Course / The Steps and Decisions In The IVF Process
Objective: To provide a high-level overview of the IVF journey from start to finish, setting realistic expectations about the timeline and the typical “attrition” of eggs to embryos.
Content:
The IVF process is a carefully orchestrated sequence that typically spans 4-6 weeks from the start of medication to embryo transfer or freezing. It’s essential to understand that IVF operates as a “funnel,” where the number of viable embryos is almost always smaller than the number of eggs retrieved.
The Standard IVF Timeline:
Week 1-2: Ovarian Stimulation & Monitoring. The intended mother or egg donor begins injectable medications to stimulate the ovaries.
Week 3: Egg Retrieval & Fertilization. The egg retrieval procedure is performed. Retrieved eggs are fertilized with sperm in the lab.
Week 3-5: Embryo Culture & Biopsy. Embryos grow in the incubator for 5-7 days. Those that develop into blastocysts may be biopsied for genetic testing (PGT).
Week 5-6: Embryo Transfer or Freezing.
In a fresh transfer cycle, a single embryo is transferred to the gestational carrier’s uterus.
More commonly, all embryos are frozen (cryopreserved) after biopsy. The genetically tested embryos are then thawed and transferred in a subsequent, prepared cycle for the gestational carrier.
Understanding the IVF Funnel:
The funnel illustrates the natural attrition at each stage. For example, a cycle might start with 15 eggs retrieved. However, not all will be mature, not all mature eggs will fertilize, and not all fertilized eggs will develop into viable blastocysts. This narrowing is normal and is why multiple eggs are stimulated. The goal is to end up with one or more high-quality, euploid (chromosomally normal) embryos for transfer.
Objective: To explain the first active phase of IVF, where medication is used to develop multiple follicles and how progress is tracked.
Content:
The goal of ovarian stimulation is to encourage the ovaries to produce multiple mature eggs in a single cycle, rather than the single egg typical in a natural cycle.
Medication Protocol: The intended mother or egg donor will self-administer injectable Gonadotropins (FSH and/or LH hormones) for approximately 8-12 days. These medications stimulate the follicles—the fluid-filled sacs in the ovaries that contain the eggs—to grow.
Suppression & Trigger Shot: To prevent premature ovulation, a protocol of suppression medications (e.g., GnRH agonists/antagonists) is used. Once the lead follicles reach an optimal size (typically 18-22mm), a final “trigger shot” of hCG or Lupron is administered. This precisely timed injection triggers the final maturation of the eggs, preparing them for retrieval about 36 hours later.
Monitoring: Progress is closely monitored through:
Transvaginal Ultrasounds: To track the number and size of the developing follicles.
Bloodwork: To measure hormone levels (estradiol, progesterone, LH), ensuring the body is responding appropriately to the medications.
Adjustments to medication dosage are common based on this monitoring, allowing for a personalized and optimized response.
Objective: To describe the minor surgical procedure used to collect the eggs from the ovaries.
Content:
The egg retrieval is a minimally invasive procedure performed under intravenous sedation, so the patient experiences no discomfort.
The Procedure: Guided by a transvaginal ultrasound, a fertility physician inserts a thin needle through the vaginal wall to access each ovary. The fluid from each follicle is gently aspirated.
Immediate Lab Work: The follicular fluid is immediately handed to the embryologist in the adjacent lab, who examines it under a microscope to identify the eggs.
Recovery & Aftercare: The procedure typically takes 20-30 minutes. Patients recover for about an hour before being discharged. Mild cramping or bloating is normal for a day or two following the procedure.
The total number of eggs retrieved is reported on the same day. It is important to note that not every follicle will necessarily contain a mature, viable egg.
Objective: To describe the minor surgical procedure used to collect the eggs from the ovaries.
Content:
The egg retrieval is a minimally invasive procedure performed under intravenous sedation, so the patient experiences no discomfort.
The Procedure: Guided by a transvaginal ultrasound, a fertility physician inserts a thin needle through the vaginal wall to access each ovary. The fluid from each follicle is gently aspirated.
Immediate Lab Work: The follicular fluid is immediately handed to the embryologist in the adjacent lab, who examines it under a microscope to identify the eggs.
Recovery & Aftercare: The procedure typically takes 20-30 minutes. Patients recover for about an hour before being discharged. Mild cramping or bloating is normal for a day or two following the procedure.
The total number of eggs retrieved is reported on the same day. It is important to note that not every follicle will necessarily contain a mature, viable egg.
Objective: To detail the critical days after fertilization when embryos develop in the lab before transfer or biopsy.
Content:
The fertilized eggs are now cultured in a state-of-the-art incubator that mimics the environment of the human body.
Days 1-3 (Cleavage Stage): The embryo divides into cells (blastomeres). By Day 3, a good-quality embryo will have about 6-10 evenly sized cells.
Days 5-7 (Blastocyst Stage): A critical developmental milestone. The embryo forms a complex structure with two distinct cell types:
Inner Cell Mass (ICM): Becomes the fetus.
Trophectoderm (TE): Becomes the placenta.
Blastocyst Grading: Embryos that reach the blastocyst stage are graded based on their expansion, the quality of the ICM, and the quality of the TE (e.g., 4AA, 3BB). This morphological grading helps the embryologist select the most viable embryo(s) for transfer or biopsy.
Only embryos that develop into robust blastocysts are suitable for transfer or freezing, as they have the highest potential for implantation.
Objective: To explain the purpose and process of Preimplantation Genetic Testing for Aneuploidy (PGT-A).
Content:
A significant cause of IVF failure and miscarriage is chromosomal aneuploidy—an embryo having an abnormal number of chromosomes. PGT-A is a powerful tool to identify these abnormalities.
What is PGT-A? It is a genetic test performed on a small biopsy of cells taken from the trophectoderm of a Day 5/6 blastocyst.
The Process: The biopsied cells are sent to a specialized genetics lab. The embryos are immediately frozen (vitrified) while awaiting results.
The Result: PGT-A determines if an embryo is euploid (normal chromosome count), aneuploid (abnormal chromosome count), or mosaic (a mix of normal and abnormal cells).
Key Benefit for Surrogacy: Transferring a known euploid embryo significantly increases the chance of a successful pregnancy in the gestational carrier and dramatically reduces the risk of miscarriage, providing immense peace of mind for intended parents.
Objective: To outline the process and key considerations for transferring an embryo to the gestational carrier.
Content:
This is the culmination of the IVF process, where an embryo is placed into the uterus of the gestational carrier.
Fresh vs. Frozen Transfer: For surrogacy, frozen embryo transfers (FET) are the standard. This allows for:
PGT-A results to be received.
Optimal synchronization between the embryo’s development and the gestational carrier’s prepared uterine lining.
A medically controlled and calm environment for the carrier.
Preparing the Gestational Carrier: The carrier takes estrogen and progesterone to build a receptive, optimal uterine lining. The transfer date is scheduled once the lining reaches the desired thickness.
The Transfer Procedure: The selected embryo is thawed (if frozen) and loaded into a soft, thin catheter. Under ultrasound guidance, the physician gently passes the catheter through the cervix and places the embryo into the uterus. The procedure is quick, painless, and does not require anesthesia.
The decision on which specific embryo to transfer is made jointly by the intended parents, the clinical team, and the embryologist, based on PGT-A results and embryo grading.
Objective: To describe the final stages of the journey after the embryo transfer.
Content:
The Two-Week Wait & Testing: After the transfer, a waiting period of approximately 9-12 days follows before a blood test can measure the beta-hCG level to confirm pregnancy. A rising level of hCG over subsequent tests confirms a viable pregnancy.
Early Pregnancy Monitoring: Once confirmed, the gestational carrier’s pregnancy will be closely monitored by her OB-GYN. The first ultrasound, typically around 6-7 weeks, is performed to confirm a fetal heartbeat and a intrauterine pregnancy.
Graduation & Delivery: After the first trimester, the gestational carrier will continue with standard prenatal care. Surrogacy4All will support all parties through this process, leading to the ultimate goal: the birth of your child. Legal parentage orders, established pre-transfer, ensure the intended parents are recognized as the legal parents immediately upon delivery.
Our job is to listen, to connect the dots between your needs, and to determine how we can best help you have your baby. If you’re asking how much does it cost for a surrogate, we’ll walk you through every step of the process to ensure there are no surprises.
To make an appointment with one of our counselors or physicians, please call (212) 661-7673 or email info@surrogacy4all.com. We look forward to hearing from you.
Surrogacy4All is a unique international surrogacy service targeted at providing state of the art IVF and surrogacy services to Intended Parents irrespective of age, sex or color, at the lowest possible cost in the world.
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