For couples who have been trying to conceive without success, or for individuals building families through assisted reproduction, the decision to pursue IVF often comes after a long and emotionally demanding period. In vitro fertilisation is one of the most well-established forms of assisted reproductive technology available, and yet the process itself remains opaque for many people who are just beginning to explore it.

Understanding what actually happens at each stage, and what to expect emotionally and physically along the way, makes the journey considerably less daunting.

What IVF is and who it is for

In vitro fertilisation is a medical process where eggs are collected from the ovaries, fertilised with sperm in a laboratory, and then transferred back into the uterus with the hope of achieving a pregnancy.

In vitro fertilisation treatment is recommended when there are blocked or damaged fallopian tubes, severe male factor infertility and unexplained infertility after other treatments have been unsuccessful. Other situations include diminished ovarian reserve, genetic conditions where preimplantation testing is needed, and for single individuals or couples pursuing parenthood. 

Step 1: Initial consultation and fertility assessment

The first step is for the doctor to understand the patient’s fertility story. It may involve coming in two to three different times during the menstrual cycle for blood tests, ultrasounds and studies. These tests assess the way reproductive organs are functioning. Doctors can also confirm fitness for pregnancy. 

Blood tests are done to check the ovarian reserve by noting AMH levels and antral follicle count on ultrasound in women. A uterine check-up is also done using a hysteroscopy or saline sonogram, and baseline hormone levels are checked.

Semen analysis for men checks sperm count, motility, and morphology. Both partners may also undergo genetic carrier screening depending on their history. 

Step 2: Ovarian stimulation

Only one egg matures and is released each month in a natural menstrual cycle, but doing ovarian stimulation encourages the ovaries to produce multiple eggs.

Ovaries produce more mature eggs after hormonal medications are injected. However, not all eggs fertilise or develop normally after fertilisation. So, retrieving more than one egg improves the chances of implantation in the later stage.

This phase lasts eight to fourteen days, so a patient is required to attend regular appointments for blood tests and ultrasound scans. This way, the fertility team can track follicle development and adjust medicines as needed. 

Step 3: Egg retrieval

Another injection is given to help the follicles reach the appropriate size and to help eggs mature. These eggs are retrieved approximately 36 hours later under sedation or light anaesthesia. The whole process takes around 20-30 minutes. A thin needle is passed through the vaginal wall using ultrasound to aspirate fluid from each follicle and collect the eggs within it. Mild cramping and bloating in the days following the procedure are quite common in patients.

Step 4: Fertilisation 

Eggs are checked for maturity in the laboratory. This is so that they can be fertilised with sperm. There are two ways to do it, either insemination or intracytoplasmic sperm injection (ICSI). ICSI is helpful when sperm quality is poor or when previous fertilisation efforts did not succeed. 

The fertilised eggs form embryos, and are cultured in the laboratory for five to six days, after which they reach the blastocyst stage. It is the most advanced stage in the development of an embryo before transfer. It is associated with higher implantation rates than earlier-stage embryos. The embryologist monitors development and gives the information to the team about the number of normally progressing embryos. 

Step 5: Preimplantation genetic testing (if required)

Some couples struggle with a known genetic condition, older maternal age or repeated implantation failure, so preimplantation genetic testing can be helpful for them. A small number of cells from the blastocyst are biopsied to rule out any abnormality in chromosomes. This process can add an extra two weeks for results. But it helps in transferring only chromosomally normal embryos to improve the implantation rate and reduce the risk of loss.

Step 6: Embryo transfer

The transfer of embryos is painless, so it does not require sedation. A patient needs to lie down on an examination table so the embryo can be guided through the cervix into the uterine cavity using a fine catheter. The whole procedure takes under 15 minutes to complete and is done through ultrasound guidance.

The number of embryos transferred is usually one, particularly in younger patients with good prognosis embryos, to minimise the risk of multiple pregnancy while maintaining a high chance of success. Any remaining good-quality embryos are vitrified, a rapid freezing technique, and stored for future use if the current cycle does not result in a pregnancy or if the couple plans further pregnancies.

Step 7: The two-week wait and pregnancy test

The period between embryo transfer and the pregnancy blood test is the most emotionally demanding part of the IVF process. The body needs time for the embryo to implant and begin producing the pregnancy hormone hCG. A blood test at the clinic provides a definitive and quantified result, and a positive test is then followed by an early ultrasound to confirm the location of the pregnancy and assess the heartbeat.

IVF success factors

The likelihood of a successful outcome depends on many factors.

• Age of the woman, as egg quality declines with age, is the single most important predictor of IVF success.
• The number and quality of embryos available for transfer
• The underlying cause of infertility
• The woman's uterine health and receptivity
• Whether a fresh or frozen embryo transfer is used

Takeaways

The IVF process includes several steps from fertility assessment through ovarian stimulation, egg retrieval, fertilisation, embryo development, and finally, transfer. Understanding IVF steps reduces anxiety in patients. It helps them engage with their care team throughout the treatment. IVF success factors are age, embryo quality, and uterine health, which means that outcomes are not the same for everyone. 

The entire process can be quite overwhelming, so emotional support from family or friends can help the people embarking on this journey.