IVF Step by Step: The Complete Process Explained

Before the Cycle Begins

IVF doesn't start with injections — it starts with preparation. In the weeks before your cycle, your clinic will finalize baseline testing (if not already completed), review your protocol, train you on self-injection technique, and establish your medication order. Most clinics schedule a "nurse teach" appointment where you'll practice mixing and administering medications with a fertility nurse.

You'll also receive a calendar outlining every step with approximate dates. This is your roadmap. Keep it visible.

Phase 1: Suppression (Optional, 1–3 Weeks)

Not every protocol includes suppression, but many do. The goal is to synchronize your follicles so they start growing at roughly the same pace during stimulation. Suppression may involve birth control pills (2–4 weeks), Lupron injections (a GnRH agonist), or both. Some protocols (antagonist protocols) skip suppression entirely and go straight to stimulation.

Phase 2: Ovarian Stimulation (8–14 Days)

This is the phase most people picture when they think of IVF. You'll inject gonadotropin medications (FSH and/or LH) daily to stimulate multiple follicles to grow simultaneously. In a natural cycle, your body selects one dominant follicle; in IVF, we want many.

Common Stimulation Medications

Dosing is individualized based on your age, AMH, AFC, BMI, and response history. Your clinic will adjust doses based on how your follicles respond — this is why monitoring visits are so frequent.

Daily Life During Stimulation

Most injections are subcutaneous (tiny needle into belly fat) and take about 5 minutes once you get the hang of it. Timing matters — most clinics want injections within the same 1–2 hour window each day. Side effects typically include bloating, mild ovarian pressure, mood fluctuations, and fatigue as follicles grow. You can continue most normal activities, though strenuous exercise is restricted as your ovaries enlarge.

Phase 3: Monitoring (Every 2–3 Days During Stimulation)

You'll visit the clinic for transvaginal ultrasound and bloodwork roughly every 2–3 days during stimulation. The ultrasound measures follicle count and size (target: 18–22mm for mature follicles). Blood tests track estradiol (rises as follicles grow), progesterone (should stay low until trigger), and sometimes LH.

Your medication doses may be adjusted at each monitoring visit. This is normal — the protocol adapts to your body's response in real time.

Phase 4: The Trigger Shot

When your follicles reach target size (typically 2–3 follicles at 18mm+, with several others at 16mm+), your clinic will instruct you to take the "trigger shot." This is a precisely timed injection of hCG (Ovidrel, Pregnyl) or a GnRH agonist (Lupron trigger) that initiates final egg maturation.

Phase 5: Egg Retrieval

Egg retrieval is a brief outpatient procedure performed under light sedation (IV anesthesia — you'll be comfortable and unaware). Using transvaginal ultrasound guidance, a thin needle is passed through the vaginal wall into each follicle to aspirate the fluid and retrieve the eggs. The procedure takes 15–20 minutes.

Afterward, you'll rest in recovery for 30–60 minutes before going home. Plan for the rest of the day off. Most patients experience cramping and bloating for 1–3 days post-retrieval. Your clinic will call with your egg count — the number of mature eggs retrieved — typically within a few hours.

Phase 6: Fertilization

Within hours of retrieval, your eggs are fertilized in the lab using one of two methods:

The morning after retrieval, you'll receive your fertilization report: how many eggs were mature, how many fertilized normally. Expect some attrition — not every retrieved egg will be mature, and not every mature egg will fertilize.

Phase 7: Embryo Culture (5–7 Days)

Fertilized eggs (now called embryos) are cultured in the lab for 5–7 days, growing from single cells to blastocysts (100–200 cells). Your clinic may provide updates on Day 3 (cleavage stage) and Day 5/6/7 (blastocyst stage).

Not all embryos will reach blastocyst stage — this is normal and expected. Attrition at each stage is the embryology lab's way of identifying the strongest embryos. Typical progression: if 10 eggs are retrieved, 8 may be mature, 6 may fertilize, and 3–4 may reach blastocyst.

Phase 8: PGT (Optional)

If you've elected preimplantation genetic testing, a few cells are biopsied from each blastocyst and sent to a genetics lab. Results take 1–2 weeks. PGT-A screens for chromosomal abnormalities (the most common cause of miscarriage and implantation failure), while PGT-M tests for specific genetic conditions you carry.

Phase 9: Embryo Transfer

Transfer may be "fresh" (same cycle as retrieval, typically Day 5) or "frozen" (a subsequent cycle after embryos have been vitrified and PGT results received). Frozen embryo transfers (FET) are increasingly the standard of care because they allow hormone levels to normalize and PGT results to return.

The transfer itself is simpler than the retrieval — no sedation required. A thin catheter is guided through the cervix under ultrasound, and the embryo is deposited in the uterine cavity. The procedure takes 5–10 minutes.

Phase 10: The Two-Week Wait

After transfer, you'll continue progesterone support (typically progesterone in oil injections or vaginal suppositories). About 9–12 days after transfer, you'll have a blood pregnancy test (beta hCG). This is the definitive test — home pregnancy tests before your official blood draw are unreliable and a source of unnecessary anxiety.