If you've been trying to conceive unsuccessfully for a certain period of time or you've received a particular diagnosis where fertility treatment may be beneficial in helping you achieve your dream of having a family, in vitro fertilization (IVF) may be recommended.

While you may have heard of IVF before, most people don't know what it entails. Below, we'll share what IVF is, what it involves, and the process step-by-step.

6 Second Snapshot

• IVF is a technique where female eggs and male sperm are combined in a special laboratory to create an embryo or embryos.
• When undergoing IVF, fertility medications are prescribed to induce the ovaries to generate as many mature eggs as possible.
• A specific IVF treatment plan is designed with your health history and family-building goals in mind.
• Your fertility clinic will provide you with an IVF calendar/schedule so you can keep track of your appointments and medications.

What Is IVF?

IVF is a technique where eggs and sperm are combined in a special laboratory to create an embryo or embryos.

A woman's eggs are collected (retrieved using a very thin needle through the vaginal wall) from the ovaries and fertilized by sperm in a lab. Then, the fertilized egg (now called an embryo) is transferred to the uterus or frozen for further dispensation.

One full cycle of IVF can take about three to four weeks. However, sometimes these steps are split into different parts, which can take longer. This means that depending on what IVF protocol your doctor is recommending, your IVF calendar can range anywhere from four to six weeks for one IVF cycle.

The IVF Process

Every month, when a woman's body releases an egg, it is known as ovulation. During ovulation, an egg is released from the ovary and waits to be fertilized for a span of 12 to 24 hours. When a patient is about to undergo an IVF cycle, the reproductive endocrinologist wants to make every effort to increase the chances of success. This is why you are given fertility medications in the hopes of producing more than one egg to increase your chances of IVF success. Fertility medications are prescribed for this to happen, and a specific IVF protocol is designed with your health history and family-building goals in mind.

This process, known as ovarian stimulation, helps the ovaries to increase the number of eggs produced; thus, ideally, more embryos can be created. After several appointments to monitor the size of the follicles growing on each ovary via ultrasound (follicles are where eggs are contained), the eggs are then retrieved through a very thin needle under light sedation. They are then combined with the partner's (or a donor's) sperm and fertilized in the IVF laboratory, where they become embryo(s).

Resulting embryos are placed in special incubators to develop over two to six days and are closely monitored for cell development. Then, one or two of the highest quality embryos (this would be discussed with your fertility doctor) would be transferred back into the uterus, hoping that the embryo will implant in the uterine lining. If an embryo implants, that means a clinical pregnancy has been achieved. Any remaining embryos can be vitrified (cryopreserved) for repeat treatment or for additional future children you may wish to have. Alternatively, all resulting embryos may be frozen for later transfer.

A Step-By-Step Breakdown of the IVF Process Timeline

Your reproductive endocrinologist will prescribe the treatment they believe will provide you the highest chance of success, and your clinical team will be your day-to-day guide.

Step 1: Baseline Test

• You will meet with your IVF nurse/caseworker, who will provide you with an overall schedule for your IVF cycle. They will advise you to call them on the first day of your period.
• You will have baseline blood work and ultrasound done on your instructed start date. You may be started on birth control the month ahead of your IVF cycle for timing purposes.
• Your injectable medications will be ordered. (Gonal-F, Menopur, etc.)
• Your clinic will often teach you how to self-administer your medications.
• Your nurse will confirm when you are ready to begin your injectable medications.

Step 2: Ovarian Stimulation

• You will have daily injections of medications for 8-14 days to induce the ovaries to generate as many mature eggs as possible. Most often, this is self-administered.

Step 3: Cycle Monitoring

• You will visit the clinic every few days for monitoring blood tests and transvaginal ultrasounds to assess follicle growth. Your doctor may modify your medication dosages based on the results.
• Once your doctor is confident most of the follicles are large enough to house mature eggs, you will be instructed to take your "trigger shot," referred to as an hCG.

Step 4: Egg Retrieval

• Your medical team will advise you of your admission time, which is typically about 36 hours after your trigger shot.
• Your eggs are retrieved with a thin needle through the vaginal wall under ultrasound guidance. You’ll likely sleep for about 20 minutes under IV sedation given by an anesthesiologist.
• After the eggs are retrieved, they are isolated under the microscope and are fertilized the same day either by injecting a sperm into each one or simply placing the sperm in the dish with the eggs (not all eggs may fertilize)
• The resulting embryos will be cultured in the laboratory for 3-6 days. Those that survive will be frozen or prepped for transfer.
• You will begin progesterone supplementation (through progesterone in oil shots or suppositories) the day after retrieval if an embryo transfer is planned.
• If you have preimplantation genetic testing or screening, the embryos will be biopsied and cryopreserved until results are obtained.

Step 5: Embryo Transfer

• Embryo(s) selected by your doctor will be transferred back into the uterus, hoping they will implant into the uterine lining.
• Following the embryo transfer (it can vary depending on if it's a frozen cycle, day three or day five), you will continue hormone supplementation until the pregnancy test.

Step 6: Pregnancy Testing

• The hCG blood test to confirm pregnancy is usually done 11 or 12 days after embryo transfer has been performed.

While it can seem overwhelming, what's important to remember is your fertility clinic is there to explain and support you throughout your fertility journey. Therefore, you should feel comfortable asking questions to take an active role in your treatment! The first step is to find the best fertility clinic for you.