IVF 101:

A guide to in vitro fertilization

Learn everything you need to know about IVF with our comprehensive guide. From the process to costs and emotional impact, we've got you covered.

What is IVF:

A complete guide

In vitro fertilization (IVF) refers to a series of different processes that can help a person become pregnant.

Chapter 1

IVF is the most effective type of assisted reproductive technology (ART) and incorporates the use of various medications and procedures that help a sperm cell fertilize an egg cell to produce an embryo and to help the embryo implant in the uterus.

The retrieval process

During IVF, medications are used to stimulate multiple eggs to grow to maturity inside the ovaries.


These eggs are then retrieved from the ovaries during a minor medical procedure and fertilized by sperm in a laboratory.


A thin needle is inserted through the vaginal wall and the collected eggs are fertilized with sperm from the partner or sperm donor.


The fertilized eggs, now embryos, are cultured in a controlled environment in the laboratory.


They are monitored for growth and development over the next few days.


The embryo is then transferred to the uterus.

This process can take about three weeks from start to finish if the full IVF cycle is done all at once. In some cases, people going through IVF may split the process up into different steps, which can make the process take longer.

People may go through IVF for a variety of different reasons, but it is often used to treat infertility in women over 40. IVF may also be an option for individuals with certain health conditions such as endometriosis, uterine fibroids, ovulation problems, fallopian tube issues, and more. If the fallopian tubes are blocked or damaged, getting pregnant without medical help may be difficult or impossible. IVF bypasses the need for fallopian tubes by allowing fertilization to occur outside the body.

IVF is also often used if there are problems with a partner’s sperm, or if an individual or couple is at risk for passing along a genetic disorder to a child. Individuals preparing to start cancer treatments or other types of medical treatments that can harm fertility may also choose to go through IVF for fertility preservation purposes.

Fertility preservation refers to the process of preserving reproductive potential, specifically eggs, sperm, or embryos for future use. When IVF is used for fertility preservation, mature eggs can be retrieved from the ovaries and can be frozen (either as unfertilized eggs or as fertilized embryos) for later implantation.

Did you know?

The history of IVF dates back to the 1960s and 1970s, when scientists started exploring the possibility of fertilizing human eggs outside the body, often in a test tube or culture dish in a laboratory setting.

During the 1970s, significant progress was made in refining the techniques for human IVF. The first "test-tube baby” was born in England in 1978, and three years later, the first IVF baby was born in the U.S.

The IVF process has evolved considerably since its inception and today accounts for about 1–3% of all annual births in the U.S. and Europe.

Who are candidates for IVF?

There are many different types of people who may consider IVF.

Chapter 2
Some of the most common reasons people pursue IVF include:
Families experiencing infertility

Infertility is defined as being unable to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination for those younger than 35 years or within 6 months for those older than 35 years. Up to 15% of couples are diagnosed with infertility. A variety of factors can cause infertility in both males and females. While some causes may be treated with medical interventions or lifestyle modifications, some individuals or families experiencing infertility may need a form of ART such as intrauterine insemination (IUI) or IVF in order to get pregnant.

Those with hereditary disorders

Some people opt for IVF in order to reduce the risk of passing along hereditary disorders to their children. There is a laboratory procedure often performed in conjunction with IVF called pre-implantation genetic testing for monogenic/single gene disorders PGT-M, which can lower the risk of passing along inherited single gene conditions such as sickle cell anemia and cystic fibrosis.

Fertility preservation for cancer or other conditions

IVF may be an option for individuals preparing to receive cancer treatments or other medical treatments that can affect fertility. Many experts recommend freezing embryos or eggs, 
prior to cancer treatments because some surgeries and treatments can cause permanent fertility changes.

LGBTQ+ family forming

For same-sex couples, IVF may be an effective way to form a family. A type of IVF known as reciprocal IVF can be an option for lesbian or trans couples who want to build their family. Reciprocal IVF involves one partner contributing eggs to form an embryo and one partner receiving the embryo and carrying the pregnancy. Same-sex cisgender male couples may choose to go through gestational surrogacy (GS) and use a gestational carrier (GC). 
This means a person is hired as a GC to carry and give birth to a baby for another person 
or couple.

Single parents by choice

A single parent by choice is someone who chooses to have a child knowing they will be that child’s sole provider, at least at the beginning. People may choose this path for different reasons, and donor-assisted reproduction is one way to make single parenthood possible. In this form of ART, donated eggs, embryos, or sperm are used to give single parents the option to have genetically related children independently.

How to prepare
for IVF

There are many physical, emotional, and logistical considerations that go into preparing for IVF.

Chapter 3

In addition to a comprehensive medical evaluation that includes an examination of both partners' reproductive health and hormone levels, and a genetic screening, the preparation process may also include lifestyle modifications such as the incorporation of a balanced diet and regular exercise, and the avoidance of tobacco, excessive alcohol, and other harmful substances.

What to consider
  • Because of the potential emotional toll IVF can take, many experts also recommend that individuals or couples preparing for the process consider counseling and support groups to help cope with stress and anxiety.
  • Financial planning is also a necessary step for many people preparing for IVF as the process can be costly in the absence of a comprehensive fertility benefits package.
  • Finally, advanced scheduling is an important part of the IVF journey as the process requires regular appointments, medication administration, and a medical procedure.
Choosing a fertility clinic

Selecting an IVF clinic is a crucial decision, as it can significantly impact the chances of success and the overall experience. Here are some important factors to consider when choosing an IVF clinic:

7 key factors to consider

Success rates: Patients should look for clinics with a track record of successful pregnancies


Accreditations and certifications: Patients should ensure the clinic is accredited by relevant medical associations and regulatory bodies in their country.


Experience and expertise: Patients should research the clinic's medical team including their specialization in reproductive medicine, and any advanced training they might have.


Technology and facilities: Modern, well-equipped facilities contribute to better outcomes.


Services offered: In addition to IVF, clinics may offer a range of services like egg freezing, embryo freezing, preimplantation genetic testing (PGT), and more.


Personalized care: It’s important to find a clinic that provides personalized treatment tailored to each patient’s specific needs.


Patient reviews and testimonials: Patients should read reviews and testimonials from others who have undergone treatment at the clinic and can offer insight into their experience.

Initial consultation and evaluation

The first step in seeking fertility guidance and care is to schedule an initial consultation and health evaluation with a fertility specialist or reproductive endocrinologist.

While every person’s fertility journey is unique, the initial consultation is typically the time for the medical provider to gather comprehensive information to understand specific fertility issues or potential causes of infertility.
The appointment usually starts with a detailed medical history review, during which the medical provider will ask questions about the patient’s reproductive health, menstrual cycles, sexual history, prior pregnancies, and any relevant medical conditions.
This conversation may also include a discussion about lifestyle factors including diet, exercise, and stress levels which may influence fertility.
The medical provider may also perform a physical examination (usually a pelvic exam or a semen analysis) and order additional diagnostic tests.
Transvaginal/pelvic ultrasound

A transvaginal/pelvic ultrasound is an imaging procedure that visualizes the cervix, uterus, fallopian tubes, and ovaries. During a transvaginal/pelvic ultrasound, a provider will gently insert a wand-like instrument called a transducer into the vagina to record images of the pelvic organs. This can help identify any abnormal structures or growths and during IVF, this same procedure is used to monitor the development of the follicles inside the ovaries.

Antral follicle count (AFC)

AFC is a key tool used to assess the ovarian reserve (number of remaining eggs) and potential fertility. AFC is typically measured during transvaginal ultrasound during the early phase of the menstrual cycle.

Anti-müllerian hormone (AMH) test

AMH is produced by the ovaries and is considered a potentially important indicator of reproductive health. An AMH test measures the amount of AMH in a blood sample and correlates with the number of eggs in the ovaries; higher levels of AMH typically means the ovaries have a larger supply of eggs. With age, the number of eggs decreases, causing AMH to also decrease; at menopause, AMH levels drop to zero when there are no eggs remaining in the ovaries.

Follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and other fertility hormones

In addition to an AMH test, other common blood tests can help provide insight into a woman’s ovarian reserve (i.e., the number of eggs available for potential fertilization). The most common hormones to test before IVF include follicle FSH, which is considered a predictor of reproductive aging, LH, which can indicate egg quality, and estradiol (often referred to as E2), which, in combination with the other tests, can offer insight into other factors of fertility.

Once the provider receives all the test results and data, they will schedule a time to discuss findings, any potential causes of infertility, and available treatment options, which may include IVF.

The cost of IVF

The cost of IVF can vary significantly depending on several factors, including geographic location, the prescribed treatment plan, the specific clinic, and any additional procedures or tests required.

Chapter 4

The average cost of one cycle of IVF in the U.S. can range from $12,000 to $15,000, but these prices do not include the cost of necessary medications or other services such as genetic testing and embryo freezing.

The cost breakdown of IVF

While IVF costs vary widely, the total expense of a single cycle can typically be broken down to reflect the following components:

10 key components

Initial consultation and diagnostic tests: This usually includes the first appointment with the fertility specialist or reproductive endocrinologist, medical history review, physical exams, blood tests, ultrasounds, and semen analysis.


Medications: The IVF process requires a variety of medications to stimulate the ovaries, control the menstrual cycle, and prepare the body for embryo transfer. Costs of these medications vary widely depending on a number of factors but medication expenses can often comprise a significant percentage of the total cost of IVF.


Egg retrieval: Retrieving the mature eggs from the ovaries requires a surgical procedure, often including an additional cost for anesthesia.


Sperm collection: If necessary, a medical provider may order sperm tests in order to analyze the sperm and prepare for fertilization.


Insemination or intracytoplasmic sperm injection (ICSI): In some cases, fertility specialists may recommend using a specific laboratory method to fertilize the eggs with sperm.


Embryo culture: Once the eggs are fertilized with sperm, the resulting embryos require several days of monitoring and culturing in a laboratory.


Embryo transfer: If the embryos are being transferred immediately following the retrieval and culturing, there will be a cost to cover the procedure to implant the embryo into the uterus.


Optional cryopreservation: If the embryos are not being transferred immediately, there will be a cost for freezing and storing the embryos for future use.


Optional genetic testing: In some cases, a provider may recommend preimplantation genetic testing (PGT) to screen embryos for genetic abnormalities.


Additional procedures: If necessary, an IVF cycle may require additional procedures like assisted hatching or embryo biopsy at extra costs.

Insurance coverage for IVF

Insurance coverage of IVF varies significantly depending on the country, state, and specific insurance plan. But in many other countries, including the U.S., most insurance plans do not offer comprehensive coverage for IVF. Some insurance plans may offer partial coverage for specific parts of the IVF process, like diagnostic testing or medications. These plans often do not cover the entire IVF process, however, and many other plans do not offer any IVF coverage at all, leaving individuals or couples to pay for the full cost of treatment out-of-pocket. The high cost of treatment and limited insurance coverage for IVF create significant barriers to access for many people, which can make it challenging to pursue fertility treatments without incurring substantial financial burdens or debt.

Financing options for IVF

For individuals or couples seeking financial assistance, there are several financing options available for IVF.

Fertility clinic financing

Some fertility clinics offer financing programs or partnerships with financial institutions, providing loans or payment plans tailored to cover IVF expenses.

Medical credit cards

Some credit card companies offer medical credit cards that can be used to pay for medical procedures, including fertility treatments like IVF. These cards often come with promotional financing options, such as interest-free periods.

Grants and scholarships

There are several non-profit organizations and foundations dedicated to providing fertility grants and scholarships to individuals and couples with financial need who are pursuing fertility treatments.

Insurance coverage or flexible spending accounts (FSAs)

Some insurance plans offer partial coverage or FSAs (pre-tax dollars) that can be used for fertility treatments like IVF.

Comprehensive fertility benefits

Employers that offer comprehensive fertility benefits  such as Carrot can help employees save money with reimbursement options and provide a simplified payment method for fertility and family-forming care in the form of the Carrot Card.

Fertility benefits for IVF

An increasing number of employers are offering fertility benefits to workers seeking treatments such as IVF. These benefits are designed to support employees facing fertility challenges, interested in fertility preservation, or exploring other family-forming options.

Fertility benefits for IVF may provide financial coverage for treatments and procedures as well as other support including care navigation and educational resources. While comprehensive fertility benefits can significantly reduce the financial burden of fertility treatments, not all employers offer this coverage.

Before beginning an IVF journey, it’s important to check an employer’s fertility benefit offerings by reviewing an employee handbook, specific health insurance policy documentation, or speaking with a representative in human resources (HR). If an individual’s company does not offer fertility benefits, it may be helpful to attend benefits enrollment meetings to ask questions about fertility coverage in the future.

If you don't have fertility benefits at your company, Carrot can reach out on your behalf.

The IVF process step-by-step

Chapter 5

The IVF journey is individualized for a variety of reasons, but in general, the process includes several steps to stimulate egg production and maturation, and fertilize eggs and sperm outside the body in a laboratory setting to create embryos. If the IVF process results in one or more healthy embryos, those embryos can then be frozen for future use or transferred into the uterus for potential implantation.

Step 1:
Ovarian stimulation

The medications used in IVF are part of a process called “controlled ovarian hyperstimulation.” Administering IVF medications every day for a period of time causes the ovaries to produce multiple follicles (fluid-filled sacs in the ovaries) that each contain an egg. In most cases, the process starts in the early stage of the menstrual cycle. After doing initial lab tests and a baseline ultrasound, the patient begins self-administering IVF medications once or twice a day for an average of 7–14 days. Medications are usually administered by injection but can be delivered in other ways too, depending on the prescribed protocol. When ovulation occurs on its own, there is usually only one egg that matures during the cycle. The medications used in IVF work in combination to help increase the number of eggs that are retrieved at the end of the IVF cycle.

There are several types of medications used during the IVF process. Gonadotropins are two hormones produced in the pituitary gland (LH and FSH) and one that is usually produced by the cells of the placenta during pregnancy (human chorionic gonadotropin or hCG). Gonadotropin medications are used to stimulate the ovaries to produce multiple egg-containing follicles during an IVF cycle. In addition to gonadotropins, the IVF cycle also involves synthetic forms of gonadotropin-releasing hormone (GnRH). This hormone is naturally produced in the brain’s pituitary gland and stimulates the ovaries. There are GnRH agonists which work by first stimulating the pituitary gland to release any stored gonadotropins (LH and FSH) and then, over the course of about 7–10 days, suppress the production of any new gonadotropins. There are also GnRH antagonists that help prevent premature ovulation, but they do not produce the initial surge of LH and FSH that agonists do. The IVF cycle may also involve progesterone in the luteal phase. Depending on your protocol, pre-cycle medication such as estrogen or testosterone may be prescribed.

The medications used in IVF may come in different forms but are usually self-administered injections that are inserted under the skin of the abdomen or thigh. Self-administering injectable medications can seem daunting for many people, but there are simple techniques and strategies to make the process as easy and painless as possible. Preparing the medications and syringes ahead of time and creating a comfortable environment in which to administer the medications can help ease any anxiety about the process.

During the IVF cycle, the patient will be required to come into the fertility clinic for regular monitoring appointments. Monitoring appointments are important to closely observe the development of follicles and the hormonal response of the ovaries. During these appointments, the patient will usually receive blood tests and a transvaginal ultrasound. The results of these tests can help the fertility specialist monitor your response to the medications and can also help them make decisions about the timing of the egg retrieval procedure. If necessary, the results of this test can help the provider know if they should adjust the medication dosage or any other part of the protocol. The frequency of monitoring appointments during IVF can vary but in most cases, patients will be asked to come in every 1-3 days, depending on where they are in the IVF cycle.

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Step 2:
Egg retrieval

The egg retrieval involves a minor surgical procedure performed under sedation or light anesthesia (lasting about 20-30 minutes) to remove the mature eggs from the ovaries for fertilization in the laboratory. The procedure is performed 36 hours after the final dose of IVF medication known as the “trigger shot”. Egg retrieval is performed by transvaginal ultrasound-guided needle aspiration. The needle is inserted into the follicle and the suction device aspirates the fluid and the egg from the follicle. The process is repeated for each mature follicle in both ovaries until all eggs are retrieved. The number of eggs retrieved can vary from a few to several, depending on a number of factors, including the patient’s age, ovarian reserve, response to fertility medications, and more. Some research indicates the average number of eggs retrieved in IVF cycles for individuals 35-years-old or younger is about 14, while the average number for 40-year-old patients is 8, but these numbers vary widely and are not necessarily indicative of live birth rates. After the procedure is completed, the patient is given time to rest and can go home shortly after.

Patients going into an egg retrieval are given intravenous (IV) sedation to prevent discomfort during the procedure and is typically administered by an anesthesiologist. In preparation for the retrieval, patients are asked not to eat or drink anything after midnight the night before the procedure. The sedation used during egg retrieval will put the patient to sleep for the duration of the procedure, and the anesthesiologist will monitor vital signs such as blood pressure and heart rate. Once the egg retrieval is complete, the anesthesiologist will gradually lower the amount of medication administered through the IV, and the patient will wake up shortly after. While they may initially feel groggy, the effects of the sedation should wear off shortly, although patients are advised not to drive or perform demanding tasks the day of the procedure. Most patients can resume normal activity the next day but should avoid heavy lifting and high impact exercise for two weeks.

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Step 3:
Sperm collection and preparation

Before starting IVF, male partners are often asked to do sperm testing, otherwise known as a semen analysis. This test analyzes the volume and quality of a man’s sperm and is considered an important first step in identifying male factor infertility. The test involves collecting a sperm sample and evaluating it in a laboratory under a microscope. A semen analysis generally evaluates sperm count, activity (or “motility”), and shape (or “morphology”). To provide the necessary sample for analysis, a man is asked to first abstain from sexual activity for 2-5 days before masturbating to produce a semen sample into a sterile container. The lab then compares the sperm in the sample to expected values and examines factors like the number of sperm, the pH of the sample, the activity level, and more.

A sperm collection may also be required on the day of the egg retrieval during the IVF process. This sample collection is performed in the same way as it is for semen analysis, typically in a private room in the fertility clinic. Typically, men are instructed to avoid sexual activity or any ejaculation for at least two days but no more than five days before providing the semen sample. The clinic provides a sterile, nontoxic plastic jar to collect the semen, and will provide instructions on how to transport the sample to the medical team. 

To prepare the sperm in the semen sample to fertilize the retrieved eggs, the medical team will filter the semen to select the sperm with the best morphology and motility. Once those sperm are filtered from the sample, they are washed and placed in a solution. In natural insemination, these sperm are then added to the petri dish containing one or more eggs. The embryologist will monitor the culture medium the next day and transfer any fertilized embryos to a different medium to support growth.

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Step 4:

There are two common types of fertilization in the IVF process: natural insemination and intracytoplasmic sperm injection (ICSI). In natural insemination, the healthy sperm and mature eggs are placed in a culture medium, as described above. The mixture is incubated overnight and monitored for development. In contrast, ICSI is a fertilization method that involves injecting one single, healthy sperm directly into each mature egg. Fertility experts may recommend ICSI for a variety of reasons, but the technique is often used when either the quality or quantity of sperm is low, if several prior IVF cycles have failed at the fertilization stage, or to fertilize previously frozen oocytes.

In some situations, fertility providers may also recommend assisted hatching, a procedure that takes place after fertilization. An embryo typically “hatches” from its membrane (known as the zona pellucida) about five or six days after fertilization, which allows it to implant into the uterine lining. Older women or those who have had previous unsuccessful IVF cycles may be advised to go through assisted hatching, which involves making holes in the embryo’s zona pellucida before transfer, which can help the embryo implant correctly. This method is also often recommended for eggs or embryos that have previously been frozen, since this can harden the outer membrane. 

Preimplantation genetic testing (PGT) is another procedure that fertility experts may recommend in certain situations. This type of testing screens for specific genetic diseases or an abnormal number of chromosomes known as "aneuploidy,” and is often performed after five to six days of development. To perform PGT, a few cells from the outer trophectoderm, which forms the placenta — not the embryo which is the inner cell mass or ICUM — are removed in the lab and tested.

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Step 5:
Embryo development and selection

Once eggs are retrieved and fertilized, the embryologist will monitor the development of the embryos and provide an embryo grading report. Embryo grading refers to the process of assessing and classifying the quality of the embryos at various stages of development. This process helps fertility specialists determine which embryos are the most viable and healthy so they can eventually transfer the ones with the greatest likelihood of successful implantation and pregnancy. The grading process evaluates several factors including the number of cells in the embryo, any fragmentation of the cells, the appearance of the nuclei, and the symmetry of the embryo.

Based on these criteria, the embryos are graded on a scale. The grading system may vary between fertility clinics, but the most common systems involve numerical values (e.g. 1 to 5, with 1 being the worst and 5 being the best) and alphabetical (e.g. A, B, C, etc. with A being the best). Embryos are typically graded on day 3 and again on days 5, 6, and possibly 7 when they have developed into blastocysts (a cluster of dividing cells that usually forms on day 5), depending on their progress.

For individuals or couples who choose to do genetic testing, this is also the time when the embryos are biopsied and the samples are sent for PGT. There are several types of PGT sometimes specified as preimplantation genetic testing for aneuploidy (PGT-A) and preimplantation genetic testing for monogenic disorders (PGT-M). This type of testing can be used to screen for specific genetic conditions or chromosomal abnormalities in the embryos before they are transferred and implanted into the uterus. 

While PGT-M is used to detect specific genetic disorders or single gene mutations in embryos, PGT-A is used to analyze the chromosomal makeup of embryos, which can help identify chromosomal abnormalities, like aneuploidies (an abnormal number of chromosomes). PGT-M is typically recommended for individuals who are known carriers of genetic disorders or who have a family history of genetic conditions. The testing involves removing a small number of cells from the embryo when it reaches the blastocyst stage and testing for the presence of a genetic mutation. When PGT-A is used, fertility specialists are looking for aneuploidies, which can lead to implantation failure, miscarriages, or certain genetic conditions like Down syndrome. This type of PGT is often recommended for older women or those who have experienced recurrent pregnancy loss.

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Step 6:
Embryo transfer

Embryos can either be transferred a few days after fertilization occurs (fresh transfer) or frozen and stored for later use (frozen embryo transfer or FET). A fresh embryo transfer typically takes place between three and five days after the egg retrieval while an FET can be performed years after the creation of the embryo. In both fresh and frozen embryo transfers, the lining of the uterus needs to be prepared to help increase the chances of the embryo planting successfully. Fertility specialists monitor the uterine lining (also known as the endometrium) using a transvaginal ultrasound to ensure it’s reached an appropriate thickness and quality for implantation. The odds of pregnancy are about the same with both fresh or frozen embryos.

Patients who have an FET often take medications like birth control pills or injectable leuprolide (Lupron) prior to the cycle start in order to reduce the activity of the ovaries. After the ovaries have been suppressed, the fertility provider will likely prescribe estrogen in the form of a pill, injection, or patch to help prepare the uterine lining to receive the embryo. Estradiol levels may be monitored through blood tests and the lining of the uterus may be measured via ultrasound for several weeks until the uterine lining is ready for implantation. At this point, the provider will likely prescribe progesterone as a pill, gel, or injection. While every case is different, many patients will continue taking estrogen and progesterone even if they become pregnant and use these medications until they are at least 10 weeks into pregnancy.

The embryo transfer procedure is typically simple and rarely requires sedation or anesthesia. During the procedure, a long, flexible tube called a catheter is passed through the cervix into the uterus. Inside the catheter is the embryo being transferred along with a small amount of fluid. The contents of the catheter is then released into the uterus and an abdominal ultrasound is performed simultaneously to make sure the embryo is properly placed. While there may be some instances that require multiple embryos to be transferred at once, single embryo transfer (SET) is the single most predictive indicator of a singleton IVF pregnancy and subsequent successful live birth. It is an important clinical protocol used to avoid multiple gestation pregnancies, which are associated with higher medical costs and poorer health outcomes for mothers and infants. In 2023, Carrot published the results of an internal study demonstrating the highest reported SET rate of fertility benefits vendors as well as an IVF pregnancy rate greatly exceeding national averages.

While frozen embryos may be stored and implanted years after they are created, fresh embryos are transferred either 3 or 5 days after they are created. Day 3 embryos are known “cleavage embryos” which refers to the cells in the embryo “cleaving” or dividing. Day 5-6 embryos are known as “blastocysts” and are more developed. A fertility provider will determine whether to transfer a cleavage embryo or blastocyst depending on the patient and their specific circumstances. 

Same-sex female couples may choose to do a specific form of IVF known as reciprocal IVF. In reciprocal IVF, one partner contributes eggs to form an embryo and one partner receives the embryo and carries the pregnancy. This type of IVF is sometimes also referred to as partner-assisted reproduction, co-maternity, co-motherhood, co-parenthood, co-IVF, or reception of oocytes from partner (ROPA). Couples considering the option will want to know the various steps involved in the process, including deciding which partner provides the genetic material and which carries the pregnancy, choosing donor sperm, synchronizing menstrual cycle, and more. There are also legal considerations of reciprocal IVF that are unique to the process and important to consider.

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Step 7:
Pregnancy test and follow up

Patients can normally resume normal activities following a frozen embryo transfer. There may be some mild side effects from the procedure, including a small amount of clear or bloody fluid from the swabbing of the uterus, breast tenderness and constipation due to increased progesterone, as well as mild bloating and cramping. Severe pain or side effects that last more than a day or so may indicate an infection or other complication, so patients experiencing this should seek immediate medical care.

It will take about 12-14 days for a pregnancy test to confirm whether the embryo transfer resulted in a pregnancy. The fertility provider will perform a blood test at this time and if the patient is pregnant, they are monitored by the fertility clinic for a few weeks in early pregnancy and then referred to an OBGYN for prenatal care (usually week 10). If the patient is not pregnant two weeks after the embryo transfer, they will discontinue medications will get a period within a week. If another IVF cycle or implantation is being considered, the patient will work with the fertility provider to discuss next steps.

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Success rates of IVF

According to the Society for Assisted Reproductive Technology, age is the most important factor when determining success rates of all ART methods.

Chapter 6

Success rates decline as women age and this decline becomes more drastic after a woman reaches her mid-30s. This decline in success is influenced by the decreased chance of getting pregnant through ART in combination with the high rate of miscarriage with age, particularly over age 40.

Did you know?

The number of live births per intended egg retrieval (embryo transfers) in 2020 demonstrates the success rates of IVF at various ages.

Women under the age of 35 have a 54.4% change of a live birth (all embryo transfers)
Women ages 35-37 have a 39.8% change of a live birth (all embryo transfers)
Women ages 38-40 have a 26.1% change of a live birth (all embryo transfers)
Women ages 40-42 have a 13.3% change of a live birth (all embryo transfers)
Women over 42 have a 4% change of a live birth (all embryo transfers)

The Centers for Disease Control and Prevention (CDC) reports that there were 326,468 ART cycles performed at 449 reporting US clinics during 2020, resulting in 75,023 live births ( one or more living infants delivered) and 79,942 live born infants. Of that total number of cycles performed in 2020, 123,304 were egg or embryo banking cycles in which all resulting eggs or embryos were frozen for future use. The CDC estimates that about 2% of all infants born in the US every year are conceived using ART.

2020 CDC report
ART cycles
U.S. clinics
live births
live born infants
egg embryo banking cycles
infants are born using ART

There are many factors aside from age that can also affect success rates of IVF. Low or high weight or body mass index (BMI), smoking, alcohol use, diet, vitamins, supplements, and stress can all take a toll on the likelihood of success with IVF. There are many potential lifestyle factors that may help improve the success rate of IVF, so patients are advised to work closely with their fertility providers to find well balanced food and exercise plans that work for them, as well as reducing or quitting alcohol, tobacco, and other substances.

Fertility experts often also recommend specific supplements and vitamins prior to and during IVF to help optimize fertility. Because sperm and egg cells take about 90 days to develop, it may be important to start taking vitamins and supplements in the months prior to IVF. Prenatal vitamins can help support egg quality and ovarian reserve, as well as the development of the uterine lining, and other aspects of fertility and overall health. It is important for prenatal vitamins to contain folate, a form of vitamin B-9.

Supplements and vitamins to consider during IVF
Folate has been shown to significantly reduce the chance of fetal neural tube defects, and may also support other parts of fetal development and maternal health. Folate has also been shown to potentially help improve egg development and embryo quality.
Fertility providers often recommend taking CoQ10, an antioxidant naturally produced in the body, because natural production of this biomolecule begins to decline starting at age 30.
Vitamin D
Because vitamin D deficiency has been associated with decreased fertility, many experts also recommend supplementation with vitamin D.
Omega-3 fish oil
Omega-3 fish oils are also important for fertility, and research has shown that increased omega-3 fatty acid levels may delay ovarian aging and improve egg quality as well as overall fertility.

The risks and side effects of IVF

Like all medical interventions and procedures, there can be some risks and side effects associated with the IVF process

Chapter 7

The medications involved in IVF carry risks of side effects including:

Side effects of IVF

Hot flashes

Mood swings


Breast tenderness


Abdominal discomfort


Ovarian hyperstimulation syndrome (OHSS)


What is OHSS?

OHSS is a medical condition that can occur as a result of the medications used during fertility treatments, particularly IVF. It involves an exaggerated response of the ovaries to the hormonal stimulation used to induce the development of multiple follicles (fluid filled sacs containing eggs). When OHSS develops, the ovaries swell and fluid accumulates in the abdominal and sometimes chest cavities. Symptoms of OHSS include: abdominal discomfort or pain, weight gain, nausea, vomiting, shortness of breath, decreased urination, increased heart rate and blood pressure. Severe OHSS is rare and can be dangerous. Prevention and management are important considerations in fertility treatment and your healthcare team will closely monitor your response to medications to ensure your safety and well-being throughout the process.

Other risks of IVF include the chance of multiple births, which can occur if more than one embryo is transferred at a time. Multiple births can be risky because they are more likely to be associated with miscarriage, gestational diabetes, pregnancy-related high blood pressure and pre-eclampsia, anemia, and the need for a cesarean section. IVF may also increase the risk for ectopic pregnancy, which means the embryo implants in a fallopian tube rather than in the uterus.

The IVF process can also be taxing and challenging emotionally. Going through IVF can affect several aspects of life, including social connections, romantic relationships, work, finances, and more. The first treatment cycle specifically has been shown to cause higher levels of anxiety and stress.

Alternatives to IVF

Because of the significant emotional, physical, and financial stress associated with IVF, many people may choose to explore alternative routes to pregnancy.

Chapter 8

Historically, much of the conversation around family-forming benefits has been on IVF, but in reality, less than 3% of infertility cases require invasive treatments like IVF in order to achieve pregnancy or become parents.

In many cases, an alternative may be more appropriate, less expensive, and more compatible with an individual or couple’s lifestyle. There are various fertility treatments and family-building alternatives available, and finding the right one depends on each person or couple’s unique circumstances, values, and preferences.

Fertility treatment alternatives to IVF
Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a type of artificial insemination that involves washing and concentrating the sperm before placing it directly in the uterus around the time of ovulation. Unlike IVF, fertilization during IUI takes place inside the body. While IUI is less expensive, it has lower success rates than IVF, which is generally recommended for couples who have failed to achieve pregnancy after three IUI cycles.

Ovulation stimulating medications

Oral medication used to induce ovulation are often prescribed to women who are experiencing difficulty with ovulation. These medications can help regulate the menstrual cycle and stimulate the release of mature eggs from the ovaries. Two main types of oral medications commonly used for ovulation induction are Clomid (clomiphene citrate) and Letrozole (Femara). Both medications increase the levels of FSH to stimulate the ovaries to produce eggs causing rising levels of estrogen. High levels of estrogen in turn will promote an LH surge, a key event that triggers ovulation.

Donor eggs or sperm

Individuals or couples may choose to utilize donor eggs or sperm for a variety of reasons, including poor egg quality, early menopause, problems with the ovaries, the risk of passing on known genetic diseases, and more. Same-sex couples, members of the LGBTQIA+ community, and individuals who do not have partners may also choose to use donor eggs or sperm to achieve pregnancy.

Surrogacy/gestational carriers

If a woman is unable to carry a pregnancy for any reason, she may choose to seek out a gestational carrier or surrogate who can carry and give birth to a baby. Gestational surrogacy is usually done through IVF and there are two kinds of surrogacy: gestational and traditional. In gestational surrogacy, the carrier of the pregnancy (the surrogate) does not provide an egg for fertilization and is therefore not genetically related to the fetus. In traditional surrogacy, the surrogate uses her own egg to conceive. This means that the surrogate is also the biological mother of the child. Typically, artificial insemination is used to fertilize the surrogate’s egg with the intended father’s sperm. Traditional surrogacy arrangements can raise legal, emotional, and ethical complexities. For these reasons, traditional surrogacy is less common than gestational surrogacy.


Some individuals or couples may choose adoption as a route to parenthood and others may pursue adoption if IVF is not an option or if they have tried and been unsuccessful with IVF. There are many different kinds of adoption and logistics to consider in the process, but for many, adoption may be the best option.

Coping with the emotional rollercoaster of IVF

Chapter 9

The IVF process can be incredibly challenging for individuals and couples on a psychological and emotional level. Research shows that the depression levels in patients with infertility are comparable to patients who have been diagnosed with cancer. It’s important to pay close attention to the areas of people’s infertility journeys that have the potential to trigger mental health issues. In addition to the unpredictability of IVF and its success, the process can contribute to social isolation, relationship strain, financial stress, and more.

Experts recommend preparing for the emotional challenges of IVF by doing as much research and information gathering as possible prior to embarking on the journey, and to cultivate a strong support network. Identifying stress triggers and coping strategies ahead of time may also help reduce discomfort through the process. It is also important to seek out professional psychological help if stress or emotions become overwhelming.


IVF is a complex process that has helped many individuals and couples achieve pregnancy. For many people dealing with fertility issues including advanced maternal age, ovulation problems, male factor infertility, or unexplained infertility, IVF may be a life-changing opportunity. It is also an important option for same-sex couples and single parents by choice who wish to have a genetically related child.

While there are many potential benefits to IVF, it’s also important to understand the potential financial consequences, as well as emotional and physical challenges. Success rates can vary based on several factors, including the woman's age, the quality of the embryos, and the underlying cause of infertility. It's essential for individuals and couples considering IVF to consult with a qualified fertility specialist or reproductive endocrinologist to understand their specific fertility challenges, explore all available options, and make informed decisions about their fertility journey.

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IVF cost: Understanding the expenses

Understand how each piece of the IVF process contributes to overall costs.

IVF frequently asked questions

How many rounds of IVF are recommended?


The number of recommended rounds of IVF can vary depending on several factors, including the individual's age, overall health, underlying fertility issues, response to treatment, and financial considerations. The decision on how many IVF cycles to pursue is typically made on a case-by-case basis in consultation with a fertility specialist. It often takes several rounds of IVF to achieve pregnancy and research has indicated that about two thirds (65.3%) of patients will be successful after six or more cycles of IVF.

What is the age limit for IVF?


In many countries, there is no legal age limit for IVF treatment, but some clinics may have their own guidelines or restrictions regarding age. IVF success rates are significantly lower for women in their late 40s and beyond, and the likelihood of achieving a successful pregnancy through IVF decreases significantly. For some women, using donor eggs from younger women may be an option to improve success rates.

Can IVF be done with a low sperm count?


Yes. Sperm count is not necessarily indicative of pregnancy success, but it may make it more difficult  for couples. IVF may be a good option for couples in which the male partner has a low sperm count when it is combined with ICSI. This involves the direct injection of a single sperm into an egg and increases the likelihood of successful fertilization and embryo development.

Can IVF be done with blocked fallopian tubes?


Yes. There are a number of reasons a woman’s fallopian tubes may be blocked, including endometriosis, fibroids, pelvic inflammatory disease, and more. Through IVF, a fertility specialist can circumvent the fallopian tubes completely and transfer an embryo directly into the uterus.

Is IVF painful?


While every person is different, most individuals do not experience a significant amount of pain during the IVF process. However, pain is subjective, and some people may find IVF more physically uncomfortable than others. Some parts of the process, including medication injections, may be more likely to cause discomfort than others. But the stimulation and egg retrieval generally do not cause intense pain in most people.

How long does the IVF process take?


While every person’s experience is unique, the IVF process generally lasts about four to six weeks from beginning to end. This includes any necessary preparation time, the 8-14 days of ovarian stimulation, the egg retrieval procedure, fertilization, possible transfer, and pregnancy test.

Can I exercise during IVF?


Light physical activity is encouraged through the IVF process if possible, but patients are advised to avoid high-intensity exercises and movements that involve twisting. This is because the ovaries become enlarged during IVF, which can increase the risk of a rare but serious condition called ovarian torsion. Ovarian torsion involves the ovary, and sometimes fallopian tubes, becoming twisted on themselves, cutting off the blood supply. In lieu of strenuous activities, experts generally recommend about 30 minutes a day of low-impact activities like walking and swimming.

What are the chances of having twins or multiples with IVF?


In 2020, about 12.6% of infants conceived through ART were multiples (twins, triplets, or more) compared with 3.2% of all infants in the birth population overall.

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