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Let’s break down the IVF process

IVF can feel like a daunting process and one that you don’t have much control over, but when I was going through my IVF cycles I found one of the things that helped was knowing exactly what each cycle entailed and what to expect next. So I have compiled a step-by-step guide to IVF for you that you can use for your own journey. Yours might deviate a little bit from this but it’s a rough guide to follow, which I hope will have you feeling more in control of your next cycle.

Working out the details of your cycle

Usually in a woman’s cycle, the body produces Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH); together they aid in the growth and release of an egg within the ovary. Only one of these will mature enough to reach ovulation which occurs about two weeks before menstruation starts.

But during an IVF cycle the goal is to have several eggs mature at the same time, and this is achieved with FSH injections which help the developing eggs to mature before collection. Then there is pituitary suppression. There are 2 cycle types:

  1. Long down-regulation – pituitary suppression before starting stimulation
  2. Antagonist cycle – pituitary suppression after the stimulation has started

Which suits you best is normally a conversation with your fertility specialist. All the information about your specific treatment cycle should be given to you by your fertility coordinator and it will help you to set out the dates and requirements for your individual medications.

This is the best time to ask any questions about this particular cycle and express any requests you may have.

Ovarian stimulation

This first stage of the cycle involves the ovaries being stimulated in order to promote the growth of follicles containing eggs. This is where daily FSH injections come in and is usually for between 9 to 14 days depending on your individual circumstances. The FSH dose used is slightly higher than what a woman produces naturally – this is in the hope of stimulating the growth of multiple follicles. You will probably have regular ultrasounds and blood tests during this time so be prepared for these appointments. It’s also worthwhile freeing up some time for your injections. You may choose to do them yourself or have your partner help you but either way it’s not something that you want to rush so make sure you allow ample time.

The trigger injection

The injection of human chorionic gonadotrophin (hCG) is designed to aid the egg’s final maturation and loosen it from the follicle wall. This happens once the numbers and size of follicles are adequate via ultrasound. For this reason you won’t know the exact date or time as it is dependent on how your body responds each cycle and your fertility coordinator will work this out for you as your ultrasound results come in.

Once you get to this point, you will have a clearer idea of the rest of the cycle as your egg retrieval will take place 34 – 36 hours after the final injection. For this reason the timing of this injection has to be spot-on so make sure you take note of that information.

Egg retrieval time

Egg retrieval requires a light sedation; for some people you may feel slightly groggy and sore afterwards so it is a good idea to schedule in some down time afterwards where you can rest, ideally for the rest of the day if possible. Make sure you take your partner or a support person who can stay with you and help you to get home (you will need it).

During egg retrieval an ultrasound-guided probe is passed through into each follicle and the fluid is extracted to look for eggs. It is a relatively short procedure (around 20-30 minutes) but one of the most important steps in the process as this is when you find out how many eggs you are able to take forward with you.

This is also generally the time for sperm retrieval and the process around this will depend on your clinic. You may also be asked about genetic testing of your embabies, have a think about this prior so you know what your preferences are.

Fertilisation (insemination) and embryo development

Once the sperm sample is washed and concentrated, it is added to the eggs and then placed in an incubator overnight. The next day, the eggs are examined for signs of fertilisation and then kept in the incubator for an additional 48 hours. Your fertility specialist will generally keep you updated on the numbers and development of your embabies during this process and it will look different for every couple. 

This is often an emotional time with the combination of waiting and having the pressure of getting ‘good enough’ numbers so please be kind to yourself during the time and schedule in some activities to take your mind off what is going on.

Embaby transfer

Exciting and scary all at the same time, that is how I would describe this part of the process. Embaby transfer occurs two to five days after egg retrieval and can feel like you are starting to come into the home stretch. For such a big step, this process usually only take a few minutes. The embaby chosen for transfer is inserted into a thin plastic catheter which is passed through the cervix, into the uterus and gently released. In general you only have one embaby transferred but in some cases you may have two (like my last cycle).

This is also the point where you get to choose what will happen with any remaining embabies which may be suitable for freezing so you can use them at a later date.

The 2-week wait

I always found this the toughest time as I am sure many people do. There is nothing to do but wait! It is the luteal phase of your cycle between transfer and pregnancy test. You may be taking progesterone medication which can cause some side effects as an extra bonus to the waiting. I highly recommend some distraction activities during this time as it can feel like 2 months rather than 2 weeks! It’s also a good time to think about what your plan forward will be if this cycle isn’t successful.

Vaginal spotting or bleeding can happen during this time but unless you get a full period bleed then you should continue any treatment as you may still have a successful cycle.

Pregnancy test

About 14 days after your transfer it will be time for a pregnancy test after which you will generally get a phone call to discuss your results. This generally signals the end of this cycle and will be the time when you will either be moving forward with a pregnancy or planning a new cycle. Like your whole cycle it can be an emotional time but at this point the results are final which means you may find this time the most emotional. Because of this it’s important that you acknowledge your emotions at this time and allow yourself time to feel them.

I hope this breaks down the general IVF cycle steps for you and gives you some understanding about what you might be expecting. Remember there is a purpose to this process even if at times it feels exhausting and frustrating.