Whether you’re freezing your eggs, pursuing IVF as an LGBTQ+ couple, or embarking on IVF as the next step on your infertility journey, not knowing what to expect or how long it will take before you could possibly have a positive pregnancy test can be a source of unease and anxiety. IVF medication protocols can vary slightly, but if you’re wondering what a typical IVF cycle looks like we’re here to break it down for you. Here’s what you can expect during each stage of the IVF process:
What is a typical IVF timeline?
A "typical" IVF cycle consists of two phases, each of which is comprised of several steps. In total, a complete IVF timeline generally takes 2-4 months. Before we detail each step, here is a quick overview of what it entails: ovarian stimulation, egg retrieval, embryo development, and embryo transfer.
While the first phase of the IVF timeline begins with ovarian stimulation, the menstrual cycle prior to this step is actually crucial in preparing your body for what’s to come. In most cases, you will be prescribed oral contraceptives to regulate your menstrual cycle, allowing your doctors to better time the ovarian stimulation. These contraceptives may be prescribed to you at the start of your previous menstrual cycle or on day 21.
Ovarian stimulation
When it’s time for you to begin ovarian stimulation, your doctor will direct you to stop taking the birth control pill and come into the office on day 2 or 3 of your menstrual period. Using a medication protocol selected by your doctor, your ovaries will then be stimulated to release multiple eggs, rather than the one egg released each month. In fact, the goal of this stimulation is for your ovaries to release as many viable eggs as possible. This increases your chances of successful fertilization, as some eggs won’t fertilize or won’t develop normally after fertilization.
All of the medication during this stage will be self-administered via subcutaneous injection. This step of the IVF process generally takes 8-12 days and requires careful monitoring. Your doctor will use ultrasounds and blood draws to measure your estrogen levels to pinpoint when your peak ovarian stimulation has been achieved. You will then administer a “trigger shot” containing human chorionic gonadotropin (HCG) and/or leuprolide acetate to stimulate egg release prior to egg retrieval.
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Egg retrieval
Within 36 hours of your trigger shot, you will go back to your fertility clinic for egg retrieval. This step of the IVF process is mildly invasive and will require you to be sedated. During the procedure, an ultrasound probe will be inserted into your vagina to find follicles. Once follicles are located, a thin needle, connected to a suction device, goes into an ultrasound guide to retrieve the eggs from the follicles. This process can retrieve multiple eggs in just 20 minutes.
The mature eggs retrieved from your follicles will be placed in a nutritive liquid and incubated for fertilization. Following the egg retrieval, you might experience some cramping and/or feelings of fullness, pressure, and bloat. It’s important to follow your clinic’s discharge instructions carefully in order to avoid any post-surgery complications, but you should feel back to normal in a couple of days.
Embryo development
Within hours of the egg retrieval, the predetermined sperm sample will be used to fertilize the mature eggs. The eggs can be fertilized by two common methods: conventional insemination or intracytoplasmic sperm injection (ICSI). Conventional insemination is completed by mixing and incubating healthy sperm with mature eggs. ICSI is the more meticulous method of injecting a single healthy sperm directly into each mature egg.
For the next six days, the fertilized eggs will continue to grow and divide in the lab, hopefully developing to a stage called the blastocyst. Of the eggs retrieved and fertilized, only about one-fourth of them will reach this stage of development. At this point, the fertilized embryos can be tested for their ability to attach to the uterus lining, and they can now be safely cryogenically frozen for future use.
This is the end of the first phase of IVF. Depending on how many embryos you end up with, and how many children you'd ideally like to have, your doctor may suggest embarking on another IVF cycle prior to moving on to the embryo transfer stage.
Embryo Transfer: Fresh vs. Frozen
Once you've successfully banked embryos, next comes the exciting part: embryo transfer! The timeline of the embryo transfer is dependent on whether or not the embryo is fresh or frozen. Some doctors and clinics might advise not implanting a “fresh” embryo during the same cycle that the eggs were retrieved. Because of increased estrogen levels, some believe this has a higher risk of yielding a failed transfer. If your doctor advises freezing your embryos and waiting for a cycle or two until transfer, then this step of the IVF phase might last two to three months. This is also the case if you opt to do pre-implantation genetic testing on your embryos prior to freezing.
If your doctor decides it’s best to use a fresh embryo, then the transfer will occur three to five days after the egg retrieval. During the transfer, your doctor will insert a catheter into your uterus by entering your vagina and going through your cervix. With the help of the embryologist, your physician will use a syringe to insert one or more embryos into your uterus through the catheter. Congrats; you are officially PUPO (Pregnant Until Proven Otherwise)!
After your embryo transfer, you will have to wait a minimum of nine days to find out if you are pregnant or not through an hCG beta blood test at your clinic. That is unless you don't take an at-home pregnancy test sooner.
From start to finish, depending on whether or not you use a fresh or frozen embryo based on your doctor’s guidance, the IVF timeline can last anywhere from two to several months. Reading that might be a tough pill to swallow, but going in with as much information as possible can help manage your expectations during the seemingly endless appointments and waiting periods. The important thing to note is that IVF can provide couples with infertility with so much hope of becoming parents. We're happy to be able to play a small part in helping you learn what to expect on this journey.
Brighid Flynn is a freelance writer based in Philadelphia where she lives with her husband and puppy. She is just beginning her journey toward motherhood.