Home›IVF (IN VITRO FERTILIZATION)

IVF Procedure Steps

Explore IVF procedure steps from stimulation to embryo transfer with expert clinical guidance.

Get clarity on your fertility journey with thorough in vitro fertilization diagnosis and tests. learn about the simple and advanced testing needed before starting IVF.

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Your Journey to Parenthood Day by Day

In Vitro Fertilization (IVF) is a journey of hope, science, and patience. For many couples, the prospect of starting treatment feels overwhelming—a blur of injections, appointments, and medical jargon. At Liv Hospital, we believe that knowledge is the antidote to anxiety. When you understand exactly what is happening inside your body at each stage, you regain a sense of control over your fertility journey.

The IVF process is a carefully choreographed series of events designed to maximize your chances of success. While every patient’s protocol is unique (tailored to your age, hormone levels, and medical history), the fundamental IVF procedure steps remain the same. Here is your comprehensive, day-by-day guide to creating life at our center.

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Controlled Ovarian Stimulation (Days 1–12)

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In a natural menstrual cycle, your body selects only one egg to mature and release. The goal of IVF is to recruit a “cohort” of eggs so that we have multiple chances to create a healthy embryo.

  • Baseline Scan (Day 2-3): Your journey begins on the second or third day of your period. You will come to the clinic for a transvaginal ultrasound to check your ovaries and a blood test to measure hormone levels (FSH, E2). This confirms that your ovaries are “quiet” and ready to start.
  • The Injections Start: You will begin daily self-injections of gonadotropins (FSH/LH). These hormones tell your ovaries to grow multiple follicles (fluid-filled sacs that contain eggs) simultaneously.
    • Fear of Needles? Don’t worry. The needles are ultra-thin (like insulin pens) and go into the fatty tissue of the belly. Most patients are surprised by how painless it is.
  • Monitoring (Days 5, 8, 10): You will visit the clinic every 2–3 days. We use ultrasound to measure the size of your follicles and blood tests to track your Estrogen levels. We adjust your medication dose precisely based on these results to prevent Ovarian Hyperstimulation Syndrome (OHSS).
  • The “Trigger Shot”: When the lead follicles reach 18–20mm in size, you are ready. You will take a final injection (hCG or GnRH agonist) at a specific time (e.g., 10:00 PM) to trigger the final maturation of the eggs. Egg retrieval will happen exactly 36 hours later.
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Egg Retrieval (OPU) (Day 14)

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This is the day of the “harvest.” It is a minor surgical procedure performed in our sterile IVF operating room.

  • Sedation: You will be given light sedation (anesthesia) by an anesthesiologist. You will be asleep and feel absolutely no pain, but you will breathe on your own.
  • The Procedure: The doctor uses a specialized ultrasound probe with a thin needle guide. The needle passes through the vaginal wall directly into the ovary. Gentle suction is used to drain the fluid from each follicle, collecting the microscopic egg inside. The procedure takes about 15–20 minutes.
  • Sperm Collection: While you are in the retrieval room, the male partner provides a fresh semen sample in a private room. (If using frozen sperm, it is thawed at this time).
  • Recovery: You will wake up in the recovery room about 30 minutes later. You may feel mild cramping (like a period) and bloating. You will be discharged after 1–2 hours of rest and a light snack.

Fertilization (ICSI) (Day 14 Afternoon)

While you rest at your hotel, the most critical work begins in the laboratory.

  • Sperm Preparation: The semen sample is “washed” and spun in a centrifuge to separate the healthy, swimming sperm from the immobile ones and debris.
  • ICSI (Intracytoplasmic Sperm Injection): At Liv Hospital, we do not leave fertilization to chance. We use ICSI for almost all cases. Our senior embryologist selects a single, structurally perfect sperm and injects it directly into the center of each mature egg using a microscopic glass needle.
  • The Check: The injected eggs are placed in an incubator overnight.
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Embryo Culture (Days 15–19)

The next morning (Day 1 post-retrieval), we check for fertilization. Seeing two “pronuclei” (one from mom, one from dad) confirms a successful embryo. Now, the waiting game begins.

  • The Embryoscope Advantage: At Liv Hospital, your embryos grow in the Embryoscope time-lapse incubator. We do not take them out to look at them (which would disturb their temperature). Instead, a camera takes a photo every 10 minutes.
  • Cleavage Stage (Day 3): The embryo should have 6–8 cells.
  • Blastocyst Stage (Day 5): This is the goal. The embryo has now divided into 100+ cells and differentiated into two parts: the Inner Cell Mass (which becomes the baby) and the Trophectoderm (which becomes the placenta).
  • Why Blastocyst? Blastocysts have a much higher implantation potential than Day 3 embryos because they have survived the critical “genomic activation” phase.

Genetic Testing (PGT-A) (Optional but Recommended)

For patients over 35, those with recurrent miscarriages, or those seeking gender-linked disease screening, we pause here for genetics.

  • Biopsy: On Day 5 or 6, the embryologist uses a laser to safely remove 5–10 cells from the Trophectoderm (placenta part) of the blastocyst. The baby cells are untouched.
  • Freezing (Vitrification): The embryo is instantly flash-frozen using liquid nitrogen. It remains safely in suspended animation.
  • The Test: The biopsied cells are sent to our genetics lab. We count the chromosomes (PGT-A) to ensure there are 46 (23 pairs).
  • The Result: Results take 10–14 days. We now know which embryos are “Euploid” (genetically normal) and safe to transfer.

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Embryo Transfer (The "Big Day")

Whether it is a “Fresh Transfer” (Day 5) or a “Frozen Transfer” (weeks later), this is the emotional climax of the cycle.

  • Preparation: You do not need anesthesia. You will be asked to drink water to have a moderately full bladder (this helps straighten the uterus for easier access).
  • The Procedure:
    1. The embryologist loads the best embryo into a soft, thin catheter.
    2. The doctor gently inserts the catheter through the cervix into the uterus under ultrasound guidance. You can watch the screen to see the white flash of the fluid bubble containing your embryo being placed.
    3. It takes 5 minutes and feels like a Pap smear—painless but slightly uncomfortable due to the full bladder.
  • Aftercare: You rest for 20 minutes, then empty your bladder and go back to your hotel.

The Luteal Phase Support (The "Two Week Wait")

For the next 12 days, you must support the uterine lining to help the embryo stick.

  • Progesterone: You will take progesterone (vaginal suppositories or injections) daily. This hormone makes the uterine lining “sticky” and receptive. Do not stop this medication until the doctor tells you to, even if you have light spotting.
  • Lifestyle: You can resume normal daily activities (walking, working) but avoid high-impact exercise (running), hot baths, and saunas. Think “take it easy,” not “bed rest.”

The Pregnancy Test (Beta-hCG)

12 days after the transfer, you will have a blood test to measure Beta-hCG (the pregnancy hormone).

  • Why Blood? Home urine tests can be misleadingly negative this early. The blood test is definitive.
  • The Result:
    • Positive (>10 mIU/mL): Congratulations! You are pregnant. You will continue medications and repeat the test in 2 days to ensure the number is doubling (indicating a healthy, growing pregnancy).
    • Negative: We stop medications and schedule a follow-up to review the cycle and plan the next step (usually a frozen embryo transfer if you have spare embryos).

FREQUENTLY ASKED QUESTIONS

What happens if no eggs are retrieved?

Empty follicle syndrome is rare, but sometimes follicles are empty, or eggs do not detach. If this happens, the doctor will review the trigger shot timing and medication protocol to adjust for a future attempt.

Modern practice emphasizes Single Embryo Transfer (SET) to avoid the high risks associated with twin or triplet pregnancies. The goal is one healthy baby at a time.

Most women compare the feeling to a Pap smear. It involves a speculum and a thin catheter passing through the cervix. It is generally not painful, though a full bladder is required, which can be uncomfortable.

Day 5 embryos (blastocysts) are more developed and have passed a natural selection point, offering higher success rates. Day 3 embryos are smaller and more challenging to select, but may be transferred if few embryos are available.

Embryos frozen via vitrification can be stored indefinitely. There have been successful live births from embryos frozen for over 20 years, as biological time stops at -196 degrees Celsius.

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