In Vitro Fertilization (IVF): Steps, Risks, Success and Cost

What is IVF?

In vitro fertilization (IVF) is a treatment in which eggs are removed from the ovaries, fertilized by sperm in a laboratory and grown for several days as embryos. One or more embryos are then transferred into the uterus, or frozen for later use. Since the first IVF birth in 1978, millions of babies have been born through assisted reproductive technology (ART).

Who IVF can help

• Blocked or damaged fallopian tubes
• Endometriosis and low ovarian reserve
• Moderate or severe male factor infertility, often with ICSI
• Unexplained infertility after other treatments
• Genetic testing of embryos (PGT) for certain conditions
• People using donor eggs, sperm or embryos or a gestational carrier
• Fertility preservation

The steps

1. Evaluation and planning. Testing of both partners and a treatment plan. See fertility testing.
2. Ovarian stimulation. Daily injectable gonadotropins for about 8 to 14 days encourage several follicles to grow. A separate medicine prevents early ovulation.
3. Monitoring. Frequent ultrasounds and blood tests adjust doses and timing.
4. Trigger shot. A trigger injection matures the eggs about 36 hours before retrieval.
5. Egg retrieval. A short procedure under sedation uses ultrasound-guided needle aspiration.
6. Fertilization. Eggs are combined with sperm, or sperm are injected by ICSI.
7. Embryo culture. Embryos are grown for 3 to 6 days. Some are biopsied for genetic testing (PGT) at the clinic’s or patient’s choice.
8. Embryo transfer. A fresh transfer happens soon after retrieval; a frozen embryo transfer (FET) uses a later cycle prepared with hormones such as progesterone.
9. Pregnancy test. A blood test roughly 9 to 14 days after transfer.

Success rates

Live birth rates depend mostly on the age of the person whose eggs are used, the diagnosis and embryo quality. They are highest at younger ages and decline from the mid-30s. Use the SART and CDC ART reports to look at published clinic data, and remember that clinics differ in the patients they accept. Pregnancy is never guaranteed.

Risks and side effects

• Ovarian hyperstimulation syndrome (OHSS), a swelling of the ovaries with abdominal pain, bloating and rapid weight gain. Severe cases need urgent care. See get help now.
• Multiple pregnancy if more than one embryo is transferred. Many clinics recommend single embryo transfer.
• Procedure risks, including bleeding, infection and anesthesia reactions, which are uncommon.
• Emotional strain. See stress and emotional health.

Cost and insurance

IVF is expensive, and coverage varies by state and employer. Budget for medication, add-ons, frozen transfers and storage as well as the base fee. Use the IVF cost estimator and read fertility costs and insurance.

Preparing for an IVF cycle

Before starting, most clinics review your history, check your ovarian reserve, test both partners for infectious diseases and may recommend carrier screening. You will sign consent forms about what happens to embryos, including storage, donation and disposal. These can be emotionally difficult, so take time to discuss them with your partner. You will also learn to give injections. Most clinics offer a teaching session, and many provide videos. If you are anxious about needles, tell your nurse, because tips such as ice before the injection can help.

Fresh versus frozen transfers

In a fresh transfer, an embryo is transferred a few days after retrieval in the same cycle. In a frozen embryo transfer (FET), embryos are frozen and transferred in a later cycle prepared with medication. Many clinics now freeze all embryos in certain situations, such as risk of OHSS, high progesterone at the trigger, or when genetic testing is planned. FET has become common because the uterus is not exposed to the high hormone levels of stimulation, and for some groups outcomes are as good or better. Your clinic will recommend an approach based on your situation.

Embryo grading and genetic testing

Embryologists grade embryos by appearance, looking at how many cells and how well they have developed. A well-graded blastocyst has a better chance of implanting, but grading is imperfect, and lower-grade embryos can still result in healthy babies. Preimplantation genetic testing (PGT) biopsies a few cells and tests for chromosomal differences (PGT-A) or specific inherited conditions (PGT-M). PGT-A is widely offered, but evidence that it improves live birth rates for all patients is debated, and it adds cost. It may be more useful for some, such as those with recurrent loss or older patients. Ask your clinic for the evidence relevant to you.

How many embryos to transfer

Transferring more than one embryo increases the chance of twins or more, which carry higher risks for both parent and babies. Professional guidelines support single embryo transfer for many patients, especially younger patients and those with good-quality embryos. Discuss your preferences and the clinic’s recommendations.

What if a cycle does not work?

A cycle that does not result in a pregnancy is a loss, even when it is common. Clinics usually offer a follow-up visit to review the cycle, consider changes to medication or the lab approach, and plan next steps. Some people take a break before trying again. Counseling can help with the emotional toll. See stress and emotional health.

Practical tips for the cycle

• Arrange time off for monitoring visits and retrieval, and for rest afterward.
• Store medication as directed and keep a calendar.
• Plan transport to retrieval, as you will be sedated.
• Eat regularly, stay hydrated and avoid strenuous exercise during stimulation, as advised.

Choosing a clinic

Compare outcomes for patients like you, itemized pricing, monitoring logistics and support. See how to choose a fertility clinic and questions for your first fertility appointment.