What to expect from an IVF cycle
The first part of an IVF cycle is called controlled ovarian stimulation (COS), followed by egg retrieval, sperm retrieval, fertilization and, finally, embryo transfer.
IVF explained
There are a number of potential causes of fertility issues, and after reviewing your general medical history, your doctor can order tests to help determine the cause.
There are tests to assess fertility for both women and men. Below is a brief overview of these tests and the IVF process.
Controlled ovarian stimulation
In natural ovulation, only one egg is ovulated. In IVF, multiple eggs are retrieved to increase the chances of producing a healthy embryo and successful implantation.
As discussed here, to retrieve multiple eggs, your doctor will need to stimulate multiple follicle growth with one or more fertility drugs (called a stimulation protocol) so that multiple eggs are produced. COS includes treatment with a drug called a gonadotropin-releasing hormone (GnRH) analogue to prevent the premature release of the eggs (ovulation) before retrieval.
What to expect during COS
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Prior to start of stimulation
Prior to the start of ovarian stimulation, your doctor may prescribe medication to help suppress the pituitary. This may be an injection of a GnRH analogue or birth control (pills or patch).
Days after your period
A few days after your period begins, your doctor may start you on treatment with follicle-stimulating hormone (FSH) and/or human menopausal gonadotropin (hMG) or highly purified hMG (HP-hMG).
Week(s) after
For the next week or more (generally 8 to 14 days), your doctor evaluates your hormone levels through blood testing and regularly examines your follicles by transvaginal ultrasound to assess their development. Your doctor also keeps track of any possible medication side effects.
When follicles are almost mature
When your follicles are almost mature, your doctor will tell you when to take your trigger injection. The hCG injection is usually given about 36 hours before egg retrieval is scheduled.
Rounding out the IVF cycle—what happens after COS
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Egg retrieval
Following trigger injection, your doctor may put you under general anesthesia or sedation to retrieve the eggs from the follicles. Using a transvaginal ultrasound probe with a thin needle attached to it, the doctor draws the fluid and egg from each follicle. This process takes less than an hour in the office.
Fertilization
Your partner’s sperm is separated from the semen and then either incubated with the eggs or microscopically inserted directly into the egg in a procedure called intracytoplasmic sperm injection (ICSI). The next morning, an embryologist will check that the eggs are fertilized and developing properly.
Embryo transfer
This typically occurs after 3 to 5 days of embryo incubation. An embryologist determines the developmental stage and quality of the embryos and will work with you to decide how many will be transferred and at what time. Although more than one embryo may increase the likelihood of pregnancy, it also increases the chances of having multiples (eg, twins or triplets). Once you have decided on an appropriate number, your doctor transfers the embryos vaginally via a narrow, hollow tube, or catheter, directly to your uterus.
Luteal phase support
In an IVF cycle, the luteal phase refers to the time following egg retrieval when your uterus is prepared for embryo transfer and implantation. After the use of ovulation-inducing drugs, progesterone levels in early pregnancy may vary widely because the natural production of progesterone may be compromised. Therefore, your doctor may prescribe progesterone in the luteal phase of an IVF cycle to supplement low progesterone levels. Progesterone function is essential to the success of human reproduction as progesterone matures the endometrium to support implantation and early development. Your doctor may prescribe progesterone medication for up to 10 weeks following a positive pregnancy test. Progesterone can be provided vaginally, orally, or as an injection—your doctor can work with you to determine which may be appropriate for you.
Possible outcomes of IVF
There are several possible outcomes of IVF, which is why multiple cycles of IVF may be needed for a successful outcome.
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Pregnant
- Normal levels of hCG increasing appropriately
- Followed by ultrasound at 6 to 7 weeks, detecting a growing gestational sac and possibly a noticeable fetal heartbeat
Not pregnant
- A negative or undetectable level of hCG
- All medications are stopped, and a follow-up appointment should be made with your doctor to discuss the cycle and next steps
Chemical pregnancy
- An initial positive hCG level followed by abnormal rise or fall in hCG
Blighted ovum
- An initial positive hCG level followed by abnormal rise or fall in hCG
- Ultrasound reveals an empty implantation sac and no heartbeat, and follow-up ultrasounds may be done to confirm the pregnancy is nonviable
Ectopic pregnancy
- The embryo is growing outside the uterus—in the cervix, ovary, or bladder instead—which is potentially dangerous and must be followed carefully by your doctor
- These are not viable pregnancies
Whatever the outcome of the IVF cycle, be sure to stay on all prescribed medications, and follow up with your doctor.
Multiple cycles mean multiple chances for success
While it’s true there are many variables that can affect the outcome of an IVF cycle, it has been shown that going through a second and third cycle may increase your chances for a successful outcome.
In fact, a study of almost a thousand women (aged 21 to 40 with a mean of 32.5 years) going through IVF treatment showed that women who underwent 3 fresh IVF/ICSI cycles, including subsequent frozen-thawed cycles, had a 63% cumulative live birth rate, higher than those who went through only 1 or 2 cycles.a
Use our mind and body tips to learn more about how you can improve your experience during the IVF process.
New technologies that may impact IVF outcomes: genetic testing
You may opt to have embryos genetically tested before embryo transfer, which is done by preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS). PGD and PGS are performed by taking a small number of cells from each embryo created during an IVF cycle and genetically evaluating them.
What is PGD?
PGD is an option for anyone who has or is a carrier of a known genetic disorder. PGD tests an embryo before it is transferred into the patient. PGD allows for the selection of unaffected embryos for transfer.
What is PGS?
PGS tests an embryo for chromosomal abnormalities. PGS may be recommended for women with recurrent miscarriage, women of advanced reproductive age, or women with a history of multiple failed fertility treatments.
Options for genetic testing
| No testing | Less frequent for younger women
Still have the option to perform genetic testing on the baby in the womb after pregnancy is established |
| Test additional embryos | There may be insufficient time to test embryos used in a fresh embryo transfer; however, subsequent frozen embryos may be tested
May improve pregnancy rate for the frozen embryos transferred |
| Test all embryos | Recommended if you:
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| Bank embryos | A cost-effective way to test embryos from several IVF cycles (if a cycle produces only 1 or 2 embryos of suitable quality for testing) |
PGD and PGS may help determine if an embryo is genetically or chromosomally normal. This information can help you and your health care provider make informed decisions during IVF. Specifically, genetic testing may be useful for selecting embryos unaffected by genetic disorders. There is a lot to consider, but speaking with a fertility specialist may help you decide if genetic testing during IVF is right for you.
