How IVF is done? Main stages and features of the procedure

IVF, or in vitro fertilization, gives hope to a lot of families who struggle with conception. Knowing how in vitro fertilization operates can help make the process seem less overwhelming and more doable. Knowing what each step entails is useful, whether you’re researching your options for IVF or you’re just interested in learning more about the procedure.

There are several important steps in the IVF process, and each one is vital to a couple’s ability to become pregnant. Every stage, from ovulation stimulation to the final embryo transfer, is meticulously planned to optimize the likelihood of success. Anticipating what lies ahead can reduce anxiety and better equip you for the journey.

We’ll take you through the key phases of IVF in this post, outlining the key points and providing explanations at each stage. Our intention is to give you easily understood information so you can approach this life-altering procedure with greater knowledge and assurance.

Stage	Description
Consultation	Meet with a fertility specialist to discuss options, evaluate health, and plan the IVF process.
Ovarian Stimulation	Take hormone medications to stimulate the ovaries to produce multiple eggs.
Egg Retrieval	Collect eggs from the ovaries using a needle guided by ultrasound, usually done under sedation.
Fertilization	Combine eggs with sperm in a lab to create embryos. This can be done through traditional methods or ICSI (injecting sperm directly into the egg).
Embryo Transfer	Transfer one or more embryos into the uterus. This is a simple procedure that doesn’t require anesthesia.
Pregnancy Test	After about two weeks, take a pregnancy test to see if the procedure was successful.

What is it?

Infertility has been used in medicine for more than 40 years worldwide. In Great Britain, the first child conceived in a test tube was born in 1978. At forty years old, this girl is a content mother. Since 2012, when the IVF program received state support as part of the effort to improve demographic indicators, the assisted method has become widely used in Russia. Over 7 million children have been born worldwide as a result of IVF. In Russia, more than 100,000 IVF procedures are carried out annually.

If a man or woman’s infertility treatment using alternative methods has not produced the intended positive outcome, then in vitro fertilization is advised.

IVF is recommended for women who lack ovaries, have impassable fallopian tubes or none at all, have severe endocrine disorders, idiopathic (undiscovered) forms of infertility, are at high risk of passing on genetic pathologies from one parent to the other, etc.

In Russia, in vitro fertilization (IVF) is restricted by quotas and must be performed under mandatory medical insurance coverage. Reproductive specialists can also be contacted for a fee.

Types

A couple seeking to conceive naturally may be offered different kinds of in vitro fertilization, each with a unique process and stages, by their doctor.

• If a woman has preserved ovarian function, the eggs mature and have satisfactory quality, and the age of the woman planning a pregnancy is not higher than 45 years, then usually a stimulated IVF protocol is carried out. It can be long and short (the difference is in the number of days of taking hormonal drugs). Stimulated IVF has a higher success rate according to pregnancy statistics, since it allows you to obtain a larger number of oocytes and even keep them frozen for the next attempt if the first one fails.

IVF using donor eggs is an option if a woman has lost her ability to produce eggs, is unable to produce eggs, or if the quality of her eggs is not suitable for fertilization. In cases of complete male infertility, donor fertilization will also be provided, albeit with donor sperm. In cases where a woman lacks a uterus or has health issues that prevent her from carrying a pregnancy, fertilized eggs can be placed into a surrogate mother who will carry and give birth to the couple’s much-needed child.

• If a woman has lost ovarian function, does not produce her own eggs or their quality is unsuitable for fertilization, IVF using donor eggs can be performed. Donor fertilization will also be offered in cases of total male infertility, but with the use of donor sperm. If a woman has no uterus or diseases and defects of the main reproductive organ cannot be corrected and interfere with carrying a pregnancy, fertilized eggs can be implanted in a surrogate mother, who will carry and give birth to the long-awaited baby for the couple.

• IVF with frozen donor eggs, own oocytes, sperm and embryos is called a cryoprotocol. Such IVF can be either stimulated or natural.

• Assisted technologies may require such precision that fertilization will be performed using only one egg and one sperm, while the male reproductive cell will be helped to penetrate the egg by introducing it under the oocyte membranes with a thin hollow needle. Such IVF will be called IVF + ICSI. The method is recommended in particularly difficult cases.

Preparatory stage

Many months prior to the planned cycle of conception, the in vitro fertilization process is being prepared. Before being admitted to the IVF protocol, the man and woman who wish to become parents must first pass all tests and go through all required examinations in stages.

A woman will undergo a full range of gynecological exams, blood tests, a cardiogram, ultrasounds of the pelvic organs and mammary glands, and vaginal smears for infections and microflora. Hysteroscopy and other instrumental and surgical examination techniques like colposcopy may be prescribed in addition to the main list. When undergoing hormone blood tests, the woman must adhere to all of the doctor’s instructions because different hormones are determined at different times during the menstrual cycle. Tests for syphilis, viral hepatitis B and C, TORCH infections, HIV status, and sexually transmitted illnesses will also be required.

The man will require blood tests for HIV, syphilis, and other sexually transmitted infections in addition to a urethral smear and a spermogram, which will display the state of his ejaculate, the viability and motility of sperm, and their morphological features. Both partners undergo general urine and blood tests, as well as chest fluorography. Couples where one partner is over 35 years old and the other is over 40 years old are subjected to karyotyping, a type of genetic testing, and depending on the results, are given separate permission by a geneticist.

The date of protocol entry is not set until after treatment is completed for any inflammatory diseases, infections, or pathologies that are found. This initial phase of preparation may take several months to complete. Spouses are advised to maintain a healthy lifestyle, stop smoking and drinking alcohol, even in moderation, take vitamins, and eat a balanced diet in order to prepare for in vitro fertilization.

Avoid going to a sauna or bath house, staying in a hot bath for an extended period of time, and wearing extremely tight underwear to prevent the pelvic organs’ blood supply and thermoregulation from being upset.

It is at this point that the couple is advised to take medication to enhance the quality of eggs and sperm if in vitro fertilization (IVF) using their own oocytes and sperm is planned. The doctor prescribes a medication and vitamin regimen, which is typically followed for a maximum of three months.

Since viral and infectious diseases have a detrimental effect on both male and female reproductive health, the couple should take extra precautions to avoid contracting them. For example, fever spikes during the flu or an acute respiratory viral infection may cause IVF to be delayed for several months.

The couple is asked to sign a written consent form and agreement for IVF after all preparations are finished.

Beginning of the protocol

To start the IVF protocol, the couple should schedule an appointment with the selected physician at the clinic of their choice on the second or third day of the woman’s cycle. A protocol is an attempt at planning along with all the steps necessary to complete it. Couples can only start the IVF treatment cycle after they have all test results, signed contracts, and a medical services agreement.

The woman has an office hysteroscopy to evaluate the internal state of the uterus and a control ultrasound of the pelvic organs, if required. The woman is then given a personalized sheet with her doctor’s prescriptions. It includes comprehensive guidelines and living standards for the upcoming month. This prescription sheet must be brought to every subsequent appointment by the woman.

The doctor establishes the parameters of the protocol on the first day of the protocol, writes down the names of the prescribed medications, their dosages, how often they should be administered, and the length of the therapy in the prescription sheet, and notes the woman’s next appointment time.

The money for the stages that have not yet been completed is fully refunded without commission if the doctor decides at any point during the protocol to stop it because of complications or an unfavorable prognosis. Payments made for stages completed already are not refundable.

Ovarian stimulation

This phase starts either prior to or following the end of the menstrual cycle. Depending on how the protocol duration is selected. Just 25% of the protocols that are being used now are lengthy. With it, the woman starts taking hormonal medications 10–14 days prior to the start of her subsequent menstrual cycle.

During this time, the drugs inhibit ovarian activity, leading to a condition known as "artificial menopause." This serves as a warm-up to the primary stimulus. The goal of the additional hormones the doctor prescribes after the preparation is finished is to encourage the development of follicles in the ovaries. At the following stage of treatment, more eggs can be harvested the more mature follicles are. There is a higher chance of successful fertilization and implantation when there are more oocytes.

A woman typically matures one egg during her regular menstrual cycle, rarely two. Hormone stimulation of superovulation allows for the production of up to 20 oocytes.

A woman will need to visit the doctor multiple times during stimulation in order to monitor the growing follicles with ultrasound and donate blood for hormone levels. This is crucial in order for medical professionals to "catch" the best time to harvest mature eggs. Furthermore, the ovaries’ reaction to stimulation is significant. By monitoring, you can identify a lackluster response early on, allowing the physician to adjust the medication or boost the hormone dosage. Additionally, it’s critical to prevent ovarian hyperstimulation syndrome, which is an extreme reaction.

When using a short or ultra-short IVF protocol, a woman starts taking hormonal medications after her period and stops on the tenth or thirteenth day of the cycle, without first suppressing her sex glands. Follicle growth monitoring is also required in this situation. The cost of the stimulation stage typically includes the cost of four to five diagnostic procedures, so there is no need to pay for each ultrasound. This sum is more than sufficient for excellent ultrasound monitoring.

The doctor will recommend an hCG injection as soon as he determines that the follicles are mature, have a diameter greater than 18 mm, and there are at least three of these follicles overall. In order to allow the oocytes to mature more quickly, this hormone is given once, thirty-six hours prior to egg collection. Unripe eggs are unfit for fertilization and do not ensure the development of a viable, healthy embryo.

A woman may experience a decline in her health during the superovulation stimulation stage, including lightheadedness, nausea, persistent lower abdominal and lumbar pain, and mild swelling. Should your health worsen, you need to notify your reproductive physician right away.

When natural methods of conception prove unsuccessful for a couple, a systematic procedure known as in vitro fertilization (IVF) can help them become pregnant. The process begins with stimulating the ovaries to release multiple eggs, which are subsequently taken out and fertilized in a laboratory using sperm. Once developed, one or more of the resultant embryos are placed into the uterus after being watched closely. While IVF requires close monitoring and careful timing at every stage, families can better prepare for this journey by being aware of each step’s significance.

Egg and sperm collection

The woman needs to visit the clinic 36 hours after the hCG injection in order to have her eggs collected. It is accomplished by puncturing. The doctor positions the woman on a gynecological chair, inserts a hollow needle through the vaginal wall into the ovaries, and extracts the eggs and contents of the follicles.

Because the procedure is painful, anesthesia is used during its execution. Anesthesia is typically given intravenously. Real-time control of the entire collection process is provided by an ultrasound sensor. This makes it possible to perform the process as accurately as possible.

After that, the resulting follicular fluid containing the oocytes is transferred right away to the embryology lab for a preliminary evaluation of the quality of the obtained eggs. It is then placed in sterile containers. The entire manipulation process takes no more than thirty minutes. The woman is monitored by medical professionals for three hours following her emergence from anesthesia. Should there be no issues, she is then discharged to her home.

You are not allowed to eat for 10–12 hours prior to the puncture, and it is not advised to drink anything 8 hours beforehand. The woman shouldn’t have any sexual activity the day before the puncture. The day of the procedure, an enema must be performed and the intestines must be cleansed in the morning. On the day of collection, avoid wearing contact lenses, perfume, or makeup. Leaving chains, earrings, and rings at home is also a good idea.

Following the procedure, there may be a slight vaginal bleeding discharge, headaches, nausea, and mild lower back and abdomen pain. Usually, these symptoms disappear after a day or two. Additionally, she starts taking medication on the day of the puncture to keep her corpus luteum functioning. These medications also aid in the thickening and loosening of the endometrium, increasing the likelihood of a successful implantation.

The woman’s partner is required to contribute new sperm at the conclusion of the puncture, which will be utilized for the next round of fertilization. This is accomplished by masturbating in a different clinic room. Additionally, semen is sent to a lab for analysis. A man who donates sperm is not given any recommendations. His life can go on normally.

In cases where ejaculation is absent or the sperm count is very low, medical professionals may opt to perform surgical sperm collection. The man can leave the clinic after two to three hours after the procedure, which is also done under anesthesia.

It is advised that the woman follow a calm regimen, eat healthily, and avoid all stressful situations. You should call an ambulance if the temperature rises above 38.0 degrees following the puncture, if there is a lot of vaginal discharge, if there is bloating in the abdomen, if there is severe pain, and if there is pain when urinating. However, if the puncture was done properly and in accordance with all guidelines, there is very little chance of these issues developing afterward—no more than 0.1-0.3%.

Fertilization

In the lab, the sacrament of the beginning of a new life occurs. The egg suitable for fertilization is extracted from a follicular liquid under a strong microscope, measured, and put in a specialized incubator with a nutrient medium. Concentrated sperm are added to incubators after four to five hours. They try to calculate so that there must be at least 45–50 thousand male germ cells for every egg in order to increase the chances of fertilization.

If there isn’t enough healthy, mobile sperm in the ejaculate, an ICSI can be performed, which involves purposefully inserting a specific reference sperm beneath the eggshells at a "point." It is evident that the cost of the extractoric fertilization protocol is considerably increased by ICSI.

If frozen eggs and sperm are used in the protocol, they must be gently defrosted and carefully microscopic "sifted" to remove damaged and inappropriate cells before being combined in the incubator’s nutrient medium. Contrary to popular belief, cryoprotocols are just as effective when using fresh germ cells that were obtained a few hours prior.

On the same day, which is regarded as zero, signs of fertilization are seen in the eggs. About 16 hours after the oocytes and sperm are connected, the first microscopic changes are observed. It will take a full day for medical professionals to ascertain the precise count of successfully fertilized oocytes.

The doctor will be able to respond to inquiries regarding the number of embryos obtained after a full day. The couple will have to start over if fertilization doesn’t happen at all. However, ICSI can be performed in accordance with the current protocol if it is discussed with the physician prior to entering the protocol.

Embryo cultivation and their diagnostics

The egg changes its state to that of a zygote as soon as fertilization occurs. This single-cell embryo already has the maternal and paternal sets of chromosomes, is gendered, and is embedded with all genetic information, including the person’s height, eye and hair color, and inherited illnesses.

The embryologist assesses how the zygote is dividing on the second day following fertilization, which are now referred to as the days of cultivation. Both the rate of this process and the caliber of the embryos that are produced are evaluated. Preimplantation diagnostics of the embryos’ quality can already be done at this point to look for any potential developmental abnormalities.

Pregnant mothers can only have embryos transferred into their uteri that have passed a quality assessment. On the third or fifth day of its existence, the actual transfer can take place. Doctors typically prefer to watch fertilized eggs develop for a maximum of five to six days, during which time they develop into blastocysts. During a natural conception, the egg descends into the uterine cavity at this point and is implanted into the uterine wall a day or two later.

Blastocyst embryos are screened for the disease’s inheritance if the couple received guidance from geneticists regarding potential fetal pathologies.

In Russia, discrimination against embryos based on gender has been illegal since 2012. Without medical justification, it is not possible to "order" a child of a particular gender in our nation. The doctor gets in touch with the spouses at the conclusion of the cultivation period and extends an invitation to attend the embryo transfer. This rule is not limited to genetic diseases associated with sexual orientation.

Embryo transfer

There is no need to implant many embryos when transferring "five-day embryos" because five-day blastocyst embryos have a higher chance of implantation. Consequently, there is a lower chance of having multiple pregnancies. Transferring embryos that are "two-day" or "three-day" has advantages and disadvantages.

The woman must come to the clinic early on the day of the transfer. Her spouse does not have to accompany her; his presence is not required. But the doctors won’t stand in the way of his desire to help his beloved. It is not necessary to go into the procedure with an empty stomach; instead, you should arrive with a somewhat full bladder.

The most crucial decision for the couple to make at this point is how many embryos will be placed into the uterus. They will be informed that there is a chance they will become pregnant again (statistics show that when two embryos are implanted in IVF, this occurs in 60% of cases).

The spouses will have to decide what to do with the remaining embryos if a large number are received. In the event that the couple wishes to have more children, they can be frozen and kept in a cryobank. If the current protocol fails, they can also be stored there, giving the next protocol the option to proceed with the transfer during the implantation window rather than using hormonal stimulation or puncture.

In addition to giving the embryos to scientists for study, the couple can donate their embryos to other infertile couples. By signing papers outlining all the terms of the embryos’ future, the spouses formally declare their agreement.

The patient is then positioned in a gynecological chair, and the physician inserts the necessary number of blastocysts into the uterus using a thin catheter that is connected to a disposable syringe. Not too complicated, painless, and time-consuming is the procedure.

After the transfer, there’s no need to stay in bed; the implantation process is unaffected.

The subsequent period

The woman and her sexual partner are in the most agonizing waiting period during this time. Women become even more anxious when they are unsure if implantation has occurred or not. In the event of intense work, sick leave might be granted. It is advised that she lie down more or practice semi-bed rest at home. She should also get a good night’s sleep, maintain a regular diet high in vitamins, and take all the recommended minerals. Stress hormones interfere with the production of their own sex hormones and lower the likelihood of implantation, so worries and emotional shocks must be ruled out.

It is imperative that prescription drugs be taken exactly as directed on the prescription sheet, at the designated dosages, without being skipped or forgotten. Occasionally, these drugs are still required until the 14–16 week mark of pregnancy, when the placenta starts to generate the hormones required for the preservation and upkeep of pregnancy on its own.

The woman may resume her regular activities a few days following the transfer, but she should abstain from alcohol and tobacco use, as well as any strenuous physical activity, such as lifting bulky groceries into the refrigerator or going to the gym. Doing a hot bath is not advised.

A woman may have spotting or a thin discharge from her genital tract during this time. There is no pathology associated with this. A few drops of blood appearing three to five days after the transfer are also not regarded as a pathological phenomenon; this could be implantation bleeding, which shows that the embryo has successfully implanted into the endometrium. Do not lose hope if you do not experience this symptom; not every woman experiences implantation bleeding following pregnancy.

If the discharge becomes more intense, if you experience lower back and abdomen cramps, if there are blood clots in the discharge, or if the temperature increases, you should see a doctor.

Diagnostics of pregnancy

After in vitro fertilization, pregnancy test strips should not be used because there is a high chance of receiving a false positive result because the woman received an injection of human chorionic gonadotropic hormone to mature the eggs. The quantitative content of hCG in the blood plasma must be analyzed on the fourteenth day following the transfer. We can say with 100% certainty, thanks to this analysis, whether the pregnancy has occurred or not.

The amount of hCG produced will rise in proportion to the number of embryos implanted at once; if the woman is carrying twins, it will rise three times, and if she is carrying triplets, it will rise five times.

A delayed implantation can be the reason for a low hCG level. It is advised that the woman retakes the blood test in two days. It is advised not to eat or take any medications other than those prescribed by the attending physician prior to the analysis.

The diagnosis, which is based on human chorionic gonadotropin, is not made by the chorion cells until the ovum has implanted. Its concentration doubles every 48 hours, assuming the embryo is developed enough. By the fourteenth day following the transfer, the hCG level will also be noticeably lower than normal if the embryo took root and was later rejected.

The woman should have her first confirmatory ultrasound in the same clinic where all the previous stages were completed on the 21st day following the transfer, or one week following a positive hCG blood test. It is possible to reschedule the initial ultrasound examination for the week beginning on the 21st and ending on the 28th day following the transfer.

In addition to confirming the existence of a pregnancy, an ultrasound examination can identify its characteristics, such as the number of fetuses, the location of the ovum’s attachment, and the viability of the pregnancy. The expectant mother will be able to hear her baby or babies’ heartbeat closer to the 28th day following the transfer. Excluding an ectopic pregnancy, a frozen pregnancy, a miscarriage that has started or is imminent, and any other pathologies is crucial.

Thirty-one days after the transfer, an additional ultrasound scan is carried out to assess the embryo’s (or multiple embryos’) dynamic development. The woman can simply register at a women’s clinic or pay for it at a commercial clinic at this point in her pregnancy, which will be between seven and eight weeks along with the obstetric period.

Following a successful second ultrasound, a summary of the procedure that was followed is released, detailing all phases, drugs, dosages, and characteristics. Included there are also the expectant mother’s test results from the lab. You should visit the women’s clinic’s gynecologist after reading this extract in order to continue managing your pregnancy until delivery.

Further actions

When a pregnancy test comes back positive, there are essentially no concerns about what to do next. The woman registers, but in order to receive the exchange card for pregnant and parturient women, she will need to take all the tests and go through the examinations once more. The outcomes of the tests she had done prior to IVF won’t be appropriate.

In the unfortunate event that the hCG blood test result is negative, it indicates that pregnancy has not occurred. As a result, progesterone medications are no longer necessary for you to take as of right now. The woman should see a reproductive specialist once more after the end of her subsequent menstrual cycle to have her condition assessed and to determine the cause of her lack of pregnancy. Blood is drawn to check for infections and hormones, and another ultrasound is performed. Medication and dosage adjustments, as well as protocol adjustments, are made as needed.

Occasionally, switching from a long to a short or ultra-short protocol, or from a stimulated to a natural or cryoprotocol, can be quite beneficial. Generally speaking, there is always a much greater chance of success in the second protocol than in the first. Furthermore, the couple has a good chance of unexpectedly falling pregnant naturally; approximately 25% of couples conceive naturally following the hormonal "push" administered to the female body.

Following the stimulated protocol, a three-month hiatus is required. The woman’s body needs this time to recuperate from the stress of her hormones. You can start planning the next protocol as early as the following month after IVF in a natural cycle. A break is required following an unfavorable pregnancy outcome (e.g., miscarriage, frozen pregnancy, or ectopic pregnancy) that occurred during the first protocol.

All efforts should be made to enhance the quality of the partners’ germ cells during the rest period, including taking vitamins, eating healthily, and maintaining an active and mobile lifestyle.

After an unsuccessful IVF cycle, it’s critical for a woman to deal with her negative feelings and disappointment as soon as possible because depression and anxiety will only make the next cycle less successful.

IVF is a sophisticated yet tried-and-true process created to support infertile couples. From ovarian stimulation to embryo transfer, knowing each step can help to demystify the procedure and give you an idea of what to expect. Understanding these phases eases your anxiety and gets you ready for the trip ahead.

IVF gives hope to many families, despite the fact that it can be a drawn-out procedure that requires patience and careful attention at every stage. Technology and medical technique developments keep raising success rates and easing the experience for all parties.

It’s critical to be transparent with your healthcare provider and support system if you’re thinking about IVF. Being ready and knowledgeable can significantly impact your experience, which will ultimately result in a more upbeat and optimistic perspective as you proceed with the process.

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⭐ How IVF is performed? Stages of the IVF and ICSI procedure