Typical IVF Cycle

Step One - Ovulation Induction

Hormone injections are given to stimulate multiple egg production rather than the single egg normally produced by the body each month. This stimulation process usually requires the initial use of Lupron to suppress the ovary to prevent ovulation until the desired time. Daily gonadotropin injections are then added to stimulate the development of the eggs. These are usually given subcutaneously (under the skin) and are much less uncomfortable than the previous generations of medication. We then monitor the progress of ovulation induction with ultrasounds and blood estrogen levels over several days.

Step Two - Egg Retrieval

An egg retrieval is performed by placing a special needle into the ovarian follicle and removing the fluid that contains the egg. This is a relatively minor procedure and is performed by visualizing the follicles with a vaginal ultrasound probe. A needle is directed alongside the probe, through the vaginal wall, and into the ovary. To avoid any discomfort, strong, short acting intravenous sedation is provided. Click here to read the frequently asked questions about the egg retrieval and IV sedation.

Step Three - Fertilization and Embryo Culture

Once the follicular fluid is removed from the follicle, the eggs are identified by the embryologist and placed into an incubator. The eggs are fertilized with sperm later that day by conventional insemination or by Intracytoplasmic Sperm Injection (ICSI).

During conventional insemination approximately 50,000 sperm are placed with each egg in a culture dish and left together overnight to undergo the fertilization process. The ICSI technique is used to fertilize mature eggs in the event of sperm or egg abnormalities. Under the microscope, the embryologist picks up a single sperm and injects it directly into the cytoplasm of the egg using a small glass needle.

ICSI allows couples with very low sperm counts or poor quality sperm to achieve fertilization and pregnancy rates equal to traditional IVF. It is also recommended for couples who have not achieved fertilization in prior IVF attempts. Special urological procedures are available to you for cases where it is difficult to obtain sperm or for men with no sperm in the ejaculate.

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The eggs will be checked the following day to document fertilization and again the next day to evaluate for early cell division. They are now called embryos and are placed in a solution called media to promote growth. Until recently, embryos were cultured for three days and then transferred to the uterus and/or cryopreserved (frozen). We now have the ability to grow the embryos for five or six days until they reach the blastocyst stage. For some couples these blastocysts may have a greater chance of implantation, allowing us to transfer fewer embryos, in some cases only one, and lower the risk of multiple birth while increasing the chance of pregnancy.

On day two or three after fertilization, the embryos will be evaluated for blastocyst culture. If there is a sufficient number of dividing embryos they will be placed in special blastocyst media and grown for two or three additional days.

Step Four - Embryo Transfer

Embryos may be transferred on day 3, 5, or 6 after egg retrieval. Transfers on day 5 or 6 are called Blastocyst Transfers. They are placed through the cervix into the uterine cavity using a small, soft catheter. This procedure usually requires no anesthesia. It is similar to the Mock Embryo Transfer which will be performed prior to the actual IVF cycle.

Do you have questions about the period between transfer and pregnancy test? Read Getting Through the Two-Week Wait to find some answers.

Step 5 - Testing for Pregnancy

Two weeks after the embryo transfer you will return to our office for a pregnancy test. If you are pregnant, we will follow your progress with blood work and ultrasounds for four weeks before referring you back your to obstetrician for continued care. You should expect a normal pregnancy, unless advised otherwise.

For a more complete overview of the typical IVF cycle download our IVF Patient Guide.