Learn about the IVF process in detail, including the risk factors, success rates, and timeline.

The process of having a baby can be unpredictable and stressful. After undergoing testing and potentially fertility treatments, such as hormone therapy or intrauterine insemination (IUI), you may decide with your fertility specialist that assisted reproductive technologies (ARTs) are best way to proceed.

This article explores the most common ART, in vitro fertilisation (IVF). We look at the IVF process in detail, including the risk factors, success rates, and the timeline for this type of fertility treatment.

IVF: An overview

In vitro fertilisation (IVF) is a medical procedure which can help people experiencing fertility problems to have a baby. In IVF, eggs are taken from the female partner's ovaries and combined with the male partner's sperm (or donor sperm) in a test tube. This results in one or more fertilised eggs that are then implanted into the woman's uterus to continue growing and developing.

This method can use either the woman's eggs and her partner's sperm, or donor eggs (currently prohibited in Switzerland) and sperm. In Switzerland, a female same-sex couple is also allowed to undergo IVF, using eggs from one of the partners and sperm from a donor, as long as they are married.

IVF can be an exciting but stressful, time-consuming, and costly fertility treatment. One complete cycle of IVF takes about four to six weeks, but the process may take longer. There are many factors that influence your chances of successfully conceiving a baby with IVF, such as your age and whether you have been diagnosed with infertility.

When choosing to do IVF, it is a good idea to ask your doctor or fertility specialist about the potential outcomes of the process.

Why is IVF done?

IVF may be offered to women over 40 who are experiencing infertility and wish to conceive. IVF can also be carried out if you or your partner have certain health conditions, such as:

  • Ovulation disorders. Ovulation disorders, such as polycystic ovary syndrome (PCOS), involve infrequent or absent ovulation. This a common cause of infertility, as fewer eggs are available for fertilisation.
  • Fallopian tube blockage or damage. Damage to the fallopian tubes can impact the fertilisation process or prevent a fertilised egg or embryo from reaching the uterus.
  • Endometriosis. In this condition, tissue similar to that which makes up the uterine lining (endometrium) grows outside of the uterus. Endometriosis can cause pain and heavy bleeding. It can also affect uterine, ovarian and fallopian tube functioning, making it harder to get pregnant.
  • Impaired sperm production or function. Having sperm parameters (concentration, size, shape and movement) that are below average can make it difficult to fertilise an egg.
  • Uterine fibroids. Fibroids are noncancerous tumors in the uterus that can make it difficult for a fertilised egg to implant. Implantation is a key step in establishing a pregnancy.
  • Previous tubal removal or sterilisation. Also called tubal ligation, this procedure to prevent pregnancy involves having the fallopian tubes blocked, clipped or removed.
  • Genetic disorders. If you or your partner have been diagnosed with a genetic disorder (or are known to be a carrier), you may consider preimplantation genetic testing. In this procedure, fertilised eggs are screened for specific genetic problems before the embryo transfer takes place.
  • Unexplained infertility. Unexplained (or idiopathic) infertility means that despite fertility testing, the cause of infertility is unknown.

Preservation of fertility in cancer or other conditions

Cancer treatments, including radiation and chemotherapy, can negatively affect fertility. In these cases, preserving fertility prior to treatment may be important. One possible solution to this is egg freezing or IVF. This involves collecting a woman's eggs from her ovaries, freezing them (either in an unfertilised state or as fertilised embryos), and storing them for future use.

IVF for surrogacy

Surrogacy is the process in which a woman carries and gives birth to a baby for another individual or couple. In the case of gestational surrogacy, the female partner's eggs are fertilised with sperm through IVF. The embryos resulting from this process are transferred to the uterus of a gestational carrier (a woman who carries a pregnancy but is not the biological parent of the baby). This approach may be suggested in instances where there are health risks to pregnancy or for same-sex couples.

Although this procedure is currently prohibited under Swiss law, it is becoming common for couples residing in Switzerland to undergo surrogacy abroad for their unfulfilled wish to have children. If you are considering surrogacy abroad, you should seek legal advice in good time.

How do I prepare for an IVF cycle?

The first step is to have an initial consultation with a fertility specialist to discuss the process and decide on a treatment plan tailored to your case.

In this consultation, the fertility specialist will ask you and your partner about your medical history, including previous fertility testing and treatments. This is a good chance to ask questions or bring up concerns. While this can be emotional, be bold and come with a long list. You should feel well-informed and comfortable with your options before you decide on a treatment path.

After the initial consultation, it is a good idea to begin considering the financial side of IVF. In Switzerland, up to 12 hormone treatment cycles may be covered by compulsory health insurance. The IVF procedure is not covered by health insurance. To minimise your stress, reach out to a financial counsellor and make a plan for financing the treatment.

After a fertility specialist reviews your case and desired treatment plan, you will have another appointment to go over the process in detail and schedule procedures. It is also fairly common to take various medications during the IVF cycle (e.g. to stimulate the growth and maturation of eggs). During this appointment, you will learn how to self-administer them.

IVF and fertility testing

Before beginning a cycle of IVF, it is common to go through various fertility tests and screenings. These can include the following:

  • Ovarian reserve testing. This combination of blood tests assesses the quantity and quality of your eggs and how you will react to fertility medication. More specifically, it measures the concentration of hormones that are critical to female fertility: follicle-stimulating hormone (FSH), estradiol (estrogen) and anti-mullerian hormone (AMH).
  • Uterine exam. These tests examine the inside lining of the uterus to diagnose your uterine condition. A couple of tests can be used for this, such as sonohysterography. This involves inserting a thin tube through the vagina to the opening of the cervix and injecting a saline solution into the uterus. A transvaginal ultrasound probe then captures internal images of the fluid-filled uterus. Another option is hysteroscopy. In this procedure, a slim, flexible hysteroscope (a thin camera with a light on the end) is inserted into your uterus via your vagina and cervix.
  • Semen analysis. A semen analysis assesses sperm count, motility (movement), morphology (size and shape) and more.
  • Infectious disease screening. There are various tests to determine whether you or your partner may be experiencing infertility due to an infectious disease, such as chlamydia and HIV.

What should I know before an IVF cycle?

Here are some things to consider before starting the IVF process:

  • Number of embryos to transfer. Typically, one embryo will be transferred at a time. However, other factors, such as your age and the number of embyros available, may mean that you have the option to transfer more. Confirm the number of embryos to be transferred during your consultation with the fertility specialist.
  • What if I get pregnant with multiples? IVF can lead to a multiple pregnancy (a pregnancy with two or more fetuses) if more than one embryo is transferred to a woman's uterus. This can potentially cause health hazards for both the woman and the babies. Fetal reduction may be considered an option to mitigate the risks, however, choosing to undergo fetal reduction is a significant choice that carries moral, emotional, and psychological considerations.
  • How will I manage extra embryos? It is possible to freeze and preserve additional embryos for ten years to use in the future. Preserving embryos can reduce the cost and invasiveness of future IVF cycles. You may also choose to discard any unused embryos.

What is the step-by-step process for IVF?

IVF is a multi-step procedure, involving: ovarian stimulation, retrieval of eggs, collection of sperm, fertilisation, and embryo transfer. This section provides an overview of the general IVF process by looking at each stage step by step.

1. Ovarian stimulation

The first step is taking medicine to suppress your natural menstrual cycle. This can be in the form of a nasal spray or an injection.

Once your natural cycle is suppressed, you take medication to stimulate your ovaries, which increases the production of eggs. This medication contains luteinising hormone (LH), follicle-stimulating hormone (FSH), or both.

Not all eggs will be successfully fertilised or develop even after fertilisation, so ovarian stimulation is necessary. With more fertilised eggs, there is a greater choice of embryos for IVF treatment.

Before extracting the eggs, it is important to evaluate whether they are mature. This is done through

  • A vaginal ultrasound, to see how the follicles (the sacs in the ovaries where eggs mature) are developing; and
  • Blood tests, which assess how your body is reacting to the medication given to stimulate your ovaries.

Once the follicles are prepared for egg retrieval, you will be given a trigger injection with human chorionic gonadotropin (hCG) or another medication to induce the final maturation of the egg.

It is possible to encounter challenges during ovarian stimulation. Sometimes, a decision is made to cancel the IVF cycle before the second stage (egg retrieval). This may be the case if

Following a cancelled cycle, the fertility specialist may suggest changes for subsequent IVF cycles, including changing medications or their dosages.

2. Egg retrieval

The egg retrieval typically takes place 36 hours after the trigger shot.

In preparation for egg retrieval or embryo transfer, you might be given progesterone supplements; these help prepare the uterine lining (the endometrium) for the egg to implant.

The standard approach to extracting eggs is transvaginal ultrasound aspiration. This technique involves using an ultrasound wand in the vagina to locate follicles, followed by the insertion of a thin needle through the vagina and into the follicles to collect the eggs. If the ultrasound probe cannot access your ovaries, an abdominal ultrasound can be used instead to determine the correct placement of the needle.

In the egg retrieval procedure, a suction device connected to the needle extracts the eggs from the follicles. This process typically takes around 20 minutes, during which multiple eggs can be collected simultaneously. After the procedure, it's common to feel cramping and some pressure.

Mature eggs (ova) are incubated in a liquid that supports the growth of cells (also known as a culture medium). The mature and healthy eggs will be combined with sperm to produce embryos. It's important to note that not all eggs may be successfully fertilised.

3. Sperm retrieval

Sperm retrieval for IVF may be done in several ways. Typically, a fresh semen sample is collected through masturbation. This sample can be provided at the clinic on the day of egg retrieval, or at home using particular guidelines. In the latter case, the sample must be given in a sterile container provided by the clinic, kept around room temperature (20 degrees Celsius), and brought into the clinic within one hour.

In some cases, such as when donated sperm is being used, IVF may be performed with a thawed sperm sample. Donor sperm may be used in Switzerland, although certain regulations must be followed. It is also possible that sperm may be directly extracted from the testicles through a medical produre called testicular sperm aspiration (TESA).

After retrieval, sperm are washed and rapidly spun to choose the most vigorous and healthy sperm for use. In the case of donated sperm, it must first be thawed before it can be prepared.

4. Fertilisation

In IVF, mature eggs may be fertilised through one of two techniques:

  • Standard insemination. This involves combining healthy sperm with mature eggs, then leaving them in an incubator to develop overnight.
  • Intracytoplasmic sperm injection (ICSI). This process entails taking mature eggs and injecting them with a single healthy sperm. ICSI can be a good option if there are issues with particular sperm or semen parameters (such as sperm motility) or if previous IVF cycles have not resulted in successful fertilisation.

Certain procedures are sometimes recommended before embryos are placed into the uterus. These include:

  • Assisted hatching. Typically, around five to six days after conception, a fertilised egg breaks out of its protective covering (the zona pellucida) and attaches to the uterus wall. If a woman is older or has experienced prior unsuccessful in vitro fertilisation (IVF) cycles, her specialist may suggest a procedure known as assisted hatching. This involves making a small opening in the zona pellucida before the embryo is transferred into the uterus, to support the hatching of the egg and subsequent implantation. Assisted hatching may also be performed to frozen eggs or embryos, as the freezing process can make the zona pellucida more resilient.
  • Preimplantation genetic testing. This procedure screens developing embyros for any genetic issues or chromosomal abnormalities. After the embryos develop in an incubator for around five to six days, a tiny sample can be taken and analysed. It's important to note that preimplantation genetic testing can minimise the chances of passing on a genetic issue, but cannot guarantee it.

5. Embryo transfer

Embryo transfer may take place with fresh embryos or frozen embryos. In a fresh embryo transfer, the embryo is inserted into the uterus shortly after the egg retrieval process without freezing it. In contrast, a frozen embryo transfer involves thawing frozen embryos, which can be from a previous IVF cycle or an egg donor, and inserting them into the uterus. Frozen embryo transfers can be performed many years after egg retrieval and fertilisation.

The embryo transfer procedure typically occurs at the clinic, about two to five days following egg retrieval. The actual transfer may cause slight discomfort, and in some cases you may experience mild cramping. Before the procedure, you may be given a mild sedative.

At the beginning of the transfer, a specialist will insert a flexible tube through your vagina and cervix into your uterus. The embryo or embryos are then transferred into your uterus by means of a syringe connected to the tube.

In a successful transfer, an embryo would typically be expected to implant in the endometrium around six to 10 days following the egg retrieval procedure.

Once the transfer is done, can go back to your daily routine. However, your ovaries may remain swollen and you may feel discomfort. In this case, take a break from strenuous exercise or activities.

Following the procedure, you may experience the following side effects:

  • Breast tenderness due to high levels of estrogen.
  • Minimal fluid discharge (clear or bloody) due to cervical swabbing before embryo transfer.
  • Mild bloating, mild cramping and constipation

While uncommon, complications, such as an infection, twisted ovary, or ovarian hyperstimulation syndrome (OHSS), can occur following the embryo transfer. If you are experiencing moderate or intense pain after the procedure, contact your fertility specialist.

Results

Pregnancy testing is typically done two weeks after egg retrieval. The two-week waiting period after the treatment can be difficult and cause anxiety due to the uncertainty of its success. For many, this is the most challenging part of the treatment process. To help cope with this period, speak with a counsellor through your fertility clinic or reach out to others in a similar situation.

Your fertility specialist will take a blood sample around 12 to 14 days after egg retrieval to determine if you are pregnant.

  • If the test is positive, your specialist will refer you to an obstetrician for prenatal care.
  • If the test is negative, your specialist will advise you to stop hormonal treatments. You will likely get your period within seven days.

Although light spotting is normal after IVF, you must inform your specialist if it doesn't clear up after a few days, especially if you experience heavy bleeding accompanied by nausea or severe cramping.

If you are not pregnant, it's time to meet with your fertility specialist before continuing with another IVF cycle. During this time, you may discuss why the cycle failed, if there is anything you can do differently for the next process, and whether you should add any procedures.

Frequently Asked Questions

IVF Timeline: How long is the IVF process from start to finish?

Each IVF cycle takes about 28–40 days, but it can take longer. It is important to remember that each case is unique, and it is normal for the IVF process and timeline to vary. Since a successful pregnancy is not guaranteed, some people may need to undergo several cycles.

Here is a guide to the IVF Cycle timeline:

  • IVF cycle day 2 -14: Stimulation medication
  • IVF cycle day 14: Trigger shot
  • IVF cycle day 16: Egg/sperm retrieval
  • IVF cycle day 20: Embryo transfer
  • 2 week wait: Pregnancy test results

What is the success rate of IVF?

The success rate of IVF depends on various factors, including:

  • A woman's age. The likelihood of getting pregnant and having a healthy baby with your eggs during IVF is linked with age, meaning younger women tend to have higher success rates. However, women who are 41 years old or older may be advised that using donor eggs could increase their chances of a successful pregnancy. In Switzerland, using donor eggs is currently prohibited.
  • Embryo status. There is moderate evidence that using a more developed embryo may be associated with higher pregnancy rates.
  • Reproductive history. Women who have previously given birth have better chances of achieving pregnancy through IVF than those who haven't. However, the success rate of IVF tends to decrease for women who have undergone multiple IVF cycles without success.
  • Cause of infertility. Your likelihood of getting pregnant with IVF can depend on whether the procedure effectively treats the cause of infertility. For example, women with severe endometriosis have lower chances of getting pregnant with IVF than those with tubal infertility.
  • Lifestyle factors. Smoking can have negative effects on the success of IVF, as women who smoke tend to have fewer eggs retrieved and may experience miscarriage more often. Thus, the chances of success with IVF are generally lower for women who smoke. Obesity can also make it more difficult to have a child. In a 2019 meta-analysis, obesity was associated with a significant decrease in the probability of live birth following IVF. Drinking alcohol, using recreational drugs, ingesting large amounts of caffeine and taking certain medications can also have a negative impact.

If you have any concerns or would like to know more about how to influence the likelihood of a successful pregnancy, speak with your doctor.

What are the risks of IVF?

IVF does not always result in pregnancy, and the process can be physically and emotionally demanding. You and your partner should be offered counselling and support to help you through the process.

There are also several health risks involved, such as:

  • Side effects from medications used during IVF treatment, such as hot flashes
  • Multiple births, which can be hazardous for both the mother and children
  • Ectopic pregnancy, where the embryo implants in the fallopian tubes
  • Ovarian hyperstimulation syndrome (OHSS) can occur when the ovaries react excessively to IVF medications.

Think about scheduling treatment for a time when you can handle it, such as when work is slower or you can take time off.

What should I eat during IVF?

While undergoing an IVF cycle, it is important to prioritise healthy, well-rounded meals. According to one study, adhering to a Mediterranean diet (which includes plenty of vegetables, fruits, seafood, whole grains and legumes) may increase the likelihood of a successful IVF cycle, particularly for women under the age of 35 who are not overweight or obese. Although more clinical research is required, maintaining a healthy diet in the weeks following the cycle may be beneficial. Additionally, since diet can impact sperm health, it may be helpful to encourage your partner to follow a Mediterranean diet alongside you.

To maintain a healthy and balanced diet, consuming plenty of fresh fruits and vegetables, lean sources of protein (such as fish and poultry), and whole grains like quinoa, farro, and whole-grain pasta is recommended. Legumes, such as beans, chickpeas, and lentils, can be beneficial. Consuming healthy fats from sources like avocado, extra-virgin olive oil, nuts, and seeds is encouraged. At the same time, heavily processed foods should be avoided. Salt should also be limited, with herbs and spices used to add flavour to meals instead.

Getting support

Psychological support is essential during this physically and emotionally challenging time, whether from friends, family, online communities, group therapy or private counselling. If you are going to try therapy, try to find a therapist who specialises in infertility. You can also explore stress management techniques like yoga, breathwork, or guided meditation.

Takeaway

IVF is an effective assisted reproductive technology used to help couples fulfil their desire to have a child. During this procedure, an egg is removed from the woman's ovaries and fertilised with sperm in a laboratory. Then, the fertilised egg, or embryo, is returned to the woman's womb to grow.

An average IVF cycle takes about four to six weeks from consultation to transfer. It is important to remember that each case is unique, and your journey may differ based on your specific circumstances and how your body responds at each stage. Your chances of success with IVF depend on many factors, such as the cause of infertility, age, and lifestyle habits.

The risks of IVF include multiple pregnancy, ectopic pregnancy, ovarian hyperstimulation syndrome, or side effects from medication. Furthermore, IVF can be emotionally and physically demanding. Under these circumstances, it is recommended seek out psychological support.

Learn more about the costs of IVF, or speak to one of our compassionate fertility specialists to get information about IVF and other treatments. Reserve your spot for a free consultation today.