on a more equal playing field.
Suppression may involve medications such as estrogen, progesterone, testosterone, birth control pills, ovulation blockers, or brain blockers.
This phase typically lasts two to four weeks.
Stimulation
After suppression comes ovarian stimulation.
Stimulation uses high doses of follicle-stimulating hormone (FSH) to encourage multiple follicles to grow at the same time.
This phase typically lasts about two weeks.
Step 3: Monitoring During IVF Stimulation
During stimulation, patients return frequently for monitoring appointments.
Monitoring includes:
Ultrasound examinations
Bloodwork
These visits usually occur every two to three days and allow the fertility team to track follicle growth and hormone levels while adjusting medications as needed.
Step 4: The Trigger Shot
Once follicles reach the appropriate stage of development, patients take a trigger shot.
The trigger shot helps finalize egg maturation before retrieval.
Dr. Crawford explains that trigger medications may include:
hCG trigger
Lupron trigger
In some cases, both
The choice depends on the individual patient and treatment plan.
Step 5: Egg Retrieval
Egg retrieval generally takes place approximately 35 to 36 hours after the trigger shot.
During the procedure, a needle attached to a vaginal ultrasound is used to access and drain the follicles. The fluid collected from each follicle is sent to the laboratory, where embryologists identify the eggs.
The procedure is performed under IV sedation, typically takes about 15 minutes, and patients go home the same day.
Step 6: Fertilization
After retrieval, the laboratory begins the next stage of the IVF process.
A sperm sample is collected and fertilization occurs using one of two approaches.
Conventional Fertilization
Eggs are placed in a dish and sperm are added. Fertilization occurs naturally within the laboratory environment.
ICSI
Intracytoplasmic sperm injection (ICSI) involves selecting a single sperm and injecting it directly into an egg.
ICSI is often used when male factor infertility is present or when clinics want to reduce the risk of fertilization failure.
Some laboratories also use Zymot technology, which Dr. Crawford describes as a type of sperm selection process designed to help identify higher-quality sperm.
Typically, about 75% to 80% of mature eggs fertilize.
Step 7: Embryo Development and IVF Attrition
Following fertilization, embryos continue developing in the laboratory.
The goal is for embryos to reach the blastocyst stage, which generally occurs on day five or day six.
One of the most important concepts in IVF is attrition.
Not every egg will:
Be mature
Fertilize
Become an embryo
Reach blastocyst
Be genetically normal
According to Dr. Crawford, approximately 50% of embryos are lost between fertilization and the blastocyst stage.
Step 8: Fresh Transfer vs Frozen Embryo Transfer
Once embryos reach the blastocyst stage, there are several possible next steps.
Fresh Embryo Transfer
A fresh transfer occurs when an embryo is transferred immediately after reaching blastocyst.
Dr. Crawford notes that fresh transfers are performed less frequently today because they are associated with lower live birth rates and higher pregnancy complications.
Frozen Embryo Transfer (FET)
A frozen embryo transfer involves freezing the embryo and transferring it during a future treatment cycle after the uterus has been prepared for implantation.
PGT-A Genetic Testing
Some embryos may undergo preimplantation genetic testing (PGT).
The most common form discussed in the video is PGT-A, which evaluates chromosome number.
After biopsy, the embryo is frozen while testing is completed.
Dr. Crawford explains that age has a significant impact on the likelihood that an embryo will be genetically normal.
For example, around age 35 to 36, approximately 50% of blastocyst-stage embryos may be genetically normal, with that percentage decreasing as age increases.
Questions to Ask Before Starting IVF
Before beginning treatment, Dr. Crawford recommends discussing the following questions with your fertility specialist:
What is my ovarian reserve?
How many eggs do you expect to retrieve?
What IVF protocol will we use?
What fertilization method will we use?
Based on my age and test results, how many genetically normal embryos might we expect?
Having realistic expectations can help patients better understand the IVF process and prepare for the potential outcomes.
IVF Success Rates
According to Dr. Crawford, one genetically normal embryo transferred during a frozen embryo transfer cycle has approximately a 65% chance of success.
She also notes that cumulative success rates increase with additional embryo transfers.
After two transfers, nearly 85% of people will have a baby.
After three transfers, approximately 95% of people will have a baby.
IVF vs FET: Understanding the Difference
One important distinction is the difference between IVF and frozen embryo transfer.
IVF refers to the process of:
Growing follicles
Retrieving eggs
Fertilizing eggs
Creating embryos
A frozen embryo transfer (FET) is a separate process that involves preparing the uterus, thawing an embryo, and transferring it into the uterus.
In some cases, patients may complete multiple IVF cycles before moving on to embryo transfer.
Final Thoughts
Understanding the IVF process step by step can help reduce uncertainty and allow you to feel more prepared for treatment.
From fertility testing and ovarian stimulation to egg retrieval, fertilization, embryo development, genetic testing, and embryo transfer, IVF involves many stages. Knowing what happens at each step can help you ask informed questions and better understand your fertility treatment journey.