Fertility experiences are all unique. Consequently, you can’t label any fertility treatment journey as ‘typical’. So, no matter the path your fertility specialist determines is the best for you, you can rest assured that you’ll be treated with compassion, care, and understanding throughout.
Most IVF cycles begin during a woman’s menstrual period. But, to make it easier to follow the various steps in the typical IVF cycle journey, we have grouped the steps into three Basic Principles of the process that are adjustable based on the patient’s needs.
Ovarian Stimulation & Egg Retrieval
Baseline Test: Day 1
The specialist schedules your office visit for day two or day three following the start of your menstrual flow. This visit is for a blood test and baseline ultrasound examination.
Ovarian Suppression: 2 – 4 Weeks
Before the specialist commences stimulation, they administer medication that suppresses the ovaries (like birth control pills). Ovarian suppression is typically from 1 to 4 weeks long. Your specialist then schedules another office visit at the end of this period, where they perform an ultrasound and blood test to ensure that they have achieved downregulation.
Ovarian Stimulation: 8-12 Days
The specialist uses injectable fertility medications to commence ovarian stimulation. This step happens on a day selected by the cycle coordinator. Then, you begin taking a precise dosage of fertility medications daily (preferably in the evening to accommodate any necessary dosage adjustments).
Cycle Monitoring: Starting Day 5
Regular office visits begin on day five of stimulation, then continue every one to two days until follicle aspiration. The specialist will perform an ultrasound and blood test during every visit. Additionally, you must call at the end of the day to get your blood test results and receive further instructions for continued medication.
Ovulation Induction: Between Day 8 and 12
The specialist triggers ovulation using an injection. They administer this trigger when they deem the follicles mature, typically between 8 and 12 days after you start receiving injectable fertility medications. The HCG dose timing is critical because they perform follicle aspiration 36 hours after the HCG.
Egg Retrieval: 36 Hours After HCG
The specialist will schedule your retrieval procedure. The aspiration process takes less than 30 minutes, so you can plan to have about a two-hour visit on the day of follicle aspiration.
Fertilisation & ICSI
Sperm Collection: Day of Egg Retrieval
Your fertility specialist obtains sperm from your partner (or donor, if that is the case) on the same day they perform the egg retrieval. Occasionally, they may request a final specimen the morning after egg retrieval. However, this is only necessary if there is sub-optimal fertilization and the embryologists are sure that an additional sperm sample may be useful. Note that it is best to abstain from ejaculation for two to seven days before the first sperm specimen. This approach optimizes sperm quality. In most cases, this will mean abstinence after the seventh day of fertility medications to the woman.
Fertilization: Day of Egg Retrieval
At this juncture, the specialists join the eggs and the sperm to allow fertilization. In most cases, they add a sperm solution to the eggs, at which point fertilization occurs naturally. Alternatively, they will conduct an Intra-Cytoplasmic Sperm Injection (ICSI) if indications call for it.
Assisted Hatching:
If the need arises, specialists will conduct Assisted Hatching to facilitate fertilization. This procedure is routinely performed for patients having preimplantation genetic testing done.
Preimplantation Genetic Test: 5-6 Days After Retrieval
Upon indication, specialists perform preimplantation genetic testing (testing for genetic conditions, chromosomal status, and gender determination) about 5 to 6 days after fertilization- when the embryo is at the blastocyst stage.
Embryo Transfer & Luteal Phase Support
Embryo Transfer: 3-5 Days After Egg Retrieval
Fresh embryo transfers typically occur around 3 to 5 days after egg retrieval. Frozen embryo transfers are usually scheduled during the week. This procedure is a simple one and doesn’t require anesthesia. However, the specialists occasionally give patients Valium to help with muscle relaxation. Therefore, it is essential to have someone drive you home afterward. For time scheduling purposes, please note that you must remain in bed for 30 minutes after the embryo transfer.
Excess Embryo Cryopreservation:
If there are any excess viable embryos left after the transfer back to your uterus, they may be frozen at this juncture.
Luteal Phase Support: Day of Transfer
You will get instructions outlining progesterone supplementation for your embryo transfer. But first, you must prepare to administer the progesterone via vaginal suppositories or injections. However, fertility specialists recommend using the progesterone until the end of the pregnancy’s first trimester or upon a negative second blood pregnancy test.
Pregnancy Testing: Days 12 and 14
Your physician will perform at least two pregnancy tests following the embryo transfer, after which they will contact you with the results.
The IVF journey is quite involved and often extended. However, you only need the right support system to help see you through. Moreover, remember that you can turn to your doctor for answers and reassurances to any questions and concerns you may encounter throughout the process.
