IVF 101: What You Need to Know

The first in vitro fertilization (IVF) procedure was successfully performed over four decades ago in 1978, and since then IVF has continued to grow in popularity. Today, millions of couples have chosen this form of assisted reproductive technology to help them conceive. Chances are, you know someone who has undergone IVF. If you’re considering IVF for yourself, it’s normal to have some questions. In this helpful guide, we’re covering the ins and outs of IVF to help you prepare for the journey ahead.

What is IVF?

In Vitro Fertilization (IVF) is a method of assisted reproductive technology in which eggs and sperm are combined and fertilized outside the body. The fertilized eggs are incubated for several days to grow to the embryo stage and then placed into the uterus. The goal is that this embryo will implant into the uterine lining and develop into a healthy baby. Alternatively, couples may also choose to freeze their embryo for use in the future. The procedure can be done using a woman’s own eggs and partner’s sperm, or donor eggs or sperm. Couples may also choose a gestational carrier to carry the pregnancy.

While there are a variety of reasons to consider IVF, some of the most common include:

• If you have PCOS, endometriosis, disease of the fallopian tubes, or other physical issues that could impact your ability to get pregnant
• If your male partner has fertility issues such as a low sperm count that could impact your chances of conceiving
• If you’ve experienced recurrent pregnancy loss or miscarriage
• LGBTQIA+ couples who wish to have their own children through reciprocal IVF of a gestational carrier

What Is the Process for IVF?

Before you begin the stimulation cycle, you will undergo various tests to ensure you are healthy for pregnancy. This includes an ultrasound, bloodwork, and screening tests such as a semen analysis, blood tests to measure your follicle-stimulating hormone (FSH), estradiol, and Anti-Müllerian Hormone (AMH) levels, and infectious disease screening.

You will also work with your provider beforehand to understand how to administer the IVF medications, fill out consent forms, and review the procedure fees. From there, it is a four-step process.

1. Ovarian Stimulation: It is necessary to obtain multiple eggs to have the best chance of success with IVF. This is accomplished by taking injectable fertility medications daily for about 8-10 days. These medications contain Follicle Stimulating Hormone (FSH) that stimulates the follicles that contain the eggs to grow. They are administered by you or your partner, following a thorough conversation with your provider. There are also online videos that you can watch that describe the process step-by-step. The needle is very small, and the injection is given just under the skin to minimize discomfort. Once the treatment has started, it is necessary to closely monitor the growth of the follicles using frequent vaginal ultrasounds and blood tests to measure hormone levels completed every 1-3 days.
2. Egg Retrieval: A “trigger” shot is given in the evening and 36 hours later, the egg retrieval is performed. This is typically done in a morning appointment. You will be given anesthesia for the procedure which takes about 30 minutes. An ultrasound is used vaginally to guide a needle into each follicle to collect the eggs. Your partner needs to come with you for the egg retrieval to collect a sperm specimen (if applicable) and to drive you home. Recovery usually takes about 1-1 ½ hours.

3. Fertilization: The eggs and sperm will be combined on the day of the egg retrieval. For some patients, this involves placing 50-100,000 sperm around each egg. For others, your provider may need to perform ICSI to assist in fertilization. Intra-Cytoplasmic Sperm Injection (ICSI) consists of injecting a single sperm directly into the egg.

4. Embryo Transfer: Successful fertilization is determined the day after the egg retrieval. Not all eggs will fertilize, but most will. Most, but not all of the fertilized eggs will divide over the next several days. After 3 days the embryos usually contain 4-8 cells. In the past, this was the stage at which embryos were transferred back to the uterus. Most patients will have their embryo transferred on day 5 at the blastocyst stage. After 5 to 6 days of culture, healthy embryos usually reach the blastocyst stage where they contain more than 100 cells. When an embryo reaches this stage, it is most viable. Here, the goal is to increase the pregnancy rate by transferring the best quality embryo. Your provider team will help you determine the best number of embryos to transfer based on several factors. Ultimately, this is based on guidelines from the American Society for Reproductive Medicine (ASRM), your age, the quality of the embryos that are available, the reason for your infertility, whether you have been successful before, and the number of previous IVF attempts. Any embryos that could result in a pregnancy that are not transferred back to the uterus are frozen for future use.

Commonly Asked Questions

When is the right time to explore IVF?

In general, a woman 35 years or older may consult a fertility specialist and consider IVF after 6 months of trying to conceive. A woman under 35 years old may consult with a fertility specialist and consider IVF after 1 year of trying to conceive. Not every case is the same, so it’s important to discuss your options with your provider.

How long is the entire IVF process?

The entire IVF process from start to finish can last anywhere from 4 to 8 weeks from time of consultation through to embryo transfer. Of course, this can vary from patient to patient.

Is IVF painful?

Because of the anesthesia used during the egg retrieval process, you should not feel any pain during the procedure. However, due to the hormonal changes your body is experiencing, it is possible to experience other side effects during the IVF process. The most common of these is abdominal cramping, similar to what you may experience with your period. You provider can recommend an over-the-counter pain reliever to help with the discomfort. If you experience severe pain, or symptoms like trouble urinating, shortness of breath, nausea, or vomiting it’s important to contact your provider.

The IVF process can be an emotional one so it’s important to have a strong support system with your care center, family, and friends. Many women also find it helpful to join an IVF support group where they can seek comfort from others who have a shared experience.

Do I need to take time off of work?

Every woman is different, but many find they can continue to work throughout the IVF process. Of course, you may need to manage your schedule to accommodate your appointments. You will need to take the day off for the scheduled egg retrieval because of the anesthesia given. It is suggested that you ‘take it easy’ the day of the embryo transfer. What you choose to do is ultimately up to you and your provider. While you do not have to disclose your personal health to your employer, some employers may offer time off for infertility treatment. Overall, it’s important to care for yourself and take the time you need for both your physical and mental health.

IVF remains the most successful form of assisted reproductive technology and has helped millions of couples pursue their dreams of parenthood.