The IVF Process: Step-by-Step What to Expect as a Patient

So many things I wish I knew before starting IVF in terms of what to expect. Of course, there are the general things I can list; waiting, how slow the process can be, the body changes and the not always perfect results. But let me lay it out for you as best I can.

The IVF Process: Step-by-Step What to Expect

First IVF Consult:

This is where you can expect to ask all the questions. You will also be asked about your medical history and if there needs to be more testing done, they will usually schedule this here so they can better know your body and what you will need. Usually, a plan is laid out here based on what you need, and a calendar will be given to you with potential and estimated dates. You will also have an initial intra vaginal ultrasound to see what your ovaries look like.

You will also most likely be asked to pay for the cycle up front. In most states, in the US, clinics ask for payment up front and or insurance if that is an option for you.

Next Steps:

If you have a regular cycle, you will be asked to call in on day 1 of your next period (if you are given the ok to go ahead and start. Again, this varies per person based on what their health needs are). I do not have a cycle so I was placed on birth control for 14 days so that I could then get a period. You will also be asked to order whatever medications for egg stimulation your clinic will want you to be on.

Baseline Appointment:

Once I got my period, I called on the first day and scheduled to come into the clinic on day 3. Here is when that did another transvaginal ultrasound (all ultrasounds are transvaginal, so I’ll just refer to them as ultrasound for now). This is called your baseline appointment. Here they will see how many follicles you have in your ovaries and will also check for any cysts or polyps or abnormalities. If this baseline is normal, they will allow you to proceed with medications for egg stimulation, or as they call it STIMS.

STIMS:

You will be told when to start your hormone injections. This is a hormone that will help your follicles/eggs grow and develop and eventually mature so that they can be extracted anywhere from 7-14 days from when you start. Don’t be surprised if you start on a very low dosage of medication. Your doctor most likely wants to see how your body reacts to this medication and how your follicles respond. You will most likely go in daily either for blood work or an ultrasound to check on your estrogen levels and to check on the follicles. Again, each clinic is different, but this was my experience at two different clinics with three different doctors.

Your medication might be upped, meaning the dosage might increase, as you progress depending on what your body needs.

Once your follicles reach a size of (typically) 18-22mm, the doctor will ask you to take a trigger shot. This is taken 36 hours prior to egg retrieval surgery. You will stop the other injections and have a day without any injections yay!

Egg Retrieval:

You will have an assigned time where you are told to come into the clinic. Prepare to have someone pick you up as you will most likely be put under anesthesia for the procedure. They usually suggest no makeup and no perfume or scented lotions to protect the follicles upon retrieval. On this day is also typically when they ask for the male sperm collection (if you have a partner that is providing this). If not frozen sperm is thawed this day so that it can be placed with the mature eggs collected upon retrieval.

They will ask you to arrive at least an hour before retrieval so you can change into a gown. You will be asked some questions and also have your vitals taken. You will be given an IV where they will eventually administer the anesthesia. Typically, an anesthesiologists will come in and talk to you prior to the surgery.

Once they are ready, the medication will be administered, and you will be taken to the surgery room. There is no incision that is made for egg retrieval. The surgery is done laparoscopically through your vagina into your ovaries. The surgery itself is fairly quick. You will be taken off the anesthesia when it is complete and most likely will wake up from anesthesia in one to two hours at which point you will be allowed to get dressed and be taken home by your caretaker that day.

After the Retrieval:

The doctor usually comes in before you leave and will tell you how many mature eggs, he was able to collect. These will now be places in a petri dish with the sperm to hopefully fertilize.

The embryologist will call you the next day to let you know how many fertilized and then will call every other day with the progression of how many made it to what is called blastocysts or cell division stage. This stage is where the embryo is formed. It can start at day 3 and move into day 5 and 6 to be considered a sound embryo. The embryologist will be calling with updates and remember to ask them questions along the way if you have any.

During this time remember to take it easy for the first 5 days post retrieval. Your Dr. and clinic will give you a protocol on how they want you to handle your body but taking it easy is important so that your body has time to heal. It is normal to feel bloated for a few days. You might also feel constipated because of the anesthesia so make sure to ask your doctor as to what medications you can take for this (Colace, miralax etc.).

PGS/PGT Testing:

Before retrieval, and if not then usually by the first embryo update, your embryologist will want to know if you wish to do PGS or PGT testing. Not all clinics offer this, and I know it is different in all parts of the world but in the states, you usually have this option. It is an added cost, but this is where you can choose to biopsy your embryos so that they can be tested to see if they are chromosomally normal embryos. You can and should talk to your doctor about this before surgery and see what he/she suggests for you.

You don’t have to test your embryos so if you are doing a frozen embryo transfer, meaning your embryos will be frozen after they form so that you can transfer them at a later date then you will be in a sense waiting for an entire cycle (about a month) before transferring. If you choose to do a fresh embryo transfer, then you will not be able to PGS test your embryos and will have a chance to transfer a few days after your retrieval. Again, this is also based on what your doctor recommends for you.

*There is no real benefit to transfer frozen versus fresh in terms of success rate.

Transfer Process:

Once you have determined that you have an embryo to transfer (and I will talk frozen embryo transfer here since that is the only kind I did), you can begin your process. Again, because I don’t get a period on my own I was put on birth control after the egg retrieval for a few weeks. Because PGS testing results take about 7-10 business days this was not a huge ordeal, and I was on birth control as we waited for results.

You will be asked to call the clinic on day one of your cycle once you stop BC or get your period on your own and will be asked to come in for another baseline appointment like the one pre-egg retrieval. Again, they will make sure your ovaries are clear and that your uterine lining is nice and thin so that they can get it thick with hormones. If you get the green light to proceed, then you will likely start estrogen within a day or two. This will be in the form of either a vaginal pill, an oral pill, an estrogen patch or estrogen shots (or a combination of these). You will be going into the clinic to check your estrogen levels and the thickness of your lining about 5-7 days after starting estrogen (again every clinic is different).

If your lining and estrogen levels are where the doctors want them to be then you will likely begin progesterone. This is typically given in a shot form. Progesterone will help support your pregnancy and will also stop your lining growth (which should be at your optimal thickness by then). Typically, one starts progesterone 5-6 days before transfer. My clinic also prescribes prednisone for those 6 days as a form of steroid so that your body doesn’t reject the embryo as it is a foreign object to your body. I was also prescribed a form of antibiotic to help eliminate any possible infections. Again, both were stopped on the day of the transfer.

Transfer Day:

THE BEST DAY! Here we go, be proud of yourself for making it this far! The clinic will ask that you come a couple hours before transfer. I was asked to come with a full bladder (this is so your bladder pushes your uterus to a more horizontal stance making easier for the doctor to transfer the embryo). The embryologist will have thawed your embryo and will also let you know how the embryo thawed.

Once the doctor is ready to go you will go into the transfer room and most likely change into a gown or at least from waist down to make it easier to transfer (at my clinic we wore hair nets and gowns as did everyone else in the room). I was also prescribed valium. This is given on occasion because it helps the uterus lessen the natural contractions that happen. It also allows you to feel more calm and relaxed.

The embryologist will come into the room, once the doctor checks your uterus with an ultrasound, and they will have the embryo with them. The nurse will call out the time of day and they will move on with the procedure. This is typically a very calm and loving experience. Your legs will be up on stirrups and you will be flat on your back. You will also be able to see the doctor place the embryo in your uterus which is so magical! The transfer itself does not hurt and it is almost like a more invasive pelvic exam. The whole process takes just a few minutes. Then you will be asked to lay there for a few minutes before being allowed to stand and use the restroom.

If you are on valium, you will be asked to make sure you have a ride home (it is probably a good idea to have someone drive you home regardless so you can continue to relax).

You will be given a protocol for what to do for the first 48 hours after transfer. Every doctor is different and it will depend on what they believe is right for you. In my experience, I was put on mild bed rest for 48 hours and then told I could resume activity to my discretion. This means do what you normally do but don’t do anything you will regret later. I do recommend walking daily and not overthinking your daily moves. You cannot affect the implantation at this point but you want to be able to look back and say you did everything you could.

Two-Week-Wait (TWW)

This is the hardest waiting time in my opinion. Avoid googling information and overthinking too much, do listen to your body when you are tired or hungry etc. Remember you are on medications that create similar symptoms as those that you might have if you are pregnant. It’s very hard to differentiate the two however you also know your body best so trust that. Just remember you have done everything you can up to this point.

Beta Day

This is typically 10-14 days after transfer. You will be asked to come in to get your blood drawn to see if your transfer worked. You should expect a call by the end of the day if not sooner (again every clinic is different). This is a blood test to check your HCG levels, which is the pregnancy hormone. Typically, they like to see it over 100 on the first draw. They will then ask you to come in for a second test to see if your numbers are doubling or at least rising 48 hours later should your Beta come back positive.

Erin Bulcao, Patient Advocate

Medical Disclaimer:

The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.