What You Need to Know Before Starting the IVF Process

The IVF process is a fertility treatment where eggs are collected from the ovaries, fertilized with sperm in a laboratory, and the resulting embryo is placed into the uterus. One IVF cycle usually includes fertility testing, ovarian stimulation, egg retrieval, sperm preparation, fertilization, embryo development, embryo transfer, and a pregnancy test. 

For couples exploring IVF in Nepal, understanding the process before starting treatment can reduce fear, improve preparation, and help you ask the right questions during your consultation with an IVF specialist.

Infertility is not rare. WHO estimates that around 1 in 6 people globally experience infertility during their lifetime. IVF is one of the most advanced fertility treatments available today, but it is not a one-size-fits-all solution. Every couple’s case is different.

What Happens in the IVF Process?

In simple words, IVF involves five main stages:

IVF Stage	What Happens
1. Fertility evaluation	Blood tests, ultrasound, semen analysis, and medical history review
2. Ovarian stimulation	Medicines help the ovaries grow multiple eggs
3. Egg retrieval and sperm collection	Eggs are collected; sperm is collected or retrieved if needed
4. Fertilization and embryo culture	Eggs and sperm are combined in the lab; embryos are monitored
5. Embryo transfer and pregnancy test	A selected embryo is placed into the uterus; pregnancy test follows

ASRM also describes the basic IVF treatment cycle as ovarian stimulation, egg retrieval, fertilization, embryo culture, and embryo transfer.

What Is IVF?

IVF stands for in vitro fertilization. “In vitro” means outside the body. In IVF, fertilization happens in a laboratory instead of inside the fallopian tube.

During IVF, eggs are collected from the ovaries and mixed with sperm in a laboratory dish or fertilized through ICSI, where one sperm is injected into one egg. The fertilized egg becomes an embryo. A suitable embryo is then transferred into the uterus.

IVF may be recommended for:

• Blocked or damaged fallopian tubes
• Low sperm count or poor sperm movement
• Endometriosis-related infertility
• Ovulation problems
• Unexplained infertility
• Age-related fertility decline
• Previous failed fertility treatments
• Genetic testing needs in selected cases

WHO notes that infertility may come from male factors, female factors, or both. Male infertility may involve semen ejection problems, low sperm count, abnormal sperm shape, or poor sperm movement. Female infertility may involve the ovaries, uterus, fallopian tubes, or hormonal system.

Why You Should Understand IVF Before Starting

Starting IVF can feel emotional, confusing, and expensive. Many couples begin the journey with hope, but also with fear: “Will it work?”, “Will it be painful?”, “How many injections are needed?”, “What if the first cycle fails?”

Knowing the IVF process helps you prepare physically, emotionally, and financially. It also helps you avoid unrealistic expectations.

IVF success depends on many factors, including age, egg quality, sperm quality, uterus health, embryo quality, medical conditions, lifestyle, and laboratory standards. No ethical IVF clinic can guarantee pregnancy.

A trustworthy IVF clinic should explain the process clearly, discuss risks honestly, and personalize the treatment plan after proper evaluation.

Before IVF: Tests and Preparation

Before beginning IVF, the fertility team usually evaluates both partners. This is important because infertility is not only a female issue.

Common Tests Before IVF

Test Area	Common Tests	Why It Matters
Female fertility	AMH, FSH, LH, estradiol, thyroid, prolactin	Checks ovarian reserve and hormonal health
Ultrasound	Antral follicle count, uterus check	Helps assess egg reserve and uterine condition
Fallopian tubes	HSG or other imaging if needed	Checks blockage or structural problems
Male fertility	Semen analysis	Checks sperm count, movement, and shape
Infection screening	HIV, hepatitis, other required tests	Ensures safety before treatment
General health	Blood sugar, CBC, medical review	Helps reduce treatment and pregnancy risks

Your IVF specialist may recommend additional tests depending on your history, age, previous pregnancy loss, previous failed IVF, PCOS, endometriosis, male factor infertility, or genetic concerns.

IVF Process Step by Step

Step 1: First Consultation With an IVF Specialist

The first step is a detailed consultation. The doctor reviews your menstrual history, marriage history, pregnancy history, previous treatments, medical conditions, age, lifestyle, and test reports.

For male partners, semen analysis is usually important. Many couples delay this test because of hesitation, but it is one of the most useful early investigations.

At this stage, your IVF specialist may explain whether IVF is needed immediately or whether simpler treatments may be tried first. In some cases, ovulation induction or IUI may be suitable before IVF.

Step 2: Ovarian Stimulation

In a natural menstrual cycle, the ovary usually releases one egg. In IVF, medicines are used to help multiple eggs grow at the same time.

These medicines are usually given as injections for several days. During this period, ultrasound and blood tests may be done to monitor follicle growth and hormone response.

The goal is not simply to produce many eggs. The goal is to produce a safe and suitable number of mature eggs.

Some women may respond strongly to medicines, especially those with PCOS or high ovarian reserve. Others may produce fewer eggs due to age or low ovarian reserve. The dosage is adjusted based on the patient’s response.

Step 3: Trigger Injection

When the follicles reach the right size, a trigger injection is given. This helps the eggs mature before collection.

Timing is very important. Egg retrieval is usually scheduled around 34 to 36 hours after the trigger injection, depending on clinic protocol.

Patients should follow the timing exactly as instructed by the fertility team. A missed or delayed trigger injection can affect the treatment cycle.

Step 4: Egg Retrieval

Egg retrieval is a short procedure done under sedation or anesthesia. A thin needle is guided through the vaginal wall using ultrasound to collect eggs from the follicles.

Many patients fear this step, but most do not feel pain during the procedure because sedation is used. Mild cramping, bloating, or spotting may happen afterward.

Patients are usually advised to rest on the day of egg retrieval. The clinic team will explain medicines, food instructions, and warning signs to watch for.

Step 5: Sperm Collection or Sperm Retrieval

On the day of egg retrieval, the male partner usually gives a semen sample at the clinic. The sample is processed in the laboratory to select healthy sperm.

If sperm is not present in the semen, or if ejaculation is not possible, sperm may be retrieved through a medical procedure. Frozen sperm or donor sperm may be used in selected cases where medically and legally appropriate.

The sperm is then used for fertilization through conventional IVF or ICSI.

Step 6: Fertilization in the Lab

After egg retrieval, the eggs and sperm are brought together in the embryology laboratory.

There are two common fertilization methods:

Method	What Happens	When It May Be Used
Conventional IVF	Eggs and sperm are placed together in a lab dish	When sperm parameters are suitable
ICSI	One sperm is injected directly into one egg	Often used in male factor infertility or previous fertilization failure

Not every egg will fertilize. Not every fertilized egg will develop into a good-quality embryo. This is normal and should be discussed before treatment.

Step 7: Embryo Culture

After fertilization, embryos are monitored in the lab for several days. Some embryos may be transferred on day 3, while others may be grown until day 5 or day 6, known as the blastocyst stage.

The embryologist and IVF specialist assess embryo development and quality. If more good-quality embryos are available, freezing may be considered for future use.

ASRM notes that extra embryos may be cryopreserved for future use.

Step 8: Embryo Transfer

Embryo transfer is usually a simple procedure. A thin catheter is used to place the embryo inside the uterus. It usually does not require anesthesia.

Some patients expect embryo transfer to be painful, but most describe it as similar to a Pap smear or mild pelvic procedure. The emotional pressure may feel greater than the physical discomfort.

Depending on the case, the doctor may recommend fresh embryo transfer or frozen embryo transfer. In some situations, freezing all embryos and transferring later may be safer or more effective.

Step 9: Medicines After Embryo Transfer

After embryo transfer, progesterone or other medicines may be given to support the uterine lining.

This waiting period can feel emotionally difficult. Patients may overanalyze every symptom. Mild cramping, breast tenderness, tiredness, or no symptoms at all can happen. Symptoms alone cannot confirm pregnancy.

Step 10: Pregnancy Test

A blood pregnancy test is usually done around 10 to 14 days after embryo transfer. The clinic will guide the exact timing.

It is better not to test too early at home because early results can be confusing. A blood beta-hCG test gives clearer information.

IVF Timeline: How Long Does IVF Take?

A single IVF cycle may take around 2 to 3 weeks from stimulation to embryo transfer, but the full journey may take longer if extra testing, cycle planning, embryo freezing, or frozen embryo transfer is needed. IVF steps may sometimes be split into different parts, making the process longer.

Phase	Approximate Duration
Initial evaluation	A few days to a few weeks
Ovarian stimulation	8–12 days
Trigger to egg retrieval	Around 34–36 hours
Fertilization and embryo culture	3–6 days
Embryo transfer	Same cycle or later cycle
Pregnancy test	10–14 days after transfer

 

Is IVF Painful?

IVF is not usually described as severely painful, but some steps can cause discomfort.

The most uncomfortable parts may include daily injections, bloating during ovarian stimulation, and cramping after egg retrieval. Egg retrieval itself is usually done under sedation or anesthesia, so patients generally do not feel pain during the procedure.

Embryo transfer is usually quick and mildly uncomfortable rather than painful.

Pain tolerance varies from person to person. If there is severe abdominal pain, heavy bleeding, fever, dizziness, or difficulty breathing after treatment, patients should contact the clinic immediately.

IVF Success Rates: What Couples Should Know

IVF success is strongly linked with age, egg quality, sperm quality, embryo quality, uterus health, and the cause of infertility.

International data shows that younger patients generally have higher success rates. HFEA reported that in the UK in 2023, the preliminary average IVF birth rate using fresh embryo transfers was 35% for patients aged 18–34 and 5% for patients aged 43–44 when using their own eggs.

Factor	How It Can Affect IVF
Female age	Egg number and egg quality decline with age
Ovarian reserve	Low AMH or low follicle count may reduce egg yield
Sperm quality	Low count or movement may require ICSI
Uterus health	Fibroids, polyps, or lining issues may affect implantation
Embryo quality	Better embryo development may improve chances
Lifestyle	Smoking, unmanaged weight, poor sleep, and stress may affect health
Lab quality	Embryology standards are important in IVF outcomes

Success rates should always be discussed individually. SART explains that success estimates are based on people with similar characteristics and may not predict one patient’s exact outcome.

What Age Is Best for IVF?

There is no single “best” age for IVF, but earlier evaluation usually gives more options. Female fertility gradually declines with age, especially after the mid-30s, because egg number and egg quality reduce over time.

For many couples, IVF outcomes are better before age 35 compared with later age groups. However, women above 35 or 40 may still benefit from consultation because treatment options depend on ovarian reserve, uterus health, partner sperm, previous history, and whether donor eggs are considered.

The right time to consult an IVF specialist is:

• After 12 months of trying if the woman is under 35
• After 6 months of trying if the woman is 35 or older
• Earlier if there are irregular periods, known PCOS, endometriosis, blocked tubes, low sperm count, repeated miscarriage, or previous fertility treatment failure

How to Make IVF Successful the First Time

No method can guarantee IVF success the first time. However, good preparation can improve the chances of a healthy treatment cycle.

1. Do a complete fertility evaluation

Both partners should be evaluated. Skipping male fertility testing can delay the right treatment.

2. Choose an experienced IVF clinic

Look for a clinic with qualified IVF specialists, trained embryology staff, transparent counseling, proper laboratory standards, and individualized treatment planning.

3. Follow medicine timing strictly

IVF depends on timing. Injections, trigger medicine, egg retrieval, and transfer schedules should be followed carefully.

4. Improve general health before treatment

Control thyroid problems, diabetes, weight-related risks, anemia, and vitamin deficiencies if advised by your doctor.

5. Avoid smoking and tobacco

Smoking and tobacco use can affect fertility and pregnancy health. Patients should discuss quitting support with a doctor.

6. Prepare mentally

IVF can be emotionally demanding. It is normal to feel hopeful, anxious, and sensitive during treatment. Emotional support from your partner, counselor, or clinic team can help.

7. Ask about embryo transfer strategy

Single embryo transfer may reduce the risk of multiple pregnancy in suitable patients. Multiple pregnancies can increase risks for the mother and babies. Your doctor should guide the safest option.

8. Understand that one cycle may not be the full journey

Sometimes the first IVF cycle provides important information about egg response, fertilization, embryo development, or implantation. If it does not work, the plan may be adjusted.

Choosing an IVF Clinic in Nepal

When choosing an IVF clinic in Nepal, do not look only at advertisements or success claims. Ask practical questions.

Questions to Ask Before Starting IVF

Question	Why It Matters
Who will manage my treatment plan?	You should know your IVF specialist
What tests do we need before IVF?	Avoids incomplete diagnosis
Is ICSI needed in our case?	Helps male factor treatment planning
Will the transfer be fresh or frozen?	Depends on safety and embryo plan
How many embryos should be transferred?	Reduces unnecessary risk
What are the total expected costs?	Helps financial planning
What happens if the first cycle fails?	Helps set realistic expectations
What emergency support is available?	Important for safety

Slavica IVF & Research Center is located in Sinamangal, Kathmandu, and its website describes the center as providing advanced reproductive technology, infertility treatment, and specialist-led care for people seeking IVF services in Nepal.

Risks and Side Effects of IVF

IVF is widely used, but it is still a medical treatment and may involve risks.

Possible side effects include:

• Bloating
• Mood changes
• Injection-site discomfort
• Mild pelvic pain
• Cramping after egg retrieval
• Spotting
• Ovarian hyperstimulation syndrome in some patients
• Multiple pregnancy if more than one embryo implants
• Emotional stress

Mayo Clinic notes that IVF can be time-consuming, expensive, and invasive, and that placing more than one embryo may lead to multiple pregnancy.

Patients should receive clear counseling about benefits, risks, costs, alternatives, and realistic outcomes before starting.

What to Prepare Before Visiting an IVF Specialist

Bring these documents if available:

• Previous ultrasound reports
• Hormone test reports
• AMH report
• Semen analysis report
• HSG or laparoscopy report
• Previous IUI or IVF records
• Medication history
• Surgery history
• Menstrual cycle details
• Pregnancy or miscarriage history

Also prepare your questions. A good consultation is not only about receiving information; it is also about clearing doubts.

IVF Process vs IUI: What Is the Difference?

Feature	IUI	IVF
Fertilization	Happens inside the body	Happens in the laboratory
Procedure	Sperm placed inside uterus	Eggs collected and fertilized outside body
Complexity	Less complex	More advanced
Cost	Usually lower	Usually higher
Suitable for	Mild male factor, ovulation issues, unexplained infertility in selected cases	Blocked tubes, severe male factor, advanced age, failed IUI, endometriosis, low reserve in selected cases
Control over embryos	No embryo observation	Embryo development can be monitored

Your doctor will recommend treatment based on diagnosis, age, duration of infertility, and previous treatment history.

FAQs About the IVF Process

How is IVF done step by step?

IVF is done through fertility testing, ovarian stimulation, trigger injection, egg retrieval, sperm collection, laboratory fertilization, embryo culture, embryo transfer, and pregnancy testing. Some patients may have frozen embryo transfer in a later cycle.

What is the most painful step in IVF?

Egg retrieval is often considered the most physically uncomfortable step, but it is usually done under sedation or anesthesia. Injections and bloating during ovarian stimulation may also cause discomfort.

What are the 5 stages of IVF?

The 5 main stages of IVF are ovarian stimulation, egg retrieval, sperm collection and fertilization, embryo culture, and embryo transfer. Many clinics also include pre-IVF testing and post-transfer pregnancy support as part of the full process.

How does IVF take sperm?

In most cases, sperm is collected through a semen sample on the day of egg retrieval. If sperm is not present in the semen or collection is difficult, a doctor may retrieve sperm through a medical procedure. Frozen sperm may also be used in selected cases.

What age is best for IVF?

IVF generally has better success rates at a younger female age, especially before 35. However, the best time depends on ovarian reserve, sperm quality, medical history, and infertility diagnosis. Women above 35 should seek fertility evaluation sooner.

How to make IVF successful the first time?

You can improve preparation by completing both male and female fertility tests, choosing an experienced IVF clinic, following medicine timing, managing health conditions, avoiding tobacco, maintaining a healthy lifestyle, and discussing embryo transfer strategy with your IVF specialist. Still, no clinic can guarantee success in the first cycle.

Conclusion

The IVF process is a step-by-step fertility treatment that requires medical evaluation, careful timing, laboratory expertise, and emotional preparation. Before starting IVF, couples should understand the tests, medicines, egg retrieval, sperm preparation, embryo transfer, possible risks, timeline, and realistic success factors.

For anyone considering IVF in Nepal, the most important first step is a proper consultation with an experienced IVF specialist. A personalized plan can help you understand whether IVF is the right option for your situation and what you can do to prepare for treatment.

 

Suggested Author Bio

Written by Slavica IVF & Research Center Team
Slavica IVF & Research Center provides fertility evaluation, IVF, ICSI, embryo freezing, sperm freezing, egg freezing, and personalized infertility care in Kathmandu, Nepal. This article is intended for educational purposes and should not replace consultation with a qualified fertility specialist.

 

Medical Disclaimer

This blog is for informational purposes only. It should not be used as a substitute for professional medical advice, diagnosis, or treatment. Always consult an IVF specialist or qualified healthcare provider for personalized fertility guidance.