IVF is a multi-week process with distinct phases, each with its own rhythm. Some days feel like nothing is happening. Other days are a flurry of appointments, injections, and decisions. Knowing the arc of a cycle—where you are, what's next, and what's normal—makes the whole thing feel less like something happening to you and more like something you're navigating with intention.
Here's the full timeline, from first consultation to pregnancy test.
Before starting IVF, your reproductive endocrinologist (RE) will run a battery of tests to understand your specific situation and design the right protocol. Think of this as the planning phase—it determines everything that comes after.
For her: blood work (AMH, FSH, estradiol, thyroid, prolactin), transvaginal ultrasound to count antral follicles, uterine assessment (sonohysterogram or HSG), and a review of any prior fertility testing or treatment history.
For him: semen analysis (count, motility, morphology), possibly a DNA fragmentation test if there's a history of unexplained failure or loss.
For both: infectious disease screening (FDA-required), genetic carrier screening (recommended), and a financial consultation with the clinic's billing department. This is also when you'll complete consent forms and decide on a treatment plan.
Your cycle officially begins when your period starts (Day 1). Some protocols include 2–4 weeks of birth control pills beforehand to synchronize your follicles and schedule your cycle timing. Not everyone needs this—it depends on your protocol.
Around Day 2–3, you'll go in for a baseline appointment: blood work (estradiol, LH, progesterone) and a transvaginal ultrasound to confirm that your ovaries are "quiet" (no cysts or dominant follicles that would interfere). If everything looks good, you'll get the green light to start stimulation medications that evening or the next day.
This is also when your medications get delivered. You'll receive a box (or several) containing syringes, mixing supplies, and the vials or pens for your injections. Many clinics offer in-person or video injection training. Take them up on it.
This is the most active phase. You'll inject gonadotropin hormones (Gonal-F, Follistim, or Menopur) daily—usually in the evening—to stimulate your ovaries to develop multiple follicles instead of the usual one. The goal is to retrieve as many mature eggs as possible in a single procedure.
Every 2–3 days, you'll visit the clinic for monitoring: blood work (to check estradiol and other hormone levels) and transvaginal ultrasound (to measure follicle growth). These morning appointments are quick—usually 20–40 minutes—but they're frequent, and most clinics require them before 9 AM. Plan your work schedule accordingly.
Around Day 5–7 of stimulation, you'll likely add a second injection: a GnRH antagonist (Cetrotide or Ganirelix) to prevent your body from ovulating prematurely. So you'll be doing two shots a day from this point until trigger.
What You'll Feel
Early in stimulation, you might not notice much. By Day 8+, most patients experience bloating (your ovaries are growing multiple follicles and can swell to the size of oranges), mild pelvic pressure, mood fluctuations, and sometimes headaches. This is normal—you're producing 10–20 times your usual estrogen level. Wear comfortable pants. Skip the intense workouts. Be gentle with yourself.
The first injection is always the hardest. Not because of the needle (it's tiny, like an insulin needle) but because of the anxiety of doing it. By Day 3, most patients say it feels routine. If mixing medications from vials feels overwhelming, ask your clinic about pre-mixed pen options (Gonal-F pens, Follistim pens). They cost slightly more but eliminate mixing entirely.
When your follicles reach the target size (typically 18–22mm on ultrasound, with several in that range), your doctor will call you—often the same day—with instructions to take your "trigger shot" at a specific time. This injection (usually hCG like Ovidrel or Pregnyl, or sometimes Lupron) triggers the final maturation of your eggs.
Timing is not flexible. Egg retrieval is scheduled exactly 34–36 hours after the trigger. If your trigger is at 9:00 PM on Monday, retrieval will be at approximately 7:00–9:00 AM on Wednesday. Set multiple alarms. Have a backup plan. Some patients keep their trigger shot in a labeled lunch bag in the fridge with a note that says "DO NOT EAT."
This is a minor outpatient surgical procedure. You'll arrive at the clinic in the morning, change into a gown, get an IV, and receive conscious sedation (twilight anesthesia). You'll be comfortable and won't feel pain during the procedure.
Using transvaginal ultrasound guidance, your doctor inserts a thin needle through the vaginal wall into each ovarian follicle and aspirates (suctions) the fluid and egg from inside. The embryology team examines the fluid immediately to confirm egg collection. The whole procedure takes 15–30 minutes.
You'll rest in recovery for about an hour. Someone needs to drive you home (you can't drive after sedation). Most patients take the rest of the day off. Mild cramping and bloating are normal. Spotting is common. Heating pads and Tylenol are your friends. Most people feel back to normal within 48 hours.
Later that day or the next morning, your clinic will call with the fertilization report: how many eggs were retrieved, how many were mature, and how many fertilized successfully. This is an emotional phone call. Whatever the numbers, try to remember that quality matters more than quantity—one chromosomally normal embryo is all you need.
Not every follicle contains an egg. Not every egg is mature. Not every mature egg fertilizes. And not every fertilized egg becomes a viable embryo. A typical progression: 12 follicles → 10 eggs retrieved → 8 mature → 6 fertilized → 3–4 blastocysts → 1–2 euploid (if PGT tested). This attrition is completely normal. Each step is a filter, and the embryos that make it through are the strongest candidates.
Your eggs are now in the embryology lab. On Day 0 (retrieval day), the embryologists combine eggs with sperm using either conventional insemination (sperm placed around the egg) or ICSI (single sperm injected directly into the egg). ICSI is used in about 70% of US cycles.
Day 1: Fertilization check. The lab confirms how many eggs successfully fertilized (showing two pronuclei—one from each parent).
Days 2–3: Embryos begin dividing. By Day 3, a healthy embryo has 6–8 cells. Some clinics do Day 3 transfers, but most now culture embryos to Day 5–6.
Days 5–6: Embryos that continue developing reach the blastocyst stage—a hollow ball of about 100 cells with a distinct inner cell mass (the future baby) and outer layer (the future placenta). This is the gold standard for transfer. Not all embryos make it to blastocyst; roughly 30–50% of fertilized eggs reach this stage, and that's normal.
If you're doing PGT-A genetic testing, the embryologist will biopsy a few cells from the outer layer of each blastocyst, freeze all embryos, and send the biopsied cells to a genetics lab. Results take 1–2 weeks. You'll then do a frozen embryo transfer in a subsequent cycle.
Transfer day is quiet compared to retrieval. No sedation, no surgery. You'll arrive with a comfortably full bladder (helps with ultrasound visibility), and your RE will use abdominal ultrasound to guide a thin, flexible catheter through your cervix and into your uterus. The embryologist loads the selected embryo into the catheter, and the RE places it precisely in the uterine lining.
The whole thing takes 5–15 minutes. Most patients describe it as similar to a Pap smear—brief pressure, no real pain. You'll see the transfer on the ultrasound screen: a tiny bright flash as the embryo is deposited. It's a remarkable moment, however it lands emotionally for you.
Single embryo transfer (SET) is now the standard of care at most clinics. Transferring one embryo at a time reduces twin pregnancy risk (which carries significantly higher complications for both mother and babies) without meaningfully reducing your overall chance of having a baby, since remaining embryos can be used in subsequent frozen transfers.
After transfer, you'll rest for 10–15 minutes, then go home. No bed rest is required—research shows it doesn't help. Resume normal activities. Avoid anything jarring (no jumping, heavy lifting, or hot baths), but light walking and regular life are fine.
Between embryo transfer and the pregnancy blood test, time passes differently. This is universally considered the hardest part of IVF—not because anything is happening to your body that you need to manage, but because you're waiting without any control over the outcome.
During this period, you'll continue progesterone supplementation (intramuscular injections, vaginal suppositories, or both). Progesterone supports the uterine lining and is essential for implantation. Side effects include fatigue, bloating, breast tenderness, and mood changes—which inconveniently mimic early pregnancy symptoms, making it impossible to read your body for clues.
About 9–12 days after transfer (your clinic will specify the exact date), you'll go in for a beta hCG blood test. This measures the pregnancy hormone in your blood. A positive result above a certain threshold means implantation occurred. A second blood test 2–3 days later confirms that hCG levels are rising appropriately.
A Word About Home Pregnancy Tests
Many patients test at home before the official blood draw. Clinics generally advise against it (to avoid the heartbreak of false negatives or the confusion of lingering trigger shot hCG), but plenty of patients do it anyway. If you choose to test at home, wait at least 9 days post-transfer and use a sensitive test like First Response Early Result. Know that the blood test is the definitive answer.
Fill your calendar. Not with distractions to avoid thinking about it—that's impossible—but with things that bring you comfort and make the days feel less empty. A show to binge, dinners with people you like, walks that get you out of your head. Some patients find journaling helpful. Others find the r/IVF subreddit community invaluable. Whatever works for you is the right approach.
What Happens After the Test
If It's Positive
A positive beta hCG is wonderful news, and it's the beginning of a new phase. You'll continue progesterone for 8–12 weeks, have an early ultrasound at 6–7 weeks to confirm a heartbeat, and then "graduate" from your fertility clinic to a regular OB-GYN around weeks 8–10. Many patients feel a strange mix of joy and lingering anxiety—after everything you've been through, it can take a while to trust that it's real. That's completely understandable.
If It's Negative
A negative result is a loss. Give yourself permission to feel that fully. Grief, frustration, anger, exhaustion—all of it is valid. There's no right timeline for processing it.
When you're ready (and not before), schedule a follow-up with your RE to discuss what happened and what adjustments they'd recommend for the next cycle. Most doctors want to wait at least one menstrual cycle before starting again. If you have frozen embryos remaining, a frozen transfer cycle is shorter, less medically demanding, and less expensive than a full fresh cycle.
One failed cycle doesn't define your outcome. Remember the cumulative numbers: 65–70% success after three cycles for women under 40. Each attempt teaches your medical team something about how your body responds, and protocols can be refined.