How Is IVF Treatment Performed? Stages, Duration, and Factors Affecting Success

Short Answer

In vitro fertilization treatment (IVF); It is an assisted reproductive treatment consisting of controlled stimulation of the ovaries, collection of developing eggs, fertilization with sperm in a laboratory environment, monitoring of the resulting embryos and transfer of the appropriate embryo to the uterus.

The time from stimulation of the ovaries to egg collection is approximately 10-14 days in most patients. However, situations such as fresh embryo transfer, freezing or genetic examination may change the total treatment time.

The protocol used in in vitro fertilization treatment is not the same for every couple. A personalized treatment plan is created by evaluating the woman's age, ovarian reserve, sperm characteristics, cause of infertility and previous treatment results.

Highlights

• In vitro fertilization treatment is not a single procedure, but a process consisting of successive stages.
• Men and women should be evaluated together before treatment.
• Ovarian stimulation takes approximately 8-12 days in most patients.
• Egg collection is usually performed under short-term sedation or anesthesia.
• Not every egg collected matures and not every egg turns into an embryo.
• Embryo transfer is generally a short procedure and does not require anesthesia.
• Lying down for a long time after transfer is not necessary for most patients.
• The age of the woman is one of the most important factors affecting the success of in vitro fertilization.
• Failure of the first in vitro fertilization attempt does not mean that subsequent attempts will also fail.

What is In Vitro Fertilization Treatment?

In vitro fertilization (IVF), medically known as in vitro fertilization (IVF), is an assisted reproductive method based on bringing together the egg and sperm cell outside the body in a laboratory environment and transferring the resulting embryo into the uterus.

During natural pregnancy, the meeting of sperm and egg occurs in the fallopian tubes. In in vitro fertilization treatment, eggs are collected from the ovaries and fertilization is carried out in the embryology laboratory.

Embryos formed after fertilization are monitored under laboratory conditions for a few days. A selection is made for transfer among the embryo or embryos with suitable developmental characteristics.

It is not correct to evaluate in vitro fertilization treatment as just "collecting the egg and introducing the embryo into the uterus". A successful treatment plan; It covers many stages, from investigating the cause of infertility to evaluating the ovarian reserve, from sperm analysis to examining intrauterine conditions.

Who can undergo IVF?

Not every couple who cannot achieve pregnancy needs to start in vitro fertilization treatment.

While methods such as ovulation treatments or IUI may be considered in some couples, in some cases direct in vitro fertilization may be a more suitable option.

In vitro fertilization treatment may come to the fore especially in the following cases:

• Bilaterally blocked or severely damaged fallopian tubes
• Advanced male factor infertility
• Sperm count or motility is significantly low
• Endometriosis
• Decreased ovarian reserve
• Advanced female age
• Unexplained infertility
• Failure to achieve pregnancy through ovulation or insemination treatments
• Planning genetic testing of the embryo in some hereditary diseases
• Failure of previous infertility treatments

Which method is appropriate should be decided by evaluating the age of the couple, duration of infertility and current medical findings.

How to Start IVF Treatment?

One of the first and most important stages of in vitro fertilization treatment is detailed evaluation.

The aim here is not only to start treatment, but also to understand as much as possible why the couple cannot achieve pregnancy.

According to the patient's condition during evaluation in women:

• Gynecological examination
• Transvaginal ultrasound
• AMH test
• Antral follicle count
• Required hormone tests
• Evaluation of the structure of the uterus
• Uterine film or advanced imaging methods when necessary

Available.

For men, one of the basic evaluations is sperm analysis.

If infertility treatment has been applied before, old treatment records are also important. Drug doses used in previous cycles, number of eggs collected, fertilization results and embryo development can help plan new treatment.

What are the Stages of IVF Treatment?

The in vitro fertilization process generally consists of the following stages:

• Initial assessment and treatment planning
• Stimulation of the ovaries with medications
• Following follicle development
• Ensuring the final maturation of eggs
• Egg collection process
• Preparation of sperm sample
• Fertilization and embryo development
• Embryo transfer or freezing of embryos
• Pregnancy test

Details of the treatment may vary from patient to patient.

1. Stimulation of the Ovaries

In a natural menstrual cycle, usually a single egg matures and ovulates.

In in vitro fertilization treatment, the aim is to develop more than one egg in the same treatment cycle. For this purpose, hormone drugs that stimulate the ovaries are used.

The type and dosage of medications are determined individually.

When planning treatment, especially:

• Woman's age
• AMH value
• Antral follicle count
• Body weight
• Ovarian response to previous treatments

Factors such as are evaluated.

For this reason, even two women of the same age may need to use different drug protocols.

How Many Days Does Ovarian Stimulation Last?

Stimulation of the ovaries with medications takes approximately 8-12 days in most patients.

However, this period is not the same for everyone.

During the treatment, the patient is called for ultrasound control at regular intervals. If necessary, hormone levels can also be evaluated with blood tests.

The aim is to follow the growth of follicles in the ovaries and determine the optimal time for egg collection.

2. How to Follow the Development of Follicles?

Follicle is the fluid-filled structure that surrounds the developing egg in the ovary.

In ultrasound checks performed during treatment:

• Number of follicles
• Size of follicles
• The response of the ovaries to treatment
• Appearance of the uterine lining

It is evaluated.

When the follicles reach a sufficient level of development, a drug known as a "cracking injection" is applied to ensure the final maturation of the eggs.

The time of administration of this medicine is important. Egg collection is carried out within the specified time interval according to the protocol used.

3. How is Egg Collection Done?

The egg collection process is called OPU (Oocyte Pick-Up).

The procedure is usually performed under short-term sedation or anesthesia.

Follicles in the ovaries are reached with the help of a special needle under transvaginal ultrasound guidance. Follicular fluids are aspirated and sent to the embryology laboratory.

The embryologist identifies the eggs by examining the collected fluids under a microscope.

It is not expected that an egg will be obtained from every follicle seen on ultrasound.

Is Egg Collection Painful?

Since egg collection is usually performed under sedation or anesthesia, the patient does not feel significant pain during the procedure.

After the procedure, in some patients:

• Mild groin pain
• Tenderness in the abdomen
• Bloating
• Slight staining

can be seen.

These complaints are mostly short-term.

However, if severe abdominal pain, heavy bleeding, significant abdominal swelling, shortness of breath, or rapidly worsening symptoms occur, the healthcare team following the treatment should be contacted.

How Long Does the Egg Collection Process Take?

The duration of the procedure may vary depending on the number of follicles and the characteristics of the patient.

It is usually a short process.

After egg collection, the patient is kept under observation for a while. If there are no problems, most patients can be discharged on the same day.

4. How to Prepare a Sperm Sample?

On the day of egg collection, a sperm sample is usually taken from the male partner.

The sperm sample is evaluated in the embryology laboratory and sperm cells suitable for fertilization are prepared.

In some cases of male infertility, there may not be enough sperm cells in the ejaculate. In suitable patients, sperm cells may need to be obtained surgically from the testicles or epididymis.

The method to be used is determined according to the patient's sperm analysis and the cause of infertility.

5. How Does Fertilization of Eggs Happen?

The collected eggs are evaluated for maturity.

Classical IVF or microinjection methods can be used as a basis for fertilization.

What is Classical IVF?

In the classical IVF method, the egg and a certain number of sperm cells are placed in the same culture medium.

One of the sperm cells is expected to fertilize the egg.

What is Microinjection (ICSI)?

In microinjection, a single sperm cell selected by the embryologist is injected directly into the egg under the microscope.

It can be used especially in certain male factor cases and when deemed clinically appropriate.

Which fertilization method will be applied is determined by the characteristics of the couple.

Can Every Collected Egg Become an Embryo?

No.

This is one of the most frequently misunderstood issues in in vitro fertilization treatment.

A natural biological elimination occurs throughout the process:

• Egg may not come out of every follicle.
• Not every egg may mature.
• Not every mature egg may be fertilized.
• Not every fertilized egg can continue its development.
• Not every developing embryo may be suitable for transfer or freezing.

Therefore, collecting 10 eggs, for example, does not mean that 10 embryos will be obtained.

Not only the number but also the characteristics of the eggs and developing embryos are important here.

6. How Many Days Are Embryos Followed?

After fertilization, the embryos are monitored in the laboratory environment.

Evaluations can be made on different days during embryo development.

In clinical practice, especially:

• 3. day embryo period
• 5. or day 6 blastocyst period

It is important.

Which day the embryo will be transferred or frozen; The number of embryos may vary depending on developmental characteristics, patient's treatment history and clinical planning.

There is no rule that every patient must wait until the 5th day.

What is Blastocyst?

Blastocyst is an advanced embryo development stage where the fertilized egg continues its development and usually reaches around the 5th or 6th day.

At this stage, the cells of the embryo have begun to differentiate.

In some patients, tracking embryos to the blastocyst stage may provide additional information in selecting embryos for transfer.

However, it cannot be said that blastocyst culture is automatically the most appropriate approach for every patient. The decision should be made according to the number of embryos and their developmental characteristics.

7. How is Embryo Transfer Done?

Embryo transfer is the process of placing the selected embryo into the uterus.

During the transfer, a thin and flexible catheter is passed through the cervix and delivered into the uterus. The embryo is deposited into the appropriate area with the help of this catheter.

The procedure is usually performed under ultrasound guidance.

Embryo transfer usually:

• Takes a short time
• Does not require anesthesia
• Does not cause significant pain

After the transfer, the patient can leave the clinic after a short rest.

What is the Difference Between Fresh Transfer and Frozen Embryo Transfer?

In in vitro fertilization treatment, the embryo can be transferred in the same treatment cycle or frozen for use at a later period.

Fresh Embryo Transfer

It is the transfer of the embryo formed during the treatment cycle in which egg collection is performed to the uterus.

Frozen Embryo Transfer

It is the freezing of the embryo by the vitrification method and its transfer to the uterus by thawing in a later menstrual cycle.

In some patients:

• High risk of OHSS
• Hormone levels not considered suitable for fresh transfer
• Intrauterine conditions are not suitable
• PGT planning
• Different individual clinical reasons

For this reason, freezing of embryos may be preferred.

Choosing frozen embryo transfer does not mean that the treatment is unsuccessful; It is part of the treatment strategy.

Is it necessary to lie down after embryo transfer?

Prolonged bed rest is usually not required.

Unless a special restriction is recommended by the doctor, the patient can return to his/her daily life in a short time.

It is not possible for the embryo to "fall out" of the uterus due to walking, climbing stairs, sitting or standing.

For this reason, it is not necessary for most patients to stay in bed for days after the transfer.

What Should Be Considered After Embryo Transfer?

One of the most important issues after the transfer is the use of prescribed medications as recommended.

In general:

• Drugs should be used regularly
• Smoking and alcohol should be avoided
• Excessive physical exertion should be avoided
• Doctor checks should not be interrupted
• The pregnancy test should not be done before the recommended date

After the transfer, you may encounter many suggestions that pineapple, pomegranate, special herbal teas or certain foods guarantee the attachment of the embryo.

However, there is no reliable approach to show that a single food or drink enables the embryo to implant.

When is the Pregnancy Test Done in IVF?

Pregnancy is evaluated by measuring the beta-hCG hormone in the blood on the determined date after embryo transfer.

Exact time of the test:

• The stage of development to which the embryo is transferred
• Treatment protocol
• Transfer method

It may vary depending on the situation.

Therefore, the test date specified by the clinic must be adhered to.

Testing too early may lead to false negative or misleading results.

How Many Days Does In Vitro Fertilization Treatment Take?

The total duration of in vitro fertilization treatment varies depending on the protocol applied.

The time from ovarian stimulation to egg collection is approximately 10-14 days in most patients.

Then, the embryos are monitored in the laboratory for a few days.

In a cycle where fresh embryo transfer is planned, the process can be completed within a few weeks.

However, if the embryos are frozen, the transfer can be postponed to one of the next menstrual periods. In cases where PGT is applied or the uterus requires separate preparation, the total process may be longer.

What Affects the Chance of In Vitro Fertilization Success?

Success in in vitro fertilization treatment is not determined by a single factor.

Female and male characteristics, embryo development and intrauterine conditions should be evaluated together.

Woman's Age

Woman's age is one of the most important factors affecting the success of in vitro fertilization.

As age progresses, the number of eggs may decrease and the probability of the eggs being chromosomally healthy may also decrease.

For this reason, the time factor becomes important, especially after the age of 35 and more specifically in advanced reproductive ages.

Ovarian Reserve

AMH and antral follicle count provide important information about the response of the ovaries to treatment.

With low ovarian reserve, fewer eggs may be obtained in a treatment cycle.

However, ovarian reserve and egg quality are not the same thing.

While AMH is mostly related to egg quantity, age is an important determinant on egg quality.

Embryo Characteristics

It is important for the embryo to continue its development regularly in terms of implantation.

Embryos can be evaluated morphologically in the laboratory, but an embryo that looks good under the microscope cannot necessarily be said to be chromosomally normal.

For this reason, although embryo quality is one of the factors affecting the possibility of pregnancy, it does not guarantee pregnancy.

Sperm Characteristics

Male factor is one of the important parts of in vitro fertilization treatment.

Initial evaluation of sperm:

• Number
• Mobility
• Morphology

It is examined.

When necessary, a more detailed evaluation can be made in terms of male infertility.

Status of the Uterus

In order for the embryo to adhere, the intrauterine environment must be suitable.

In some patients:

• Endometrial polyp
• fibroid affecting the uterine cavity
• Intrauterine adhesion
• Some congenital uterine anomalies

It may affect the treatment plan.

For this reason, it is important not only to obtain good embryos but also to evaluate the environment in which the embryo will be transferred.

Cause of Infertility

In vitro fertilization treatment can be applied to many different causes of infertility.

For example:

• Clogging of the tubes
• Endometriosis
• Male factor
• Decrease in ovarian reserve
• Unexplained infertility

It may require different treatment plans.

Therefore, the cause of infertility should also be taken into consideration when evaluating the success of in vitro fertilization.

Lifestyle

Smoking, severe obesity and some uncontrolled health problems can negatively affect reproductive health.

It is important to ensure that general health is as good as possible before treatment.

However, it is not correct for patients to evaluate the outcome of the treatment solely on nutrition, stress or daily activities. In vitro fertilization success is multifactorial.

What is the Success Rate in In Vitro Fertilization?

There is no single "IVF success rate" valid for all patients.

The likelihood of success is particularly:

• Woman's age
• Ovarian reserve
• Number of eggs obtained
• Embryo development
• Sperm characteristics
• The cause of infertility
• Previous treatment results

It may vary depending on factors such as

It is also important what the "success rate" announced by a center means.

Success;

• Positive pregnancy test
• Clinical pregnancy
• Live birth per embryo transfer
• Live births per treatment cycle started
• Cumulative live birth

It can be expressed with different criteria such as

For this reason, when comparing the success rates of different centers, attention should be paid to whether the same criterion is used.

Does In Vitro Fertilization Work at the First Try?

Yes, in vitro fertilization treatment can be successful on the first try. However, there is no guarantee of this.

Failure of the first treatment does not mean that pregnancy cannot be achieved in the future.

On the contrary, the first treatment cycle can provide important information for the physician.

For example:

• How the ovaries respond to medications
• How many eggs were obtained
• Maturity rate of eggs
• How fertilization occurs
• To what stage do embryos develop
• Whether pregnancy occurs after the transfer

It may help plan the next treatment.

How Many Times Can IVF Be Tried?

There is no exact number of in vitro fertilization attempts for everyone.

When making a new treatment decision:

• Woman's age
• Ovarian reserve
• Number of eggs and embryos obtained in previous treatments
• Possible reasons for failure
• Uterine structure
• Sperm characteristics
• General health status of the couple

It is evaluated.

Especially in case of recurrent failures, it is important to analyze previous cycles in detail instead of repeating the same treatment without making any changes.

Is PGT performed on every IVF patient?

No.

PGT (Preimplantation Genetic Testing) is the general name of the methods that enable the evaluation of embryos obtained during in vitro fertilization treatment in terms of certain genetic or chromosomal characteristics.

Especially:

• Known risk of single gene disease
• Certain chromosomal structural change in one of the parents
• Some appropriately selected clinical situations

Can be evaluated for.

The use of PGT-A in cases such as advanced maternal age, recurrent miscarriage or recurrent unsuccessful transfer should be handled individually according to the patient's characteristics.

PGT should not be considered as a procedure that should be performed routinely in every IVF patient and that guarantees pregnancy.

Common Mistakes in IVF Treatment

“The more eggs collected, the higher the success.”

Wrong. Although the number of eggs is important, age, egg quality and embryo development are also important.

“If a good quality embryo is transferred, pregnancy will definitely occur.”

No. The attachment of the embryo to the uterus is a biological process in which many factors play a role.

“After embryo transfer, it is necessary to lie down constantly.”

Usually no. Long-term bed rest is not necessary unless the doctor has a specific recommendation.

“Twin pregnancy is a more successful outcome in in vitro fertilization.”

No. The main goal of treatment is to achieve as healthy a pregnancy and live birth as possible. Multiple pregnancies may carry additional risks for mothers and babies.

“If the first in vitro fertilization fails, subsequent attempts will also fail.”

Wrong. Information obtained from the first treatment can help plan the next treatment more individually.

“If PGT is performed, the embryo will definitely adhere.”

No. PGT can provide information about certain genetic or chromosomal characteristics but does not guarantee implantation or live birth.

When Should You Consult a Doctor for In Vitro Fertilization?

In couples who cannot achieve pregnancy, the timing of evaluation varies depending on age and existing risk factors.

In general, infertility evaluation is recommended for women under the age of 35 when pregnancy does not occur despite 12 months of regular unprotected intercourse.

Earlier evaluation is considered for women aged 35 and over.

However:

• Menstrual irregularity
• Known low ovarian reserve
• Endometriosis
• Known issue with tubes
• Serious male factor
• Ovarian surgery history
• Another known disease that may affect fertility

If there is, it may not be appropriate to wait for a long time.

Assoc. Prof. Dr. Nurettin Türktekin's Evaluation

One of the most important points in in vitro fertilization treatment is to see the process not as a standard protocol, but as a personal treatment that should be shaped according to the characteristics of the couple.

The woman's age, ovarian reserve, sperm characteristics, uterine structure, cause of infertility and previous treatments should be evaluated together. It is not correct to apply the same drug dose, the same embryo transfer strategy or the same additional laboratory procedures to every patient.

The aim of treatment is not to perform as many procedures as possible; is to perform the necessary procedures on the right patient and at the right time. This approach helps both evaluate the expectation of success more realistically and avoid unnecessary interventions.

Conclusion

How is in vitro fertilization treatment done? The most basic answer to the question; It is a controlled stimulation of the ovaries, collection of eggs, fertilization in a laboratory environment, monitoring of embryos and transferring the appropriate embryo to the uterus.

However, a successful in vitro fertilization process is not just about these technical stages.

The woman's age, ovarian reserve, sperm characteristics, cause of infertility, embryo development and intrauterine conditions should be evaluated together. The treatment protocol should be personalized in line with this information.

Failure of the first attempt does not mean that the treatment will not be successful in the future. Similarly, obtaining a large number of eggs or having a good-looking embryo alone does not guarantee pregnancy.

The best approach is to evaluate the couple in detail before treatment, create a realistic expectation of success, and include only medically necessary practices in the treatment plan.