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In-vitro fertilisation, or IVF, is a fertility treatment where eggs are collected from the ovaries and fertilised with sperm in a laboratory. The resulting embryo may then be transferred into the uterus, with the aim of achieving pregnancy.
Couples may consider IVF for different reasons, including blocked fallopian tubes, male factor infertility, endometriosis, ovulation problems, unexplained infertility, age-related fertility concerns, or previous unsuccessful fertility treatment. While IVF is one of the more established assisted reproductive treatments, the process can feel unfamiliar at first because it involves several medical, laboratory and waiting stages.
What Is IVF?
IVF is a form of assisted reproductive treatment. Unlike natural conception, where fertilisation happens inside the body, IVF allows eggs and sperm to be brought together in a laboratory. If fertilisation occurs and an embryo develops, an embryo may be transferred into the uterus.
IVF may involve:
- Ovarian stimulation
- Monitoring scans and blood tests
- Egg retrieval
- Sperm collection and preparation
- Fertilisation in the laboratory
- Embryo culture
- Embryo transfer
- Pregnancy testing
- Freezing of suitable embryos where applicable
The exact plan may vary depending on the patient’s age, ovarian reserve, sperm quality, medical history and previous treatment response.
Step 1: Initial Fertility Consultation
The IVF process usually starts with a fertility consultation. The doctor will review both partners’ medical history, reproductive history, previous pregnancies, menstrual cycle, medication, lifestyle factors and any previous fertility tests or treatments.
The consultation may cover:
- How long the couple has been trying to conceive
- Menstrual cycle pattern
- Ovulation concerns
- Previous miscarriages or ectopic pregnancy
- History of pelvic infection or surgery
- Known PCOS, endometriosis, fibroids, or ovarian cysts
- Semen analysis results
- Previous IUI or IVF attempts
- Age-related fertility considerations
- Fertility goals and treatment preferences
For patients looking for a recommended fertility clinic or specialist option in Singapore, Health & Fertility Centre for Women, led by Dr Kelly Loi, provides fertility, IVF, gynaecology and obstetric care.
Step 2: Fertility Tests Before IVF
Before starting IVF, the doctor may recommend tests to understand the possible cause of infertility and plan treatment safely.
Common tests may include:
- Hormonal blood tests
- Ovarian reserve testing
- Pelvic ultrasound
- Fallopian tube assessment where relevant
- Semen analysis
- Infection screening where relevant
- Review of previous scan or surgery reports
- General health assessment
- Pre-pregnancy blood tests where needed
These tests help the fertility specialist decide the medication plan, stimulation dose and whether IVF, ICSI, or another approach may be suitable.
Step 3: IVF Cycle Planning
Once the test results are reviewed, the doctor will discuss the IVF treatment plan. This may include the type of stimulation protocol, medication schedule, expected number of visits, estimated timeline, possible risks and cost considerations.
Patients should ask:
- Why is IVF recommended in our case?
- Is ICSI needed?
- What medication will be used?
- How many clinic visits are expected?
- What side effects should I watch for?
- What happens if the ovaries respond too strongly or too weakly?
- What happens if the cycle needs to be cancelled?
A written treatment schedule can help patients prepare for medication timing, scans and procedures.
Step 4: Ovarian Stimulation
During a natural menstrual cycle, usually one egg matures and is released. In an IVF cycle, medication is used to encourage the ovaries to develop multiple follicles. Each follicle may contain an egg, although not every follicle will necessarily contain a mature egg.
Ovarian stimulation usually involves hormone injections over several days. The exact duration and dose vary between patients.
During this stage, patients may experience:
- Bloating
- Mild pelvic discomfort
- Breast tenderness
- Mood changes
- Tiredness
- Injection-site discomfort
Patients should follow medication instructions carefully and contact the clinic if they miss a dose, experience severe pain, or develop concerning symptoms.
Step 5: Monitoring Scans and Blood Tests
During ovarian stimulation, the clinic will monitor how the ovaries are responding. This usually involves ultrasound scans and, in some cases, blood tests.
Monitoring helps the doctor assess:
- Number of developing follicles
- Follicle size
- Endometrial lining thickness
- Hormone levels where needed
- Whether medication adjustments are required
- When the eggs may be ready for retrieval
Patients may need several visits during this period. The schedule can change depending on follicle growth and response to medication.
Step 6: Trigger Injection
When the follicles reach a suitable stage, the doctor will prescribe a trigger injection. This injection helps the eggs complete their final maturation before egg retrieval.
Timing is important. The trigger injection must usually be taken at a specific time because egg retrieval is scheduled based on it.
Patients should confirm:
- Exact trigger injection time
- Injection method
- Whether other medication should continue or stop
- Time of egg retrieval
- Fasting instructions before the procedure
- What to bring on the day of retrieval
If the trigger timing is missed or delayed, patients should contact the clinic immediately for advice.
Step 7: Egg Retrieval
Egg retrieval is a procedure where eggs are collected from the ovaries. It is usually performed under sedation or anaesthesia. The doctor uses ultrasound guidance to collect fluid from the follicles, which is then checked by the laboratory for eggs.
Patients may experience mild cramping, bloating, spotting, or tiredness after the procedure. Most patients need someone to accompany them home because sedation can affect alertness.
After egg retrieval, patients should ask:
- How many eggs were collected?
- How many were mature?
- What symptoms are expected after the procedure?
- What symptoms should prompt medical review?
- When will fertilisation updates be provided?
Patients should seek medical advice if they develop severe abdominal pain, heavy bleeding, fever, fainting, severe bloating, vomiting, or shortness of breath.
Step 8: Sperm Collection and Preparation
On the day of egg retrieval, a sperm sample is usually collected and prepared in the laboratory. In some cases, frozen sperm may be used. If there are male factor fertility concerns, the fertility team may discuss additional steps or referral where needed.
Sperm preparation helps select sperm for fertilisation. The laboratory will then use standard IVF insemination or ICSI depending on the treatment plan.
Patients should ask:
- Is a fresh or frozen sperm sample being used?
- Is ICSI recommended?
- What happens if sperm quality is lower than expected?
- Are additional male fertility tests needed?
Step 9: Fertilisation in the Laboratory
After egg and sperm collection, fertilisation takes place in the laboratory.
There are two common methods:
- Standard IVF: Eggs are placed with prepared sperm and fertilisation happens in the laboratory dish.
- ICSI: A single sperm is injected directly into an egg to assist fertilisation.
ICSI may be discussed when there are sperm-related concerns, previous fertilisation problems, or other clinical reasons.
The clinic will usually update patients on how many eggs fertilised. Not every egg will fertilise, and not every fertilised egg will continue developing into a suitable embryo.
Step 10: Embryo Culture
After fertilisation, embryos are monitored in the laboratory for development. Embryos may be cultured for several days before transfer or freezing, depending on the treatment plan.
During this stage, patients may receive updates on:
- Number of fertilised eggs
- Embryo development
- Embryo quality
- Timing of embryo transfer
- Whether embryos are suitable for freezing
- Whether a fresh or frozen transfer is planned
Embryo development can be uncertain. Some embryos may stop developing before transfer. The fertility team will explain what this means and what options remain.
Step 11: Embryo Transfer
Embryo transfer is the procedure where an embryo is placed into the uterus. It is usually shorter and less invasive than egg retrieval. Sedation is not always required, although this depends on clinic protocol and patient factors.
During the procedure, a thin catheter is used to place the embryo into the uterus. The number of embryos transferred depends on medical advice, embryo quality, patient age, treatment history and local regulations.
Patients should ask:
- How many embryos are recommended for transfer?
- What is the embryo quality?
- What should I do after transfer?
- Do I need bed rest?
- What medication should I continue?
- When should I take a pregnancy test?
Patients should follow the clinic’s instructions after embryo transfer and avoid making medication changes without medical advice.
Step 12: Luteal Phase Support
After embryo transfer, patients may be prescribed medication to support the uterine lining. This is often called luteal phase support. It may involve progesterone or other medication depending on the protocol.
Patients should ask:
- What medication should I take?
- How often should I take it?
- What side effects are expected?
- When should I stop or continue medication?
- What if I miss a dose?
Some medication side effects may feel similar to early pregnancy symptoms, which can make the waiting period emotionally challenging.
Step 13: The Two-Week Wait
The period between embryo transfer and pregnancy testing is often called the two-week wait, although the exact number of days may vary.
During this time, patients may feel anxious and may look for symptoms. However, symptoms such as bloating, cramping, breast tenderness, tiredness, or light spotting can be caused by medication, the procedure, or early pregnancy. Symptoms alone cannot confirm whether IVF has worked.
Patients should avoid testing too early unless advised by the clinic, as early testing may give unclear or misleading results.
Step 14: Pregnancy Test
The clinic will usually advise when to take a blood pregnancy test. This test measures pregnancy hormone levels and is more reliable than relying on symptoms alone.
If the test is positive, further blood tests or an early pregnancy scan may be arranged. If the test is negative, the doctor may advise stopping certain medication and arranging a review appointment.
Patients should ask:
- When should I do the pregnancy test?
- Is a blood test needed?
- What happens if the result is positive?
- What happens if the result is negative?
- When should I schedule a review?
Step 15: What Happens If IVF Is Successful?
If pregnancy occurs, the clinic may arrange follow-up blood tests and an early ultrasound scan to confirm pregnancy location and development. Once the pregnancy is stable, care may continue with an obstetrician.
Patients should ask:
- When is the first pregnancy scan?
- Should I continue medication?
- When will I transfer to pregnancy care?
- Are there warning symptoms to watch for?
- What lifestyle advice should I follow?
Patients should seek urgent medical care if they have severe abdominal pain, heavy bleeding, fainting, or shoulder tip pain, as these symptoms need prompt assessment.
Step 16: What Happens If IVF Is Not Successful?
An unsuccessful IVF cycle can be emotionally difficult. A review appointment can help patients understand what happened during the cycle and what may be considered next.
The doctor may review:
- Ovarian response
- Number of eggs collected
- Egg maturity
- Fertilisation outcome
- Embryo development
- Embryo transfer details
- Uterine lining
- Medication protocol
- Whether frozen embryos are available
- Whether changes are needed for another cycle
Patients should ask what can be learnt from the cycle and whether another attempt, frozen embryo transfer, further testing, or a different treatment approach may be discussed.
Frozen Embryos and Future Transfers
If suitable embryos remain after an IVF cycle, they may be frozen for possible future use. A frozen embryo transfer may allow patients to attempt pregnancy without repeating ovarian stimulation and egg retrieval.
Patients should ask:
- Were any embryos suitable for freezing?
- How long can embryos be stored?
- What are storage costs?
- What consent forms are needed?
- When can a frozen embryo transfer be considered?
- What preparation is needed for a frozen transfer?
Not every cycle results in embryos suitable for freezing.
Possible Risks and Side Effects of IVF
IVF is generally planned carefully, but patients should understand possible risks and side effects.
These may include:
- Medication side effects
- Bloating and pelvic discomfort
- Ovarian hyperstimulation syndrome
- Bleeding or infection after egg retrieval
- Multiple pregnancy risk depending on embryo transfer plan
- Ectopic pregnancy
- Emotional stress
- Cycle cancellation if response is unsuitable
Patients should ask their fertility specialist which risks apply to their situation and what symptoms should prompt medical review.
The IVF process involves several stages, from initial fertility assessment and cycle planning to ovarian stimulation, monitoring, trigger injection, egg retrieval, sperm preparation, fertilisation, embryo culture, embryo transfer and pregnancy testing.
Each patient’s IVF journey may differ depending on age, ovarian reserve, sperm quality, medical history, diagnosis and treatment response. Some patients may proceed with fresh embryo transfer, while others may have embryos frozen for a later transfer. Some cycles may also need adjustment, cancellation, or further review depending on response and results.
Patients in Singapore should ask their fertility specialist for a clear explanation of the treatment plan, expected timeline, possible risks, costs and next steps after either a positive or negative result. Understanding the IVF process step by step can help couples feel more prepared and informed throughout treatment.
FAQ
What is IVF?
IVF, or in-vitro fertilisation, is a fertility treatment where eggs are collected from the ovaries and fertilised with sperm in a laboratory. An embryo may then be transferred into the uterus.
How long does the IVF process take?
The timeline varies depending on the stimulation protocol, monitoring response and whether a fresh or frozen embryo transfer is planned. Patients should ask their clinic for a personalised schedule.
Is egg retrieval painful?
Egg retrieval is usually performed with sedation or anaesthesia. Some patients may have mild cramping, bloating, spotting, or tiredness afterwards.
What is the difference between IVF and ICSI?
In standard IVF, eggs are placed with sperm in the laboratory. In ICSI, a single sperm is injected directly into an egg. ICSI may be recommended for sperm-related concerns or previous fertilisation issues.
What happens after embryo transfer?
Patients usually continue prescribed medication and wait until the scheduled pregnancy test. Symptoms during this period do not reliably confirm whether IVF has worked.
What if the IVF cycle is unsuccessful?
The doctor may review ovarian response, egg numbers, fertilisation, embryo development, transfer details and uterine factors before discussing whether another cycle, frozen embryo transfer, further testing, or a different approach may be suitable.
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