IVF has been a huge gift to so many couples seeking to start a family, with more than 8 million successful pregnancies and healthy babies born since the first test tube baby more than 40 years ago. The procedures have been honed over the last four decades and, coupled with tremendous advances in science and medicine, IVF now has a very high success rate.
But understanding the procedures and the time frame for a cycle of IVF can be confusing. Since each IVF plan is customized based on the patient’s situation, the exact timing of each step can vary. Some parts of the process have a range of dates, while others are exact based on ovulation and next steps.
In Vitro Fertilization (IVF) is a series of medications and procedures used by couples and individuals who have difficulty getting pregnant on their own, wish to use a surrogate or may have other needs that cause them to turn to IVF. The reasons span a wide range, including ovulation challenges, sperm quality, egg quality, uterine issues, previous surgeries and illnesses, and other factors that may hamper reproduction.
In a nutshell, the simplest explanation of IVF would be as follows: IVF medications work to boost the production of healthy eggs. Then at the right time, the mature eggs are collected, taken to the lab and fertilized with healthy sperm. The resulting embryos are nurtured in the lab for a little while, then one or more choice embryos are transferred back into the uterus, which has also been nurtured to be healthy in order to carry the pregnancy to term.
There are many variations on this typical IVF plan which address the many different issues and needs of various patients. Some cases are more straightforward and can be done with the couples’ own egg and sperm, while others require eggs, sperm or embryos from a donor. Some couples or individuals require a surrogate to carry the pregnancy to term. For reasons like these, the full IVF round may vary in its timing.
With IVF, the doctor creates a plan specific to the patient’s circumstance, including the necessary steps to address the issues at hand. This plan is discussed with the patient in detail beforehand so they know exactly what to expect.
While a “typical” round of IVF lasts the length of a woman’s cycle plus a couple of weeks for embryo growth and implantation, the process and timing can vary, and may include an extra month of hormone therapy before IVF actually begins, in order to regulate the menstrual cycle.
When you first meet with your doctor, you’ll plan some initial tests and exams to determine your health and your partner’s health. At this stage, the doctor will diagnose any complications you may have. Certain tests will be ordered such as an ultrasound, evaluation of the uterine lining and sperm analysis. From this information, a customized fertility treatment plan and schedule of procedures is created.
Depending on the patient’s issues, the doctor might regulate the menstrual cycle before beginning IVF. This is often done with patients who experience issues with menstruation, such as infrequent periods or variable cycles. This process involves taking medication, typically birth control pills, which regulate the cycle and make the timing of ovulation more predictable. It also allows for a fuller formation of the eggs.
One cycle of IVF usually involves the following steps and timeline.
At the beginning of the woman’s next cycle, hormones are administered in order to stimulate egg production. These hormones activate the ovaries to produce many ripening eggs instead of just one. More than one egg is needed for IVF, because some of the eggs might not fertilize or develop properly.
At the same time that the ovaries are being stimulated to ripen many eggs, the release of the eggs, called ovulation, is being suppressed. This step is necessary so that the eggs can be properly retrieved for fertilization in the lab – if the eggs release on their own, they can’t be retrieved and used for an IVF procedure.
After 10 days of fertility drugs, you’ll visit your doctor to confirm that the process is working. The doctor will check to confirm that the ripening eggs look viable, that you haven’t yet ovulated.
Once the eggs are fully formed and your doctor has confirmed that the eggs are viable, it’s time to stimulate the ovaries to get ready to release the fully formed eggs. This is done with injectable medications.
After about 8 days, the doctor will do blood tests and a transvaginal ultrasound to determine the size of the eggs and the ideal date for retrieval. The eggs are considered fully mature and ready to retrieve when they reach 18 – 22 mm in width.
Controlling the timing of the egg release is critical. Exactly 36 hours before the procedure, you will receive an injection of hCG (human chorionic gonadotropin). This medication stimulates the ovaries to release the eggs, but the timing is precise – exactly 40 hours after the injection, the eggs will release from the ovaries and must be captured for fertilization outside the womb. It is critical that they are collected before they are released from the ovaries.
Although it’s taken a lot of time and care to get to this stage, the actual egg retrieval is minimally invasive and relatively quick, taking about 30 minutes. This is done in the doctor’s office.
If your partner is providing the sperm, it is collected on the same day as the egg retrieval in order to ensure the freshest and most active sample possible.
The IVF fertilization process begins shortly after the eggs are harvested. Depending on the various factors – whether fresh or frozen sperm is used, whether ICSI is used, for example – will determine how long this part of the IVF process will take.
Once the eggs are successfully fertilized, they are nurtured in the lab for about 6 days until they are large and strong enough to be transferred back to the uterus. During this time, doctors can monitor the embryos and choose the best quality ones for the procedure, and to also perform genetic tests to rule out any embryos that may carry genetic conditions that would lessen the chances of a successful pregnancy.
As soon as the eggs are harvested, you will begin preparing your body for the embryo transfer by preparing the lining of the uterus with progesterone supplements. This process helps to create a healthy womb where the embryo or embryos will thrive.
Once the embryos have matured for about 6 days and confirmed to be healthy, they are transferred back to the uterus. This simple, quick procedure involves a small catheter that is inserted through the vagina and into the uterus through the cervix, where the embryos are injected. Once transferred, the embryos will attach themselves to the wall of the uterus as with a natural pregnancy.
After embryo transfer, you can usually resume normal activities while the embryos continue to grow. This stage usually lasts 12 – 14 days.
Once the embryos have been given a couple of weeks to mature, a blood test can determine a viable pregnancy. This is quick and done by your doctor.
In a lot of cases, one round of IVF is all you need for a successful pregnancy. In other cases, more than one round is needed. The odds of successful IVF depend on a lot of different factors, including age and the reasons behind your infertility issues.
Physical impairments such as damage to your fallopian tubes, endometriosis or uterine fibroid tumors can be the cause of infertility. If you have challenges ovulating regularly, or have had a previous surgery such as tubal ligation, that can also pose challenges getting pregnant.
Male fertility issues can also be at play – challenges with sperm production, such as too few, or sperm that have impaired mobility could be the cause.
There are also unexplained causes of infertility, and IVF can give you the boost needed for a successful pregnancy by stacking all the cards in your favor with mature, healthy eggs, timed harvesting, controlled fertilization and the best chance at carrying full-term.
Embarking on IVF can be overwhelming, with lots to consider and plan for financially, emotionally and physically. Fertility Finders can help you with each step in your IVF process. We encourage you to use our free resources on our website, and call us if you have further questions or need help connecting with the right services for you.