There’s no question that the invention of fertility treatments like in vitro fertilization (IVF) is miraculous. Still, the process can feel really stressful. On top of the many steps and injections you have to keep tabs on, the stress of whether the treatment will work or not is never too far out of mind. It’s a lot to go through on its own — even more so when you have to take injections in the office bathroom or deal with the side effects while parenting.
“The thought of undergoing this process can feel overwhelming,” says Dr. Sandy Goodman, a fertility doctor at the Reproductive Medicine Group. But knowing what to expect along the way can help you “feel more comfortable and ready to move forward in your journey toward parenthood.”
As your trusted sidekick in all things fertility, Rescripted is here to explain the process from beginning to end. In this article, we’re going deep into IVF with embryo transfer.
The 411 on IVF
IVF is a form of fertility treatment where embryos are created in a lab and then transferred into the uterus. It’s a long, complex process. From start to finish, it may take 6 to 16 weeks to complete an IVF cycle depending if you are having a fresh transfer or freeze- all with frozen embryo transfer.
The IVF process in 10 steps
Leading into the start of the IVF cycle stimulation medications, in most cases, you may be prescribed a short course (usually 2 weeks or less) of down regulating medications such as birth control pills or estrogen tablets with or without topical androgens to make sure the ovarian follicles (fluid-filled sacs that contain the eggs) are in sync.
Step 1: Ovarian Stimulation
At the beginning of an IVF cycle, you’ll take injectable medications to help stimulate the development of multiple eggs in the ovaries. This usually happens after the downregulation medications are completed and menstrual bleeding starts. Prior or during your course of down-regulation medications, your IVF coordinator/nurse will show you how to administer the medications as you and/or your partner or support person will be doing the injections at home. Stimulating the maturation of multiple eggs allows for the best chances of creating healthy embryos.
The exact medications vary, but they’re usually one or more of the following:
Step 2: Monitoring
Your clinic will monitor your egg development via ultrasound and blood work. Medications may be adjusted in response to monitoring results.
Step 3: Trigger Shot
When the monitoring of your egg development indicates that you’re ready for egg retrieval, you/your partner will inject you with a “trigger shot” of human chorionic gonadotropin (hCG; brand names include Profasi, Novarel, Pregnyl, or Ovidrel), Lupron, or both. This last injection gives your eggs the necessary boost to reach their final level of maturation. It typically happens about 34-36 hours before egg retrieval.
Step 4: Egg Retrieval
You’ll go to your clinic, receive intravenous (IV) sedation, and have your eggs extracted through minimally invasive techniques.
Using a vaginal probe attached to a needle and guidance via ultrasound, your doctor will insert the needle into your follicles. The needle will suction fluid containing the egg out of the follicles. The fluid will be given to the embryologist to identify the eggs. The whole process will only take about 10-20 minutes.
Once you wake up from the sedation, you’ll find out how many eggs were retrieved. The average number is 8-15 eggs ideally but varies depending on your ovarian reserve results including your antral follicle count and how your ovaries respond to the medications. Common symptoms in the first 24 hours after egg retrieval include spotting, cramping, bloating, and constipation. Pain medication and heating pads can help. Symptoms usually resolve within 1-2 days.
The retrieved eggs are placed in a controlled environment in the embryology lab until fertilization.
Step 5: Sperm Collection
Sperm can be collected fresh from a partner or previously collected and frozen sperm, either from a partner or a donor, can be thawed.
Wherever the sperm come from, they’re washed and examined so only the healthiest, highest-quality ones are used.
Step 6: Fertilization
This is where the magic happens: The egg(s) are fertilized with sperm to create the embryos that will later be transferred into the uterus.
The eggs may be fertilized with a specific concentration of sperm placed in a droplet with the egg or through a technique called intracytoplasmic sperm injection (ICSI). With ICSI, each mature egg is injected with an individual sperm. ICSI may be especially effective when the partner providing sperm has fertility issues or if pre-implantation genetic testing of the embryos is planned.
The unfertilized eggs and sperm or the eggs injected with sperm are placed back into a controlled environment to develop.
Step 7: Embryo Development and Selection
The embryos will be incubated in a controlled environment to help them grow. After 5-6 days, if a fresh embryo transfer is planned, the embryologist will select the best grade, most advanced embryo for transfer into the uterus. Remaining healthy appearing blastocysts can be frozen for future transfer. If preimplantation genetic testing (PGT) is planned, embryos that have reached the “blastocyst” stage of development will be biopsied and then frozen/cryopreserved.
Not all eggs will fertilize even if sperm is directed injected via ICSI, not all fertilized egg/embryos will develop into the blastocyst stage, and not all blastocysts, even if they appear healthy will be genetically “normal.” PGT (preimplantation genetic testing) is performed to screen embryos for genetic abnormalities before they’re transferred into the uterus. Freezing embryos would mean another retrieval wouldn’t be needed for a future transfer cycle.
Step 8: Embryo Transfer
Your uterine lining is prepared for transfer with medications that contain the hormones estrogen and progesterone. If embryos are frozen, they will be thawed before the transfer. When it’s transfer time, an ultrasound will be used to guide the embryo’s placement into the uterus. Anesthesia typically isn’t needed.
Step 9: Support Medication
After the transfer, you’ll take more hormonal medication (usually estrogen and progesterone) to support the uterine lining and increase the chances of implantation.
Step 10: Pregnancy Test
About 9-12 days after the embryo transfer, you’ll take a blood pregnancy test. If the results are positive, you’ll likely take another test 2-3 days later. A confirmed pregnancy will continue to be monitored to make sure it’s healthy and keeps developing. You’ll switch to prenatal care with your OB/GYN at 7-10 weeks of pregnancy.
If the results are negative, you can talk to your clinic about next steps. Some people choose to try another IVF cycle right away, while others may need time to process and heal. There’s no wrong way to go here.
IVF success rates
Because there are so many steps in the IVF process, predicting IVF success rates isn’t as simple as it may be for other procedures. Experts call this complexity the “IVF funnel”: each step of the funnel has fewer viable options than the last.
All of this makes understanding IVF success rates a bit complicated. Some clinics offer “IVF funnel” estimates based on age. But in terms of overall success rates, we can look to data released by the Society of Assisted Reproductive Technology (SART) every year.
SART’s 2022 report breaks IVF success rates down into the percentage of people who had live births after their first embryo transfer — and the percentage of people who had live births after all embryo transfers.
Among people who used their own eggs in 2022, here’s what percentage of each age group had a live singleton birth (one baby) from one egg retrieval and their first embryo transfer:
Under 35 years old: 35%
35-37 years old: 26.3%
38-40 years old: 17.1%
41-42 years old: 8.6%
Over 42 years old: 2.6%
Among people who used their own eggs in 2022, here’s what percentage had a live singleton birth from one egg retrieval and any number of embryo transfers:
Under 35 years old: 42%
35-37 years old: 30.8%
38-40 years old: 19.2%
41-42 years old: 9.2%
Over 42 years old: 2.8%
Basically, the more cycles you undergo, the better your chances are of getting pregnant and having a baby.
Because this data accounts for over 300,000 IVF cycles, they might not represent your experience. Everyone’s chances of IVF success are different. Age is one of the most important factors. You can talk to your clinic about what to expect. They’ll also have their own success rates that you can look at. So, consider all of this data, but take it with a grain of salt.
One more thing: The “IVF funnel” highlights the benefit of starting with as many retrieved eggs as possible. It might seem logical that transferring a higher number of embryos would also increase the odds of pregnancy. But the truth is that transferring more embryos doesn’t play a significant role in increasing odds. It does, however, increase the likelihood of getting pregnant with multiples.
Now that you’re up to speed on the IVF process, here’s another important piece of info: For those of us looking for a little extra guidance for keeping up with all of those medications, our IVF-regimen tool has you covered.
Sarah duRivage-Jacobs is a sexual and reproductive health writer, educator, and communicator. In addition to Rescripted, her words can be found on the blogs of reproductive health and mental health companies like Modern Fertility, Hey Jane, Millie, Carrot, Origin, O.school, and Charlie Health. You can visit her website here.