IVF Step by Step: What Happens From First Visit to Pregnancy Test

IVF can feel like a blur of appointments, injections and decisions. Knowing the sequence in advance makes it easier to plan work, ask the right questions and spot when something is not normal. This guide walks through a typical IVF cycle in order, using patient guidance from ACOG and ASRM and national outcome data from SART. Every clinic’s protocol differs, so treat this as the outline, and your clinic’s calendar as the plan.

Step 1: Testing and planning

Before a cycle starts, both partners are evaluated. ACOG lists a semen analysis and hormone tests for men, and for women blood tests including ovarian reserve, thyroid function and prolactin, plus imaging such as ultrasound and tests of the uterus and fallopian tubes.⁷ The results shape the medicine protocol and whether ICSI or genetic testing makes sense. This is also the time to understand cost and coverage; our IVF cost guide covers what a cycle costs and what insurance may pay.

Step 2: Ovarian stimulation

In a natural cycle the body matures one egg. In IVF, the goal is to safely grow several. ACOG explains that ovulation is usually stimulated with gonadotropins so that multiple eggs develop.¹ ASRM describes about 10 to 12 days of self-given daily injections, with blood tests and ultrasounds to track how the ovaries respond.² Doses may be adjusted along the way.

When the follicles reach the right size, you take a "trigger" injection to finish maturing the eggs; retrieval is timed precisely after it. ASRM notes that the follicle count at the start is only an estimate; how many follicles actually grow is a better guide to how many eggs will be retrieved.³

Step 3: Egg retrieval

Egg retrieval is a brief outpatient procedure under light anesthesia, typically 15 to 30 minutes.² A needle is used to remove the mature eggs from the ovaries, and an embryologist inspects them.¹² It is an outpatient procedure, so you go home afterward.

Step 4: Fertilization

On the day of retrieval, eggs are fertilized in one of two ways: sperm are added to the eggs in a dish (conventional insemination), or a single sperm is injected into each egg (ICSI). The eggs are checked the next day to see which fertilized.¹ FertilityIQ reports ICSI is used in about 70% of US IVF cases, adding around $3,000, and that its clearest benefit is for severe male factor infertility or a previous failure to fertilize.⁵

Step 5: Embryo culture and optional genetic testing

Fertilized eggs grow in the lab for several days. A day 3 embryo typically has 6 to 12 cells; a day 5 or 6 embryo, called a blastocyst, has hundreds of cells and an inner cell mass that becomes the fetus. ASRM says blastocyst transfers have higher implantation per embryo than day 3 transfers, especially with good-quality embryos.³

Some patients choose preimplantation genetic testing (PGT), which takes a few cells from each blastocyst; the embryos are then frozen while results come back. FertilityIQ puts PGT-A at around $5,000 and notes it helps select embryos and reduce miscarriage in older patients but does not raise the chance that a given cycle works.⁵ ASRM says evidence on assisted hatching, another add-on, is mixed.³

Most embryos that are not transferred are frozen. SART reports a cryopreservation rate of 90% for retrieval cycles in people under 35 in 2023, falling to 52.4% in those over 42.⁴

Step 6: Embryo transfer

At transfer, the embryo is placed in the uterus through the vagina.¹ It can be "fresh", a few days after fertilization, or "frozen", in a later cycle. Frozen transfers are done either in a programmed cycle, where estrogen and progesterone medicines prepare the uterus lining, or in a natural or modified natural cycle timed to your own ovulation.⁸

How many embryos? ASRM and SART guidance recommends transferring a single embryo when the eggs come from someone under 38 or the embryo has been genetically tested.³ The decision is made jointly by you and your physician. In 2023, the average number of embryos transferred was 1.1 for people under 38, according to SART.⁴

Step 7: The wait and the pregnancy test

Then comes the wait of about two weeks between transfer and the pregnancy test, which researchers describe as a very stressful time during IVF.⁶ Your clinic will tell you which medicines to continue and when to test. Our guide to coping with the two-week wait has practical tools, and the Support section covers therapists and free support groups.

How often does IVF work?

In SART’s final 2023 report for people using their own eggs, the share of egg retrievals that led to a live birth, counting all transfers within a year, was 53.2% under 35, 39.9% at 35 to 37, 26.2% at 38 to 40, 13.2% at 41 to 42 and 4.1% over 42.⁴ People who had a live birth needed an average of 1.32 transfers if under 35.⁴ Ask your clinic for its own numbers by age and diagnosis, and see IUI vs IVF if you are deciding between treatments.

Risks of IVF

ACOG names two main risks. Multiple pregnancy is more likely with IVF, which is why limiting the number of embryos transferred matters.¹ Ovarian hyperstimulation syndrome can follow stimulation, especially with gonadotropins; most cases are mild, but severe cases may need a hospital stay.¹ Talk to your clinic about your personal risk of hyperstimulation, especially if you have PCOS, which FertilityIQ flags as a higher-risk group for dosing.⁵

If the first cycle does not work

Many people need more than one cycle or transfer. ACOG notes IVF may take more than one cycle to succeed.¹ Frozen embryos from the same retrieval can be used without another round of stimulation. After a failed transfer, ask your clinic for a review of what happened and what could change. For the bigger picture of options and cost, see the Treat hub and our guide to egg freezing cost if you are thinking about preserving eggs for later.