Understanding the Different Stages of IVF

What are the different stages of IVF? Consider this your at-a-glance guide for IVF (In Vitro Fertilization) from consultation to conception.

The IVF process can be broken down into 10 general stages. While the specific medications and timeline are unique to everyone, this lineup provides a general overview of what you can expect and when.

The first thing you should know? Actually starting an IVF protocol can take months. Coordinating your cycle with the clinic's availability and topping that with a bevy of required baseline testing means that your start date might not be as near as you'd like. So, if it’s something that you are even just considering, time is of the essence.

Just how common is IVF?

Infertility affects an estimated 10-15% of the population, and often, Invitro Fertilization (IVF) can seem like a simple one-size-fits-all solution. After all, tons of parents conceive through IVF each year. Far from a simple solution however, IVF is an intensive process which isn’t right for everyone. On the other hand, IVF can help couples and individuals who wouldn’t otherwise be able to conceive. That’s where understanding the full process comes in handy. Whether you’ve been trying to conceive for years or just a few months, this guide can walk you through the complex process of in vitro fertilization to get you started on the right foot.

What you need to know before starting fertility treatment:

Consultation – The first step in any medical procedure starts with a regular office visit. The best way to get started is by scheduling a consultation with a qualified reproductive specialist, typically a Reproductive Endocrinologist (RE), though some OBGYNs may be able to help get you on the right track at first too. Either way. your doctor will be able to go over your medical history, order any necessary diagnostic tests, and discuss your best treatment options. Though many assume that any difficulty conceiving can be fixed with IVF, your doctor may offer less invasive or less costly measures first, depending on your unique medical needs.
Bloodwork – All reproductive medical procedures generally start with bloodwork to test hormone levels and make sure that everything is ready to go before trying to conceive. Bloodwork might help reveal the source of your difficulty conceiving and can often influence the kinds of medication or supplements your doctor will prescribe. Most Reproductive Endocrinologists (REs) will also monitor hormone levels throughout the entire IVF cycle to check that the medications are working and keep an eye out for any possible complications from the medications.
Insurance – IVF costs vary from state to state and even from one specialist to the next, but it always carries a big price tag. In the USA, many insurance plans do not offer infertility coverage, so IVF can incur a significant out-of-pocket cost. If your plan does offer infertility coverage, you’ll want to check their maximum payout, your co-pay or percentage, and whether things like facility costs and medications are covered in addition to the doctor’s time. Many fertility practices, however, offer payment plans or discount programs, so it never hurts to ask about financing ahead of time.
Medications – Your doctor will prescribe a list of medications with instructions for home administration. Since these medications aren’t generally carried by typical pharmacies, they have to be ordered ahead of your planned IVF cycle, and they usually make up a decent chunk of the overall cost of IVF, which, unfortunately, has to be paid upfront. Your doctor may be able to guide you to needs-based discount programs, but these do take time to get approved. It’s important to plan for medication costs ahead of time, since following the exact instructions for timing and dosage of medication will make or break a round of IVF.
Counseling – Experiencing infertility causes a lot of stress for couples and individuals alike. Consider seeking help from a qualified mental health professional to manage the emotional toll that fertility treatment can take. Never underestimate the impact that trying to conceive can have on relationships with friends, family and loved ones.

Ok, now for the good stuff. Here’s a general outline of what’s to come if you’re about to start IVF:

What are the different stages of IVF?

IVF Stage 1: Ovulation Induction

First, medications are taken to stimulate follicle growth, which will produce multiple eggs at once. Then, a trigger shot is used to initiate ovulation at just the right moment.

IVF Stage 2: Egg Retrieval

With the patient under anesthesia, the doctor uses a needle and syringe to collect all available eggs.

IVF Stage 3: Fertilization

Embryologists will combine the collected eggs with the patient’s given (or chosen) sperm sample and monitor their growth process.

IVF Stage 4: Transfer

Generally, after a few days, one to two high-quality embryos will be transferred into the womb via a catheter.

IVF Stage 5: Two Week Wait

Just as with a natural pregnancy, it takes about two weeks post transfer to test positive for pregnancy hormones.

How does ovulation induction work?

Whether you are thinking about pursuing IVF and doing your research, or, you are already well on your way in the journey, understanding what’s actually happening to your body during each phase can help ease you through the process a bit more. Infertility can make you feel so powerless, knowledge can be empowering.

Begin Birth Control

This step may seem counterintuitive, but your RE needs to regulate the timing of your cycle. You may only have to take The Pill for a week or two, depending on where you are in your cycle and when your planned IVF round is scheduled to begin. Essentially, the birth control ensures that your body starts the IVF cycle from ground zero rather than any other stage of your normal cycle.

Give blood

Now it’s time for baseline exams & monitoring. At the start of your cycle, your RE (Reproductive Endocrinologist) will order blood work as well as a pelvic ultrasound to check your ovaries and uterine lining. Your doctor will use these initial results for comparison as they monitor follicle growth throughout the cycle.

Stimulation

Usually lasting about one to two weeks, this stage involves the injection of hormonal medications which manipulate the development and release of ova. Medications involve a class known as Gonadotropins, which cause multiple follicles to form and develop into mature eggs. Some commonly prescribed Gonadotropins include Gonal-f, Menopur, Repronex, and Bravelle.

In addition, you may be prescribed one or more medications intended to prevent premature ovulation, the most well-known of which is called Lupron. All of these medications are typically injected just under the skin of the belly (or sometimes the hip) at home by the patient. Your RE should make sure you understand how and when to use each medication. Timing medications correctly is crucial and could change according to the results of your ongoing ultrasounds/bloodwork.

Trigger Shot

The final step of ovulation induction involves an HCG (human chorionic gonadotropin) Shot which will cause the follicles to rapidly mature and trigger ovulation within a period of about 36 hours. This shot must also be carefully timed so that ovulation doesn’t come too early or too late. This step leads into the next stage of IVF, egg retrieval, which must be performed as close to the moment of ovulation as possible.

What are the side effects of ovulation induction?

The ovulation induction process can take a toll on many patients due to the number and amount of active hormones involved. Many patients will experience symptoms commonly associated with PMS such as bloating, headaches, breast tenderness, mood swings, nausea, and tenderness in the pelvic region. In addition, superficial bruises or skin irritation can form at or around injection sites, which may or may not cause additional tenderness to those areas. Side effects are generally mild to moderate and do not typically interfere with the activities of everyday life.

Occasionally, some serious side effects of IVF medications occur. The most common complication is called Ovarian Hyperstimulation Syndrome (OHSS), which involves enlarged ovaries and fluid buildup in the abdomen following the stimulation stage. A mild (but uncomfortable) form occurs in 10% to 20% of cycles and usually resolves quickly without complications. The more severe presentation only occurs in about 1% of the population. For more information, the American Society of Reproductive Medicine (ASRM) provides an in-depth list of possible side effects from IVF drugs.

How many eggs should I expect after stims?

In short, every woman can expect a different number of eggs to be retrieved. While it can be tempting to play the comparison game, those who have been through it will advise you to stop right there. Quantity is great but it is far from the only important factor when it comes to evaluating egg retrieval results. Here, quality, ability to fertilize and more all come into play.

There is a lot that goes into quantity alone! Below are some of the most important factors:

Age
Medication doses (more meds typically mean more eggs, but also a higher risk of OHSS)
Pre-existing health conditions such as PCOS or Premature Menopause or Peri-Menopause
Miscellaneous Factors

Generally speaking, practitioners see an average of 8-14 eggs from a typical IVF cycle. Critically, however, having a lot of eggs doesn’t necessarily mean there are a lot of good quality eggs. In fact, several studies have found that egg quality tends to decline with an overproduction of eggs. For most patients, egg quality tends to decrease as egg count increases past 15.

What is a good number of eggs to get from retrieval?

Since age is one of the top determining factors in egg count and quality, many studies have been conducted to assess the typical range of quality eggs collected based on various age groups. According to one recent study:

On average, the number of eggs and the total number of mature eggs retrieved for people decreased significantly as age increased.
Patients up to age 35 had about 14 mature eggs retrieved in one cycle on average.
40-year-olds had about 8 mature eggs retrieved on average.

Another study found similar results:

In the Age Group 35-39 the best results occur with moderate numbers of about 5-9 eggs.
In the Age Group 40 and Up “there is a direct correlation between the number of eggs at retrieval and pregnancy rate.

Should I be worried if my sister, friend, coworker, etc., had more eggs than me?

Absolutely not! Comparison to someone else can’t offer a clear perspective because every IVF cycle is as unique as the patient undergoing treatment. Egg quality and count will vary and so will individual stress levels, biology, medical history, and everything else. Because of how complex and unpredictable fertility treatment can be, someone with 10 mature eggs may end up with only 1 viable embryo while someone with only 5 mature eggs could see all five viable and ready to go.

If I do IVF, what could go wrong?

Perhaps the most common thing that can “go wrong” in IVF is a failed cycle. Emotionally, financially and physically taxing, the news that “it didn’t stick” can be debilitating so do prepare yourself. IVF is not a guarantee. Even though the procedure gets less reliable as age goes up, many folks do go on to have successful pregnancies at 40 years of age and older.

Some other things that could steer your fertility treatment off course include:

Delay due to adverse side effects. For example, OHSS (Ovarian Hyper Stimulation Syndrome) may mean you have to wait to implant your mature embryo while the OHSS is treated.
Unexplained Egg Quality Failure – Rarely, none of the eggs harvested in a given cycle are viable. This can occur due to age or some medical conditions.

But worrying now certainly won’t do you any good. Focus on the positive - the exciting chapter that you are about to embark upon! At the start of your IVF journey, the best you can do is live a healthy lifestyle, educate yourself with trusted resources, and proceed with hope. Modern medicine has opened up doors that no other generation of parents has had access to, so thankfully, countless parents can thank assistive reproductive care like IVF for their growing families. Yours just might be next.