The time from the start of fertility medications until pregnancy testing is a "treatment cycle." Prior to and during the cycle all IVF patients receive with personalized instructions and education. Patients should know what to expect and when to expect it. Because the entire process takes place over several days and appointments, patients may see more than one physician in a treatment cycle.

First Steps

A physician starts by examining the woman partner thoroughly, including an ultrasound.

The couple then meets with an IVF nurse coordinator to plan the treatment cycle on everyone's calendar. Mandatory clinic appointments allow monitoring of the woman's response to fertility drugs. The couple attends a mandatory class to learn how to use injectable fertility medications. At that time, patients learn more about details of the cycle and also sign consent forms.

An IVF treatment cycle normally spans two menstrual cycles. The steps are:
   1. Prevention of ovulation
   2. Follicle stimulation
   3. Follicular Maturation Trigger
   4. Egg retrieval and fertilization
   5. Embryo transfer
   6. Pregnancy test

1. Prevention of Ovulation

On the first day of her menstrual period, the woman patient notifies the clinic office by phone. She takes birth control pills from day two or three of her period for about two to three weeks. At that time, ultrasound allows a specialist to investigate the ovaries' condition. If they are normal, she begins a drug called Lupron and stops taking the birth control pills.

Lupron prevents the ovaries from releasing eggs too soon within the IVF cycle. The patient takes it as a daily injection . Common side effects of Lupron include hot flashes, headaches, and vaginal dryness. Some patients instead receive Antagon® or Cetrotide®, or a different formulation of Lupron called microdose Lupron.

2. Follicle Stimulation

About a week after starting Lupron, ultrasound indicates the condition of the ovaries again. If there are no cysts, the woman begins taking medications to stimulate ovulation – either Gonal-F or Follistim daily as an injection in the abdomen, thigh, or upper arm. She also continues taking Lupron, but at around half the dosage amount, until Step 3 below.

Gonal-F or Follistim can stimulate the ovaries to produce many eggs. The reason for producing more eggs is to increase chances for more high-quality embryos, thereby increasing chances for pregnancy

On the fifth or sixth day after starting Gonal-F or Follistim, the clinic tests the woman's blood estrogen level and perform a vaginal ultrasound. Depending on the test results, the daily dose of Follistim or Gonal-F may be adjusted.

3. Follicular maturation trigger

Once the egg follicles are mature, the patient learns how to give herself an injection of human chorionic gonadotropin, hCG. This gives the eggs a final growth spurt. She also schedules a pre-operative exam and the egg retrieval.

4. Egg retrieval

The woman must arrive almost an hour earlier than her scheduled egg retrieval procedure so that an anesthesiologist can administer intravenous (IV) sedation.

The physician then inserts an ultrasound probe and special hollow needle through the vagina, locating the follicles and aspirating (removing) the surrounding fluid. The procedure usually takes between 30 and 60 minutes.

On the same day, the male partner provides a semen sample, whether through ejaculation or surgery (surgery is only used for specific, identified conditions.) In cases where the prior decision was to use ICSI with IVF, the ICSI procedure occurs at this time.

Post retrieval recuperation usually requires that the woman rest at the clinic for about an hour and be driven home. She should remain home for the rest of the day and may experience vaginal bleeding and lower abdominal pain. Heating pads and acetaminophen are generally helpful.

The day following egg retrieval, progesterone injections begin and continue until the patient takes a pregnancy test. Progesterone supplements the body's natural production to promote healthy uterine lining for implantation.

5. Embryo transfer

The clinic contacts each patient the day after egg retrieval to inform her of how many embryos have resulted from fertilization. At that time, she makes an embryo transfer (ET) appointment three days following or, in the case of blastocyst transfer, five to six days later. The clinic’s staff also confirm the patient’s previous decision on how many embryos to transfer.

Embryo transfer is usually quicker than egg retrieval. The physician transfers the embryo(s) between their storage container and the woman's uterus with a flexible tube called a catheter inserted through her vagina and cervix. Afterward, the patient should be driven home and rest in bed for the following 36 hours. Normal activities may be resumed, but not strenuous physical exertion or intercourse until the day of the pregnancy test.

6. Pregnancy test

The clinic’s staff performs pregnancy tests in the lab early in the morning, two weeks following egg retrieval. Results are available to patients by midday.

Possible Complications

IVF is not without risk. As with any medical therapy, patients should weigh the potential risks of treatment against the potential benefits. The clinic’s staff takes standard precautionary steps to avoid any and all adverse events.

Possible adverse affects of the fertility medications used in IVF include:
- Systemic reactions
- Ovarian hyperstimulation syndrome (OHSS)
- Possible adverse affects from egg retrieval are the same as for any minor surgical procedure, including:
- Infection
- Bleeding that may warrant blood transfusion or surgery
- Internal puncture and resulting organ injury