IVF can feel overwhelming before you understand it. The terminology is unfamiliar. The process involves multiple stages that build on each other. And the emotional weight of what is at stake makes every piece of information feel more complex than it might otherwise be.
The simplest antidote to that overwhelm is clarity. When you understand exactly what happens at each step — what the purpose of each step is, what it involves physically, and what the next step depends on — the process becomes something you can follow, prepare for, and engage with as a participant rather than as a passive subject of a medical procedure you do not fully understand.
This article explains the IVF process in seven steps. Each step is described clearly, with the clinical detail necessary for genuine understanding and without the jargon that obscures rather than illuminates. By the end, you will have a complete picture of what IVF involves — from the first injection to the blood test that determines whether the cycle has resulted in a pregnancy.
Step 1: Ovarian Stimulation — Preparing the Eggs
In a natural menstrual cycle, one follicle — the small fluid-filled sac in the ovary that contains an egg — develops to maturity each month. At ovulation, that follicle releases its egg, which travels into the fallopian tube where fertilization may occur.
For IVF, one egg is rarely sufficient. More eggs mean more fertilization opportunities, more embryos, and a greater probability that at least one embryo will be of adequate quality to result in a successful pregnancy. The first step of IVF is therefore to stimulate the ovaries to develop multiple follicles simultaneously — a process called controlled ovarian hyperstimulation.
This is achieved through daily injections of gonadotropin medications — hormones that signal the ovaries to develop multiple follicles at the same time. These injections are subcutaneous — administered under the skin of the abdomen — and are typically started on day two or three of the menstrual cycle. Most patients learn to self-administer the injections at home after a brief training session at the clinic.
The stimulation phase typically lasts ten to fourteen days. The specific medications, doses, and duration are determined by the patient's individual hormonal profile and ovarian reserve — primarily AMH level and antral follicle count — and are adjusted during the stimulation phase based on the ovarian response observed at monitoring visits.
During stimulation, the patient visits the clinic every two to three days for monitoring ultrasound scans and blood tests. The ultrasound measures the number and size of developing follicles. The blood test measures estradiol — a hormone produced by the developing follicles that reflects their growth. Together, these monitoring results guide any dose adjustments and determine when the follicles are ready for the next step.
Physically, most patients experience increasing abdominal fullness and bloating as the follicles develop and the ovaries enlarge. This is expected and managed with appropriate rest. Strenuous exercise is discouraged during stimulation to reduce the risk of ovarian torsion — the enlarged ovaries are more vulnerable to twisting than usual.
The purpose of Step 1: To produce multiple mature eggs for retrieval, maximizing the number of fertilization opportunities in a single cycle.
Step 2: The Trigger Injection — Final Maturation of the Eggs
When the monitoring ultrasound shows that the lead follicles have reached the appropriate size — typically 18 to 20 millimetres in diameter — and the overall follicle development pattern is satisfactory, the stimulation medications are stopped and a trigger injection is given.
The trigger injection initiates the final maturation of the eggs — the last stage of development before they are capable of being fertilized. Without this trigger, the eggs would be retrieved before they are fully ready, and immature eggs have a much lower fertilization potential than mature ones.
The timing of the trigger injection is precise. Egg retrieval must take place approximately 34 to 36 hours after the trigger — a specific window during which the eggs are fully mature but have not yet been spontaneously released. The retrieval appointment is scheduled with this timing in mind, and it is important that the trigger injection is given at the exact time specified — usually late in the evening, with retrieval scheduled for the morning of the second day following.
Two types of trigger are used in IVF — an hCG trigger, which mimics the natural LH surge that causes ovulation, and a GnRH agonist trigger, which stimulates the pituitary gland to release its own LH surge. The choice between these two approaches depends on the patient's ovarian response — women with very high follicle counts, particularly those with PCOS, may receive a GnRH agonist trigger to reduce the risk of ovarian hyperstimulation syndrome, while an hCG trigger is more commonly used in patients with a moderate response.
The purpose of Step 2: To complete the final maturation of the eggs and time the retrieval precisely within the window when the eggs are ready.
Step 3: Egg Retrieval — Collecting the Eggs
Egg retrieval is the most significant procedure in the IVF cycle and the step that most couples approach with the greatest anxiety. Understanding exactly what it involves typically reduces that anxiety substantially.
The procedure is performed under light sedation — the patient is administered intravenous medication that makes her comfortable and unaware during the procedure. She does not experience pain during the retrieval itself.
The doctor uses a thin ultrasound probe inserted vaginally — the same type of probe used for monitoring ultrasounds throughout the stimulation phase — with a fine needle attached. The needle is guided by ultrasound into each follicle in turn, and the fluid within each follicle — along with the egg it contains — is gently aspirated into a collection tube.
The collection tube is immediately handed to the embryologist in the adjacent laboratory, who examines the fluid under a microscope and identifies the eggs. The embryologist's real-time communication with the doctor in the procedure room means that both partners know the number of eggs collected before leaving the clinic.
The entire procedure takes approximately twenty to thirty minutes. The patient wakes from sedation in the recovery area and rests for one to two hours before being discharged home. A companion must accompany her — sedation affects coordination and judgment temporarily, and driving is not safe for several hours.
On the same morning as the egg retrieval, the male partner provides a semen sample at the clinic. The sample is processed by the embryology team — washed, concentrated, and prepared — for use in the fertilization step that follows.
Physically, the day of retrieval is a full clinic day. Most patients experience some cramping and bloating for one to two days afterward, comparable to moderate period discomfort.
The purpose of Step 3: To collect the mature eggs from the follicles before they are spontaneously released, for use in laboratory fertilization.
Step 4: Fertilization — Egg Meets Sperm
Once the eggs have been collected and the semen sample has been prepared, the fertilization step takes place in the laboratory. This is the step that gives IVF its name — in vitro fertilization, or fertilization in glass, outside the body.
Fertilization can be performed through two methods, depending on the quality of the sperm and the clinical circumstances.
Conventional IVF fertilization involves placing the mature eggs and a concentration of prepared sperm together in a specialized culture dish and allowing fertilization to happen naturally — the sperm swim to the eggs and, if successful, one penetrates the egg membrane and fertilizes it. This method works well when sperm quality is adequate.
ICSI — intracytoplasmic sperm injection — is used when sperm quality is a concern or when conventional fertilization has been unsuccessful in previous cycles. In ICSI, the embryologist selects a single sperm under high-powered magnification, picks it up with an ultra-thin glass needle, and injects it directly into the center of the egg. Fertilization success rates with ICSI are generally higher than with conventional IVF in cases of male factor infertility, because the sperm does not need to penetrate the egg independently.
The following morning — approximately sixteen to eighteen hours after fertilization — the embryologist checks the eggs for fertilization. A normally fertilized egg shows two pronuclei — one from the egg and one from the sperm — a sign that fertilization has occurred correctly. The fertilization result is reported to the couple the morning after retrieval.
Fertilized eggs are now called embryos, and they are placed in specialized incubators where temperature, atmospheric composition, and humidity are precisely controlled to replicate the conditions of the fallopian tube in which natural fertilization and early embryo development occur.
The purpose of Step 4: To create embryos by uniting the egg and sperm, either naturally or through direct injection, in a controlled laboratory environment.
Step 5: Embryo Culture and Development — Watching the Embryos Grow
Once fertilized, embryos remain in the laboratory incubator for three to five days, developing from a single fertilized cell into a multi-cell structure under the careful observation of the embryology team.
The development milestones are specific. On day two, a normally developing embryo has two to four cells. On day three, it has six to eight cells. By day five, the embryo reaches the blastocyst stage — a highly organized structure with approximately one hundred cells organized into two distinct compartments: the inner cell mass, which will become the fetus, and the trophectoderm, which will become the placenta.
Blastocysts have a higher implantation potential than day-three embryos and are generally preferred for transfer because they represent a more advanced, more independently viable stage of development. However, not every embryo reaches the blastocyst stage — some arrest in development between day three and day five, a natural process of selection that reflects the quality of the embryo's genetic material and energy reserves.
The embryologist monitors development and reports to the couple — typically on day three and day five — with updates on the number and quality of developing embryos. These daily reports are among the most emotionally charged communications of the IVF cycle.
Embryos that are not selected for immediate transfer but are of adequate quality are cryopreserved — frozen — at the blastocyst stage for potential use in future transfer cycles. Embryos that do not reach a transferable developmental stage are not used.
If PGT-A — preimplantation genetic testing — has been recommended, embryos at the blastocyst stage are biopsied: a few cells from the trophectoderm are removed and sent for chromosomal analysis. The embryos are then frozen while the results — which typically take one to two weeks — are awaited. Only chromosomally normal embryos are subsequently transferred.
The purpose of Step 5: To allow embryos to develop in a controlled environment to the point where the best-quality embryo or embryos can be selected for transfer.
Step 6: Embryo Transfer — Placing the Embryo in the Uterus
Embryo transfer is the step that most couples have been building toward since the cycle began — the moment when the embryo is placed inside the uterus where, if all goes well, it will implant and a pregnancy will begin.
The procedure is considerably simpler than the egg retrieval. No sedation is required. No recovery time is needed. Most patients describe it as causing minimal discomfort — comparable to a cervical smear.
The patient lies on the examination table. A speculum is placed in the vagina. The doctor passes a thin, soft catheter through the cervix into the uterine cavity. The embryo — contained in a tiny drop of culture medium at the tip of the catheter — is deposited gently inside the uterus. The entire procedure takes approximately five to ten minutes.
The transfer is guided by abdominal ultrasound — the doctor watches on the ultrasound screen as the catheter is advanced through the cervix and the tiny bright spot of the embryo is deposited at the optimal location within the uterine cavity.
After the transfer, the patient rests at the clinic for thirty to sixty minutes. Normal, light daily activities can typically be resumed the same day — the evidence does not support prolonged bed rest after embryo transfer, and the embryo is not dislodged by normal physical activity. Strenuous exercise, heavy lifting, and vigorous activity are typically avoided for a few days.
From the day of transfer, progesterone supplementation — usually as vaginal pessaries or injections — is continued to support the uterine lining and encourage implantation.
The purpose of Step 6: To place the embryo inside the uterus at the optimal time and location for implantation to occur.
Step 7: The Two-Week Wait and the Pregnancy Test — The Final Answer
After the embryo transfer, the most physically passive — and most emotionally demanding — phase of the IVF cycle begins. It is called the two-week wait.
For fourteen days, the couple waits. No intervention. No monitoring scan. No clinical action. The embryo has been transferred to the best uterine environment the preparation could create. Whether it implants and a pregnancy begins is now determined by biological processes that are no longer within anyone's clinical control.
The hormone progesterone, taken as a supplement during this period, supports the uterine lining and the earliest stages of implantation. Some women experience side effects from progesterone — bloating, breast tenderness, occasional mood changes — that are indistinguishable from early pregnancy symptoms. This makes the two-week wait particularly challenging, because the symptoms that might feel encouraging are present regardless of whether implantation has occurred.
Home pregnancy tests are generally discouraged during the two-week wait for two reasons. First, the trigger injection — particularly an hCG trigger — can cause a false positive result for up to ten days after administration. Second, a negative home test result early in the wait can cause premature distress in a cycle that may still result in a positive blood test.
On the fourteenth day after the embryo transfer, a blood test — measuring the level of beta-hCG, the hormone produced by a developing placenta — determines whether the cycle has resulted in a pregnancy. A positive result is the beginning of the next phase — close early pregnancy monitoring through the first trimester. A negative result is the beginning of a clinical review — an assessment of what the cycle revealed and what the next steps should be.
In either case, the fourteen days of waiting have an answer. And that answer, whatever it is, is the foundation of the next clinical decision in the fertility journey.
The purpose of Step 7: To allow the embryo time to implant and the blood test to confirm whether the cycle has resulted in a pregnancy.
What Happens After the Pregnancy Test
If the pregnancy test is positive, the Metro IVF team continues to monitor the early pregnancy — serial hCG measurements to confirm the hormone is rising appropriately, and an early ultrasound at approximately six to seven weeks to confirm a fetal heartbeat and the location of the pregnancy. Once the pregnancy is confirmed as ongoing, care is typically transferred to an obstetrician for routine antenatal management.
If the pregnancy test is negative, the Metro IVF team schedules a review appointment — to discuss what the cycle revealed, what factors may have contributed to the outcome, and what the recommended next steps are. For couples who have frozen embryos from the stimulation cycle, a frozen embryo transfer cycle is typically the next step. For couples who need a new stimulation cycle, the review informs the protocol design for the next attempt.
At Metro IVF, a negative result is never treated as the end of the conversation. It is treated as clinical information — data that tells something about what happened and what should be different next time.
Your Next Step
If you are considering IVF and want to understand exactly how the process would work for your specific situation — which protocol, which monitoring schedule, what the investigation before the cycle should include — a consultation with Dr. Ashish Soni at Metro IVF in Ambikapur is the right starting point.
The seven steps described here are the framework. The specifics — the medications, the doses, the timing, the laboratory approach — are designed individually around each patient's clinical picture. That individualization begins with the first consultation.
Metro IVF Test Tube Baby Center Ambikapur, Chhattisgarh metrofertility.in Led by Dr. Ashish Soni — North India's First Fertility Super Specialist
Seven steps. One goal. Book your consultation with Dr. Ashish Soni at Metro IVF today — and take the first step toward yours.