IVF Process Timeline: What Happens During IVF Treatment?

In vitro fertilization (IVF) is the most commonly known assisted reproductive technology for fertility treatment. The IVF process timeline involves seven steps, starting from taking hormonal medications to the embryo transfer procedure. 

IVF treatment is considered one of the best assisted reproductive methods. It increases the chance of fertilization between sperm and egg by contributing to the proper function of male and female sex cells when they join each other in the laboratory. Most patients believe that realizing how IVF works helps them prepare better and have a more realistic outlook toward it. 

Having taken advantage of prominent physicians, infertility clinics, and centers offering advanced fertility treatments, Iran is considered a leading country in the Middle East to provide effective treatments and a top country worldwide.

How long Does the IVF Process Take From Start To Finish?

In general, the IVF treatment process takes about 4 to 6 weeks. It takes a few weeks for the eggs to mature, and it will take almost half a day for ovulation, a semen sample of man, and fertilization in the laboratory. If the uterus condition is favorable, the resulting embryos are transferred into the uterus about 2 or 5 days later.

Most patients will not need to be hospitalized during the IVF process. Still, in rare cases, if the number of eggs extracted from the ovary is high, the doctor will prescribe an overnight stay in the hospital after the egg retrieval operation. We should note that the success rate of this method and a healthy delivery depends on various factors, such as the couple's age and the health of their reproductive organs.

IVF Timeline

Pre-IVF preparations

There are several steps you have to follow before IVF treatment, including:

• Perform an ovarian test and blood test to determine the level of follicle-stimulating hormone and also obtain information about the size and quality of the egg;
• Take a semen sample of the male partner to evaluate the number, shape, and size of sperm. The sperm is injected directly into the egg using the ICSI method.
• Take an ovarian reserve test to evaluate the quantity and quality of eggs as well as the level of hormones such as estrogen, follicle-stimulating hormone (FSH), and anti-Müllerian hormone in the blood (AMH test) ;
• Take blood tests for diagnosing infectious diseases such as AIDS; and
• Take tests and ultrasounds to determine the depth of the uterus. Before starting the IVF procedure, doctors should determine the depth of the uterus with the help of Sonohysterography (also called saline infusion sonography or SIS).
• Ask your doctor how many embryos will be transferred and what will happen to the extra ones. 

Read more: The Best Diet Before Embryo Transfer to Increase Fertility Chances.

Preliminary ultrasound evaluation

Before receiving injections for IVF treatment and starting the cycle, patients will usually require ultrasound imaging. The preliminary ultrasound evaluation in the IVF process is important since it is used to examine the woman's uterus and ovaries and study the follicles count, the amount of blood flow to the ovaries, and finally, the uterine condition.

Secondary ultrasound on the fifth day of menstruation

The patient must perform another ultrasound on the fifth day of the menstrual cycle. This testing allows the doctor to check the growth of follicles and the thickness of the endometrium. Follicle growth prepares the woman's body for ovulation and estrogen production. At this time, two blood tests are performed to assess estrogen levels.

IVF Process Step-by-Step

In Vitro Fertilization, or IVF, is one of the most effective forms of assisted reproductive technology. This method removes a mature egg from a woman's ovary, fertilizes it with sperm in a laboratory dish, and then transfers it into the uterus.

The process takes about three weeks; however, in some cases, this cycle is divided into several stages and will take longer. Understanding how does IVF work and what steps it involves make the couple fully aware of IVF's different stages so they will choose this technique more confidently. The following will describe the IVF process timeline from beginning to end.

Step1: Preparing for in vitro fertilization

Your doctor may prescribe birth control pills before the program. These pills will reduce ovarian cysts and prevent ovarian hypersensitivity syndrome; however, there is a disagreement between doctors about this issue.

If your menstrual cycle is irregular, your doctor will prescribe progesterone for you. After six days of taking progesterone, some doctors also prescribe injectable antagonists or agonists that will affect ovulation.

Step 2: Proceeding with IVF

An IVF treatment cycle begins on day 1 of your period. On the second day, blood tests and vaginal ultrasounds are performed, which respectively check the size of follicles and determine the level of estrogen and estradiol.

Step 3: Stimulation of the ovaries

In this stage, the patient receives injectable fertility drugs that stimulate the ovaries to produce multiple viable eggs. They should usually be injected one or four times a day (for 7 to 10 days). The injections for IVF treatment control the growth of the ovaries and oocytes, which are immature egg cells.

Read more: After Egg Retrieval: Do's and Don'ts

Step 4: Oocyte maturation

At this stage, the doctor will prescribe an HCG injection. With HCG injections, timing is an essential factor. If the drug is taken early, the egg will not mature enough; if it is taken too late, it will mature too much. This injection is usually given when the size of four follicles reaches 18 to 20 mm and the estrogen level is up to 2000 pg/ml.

Step 5: Egg retrieval

Egg retrieval is usually done 34 to 36 hours after HCG injection. In this operation, the doctor uses local anesthesia and usually harvests between 8 and 15 oocytes. The fertility doctors often start the process by inserting an ultrasound probe into the vagina to locate the mature follicles and a needle to retrieve them. Sometimes, the doctor uses abdominal ultrasound to identify the eggs and guide the needle and suction device.  

After retrieval, the eggs are placed in a nutritive liquid and sent to the laboratory, fertilizing them with the male partner's sperm. Remember that not all eggs can be fertilized; some lack the appropriate quality. A few days after the egg retrieval, you may experience spotting, cramps, and pressure in the lower abdomen, which is normal and disappears after a few days.

Step 6: Egg fertilization

On the morning of egg retrieval, the male partner should provide a semen sample at the laboratory or doctor’s office. Usually, the semen is collected through masturbation in a sterile cup. However, if there is a problem with the male reproductive system (such as azoospermia), the doctor harvests the sperm through testicular aspiration.

After retrieving the healthy and motile sperm, the egg and sperm are fertilized in the laboratory, and the embryo is formed.

Step 7: Embryo transfer

Two to five days after egg retrieval, the healthy embryo(s) is transferred into the mother’s uterus or cervix by a long, thin tube called a catheter. The catheter contains one or more embryos suspended in a small amount of fluid. 

Before the embryo transfer, you may be asked to take a mild sedative to feel no pain during the procedure. Transferring the embryo takes almost 15 minutes, and you can go home right after the procedure. Although embryo transfer is simple and painless, you may experience mild soreness in your lower abdomen and pelvis afterward.

Pregnancy Test After IVF

Fourteen days after implantation, you can take a pregnancy test to determine whether you are pregnant. Although it takes only six to 10 days for the embryo to implant in some cases, it is recommended to wait two weeks before taking a pregnancy test so that your result will be accurate. 

What to do after the embryo transfer?

In most cases, women experience spotting and light bleeding after embryo transfer. The spotting can occur due to embryo implantation; however, using vaginal suppositories can also be another reason. In case of severe bleeding, you should see a doctor immediately.

In general, after the embryo transfer, you should consider the following:

• Take partial rest for three days;
• Avoid strenuous sports activities;
• Abstain from sexual intercourse for 17 days;
• Avoid moving heavy objects;
• Use a diet containing fresh vegetables and fruits as well as laxatives to prevent constipation;
• Do not use a vaginal douche or tampon;
• Do not use the bathtub, and also do not swim for 48 hours.

Sleeping or resting is allowed in any situation. See a doctor in case of severe bleeding, shortness of breath, nausea or severe pain is recommended.

To know more about what to eat after embryo transfer, check the best foods after embryo transfer article.

Read more: What to Do After Embryo Transfer to Increase Success?

IVF Aftercare

Based on the findings of IVF specialists, you don't have to do anything special after IVF embryo transfer; however, there are some tips and recommendations that patients must follow to increase the chance of successful IVF:

• If you have experienced frequent miscarriages, severe bleeding, and placenta previa in previous pregnancies, have enough or even absolute rest after embryo transfer;
• Avoid lifting heavy objects and doing strenuous activities;
• Avoid doing some sports such as swimming, horse riding, Pilates, and aerobics;
• Avoid sexual intercourse and orgasm for two months after embryo transfer;
• Avoid smoking and drinking alcohol;
• Do gentle exercises such as walking and yoga to reduce stress and anxiety and regulate your blood circulation;
• Avoid bathing with hot water, taking a sun bath, and using a hot sauna or hot tub until your doctor permits;
• Take omega-3 and folic acid supplements to have a healthy fetus;
• Sleep at least 8 to 9 hours every night in the dark to improve melanin production and, as a result, have healthy follicles; and
• Maintain a balanced BMI with a low-fat, high-quality diet rich in iron, magnesium, potassium, calcium, and protein. 

Read more: How to Increase Chances of Successful IVF?

What to Expect after Embryo Transfer?

In most cases, women experience spotting, light bleeding, breast tenderness, and constipation after embryo transfer. The spotting can occur due to embryo implantation; however, using vaginal suppositories can also be another reason. See a doctor in case of severe bleeding, shortness of breath, nausea or severe pain is recommended. To know more about what to eat after embryo transfer, check the best foods after embryo transfer article.

When Is IVF Recommended?

The IVF method is often recommended in the case of occurring the following conditions:

• Women over 40 years old;
• Blockage or damage of the fallopian tubes;
• Poor ovarian function;
• Endometriosis;
• Uterine fibroids;
• Low sperm count or sperm deformity;
• Existence of genetic disorders;
• Unexplained infertility;
• Secondary infertility;
• Recurrent miscarriages;
• Polycystic ovary syndrome (PCOS).

Depending on the situation of the infertile couple, IVF process can be performed in the following ways:

• Use of the woman's eggs and her partner's sperm;
• Use of a donated egg and the male partner's sperm;
• Use of a donated embryo.

However, the doctor may use surrogacy or uterus transplant in women with uterine insufficiency.

IVF Success Rate

Depending on several factors, such as the mother's age, weight, and lifestyle, the success rate of IVF is different. On average, the success rate of the IVF method is less than 50%, and according to the mother's age, it changes as follows:

• 13-18% for women over 40 years old;
• 23-27% for women between 38 and 40 years old;
• 33-36% for women between 35 and 37 years old;
• 41-43% for women under 35 years old.

As can be seen above, the success rate of IVF decreases significantly in women over the age of 40. In other words, women's fertility decreases by 9% annually from age 35 onwards. Moreover, genetic abnormalities are observed in most eggs after age 45. Note that by performing preimplantation genetic diagnosis/screening (PGD/PGS), embryos without chromosomal defects can be selected for transfer. In addition to reducing the risk of miscarriage in elderly mothers, the chance of having successful IVF is increased by 10%.

What factors determine IVF success rates?

The IVF success rates vary for everyone and depend on various factors and conditions, which can help observe the related effective points. The most important factors influencing the IVF success rate include the following:

• Mother's age

Younger women are more likely to have a successful pregnancy and give birth to a healthy baby. For mothers over the age of 41, using donated eggs increase the chances of a successful pregnancy.

Read more: How to Get Pregnant with an Egg Donor?

• Reproductive history

Women with a history of a successful pregnancy before starting the IVF process are more likely to succeed in their treatment. We should note that in the case of repeated failure in the IVF cycle, the chance of pregnancy decreases.

• Sperm condition

The chance of a successful pregnancy can usually be increased by transferring more mature sperm.

• Causes of infertility

Infertility problems occur due to various reasons. For example, a regular egg can increase the chance of a successful IVF, while severe endometriosis can reduce the success rates.

• lifestyle

The couple's daily behaviors and lifestyle - especially the mother - play an essential role in increasing the Success of IVF treatment. For example, couples should avoid smoking, drinking alcohol and high caffeine, and consuming drugs. Also, in case of severe obesity, you should return to your average weight.

Causes of IVF Failure

IVF may sometimes fail due to the following reasons:

• Failure in implantation: more than 95% of IVF failures are caused because the mother's body recognizes the embryo as a foreign object and rejects it. This rejection weakens the embryo and makes it unable to grow and implant.
• Poor quality of the embryo: in the IVF method, even if the embryo is of high quality in the laboratory environment, it may not have the necessary quality for implantation in the mother's uterus, which will cause IVF failure.
• Problems with hormones: sometimes, ovulation induction drugs cannot stimulate ovulation, or the body does not respond to them. For example, it is challenging to produce FSH hormone in women over 37 years old, and this causes IVF to fail.
• Chromosomal abnormalities: chromosomal abnormalities, especially from age 40 onwards, are the common causes of IVF failure because aging causes the cells not to divide correctly. Of course, sperm chromosomal disorder is less frequent than egg chromosomal disorder.

Also, other factors cause IVF failure, such as:

• Fibroma;
• Endometrial polyps;
• Thin uterine lining;
• Polycystic ovary syndrome (POS); and
• Hydrosalpinx.

If you want more information about IVF failure reasons, don't miss the (Main reasons for IVF implantation failure) article.

What Medications Are Used in IVF?

In the IVF process, the doctor prescribes different hormonal medications for the mother, which are used either orally or as an injection. In some cases also, she should take her drugs transdermal or as vaginal suppositories to avoid digestive problems. The main medications used in IVF include,

• FSH: A follicle-stimulating hormone helps the ovaries produce more eggs. Usually, the intended mother has to take FSH injections for 14 days.
• hCG: Human chorionic gonadotropin injections improve the quality of eggs, mature them, and boost ovulation. 
• Gonadotropin-releasing hormone (GnRH): these medications, like leuprolide acetate, prevent premature ovulation. 
• Progesterone supplements: they are used to thicken the endometrium and make it ready for implantation. 
• Letrozole: it increases the number of eggs in ovaries and soars the chance of successful ovulation.

Frozen Embryo Transfer in IVF

If a woman has a low ovarian reserve, cancer, or other health issues, the IVF specialist suggests the couple use frozen embryos for IVF. Using a frozen embryo allows the couple to perform IVF anytime, significantly reducing the mother's health issues. 

During frozen embryo transfer (FET), the embryo is first defrosted and injected into the mother's uterus using a narrow plastic tube. Before FET, the doctor asks the mother to take several blood tests and perform physical examinations to ensure that her body and uterus are ready for implantation. IVF with frozen embryos has a higher success rate in many cases because it lets the uterus return to its normal state after IVF medication.

Read more: Frozen Embryo Transfer: Timeline, Process & Tips

Is IVF Painful?

IVF has multiple complications, like any other fertility treatment, and may cause mild or moderate pain. At first, some women may feel pain while injecting hormonal drugs, which is almost similar to the pain of injecting other drugs. The mild pain and irritation caused by the injections are not a big deal for most women. Later, when the ovulation induction drugs have been affected and the follicles are fully developed, you may experience bloating and mild abdominal pain due to the enlargement of the ovaries.

But the main stages of IVF are the egg retrieval process and embryo transfer, which are relatively invasive. The good news is that since both of these procedures are done under local anesthesia, you don't experience severe pain and discomfort during and after the operation. The only reason some women feel pain after IVF is that the doctor uses a speculum to keep the vagina open, which may hurt the vaginal opening. 

What are the Risks and Side Effects of IVF?

Being time-consuming and expensive and having uncertain treatment outcomes, IVF can be stressful for infertile couples. Besides, in some cases, we can see complications from ovarian stimulation drugs and egg retrieval or embryo transfer methods. You should see your doctor if you notice any abnormal symptoms during IVF.

Read more: Side Effects of IVF Injections: How to Deal?

Although most potential complications and risks of the IVF process rarely occur, you must be aware of some probable dangers. Some of these dangers include:

• Fetal weight loss and occurring preterm birth due to the possibility of multiple pregnancies because of the placement of multiple sperms in the uterus;
• Pregnancy loss or abortion;
• An ectopic pregnancy occurs in 2 to 5% of IVF cases and leads to the impossibility of continuing the pregnancy;
• Occurrence of ovarian hyperstimulation syndrome, which leads to high accumulation of fluid in the chest and abdomen after swelling of the ovaries due to injection of human chorionic gonadotropin (HCG);
• Infection, bleeding, and in rare cases, damage to the bladder or intestines;
• The possibility of nausea and vomiting;
• Flatulence and severe stomach pain;
• Dizziness;
• Significant weight gain in 3 to 5 days;
• Inflammation;
• Damage to internal organs and blood vessels because of using a needle to collect eggs;
• Occurrence of stress.

We should note that although some researchers believe that using the IVF method causes problems such as congenital disabilities and ovarian cancer, no credible research has confirmed such hypotheses.

Side Effects of IVF Stimulation Drugs

• Mood swings;
• Hot flashes and bloating;
• Constipation and breast pain;
• Rapid weight gain within 3 to 5 days;
• Oliguria;
• Shortness of breath;
• Ovarian cancer.
• Severe uterine bleeding;
• Pelvic pain;
• The presence of blood in the urine;
• A fever over 38° C;
• Infection;
• Damage to the intestines, bladder, or blood vessels;
• Ovarian hyperstimulation syndrome (OHSS).

Read more: How to Prevent Ovarian Hyperstimulation Syndrome After Egg Retrieval?

How Long Should I wait between two IVF cycles?

To Reach a regular menstrual cycle, doctors recommend space between two IVF cycles for 2 or 3 months – after two menstrual cycles were passed. Of course, to restart the IVF process, it is unnecessary to see a doctor precisely two months after the first treatment period; Instead, you can repeat the second IVF cycle whenever you are ready.

We should note that some tests have a validity date of 6 months and may need to be repeated if restarting treatment takes longer. However, couples with frozen embryos must not repeat the IVF procedure. Doctors will only repeat the embryo transfer stage.

The following steps are taken to repeat the IVF Process:

• Use birth control pills on the third day of menstruation;
• Performing ultrasound scanning and prescribing diphtheria ampoules on the 17th day of menstruation;
• Re-examination and performing another ultrasound along with prescribing estradiol tablets on the second or third day of the next menstrual period;
• It evaluates the effect of estradiol within 6-7 days after its consumption and adjusts the intake amount to help the endometrial thickness reach 7-8 mm.

PGD (Gender Selection) with IVF

Preimplantation Genetic Diagnosis (PGD) is an accurate method of gender selection with a success rate of 95%. During PDG, one or more cells are retrieved from the embryo using focused laser beams or a biopsy technique to determine its gender. If the embryo has a XX chromosome, it is a girl; if it has an XY chromosome, it’s a boy. People use the PGD technique to have a child of a specific gender or to prevent transferring gender-related genetic disorders such as Turner syndrome to their child.

Read more: IVF Gender Selection: Pros and Cons

Fertility Treatment in Iran

The presence of well-equipped medical centers and experienced doctors have made Iran one of the hubs of fertility treatment in the region and a favorite destination for many infertile couples from different countries. One of the main reasons foreigners choose Iran to receive fertility treatment services is the much lower treatment cost compared to other countries, by which they can save up to 50%.

IVF in Iran

In general, methods such as IUI are inexpensive treatments that vary in price from one treatment center to another. At the same time, you have to pay more for other fertility treatments such as IVF or microinjection. We should say that the low cost and, at the same time, high-quality fertility treatment services in Iran have made this country one of the hubs of IVF treatment.

Frequently Asked Questions About IVF Treatment

What if ovulation occurs before the egg is removed?

The occurrence of ovulation before the egg is removed the possibility of egg retrieval and prevents further treatment. For this reason, careful and regular check-ups by the medical team are essential to know the level of blood hormones and to determine the time of ovulation.

Is it normal to spot after egg retrieval?

Yes. As mentioned, minor bleeding or spotting after ovulation is possible, often caused by a perforation of the vaginal wall with the needle. Spotting is expected within 42 to 84 hours after egg retrieval, but you should see a doctor immediately in case of more severe bleeding.

Other causes of spotting after embryo transfer include successful implantation, implantation of one embryo, and separation of the other – if more than one embryo is transferred -the coming of the menstrual cycle may also be a sign of infertility.

How many times is it possible to repeat the IVF cycle?

There are no restrictions on the IVF procedure recurrence, which is up to the couple and the doctor.

Is it wrong to have intercourse between the onset of IVF and ovulation?

The man is recommended to refrain from ejaculating for 84 hours before taking a semen sample. Of course, it is better to ejaculate 5 to 6 days before semen sampling, resulting in the highest number of healthy and motile sperm on the sampling day.

When is a woman's pregnancy or non-pregnancy determined?

If the IVF treatment is successful, the person will have symptoms like a normal pregnancy. The most accurate way is to perform a pregnancy test two weeks after the embryo transfer.

How many embryos are transferred to the uterus?

As mentioned above, in most cases, more than one embryo is transferred to the uterus to increase the chance of pregnancy. This depends on several factors, such as the results of medical examinations, the couple's readiness to have multiple children, the percentage of multiple pregnancies in the medical center, the mother's age, and embryo grading.

Read more: What Is Embryo Grading in IVF?

In most cases, a maximum of three embryos are transferred to the uterus; however, if the mother is older – for example, over 53 years – sometimes, transferring more than three embryos is permitted.

When can you start your daily activities after the embryo transfer?

It is usually best to take a complete 42-hour break after embryo transfer. It is also necessary to avoid strenuous exercise, such as swimming, horseback riding, running, etc., about two weeks after the transfer until pregnancy is confirmed. However, daily light activities are not prohibited.

Is there a possibility of multiple births in IVF?

Yes. Usually, some embryos are transferred to the uterus to increase the chance of implantation, and the chance of having multiple children also increases.

We should note that the probability of having twins in a natural pregnancy is about one in eighty, while in IVF pregnancies, this rate reaches about 52%. However, the probability of having triplets in IVF treatment is also about 2 to 3%.

Read more: IVF Multiple Births

When to have sexual intercourse after the embryo transfer?

It is impossible to pinpoint an exact time for sexual intercourse after IVF, but doctors recommend delaying sexual intercourse for at least two or three weeks. Vaginal muscle contractions during orgasm may adversely affect the fetal implantation process.

However, it should be noted that, according to doctors, having sex the night before the embryo transfer will increase pregnancy chances.

What happens to the remaining embryos in IVF?

More than one egg is usually extracted during each egg retrieval process, so more than one embryo can be produced in the laboratory. If the first one is unsuccessful, several resulting embryos are transferred to the uterus while the rest are frozen to be used in further IVF cycles.

Furthermore, these frozen embryos can be used if the couple wishes to have children again in the coming years. Although the chances of a successful pregnancy with frozen embryos are slightly lower; but, its lower cost and the reduced risks and complications of re-egg retrieval make this method a perfect option.