What happens during an IVF cycle? Step-by-step guide to fertility treatment

As more couples turn to IVF for parenthood, understanding the step-by-step process, costs and success rates is key to navigating this complex journey

According to the State of World Population Report 2025  by the United Nations Population Fund (UNFPA), India’s Total Fertility Rate (TFR) has dropped to 2.0, below the replacement level of 2.1. A Lancet report  published last year projects a further decline of 1.3 points by 2050 and 1.04 points by 2100. In-vitro fertilisation (IVF) has become a vital option for couples facing infertility, with cases increasingly linked to modern lifestyles, delayed parenthood, and various health conditions. 

 

Experts note that most IVF patients are now under the age of 30, a trend driven by stress, poor diet, and late-night work habits. As reliance on assisted reproductive technology (ART) grows, it is crucial to demystify IVF for those considering it, as it remains one of the most effective options available today.

 

 

What is IVF?

 

In-vitro fertilisation (IVF) is a medical procedure where an egg and sperm are combined outside the body in a lab, and the resulting embryo is then implanted into the uterus. IVF is often used when other fertility treatments have failed or when couples face specific medical issues such as blocked fallopian tubes, low sperm count, or unexplained infertility.

 

IVF Cycle: Step-by-step process

“A single IVF cycle typically involves about 6–10 clinic visits. This is usually a Consultation and Pre-cycle Assessment (1–2 visits), Ovarian Stimulation Monitoring (3–5 visits for ultrasounds and blood tests), Egg Retrieval (1 day-care stay for procedure under anaesthesia) and Embryo Transfer with Post-transfer follow-up (1–2 visits) in 20 days. Some women may need more visits or treatments before or after this duration too,” explained Dr Astha Dayal, director of obstetrics and gynaecology with the CK Birla Hospital, Gurugram.

 

1. Initial Consultation and assessment

The process starts with a detailed fertility evaluation for both partners. This usually includes blood tests, ultrasounds, semen analysis, and a discussion around medical history and lifestyle factors.

 

2. Ovarian stimulation

Fertility medications are prescribed to stimulate the ovaries to produce multiple eggs rather than the single egg that develops naturally each month.

“After initial consultation, the next phase is where we stimulate the ovaries using special hormone injections for around 10–14 days. During this time, patients come in for regular alternate-day/every third day scans and blood tests so we can monitor how things are progressing,” said Dr Dayal.

 

3. Egg Retrieval (Ovum Pick-Up)

Once the eggs are mature, a minor surgical procedure is performed under sedation to retrieve them from the ovaries.

“Once the eggs are ready, we retrieve them using a minor procedure under short general anaesthesia and the patient goes home the same day,” explained Dr Dayal.

 

“Ovum pickup is done once follicles are 18-20 mm,” said Dr Hina Shaikh, consultant for obstetrics & gynaecology, Fortis Hiranandani Hospital.

 

4. Fertilisation and Embryo Development

Dr Shaikh explained, “The retrieved eggs are combined with sperm in a laboratory setting through ICSI (Intracytoplasmic Sperm Injection), which is a technique where a single sperm is injected directly into an egg.”

This process usually helps with male infertility issues. If fertilisation is successful, embryos are monitored for a few days before selection. “This will be followed by evaluation for embryo progress and then we freeze the embryos and plan for Frozen Embryo transfer,” she said.

 

5. Embryo Transfer

Following the fertilisation process, the embryo (sometimes more than one) is transferred into the uterus using a thin catheter. This is generally a painless, outpatient procedure.

Some mild symptoms that may be experienced after embryo transfer:

• Mild bloating and cramping.
• Breast tenderness from high oestrogen levels.
• Spotting.
• Constipation.

 

6. Pregnancy Test

Around two weeks after the embryo transfer, a blood test is conducted to check if the implantation was successful.

“After 3-5 days, the healthiest embryos are identified, and then one or more are gently transferred into the woman’s uterus. Then there’s a two-week wait for a pregnancy test to confirm if the conception happened,” said Dr Dayal.

 

Success rates and influencing factors

The success of IVF can vary depending on age, underlying health conditions, and lifestyle factors. 

Dr Shaikh explained, “The success rate is around 40-50 per cent. Factors like age, ovarian reserve measured using Anti-Mullerian Hormone (AMH), semen parameters, uterus health condition and other comorbidities the couple may be suffering from have to be taken into account.”

 

Dr Sunita Tandulwadkar, president, Federation of Obstetric and Gynaecological Societies of India, and President Elect I.S.A.R (Indian Society For Assisted Reproduction: I.S.A.R) broke it down as follows: 

• Women under age 35: 50–60 per cent success per cycle
• Ages 35–40: 35–45 per cent success
• Women above age 40: 10–20 per cent success

 

Adding to the discourse, Dr Dayal said, “A big misconception is that age does not matter- couples don't understand that success rates of IVF or egg freezing drop significantly after age 35 of the woman. Another mistake is assuming IVF can overcome all causes of infertility, there may be certain situations where IVF may not work either. Some couples think of IVF as an easy option to postpone planning pregnancy, but they highly underestimate the emotional and physical strain that it entails.”

 

IVF costs in India: A breakdown

Dr Dayal informed that a single IVF cycle in India can cost around ₹1,00,000 to ₹3,00,000, depending on the clinic and whether any advanced techniques are needed. 

“Medicines often account for a third of the expense. If specialised procedures like ICSI, blastocyst culture, genetic testing, embryo freezing, or preimplantation genetic testing are needed, costs rise further. There could be extra charges for things like storing embryos, using donor eggs/ sperm, or needing additional medications. Repeat cycles or failed cycle expenses, pre- and post-procedure counselling and psychological support also add to the expense,” she said.

 

Dr Shaikh broke down the expenses as follows:

• Injections: ₹70,000 – ₹80,000
• Diagnostics: ₹20,000 – ₹30,000
• Procedure: ₹25,000 – ₹30,000
• Hospital charges with lab: ₹70,000 – ₹80,000

 

While most health insurance policies in India do not fully cover IVF treatments, a few private insurers have begun to include limited fertility benefits. Government schemes are still sparse but slowly gaining traction.

 

Emotional toll

IVF can be emotionally taxing — hope, anxiety, and fear often walk together. “Physically, while the procedures are largely safe and minimally invasive, hormonal stimulation and the waiting period can be stressful. Counselling and empathetic care play a critical role in supporting patients,” said Dr Tandulwadkar.

 

Common Misconceptions

Dr Prachi Benara, fertility specialist at Birla Fertility & IVF, addressed some misconceptions surrounding IVF:

 

1. “IVF leads to an unnatural or artificial pregnancy” - An IVF pregnancy is no different from a natural pregnancy once conception occurs. The only difference is that the eggs and sperm are fertilised outside the body in a lab.
2. “IVF guarantees success in one cycle” - Success depends on factors such as age, egg and sperm quality, and any underlying medical conditions. While many couples do conceive in the first cycle, sometimes multiple cycles are required.
3. “IVF always results in twins or triplets” - With advanced techniques, doctors transfer the optimal number of embryos, significantly reducing the chances of multiple pregnancies. The focus is always on achieving a safe, healthy pregnancy.

     

For more health updates, follow #HealthWithBS

This report is for informational purposes only and is not a substitute for professional medical advice.