Fertility & IVF
The IVF Process Step by Step: From First Injection to Pregnancy Test
IVF (in vitro fertilization) happens in five main steps: ovarian stimulation with hormone injections, egg retrieval, fertilization in the lab, embryo growth, and embryo transfer into the uterus. Stimulation usually lasts about 8 to 14 days, retrieval is a short procedure under sedation, and a pregnancy blood test comes about 9 to 12 days after transfer. Many people also freeze embryos for later transfers.
What the brochures don't tell you is how much of IVF is logistics: early-morning blood draws, a refrigerator shelf full of medicine, and a trigger shot timed to the minute. Here's the cycle in order, with what each stage actually asks of you.
Before the cycle: testing and planning (a few weeks)
A reproductive endocrinologist (REI) will usually order:
- An ultrasound to count the small follicles in your ovaries (antral follicle count)
- Bloodwork such as AMH, which helps predict how your ovaries will respond to medicine
- A look at the uterine cavity, often a saline ultrasound or hysteroscopy
- A semen analysis if a partner's sperm will be used
- Infectious disease screening for both partners, which clinics routinely require
- Optional genetic carrier screening
Then comes the "teach" visit: a nurse shows you how to mix and inject your medicines and hands you a calendar. Some protocols start with birth control pills or another medicine the month before to line up the timing.
Tip: The medication delivery often arrives in a big insulated box from a specialty pharmacy. Make sure someone can receive it, and clear fridge space before it shows up.
Days 1 to about 12: stimulation
Normally your body matures one egg a month. IVF uses injectable hormones (gonadotropins) to mature several at once, because more eggs means more chances at healthy embryos.
What your days look like:
- Daily injections at home, under the skin with a small needle, usually in the belly. Most people say the anticipation is worse than the shot itself.
- A second medicine added partway through to prevent early ovulation
- Monitoring visits every one to three days, usually early morning, for a transvaginal ultrasound and blood draw. Many New York clinics run monitoring hours before the workday starts, so people can get to work after. Ask whether your clinic has a satellite office closer to home or work for monitoring.
- Dose changes based on how your follicles grow. Expect a call or portal message each afternoon with that night's instructions.
Bloating, breast tenderness, mood swings and mild pelvic pressure are common by the end. Wear stretchy waistbands.
The trigger shot
When enough follicles reach the right size, you take a "trigger" shot to finish maturing the eggs. The timing is precise: retrieval is usually scheduled about 34 to 36 hours later. Set two alarms.
Retrieval day
Egg retrieval is a short outpatient procedure, usually 15 to 30 minutes.
- You get IV sedation or anesthesia, so most people don't feel it.
- The doctor uses a thin needle guided by vaginal ultrasound to draw fluid and eggs from each follicle. There's no abdominal incision.
- You'll need someone to take you home. A taxi or rideshare alone usually isn't allowed after sedation.
Most people rest that day and are back to normal within a day or two. Cramping, bloating and spotting are common. You'll usually hear how many eggs were retrieved before you leave. Not every follicle holds an egg, and not every egg is mature, so the number tends to drop at each stage. That's expected.
Day 1 after retrieval: fertilization report
On retrieval day, the lab combines eggs and sperm one of two ways:
| Method | How it works | Often used when |
|---|---|---|
| Conventional IVF | Eggs and many sperm are placed together in a dish | Sperm values are normal |
| ICSI (intracytoplasmic sperm injection) | An embryologist injects one sperm directly into each mature egg | Low sperm count or movement, prior fertilization failure, or other lab reasons |
The next day, the clinic calls with how many eggs fertilized normally.
Days 3 to 7: embryo growth (and the waiting)
Fertilized eggs grow in an incubator for 3 to 7 days. Many clinics grow them to the blastocyst stage, usually day 5 or 6. Some embryos stop developing along the way, which is normal and is one of the hardest parts emotionally. Many patients say the daily updates feel like a countdown.
If you choose preimplantation genetic testing (PGT), a few cells are taken from each blastocyst for testing, and the embryos are frozen while you wait for results. More in our guide to PGT embryo testing.
Good-quality embryos that aren't transferred can be frozen (vitrified) for later.
Transfer day
Embryo transfer is quick and feels a lot like a Pap test. No anesthesia needed.
- A thin catheter passes through the cervix and places the embryo in the uterus, guided by abdominal ultrasound.
- Many clinics ask you to arrive with a full bladder for a clearer ultrasound view. It's uncomfortable, but it's over in minutes.
Fresh transfer happens a few days after retrieval, in the same cycle. Frozen embryo transfer (FET) happens in a later cycle, after your lining is prepared with medicine or timed to your natural ovulation. Frozen transfers are common, and they're recommended in some situations, such as a high risk of ovarian hyperstimulation or when genetic testing is done.
ASRM recommends limiting the number of embryos transferred, and single embryo transfer is encouraged for many patients. Twins and higher-order multiples carry higher risks for both the pregnant person and the babies.
The two-week wait
After transfer, most people take progesterone (by injection, vaginal medicine, or both) to support the lining. Your clinic will give exact instructions.
A blood pregnancy test (hCG) is done about 9 to 12 days after transfer. Home tests can mislead during this window, especially if your trigger shot contained hCG. Almost everyone is tempted to test early anyway; just know a result can be wrong in either direction.
If it's positive, you'll have repeat blood tests and an early ultrasound before the clinic refers you to an OB/GYN or midwife for prenatal care.
Risks to talk through
- Ovarian hyperstimulation syndrome (OHSS): fluid shifts that cause bloating, weight gain and, rarely, serious complications. Higher risk with PCOS or many follicles.
- Multiple pregnancy, if more than one embryo is transferred
- Retrieval risks like bleeding or infection, which are uncommon
- Ectopic pregnancy, which can still happen after IVF
- Emotional strain. Many clinics offer counseling, and support groups are easy to find.
What are the odds?
Success depends most on the age of the person providing the eggs, plus the cause of infertility and embryo quality. Be wary of single "success rate" numbers on websites. The CDC and the Society for Assisted Reproductive Technology (SART) publish clinic-reported data with explanations of how to read it. Ask your doctor for an estimate based on your own results.
Does insurance cover IVF in New York?
Since January 1, 2020, fully insured large-group plans in New York must cover three IVF cycles, including IVF medications. Self-funded employer plans, individual and small-group plans, and Medicaid aren't required to cover IVF. Call HR and ask, "Is our plan fully insured or self-funded?" It's the question that decides most of this. See our full guide to the New York IVF insurance mandate.
When to call your provider
During an IVF cycle, call your clinic right away if you have:
- Severe belly pain or swelling, or rapid weight gain over a day or two
- Shortness of breath, or peeing much less than usual
- Heavy vaginal bleeding or fever after retrieval
- Fainting, dizziness, or severe one-sided pain after a positive test
Before you start, talk with a reproductive endocrinologist about whether IVF is the right first step or whether something simpler, like IUI, makes sense. Browse fertility specialists in Manhattan or on Long Island.
Frequently asked questions
How long does one IVF cycle take?
From starting injections to egg retrieval usually takes about two weeks. With a fresh transfer, the pregnancy test follows roughly 9 to 12 days after transfer. With a frozen transfer, the transfer happens in a later cycle, so the whole process can take one to two months or more.
Is egg retrieval painful?
Egg retrieval is usually done under IV sedation or anesthesia, so most people don't feel the procedure. Cramping, bloating and spotting for a day or two afterward are common.
How many embryos are transferred in IVF?
ASRM guidance supports transferring a single embryo for many patients, especially younger patients and those with good-quality embryos, to lower the risk of twins and higher-order multiples. Your doctor will base the number on your age and embryo quality.
What is the difference between a fresh and frozen embryo transfer?
In a fresh transfer, an embryo goes into the uterus a few days after retrieval. In a frozen transfer, embryos are frozen and transferred in a later cycle after the lining is prepared, which also leaves time for genetic testing if you choose it.
Sources
- ASRM — In Vitro Fertilization (IVF) patient fact sheet
- ASRM — Guidance on the limits to the number of embryos to transfer: a committee opinion
- ASRM — Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline
- CDC — Assisted Reproductive Technology (ART) National Summary
- ACOG — Treating Infertility FAQ
This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.