Step by step breakdown of the IVF process

To start with: what exactly is IVF? 

The word “in-vitro” literally means “in glass”, which refers to work done in a laboratory. In the same way, IVF entails the retrieval of eggs from one’s ovaries, to be fertilized with sperm in a laboratory. Eggs that are fertilized become embryos, which are then transferred to a patient’s uterus. Pregnancy then occurs when the embryo attaches to the uterus lining. 

Step 0. Pre-treatment Consultation and Testing:

Before you can start the actual IVF (in-vitro fertilization) process, your fertility clinic will conduct various fertility tests to fully understand your current fertility and overall health status. This may include:

• Blood tests to check on various hormone levels related to fertility, as well as to assess your ovarian reserve (the amount of eggs you have remaining), such as the Anti-Mullerian hormone test.
• Other blood tests to evaluate your health
• Genetic carrier screening to check for certain genetic disorders
• Transvaginal ultrasound to evaluate the cervix, uterus and ovaries
• Sonohysterogram to evaluate for uterine abnormalities (fibroids, polyps or scar)
• Hysterosalpingogram to evaluate the fallopian tubes and uterus

If you have a male partner who will be providing sperm as part of the IVF process, they will also need to undergo blood tests and a semen analysis to check for male fertility issues.

Although this may sound tedious, these tests are vital to set you up for success. Because the IVF process requires significant time and effort, it is critical that your fertility clinic has enough information to determine the best course of action and sidestep any potential issues further down the road. Specialists may also prescribe medication before the process starts to better prepare your body for the next phase.

Once the tests are complete and you have been given the green flag to go ahead, it is time for the actual IVF process to begin.

Step 1: Ovarian stimulation 

The goal of IVF is to access multiple mature eggs in a single cycle. This makes reproduction more “efficient”; The more eggs retrieved, the more eggs we are able to fertilize into embryos, which gives us more chances of having a successful pregnancy. In order to stimulate egg development, you will need to take injectable medication for 8-14 days. This is usually in the form of Follicle Stimulating Hormone (FSH) injections, which help to develop the ovarian follicles and the eggs stored inside.

Throughout this period, your fertility clinic will also conduct regular blood tests and ultrasounds to monitor the development of your follicles and make sure everything is on track. They will also tell you when you need to do a final “trigger injection”, which will cause final egg maturation and prepare the eggs for ovulation (the phase in your menstrual cycle when an egg is released from your ovary). This then leads to the next step: egg retrieval.

Step 2: Egg Retrieval 

This is a minor surgical procedure that usually takes about 15 to 30 minutes. You will be sedated throughout the procedure. Using ultrasound technology, a specialist will insert a needle through the vaginal wall and into the follicles of each ovary to retrieve the eggs. Eggs are microscopic and found within the fluid-filled ovarian follicles.

The average number of eggs collected will vary from person to person, and depends on multiple factors including age, ovarian reserve and medical history. The specialist will have access to your medical information from your prior testing, and will make use of this information to gauge approximately how many eggs they can expect to retrieve. 

Step 3: Egg fertilization

After the eggs have been retrieved, the next step is fertilization, which will be done on the same day. This can be done using either a partner’s sperm or a donor’s sperm. For couples who are using a partner’s sperm, the male partner will have to produce a sample on the day of the egg retrieval. 

The healthiest sperm will be collected from the sample, and then used for fertilization with the eggs collected. This is the process known as insemination. Normally, a sperm will take a few hours to naturally inseminate an egg. Specialists can also use the intracytoplasmic sperm injection (ICSI) technique to individually inject a single sperm into an egg to facilitate insemination. 

Step 4: Embryo development

Once an egg has been successfully fertilized, it becomes an embryo. Specialists will monitor the development of embryos in special incubators that mimic the best environment for growth. The embryos will continue to develop over the course of the next 5-6 days. At each stage of growth, specialists will evaluated the embryos for characteristics of a healthy embryo:

• Day 3: After 3 days the embryo enters the cleavage stage, and ideally should have 6 to 10 cells, although embryos with 3-6 cells can also develop into healthy fetuses. 
• Day 5-6: After 5 or 6 days the embryo enters the blastocyst stage, and ideally has roughly 100 cells. Specialists will also be looking at how tightly packed and defined the cells within the embryo. 

At the blastocyst stage specialists will be able to give the embryo a grade, which is associated with the likelihood of the embryo leading to a successful pregnancy. Be aware, however, that a high quality embryo is not a guarantee of conception, and an embryo with a lower grade may still result in a successful pregnancy. 

This is also the point at which preimplantation genetic testing (PGT) may be done. PGT is a screening test conducted on embryos to analyze them for genetic disorders or chromosomal abnormalities. Embryos are frozen at the blastocyst stage and sent to a laboratory, where a small number of cells from the embryo are taken for testing. Once the test results are out, embryos that are deemed suitable are then selected and thawed for transfer into the uterus at a later cycle. 

Step 5: Embryo transfer

The final step is to place the embryo(s) into your or a surrogate’s uterus. This is a simple procedure that takes about 5 minutes - a small tube is inserted through the cervix and into the uterus to place the embryo(s) within the uterine cavity.

Two weeks after the embryo transfer, a pregnancy test will then be conducted to determine if the IVF process has been successful. 

All in all, from stimulation to getting the pregnancy test results, an IVF cycle can take about 5 to 6 weeks. Do note that this doesn’t include the pre-treatment consultation and testing nor the PGT process. It may also take additional time to sync your menstrual cycle with the treatment cycle.

Because the IVF process can take a toll on you both physically and mentally, consider having trusted family members or friends you can talk to about the IVF process, especially if it is your first time. Fertility support groups are also available both online and offline for you to learn from others and share your own experiences. Check with your fertility clinic to find out more about these support groups and other helpful resources.

Fertility specialists and scientists have done the utmost to ensure the IVF process is as safe and efficient as possible. Regardless, it is still a significant commitment for anybody, and we encourage you to understand each step of the process so that you will have full information on what’s next in your fertility journey!