What Actually Happens During an IVF Cycle
If you're about to start IVF, you probably want to know exactly what you're signing up for — how long it takes, what each phase involves, and when you'll finally know if it worked. Here's the full timeline, week by week. A typical cycle runs about 6–8 weeks from start to finish, though prep work can begin months earlier. The ASRM has a good clinical overview if you want the technical version.
Weeks 1–4: Testing and Prep
Before anything happens, both partners get thoroughly evaluated. For women: blood tests (AMH, FSH, estradiol, thyroid), a transvaginal ultrasound to count follicles, an HSG or saline sonogram to check the uterine cavity, and infectious disease screening. Men do a semen analysis and bloodwork. Some clinics also do a mock embryo transfer — basically a practice run to map the uterus.
This phase can feel slow, but it's important. Your clinic needs this information to design your protocol.
Week 5: Birth Control (Yes, Really)
It sounds backwards, but many IVF protocols start with 2–3 weeks of birth control pills. The goal is to sync up your follicles so they grow evenly during stimulation. Some doctors use estrogen priming instead. Either way, this is also when you'll order your meds, do an injection teaching session, and sign consents. Use this time to get organized.
Week 6: Stimulation — The Main Event (Days 1–10)
This is the heart of the cycle. You'll give yourself daily hormone injections — gonadotropins like Gonal-F or Menopur — to coax your ovaries into producing multiple eggs instead of the usual one. Every 1–3 days you'll go in for monitoring (blood draw + ultrasound) so your doctor can track follicle growth and adjust your doses.
The injections sound scary, but most people get the hang of it by day two. The side effects — bloating, mood swings, fatigue — are real but manageable.
End of Week 6 / Week 7: Trigger and Egg Retrieval
When your follicles hit about 18–20mm, you'll take a "trigger shot" to finalize egg maturation. Exactly 36 hours later — timing matters here — you'll have your egg retrieval. It's a 15–20 minute procedure under light sedation. An ultrasound-guided needle aspirates the eggs from each follicle.
On the day: Arrive with no food or water for several hours before anesthesia, and bring someone to drive you home. You won't feel the retrieval itself — you'll be sedated. You'll wake up in a recovery area, sometimes groggy or crampy. The team will tell you how many eggs were retrieved before you leave.
What's a normal egg count?
Anywhere from 3 to 25+ eggs depending on your protocol and ovarian response. More eggs don't guarantee a better outcome — you need them to fertilize, develop to blastocyst, and (if doing PGT) test chromosomally normal. A retrieval of 10–15 mature eggs is generally a strong response. Recovery is typically 1–2 days of rest; most people return to light work the next day.
Week 7: Fertilization and the Lab Phase
On retrieval day, your eggs get fertilized — either the traditional way or via ICSI (where a single sperm is injected directly into each egg). The next morning, you'll get your fertilization report. Then your embryos grow in the lab for 5–7 days to reach the blastocyst stage. The embryology team gives you daily updates, which can be nerve-wracking. If you're doing PGT, embryos get biopsied around day 5–6 and frozen while results come back.
How Embryos Are Graded
By day 5 or 6, your embryologist will assign each surviving blastocyst a grade. The most common system uses three components:
- Expansion score (1–6) — How fully the blastocyst has expanded. A 3–4 is typical at day 5; 5–6 means fully expanded or actively hatching.
- Inner cell mass (ICM) grade (A, B, or C) — The cluster of cells that becomes the baby. A is tightly packed and well-defined; C is very few cells.
- Trophectoderm (TE) grade (A, B, or C) — The outer layer that becomes the placenta. A is many organized cells; C is sparse and irregular.
A "4AA" or "5AA" embryo is top grade. A "3BB" is good. Lower-grade embryos have resulted in healthy pregnancies. Embryo grade reflects physical development; PGT-A checks chromosomal status — they're measuring different things. A beautiful AA embryo can be chromosomally abnormal, and a BB can be chromosomally normal (euploid) and implant perfectly. Don't read too deeply into grades before you have PGT results back.
Week 7–8: Embryo Transfer (Fresh or Frozen)
For a fresh transfer, this happens about 5 days after retrieval. It's quick (5–10 minutes), painless, and doesn't need sedation — a thin catheter guided by ultrasound places the embryo into your uterus.
Fresh vs. Frozen Embryo Transfer (FET)
Most modern IVF programs now prefer a frozen embryo transfer (FET) over a fresh transfer. The reason: high-dose stimulation hormones can leave your uterine lining in less-than-ideal shape for implantation. Freezing all embryos and transferring in a separate cycle — after hormones settle and your lining is freshly prepared with estrogen and progesterone — tends to improve implantation rates. If you're doing PGT, a freeze-all cycle is required because biopsy results take 1–2 weeks.
For a frozen embryo transfer, you'll typically do 2–3 weeks of estrogen to build the lining, then add progesterone before the transfer. It adds roughly 4–8 weeks to your overall timeline but is often worth it for outcomes. Most patients scheduled for a freeze-all cycle go home after retrieval and return for the FET the following month.
The Two-Week Wait
Now comes the hardest part: waiting. About 10–14 days after transfer, you'll go in for a blood pregnancy test (beta hCG). Keep taking your progesterone. Stay reasonably active but skip intense exercise and hot baths. Try not to read too much into every twinge and symptom — easier said than done, but your sanity will thank you.
A Good Clinic Makes Every Step Easier
When a clinic is well-organized, communicates clearly, and actually cares about your experience, the whole process feels more manageable. Use the Fertility Clinic Finder to find top-rated clinics in your state and go in feeling prepared.
Wondering what all of this costs? Check our IVF cost breakdown for a realistic look at prices by state.
Haven't chosen a clinic yet? Get matched with a fertility clinic based on your needs and location.