IVF Cycle Timeline: Your Team, Your Schedule and Your Options

Reasons to pursue IVF are many and varied. Perhaps you have been trying to conceive for some time, have tried several rounds of intrauterine insemination (IUI), or have a medical condition that makes pregnancy impossible without IVF. Maybe you’re in a same-sex relationship and you want to do reciprocal IVF, you’re going to use a surrogate, or you are hoping to become a parent on your own. We want to walk you through what to expect and the IVF Cycle Timeline.

An Overview

In Vitro Fertilization is commonly referred to as IVF. Women are prescribed fertility medications to fit their particular diagnosis or circumstances. These hormones stimulate the woman’s ovaries so that there is an increase in the number of follicles that will develop over a single cycle. During the course of the IVF Cycle timeline, women have several appointments to monitor to size of her follicles (each follicle contains an egg). When the doctor believes the time is right, the eggs will be retrieved using ultrasound and non-invasive techniques. Follicles are visualised using ultrasound and then a very thin needle is inserted into the follicle to retrieve the egg. The mature eggs are then fertilized with the partner’s (or a donor’s) sperm. Any resulting embryos are left to develop over two to five days and monitored for quality. One or two viable embryos may be transferred back into the uterus in the hopes that an embryo will implant in the uterine lining. Good-quality embryos can be vitrified (frozen) for future transfer.

Consultation to Discuss the IVF Cycle Timeline

Before you begin treatment, you will meet with your reproductive endocrinologist. He or she will review your medical history, previous fertility treatments you may have had, any formal diagnosis for you or your partner and how many children you hope to have. Women will often have a transvaginal ultrasound. The doctor will evaluate your uterus and ovaries and provide an idea of your follicle count (your follicle count correlates with the number of eggs you have). Then blood work will most likely be performed to get an idea of your ovarian reserve and will include the measure of hormones as FSH, oestradiol, AMH (FSH and oestradiol are usually measured on day 2 or 3 of your menstrual cycle). After the consultation your results will be reviewed, and your doctor will put together a personalised IVF protocol for you and your partner.

Advocating for Yourself

When planning your IVF treatment, you may ask questions about possible testing options. Preimplantation Genetic Testing for Aneuploidies (PGT-A) is an optional test that identifies chromosomal abnormalities before embryo transfer. The PGT-A counts the chromosomes in each embryo making sure all the genetic material is there and nothing is missing or extra. Another optional test called Endometrial Receptivity Analysis (ERA), can help establish the best day for embryo transfer. Ask your doctor to tell you more about the potential benefits and risks of these tests.

Implementing the IVF Cycle Timeline

• Once your IVF protocol is determined, you will meet with your IVF coordinator or a nurse at your clinic who will provide you with an estimated IVF Cycle timeline.
• In some cases, if it fits with your specific protocol, your doctor may prescribe you birth control pills for the timing of your IVF Cycle.
• Your nurse will order your medications for your cycle (Note: If you have insurance, you should call your provider and discuss whether or not your medications may be partially or completely covered).
• You learn how to self-administer medications typically through an injection class.
• You will have baseline blood work and ultrasound on your planned start date.
• The nurse will confirm when you are ready to begin your injectable medications (you typically contact the clinic on the first day of your period).
• Hormone stimulation/injections go on for approximately 8 to 14 days as part of your IVF Cycle timeline.
• Monitoring will be either every day or every other day as per your doctor orders (blood work and ultrasound).
• Once follicles are mature, you will be instructed to take your trigger shot.
• Egg retrieval is typically 34-­36 hours after trigger. The clinic or your nurse will advise you of your exact admission time.
• If your doctor is recommending it, you will begin progesterone supplementation the day after oocyte retrieval.
• If you’re doing a fresh embryo transfer, it usually happens on day 3 or day 5 after fertilization.
• If it is part of your protocol, you would continue hormone supplementation until pregnancy test.

If you are doing preimplantation genetic testing (PGT-A/PGD), your embryos will be biopsied on day 5 or day 6 and cryopreserved until results are obtained. An embryo will be transferred back into the uterus in a future cycle. The IVF process can be difficult both physically and emotionally. Asking questions to clarify the process can help you to feel more in control. Asking for support can make the process less intimidating and increase your general sense of well-being.