Before You Begin: The Diagnostic Phase
Before your first cycle begins, your clinic will run a full diagnostic workup. Expect blood draws for both partners (AMH, FSH, estradiol, TSH, prolactin, and infectious disease panels), a transvaginal ultrasound to count antral follicles, a semen analysis, and in some cases a hysteroscopy or saline sonogram to look at the uterine cavity. Scheduling this phase usually takes two to four weeks.
Once results come back, your doctor designs a stimulation protocol based on your ovarian reserve and medical history. The two most common are the antagonist protocol, which is shorter and kicks off on cycle day 2 or 3, and the long lupron protocol, which starts with suppression in the cycle before.
Week 1: Baseline and Stimulation Start (cycle Days 1 to 5)
Cycle day 2 or 3 brings you back to the clinic for baseline bloodwork and an ultrasound. That ultrasound checks for leftover cysts from your last period and counts your resting follicles. If everything looks right, you start injections that same afternoon.
Stimulation medications usually include an FSH like Gonal-F or Follistim, sometimes paired with LH activity from Menopur. Daily doses range from 150 to 450 IU depending on your protocol. Most patients inject subcutaneously into the belly using a pen device or a standard syringe.
The first few days can feel almost pointless. You may notice nothing at all, or just mild bloating and a little tenderness where you inject. Your ovaries have not visibly responded yet.
Week 1 to 2: Monitoring (cycle Days 5 to 12)
By day 5 or 6, you are back at the clinic every one to two days for blood draws and ultrasounds. The team is tracking two things: your estradiol levels, which climb as follicles grow, and the size of each follicle, measured in millimeters.
Around day 5 to 7 on an antagonist protocol, you add a GnRH antagonist (Cetrotide or Ganirelix) to keep your body from ovulating too early. This is a daily subcutaneous injection, usually in the morning.
By day 8 to 10, the bloating becomes noticeable. Your ovaries, normally almond-sized, can swell to the size of lemons. This is expected. Skip high-impact exercise, twisting motions, and anything that compresses your abdomen.
The Trigger Shot (cycle Day 10 to 14)
When monitoring shows your lead follicles have reached 17 to 20 mm and estradiol is in the expected range, your doctor schedules 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 here is precise, often down to the minute. If your retrieval is set for 8:00 AM on Wednesday, your trigger shot goes in at 8:00 PM 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 takes 15 to 20 minutes under light sedation (IV anesthesia, not general). A transvaginal ultrasound-guided needle aspirates fluid from each mature follicle. You will not feel the procedure itself, though cramping and pressure afterward are common.
Most patients go home within an hour. Plan to rest for the rest of the day. Bloating, mild to moderate cramping, spotting, and fatigue are all normal side effects. Your clinic will call later that day or the next morning with the egg count.
A typical retrieval yields anywhere from 5 to 25 eggs, depending on age, AMH, and how well you responded to stimulation. Roughly 70% to 80% of those 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 for conventional insemination or injected individually via 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 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 watch the numbers drop at each stage. Starting with 12 eggs does not mean 12 embryos. A reasonable expectation is that roughly 30% to 50% of fertilized eggs will reach blastocyst stage.
Transfer or Freeze
A fresh transfer 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 whole 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 later cycle, after your body has recovered from stimulation. Many clinics now prefer this approach because it lets the uterine lining develop without the hormonal effects of stimulation.
The Two-Week Wait
After transfer, you 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 hardest stretch emotionally. Symptom spotting is unreliable here because progesterone supplementation causes many pregnancy-like symptoms (breast tenderness, bloating, fatigue, cramping) whether or not 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. Our nutrition hub has fertility-focused meal plans, and our other IVF guides cover medications, costs, and emotional support.