How long does IVF take? If you are considering doing IVF, whether it is egg freezing for fertility preservation or creating embryos because you're ready to conceive, you're likely curious about what the process is like and how long it's going to take.

So, if we're talking about getting to the egg retrieval, there's three main stages. And then if you're actually creating embryos and trying to get pregnant, that is stage number four. So, the first few stages:

·       Number one is compliance checklists, testing, consent signing, understanding the process and making decisions about what you're going to do when you actually do the cycle.

·       Number two is the preparation, kind of getting the ovaries ready. Typically, it's taking birth control pills to lead into the stimulation cycle.

·       Number three is the actual cycle. And this is what most people think about when they think about IVF. They think about these two weeks where you're taking shots to prepare the ovaries in order to mature multiple eggs and getting the eggs out with the egg retrieval. That's actually really only about two weeks, but this whole process takes a lot longer.

·       And then if you're doing egg freezing, then once those eggs are out, we freeze them and you're done.

·       But if you're creating embryos and trying to get pregnant, there's going to be that fourth stage.

So, recap, compliance checklist, preparation for stimulation, the actual stimulation cycle, and then if you're making embryos and trying to get pregnant, getting pregnant. The overall process, if you are planning to do an egg retrieval and freeze your eggs, might honestly take about six to eight weeks. That does not mean that you're taking medication that whole time, but just kind of the preparation and the learning and all that stuff ends in the egg retrieval. That's probably about six to eight weeks.

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If you are creating embryos and trying to get pregnant, the whole process is going to be about two and a half to three months. So let's go through each of these stages one step at a time.

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·       So first of all, compliance checklist, what does that mean?

Well, there's a lot of preparation when you're really deciding to do IVF and preparing for it. There's lots of different things. So first of all, you want to have a really clear plan with your doctor. How are you going to fertilise the eggs? Are you going to do ICSI or intracytoplasmic sperm injection or not? Are you going to do genetic screening on the embryos? That can absolutely change your timeline and is important to figure out beforehand. Do you have insurance coverage? Because if you do, that is fantastic and everyone should. So work with your financial team if you have insurance coverage to make sure you really understand how it works.

There's some tests that should be done before you do IVF. Of course, you should do tests to learn about ovarian reserve and do a semen analysis that helps kind of understand the protocol and what best to do in the lab when we're kind of getting ready for this, but also virology testing.

Also, patients should have the option to do carrier screening. So even if you don't have cystic fibrosis or have a family member with that disease, you could still carry a mutation for that disease. And if your partner also carries that mutation, you have a 25% chance of having an affected child with cystic fibrosis. So, there are carrier screening tests that you can do that can screen for hundreds of different mutations. And it's really important to know that before you start IVF, because if you know that there's something to look for, then you can look for it in the embryo.

So, this compliance checklist is kind of getting your finances in order. It's making sure that your IVF plan is complete. Consent forms are important, making sure your testing is done beforehand. You want to do a uterine cavity evaluation, because if you're planning to do a fresh transfer a few days after the egg retrieval, you want to make sure that the uterus is perfect and that there's no issues that could impact implantation.

There are so many different ways to lead into an IVF cycle, but it's very common for part of the protocol to include birth control pills to lead into the cycle. When we're doing stimulation of the ovaries, we want to make sure that all the eggs are on the same starting line, because when they see the shots, the medications, the gonadotropins, we want them all to come forward and as many as possible to be mature at that egg retrieval, because only mature eggs are going to fertilise with sperm. And so, one way to get the eggs kind of all lined up and on the same starting line is with a period. It's typically on cycle day two, the second day of bleeding, you start active birth control pills. You typically don't take a full pack of pills. Every protocol, every lab is going to be a little different.

Definitely talk to your doctor and your team about what's right for you. It's all in the branding, call them IVF prep pills. And so, it really is just trying to get all the eggs lined up and even so that when you start the shots and the stimulation and the recruitment, you're going to get as many mature eggs as possible to help with your outcome and make sure your cycle is a success. Now there are other ways to lead into or prepare the ovaries.

Sometimes people will do only oestrogen to lead in. Sometimes people actually start stimulation in the luteal phase in a previous cycle. Sometimes people will just with a period start stimulation medication that evening. So, not everybody takes birth control pills in preparation for stimulating the ovaries, but there usually is some sort of preparation or timing of thinking about when it's best to start the stimulation and the recruitment of the eggs because that is important for your best outcome.

·       So now stage three, and this is what most people think about when they think about IVF and shots and just the process. So, IVF, the actual cycle or the egg freezing cycle, ovarian stimulation, it's all kind of the same thing. It's basically an amplified menstrual cycle in that when you are cycling regularly, your own pituitary gland is making gonadotropins to recruit and mature usually one egg and it ovulates in the middle of the cycle. If you get pregnant, you don't get a period. You're pregnant. If you don't get pregnant, you get a period. Now these gonadotropins from the pituitary gland, we don't make that much in that even if we have 20 eggs that are up for grabs in a cycle, our pituitary gland only makes a small number of gonadotropins so we only mature and ovulate one egg. That's why we don't have tonnes and tonnes of babies.

But IVF is taking advantage of these eggs that are, it's kind of like a vault of eggs. And so we're giving the same thing that our own bodies are making, but just in an amplified dose so that we can get 10 eggs or we can get 20 eggs as opposed to just that one. And so just your own cycle, your own pituitary gland makes these gonadotropins for about 10 to 14 days. You take gonadotropins for approximately 10 to 14 days and then you do a retrieval. And so, in those 10 to 14 days, this is the time that you don't want to travel if you don't have to. You don't want to have big deadlines at work if at all possible.

You might need to come to the clinic four or five times within those two weeks because with ultrasounds and oestrogen, we're trying to decide when is the best time to actually do a retrieval. We want to do a retrieval when the majority of the eggs are mature. And sometimes it takes a little bit of finessing and a couple, sometimes we see you two days in a row, but we just want the best for you.

·       And then the last shot that you take is the trigger shot that helps with the final maturation of the eggs. And approximately 36 hours later, you have your egg retrieval. When you have your egg retrieval, if you are doing egg freezing, you are done.

So that stage is done. And about 7 to 10 days after the egg retrieval, you get a period that is finishing this amplified menstrual cycle. You should absolutely have a return visit with your doctor to go over how you're feeling after the cycle and the number of eggs that you got and talk about like, hey, did I meet my goal? Or should maybe I do another stimulation cycle to freeze more eggs? Because especially as we age, it takes more and more eggs to have a positive outcome when you want to use them in the future. This whole process is making sure that you really go over everything with your doctor after that egg retrieval.

Now, if you're not doing egg freezing and you're creating embryos, well, once the eggs are out that same day, there's fertilisation, whether it's passive, like conventional insemination or active with intracytoplasmic sperm injection, where we put one sperm in each egg, but it takes about five or six days for an egg and sperm that are fertilised to become a mature embryo. It's called a blastocyst. It's about a hundred cells. Now, if you're doing a fresh embryo transfer, you can have a transfer five days after your egg retrieval.

You can't do a fresh transfer with a tested embryo. We also know that if someone is overstimulated, the uterine lining can get out of sync. So, someone has a really robust response it's not the best idea to try to get pregnant at that time. Their body needs to recover. And so, if somebody is freezing the embryos, that happens about a week, it's like five or six days after the egg retrieval. And then if you want to get pregnant as soon as possible with a frozen embryo transfer, well, your body has to reset. So, then you get a period about seven to 10 days after the egg retrieval, and then you get ready for your frozen embryo transfer, which is about, depending on protocols and all that kind of thing, it's probably about six weeks after the egg retrieval.

And with a frozen embryo transfer, typically the ovaries aren't working. They're kind of keeping quiet and we're building up the uterine lining with oestrogen, stabilising it with progesterone and doing that transfer on the right day for you. So that is where all this time kind of comes in.

That's good medicine. We need you to understand exactly what we're doing and what the risks are. We need to make sure we have all this testing done. We need to make sure that your finances are in order, especially if you need preauthorization for insurance.

And a lot of that is kind of preparation. So, what can throw off that timing? Like if, if you have in your mind, okay, I've made a decision that I want to do IVF. Yes, I have to wait for my period to come to start birth control or whatever, but like, you know, I want to have a baby, you know, in this calendar year, what is going to throw that off? And so, it's important to kind of know what could throw that off.

So, things that can change the timeline, of course, is what your plan is. If you're planning to do egg freezing, it's going to be a shorter timeline. If you're planning to do a frozen embryo transfer with genetic screening of your embryos, that's going to be a little bit longer.

The only way that they can manage that is they can't be doing egg retrievals 365 days a year. So, they often will batch their cycles. So, they'll only have people doing egg retrievals or transfers 3-4 times a year in order to just manage the flow of the clinic and how busy things can be.

Another thing is depending on what your plan is, some clinics are not always doing chromosomal screening. So if your goal is to do genetic screening on your embryo, some clinics have only certain embryologists that are able to do the embryo biopsy. And so they might say like, oh sure, we're doing IVF all the time, but if you want to do chromosomal screening, we're only doing it in these particular months because that's when the embryologist is here to be able to do it.

So, most clinics do have a master calendar and they are trying to make sure that each patient gets their individual care and we can't have 20 egg retrievals on one day and zero on another. And so, you do want to stagger starts and just maximise individual attention for patients. So sometimes there is a little bit of a wait list, but just ask a little bit about what the clinic's kind of policy or what their kind of wait list is, or if they batch just to kind of get that information again, all about setting your expectations.