In-vitro fertilization (IVF) brings hope to many couples who face challenges conceiving naturally. Over the decades, IVF has become a highly refined process.
From the first step of preparing the ovaries to the final pregnancy test, each stage is carefully timed to maximize success. Understanding this timeline can help you feel more confident and prepared as you embark on your IVF journey.
Below, we walk through the typical IVF process over roughly 30 days, from the start of your menstrual cycle to finding out whether you are pregnant.
We also cover variations like frozen embryo transfers (FET) and preimplantation genetic testing (PGT), discuss potential challenges, and outline the costs involved in India.
Starting the Cycle: Days 1–3
Day 1 marks the onset of your period. You visit your clinic for baseline tests: a blood draw checks your hormone levels (FSH, LH, estradiol), and a transvaginal ultrasound measures the lining of your uterus and ensures there are no cysts. These tests confirm that your ovaries are ready for stimulation.
On Days 2 and 3, you begin taking ovarian stimulation drugs. These are usually injectable hormones (FSH and sometimes LH) that encourage your ovaries to develop multiple follicles instead of the single follicle in a natural cycle. Producing more follicles increases your chance of retrieving several mature eggs.
Ovarian Stimulation and Monitoring: Days 4–10
Between Days 4 and 10, you continue daily hormone injections. During this period, you have 3–5 monitoring visits (every two or three days). Each visit includes:
- Blood tests to measure estrogen levels, which rise as follicles grow.
- Transvaginal ultrasounds to measure follicle size and count.
Your clinic uses this information to adjust your medication dose. If follicles grow too quickly or too slowly, your doctor may tweak the dose to avoid complications such as ovarian hyperstimulation syndrome (OHSS).
By Day 8 to Day 10, you usually see multiple follicles reaching 14–18 mm in diameter. This is an indicator that they are near maturity.
Trigger Shot: Day 11 or Sooner
Once at least two or three lead follicles reach about 18–20 mm, your clinic schedules a “trigger” injection. This shot contains either human chorionic gonadotropin (hCG) or a GnRH agonist.
It finalizes the maturation of eggs and times ovulation. You give yourself this injection 34–36 hours before the planned egg retrieval.
Egg Retrieval (Oocyte Collection): 36 Hours After Trigger
Approximately 36 hours after the trigger shot, you undergo the egg retrieval procedure:
- Sedation or light anesthesia ensures you feel no pain.
- A needle guided by ultrasound enters the follicles through the vaginal wall.
- Fluid from each follicle is suctioned into tubes.
- An embryologist examines the fluid under a microscope and identifies each egg.
The procedure takes 15–30 minutes and usually has minimal side effects. You rest for a few hours before going home. Mild cramping or spotting may occur for a day or two afterward.
Fertilization: Day 1 Post-Retrieval
Within a few hours of retrieval, your eggs go to the lab. There, the embryologist inseminates them in one of two ways:
- Conventional insemination places many sperm next to each egg in a petri dish.
- Intracytoplasmic sperm injection (ICSI) injects a single high-quality sperm directly into each mature egg.
ICSI is often used when sperm quality is low or when previous cycles have failed. After fertilization, scientists look for the two pronuclei (male and female genetic material) under a microscope. This confirms successful fertilization.
Embryo Culture and Grading: Days 2–6
After fertilization, embryos grow in a carefully controlled incubator. The lab monitors them daily:
- Day 2: The embryo has 2–4 cells.
- Day 3: It reaches 6–8 cells.
- Day 5–6: The embryo forms a blastocyst, a fluid-filled structure with about 100 cells, divided into the inner cell mass (future baby) and the trophectoderm (placenta).
Embryologists grade embryos based on cell number, symmetry, and fragmentation (pieces of cytoplasm). Higher-grade embryos have better chances of implantation.
Fresh Embryo Transfer: Day 5 or 6
In a fresh cycle, you often transfer embryos on Day 5, when they are at the blastocyst stage. Transfer follows these steps:
- You arrive with a full bladder, which helps provide a clear ultrasound view.
- A speculum opens your vagina.
- A soft, flexible catheter loaded with 1–2 embryos passes through the cervix into the uterine cavity.
- The embryos are gently expelled into the uterine lining under ultrasound guidance.
The procedure takes less than 10 minutes and requires no anesthesia. You may rest briefly afterward before going home.
Luteal Phase Support: Days 6–19
After transfer, you begin progesterone supplementation via injections, vaginal gels, or suppositories to support the uterine lining and encourage implantation. Your clinic schedules follow-up blood tests to monitor progesterone and, later, hCG levels.
Pregnancy Test: Around Day 16–19
About 10–14 days after embryo transfer, you return for a blood hCG test. A positive result indicates that an embryo has implanted and begun producing hCG.
Your clinic may repeat the test 48 hours later to confirm that hCG levels are rising appropriately.
If the test is negative, you stop hormone supplements and expect menstruation within a week.
You and your doctor then discuss next steps: another fresh cycle, a frozen embryo transfer (FET), or additional diagnostic testing.
Frozen Embryo Transfer (FET) Timeline
If you have surplus embryos frozen at the blastocyst stage, a FET may follow a simpler timeline:
- Preparation of the endometrium with estrogen, either via pills or patches, for 10–14 days.
- Monitoring of the uterine lining thickness via ultrasound.
- Progesterone supplementation starts a few days before transfer.
- Embryo transfer occurs 5 days after progesterone begins.
- Pregnancy test 10–14 days later.
Because there’s no need for egg retrieval or ovarian stimulation, FET cycles tend to have lower stress, milder side effects, and similar success rates to fresh transfers.
Preimplantation Genetic Testing (PGT) Option
Some patients choose to test embryos for chromosomal normality (PGT-A) or for specific genetic mutations (PGT-M). This adds 1–2 weeks:
- On Day 5 or 6, embryologists biopsy a few cells from each blastocyst.
- Biopsied cells go to a genetics lab for analysis (1–2 weeks).
- Chromosomally normal or unaffected embryos are thawed later for FET.
PGT can reduce miscarriage risk and improve live-birth rates, especially for older patients or those with known genetic risks.
Possible Complications and Side Effects
IVF is generally safe, but you should know potential issues:
- Ovarian Hyperstimulation Syndrome (OHSS): Over-response to hormones can cause bloating, pain, and, in rare cases, fluid buildup. Clinics monitor hormone levels closely and adjust medications to minimize this risk.
- Multiple Pregnancy: Transferring more than one embryo increases the chance of twins or higher-order multiples. Many clinics now recommend single embryo transfer (SET) to reduce risks.
- Ectopic Pregnancy: Very rarely, an embryo implants outside the uterus. Early monitoring ensures timely detection.
- Emotional Stress: IVF can be physically and emotionally demanding. Support from counseling or support groups helps manage anxiety and uncertainty.
Factors That Affect Success Rates
Success varies by individual factors:
- Younger women generally have higher egg quality and better outcomes.
- Ovarian Reserve is measured by AMH and antral follicle count, it predicts the number of eggs you can produce.
- Sperm Quality like high motility and low DNA fragmentation improve fertilization and embryo health.
- Maintaining a healthy weight, quitting smoking, and managing stress can boost success.
- Choose a clinic with strong lab standards, experienced embryologists, and up-to-date protocols.
Typical live-birth rates per fresh cycle in India range from around 50–60% for women under 35, 30–40% for ages 35–39, and 10–20% for women over 40.
IVF Cost in India
Total costs often fall between ₹1.5 lakhs and ₹3 lakhs for a fresh cycle with standard add-ons. Clinics may offer packaged rates or financing options.
Always confirm inclusions labs, consultations, anesthesia, and follow-up tests before you begin.
When to Consider Changing Clinics or Protocols
If you experience repeated cycle failures or poor embryo quality, discuss changing your stimulation protocol or clinic. A second opinion can provide fresh insights different drug routine, lab techniques or complementary therapies may help.
Pregnancy and Beyond
If your pregnancy test is positive, you continue progesterone support until about 10–12 weeks, when the placenta takes over hormone production.
Early ultrasounds confirm implantation location and viability. Once your obstetric care begins, you transition to standard prenatal monitoring.
If the test is negative, allow yourself time to rest emotionally and physically. You usually begin your next cycle with your doctor’s guidance after your period.
Many couples require more than one attempt—each cycle offers information to fine-tune your approach.
Conclusion
The IVF timeline from the first menstrual bleed to the pregnancy test takes roughly a month for a fresh cycle, with key milestones every few days. Knowing what to expect at each stage can reduce anxiety and help you feel in control.
Modern IVF techniques, including ICSI, FET, and PGT, offer tailored options to suit individual needs.
While success rates vary, careful monitoring, lifestyle choices, and working with experienced professionals can significantly increase your chances.
