IVF is discussed constantly and explained rarely. Couples arrive knowing the acronym and almost nothing about what the weeks involve, how often they will need to attend, or what the injections feel like.
This is the cycle from start to finish, described plainly.
What IVF Does
In a natural cycle, one egg matures and is released, and fertilisation happens in the fallopian tube. IVF moves fertilisation outside the body.
The ovaries are stimulated to mature multiple eggs rather than one. Those eggs are collected, combined with sperm in the laboratory, and the resulting embryos are grown for a few days. One is then placed into the uterus.
Multiple eggs are needed because not every egg fertilises, not every fertilised egg develops, and not every embryo implants. The numbers reduce at each stage.
Before the Cycle Starts
Preparation typically takes one to two months and is not wasted time.
- Baseline hormone tests including AMH, and an antral follicle count
- Infection screening for both partners, which is a regulatory requirement
- A uterine cavity assessment, sometimes by hysteroscopy, to exclude polyps or adhesions
- Repeat semen analysis and a plan for whether ICSI is needed
- Correction of thyroid, vitamin D and anaemia
- Weight optimisation and stopping smoking, both of which affect success rates
The protocol is then chosen based on your AMH and age, which determines the drug doses used.
Stage One: Ovarian Stimulation
This lasts roughly ten to twelve days and involves daily injections given into the fat of the abdomen or thigh.
The needles are very fine and most women self administer after being taught once. The injections sting briefly rather than hurting. Bruising at the site is common and harmless.
You will attend for scans and blood tests every two to three days so the response can be tracked and doses adjusted. This is the part couples underestimate: it means several hospital visits, usually early morning, over a fortnight.
Common effects include bloating, breast tenderness, mood swings and tiredness. Most women continue working, though the appointments require flexibility.
Stage Two: Trigger and Egg Collection
When the follicles reach the right size, a trigger injection is given at a precisely specified time, usually late evening. Timing matters to the hour, because collection is scheduled around thirty six hours later.
Egg collection is a short procedure, fifteen to twenty minutes, done under sedation. A needle is passed through the vaginal wall under ultrasound guidance to draw fluid from each follicle, and the eggs are identified in the laboratory.
You go home the same day. Cramping and light bleeding for a day or two are normal. The number of eggs collected is usually known immediately, and it is often lower than the number of follicles seen, which is expected.
Stage Three: Fertilisation in the Laboratory
On the same day, sperm is prepared and combined with the eggs by one of two methods.
Conventional IVF places sperm around each egg and allows fertilisation to occur. ICSI injects a single selected sperm directly into each egg, and is used for male factor infertility, previous failed fertilisation, or small numbers of eggs.
Fertilisation is checked the next morning. Typically around seventy percent of mature eggs fertilise. The embryos are then cultured, with blastocyst culture to day five now common, since it allows better selection of which embryo to transfer.
You will receive updates over these days, and this waiting period is emotionally difficult because the numbers fall at each stage.
Stage Four: Embryo Transfer
Embryo transfer is far simpler than most people expect. A fine catheter passes through the cervix and the embryo is placed into the uterine cavity under ultrasound guidance.
It takes a few minutes, requires no anaesthetic, and feels similar to a smear test. You will be asked to attend with a comfortably full bladder, which improves the ultrasound view.
Single embryo transfer is now standard practice, because transferring two significantly increases the chance of twins, and twin pregnancy carries real risks for mother and babies. Remaining good quality embryos are frozen for future attempts.
Bed rest afterwards does not improve outcomes. You can resume normal activity the same day.
The Two Week Wait
The interval between transfer and the pregnancy test is widely described as the hardest part of the process.
Progesterone support is given by pessary or injection during this time. Its side effects, including bloating, breast tenderness and mild cramping, mimic both early pregnancy and an imminent period, which makes symptom watching completely unreliable.
Home pregnancy tests before the scheduled date give misleading results, either falsely positive from the trigger injection or falsely negative if taken too early. Wait for the blood test.
Light spotting can occur and does not necessarily indicate failure.
Success Rates and Realistic Expectations
Success is dominated by the woman's age at egg collection, and honest figures matter more than optimistic ones.
Live birth rates per embryo transfer are broadly around forty percent under thirty five, falling progressively through the late thirties, and into single figures over forty three with a woman's own eggs.
Two things follow from this. First, cumulative success across several cycles is considerably higher than a single cycle figure, so plan financially and emotionally for more than one attempt. Second, be sceptical of any clinic quoting a single very high success rate without specifying the age group and whether it refers to pregnancies or live births.
Risks to Know About
IVF is generally safe, but there are specific risks worth understanding.
- Ovarian hyperstimulation syndrome: an excessive response causing fluid shift, abdominal swelling and in severe cases breathlessness. Modern protocols have reduced severe cases substantially, but report rapid abdominal swelling, severe pain, vomiting or reduced urine output immediately
- Multiple pregnancy: minimised by single embryo transfer
- Ectopic pregnancy: slightly higher than natural conception
- Procedural risks of bleeding or infection at egg collection, which are uncommon
- Emotional strain, which is the most consistently underestimated risk
The psychological demand of treatment is real, particularly across repeated cycles, and support should be sought rather than endured.
An IVF cycle takes roughly four to six weeks from the first injection to the pregnancy test, with the stimulation phase requiring frequent early morning visits. Understanding the sequence removes a good deal of the fear, though not the emotional weight.
Our fertility department at T. Nagar provides IVF, ICSI and embryo freezing with counselling as part of the programme.
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