IVF – how does it work, and what happens when?

Ovally now supports patients undergoing in-vitro fertilization (IVF) in addition to our egg and embryo freezing patients, by matching you with clinics that are up to 70% more affordable than comparable top clinics in the US, supporting you throughout your journey as your personal fertility coach, and serving as your individual travel planner for your IVF trip to Spain. That’s why we’re kicking off a new blog post series on IVF, starting with the basics: How does IVF work, and what happens when?

How does IVF work? The high level: 

IVF uses follicle-stimulating hormones, which your body produces naturally, to stimulate more eggs to grow on your ovaries during the month of the procedure. During a typical menstrual cycle, only one egg ovulates, while a number of other eggs disintegrate. The hormonal treatment tries to mature a larger number of eggs, which are retrieved at the point when they’re ready to ovulate and be fertilized. The retrieved eggs are fertilized with your partner’s or a donor’s sperm and then develop in the laboratory until they’re ready to be “transferred” to your uterus. That’s when one embryo (or sometimes several) is implanted into your uterus and ideally grows to be a healthy baby.

What happens when? 

1. The prep phase (~1-2 months): 

The prep phase involves lots of fertility testing to determine the underlying cause(s) for your fertility issues. You may have already tried intrauterine insemination (IUI), ovulation-supporting drugs, or IVF, in which case the prep phase will be shorter for you and require fewer, if any, tests. Typical pre-treatment tests include blood tests for hormone levels, ultrasounds of your ovaries, genetic analyses, and sperm tests, to name a few. If you’re undergoing IVF abroad, you complete a battery of tests at home and share them with your Spanish doctor, so they’re able to develop your personal IVF treatment plan based on your results and medical history. This phase is often the most logistically challenging – it can be difficult to figure out which of the many tests are covered by insurance and which providers are cost-effective and in-network for you (e.g., for ultrasounds). In addition, certain tests need to be scheduled on specific days in your cycle.

2. The follicle stimulation phase (~7-11 days): 

Your IVF treatment begins with hormonal “stimulation” to get a larger number of eggs to mature. This phase of the treatment until the embryo transfer takes place abroad for our Ovally patients. You’ll inject yourself with these “follicle-stimulating hormones” once a day at the same time, and during regular appointments your doctor will make sure you’re responding well to the treatment, and your eggs are growing. If your eggs are growing at slightly different speeds, you may begin injecting yourself with another hormone that prevents ovulation for those faster-maturing eggs. Once all of your eggs are close to being fully mature, you’ll administer a “trigger shot” that gets them to full maturation. Most women experience few side effects during this stimulation phase; bloating from enlarged follicles is very common.

3. The egg retrieval (36h later): 

36h after the “trigger shot”, your eggs will be ready to be retrieved. You’ll be under anesthesia for about 15min while a doctor collects your eggs. Some women experience some soreness and/or light bleeding afterwards. Ibuprofen is typically enough to alleviate the discomfort.

4. Embryo fertilization & development (3-6 days): 

Your retrieved eggs are tested for maturity (i.e., having the right number of chromosomes), and all mature eggs are fertilized using your partner’s or a donor’s sperm. The resulting embryo(s) develop in the lab until one is ready to be implanted in your uterus. This development phase varies from 3, to 5, to 6 days; 5 days of development are becoming the most common.

As the embryos develop, an embryologist grades their speed of development, size, and morphology to determine the highest quality embryos. At the end of this incubation phase, embryos can be genetically tested or frozen for later use. The number of embryos will vary depending on the quality and number of eggs and sperm and typically decreases with every step of the process (e.g., only 70% of eggs may successfully be fertilized).

5. The embryo transfer: 

At the end of the incubation phase, the highest quality embryo is “transferred” to your uterus. Ideally, only one embryo is transferred, but there are circumstances where your doctor may recommend transferring more than one (more on this in an upcoming post). Leading up to this transfer, your doctor may have prescribed hormonal supplements such as progesterone to make your uterus more receptive to implantation. The “transfer” itself happens very quickly and is typically painless.

6. The pregnancy test (~10-15 days later): 

10-15 days after the transfer, a blood test checks your hormone levels to see if you’re pregnant. This test can be performed back home; ideally it’s positive, and you continue to be monitored throughout a healthy pregnancy.


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