Starting IVF typically takes four to six weeks from your first consultation to embryo transfer, though the preparation phase before that can add another month or two depending on your situation. The process follows a predictable sequence: diagnostic testing, ovarian stimulation, egg retrieval, fertilization in the lab, and embryo transfer. Understanding each step helps you plan your schedule, your finances, and your expectations before you commit.
Book a Fertility Consultation and Get Tested
The first real step is scheduling a consultation with a reproductive endocrinologist. This is a specialist in fertility, not your regular OB-GYN, and most people find one through their insurance network, a referral, or by searching the Society for Assisted Reproductive Technology (SART) clinic directory. At this visit, you’ll discuss your medical history, previous attempts to conceive, and any known conditions. The doctor will order a round of baseline tests for both partners.
For the person who will carry the pregnancy, blood work typically includes three key hormone markers. FSH (follicle-stimulating hormone) measures how hard your body is working to produce eggs. A level above 12 suggests diminished ovarian reserve. Estradiol, tested alongside FSH, flags a problem if it’s above 80 pg/ml. AMH (anti-Müllerian hormone) gives a snapshot of your remaining egg supply. Levels below 0.3 ng/ml indicate fewer eggs will respond to stimulation medications, which affects the treatment plan your doctor recommends.
You’ll also get a transvaginal ultrasound to count your antral follicles, the small fluid-filled sacs on your ovaries that each contain an immature egg. This count, combined with your hormone levels, helps your doctor predict how your ovaries will respond to medication and choose the right protocol. For the male partner or sperm provider, a semen analysis evaluates sperm count, movement, and shape. Additional tests like an HSG (a dye test to check for blocked fallopian tubes) or a uterine cavity evaluation may also be ordered.
Prepare Your Body Before the Cycle
Most fertility specialists recommend starting certain supplements one to three months before your IVF cycle. A prenatal vitamin with 400 to 800 mcg of folic acid is standard for preventing neural tube defects. CoQ10, typically taken at 300 mg twice daily, supports egg quality by helping cells produce energy more efficiently. Your doctor may also check your vitamin D levels, aiming for a blood level above 30 ng/ml, and recommend supplementation if you’re low.
Beyond supplements, the preparation window is a good time to reduce alcohol, stop smoking, and limit caffeine. These aren’t just general wellness suggestions. Smoking directly damages egg and sperm DNA, and even moderate alcohol intake during IVF cycles has been linked to lower success rates. If your BMI is very high or very low, your doctor may discuss weight changes, since both extremes can affect how well you respond to stimulation medications.
The Stimulation Phase: Days 2 Through 15
Your IVF cycle officially begins on day one of your menstrual period. On day two or three, you’ll start daily hormone injections designed to push your ovaries to develop multiple eggs at once instead of the single egg your body normally releases. These injections typically continue for 7 to 14 days. Your clinic will give you a personalized calendar with exact medication types and timing.
The injections fall into two categories. Stimulation drugs contain FSH (sometimes combined with LH) to grow multiple follicles. Suppression drugs prevent your body from ovulating too early, which would ruin the cycle. You’ll administer these yourself at home using small subcutaneous needles, usually in the abdomen. Most people find the injections manageable after the first couple of days, though bloating, mild cramping, and mood changes are common side effects as your ovaries enlarge.
During stimulation, you’ll visit the clinic every two to three days for monitoring appointments. These involve a quick blood draw and a transvaginal ultrasound to measure your follicles and track hormone levels. Your doctor adjusts medication doses based on how you’re responding. This is the most schedule-intensive part of the process, so plan for frequent morning appointments that typically last 30 to 60 minutes.
The Trigger Shot and Egg Retrieval
Once enough follicles reach the right size, usually around days 9 through 15, you’ll receive a “trigger shot.” This injection causes the final maturation of your eggs and is precisely timed: the retrieval is scheduled exactly 36 hours later. Missing this window can mean losing the cycle, so your clinic will give you an exact time down to the minute.
Egg retrieval is a short outpatient procedure lasting about 20 to 30 minutes. You’ll receive IV sedation, so you’ll be comfortable and likely won’t remember the procedure. The doctor uses an ultrasound-guided needle passed through the vaginal wall to drain each follicle and collect the eggs. You’ll rest in recovery for about an hour afterward.
Plan to take the entire day off. You cannot drive yourself home due to the sedation, so arrange a ride in advance. For the days following retrieval, avoid submerging in water (no baths, pools, or hot tubs), skip heavy exercise, and stick to short walks of less than a mile. Your ovaries will be swollen and tender, and they won’t return to normal size until your next period or, if you become pregnant, until about 6 to 10 weeks into the pregnancy.
Fertilization, Embryo Development, and Grading
On the same day as your retrieval, the lab combines your eggs with sperm. This happens through conventional insemination (placing sperm and eggs together in a dish) or ICSI, where a single sperm is injected directly into each mature egg. ICSI is more common today and is typically used when sperm quality is a concern or when previous cycles had low fertilization rates.
Over the next five to six days, embryologists monitor the fertilized eggs as they divide and grow. Not every egg will fertilize, and not every fertilized egg will develop into a viable embryo. This attrition is normal and expected. By day five or six, the strongest embryos reach the blastocyst stage, a hollow ball of about 100 cells with two distinct parts: the inner cell mass (which becomes the baby) and the trophectoderm (which becomes the placenta).
Embryos are graded based on how well these structures look under a microscope. A “good” grade means the inner cell mass has a large, tightly packed cluster of cells, and the trophectoderm forms a smooth, continuous layer. “Fair” embryos have moderate cell numbers or less organized structures. “Poor” embryos have few cells or gaps. Higher-graded embryos generally have better implantation rates, but fair-grade embryos result in healthy pregnancies regularly. Your embryologist will walk you through your specific results.
Optional Genetic Testing
Many clinics offer preimplantation genetic testing (PGT-A), which screens embryos for extra or missing chromosomes before transfer. The biopsy happens at day five or six, when a few cells are carefully removed from the trophectoderm. Embryos are then frozen while the cells are sent to a genetics lab, with results returning in one to two weeks.
PGT-A looks for aneuploidy, which means having too many or too few of the normal 46 chromosomes. This is the most common reason embryos fail to implant or result in early miscarriage. The test can also detect conditions like Down syndrome. A separate version, PGT-SR, screens for inherited structural chromosome changes like translocations if either parent is a known carrier. Testing adds cost but can help avoid transferring embryos unlikely to result in a healthy pregnancy, which is especially relevant for patients over 37.
Embryo Transfer
If you’re doing a “fresh” transfer without genetic testing, this typically happens five or six days after retrieval. If embryos were frozen for PGT-A or scheduling reasons, a frozen embryo transfer (FET) is scheduled during a subsequent cycle, usually one to two months later. Your doctor will prescribe progesterone, typically as injections or vaginal suppositories, to prepare your uterine lining for implantation.
The transfer itself is anticlimactic compared to everything that preceded it. It takes about five minutes, requires no anesthesia, and feels similar to a Pap smear. A thin catheter is guided through your cervix, and the embryo is placed in the uterus under ultrasound guidance. You’ll rest briefly and then go home. A blood pregnancy test is scheduled about 9 to 12 days later.
What It Costs
A single IVF cycle in the United States runs between $12,000 and $18,000 for the base procedure, which covers monitoring, egg retrieval, lab fertilization, and embryo transfer. Medications are usually billed separately and add $3,000 to $5,000. Genetic testing, embryo freezing, and frozen transfer fees can push the total to $20,000 to $25,000 or more per cycle.
Insurance coverage varies dramatically by state. Only 19 states have passed laws requiring insurers to cover some form of fertility treatment, and just nine of those (Colorado, Connecticut, Delaware, Illinois, Maryland, New Hampshire, New Jersey, New York, and Rhode Island) mandate coverage for both IVF and fertility preservation. Even in those states, many policies have lifetime caps, and exemptions exist for religious organizations, small employers, and certain plan types. Call your insurance company before your first appointment and ask specifically whether IVF is covered, how many cycles, and what your out-of-pocket maximum will be.
If you’re paying out of pocket, most clinics offer payment plans, and some have multi-cycle discount packages that reduce the per-cycle cost if the first attempt doesn’t work. Fertility-specific lenders and grants from organizations like Baby Quest Foundation or the Cade Foundation are additional options worth exploring early in the process.
Success Rates by Age
Age is the single strongest predictor of IVF success. National data from SART’s 2023 report shows live birth rates per egg retrieval of 53.2% for patients under 35, 39.9% for ages 35 to 37, 26.2% for ages 38 to 40, 13.2% for ages 41 to 42, and 4.1% for patients over 42. These numbers reflect all embryo transfers from a single retrieval, meaning some patients needed more than one transfer attempt from that batch of embryos to achieve a live birth.
These are national averages. Individual clinic rates vary, and your personal odds depend on your specific diagnosis, egg quality, sperm quality, and the number of embryos your cycle produces. When comparing clinics, look at their SART-reported data for your age group rather than relying on headline success rates, which sometimes reflect only the healthiest patient populations.