Before you begin: the diagnostic phase
Most fertility clinics schedule a diagnostic workup before your first cycle. This typically includes blood work for both partners (AMH, FSH, estradiol, TSH, prolactin, and infectious disease panels), a transvaginal ultrasound to count antral follicles, a semen analysis, and sometimes a hysteroscopy or saline sonogram to evaluate the uterine cavity. Plan for this phase to take two to four weeks, depending on scheduling.
Your doctor will use these results to design a stimulation protocol tailored to your ovarian reserve and medical history. The most common protocols are the antagonist protocol (shorter, starting on cycle day 2 or 3) and the long lupron protocol (starting with suppression in the cycle before).
Week 1: Baseline and stimulation start (cycle days 1 to 5)
On cycle day 2 or 3, you will go to the clinic for baseline bloodwork and an ultrasound. The ultrasound confirms there are no large cysts from the previous cycle and counts your resting follicles. If everything looks good, you start injections that same day.
Stimulation medications typically include a follicle-stimulating hormone (FSH) like Gonal-F or Follistim, sometimes combined with LH activity from Menopur. Doses range from 150 to 450 IU per day depending on your protocol. Most patients inject subcutaneously into the belly using a pen device or standard syringe.
The first few days often feel anticlimactic. You may feel nothing at all, or mild bloating and tenderness at the injection site. Your ovaries have not yet responded visibly.
Week 1 to 2: Monitoring (cycle days 5 to 12)
Starting around day 5 or 6, you will visit the clinic every one to two days for blood draws and ultrasounds. The clinic is tracking two things: your estradiol levels (which rise as follicles grow) and the size of each follicle (measured in millimeters).
Around day 5 to 7 on an antagonist protocol, you will add a GnRH antagonist (Cetrotide or Ganirelix) to prevent premature ovulation. This is a daily subcutaneous injection, usually in the morning.
By day 8 to 10, you may feel noticeably bloated. Your ovaries, normally the size of almonds, may have grown to the size of lemons. This is normal and expected. Avoid high-impact exercise, twisting motions, and anything that puts pressure on the abdomen.
The trigger shot (cycle day 10 to 14)
When monitoring shows that your lead follicles have reached 17 to 20 mm and your estradiol levels are in the expected range, your doctor will schedule the trigger shot. This is an injection of hCG (Ovidrel, Pregnyl, or Novarel) or a GnRH agonist (Lupron), timed exactly 36 hours before your egg retrieval.
The timing is precise, often down to the minute. If your retrieval is scheduled for 8:00 AM on Wednesday, your trigger shot will be at 8:00 PM on Monday night. Set multiple alarms. This is the one step where timing truly matters to the minute.
Egg retrieval (about cycle day 12 to 16)
Retrieval is a 15 to 20 minute procedure under light sedation (IV anesthesia, not general). A transvaginal ultrasound-guided needle aspirates fluid from each mature follicle. You will not feel the procedure, though you may feel cramping and pressure afterward.
Most patients go home within an hour. Plan to rest for the remainder of the day. Common side effects include bloating, mild to moderate cramping, spotting, and fatigue. Your clinic will call later that day or the next morning with the number of eggs retrieved.
A typical retrieval yields anywhere from 5 to 25 eggs, depending on age, AMH, and stimulation response. Of those, roughly 70% to 80% will be mature (MII stage), and of the mature eggs, about 70% to 80% will fertilize normally.
Fertilization and embryo development (days 1 to 6 post-retrieval)
On retrieval day, your eggs are either mixed with sperm (conventional insemination) or injected individually (ICSI, intracytoplasmic sperm injection). ICSI is used when sperm count or motility is low, or when previous cycles had poor fertilization.
The embryology lab will provide updates:
- Day 1: Fertilization check. You will learn how many embryos formed normally (showing two pronuclei).
- Day 3: Embryos are at the 6 to 8 cell stage. Some clinics transfer at this point, though most now culture to day 5.
- Day 5 or 6: Surviving embryos reach the blastocyst stage. This is the most common point for transfer or biopsy (if doing PGT-A genetic testing).
It is normal, and still hard, to see the numbers drop at each stage. Starting with 12 eggs does not mean 12 embryos. A common expectation is that roughly 30% to 50% of fertilized eggs will reach blastocyst stage.
Transfer or freeze
If you are doing a fresh transfer, this happens on day 3 or day 5 post-retrieval. The embryo is loaded into a thin catheter and guided through the cervix into the uterus under ultrasound. The procedure takes about five minutes and typically requires no anesthesia.
If you are doing PGT-A testing or a frozen embryo transfer (FET), all blastocysts are vitrified (flash-frozen) and stored. The transfer happens in a subsequent cycle after your body has recovered from stimulation. Many clinics now prefer this approach, as it allows the uterine lining to develop without the hormonal effects of stimulation.
The two-week wait
After transfer, you will start progesterone support (vaginal suppositories, intramuscular injections, or both). The first pregnancy blood test (beta hCG) is typically scheduled 9 to 12 days after a day-5 transfer.
The two-week wait is widely considered the most emotionally difficult part of IVF. Symptom spotting is unreliable because progesterone supplementation causes many pregnancy-like symptoms (breast tenderness, bloating, fatigue, cramping) regardless of whether implantation occurred. For strategies to get through this stretch, see our separate guide on the two-week wait.
What the numbers look like
According to SART (Society for Assisted Reproductive Technology) data from 2021:
- Under 35: approximately 50% to 55% live birth rate per retrieval cycle
- 35 to 37: approximately 38% to 42%
- 38 to 40: approximately 26% to 30%
- 41 to 42: approximately 13% to 17%
- Over 42: approximately 4% to 7%
These are per-retrieval rates, meaning they include all transfers from eggs retrieved in one cycle. Per-transfer rates for PGT-A tested embryos are higher, often 60% to 65% regardless of age at retrieval.
What to do next
If you are preparing for IVF, start by finding a reproductive endocrinologist in the Baaby provider directory. Use our nutrition hub for fertility-focused meal plans, and explore our other IVF guides covering medications, costs, and emotional support.