What are the 5 stages of IVF?

That's where we come in to help. In this article, we'll go through all the main stages of an IVF cycle and what happens at each stage of this fertility treatment.

Introduction to in vitro fertilisation (IVF)

IVF is an assisted reproductive technology (ART) that combines eggs and sperm in a lab. Once the embryos are fertilised, they’re transferred back into the woman's uterus to grow. Any extra embryos can be frozen for future use, giving you even more chances to start or grow your family.

IVF process and its steps

There are 5 stages of in vitro fertilisation:

1. Preparing for IVF treatment

2. Egg retrieval 

3. Sperm collection

4. Fertilisation

5. Embryo transfer

Typical IVF treatment lasts around six weeks but may vary based on personal health, treatment plan, and fertility clinic.

Understanding — let alone going through — IVF can be a daunting experience, especially if you're not familiar with the ins and outs of IVF. So, we're here to help make it a little less overwhelming. Keep reading for a guide that breaks down the phases of IVF and what to expect.

Step 1: Preparing for IVF treatment

Before starting IVF, you (and your partner, in the case of couples) may have to undergo tests to check your health, fertility status, and potential cause of infertility. These tests can include: 

• Anti-müllerian hormone (AMH) blood test to check your ovarian reserve and predict how your ovaries will respond to IVF treatment. Some clinics, including Apricity, offer at-home AMH tests.

• Hormone screening - we also do this at home. 

• A vaginal ultrasound to check the uterus and ovaries.

• HIV, hepatitis B, and hepatitis C screening 

• Sperm analysis to check the quality of sperm. 

Another important step of the IVF process is stimulating the ovaries to produce more, improving the chances of creating more embryos. Depending on the treatment, a "long protocol" may be recommended, which involves temporarily suppressing the body's natural hormone production. Patients are prescribed gonadotropin-releasing hormone (GnRH) antagonists as a daily injection or nasal spray to make the ovaries more receptive to the drugs that stimulate them later. 

After that, patients are prescribed follicle-stimulating hormone (FSH), encouraging the ovaries to produce more eggs. The medication comes as a daily self-administered injection for around ten days, though the treatment length can vary depending on the patient. How many injections you’ll need for IVF treatment also varies. Some people will be required to do just one injection per day while others will need two or more.

Throughout the process, your clinical team doctors will closely monitor your ovaries with regular ultrasound scans and blood tests to ensure everything is going well and to check for any complications. They’ll also be able to advise you on dos and don’ts during IVF stimulation, such as setting reminders to administer you medications and preparing your equipment.

Step 2: Egg retrieval process

When it's time for egg collection, the fertility doctor will ensure you're as comfortable as possible. You'll be given either sedation or a general anaesthetic, and the doctor will use ultrasound guidance to gently collect the eggs from each ovary using a tiny needle inserted through your vagina. The needle is connected to a suction device that pulls your eggs out of each follicle.

The process usually lasts around 30 minutes and may cause some mild cramping or light vaginal bleeding afterwards, but we'll be here to support you every step of the way. Our advisors are available during the chat, and can answer any worries you have. 

Step 3: Sperm collection

If you're using your partner's sperm, they'll need to provide a semen sample on the day of your egg retrieval. The sperm are centrifuged and washed to select the healthiest and most active sperm.

If using your partner's sperm isn't an option, there are alternatives, such as donor sperm, which can be just as successful. Sometimes, sperm can be collected and frozen for future use, depending on your partner's fertility and overall health. If donor or frozen sperm is used, the sample is thawed on the day of the egg retrieval. 

Step 4: Fertilisation

On the day when both the eggs and sperm are collected, they will be mixed in a lab to create an embryo. Fun fact — that's where "in vitro fertilisation" comes from. 

If male infertility is part of the diagnosis, each egg may also need to be injected individually with a single sperm. This process is called intracytoplasmic sperm injection (ICSI), a common add-on to IVF. 

Once the fertilisation is complete, the embryos will grow in the lab for up to six days. Afterwards, the best embryo will be selected to be transferred back into your womb. 

Step 5: Embryo transfer

When the embryos are ready, they will be transferred back to your uterus using a thin tube called a catheter. The procedure is quick and similar to a cervical screening test, so you won't need anaesthesia.

Before the embryo transfer, your doctor will prescribe hormones (in the form of an injection, vaginal pessary, or gel) to help prepare your uterus lining. They'll also discuss with you how many embryos to transfer based on your age, the quality of the embryos, and your past IVF cycles. 

If you're younger, chances are you'll have better-quality embryos, which can increase your chances of getting pregnant. If you're using donor eggs, we'll use the donor's age to determine the embryo quality. Transferring more than two embryos can increase the risk of a multiple pregnancy, so it's not recommended.

After the transfer, you'll be given progesterone for up to eight weeks to help the embryo attach inside your uterus. 

After undergoing an embryo transfer, it's recommended that you wait for at least two weeks before taking a test — known as the dreaded "two-week wait". Waiting for the results of a pregnancy test can be exciting and nerve-wracking, and whether you choose to use an at-home test or visit your clinic for a blood test, it's important to avoid taking the test too early. Even the most advanced tests may not detect a pregnancy before the two-week mark. 

What is the most crucial stage of IVF?

Throughout the stages of an IVF cycle, there are many moments that are pivotal to the process progressing. For example, the stimulation medication having the required effect on egg ovaries, eggs being successfully collected from the ovaries, and sperm fertilising mature eggs to produce blastocysts.

However, the most crucial stage of IVF is often considered to be the embryo transfer. This is the moment when a carefully cultured embryo is placed into the uterus, with the hope that it will implant and result in a successful pregnancy. The care and precision involved in this step are paramount because the embryo needs to attach to the uterine lining for pregnancy to occur.

What is the hardest stage of IVF?

The hardest stage of IVF can vary from person to person, and all the steps of IVF likely involve some physical and emotional challenges. Many actually find the waiting for updates between each stage to be the most difficult part of the process. As the outcomes can be uncertain, the waiting can feel very long, and you may feel anxious. For example, you’ll usually have a few days between each check up to see how your ovaries are responding to stimulation. Following egg collection, it’ll likely be the following day before you receive news about the number of eggs that have fertilised. And after egg transfer, there is the two-week wait. This is the period when you wait to find out if the embryo has implanted and you are pregnant.

How long do the 5 stages of IVF take?

How long IVF takes depends on each person but there are key aspects of the IVF process that typically follow the same timeframe:

• Ovarian stimulation: 10-14 days

• Egg Retrieval: 36 hours post-trigger shot

• Fertilisation:  3-6 days

• Embryo transfer: Usually 5 or 6 days after retrieval but some people do have a day 3 embryo transfer

The overall process from the start of ovarian stimulation to the embryo transfer usually spans about 4-6 weeks.

What stage does most IVF fail?

Most IVF cycles fail at the implantation stage, after the embryo transfer. Despite successful egg retrieval and fertilisation, and even though a healthy-looking embryo is transferred, the embryo may not implant in the uterine lining. There are numerous factors at play, including embryo quality, uterine environment, and underlying health conditions, making this stage particularly delicate.

Conclusion

Undergoing IVF treatment can be overwhelming, but understanding each step of the process can make it less stressful. It's important to remember that everyone's journey with IVF is unique, and the outcome can be pretty unpredictable. Various factors such as age, medical conditions, and lifestyle can significantly impact the process. While some women may conceive right away, others may require multiple cycles. Your doctor will provide information on the success rates of IVF, but it's important to know that if it doesn't work the first time, it doesn't mean you should lose hope.

Get in touch with our team of fertility experts at Apricity to discuss your treatment options and how we can help.

References

1. (n.d.). IVF. NHS. https://www.nhs.uk/conditions/ivf/getting-started/

2. (n.d.). Before starting IVF. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg156/ifp/chapter/Before-starting-IVF

3. (n.d.). IVF. NHS. https://www.nhs.uk/conditions/ivf/getting-started/