IVF Step by Step : A five-minute guide
03 October 2024
IVF (In Vitro Fertilisation) is the most common assisted reproductive technology (ART), and it has helped millions of people worldwide conceive over 10 million babies. In the UK alone, there have been around 1.5 million cycles with 400,000 babies conceived. With IVF, an egg is removed from the ovaries, and fertilized with sperm in a lab to create an embryo, before being transferred to the womb to grow.
This guide will outline the IVF process, which takes approximately four weeks from start to finish. We will also include answers to questions frequently asked by our patients on each step of the process, answered by Apricity's Senior Fertility Midwife, Gemma.
1. Daily hormone injections
During the first two weeks, you'll take daily hormone injections to grow multiple eggs in the ovaries, the goal to create as many eggs as possible.
During this time, you'll be closely monitored with routine scans and blood tests so your care team can regularly check how your body is responding to the medication.
Do you have to inject yourself for IVF?
Gemma - Yes, you do have to inject yourself during the IVF process. Some can feel nervous about the injections; however, these drugs are created by drug companies for patients who have never injected themselves before. They are small and very similar to insulin pens. No matter where you have your treatment you will be given clear instructions on what to do; at Apricity we always book patients in specifically for an 'injection teaching session' to ensure you feel confident in the process.
2. Egg release
At the end of those two weeks, once your doctor gives their approval, an hCG hormone shot is given to trigger the maturation of the eggs you have been growing in your follicles.
Does IVF affect natural conception chances?
Gemma - No, there is no long-term effect of IVF on your chances of natural conception, however we will ask you not to try and conceive during an IVF cycle to ensure the procedure runs as safely as possible.
Does IVF cause early menopause?
Gemma - No it doesn't. IVF does not deplete your ovarian reserve and so is not a cause of menopause. The reason we aim to collect multiple eggs is to increase the chances of multiple healthy embryos for the embryologist so that they have the widest selection available.
3. Egg collection
Approximately 36 hours after the trigger shot, you'll go into the clinic to have your eggs collected under light sedation. The eggs are collected via a fine needle inserted into the vaginal wall under ultrasound scan guidance. It's a quick procedure, taking about ten minutes.
Is the egg collection painful?
Gemma - People can react differently, but on the whole the collection procedure is not reported as being painful. You will be given some medication, typically into the back of your hand to make you comfortable and sleep through the procedure (this is not a general anaesthetic but a lighter sedation). However, you might feel achy afterwards, so just in case, we would recommend you taking the rest of the day off work if you are able.
4. Sperm sample
On the day of egg collection, a sperm sample is provided by the male partner, or previously collected frozen or donor sperm is used.
5. Fertilisation
Once in the lab, a trained Embryologist will put the sperm and eggs together in a Petri dish to form embryos.
Embryos are created by mixing the sperm and the eggs in a Petri dish. They can also be fertilised using an additional procedure of intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg. This can be used if there is a sperm quality issue, or if frozen eggs are being used.
How long does it take for embryos to be created in IVF?
Gemma - Embryos are closely monitored by embryologists, with the 'Blastocyst' embryos forming five to six days after egg collection.
6. Blastocyst stage
After five or six days, the most viable embryo is selected for transfer.
The embryos are carefully cultured in the lab by the embryology team and the embryologist will decide on the best embryo to place back into the womb. At this time, the embryos will have enough cell structure to be graded and the top-quality ones are selected for your current treatment. In some cases, embryo biopsy and genetic testing (PGT) is also performed to help select the most viable embryo. Even though one embryo is chosen, you usually will have the option to freeze the remainder for future use.
How does the embryologist decide on the best embryo to use?
Gemma - Embryo selection is based on choosing blastocysts with the best chance of success. This is judged on multiple factors including growth rate in the incubator, size, number and shape of the cells, and very often AI is used.
7. Embryo transfer day!
Embryo is transferred back into the uterus.
You will then return to the clinic for the embryo transfer, which is a simple and painless procedure where the selected embryo is placed into the uterus via the cervix using a thin catheter. No sedation is required and is a similar feeling to a smear test.
Why not transfer multiple embryos?
Gemma - We would recommend that single embryos are transferred - if two embryos are put back there is a much higher chance of a multiple pregnancy. I'm a midwife and have seen first-hand that twin and triplet pregnancies are much higher risk, both for babies and for mothers. Our long-term goal is to get you through this process with everyone happy and healthy and this standpoint is also backed up by our regulatory body the HFEA, who also discourage multiple pregnancies.
8. The two week wait
Two week pause during the luteal phase, after the embryo is transferred.
After the transfer, you will take progesterone supplements to support the uterine lining and facilitate embryo implantation, this taking ten to fourteen days. This is otherwise known as luteal phase support. The luteal phase is the part of the menstrual cycle that occurs after ovulation where your body is working to support a possible pregnancy.
How can you make sure IVF is a success?
Gemma - There is no set of rules to guarantee IVF is successful. In this phase of IVF I would say take it easy, stay active but nothing too strenuous. Continue eating and drinking in a healthy fashion and look after your mental health. This 'two week wait' can be an extremely mentally challenging time so above all, be kind to yourself.
9. Taking a pregnancy test
About 10-14 days after the embryo transfer, a blood test is taken to check for pregnancy. If positive, further tests confirm and monitor the pregnancy.
If the pregnancy test is not positive, what do I do?
Gemma - Always consult with your advisor for next steps. With Apricity, we offer care through a bespoke mobile app where you can message in to let us know what your results are (negative or positive) and your dedicated care team will guide you through the next steps. Regardless of outcome, again, remember to be kind to yourself.
IVF is a complex but highly effective fertility treatment that offers hope to many couples struggling with infertility. Understanding the detailed steps and knowing what to expect can help reduce anxiety and prepare you for the journey ahead, however, always consult with a qualified fertility specialist to discuss your specific situation.
About the author
Apricity Fertility Clinic offers comprehensive fertility care from the comfort of your home. They are the UK's leading private clinic for IVF, treatments, and testing, offering convenient online and virtual appointments.