The Basics of IVF: Understanding Protocols, Injections and Timeframes

In vitro fertilization (IVF) is a widely recognized assisted reproductive technology that offers hope to individuals and couples on their journey to parenthood. However, navigating the world of IVF can be extremely overwhelming, especially for those new to the process. Here I will provide an overview of IVF basics, typical protocols, injections and the timeframes involved. Let’s dive in and unravel the essentials of this transformative fertility treatment.

Understanding IVF Protocols

The protocol is the step by step process that you will undergo during an IVF cycle. The two primary protocols are the long and the short protocol. The long protocol involves suppressing the natural menstrual cycle with medications before stimulating the ovaries to produce multiple eggs. When I underwent the long protocol (unusual for someone with diminished ovarian reserve), I was suppressed towards the end of my cycle (around Day 19 due to having shorter cycles; more typically this is done on Day 21) with a single injection and then began stims around Day 2 or 3 of the next menstrual cycle.

The short protocol starts ovarian stimulation around Day 2 or Day 3 of the menstrual cycle, without the prior ovarian suppression. I also had numerous short protocols and found that my personal response to stims in these cycles was worse than when I was on a long protocol. Your fertility specialist will work with you to determine the best protocol for your situation.

Ovarian Stimulation and Injections

During an IVF cycle, ovarian stimulation is a crucial step to encourage the growth and development of multiple eggs. This is achieved through self-administered injections (or if you can find a willing and able partner, from someone you trust) of fertility medications, usually follicle-stimulating hormone (FSH). These injections are subcutaneous and are usually in the stomach area. If anyone has ever done this they know about the 1 inch circle around the belly button to pinch and inject, swapping sides each day so as not to bruise too much on one side.

Usually the injections are taken for about 8-14 days, depending on your response, which will be closely monitored by your fertility specialist through ultrasounds and blood tests. They may adjust the dosage and/or timing of the injections as you go through the cycle. Furthermore, you will be required to be prevented from ovulating and this may be an additional injection to take daily or through a suppression injection taken the cycle before.

Finally, about 36 hours before egg retrieval you will take a “trigger” shot to finalize the growth of the follicles and prepare you for the next stage, the egg collection.

Egg Retrieval and Fertilization

Once the follicles have reached the right size, a minor surgical procedure is performed known as egg retrieval. Under sedation, a thin needle is guided through the vaginal wall to collect mature eggs from the ovaries. The retrieved eggs are then combined with the sperm in the laboratory for fertilization. The sperm can be fresh or frozen depending on your individual circumstances.

The fertilization process may be conventional IVF, where the sperm and egg are left to meet each other in the lab or intracytoplasmic sperm injection (ICSI), where a single sperm is selected and injected into each egg. ICSI is more commonly used when there is male factor infertility involved and is required if you plan to genetically test the embryos following their development.

Following egg retrieval and prior to transfer, if you are having a fresh transfer, you will be required to start taking progesterone to build up your lining for your transfer.

Embryo Transfer and the Two-Week Wait

After fertilization, the embryos are cultured in a lab for a few days, typically to Day 3 (typically 8 cells) or Day 5 (which will be a blastocyst). The embryos are often graded and each lab uses a slightly different grading system. If you are having genetic testing on your embryos your cycle will effectively end at this point while you await the results of the testing.

If you are having a fresh transfer, your clinic will determine the best embryo or embryos for transfer into the uterus. You are awake for this process and will usually need a full bladder (this was always the part I found the hardest, having to keep my bladder full 🙈). Following transfer, you will need to wait around 9-10 days before taking a blood hcg test to determine whether you are pregnant or not.

Many people (myself included) test earlier than this and some people begin testing as early as 5 days post transfer (and they are able to see very very very faint lines on pregnancy tests). I was never a serial tester and tried to only test once I was 7 days past transfer, because that way I knew for sure that there was no trigger shot left in my system and the line would usually be visible enough to be clear one way or another whether I was pregnant or not.

To conclude, IVF can be an incredible journey of hope and resilience. Understanding the basics of a cycle as outlined above can provide a foundation of knowledge as you navigate this process. Remember, every IVF journey is unique and your fertility specialist will guide you through your specific situation adjusting accordingly.

If you are currently navigating a cycle or are about to begin one and would like to feel more generally supported throughout, please do not hesitate to get in touch. Not only can I provide real world experience (I went through 7 egg retrieval cycles, 6 fresh transfers, 3 frozen transfers, recurrent implantation failure, genetic testing and 3 pregnancies from IVF (resulting in 2 earth side children)) but I can also provide emotional support as your fertility doula, so you are not alone during this roller coaster journey.

Disclaimer: I am not a medical professional and the above is merely meant as a general guide to an IVF cycle, using my own experiences. All the specifics of IVF protocols, injections and timeframes will be specific to your individual circumstances and should be discussed with your fertility specialist to determine the best path forward for yourself.