The Basics of In Vitro Fertilization

In vitro fertilization (IVF) is a medical treatment that can help people get pregnant. In 1978, Louise Brown was the first baby born through IVF. Since then millions of babies have been born thanks to IVF. IVF is constantly changing as more medical advances are developed, and over the last 40 years it has become safer and even more successful. 

If you’re starting IVF treatments, it’s normal to feel anxious and even scared. Understanding the IVF process can help you feel more comfortable and confident as you go through the steps. 

In vitro fertilization is a process with several steps

You might hear the terms “a round of IVF” or a “cycle of IVF” — these terms are used to describe the fact that IVF is actually a process with several steps. Each step requires different tests, medications, and procedures. Let’s take a look at each one.

Ovulation induction

During this step you use hormone medications to get the ovaries to produce eggs. Normally, only one egg is produced during a menstrual cycle. These medications tell the ovaries to make as many eggs as possible during a single menstrual cycle. This step is the most time intensive because you will need to have “monitoring” while you’re on the medications. This includes daily (or every other day) blood work and ultrasounds. You’ll also have to give yourself several medications each day (the number varies depending on your treatment plan). And you’ll need to take them at the same time each day. Unfortunately, all the medications are injected, so it’s not a comfortable process.

Egg (and sperm) retrieval 

Once your eggs have grown, you’ll use a special injected medication to “mature” your eggs — this is called the “trigger.” You’ll have your egg retrieval 12 to 24 hours after your trigger, although some centers wait up to 36 hours after the trigger. During the egg retrieval, the doctor will insert a needle through your vagina into your ovaries to retrieve the eggs. You’ll get anesthesia, so you’re asleep and free of pain during this process. It’s also pretty quick, lasting 20 minutes.

If you’re using fresh sperm for your cycle, the male will be asked for a sample during your retrieval. Once you wake up from your egg retrieval, your team will tell you how many eggs they were able to retrieve. 

Fertilization

IVF actually refers to the process of adding sperm to eggs in a laboratory. During this step, the eggs and sperm are placed together, and fertilization takes place. Not every egg that’s retrieved will get fertilized. But the ones that do get fertilized can become embryos. Usually the day after your egg retrieval, your team will call you to let you know how many embryos were made from the IVF process. 

Embryo transfer

On the third or fifth day after your egg retrieval, you’ll have an embryo transfer. You’ll meet with your team and they’ll give you a picture of your embryo and review the plan for your 2-week wait. 

During the transfer, one or more embryos will be placed into your uterus using a tube called a catheter. This only takes about 10 minutes and is a relatively painless step, so you will not need anesthesia. Some people will have more than one embryo transferred at a time. Some people may choose to skip this step and instead freeze their embryos or send them for genetic testing first.

Two-week wait

This last step is the most difficult for many people. Like it sounds, all you do now is wait and give yourself one daily medication — progesterone. This medication can be used as an injection or a suppository. On the fourteenth day you’ll have a blood test to see if you’re pregnant. 

Getting through the 2 week wait isn’t easy. After so many appointments, blood tests, and procedures — not to mention the hormone medications — it can feel very anticlimactic to sit and wait. It’s also hard to wait and wonder if symptoms might mean you're pregnant. In general, during this time, it’s best to keep busy and find social support. It’s also a good idea to stop using alcohol and certain medications. You should also avoid foods that shouldn’t be eaten during pregnancy and take a prenatal vitamin. “Acting like you’re pregnant” can take an emotional toll during the wait, but it’s important to be safe during this time.

An entire IVF cycle takes about 4 weeks, about the same amount of time as a menstrual cycle. 

In vitro fertilization is expensive, but there are ways to find savings

IVF is expensive. Many states have laws requiring insurance companies to pay for fertility treatments — which may include all IVF cycle costs or just induction medications. Even if you don’t live in one of these states, your commercial insurance may still cover IVF cycle costs. But even if your insurance covers IVF, they might only cover one or two cycles. If you need more cycles, things can become expensive quickly.

Fertility centers will have options if you don’t have insurance coverage. Some centers offer a sliding-scale cost for a cycle of IVF that’s based on your income. Other centers offer discounts on additional cycles. Some centers offer “guarantee cycles” — this could mean a free cycle if your first isn’t successful. Or you might get your money back if the cycle isn’t successful. 

It’s important to understand all the costs associated with your cycle. IVF cycle costs vary depending on where you live. But in general, a cycle with medications can cost between $17,000 and $25,000. You should discuss each cost with your insurance provider and your fertility center so you don’t face any surprise charges. Here are some points to discuss:

• Medication costs: Induction medications, trigger medication, and intramuscular progesterone are carried by speciality pharmacies. If your insurance company is covering the cost of medication, ask if you have to use a specific pharmacy. Your center can send the prescriptions to the pharmacy of your choice. If you need multiple cycles, save medications you don’t use for subsequent cycles — this can save you money. 

• Ultrasounds, bloodwork, retrieval, and transfer costs: Cycle costs should cover all of your bloodwork, ultrasound monitoring, and visits to your doctor during the cycle. It should also cover all egg-retrieval costs — including anesthesia, operating room costs, anesthesiologist fees, and the embryo transfer. 

• Embryology lab costs: After fertilization, the embryos are kept in a special embryology lab where embryologists care for and monitor them. This should be included in the cycle costs. But there may be extra charges for specialized procedures like intracytoplasmic sperm injection (ICSI) and embryo hatching. If you’re freezing your embryos, you should be aware that insurance may not cover embryo freezing, storage, and thawing. Ask your center if these costs are covered in your cycle costs or if there are separate fees. 

• Processing and miscellaneous fees: Discuss potential additional fees with your center, such as the cost of sperm processing — whether fresh or frozen. Also ask about egg thawing if you’re using frozen or donor eggs, additional embryo freezing, and additional frozen embryo transfers. Your cycle costs may not include preimplantation genetic testing either. Ask if there are other fees you should be aware of — the center can tell you about additional costs so you aren’t taken by surprise. 

In vitro is overwhelming, but you’re not alone

If you’re feeling overwhelmed right now, know that it’s totally normal. IVF is an enormous life event. But you’re not alone. A recent poll showed 33% of Americans have either gone through fertility treatment or know someone who has. There’s an incredible and supportive community of people who have gone through this before. They have knowledge and tips to share — and shoulders to lean on. Your fertility center will have support groups they can recommend, or you can visit Resolve.org to find a local group in your area. 

Why trust our experts?

Written by:

Jennifer Clements, MD, MSEd, NBHWC

Jennifer Clements, MD, MSEd, NBHWC, is a board-certified physician and health coach who is passionate about achieving optimal health through healthy lifestyles. Clements is a diplomate of the American Board of Obesity Medicine and the American Board of Integrative Medicine.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Our editorial standards

Meet our experts