In Vitro Fertilization (IVF) Step-By-Step Guide from a Fertility Nurse

Finding out you may need fertility treatment in order to conceive is overwhelming. While we can’t take all the stress away completely, we can give you the tools and information that you need to tackle this journey feeling more prepared for what lies ahead.

In this article:

• What is the IVF process like?
• The Diagnostic Cycle
• Your Dedicated Fertility Support System
• The Follow-Up Consultation
• Get Organized for Your IVF Cycle
• IVF Begins: Follicle Growth Phase
• IVF Continues: Egg Retrieval
• IVF Continues: Embryo Development
• IVF Concludes: The Embryo Transfer
• The Pregnancy Test

Beginning Your IVF Journey

We know how difficult it can be to hear that you may need to undergo in vitro fertilization (IVF) treatment in order to conceive the baby you've been dreaming of. We also know that having an idea of what lies ahead of you can be empowering and helpful.

In this overview of what to expect in a typical IVF cycle, we will offer a "zoomed out" picture of the IVF process. Rest assured that your doctor, nurse, and patient navigator will help you "zoom in" with guidance that applies specifically to your situation before you get started.

A quick note: This IVF breakdown pertains to Illume Fertility's protocols and procedures. If you are undergoing treatment at a different fertility clinic, your steps may vary slightly. However, they will typically follow this same general timeline and plan.

What is the IVF process like?

If you've landed here, you probably already have some idea of what IVF treatment involves. However, let's break it down step by step, so you can feel more educated and empowered about the journey ahead of you. First up? Fertility testing and uncovering your diagnosis.

1. The Diagnostic Cycle

At a glance:

• Purpose: To determine your specific fertility diagnosis
• What to expect: 2-3 office visits
• Time: 4-6 weeks

The first step is for your doctor to get to know your fertility story. This is called a "diagnostic cycle." You will be asked to come in 2-3 different times during your menstrual cycle for various blood tests, ultrasounds, and studies.

We are assessing how strong and well-functioning your ovaries and reproductive organs are and confirming that you are healthy and fit for pregnancy. Depending on where you are in your menstrual cycle, it can take 4-6 weeks to complete this first step.

FYI: You’re not alone in this process! If you have a male partner, we will ask that he come in for a semen analysis and bloodwork as well.

What if you find out something is wrong?

While gathering diagnostic information, your doctor may find something that they'll want to address before proceeding with treatment. For example, you may have a thyroid level that is not ideal for pregnancy or a blood sugar level that is concerning.

Often, these are minor things that can be fine-tuned quickly. Other times, we may recommend that you delay trying to get pregnant until your health concerns are addressed.

Feeling overwhelmed?

At this point, you might be thinking that this first step sounds like a lot. A lot of testing, a lot of waiting, a lot of visits…and it is. We understand the frustration.

But here's some good news: the more prep work we do prior to starting IVF, the higher your chances of success are. In short, it's all worth it to know you've given yourself the best shot at a healthy pregnancy and baby.

If you're also thinking that all these appointments are going to require a significant amount of time and effort to complete, you're right - but you will receive constant support from your team as you move through each part of the process. 

Your Dedicated Fertility Support System

At Illume Fertility, we equip you with a full team of fertility care professionals to personally help you navigate your entire journey. This Care Team includes a board-certified reproductive endocrinologist (often referred to as a fertility doctor), a fertility nurse, a Patient Navigator, and an Insurance & Billing Advocate.

We will reference all of these team members throughout the process, as they are relevant during your IVF journey.

The best thing about having a Care Team? You will never be alone for any of this. You will always have a close-knit, experienced group of people in your corner, cheering you on.

The team member you will likely interact with most frequently is your Patient Navigator. This is your go-to person, the one who will help you manage all the various pieces of your journey and ensure you check off all the boxes along the way.

Your Patient Navigator will help schedule appointments, send reminders about important tasks and dates, and field questions when you don’t know who to reach out to. They will be available to support you by both phone and email.

2. The Follow-Up Consultation

At a glance:

• Purpose: To determine your specific cycle protocol
• What to expect: A virtual consultation via Zoom
• Time: 1 hour

Once you have completed your diagnostic cycle and we have all of the necessary info, your doctor will sit down with you for a follow-up consultation. Together, you and your doctor will decide if IVF is right for you, and if it is, they will begin to customize your treatment protocol.

Your IVF protocol is a unique, carefully thought out "recipe" (medications, blood work, and ultrasounds) that is very specific to you and your medical history. You will follow this protocol for several weeks, and your team will carefully monitor you along the way. 

Is IVF right for you?

Learn how much IVF costs, how long the process typically takes, and how this treatment method can help make your dreams come true.

3. Getting Organized for Your IVF Cycle

At a glance:

• Purpose: To enter IVF treatment with confidence
• What to expect: Paperwork, phone calls and/or emails, and video modules
• Time: It depends! It typically takes days or weeks to regulate your natural hormones, sign all of your consent forms, get insurance approval (if using insurance to pay for treatment), and watch all of your educational video modules.

After your follow-up consultation, your Care Team will help you get organized for your  treatment cycle. In order to proceed with IVF, you will need to:

• Be financially cleared by your Insurance & Billing Advocate
• Complete and sign all consent forms
• Learn how to mix and administer your injections
• Have all the medications necessary to start 

How will I know what to do?

At Illume Fertility, your assigned nurse will email you a series of online modules to watch. These are mandatory, educational videos that will teach you everything you need to know about IVF.

These videos cover it all – what to expect during treatment, how your body will respond, how to mix your medications, how to correctly give yourself injections, and what to do should you have an emergency or need assistance when the office is closed.

The videos can be watched at your own pace, from the comfort of your own home. You may find it helpful to have a friend or partner watch them with you - if you want, you can even watch them multiple times. 

Once you have watched each of the video modules, you will be prompted to complete your consent forms. We utilize an electronic signing program which allows you (and any partner involved) the ability to sign and submit consents electronically.

Note: You will not be allowed to start treatment without signing those consents. We encourage you to complete ALL forms as soon as they are received to avoid any delays.

Wait, what about insurance?

While you are watching your modules and completing your consents, your Insurance & Billing Advocate will be hard at work. They have the tricky task of getting insurance companies to approve the treatments and medications you need. They will work very closely with you so that you understand what you will have to pay along the way - no unexpected surprises.

Once they are confident that both you and your insurance company are on board with the treatment plan, they will give your nurse the "green light" to order your IVF medications.

Getting Your IVF Medications

All IVF medications are ordered through specialty pharmacies – meaning you can’t just pick them up at your local CVS or Walgreens, unfortunately. If your insurance company is paying for your meds, they will tell us which pharmacy to use.

Meanwhile, your nurse will coach you on how and when to start medication that will appropriately "prep" you for a treatment cycle. (Remember that our first goal is to make sure that your naturally occurring hormones don’t interfere with the IVF medications.)

To achieve this, we will ask that you start birth control pills (during a menstrual period) or estrogen pills (before a period). Your nurse will instruct you on the appropriate way to do this.

A Quick Recap

We know that this stage of the process can feel really overwhelming - so let's run through it one more time. Once you have been:

• Been financially cleared
• Watched your online video modules
• Signed all treatment consent forms
• Received medications from the specialty pharmacy
• Been appropriately prepped with birth control pills or estrogen pills

...you'll be ready to officially begin your IVF cycle! Take a nice, deep breath - you've got this.

4. IVF Begins: Follicle Growth Phase

At a glance:

• Purpose: To successfully administer meds and produce as many eggs as possible
• What to expect: Daily injections, plus repeat blood work and ultrasounds (morning monitoring) every other day
• Time: 10-12 days

There's been so much build up, and it's all for this!

You're likely feeling a whole bunch of emotions right now, and that's to be expected. Whether you're excited, anxious, scared or hopeful, remember that you're not alone. Don't be afraid to join our support groups or ask your team for more guidance whenever needed.

Your Personalized IVF Protocol Calendar

To keep things straight, your nurse will give you a customized IVF protocol calendar to follow. It will tell you every single thing you need to do each day.

Your first to-do will be coming in for your first blood test and ultrasound. At this visit, we are ensuring that everything is "quiet" in your reproductive system (in fact, you may hear us call this visit a suppression or baseline check).

Why? We want to make sure that the lining of your uterus is thin, that your hormone levels are appropriately low, and that there aren’t any sneaky follicles or cysts growing on your ovaries. If all looks good, we will instruct you to start your injections. If something is going on that we were not hoping for, you will be given an updated plan. 

Did you know? Most patients need IVF injections for 10-12 days. The exact amount of time varies from person to person, so don’t be alarmed if you need a little less (or more) time. It’s not a race! Your ovaries will tell us when they are ready to go.

While you are giving yourself shots (or having someone step in to help administer them), we will ask you to come in for blood work and ultrasounds regularly - typically every other day. We refer to this as "morning monitoring." As the follicles on your ovaries grow, we will count and measure each one of them.

This process will continue until your ovaries tell us they are ready for egg retrieval!

5. IVF Continues: Egg Retrieval

At a glance:

• Purpose: To retrieve as many mature eggs as possible
• What to expect: Quick procedure under anesthesia
• Time: 2-3 hours total

On egg retrieval day, you should expect to be in our Norwalk office for 2-3 hours total - though the procedure itself typically only takes around 15 minutes.

You will receive anesthesia (pain medication plus sedation) through an IV to help you sleep comfortably. Once you wake up, one of our nurses will monitor you for an additional hour.

Before you go home, we will be able to tell you how many eggs were collected. You’ll be instructed to go home and rest. You may still feel crampy, bloated, or tired. Tylenol is usually sufficient for any discomfort you may experience.

However, if you have any concerns, always bring them up to your nurse or doctor!

6. IVF Continues: Embryo Development

At a glance:

• Purpose: Create, foster, and monitor embryos
• What to expect: Multiple updates as fertilization and development progresses
• Time: 5-7 days

The day after your egg retrieval, a nurse will call to check in with you. They will make sure you’re feeling okay and also tell you how many eggs were successfully fertilized in the lab.

From there, you will get regular updates from us until we know how many of your embryos reach the blastocyst stage – which is the stage needed to achieve a pregnancy. At this point, we can either proceed with a fresh embryo transfer or freeze embryos for a future transfer.

IVF Embryo Transfer 101

What happens before, during and after your embryo transfer? A medical assistant answers FAQs to help you feel more prepared for the big day.

7. IVF Concludes: The Embryo Transfer

At a glance:

• Purpose: To transfer a healthy embryo into the uterus for implantation
• What to expect: A simple procedure, you’ll be awake and able to watch everything
• Time: 2-3 hours total

If your plan is to transfer a fresh blastocyst, it will occur immediately after the embryo development phase. If your plan is to do preimplantation genetic testing (PGT), we will cryopreserve (freeze) your embryos for future use. You might have to take more medication, including a progesterone in oil injection.

The actual embryo transfer procedure itself is quick (10-15 minutes), painless, and easy – a catheter is inserted through the cervix, where the embryo will eventually be deposited. Your tiny embryo will then rest in your uterus in the perfect spot, ready for implantation.

How to Increase Your Chances of Successful Implantation

On the day of the your transfer, we recommend laser acupuncture before and after the procedure, as it has been shown to significantly increase implantation success rates. If you have been receiving regular acupuncture treatment throughout your IVF cycle (and not just on transfer day), the benefits are even greater.

8. The Pregnancy Test

At a glance:

• Purpose: To determine if you’re pregnant or not
• What to expect: Occurs 8-10 days after a transfer, via blood test
• Time: 1 day

You will come into the office 8-10 days post-embryo transfer for simple blood work. Your nurse will call you as soon as results are received to relay that information to you.

Of course, we are always hoping for a positive pregnancy test, right alongside you! If you get good news, we will celebrate with you and answer any questions, then discuss next steps. 

What if I don't get pregnant?

If you end up with a negative pregnancy test result, we will talk through it with you and decide how to proceed - only when you are ready. 

Sadly, fertility treatment isn’t a perfect science. Sometimes that means we have to give you disappointing news along the way - perhaps your ovaries didn't respond to medications the way we had hoped, the number of eggs we got in the operating room may be less than we expected, or your fertilized eggs may not develop into normal embryos.

If this happens, we realize you may feel sad, disheartened, frustrated, or maybe even angry. All of those emotions are normal. You work so hard to get to this point, and hearing disappointing updates can really take a toll on your mental health.

The good news? This news rarely sneaks up on us, and we will be communicating any concerns along the way. We also have a great team of wellness providers ready to help anytime you feel overwhelmed or need help making decisions about what to do next.

IVF is Tough, But So Are You

Yes, IVF treatment can be intense, complicated, and prolonged. But it can also be empowering. Many people feel relieved that they are able to be proactive and move forward.

We also know that a lot of responsibility falls on you (the patient) throughout this process, and it can feel overwhelming. We know that you will be rearranging your schedule like an executive assistant, mixing medications like a chemist, and administering injections like a professional nurse.

Remember that you'll never be alone during IVF - we will give you all the tools, skills, and support you need to conquer it with confidence. Your Care Team will be your biggest cheerleaders, and will always be rooting for you, no matter what. 

We wish you the best of luck on your IVF journey. You've got this!