Understanding IVF

Introduction

In vitro fertilisation represents one of modern medicine's most remarkable achievements, offering a pathway to parenthood for those facing fertility challenges. At its core, IVF involves stimulating the ovaries to produce multiple eggs, collecting those eggs, fertilising them with sperm in a laboratory, and transferring resulting embryos into the womb. While scientifically straightforward, the journey touches on the deepest aspects of human experience—the desire to create family.

This guide aims to provide a balanced understanding of both the medical procedures and the emotional landscape of IVF, empowering you with knowledge while recognising that each person's journey is uniquely their own

IVF isn’t just a protocol — it’s a crash course in emotional stamina, medical systems, decision overwhelm, and hope. How you engage with the process matters just as much as your protocol. This quiz reveals your IVF mindset style — so you can move through treatment with more confidence, less confusion, and a toolkit that actually fits who you are.

What’s Your IVF Mindset Archetype?

The IVF Pathway: Key Stages

1. Initial Assessment and Planning

Every IVF journey begins with thorough assessment to understand your unique fertility profile. This preparatory phase creates the foundation for your personalised treatment plan.

The fertility assessment typically involves:

Ovarian reserve evaluation through blood tests measuring hormones like Follicle Stimulating Hormone (FSH) to assess egg quantity
Uterine assessment via transvaginal ultrasound to examine the womb's shape, lining thickness, and identify any structural issues
Sperm analysis to evaluate count, motility (movement), and morphology (shape)
General health screening including thyroid function, vitamin D levels, rubella immunity, and infectious disease testing

These baseline tests help your fertility team identify any underlying issues and determine which approach might be most suitable for your specific situation.

2. Regulating Your Cycle and Ovarian Stimulation

Most IVF cycles involve two key medication phases: suppressing your natural cycle and then stimulating your ovaries to produce multiple eggs.

Suppressing the natural cycle

Many protocols first create a controlled hormonal environment using medications called gonadotropin-releasing hormone (GnRH) agonists or antagonists. These prevent premature ovulation and allow precise timing of egg development. This phase typically lasts 1-2 weeks and may cause mild menopausal-like symptoms as hormone levels temporarily decrease.

Stimulation medications

Following suppression (or sometimes immediately, in short protocols), you'll begin stimulation medications. These are typically self-administered injections of follicle-stimulating hormone (FSH) to encourage multiple follicles to grow.

Monitoring during stimulation

This phase requires careful tracking through:

Regular transvaginal ultrasound scans to count and measure growing follicles
Blood tests to check hormone levels, particularly estradiol
Potential medication adjustments based on your individual response

The stimulation phase typically lasts 8-14 days. During this time, many experience mild bloating and sometimes mood fluctuations as hormone levels rise.

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3. Triggering Ovulation and Egg Collection

When your follicles reach optimal maturity (usually 18-22mm in size), your treatment enters a precisely timed phase

Triggering final maturation

A specific injection triggers the final maturation of eggs approximately 36 hours before collection. The timing of this injection is absolutely crucial—it must be administered at the exact time specified by your clinic.

Two types of triggers are commonly used:

Human chorionic gonadotropin (hCG), which mimics the natural LH surge that triggers ovulation
GnRH agonist triggers, which may be used for patients at higher risk of ovarian hyperstimulation syndrome (OHSS)

Egg collection

This minor surgical procedure performed about 36 hours after the trigger:

Is conducted under sedation or light anaesthesia for comfort
Uses ultrasound guidance to visualise the follicles
Involves a thin needle passed through the vaginal wall to carefully aspirate fluid from each follicle
Typically takes 20-30 minutes, with recovery requiring a few hours
May cause mild cramping and spotting afterwards

Each follicle's fluid is immediately examined by embryologists to identify the eggs, which are then prepared for fertilisation.

4. Fertilisation and Early Embryo Development

Once eggs have been collected, the creation of embryos begins in the laboratory

Fertilisation methods:

Conventional IVF: Eggs and specially prepared sperm are placed together in culture medium, allowing natural fertilisation to occur—suitable when sperm parameters are normal
Intracytoplasmic Sperm Injection (ICSI): A single sperm is directly injected into each mature egg—often used for male factor infertility or previous fertilisation failure

Successfully fertilised eggs begin dividing to form embryos:

Day 1: Fertilisation is confirmed by checking for two pronuclei (from egg and sperm)
Days 2-3: Embryos develop from 2-4 cells to 8 cells (cleavage stage)
Days 5-6: Embryos may develop into blastocysts with a fluid-filled cavity and two distinct cell types

Throughout this period, embryologists grade embryos based on appearance and development rate

Understanding IVF Attrition and the Factors That Shape Success

While this process sounds linear, in reality it’s where many hopeful embryos fall away. Not all fertilised eggs develop as expected, and even embryos that look promising early on may not reach blastocyst stage. This natural drop-off is known as IVF attrition—and it’s one of the most misunderstood aspects of fertility treatment. Each stage introduces a natural level of attrition. Even with high egg numbers or good test results, it’s not unusual for only a few embryos to make it to transfer. This is frustrating—but normal—and understanding why can help make the process feel less destabilising.

IVF Attrition: Why It Happens

IVF is not just one procedure—it’s a chain of biological events, each with its own hurdle. Even in well-supported cycles with strong initial results, it’s common to experience attrition at every step.

This drop-off doesn’t mean something is wrong. It reflects the natural inefficiency of human reproduction, magnified by lab conditions. In fact, even in unassisted conception, most fertilised eggs do not result in pregnancy.

5. Embryo Transfer

Embryos may be transferred to your womb 3-5 days after egg collection, depending on your clinic's protocols and your specific situation.

The Transfer Procedure

A soft, thin catheter containing the selected embryo(s) is passed through the cervix into the uterus under ultrasound guidance
The procedure is usually quick (about 15-20 minutes) and relatively comfortable
A full bladder is often required to optimise the ultrasound view, which can feel uncomfortable
One or two embryos are typically transferred, following careful discussion about multiple pregnancy risks
The procedure doesn't require sedation or anaesthesia

Fresh vs. frozen transfer

Depending on various factors, embryos may be transferred in:

The same cycle as egg collection ("fresh" transfer)
A subsequent natural or medicated cycle after embryos have been frozen

Current research shows better results with frozen embryo transfers, which can allow your body time to recover from the stimulation phase.

6. Luteal Phase Support and Pregnancy Testing

The period between embryo transfer and pregnancy testing is medically known as the "luteal phase" and requires specific support

Luteal support medications

Progesterone supplements mimic the natural progesterone produced by the corpus luteum after ovulation
Help prepare the uterine lining for potential implantation
Continue until pregnancy testing and often beyond if pregnancy is confirmed

The waiting period

Lasts approximately two weeks between transfer and pregnancy testing
Represents a unique emotional challenge in the IVF journey
Progesterone supplements may cause symptoms that mimic both early pregnancy and premenstrual symptoms

Most clinics recommend pregnancy test around 10- 14 days after embryo transfer

Common IVF Protocols

Your fertility specialist will recommend a specific protocol based on your age, hormone levels, ovarian reserve, and any previous treatment response.

The main protocols include:

Long Protocol

Involves suppressing the natural cycle with GnRH agonists for approximately two weeks before starting stimulation medications
Creates a controlled hormonal environment that allows for precise timing
Typically suitable for women with regular cycles and normal ovarian reserve
Often takes longer to complete than other protocols

Short (Antagonist) Protocol

Stimulation medications begin immediately without prior extended suppression
GnRH antagonists are added mid-stimulation to prevent premature ovulation
Often recommended for women with lower ovarian reserve or those over 35
Generally involves fewer injection days and a shorter treatment timeline
May reduce the risk of ovarian hyperstimulation syndrome (OHSS)

Mild Stimulation Protocol

Uses lower doses of stimulation medications
Aims to produce fewer but higher quality eggs
Reduces medication side effects and cost
Minimises risk of ovarian hyperstimulation syndrome
May be particularly suitable for certain patient groups including older women or poor responders

Navigating IVF: A Practical Timeline

This quick-glance guide outlines what typically happens at each stage of treatment, including stimulation, egg collection, and embryo development. Ideal for keeping track of where you are in the process, and what’s likely to come next—whether you’re going through the NHS or private care.

NHS vs Private Treatment

NHS Treatment

The NHS offers IVF treatment subject to specific eligibility criteria:

Funding variations: Despite NICE recommendations for up to three full IVF cycles for women under 40, local Integrated Care Boards (ICBs) set their own criteria, creating significant regional variation
Eligibility typically includes:
- Age limits (usually women under 43, though often stricter)
- BMI restrictions (typically 19-30)
- Non-smoking status for both partners
- No or limited previous children
Waiting times: NHS waiting lists vary considerably by region, with some areas having waits of several months from referral to treatment
Treatment options: Typically standardised protocols with potentially limited access to certain add-on treatments

NHS treatment offers the significant advantage of reduced financial burden but may involve less flexibility in scheduling, potentially standardised rather than personalised protocols, and sometimes limited access to certain additional treatments or techniques.

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Private Treatment

For those ineligible for NHS funding or seeking different treatment options, private care offers alternative

Cost considerations:

Private IVF typically costs £4,000-£8,000 per cycle (minimum)
Additional costs for techniques like ICSI (£1,000-£1,500), embryo freezing (£500-£1,000), and medication (£1,000-£2,000)
Some clinics offer multi-cycle packages or money-back guarantees

Managing Expectations

The emotional aspects of IVF are as significant as the medical procedures. Understanding both realistic success rates and emotional support strategies can help create resilience throughout treatment.

Understanding Success Rates

Success rates vary considerably based on several factors

Other factors affecting success:

Ovarian reserve and egg quality
Sperm parameters
Underlying fertility conditions
Previous pregnancy history
Response to stimulation medications
Embryo quality and development stage at transfer

Cumulative Success: A More Realistic Measure

One failed cycle doesn’t mean IVF won’t work. Research shows that live birth rates increase substantially across repeated cycles:

After 1 IVF cycle: ~30–35% chance of live birth
After 3 cycles: ~65–72% for women under 35
After 6 cycles: up to 80–90% cumulative success in younger age groups

Yet many patients don’t complete multiple rounds. Emotional fatigue, cost, or disillusionment often lead people to stop after one or two cycles—even if medically, chances would have improved with time.

Understanding these statistics helps set realistic expectations, though they never predict individual outcomes. Discussing your personal prognosis with your fertility specialist provides more tailored information based on your specific situation.

Age is a significant factor:

Women under 35: Approx 33% per embryo transfer
Women 35-37: Approx 25% success per transfer
Women 38-40: Approx. 15% success per transfer
Women over 40: Approx 5% success per transfer

Understanding the Emotional Landscape

Common emotional responses include:

Heightened anxiety during waiting periods
Grief reactions (even in successful cycles for embryos not used)
Identity challenges when facing medical intervention
Feeling a loss of control over your body and reproductive future
Swings between hope and disappointment

Relationship impacts:

Partners often process fertility challenges differently
Treatment logistics and scheduling can create practical stress
Intimacy and sexuality may be affected
Financial pressures can add strain, particularly with private treatment

Cumulative effects

The emotional impact often increases with each treatment cycle, with many describing a "fertility treatment fatigue" that requires renewed emotional resources

The Fertility Family report highlighted that 78% of people reported that fertility challenges had a significant impact on their mental health, with 63% experiencing symptoms of anxiety and 54% reporting depressive symptoms. These responses are normal given the profound nature of the fertility journey.

Conclusion

The IVF process combines precise medical science with the deeply personal journey of creating family. While this guide outlines common elements and protocols, your experience will be uniquely yours—shaped by your medical circumstances, emotional responses, support system, and personal values.

References

British Fertility Society (2024). Guidelines on patient-centred fertility care. London: BFS Publications.
European Society of Human Reproduction and Embryology (2023). Good practice recommendations for information provision in fertility care. Human Reproduction Open, 2023(1).
Fertility Family (2024). The Infertility Awareness Report 2024. https://www.fertilityfamily.co.uk/blog/the-infertility-awareness-report-2024/
Human Fertilisation and Embryology Authority (HFEA) (2024). Fertility Treatment Trends & Success Rates Report. London: HFEA Publications. https://www.hfea.gov.uk/about-us/publications/research-and-data/fertility-treatment-2021-trends-and-figures/
National Institute for Health and Care Excellence (NICE) (2023). Fertility problems: assessment and treatment (CG156). London: NICE. https://www.nice.org.uk/guidance/cg156
NHS (2023). IVF Overview & Process Guide. NHS UK. https://www.nhs.uk/conditions/ivf/
Royal College of Obstetricians and Gynaecologists (2024). The emotional impact of fertility treatment: Patient guidance. London: RCOG Press.
Fertility Network UK (2023). Regional variations in NHS fertility provision: Annual audit. London: FNUK Publications. https://fertilitynetworkuk.org/
Bosch, E., et al. (2023). Fresh versus frozen embryo transfer: A systematic review and meta-analysis of cumulative live birth rates. Human Reproduction Update, 29(1), 102-117.
Gameiro, S., et al. (2022). Psychological interventions for infertile couples: A systematic review and meta-analysis. Human Reproduction Update, 28(5), 641-662.
Macklon, N. S., & Ahuja, K. K. (2023). The UK's approach to fertility treatment: Achievements and challenges. The Lancet, 401(10386), 1326-1337.
Care Fertility (2024). Managing Emotional Challenges During IVF. UK: Care Fertility Group.
Human Fertilisation and Embryology Authority (2024). Emotional Support During Fertility Treatment. https://www.hfea.gov.uk/treatments/explore-all-treatments/support-during-fertility-treatment/