In Vitro Fertilization (IVF) Side Effects at Each Stage

Fertility treatments are considered very safe, but all medical procedures carry some risk of potential side effects. With in vitro fertilization (IVF), each stage of the process can bring on a unique set of symptoms. Here's what IVF side effects you can expect throughout your journey.

In this article:

• What can I expect from IVF treatment?
• The Stages of In Vitro Fertilization (IVF)
• Stage 1: Suppression
• Stage 2: Stimulation
• Stage 3: Egg Retrieval
• Will I be in pain after my egg retrieval?
• What is Ovarian Hyperstimulation Syndrome (OHSS)?
• Stage 4: Embryo Transfer
• Fresh vs Frozen Embryo Transfer
• FAQs About the IVF Process

What can I expect from IVF treatment?

Here at Illume Fertility, we want you to feel as prepared as possible as you navigate fertility and family building. One of the best ways to do this is to learn what lies ahead.

This informative guide explores each stage of IVF treatment and what side effects you may experience along the way, including what's normal and what to be concerned about, and when you should reach out to your Care Team for additional support.

The Stages of In Vitro Fertilization (IVF)

You've had your initial consultation with your reproductive endocrinologist, undergone diagnostic fertility testing, discussed your potential family-building options, and have decided to move forward with IVF to grow your family. Here's what comes next:

Stage 1: Suppression 

What happens? 

In this first step, our goal is to "quiet" the ovaries from their usual hustle and bustle, usually by using oral contraceptives. Let's talk about why this is so important.

In a normal menstrual cycle, your follicles (the tiny fluid-filled sacs that hold the eggs) grow at different rates - some slower, some faster. Their size corresponds with their maturity, and ultimately, one dominant follicle will win out. We don’t really want this to happen during IVF. 

Instead, we want all of your eggs to reach maturity around the same time, resulting in a higher yield during egg retrieval. Taking oral contraceptives (AKA birth control pills) prior to your beginning your IVF cycle helps pause follicular growth at a small size so that when we move on to the next stage, each follicle is starting at a similar size and growing together. 

Suppression Side Effects

Overall, the side effects of this stage of IVF are mild, if noticeable at all. They can include:

• Spotting
• Breast tenderness
• Nausea
• Mood changes

Stage 2: Stimulation 

The next stage of IVF is the injection phase. You’ve likely already heard about this part (and likely aren’t looking forward to it). That's okay – we totally get it! Let’s break it all down to understand what you can expect.

What happens? 

First off, why injections? Why can’t you just take more pills? We hear you.

Unfortunately, at this point in the IVF process, oral medications alone are not strong enough. In order to make a group of follicles potential "players" in the fertility game for that month (i.e. helping them reach maturity so they can be fertilized), we have to be more aggressive.

Some follicles may remain small, and that’s normal. They will still be retrieved, but it’s unlikely that they will be mature enough to respond to sperm and end up fertilizing.

Stimulation Side Effects

During this phase, your side effects will likely become increasingly more noticeable (and potentially uncomfortable) as you near the date of your egg retrieval. Here are the most common side effects IVF patients report experiencing:

• Headaches
• Hot flashes
• Nausea
• Bloating
• Bruising at the injection site
• Breast tenderness

Your IVF Injection Schedule

Your injections need to be administered on a daily basis and around the same time (within a 2-hour window) in order to mimic how the body would normally produce the hormones that cause follicular growth (FSH and LH).

You can choose what time period (in the evening) works best for you. If you pick a window between 6-8pm, for example, you should try to stick to this as much as possible, but it doesn’t need to be followed so precisely that it completely disrupts your life. 

For example, if you are leaving for dinner at 6pm and won’t be home until 8pm, you don’t need to bring your meds with you and inject them in the bathroom. You can take them a little early or a little late that day, then get back on track the next day. 

Have other questions? Reach out to your nurse or doctor for personalized guidance.

Stage 3: Egg Retrieval 

The third stage of IVF is a short procedure called an egg retrieval (performed under anesthesia) where the eggs are gently removed from the follicles. 

How does it work?

Since we can’t see the actual eggs, your assigned surgeon (who will be one of our reproductive endocrinologists) will puncture each follicle to withdraw the follicular fluid.

That fluid then immediately gets emptied into a small dish for the embryologist to view under the microscope in the lab. The embryologist will count the number of eggs and prepare them to be mixed with sperm. 

Whether or not your ovaries responded well to stimulation and the trigger shot will become evident the following day, when the embryologist will assess which eggs are perfectly mature and successfully fertilized after retrieval.

Eggs that are pre- or post-mature are still collected and counted, but are not in the proper stage of cell division to respond to sperm, so they do not fertilize. While this can be disappointing to hear, attrition is expected and normal. 

Egg Retrieval Side Effects

Remember, an egg retrieval is a surgery and you will be under anesthesia. That comes with its own set of side effects. For most patients, the following symptoms are fairly mild and will go away within a couple of days after the procedure. If they worsen, always tell your Care Team.

• Soreness
• Spotting
• Constipation
• Bloating
• Cramping
• Fatigue
• Nausea
• Vomiting (anesthesia side effect)

NOTE: If you experience rarer, more severe side effects such as rapid weight gain, increased abdominal circumference or difficulty breathing, please call your doctor or nurse, as these could be symptoms of ovarian hyperstimulation syndrome (OHSS) and require treatment. More information on OHSS and what causes it can be found below.

Will I be in pain after my egg retrieval?

Due to the multiple vaginal and ovarian punctures, it is normal to feel sore and have some spotting after retrieval. Think of the ovaries as being swollen, bruised, and needing to heal. After you bang your knee, for example, it might take the bruise a few days to appear and will be sore for those days until it resolves.

Likewise, many patients feel worse the first few days after retrieval than they feel on the day of it, some reporting menstrual-type cramping, bloating and abdominal discomfort. 

After 5-7 days, the ovaries should return to their original size and most patients feel better. As with any surgery, there is a small risk of bleeding or infection. Always tell your Care Team if you feel worse than the side effects described above, or have symptoms such as a hard abdomen, intense abdominal pain or bleeding or fever. 

What is Ovarian Hyperstimulation Syndrome (OHSS)?

If you have symptoms of excess fluid collection, such as a drastic weight change or an increase in abdominal circumference, this may not be related to the surgery at all, but a sign of a rare event called ovarian hyperstimulation syndrome (OHSS).

Some amount of ovarian hyperstimulation is needed in order to develop the multiple mature follicles needed for IVF. However, when OHSS occurs, the body responds rapidly to the stimulating medications, and the consequences of this are a result of fluid collecting in the body in certain spaces that are usually hollow (such as the abdomen or beneath the lungs).

Symptoms that reflect this, such as an increased abdominal circumference and difficulty breathing, should always be reported to your team quickly to manage this syndrome.

Thinking about IVF?

Download our free guide to IVF to learn more about how much it costs, how long it typically takes, and how this fertility treatment can help you.

Stage 4: Embryo Transfer

An embryo transfer is a procedure during which either fresh or thawed blastocysts (embryos) are placed in the uterus of the person who will be carrying the resulting pregnancy. This could be either the intended mother or a gestational surrogate.

The embryo transfer is done in the same surgical suite where you had your egg retrieval, but this time, no anesthesia is required.

We ask that you have a full bladder at the time of the transfer, for two reasons:

1. A full bladder helps us visualize and confirm proper placement of an embryo in the uterus when using the abdominal ultrasound probe.
2. A full bladder straightens out the natural curve of the cervical canal, making the passage of the transfer catheter (with your fragile embryo inside it) a bit easier. 

Watch this video from our Nurse Practitioner to learn how full of a bladder is too full.

What to expect after embryo transfer:

You will rest and be monitored by a nurse for 20 minutes in one of the recovery beds in our surgical suite before being discharged. Many patients ask if they should be on bedrest after their transfer, and the answer is no, it's not necessary. However, we do recommend light activity the day of transfer and day after transfer.

We also ask that you refrain from intense exercise or heavy lifting for the next few days, because we want you to feel confident that you have created the best uterine environment to allow implantation to take place. That said, if you forget and lift something heavy once or twice, it won't ruin your chances of pregnancy!

Learn more about IVF do's and don'ts from one of Illume's nurses, Jocelyn. 

Embryo Transfer Side Effects:

The side effects of administering progesterone and estrogen can often feel like early pregnancy and are typically mild. That said, the embryo transfer procedure itself has little to no side effects other than (hopefully) pregnancy! Here's what you can expect:

• Breast tenderness
• Bloating
• Cramping
• Constipation
• Fatigue
• Bruising at the injection site

The transfer process will be similar whether it is "fresh" or frozen, but the lead up to your transfer will be different. Let's take a closer look at the differences between fresh and frozen embryo transfers and why someone might opt for one or the other. 

Fresh vs Frozen Embryo Transfer

There are many reasons to cryopreserve (freeze) your embryos before a transfer. For instance, if you are having preimplantation genetic testing (PGT) performed on your embryos, we will freeze your embryos in order to wait for the test results, then transfer them back to the uterus in a later cycle.

Another reason to freeze embryos would be if you are diagnosed with OHSS (see indicators above), so we can let your body heal prior to attempting pregnancy. Additionally, the stimulating medications generate many mature follicles, which can cause your body to produce elevated levels of progesterone. Here's why that matters:

In a natural menstrual cycle, there is only a short period of time that the uterus is receptive to a blastocyst, and elevated levels of progesterone can close or advance this window, decreasing your chances of implantation. If this occurs, we will schedule you for a frozen embryo transfer (FET) cycle so we can make sure your uterine lining is ideal before we transfer the embryos back.

If none of the above scenarios apply to you, you’re ready for a fresh embryo transfer. Fresh transfers happen within a week of your egg retrieval!

Estrogen & Progesterone After Embryo Transfer

Whether you have a fresh or frozen transfer, we need to ensure that the uterus is hormonally ready to receive the embryos. We do this by having you take estrogen and progesterone, which are administered daily as oral or vaginal medications and/or intramuscular injections.

Believe me, we have tried to not give you any more injections, but the research still tells us that, at this point, injecting progesterone is the best option. The good news is that you don’t need to come in for blood work until your pregnancy test, so your veins get a little break (albeit at your sore gluteal muscle’s expense). 

When will I know if I'm pregnant?

A pregnancy test is scheduled for approximately 9-10 days after your transfer. And yes, those will feel like the longest 9-10 days of your life. During this time (often referred to as the "two-week wait," focus on distraction and self-compassion. Allow yourself to feel whatever emotions arise, whether it be anxiety, excitement or anything else.

And though we know it's tempting, we strongly advise against taking an early pregnancy test at home in order to try and mentally prepare for what's to come. 

The only way to really know if you are pregnant is by a blood test on your scheduled day. Urine tests can give false positive or negative results, depending on timing and the test, so our policy is to only rely on a blood test.

After the pregnancy test, your next steps depend on the results. If you are pregnant, we will monitor you closely until your first appointment with your OB/GYN. If you are not pregnant, we will discuss other options or next steps for a subsequent transfer or IVF cycle. 

FAQs About the IVF Process

Still have some lingering questions? Understandable! Let's tackle a few more topics we're asked about by other fertility patients. Have a question not answered here? Reach out to your Care Team or submit it to our Nurse Practitioner, Monica for a video response.

How long does it take for follicles to grow?

Eggs are microscopic structures that live in fluid-filled sacs called follicles within your ovaries. We measure the diameter of your follicles as an indirect measurement of the maturity of the eggs. This happens during short appointments we refer to as "morning monitoring."

Most patients take 8-10 days of medications before their "lead" follicles are ready to be triggered (remember, the follicles usually grow at different paces). A "trigger" shot contains medication that causes the final maturation of the eggs and helps them release from the follicular walls in preparation for ovulation. 

How will you know when I'm ready for egg retrieval?

We see you often during this time so that we can decide the best day for you to take your trigger shot. Most patients will come into the office for "morning monitoring" about 5-7 times for ultrasounds and blood tests (to measure the amount of estrogen, which reflects follicular growth and health, and progesterone, which is indicative of ovulation). 

What IVF medication side effects should I be concerned about?

We would always rather you contact your nurse or doctor if you aren't sure whether something that you’re experiencing is "normal" or not. However, here are a few of the rarer (but more concerning) side effects that we would like to know about as soon as possible:

• Shortness of breath
• Reduced (or no) urination 
• Calf or chest pains
• Abdominal bloating or distention that is severe or not resolving over time
• Heavy bleeding (saturating more than one maxi pad per hour)
• Fever higher than 101°F

Am I "using up my eggs" in the IVF process?

The short answer is no, we are not depleting your ovarian reserve with IVF. Here's why:

A certain group of eggs are chosen by your body that month and there’s nothing we can do about that. This group of eggs, called a cohort, are removed from your total egg supply with the hopes that one will become dominant and the others will just stop growing and get reabsorbed by the body. That’s what happens during a natural menstrual cycle.

You “lose” the same number of eggs each month whether undergoing IVF or not. 

However, during IVF, the daily stimulation injections salvage the remaining eggs in that month’s cohort that would normally get reabsorbed. Now, a bunch of dominant follicles can develop (instead of just one) and more eggs are available to be retrieved and fertilized. 

Meet Katie

After a long journey through multiple rounds of IVF, unsuccessful cycles and pregnancy loss, Katie shares the 3-part story of how she became a mom to two.

Feeling ready for your IVF journey?

We understand this is all a lot to take in. Remember that we're here to support you and you don't have to navigate the fertility treatment process by yourself.

Let's be honest: IVF is an intense physical, emotional and mental commitment that takes much of your time and energy (if not all of it). Not only do you have to worry about the logistics of financing and medications, you also have to deal with the physical kickbacks like fatigue, nausea and bloating, just to name a few. 

Know that your Care Team is here to help you understand what’s going on with your body throughout your IVF cycle. We encourage you to take steps now to mentally prepare for this experience, so that whatever happens with your body, no matter what you’re feeling, you feel confident knowing what is normal and what isn’t.

Good luck on your IVF journey, and thank you for allowing us to participate in your care!