IVF: The Basics

Venturing into the IVF world can be daunting, especially when infertility treatments were not in your original conception plans.  There are so many different treatment variables, medications, appointments, and verbiage you may be completely unfamiliar with.  High school biology doesn’t compare to the amount of knowledge you will learn about reproduction and learning your own body through the process of infertility and pursuing fertility treatments.

So, where do you begin?

Hopefully our infertility journey can help guide you through the process of finding a specialist and feeling confident moving forward with your own fertility adventure.

Infertility - IVF Getting Started - section - what is IVF

In Vitro Fertilization (IVF) is a type of assisted reproductive technology and is the most effective fertility treatment option with pregnancy rates up to 5x that of  Intrauterine Insemination (IUI).   Individuals and couples who have been unable to conceive within 12 months may consider IVF as an option for their next steps.

During IVF, eggs are collected from a woman’s ovaries in an outpatient surgical procedure, which can often happen right your in your doctor’s clinic if they are well established.   The egg is then placed in a petri dish with sperm to be fertilized.

If there are abnormalities with the sperm, which can be found through a semen analysis, then your doctor may choose to use a fertilization technique called Intra-Cytoplasmic Sperm Injection, also known as ICSI.  Because sperm with low morphology can have a difficult time penetrating the egg for fertilization, the lab will do this manually.  ICSI was automatically included in our IVF package, so if you can find a doctor who includes this at no extra cost, that is always a great bonus!

The fertilized eggs will continue to grow in the lab until they are ready to be transferred.  Once the eggs are fertilized they are now called embryos, and your doctor may choose to transfer the embryos between three and five days after fertilization.

This timeline will change if you are not able to do a fresh transfer from either choosing PGS (preimplantation genetic screening) or due to Ovarian Hyperstimulation Syndrome (OHSS) concerns.  If you will be doing a frozen embryo transfer (FET), then you will be looking at transferring after you have started your period again.  This happened to be the case for us.  We had every intention on doing a fresh transfer.  Fortunately and unfortunately, my body responded extremely well to the medication, so OHSS became a risk we did not want to take and our doctor made the call choose the safer route for my body.  

Once an embryo transfer has happened, you wait about nine to fourteen days to go in for your pregnancy test!

Infertility - IVF Getting Started - section - who is it for

Who is IVF for?  Is this something you could benefit from?

There are multiple variables that can determine which type of fertility treatment is right for you.  Your doctor may choose to prescribe medication and have you focus on timed intercourse, or move into an IUI cycle.  If either of these options haven’t worked, or your doctor feels they are not the right treatment for you, then IVF may be the answer you’ve been waiting for.  IVF is the most common treatment option in the following scenarios:

  • Simpler treatments like medicated cycles and IUI have been unsuccessful
  • Recurrent Miscarriages
  • One or both individuals carry, or have family, with genetic defects
  • Women with age-related infertility
  • Women with low ovarian reserve, PCOS, or endometriosis
  • Women who are unable to ovulate, or have blocked or damaged tubes
  • Men with poor sperm quality or quantity
  • Couples with unexplained infertility

Infertility - IVF Getting Started - section - the consultation

The IVF consultation is a great place to start.  This consultation will take place after you have completed the diagnostic testing and perhaps tried additional routes to achieve pregnancy.  The IVF consultation is different than your initial consultation with your fertility specialist in that this visit will be all about your upcoming IVF cycle and everything that is involved with the process.  You will have a chance to learn what to expect during each step of the IVF treatment process and determine the best route for your specific needs.

You and your spouse, along with your fertility specialist and their team will come up with a game plan for your cycle.  You will discuss a start date, the medication plan, and additional treatments your doctor would like to include over the course of the cycle to make this a successful IVF treatment.  Your doctor will have set aside time for this appointment and be able to give their undivided attention to answering any questions you have about the process.

While every couple’s IVF journey is unique, the IVF process typically consists of a few main steps, which take place over the span of one menstrual cycle.

Infertility - IVF Getting Started - section - baseline appointment

At your IVF baseline appointment, you doctor will have you and your partner come in for blood work.  Your doctor will check your hormone levels and use this blood sample for an STD panel from both of you.  Your doctor will also perform a basic ultrasound to take a look at your ovaries and uterus to make sure everything looks good and there are no concerning cysts or other issues that need to be addressed before moving forward with medication and the rest of your IVF treatment process.  When your doc gives you the go-ahead, it’s treatment time!

Infertility - IVF Getting Started - IVF Basics 2

Infertility - IVF Getting Started - section - the process

Let me tell you: I was not expecting the cycle length that would happen with an IVF cycle.  My typical 26 day cycle ended up being 36 days from the start of my period before medication to the time my period started again after the egg retrieval.  For someone who has tracked her cycles religiously for nearly five years, that definitely threw me for a loop!  Why is that?  What all is involved in the IVF treatment process?  Let’s take a look:

Step 1: Ovarian Suppression
I’m sure you’ve heard it before, but it is quite ironic that your doctor may choose to start your IVF cycle with birth control pills.  Let me tell you, I learned much more about birth control pills during my IVF cycle than when I was actually taking them years ago to prevent pregnancy.  Go figure.  Your doc will likely use birth control pills to keep you from releasing eggs on your own and/or releasing mature eggs to be fertilized naturally.  Birth control pills will help your doctor be able to control the cycle bleed before your egg retrieval and/or embryo transfer and have more control over the timing of both your egg retrieval and embryo transfer dates.   Our doc used a birth control pill that contained an even dose of progesterone and estrogen.

Step 2: Ovarian Stimulation
Stimulation, or “Stims” as we say in the IVF world, is brought on through hormone injections(Here’s what I was prescribed)  The point of ovarian stimulation is to cause your body to grow multiple follicles and hopefully collect multiple mature eggs from those follicles.  In an average (unmedicated) cycle, your body typically will produce one mature follicle which suppresses other less mature follicles, and the mature follicle is the one that releases an egg to be fertilized.

Infertility - IVF Getting Started - Follicle Size ChartThe focus during the stimulation process is in the quality of the eggs, but the more (high quality) eggs you have, obviously the better your IVF outcome can be.  Your doctor will check your hormone levels and the size of your follicles throughout this process through multiple blood work and ultrasound appointments.  Your doctor will likely be hoping for follicles that are larger than 18mm.

Want to see what size your follicles are?  Check out this printable here!  Boy can you imagine having multiple follicles 18mm or larger?!  I had QUITE a few, and felt it!

Step 3: Egg Retrieval
Egg retrieval day is also considered ovulation day!  Once your follicles have a reached a certain size, your doctor will instruct you to do your trigger shot.  Your trigger shot should be given exactly 36 hours prior to your scheduled egg retrieval procedure, but don’t worry, your office will schedule all of this accordingly.  Your doctor may choose to use an injection such as Pregnyl, which is really common for IVF and IUI cycles.  Your doctor may also choose to use Lupron, which doesn’t contain HCG and can greatly reduce, or even eliminate, the risk of ovarian hyperstimulation.  Our doctor ended up having us use this one for our IVF cycle.

Many times an egg retrieval will be scheduled earlier in the morning, since general anesthetic sedation is used for this procedure – for which fasting is required.  This is an outpatient procedure, but be sure to have someone who can drive you home from your appointment, as you will still be groggy from the anesthesia.   During this procedure, your doctor will drain the follicles, collecting all the eggs he/she sees.  They will then take your eggs and the sperm sample (which your partner either gives right before or during your procedure, unless you are using donor sperm) to the lab and begin fertilizing every mature egg collected during the procedure.   We were told right after the procedure how many eggs were collected!   

Step 4: Fertilization
Here is where there is some wait time!  While you’re recovering from your egg retrieval, the embryologist is fertilizing eggs, and they’re doing their thing!  The embryologist will wash the sperm and set them in a petri dish to fertilize on their own.  If there are concerns with sperm motility or morphology, your doctor will recommend using ICSI with your IVF cycle.  Some offices offer ICSI free of charge and use that technology with every IVF cycle.  ICSI is where the embryologist will pick the best looking sperm from the sample and manually place one sperm into each mature egg through a needle injection, to then fertilize instead of relying on the sperm to find the egg and penetrate it on its own.

You should get a call from the embryologist the next day or two following the procedure to let you know how many eggs fully fertilized.

Step 5a: Fresh Embryo Transfer
The fertilized eggs, now called embryos, are then implanted into the woman’s uterus or may be frozen for use in a subsequent cycle.  An embryo transfer will take place 3 or 5 days following the egg retrieval, depending on how well the embryos are developing in the lab.
You doctor will have you come in for another outpatient procedure.  You can opt to have this procedure done with anesthesia for an additional cost, but it is not necessary.  The doctor will inject the embryo into your uterus in a similar way an IUI procedure is performed.  The doctor will use a catheter along with a vaginal ultrasound wand to find the perfect spot to place the embryo.  After the transfer procedure is completed, your doctor may recommend you lay down for an additional twenty to thirty minutes, and then you can check out and get on with the rest of your day!  Bed rest isn’t usually recommended following your transfer.  Any remaining embryos will be frozen for future pregnancy attempts.

Step 5b: Frozen Embryo Transfer
A frozen embryo transfer may be preferred over a fresh embryo transfer for a couple different reasons.
First, if you risk ovarian hyperstimulation, your doctor may choose to delay your embryo transfer, as HCG (which is produced in the body during pregnancy) can heighten the side effects of hyper-stimulation and can be pretty severe.   Depending on how your bloodwork looks prior to egg retrieval, you doctor may choose to have you trigger with an agonist trigger shot (such as Lupron) for this very reason and let your body settle down after the retrieval before moving forward with an embryo transfer.  But don’t worry, you will likely be able to move forward with the frozen embryo transfer within 4-6 week following your egg retrieval cycle.
Secondly, a frozen embryo transfer is necessary if you choose to send your embryos to a lab for preimplantation genetic screening.  This process can take a few weeks, so the results won’t be back in time for a fresh transfer.
Your doctor will have you start a progesterone regimen about five or six days prior to your transfer.  Your doctor can prescribe progesterone in a variety of ways.

Step 6: Embryo Implantation
Ah, yes, the lovely Two Week Wait.  With IVF the two week wait isn’t quite as long as it is for a natural cycle as you are still pretty involved with the process the first few days following your egg retrieval or “ovulation.”  Your wait is only about nine or ten days until the pregnancy test.  During this time, you should continue life as normal.  Remember to relax.  Think positive thoughts, do some deep breathing, take it easy, and don’t stress.

Step 7: Pregnancy Test
And there it is, the final step.  As tempting as it might be to test at home, don’t!  Wait until your doctor appointment and let them do the pregnancy test for you.  They will do blood work and measure your HCG levels and call you with results when they get them back from the lab.  One thing we love about our clinic is that they stick with us after a positive pregnancy test until the OB will actually be willing to do their first appointment at around 8 weeks.  Our doc will continue to do blood work and will do an ultrasound appointment at six weeks along.  How great is this?!  Many clinics offer this, but not all doctors include this in their IVF package.  Finding the right specialist that fits your needs and your journey is crucial for a more enjoyable experience.

Infertility - IVF Getting Started - IVF Basics

If you’re ready to move forward with your IVF treatment, check out the rest of our infertility series which includes blog posts about:

  • Preparing for Conception
  • IVF Costs + Medication
  • IVF: Getting Started
  • Finding a Specialist
  • Making It Through IVF Appointments and Injections

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Want a fun way to document your infertility journey?  Check out our Infertility Journey Milestone cards you can print and use as photo props on your blog or to share your journey with friends and family on social media, or you can even print these and journal on the back for a special keepsake of all the special moments in your journey!

Infertility - IVF The Basics


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