IVF cycles involve seven steps, including ovarian stimulation, follicular development monitoring, egg retrieval, sperm sample retrieval, insemination (by IVF or ICSI), embryo transfer, and finally, the two-week wait. In this section, we take a closer look at what each of these steps entail.

Step 1:

Ovarian stimulation During ovarian stimulation, the female partner injects herself with fertility medication in order to stimulate the growth of multiple follicles and prevent early ovulation. Depending on your clinician’s experience and other factors, you’ll either undergo the long or short protocol. 

With the long protocol, the injections typically start around day 21 of your cycle, and they help to suppress or “down-regulate” your body’s natural production of FSH and LH. All in all, a “long protocol” should take approximately four weeks. A short protocol, on the other hand, is a better option for women who have high FSH levels, or have responded poorly to previous ovarian stimulation. If you’re adhering to a short protocol, you’ll administer lower doses of injections starting on the first day of your period to block out your own ovarian function, and follow this up with injections to stimulate your follicles in the next few days. When you’re undergoing ovarian stimulation, drink plenty of water, and get as much rest as you need. If you have a stringent workout routine, we recommend easing off temporarily. In particular, don’t undergo any aerobic training or exercise, which will redirect blood flow away from your follicles.

Step 2:

Monitoring While undergoing ovarian stimulation, you’ll have to pay several visits to your clinic or hospital so that your ob-gyn can keep an eye on your progress. Your doctor will probably schedule a few ultrasounds to examine your ovaries and the development of the follicles, and you’ll have to sit through blood tests to check your hormone levels as well. Depending on your response to stimulation, the dose Depending on your response to stimulation, the dose and type of drugs may be changed or maintained. When the follicles have reached the optimum number and size, you’ll be given an injection of HCG to prepare your eggs for final maturation.

Step 3:

Egg retrieval Thirty-six to 40 hours after the HCG injection, an egg retrieval procedure will be performed. As a general rule of thumb, about 90% of follicles which are of the right size (18 to 23 mm in diameter) will produce a retrievable egg. That said, it’s impossible to tell whether the eggs are mature or are of good quality. The egg retrieval process is quick and straightforward; it simply takes five to 10 minutes to complete, and it’s done under sedation. During egg retrieval, an ultrasound probe is inserted into the woman’s vagina, and the fertility specialist inserts a hollow needle into the pelvic cavity to collect the eggs from the mature follicles. After the follicular fluid from the follicles have been sucked out, the embryologists inspect the fluid and identifies the eggs. Insemination of the mature eggs are then performed. Among other things, the embryologists will look at the number and appearance of the cells in the developing embryo, as well as the degree of fragmentation. As you wait to hear the results, do keep in mind that grading isn’t an exact science. While highgrade eggs do indicate that you’ll have an easier time conceiving, these aren’t by any means a guarantee. In my time as an fertility specialist, I’ve seen many couples who have poor-quality eggs, but went on to achieve success with IVF; the reverse is true as well.

Step 4:

Sperm sample retrieval Once the female partner’s eggs are retrieved, the male partner will be asked to contribute a sample of his sperm. Most clinics and hospitals will require the male partner to produce the sample at the clinic, so that he can hand it over immediately. That said, some may allow for him to produce the sample at home, with the caveat that he transports the sample to the clinic or hospital within an hour of production. For men with low sperm count or no sperm in their semen, there are several surgical sperm retrieval techniques to consider. The simplest and least invasive procedure is the Percutaneous Epididymal Sperm Aspiration (PESA), which involves sperm being collected through a fine needle directly from the epididymis.

Step 5:

Insemination During insemination, the male partner’s sperm is prepared, washed, and combined with the female partner’s eggs in laboratory dishes. The dishes are then incubated at 37 degrees Celsius. After 18 hours, the dishes are retrieved and eggs examined for signs of fertilization. There will be two pronuclei (one from the sperm, and the other from the egg) if fertilization has successfully occured. In certain cases, several factors (such as poor sperm motility, low sperm count, high proportions of abnormal sperm, and high levels of antibodies in the semen) may indicate that the chances of fertilization are slim. Under such circumstances, an intracytoplasmic sperm injection (ICSI) might be necessary to increase the chances of fertilization. During this procedure, a single sperm is injected into each egg under a microscope using fine glass microtools. Again, the eggs will be monitored to check that fertilization does take place. Embryos are cultivated in the incubator for between two to five days. Your embryologist will then select the most viable embryos to undergo the next step. 

Step 6:

Embryo transfer During embryo transfer, your embryos are loaded into a flexible catheter (a soft thin tube made from medical grade material), and this catheter is inserted through your vagina and cervix into the uterus. When the catheter is in the optimum position for the transfer to take place, your embryos are expelled, and the catheter slowly removed. Embryo transfer is a safe and routine procedure, and they don’t commonly come with side effects other than cramping. To manage your stress levels, try and use relaxation techniques including deep breathing and meditation. Following your embryo transfer, you’ll have to rest in the hospital for at least an hour before getting discharged. On top of this, I recommend taking at least three days off so that you can rest in bed. To increase your chances of implantation and conception, keep your activity to a minimum. You’ll want to lie down and allow the blood to flow to your endometrium.

Step 7:

The two-week wait As many of my patients have told me, the subsequent two-week wait can be downright torturous. Again, try and get as much rest as possible, and stay away from caffeine, tobacco, alcohol, drugs, strenuous exercise, and sexual intercourse. Participating in any activities that will skyrocket your body temperature is also not advised - so this means sunbathing, or sitting in a sauna, hot tub, or jacuzzi are out of the picture. At the end of the two weeks, you’ll have to return to your clinic or hospital for a HCG pregnancy test. While there are many home testing kits that you can purchase in pharmacies or drug stores, I don’t recommend the use of these kits. Even the most sensitive urine pregnancy kits will not be able to detect HCG until ten days after ovulation, and assuming you were given an HCG injection as part of your fertility treatment, this may serve to distort your HCG readings. The bottom line? Using a home testing kit may or may not give you accurate results, so to avoid being misled, wait until it’s time to return to your clinic for your pregnancy test.