Deciding to do IVF likely marks a turning point on your TTC journey. You might be feeling excited—perhaps you’ve been waiting for a diagnosis or some direction on how to improve your odds of conceiving. But you might also be feeling uncertain about the process—and more specifically, how long the process could take. Here, we break down the long and short of an IVF cycle.
Step 1: Baseline investigations
How long it takes: The timing varies, but it needs to be done at least one month before you start an IVF cycle. Your doctor needs this information to personalize your treatment plan to optimize your results.
What it is:
When you’re referred to a fertility clinic, your team will reach out to you and have you complete baseline testing in the form of bloodwork and diagnostic imaging. Although each clinic might have slightly difference variations, the general fertility work-up consists of:
General health assessment
These evaluations aim to understand your current medical status in the hopes of improving each variable. This can include weight, blood pressure, glucose levels as well as endocrine system testing (like prolactin and thyroid-stimulating hormone tests) and infectious screening testing (to look for HIV, hepatitis and other infections that could be passed to the fetus or that could impact fertility and pregnancy outcomes).
Bloodwork, ovarian reserve tests and a pelvic ultrasound
For the partner with ovaries, you’ll have specific hormone bloodwork testing to be done on cycle day three (or between cycle days two and five if day three isn’t possible) including testing follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estrogen.
It’s also common to test anti-Müllerian hormone (AMH) to assess your ovarian reserve. This estimates the number of follicles being recruited to grow in a cycle. If AMH is low, it indicates lower fertility—a lower number of eggs remaining in the ovaries.
In addition to bloodwork on cycle day three, you’ll also have a pelvic or transvaginal ultrasound done to measure the number of follicles.
The uterus is assessed by an ultrasound. A pelvic ultrasound can measure the size and volume of the uterus, and to check for any fibroids that could be present. A sonohysterogram (SHG) is essentially a pelvic ultrasound but with the addition of fluid inside the uterus to distend it and evaluate the inner cavity and make sure there’s no fibroids, polyps or scar tissue (adhesions) inside it.
Fallopian tubes assessment
During the sonohysterogram (SHG) the fallopian tubes will be evaluated. The fluid inserted into the uterus should advance through the fallopian tubes thus confirming that they’re both open.
Some clinics will ask patients to undergo a diagnostic cycle monitoring. This requires the patient to come in for a several assessments (a combination of a pelvic ultrasound and hormonal bloodwork) at several time points during their menstrual cycle, commonly at the start (days two to five), around ovulation, and in the middle of the luteal phase (between ovulation and your expected period)
The partner providing the sperm will also require a general health assessment in addition to having their semen sample examined. A semen analysis measures the volume of the semen fluid, concentration of sperm, how many sperm can swim (motility) and can determine what percentage of the sperm look normal (morphology). If a semen analysis comes back abnormal, more testing may be required, including additional hormone testing, a scrotal ultrasound or a sperm DNA fragmentation test which reports the percentage of DNA breaks or damage in a sperm sample’s DNA.
These investigations help your doctor decide the best course of action for your IVF treatment including what hormone medications are best suited to your unique circumstance and the timing of each.
Step 2: Priming (or not)
How long it takes: About two weeks to two months
What it is:
Based on your initial investigations, your doctor will recommend a plan for IVF. In some cases, you can start right away with your next menstrual cycle, while other cases might need extra time to prepare the reproductive system (also known as priming prior to IVF), using hormone pre-treatments such as Lupron, DHEA, testosterone, estrogen or the birth control pill (estrogen and progesterone).
These priming treatments can help the ovaries respond better to hormone medications during your actual cycle and help control the natural levels of hormones. Your doctor may recommend priming in the hopes to prevent the formation of cysts, suppress endometriosis and synchronize hormones to improve the recruitment of follicles.
Step 3: Ovarian stimulation and egg retrieval
How long it takes: About two to three weeks
What it is:
It’s IVF cycle time! After contacting your clinic on the first day of your menstrual period, they’ll arrange for you to go in to start monitoring your ovaries. This includes hormonal blood work and ultrasound which are repeated every few days as you proceed through the egg retrieval process.
This process includes:
Controlled ovarian stimulation (COS): Injectable hormones are used to promote the growth and maturation of as many eggs as possible, while also preventing those eggs from being ovulated naturally (so they can be collected and not lost to the fallopian tube abyss). Hormonal treatment continues until enough follicles reach a certain size. This phase commonly lasts eight to 12 days.
Trigger: When the follicles grow to the proper size, you’ll be instructed to inject a medication that acts like the hormone LH, referred to as a trigger shot. By acting like LH, it causes the follicles to release the eggs from the follicle wall into the follicular fluid (and starts the maturation process of the eggs), so that the doctor or technician can collect them from the fluid within the follicle. This must be timed perfectly so that they can pick up the released eggs before they disappear from the ovary.
Ovum pickup (OPU) or egg retrieval: Collection and retrieval of the mature eggs from the ovary happens commonly between 34 to 36 hours after the trigger shot (but this is clinic and protocol dependent).
Step 4: Fertilization and Embryo Growth
How long it takes: Three to six days after egg retrieval
What it is:
If you are undergoing egg freezing, then you’ve reached the end of your current treatment and are not in the recovery portion of the journey. The eggs will be stripped and frozen for future use.
If you plan to create embryos, then on the same day as the OPU a new sperm sample is produced (unless using previously frozen sperm), it is washed to remove debris and damaged or dead sperm and the best looking sperm is selected to be used for fertilization. There are two different ways to fertilize your eggs: in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
- IVF: Up to one hundred thousand sperm are incubated with each egg, and the embryologist will check to see if the egg was fertilized the next day (about eighteen hours later).
- ICSI: A healthy looking sperm is chosen and injected directly into the egg. The fertilization check occurs the same as the IVF route.
IVF or ICSI?
Your doctor will review your options and give their clinical opinion as to which fertilization method may be best. ICSI has become a much more common method of fertilization and is often recommended in cases of poor sperm counts or quality, and when using frozen sperm samples.
Embryos (eggs that have successfully fertilized) formed from either IVF or ICSI are incubated, and their growth and development are carefully monitored over the course of the following three to seven days. Depending on your situation, including the number and quality of those initial embryos, your doctor will decide when and which type of embryo transfer to do:
Transfer a three- (cleavage) or five-day (blastocyst) embryo into the uterus immediately (also called a fresh transfer).
Freeze the embryo(s) to use in the next or future cycle (called a frozen embryo transfer). Most embryos are frozen once they reach the blastocyst stage, but it's certainly an option to freeze them earlier at the cleavage stage. Embryos that are biopsied at the blastocyst stage for chromosome screening (PGT-A) are frozen until the results of the biopsy are back.
Step 4B: Frozen embryo transfer cycle
How long it takes: About a month
What it is:
There are many reasons why embryos are frozen for a future use, including If you’re having your embryos chromosomally tested (PGT-A), or if your hormone levels and uterus lining weren’t optimal for a fresh transfer. Embryos transferred in a separate cycle called a Frozen Embryo Transfer (FET) cycle.
An FET cycle can be done relying on your own ovulation and the hormones released from the ovary or a medicated approach (where the hormones—estrogen and progesterone—are given as a medication).
Either way, it generally takes two to three weeks of estrogen stimulation (from your ovaries or via medications) to thicken the uterine lining. The endometrial thickness is measured through a pelvic ultrasound. Once the endometrial thickness and pattern are reassuring, the endometrium will be prepared for implantation with progesterone exposure (from your ovaries once you ovulate in a natural FET or with medications in a medicated FE)T.
The embryo transfer is timed to the start of the progesterone exposure, and depending on the protocol, is generally five to seven days after progesterone is initiated.
Step 5: The two-week wait and pregnancy test
How long it takes: Ten to 14 days
What it is:
You’ll be brought back into the clinic about two weeks later for a pregnancy blood test after your frozen or fresh embryo transfer. Although two weeks can seem like an eternity, it’s best to avoid doing an at-home pregnancy test during this time as some medications (like the trigger shot which contained the HCG hormone) can interfere with test results (create a false positive), and the blood test will always be more accurate.
So, how long does IVF take?
There are so many different types and lengths of IVF protocols. Some will require priming for two weeks or two months, while others won’t. Some will require stimulation medications for longer than others. The actual IVF cycle can be as short as four weeks, but in other cases it can take months. Embryo transfers can be delayed if the uterine lining doesn’t thicken well enough. It’s also possible for an IVF cycle to result in zero viable embryos, which would mean having to regroup with your doctor and try again with a similar or different protocol (or with donor eggs or sperm).
Having a high quality chromosomally normal embryo to transfer also doesn’t guarantee a pregnancy. Good quality embryos can fail to implant for many reasons which can result in multiple attempts and transfer cycles. All these paths involve frequent clinic appointments, hormone treatments and injections, and a lot of emotions. If you’ve decided to do IVF, plan ahead and make sure you have the space in your life for it, allow yourself time to recover from each procedure and lean on your support system. Most importantly, be patient with your body and practice daily self-care and self-love.