Understanding IVF Treatment

IVF is the most effective fertility treatment available, helping millions of couples worldwide achieve pregnancy.

What Is IVF?

In Vitro Fertilization (IVF):

• Eggs retrieved from ovaries
• Fertilized with sperm in laboratory
• Embryos develop for 3-5 days
• Best embryo(s) transferred back to uterus
• “In vitro” means “in glass” (outside the body)

IVF bypasses many fertility obstacles:

• Blocked fallopian tubes
• Severe male factor
• Endometriosis
• Unexplained infertility
• Age-related factors
• Failed IUI cycles

Most successful fertility treatment available.

Best Candidates for IVF

When IVF Is Recommended

Blocked or damaged fallopian tubes:

• IVF bypasses tubes completely
• Most common reason for IVF originally

Severe male factor infertility:

• Low sperm count
• Poor motility or morphology
• Combined with ICSI (single sperm injection)

Endometriosis:

• Stage III or IV
• Failed other treatments

Advanced maternal age:

• Over 40 years old
• Low ovarian reserve
• Limited time

Unexplained infertility:

• All tests normal
• Failed IUI cycles (usually after 3-6)

Ovulation disorders:

• Severe PCOS not responding to other treatments

Previous tubal ligation:

• Alternative to surgical reversal

Genetic screening needed:

• Family history of genetic disorders
• Preimplantation genetic testing (PGT)
• Prevent passing on genetic conditions

Single women or same-sex couples:

• Using donor sperm
• Using donor eggs

Who Benefits Most

IVF success rates highest for:

• Women under 35
• Good ovarian reserve
• Good quality embryos
• No other health complications
• First or second IVF cycle

The IVF Process: 7 Steps

Complete Timeline: 4-6 Weeks Per Cycle

From start of medications to pregnancy test takes about one month.

Step 1: Ovarian Stimulation (10-14 Days)

Goal: Stimulate ovaries to produce multiple eggs

Medications (injectable):

• Gonadotropins (FSH/LH) – stimulate follicle growth
• Started Day 2-3 of cycle
• Daily injections
• Dosage based on age, weight, ovarian reserve

How many eggs we want:

• More eggs = more chances
• Goal: 8-15 mature eggs
• Each woman responds differently

You’ll learn to give yourself injections – clinic teaches you, easier than it sounds!

Step 2: Monitoring (Throughout Stimulation)

Frequent clinic visits every 2-3 days:

Transvaginal ultrasounds:

• Count developing follicles
• Measure follicle sizes
• Each follicle contains one egg
• Looking for follicles 18-20mm (mature)

Blood tests:

• Estradiol (estrogen) levels
• Indicates follicle maturity
• Helps adjust medication doses
• Predicts optimal retrieval timing

Typical monitoring schedule:

• 3-5 monitoring appointments during stimulation
• More frequent as you get closer to retrieval
• Early morning appointments usually

Monitoring is critical – ensures safety and optimal timing.

Step 3: Preventing Premature Ovulation (Days 5-10 of Stimulation)

Additional medications added mid-cycle:

GnRH antagonist (Cetrotide) OR GnRH agonist (Decapeptyl/Gonapeptyl):

• Prevents early ovulation
• Keeps eggs in follicles until retrieval
• Daily injection
• Added when follicles reach certain size

Without these medications:

• Eggs could be released before retrieval
• Cycle would be canceled
• Critical part of protocol

Step 4: Trigger Shot (36 Hours Before Retrieval)

When follicles are mature:

hCG injection (trigger shot):

• Final egg maturation
• Must be given at EXACT time specified
• Usually between 9pm-midnight
• Ovulation occurs 36-40 hours later
• Retrieval scheduled before ovulation happens

Timing is everything!

• Set alarms
• Double-check time
• Have backup plan
• Missing trigger means cycle canceled

Step 5: Egg Retrieval (Day 0)

Outpatient surgical procedure:

Preparation:

• No eating/drinking after midnight
• Arrive 1-2 hours before procedure
• Partner provides sperm sample (or donor sperm thawed)
• IV placed

The procedure (20-30 minutes):

• General anesthesia or conscious sedation (you’re asleep)
• Transvaginal ultrasound-guided
• Needle inserted through vaginal wall into each ovary
• Fluid aspirated from each follicle
• Eggs extracted
• No incisions, no stitches

Immediately after:

• Recovery room 1-2 hours
• Told how many eggs retrieved
• Some cramping and bloating
• Rest of day off

Recovery:

• Rest day of retrieval
• Most return to normal activities next day
• Mild cramping and bloating for few days
• No restrictions on movement

Partner’s role:

• Drive you home (cannot drive after anesthesia)
• Provide semen sample
• Emotional support

Step 6: Fertilization & Embryo Development (Days 1-5)

Happening in the lab while you recover:

Day 0 (Retrieval Day):

• Eggs assessed for maturity
• Only mature eggs (Metaphase II) can be fertilized

Day 1 (Next Morning):

• Sperm and eggs combined (standard IVF) OR
• Single sperm injected into each egg (ICSI)
• You’re told fertilization results
• Example: “12 eggs retrieved, 10 mature, 8 fertilized”

Day 2-3:

• Embryos dividing
• Assessed for quality
• Some embryos stop developing (normal)

Day 5-6 (Blastocyst Stage):

• Embryos have 100+ cells
• Highest quality stage
• Best for transfer or freezing
• Not all embryos make it to blastocyst (normal attrition)

Typical numbers:

• 12 eggs retrieved → 10 mature → 8 fertilized → 4-5 blastocysts

Daily updates:

• Some clinics call daily
• Others call Day 1, then day of transfer
• Waiting is stressful

Embryo grading:

• Quality assessed
• Grade helps predict success
• Grade 4AA or 5AA = excellent
• Lower grades can still succeed

Step 7: Embryo Transfer (Day 3 or Day 5)

Placing embryo(s) into uterus:

Day 3 transfer (less common now):

• 6-8 cell embryo
• Sometimes done if few embryos

Day 5 transfer (blastocyst – preferred):

• More developed
• Higher implantation rates
• Better selection of best embryo

The procedure (5-10 minutes):

• No anesthesia needed
• Full bladder (helps visualize uterus)
• Speculum inserted
• Soft catheter through cervix
• Embryo(s) placed in optimal uterine location
• Ultrasound guidance
• Brief rest after
• Go home same day

Pain level:

• Usually painless
• Mild cramping possible
• Like Pap smear

How many embryos transferred:

• Usually 1 (single embryo transfer)
• Sometimes 2 (age over 38, previous failures)
• Rarely more than 2 (multiple pregnancy risk)
• Goal: one healthy baby

Remaining embryos:

• High-quality blastocysts frozen (cryopreserved)
• For future cycles
• Excellent survival rates with freezing

After transfer:

• Rest 10-15 minutes
• Resume normal activities
• No bed rest needed (doesn’t improve success!)
• Wait for pregnancy test

Step 8: Luteal Phase Support

Progesterone supplementation:

Medications:

• Vaginal suppositories (Cyclogest) most common
• OR injections
• OR oral capsules

Why needed:

• Ovulation medications suppress natural progesterone
• Progesterone supports implantation
• Critical for early pregnancy

Duration:

• Started day after retrieval or day of transfer
• Continued through pregnancy test
• If pregnant, continued 8-12 weeks into pregnancy

Side effects:

• Vaginal discharge/irritation with suppositories
• Breast tenderness
• Fatigue
• Symptoms similar to early pregnancy (confusing!)

Step 9: Pregnancy Test (Day 9-14 After Transfer)

The two-week wait (actually 9-14 days):

Blood test at clinic:

• Measures hCG (pregnancy hormone)
• 9-14 days after transfer (depends on protocol)
• More accurate than home tests

Positive result:

• Second blood test 2-3 days later (should double)
• Ultrasound at 6-7 weeks (see heartbeat)
• Continue progesterone
• Graduate to regular OB care at 8-10 weeks

Negative result:

• Stop progesterone
• Period starts few days later
• Debrief with doctor
• Plan next steps

Success Rates

By Age (Fresh Embryo Transfer)

Live birth rate per retrieval:

• Under 35: 45-50%
• 35-37: 40-45%
• 38-40: 30-35%
• 41-42: 15-20%
• 43-44: 5-10%
• Over 44: Under 5%

Success rates decline significantly with age due to egg quality.

Frozen Embryo Transfer

Success rates similar or slightly better than fresh:

• No ovarian stimulation
• Better uterine receptivity
• Increasingly common approach

Factors Affecting Success

Better outcomes with:

• Younger age
• Higher ovarian reserve (more eggs)
• Good quality embryos
• Normal uterine cavity
• Healthy lifestyle factors
• First or second IVF cycle

Lower success with:

• Advanced age (especially over 40)
• Low ovarian reserve
• Poor embryo quality
• Uterine abnormalities (fibroids, polyps, scarring)
• Obesity or underweight
• Smoking
• Multiple previous failed cycles

Cumulative Success Rates

Multiple cycles increase chances:

• After 3 complete cycles: 65-75% under age 35
• Most who continue treatment eventually succeed
• Each cycle provides information for optimization

Risks and Complications

Common Side Effects

From medications:

• Bloating and abdominal discomfort
• Mood swings
• Breast tenderness
• Headaches
• Fatigue

From egg retrieval:

• Cramping and bloating for few days
• Light spotting
• Ovaries enlarged and tender

Serious Complications (Rare)

Ovarian Hyperstimulation Syndrome (OHSS):

• Overstimulated ovaries
• Severe bloating, rapid weight gain, difficulty breathing
• 1-2% of cycles
• Higher risk: PCOS, young age, high egg numbers
• Can be serious, requires monitoring
• Call clinic if severe symptoms

From egg retrieval (very rare):

• Infection (less than 1%)
• Bleeding
• Damage to surrounding organs
• Anesthesia complications

Multiple Pregnancy

Risk with multiple embryo transfer:

• Twins: 10-20% if two embryos transferred
• Higher-order multiples: Very rare with 1-2 embryos
• Single embryo transfer minimizes risk

Multiple pregnancy risks:

• Preterm birth
• Low birth weight
• Pregnancy complications
• C-section more likely

Most clinics recommend single embryo transfer under age 38.

Emotional Journey

The Roller Coaster

IVF is emotionally intense:

• Hope at start of cycle
• Anxiety during monitoring
• Fear before retrieval
• Obsessing over fertilization reports
• Waiting after transfer is torture
• Devastation if negative

This is normal. IVF is emotionally exhausting.

Coping Strategies

Throughout cycle:

• Stay busy during stimulation
• One step at a time
• Connect with others going through it
• Self-care priorities
• Plan distractions for two-week wait
• Prepare for either outcome

Partner Support

IVF affects both partners:

• Different coping styles normal
• Communicate openly
• Attend appointments together when possible
• Share responsibilities
• Be patient with each other

Insurance Coverage

Varies dramatically:

• Some states mandate coverage
• Many plans exclude fertility treatment
• Some cover diagnostics but not treatment
• Check your specific benefits

Questions for insurance:

• What’s covered?
• Lifetime maximum?
• How many cycles?
• Pre-authorization required?

Multiple Cycles

Many need more than one cycle:

• Budget for 2-3 cycles
• Frozen embryo transfers less expensive
• Financial stress is real

Financial assistance:

• Some clinics offer payment plans
• Medication discount programs
• Grants and scholarships available
• Shared risk programs (money-back guarantees)

Improving Your Success

Before Starting IVF

Optimize your health:

• Achieve healthy weight (BMI 18-30 ideal)
• Prenatal vitamins with folic acid 3+ months before
• Stop smoking (dramatically reduces success)
• Limit alcohol
• Reduce caffeine (under 200mg daily)
• Manage stress
• Exercise moderately
• Treat any underlying conditions (thyroid, diabetes, etc.)

Both partners should optimize health.

During IVF Cycle

Follow protocol exactly:

• Take medications precisely as prescribed
• Don’t miss doses
• Attend all monitoring appointments
• Follow dietary and activity recommendations

Support your body:

• Stay hydrated
• Eat protein-rich diet
• Get adequate sleep
• Gentle exercise okay
• Avoid intense exercise during stimulation

After Transfer

No special interventions proven to help:

• Bed rest doesn’t improve success (normal activities fine)
• No special diet required
• Moderate exercise okay
• Sex okay (though you may not feel like it)

Focus on:

• Reduce stress
• Stay busy
• Take progesterone as prescribed
• Be patient

If IVF Doesn’t Work

Next Steps

After failed cycle:

• Grieve the loss
• Debrief with doctor (what can be improved?)
• Review embryo development
• Adjust protocol if needed
• Consider additional testing

Each cycle provides information to improve next attempt.

When to Keep Trying

Many succeed on later cycles:

• Protocol adjustments help
• Different outcomes each cycle
• Don’t give up too soon

When to Stop or Consider Alternatives

Consider alternatives if:

• Multiple failed cycles with good embryos
• No embryos developing
• Financial or emotional exhaustion
• Medical reasons

Other options:

• Donor eggs
• Donor embryos
• Surrogacy
• Adoption
• Child-free living

Questions to Ask Your IVF Doctor

Before starting:

✓ What’s my expected success rate?

✓ What protocol do you recommend for me and why?

✓ How many eggs do you expect to retrieve?

✓ Do you recommend PGT testing?

✓ How many embryos will you transfer?

✓ What’s your policy on single embryo transfer?

✓ What are the main risks for me specifically?

✓ What if I don’t respond well to medications?

✓ What’s included in the cycle cost?

Remember

IVF is a powerful technology that has helped millions of people become parents. While it’s physically, emotionally, and financially demanding, success rates are good.

IVF gives you the best chance of pregnancy for many conditions.

Each cycle is an opportunity. Even if it doesn’t work, you gain information.

Success rates are encouraging, especially for younger women and with multiple cycles.

You are strong for doing this. IVF takes courage.

Whatever the outcome, you will get through this.