IVF (In Vitro Fertilization): What is It, Procedure, Steps, Side Effects & More 

Introduction

Assisted reproductive technology (ART) has advanced rapidly over the past few decades, transforming the landscape of infertility treatment worldwide. India, in particular, has witnessed one of the fastest-growing ART sectors, with a significant rise in the number of fertility centres and ART cycles performed each year¹.  

ART includes a range of medical techniques designed to help couples conceive by manipulating reproductive cells outside the human body². Among these techniques, in vitro fertilization (IVF) stands out as the most widely used and well-established method². And over the years, IVF has evolved with improvements in laboratory technology, culture systems, and embryology practices, leading to higher success rates and safer procedures³. 

Through this article, we aim to explore what is IVF, how the procedure works, the detailed steps involved, its indications and benefits. We will also cover IVF side effects, potential risks, and what individuals or couples can expect throughout the process. 

What is IVF?

IVF is a specialised fertility treatment in which a woman’s egg and a man’s sperm are combined/fertilized outside the body. This is typically achieved in a controlled laboratory environment⁴.  

Under normal circumstances, an egg and sperm meet inside the woman’s fallopian tube after intercourse. And if fertilization (fusion of egg and sperm) occurs, the resulting embryo travels to the uterus and implants in the uterine lining. This leads to a natural conception/pregnancy.  

However, when this process does not occur on its own, IVF provides an alternative path to conception⁴. The term in vitro literally means “in glass,” referring to fertilization that occurs outside the natural reproductive system⁵. 

IVF is one of the most widely practised forms of ART. The IVF process involves retrieving mature eggs from the ovaries, fertilizing them with sperm in a laboratory to create embryos, and then either²: 

• transferring one or more of these embryos into the woman’s uterus, or 
• freezing (cryopreserving) the embryos for future use 

Benefits of IVF

IVF offers several important benefits that help individuals and couples overcome infertility and improve their chances of having a healthy pregnancy. Benefits of IVF include²: 

• Aids couples with unexplained fertility issues who may have no other effective option^2,4. 
• Helps achieve pregnancy when natural conception is not possible (e.g., blocked tubes, low sperm count and blockage)⁴. 
• Provides flexible options, meaning you can use your own eggs/sperm, or donor eggs/sperm/embryos when needed². 
• Allows embryo or egg freezing, helping people preserve fertility for the future (useful before cancer treatment or delaying pregnancy)². 
• Enables genetic testing of embryos, reducing the risk of inherited diseases and some chromosomal problems⁴. 
• Higher success rates compared to many other fertility treatments⁶. 

The IVF Procedure Step by Step

IVF involves a series of carefully planned steps that help eggs and sperm come together outside the body. This is followed by placing a healthy embryo into the uterus. The following outlines the IVF procedure step by step⁴: 

Step 1: Ovarian Stimulation (Super-ovulation)

• The woman is given fertility medications to help her ovaries produce multiple mature eggs (instead of the single egg normally released each month). 
• During this phase, doctors monitor the ovaries closely through regular ultrasounds and blood tests to track hormone levels and egg development. 

Step 2: Egg Retrieval

• Once the eggs are ready, they are collected through a minor procedure called follicular aspiration.  
• It is usually done under light sedation. 
• Using ultrasound guidance, a thin needle is passed through the vagina into the ovaries to gently suction out the eggs from each follicle. 
• The process may cause mild cramping, which typically resolves within a day. 
• If a woman cannot produce eggs, donor eggs may be used. 

Step 3: Fertilization (Insemination)

• The retrieved eggs are mixed with the man’s sperm in the laboratory. 
• The sperm naturally fertilizes the egg a few hours after being combined. 
• If there is a low chance of natural fertilization (due to male infertility), a technique called intracytoplasmic sperm injection (ICSI) may be used, where a single sperm is directly injected into the egg. 
• Many fertility centres perform ICSI routinely for better fertilization outcomes, but this is only possible if the cause of infertility is related to the male partner. 

Step 4: Embryo Culture

• After fertilization, the developing embryos are kept in a controlled environment and monitored for proper growth. 
• By day 3 to 5, a healthy embryo will have divided into multiple cells. 
• For couples at risk of genetic disorders, preimplantation genetic testing (PGT) may be offered to test embryos before transfer. This helps identify embryos free of specific genetic conditions. 

Step 5: Embryo Transfer

• 3 to 5 days after fertilization, one or more healthy embryos are gently placed into the woman’s uterus. 
• The procedure is quick and usually painless. 
• A thin catheter is used to guide the embryo through the cervix into the womb. 
• If the embryo implants in the uterine lining, pregnancy begins. 
• Any remaining healthy embryos may be frozen for future use. 

Medications and Procedures Used

Several medications are used during an IVF cycle to help the ovaries produce eggs, control hormone levels, and prepare the uterus for embryo transfer. The main types include: 

• Ovarian Stimulation Medications: These medicines help the ovaries produce multiple mature eggs instead of just one. Common examples²: 
  • Exogenous gonadotropins [follicle stimulating hormone (FSH) and luteinizing hormone (LH)] 
  • Selective oestrogen receptor modulators (clomiphene citrate) 
  • Aromatase inhibitors (letrozole) 
• Medications to Prevent Premature Ovulation: These drugs stop the body from releasing eggs too early. Common options²: 
  • Gonadotropin-releasing hormone (GnRH) agonists 
  • GnRH antagonists (GnRHa) 
• Trigger Shot (Final Maturation Injection): Once the eggs are developed, a “trigger shot” is given to help the eggs mature fully before retrieval. Examples²: 
  • hCG (human chorionic gonadotropin) 
• Progesterone Support: After egg retrieval and embryo transfer, progesterone is given to prepare the uterine lining and support early pregnancy². Forms include⁷: 
  • Vaginal gel 
  • Vaginal capsules/tablets 

Preparation for IVF

Before starting an IVF cycle, individuals undergo several important evaluations to ensure the treatment is safe, appropriate, and has the best chance of success. These assessments help identify any factors that may affect egg quality, sperm health, or embryo implantation. 

1. Assessment of Ovarian Reserve (Female Partner)

Tests are done to understand how many good-quality eggs the woman may be able to produce. Common tests include²: 

• Day-3 FSH and oestradiol (E2) 
• Anti mullerian hormone (AMH)
• Antral follicle count (AFC) using ultrasound 

If the results show poor ovarian reserve, IVF is still possible, but the woman may need to consider options such as donor eggs. 

2. Semen Analysis (Male Partner)

The male partner provides a semen sample to assess²: 

• Sperm count 
• Motility (movement) 
• Morphology (shape) 

These results help determine if standard IVF is suitable or if ICSI (Intracytoplasmic Sperm Injection) is needed. 

3. Evaluation of the Uterine Cavity

Imaging tests help identify structural issues that may interfere with embryo implantation, such as²: 

• Fibroids 
• Polyps 
• Adhesions 
• Uterine septum 

Addressing these problems beforehand improves the chances of a successful pregnancy. 

4. Infectious Disease Screening

Both partners are screened for infections such as²: 

• HIV 
• Hepatitis B & C 
• Syphilis 

This ensures patient safety and prevents transmission during treatment. 

5. Coordinated Care and Emotional Support

IVF requires a multidisciplinary team, including doctors, nurses, embryologists, counsellors, and lab staff². 

• Good communication and strong emotional support are essential, as the IVF process can be stressful.  
• Providing patient-centred care and clear guidance helps individuals feel supported and improves their overall IVF experience. 

Important: Alcohol and smoking may negatively influence ART/IVF outcomes⁸. Therefore, individuals undergoing ART should follow a balanced diet and avoid alcohol and smoking to support better treatment outcomes. 

IVF Treatments

Different approaches may be used during an IVF cycle depending on the couple’s fertility issues, age, and medical history. The most commonly used treatment options include: 

• Standard IVF (Conventional IVF): In this method, multiple sperm are mixed with each mature egg in the laboratory and fertilization occurs naturally⁴. 
• ICSI: A single healthy sperm is directly injected into each mature egg to achieve fertilization⁴. 
• Use of Donor Eggs or Donor Sperm: Donor eggs or sperm may be used when one partner cannot produce healthy gametes². 
• Frozen Embryo Transfer (FET): Previously created and frozen embryos are thawed and transferred in a later cycle⁹. Frozen embryo transfer success rates are equal to the fresh transfers, and no additional abnormalities occur. 
• PGT: Embryos are tested for chromosomal abnormalities or specific genetic diseases before transfer^2,4. 
• IVF with Donor Embryos: Embryos donated by other couples are transferred to the recipient’s uterus². The 2021 ART Act in India oversees that ART clinics and donor banks to ensure safe, ethical, and transparent practices¹⁰. 
• Gestational Surrogacy: An embryo created through IVF is transferred to a surrogate who carries the pregnancy¹¹. 

What to Expect During and After the Procedure

IVF can bring both emotional and physical challenges, but support is available throughout the process. Your team of doctors, counsellors, and fertility support groups can help you navigate this journey. 

• Counselling: Counselling provides a confidential space to discuss your feelings, worries, and expectations. It is recommended for everyone undergoing IVF, and clinics generally offer access to a counsellor before, during, and after treatment¹². 
• After the Procedure: Post embryo transfer, light rest may be advised for the remainder of the day. Full bed rest is not usually required unless there is a risk of ovarian hyperstimulation syndrome (OHSS). Most women can return to normal activities the following day⁴. You may be advised to avoid heavy exercise and intercourse until the pregnancy test. 
• Progesterone Support: Daily progesterone (injections or pills) may be required for 8 to 10 weeks after embryo transfer. Some women may continue progesterone supplementation for 8 to 12 weeks if pregnancy occurs⁴. This should only be considered if advised by a doctor. 
• Pregnancy Test: A blood test to check for pregnancy is done 12 to 14 days after the embryo transfer⁴.

Joining support groups and connecting with others going through similar experiences can be reassuring during this phase¹². 

IVF Side Effects

Women taking fertility medicines may experience⁴: 

• Bloating 
• Abdominal discomfort 
• Mood swings 
• Headaches 
• Bruising at injection sites 

These symptoms are usually temporary and related to the hormonal changes during treatment. 

Risks and Complications

IVF is generally safe, but like all medical treatments, it carries certain physical, emotional, and financial risks. These may vary from mild to more serious. 

• Risks from Egg Retrieval Procedure: There may be some risks associated with retrieving eggs. These include⁴: 
  • Reaction to anaesthesia 
  • Bleeding or infection 
  • Injury to nearby organs (bowel or bladder) 
• Multiple Pregnancy: Transferring more than one embryo increases the risk of twins or higher-order multiples^4,12. 
  • This increases the chances of premature delivery, low birth weight, and various health complications for both the mother and the babies.  
• Ectopic Pregnancy: A fertilized egg may implant outside the uterus (usually in the fallopian tube). This needs urgent medical care¹². 
• Ovarian torsion: Rare risk of ovarian torsion, particularly in patients with polycystic ovarian syndrome (PCOS) who may develop enlarged ovaries during stimulation¹³. 
• OHSS (rare but serious): This occurs when the ovaries over-respond to fertility medications. However, with modern techniques/medications, this risk is much less prevalent. Symptoms may include⁴: 
  • Severe bloating and abdominal pain 
  • Rapid weight gain (over 10 pounds in 3 to 5 days) 
  • Decreased urination 
  • Nausea or vomiting 
  • Shortness of breath 

Mild cases may improve with rest, but severe cases may require draining fluid or hospitalisation. 

• Emotional and Financial Stress: IVF requires significant time, emotional energy, and financial resources. Many couples may experience stress, anxiety, or depression during treatment. In addition to this, treatment costs are also high, and insurance coverage may be limited⁴. 

Success Rates and Results

IVF success varies widely and depends on several factors, such as maternal age, egg quality, embryo type (fresh or frozen), and the underlying cause of infertility. Although effective, the chance of pregnancy from a single fresh embryo transfer remains modest. 

For women (under 35), general success rates are: 

• Successful implantation with fresh embryos ranges from 30 and 45% per cycle¹⁴. 
• Success increases cumulatively across multiple cycles, reaching 60% after 3 cycles¹⁵. 

Note: Success rates may decline with advancing maternal age, especially after 40 years¹⁶.  

When to See a Doctor?

After IVF, it is important to watch for symptoms that may indicate complications. Contact your doctor immediately if you experience^4,12: 

• Fever above 100.5°F (38°C) 
• Pelvic pain 
• Heavy vaginal bleeding 
• Blood in the urine 
• Feeling faint 
• Coughing up blood 

Urgent medical help may be required in the following cases¹²: 

• Difficulty breathing 
• Chest pain or pain in the upper back 
• Severe thirst with reduced urination 
• Swelling anywhere in the body 
• Sharp lower abdominal pain on one side 
• Pain at the tip of the shoulder 

These symptoms may indicate severe OHSS or an ectopic pregnancy and require urgent medical attention. 

Conclusion

IVF is a widely used and effective fertility treatment, but its success depends on many factors, including age, egg and embryo quality, and underlying medical conditions. The process involves several steps, requires careful preparation, and may come with emotional, physical, and financial challenges. Thus, understanding the procedure, potential risks, and expected outcomes can help individuals make informed decisions. 

As you consider or undergo IVF, it is important to maintain realistic expectations, seek strong emotional support, and work closely with an experienced medical team. Many individuals and couples can achieve a successful and rewarding outcome with the right guidance and care. 

Frequently Asked Questions (FAQs)

References

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