IVF Step by Step: What to Expect From Start to Finish

In vitro fertilization (IVF) is one of the most effective fertility treatments available today. During IVF, eggs are collected from the ovaries, fertilized with sperm in a specialized laboratory, and one healthy embryo is transferred into the uterus.

Although an IVF cycle itself usually lasts only **2–3 weeks**, successful treatment often begins **2–3 months beforehand**. This is because both eggs and sperm need around three months to mature before they can be used for fertilization.

Preparing your body before IVF won't guarantee success, but it may help optimize egg and sperm quality and allows your fertility team to identify potential issues before treatment begins.

Before IVF: Preparing for Treatment

Optimize Your Health

A healthy lifestyle supports reproductive health for both partners.

Your fertility specialist may recommend:

• Maintaining a healthy body weight
• Eating a balanced, nutrient-rich diet
• Exercising regularly
• Stopping smoking
• Limiting alcohol
• Getting enough sleep
• Managing stress where possible

Many clinics also recommend supplements before IVF.

For women, these commonly include:

• A prenatal vitamin containing folic acid or methylfolate
• Vitamin D if levels are low
• Omega-3 fatty acids
• Coenzyme Q10 (CoQ10), particularly for women with reduced ovarian reserve or advanced maternal age

For men, your doctor may recommend supplements such as CoQ10, L-carnitine, zinc, selenium, vitamin C or vitamin E, depending on the underlying cause of infertility.

Check Sperm Health

A semen analysis measures:

• Sperm concentration
• Motility (movement)
• Morphology (shape)

In some couples, your doctor may also recommend a **sperm DNA fragmentation test**.

Unlike a standard semen analysis, this test looks at the quality of the sperm's genetic material.

It may be particularly helpful in cases of:

• Recurrent miscarriage
• Repeated IVF failure
• Unexplained infertility
• Previous poor embryo development
• Known male-factor infertility
• Advanced paternal age

If DNA fragmentation is elevated, your doctor may recommend lifestyle changes, antioxidant treatment, treatment of conditions such as varicocele, shorter periods of abstinence before sperm collection, or specialized sperm selection techniques.

Consider Genetic Carrier Screening

Many healthy people carry a genetic mutation without ever knowing it.

Carrier screening is a blood or saliva test that checks whether you and your partner carry variants in the same inherited disease.

If both partners carry the same recessive condition, each pregnancy has:

• **25% chance** of an affected child
• **50% chance** of a healthy carrier
• **25% chance** of a child who inherits neither mutation

If a couple is identified as carriers, IVF combined with **Preimplantation Genetic Testing for Monogenic Disorders (PGT-M)** allows embryos to be tested before transfer, reducing the risk of passing on certain inherited diseases.

Carrier screening is increasingly recommended before pregnancy, especially for couples planning IVF, because it can identify risks that would otherwise remain completely unknown.

Step 1: Ovarian Stimulation

Instead of producing one mature egg, hormone injections encourage several follicles to grow at the same time.

This increases the number of eggs that can be collected, giving more opportunities to create embryos.

Stimulation usually lasts **8–12 days**, although every woman responds differently.

Step 2: Monitoring

During stimulation, you'll attend several appointments for:

• Ultrasound scans
• Blood tests

These visits allow your fertility specialist to:

• Monitor follicle growth
• Measure hormone levels
• Adjust medication if necessary
• Choose the ideal time for egg retrieval

When the follicles are ready, you'll receive a **trigger injection**, which completes the final maturation of the eggs before retrieval.

Step 3: Egg Retrieval

Approximately **36 hours after the trigger injection**, the eggs are collected.

Egg retrieval is a short outpatient procedure performed under light sedation or anesthesia.

Using ultrasound guidance, your fertility specialist gently removes the fluid from each follicle with a fine needle. The embryology laboratory immediately examines this fluid to identify and collect the eggs.

The procedure usually takes **15–30 minutes**, and most women return home the same day.

Not every follicle contains an egg, and not every egg collected is mature enough to be fertilized. This is completely normal.

Step 4: Fertilization

The mature eggs are prepared in the laboratory and fertilized using one of two methods.

Conventional IVF

Thousands of sperm are placed around each mature egg and fertilization occurs naturally in the laboratory.

This approach is generally used when sperm quality is normal.

ICSI (Intracytoplasmic Sperm Injection)

With ICSI, a single carefully selected sperm is injected directly into each mature egg.

Today, ICSI is commonly used for:

• Male-factor infertility
• Previous fertilization failure
• Frozen eggs
• Surgical sperm retrieval
• IVF cycles involving genetic testing

Your fertility specialist will recommend the technique that best suits your situation.

Step 5: Embryo Development

If fertilization is successful, the eggs begin dividing to form embryos.

The embryology laboratory monitors them carefully over the following **5–7 days**.

Typical development looks like this:

• **Day 1:** Fertilization is confirmed.
• **Days 2–3:** The embryo divides into multiple cells.
• **Days 5–7:** Some embryos reach the **blastocyst** stage.

Only a proportion of fertilized eggs become blastocysts. This natural selection process is expected and does not necessarily indicate that anything went wrong.

Blastocysts are graded according to their appearance, which helps estimate their developmental potential. However, a beautiful-looking embryo is not always genetically normal.

Step 6: What Happens Next?

Once embryos reach the blastocyst stage, your fertility team will discuss the next step.

Option 1: Fresh Embryo Transfer

A fresh embryo transfer takes place during the same IVF cycle, usually around five days after egg retrieval.

It may be recommended if:

• Your hormone levels are appropriate.
• Your uterine lining is ready.
• There is no increased risk of ovarian hyperstimulation syndrome (OHSS).
• Genetic testing is not planned.

Option 2: Freeze-All Strategy

Many clinics now recommend freezing all suitable embryos and transferring one in a later menstrual cycle.

This allows:

• Your hormone levels to return to normal.
• The uterus to recover from ovarian stimulation.
• Time for genetic testing, if required.
• Reduced risk of OHSS.

Frozen embryo transfers have become extremely common, and pregnancy rates are at least comparable to fresh transfers for many patients.

Your doctor will recommend the approach that best fits your medical situation.

Step 7: Should Your Embryos Be Genetically Tested?

Not every IVF patient needs embryo genetic testing, but it can be valuable in selected situations.

PGT-A: Checking Chromosome Number

PGT-A (Preimplantation Genetic Testing for Aneuploidy) checks whether an embryo has the correct number of chromosomes.

Embryos with the correct chromosome number are called **euploid**. They are more likely to implant successfully and are less likely to result in miscarriage.

PGT-A may be considered for:

• Women of advanced maternal age
• Recurrent miscarriage
• Repeated IVF failure
• Selected cases of severe male-factor infertility

It is important to note that PGT-A is not recommended for everyone, and its benefits depend on the individual clinical situation.

PGT-M: Testing for a Specific Genetic Disease

PGT-M (Preimplantation Genetic Testing for Monogenic Disorders) is different.

Rather than counting chromosomes, it looks for **a specific inherited disease**.

It is recommended when:

• Both partners carry the same recessive genetic condition.
• One parent carries a dominant disease-causing mutation.

Examples include cystic fibrosis, spinal muscular atrophy, sickle cell disease, and many other inherited conditions.

Carrier screening performed before IVF helps identify couples who may benefit from PGT-M.

Step 8: Embryo Transfer

Whether the embryo is transferred immediately or after freezing, the procedure is simple and usually painless.

Using a thin catheter, the fertility specialist gently places one embryo inside the uterus under ultrasound guidance.

The procedure usually takes only a few minutes and does not require anesthesia.

Today, most clinics recommend transferring **a single embryo**, as this offers an excellent chance of pregnancy while minimizing the risks associated with twins.

Any additional suitable embryos can remain frozen for future pregnancy attempts.

Step 9: The Two-Week Wait

After embryo transfer, you'll continue hormonal support while waiting for implantation to occur.

A pregnancy blood test is usually performed **10–14 days later**.

This waiting period is often emotionally challenging. It's important to remember that symptoms—or the absence of symptoms—cannot reliably tell you whether the treatment has been successful.

Bboom Tip

Every IVF journey is unique. Two patients of the same age may follow completely different treatment plans depending on their ovarian reserve, sperm quality, medical history, or genetic background.

The most successful IVF treatments are highly personalized. Understanding each step—from preparing your health before treatment to deciding between a fresh or frozen transfer, and knowing when genetic testing may be helpful—can help you have more informed conversations with your fertility team and feel more confident throughout the process.

**Related reading**

• _Preparing for IVF: Tests, Supplements & Lifestyle_
• _IVF vs. ICSI: What's the Difference?_
• _What Is Sperm DNA Fragmentation?_
• _What Is Genetic Carrier Screening?_
• _Understanding PGT-A and PGT-M_