IVF involves several distinct stages, and each one comes with a different type and level of discomfort. The honest answer is that some parts barely register, some feel like moderate period cramps, and one or two can genuinely hurt. Most people find the process manageable but more physically and emotionally demanding than they expected. Here’s what each phase actually feels like.
Hormone Injections: 10 to 14 Days of Shots
The stimulation phase requires daily self-administered injections for roughly 10 to 14 days, sometimes more than one shot per day. The needles used for subcutaneous injections are small, typically 27-gauge (about the width of a thin sewing needle) and only 5/8 of an inch long. Most people describe the sensation as a quick sting or pinch in the belly, similar to the feeling of being snapped by a rubber band. Individually, each shot is minor. The cumulative effect of doing it every day is what wears people down.
Beyond the needle itself, the hormones cause your ovaries to grow multiple follicles at once, which makes them swell significantly beyond their normal size. By the end of the stimulation phase, many people feel noticeably bloated, heavy, and sore in the lower abdomen. Bending over, walking quickly, or sitting in certain positions can feel uncomfortable. Some people also experience headaches, breast tenderness, and mood shifts from the elevated hormone levels.
Egg Retrieval: The Most Physically Intense Step
Egg retrieval is a short surgical procedure, usually lasting 15 to 30 minutes, where a needle is guided through the vaginal wall and into each ovary to aspirate the follicles. It sounds alarming, but you won’t be awake for it in the way you might fear. The procedure is typically performed under sedation or general anesthesia, using fast-acting medications that keep you deeply relaxed or fully asleep. Most people remember nothing about the procedure itself.
The pain comes afterward. In a study measuring post-retrieval discomfort, patients reported an average peak pain score of 5 out of 10 during the first 24 hours. That’s roughly equivalent to strong menstrual cramps or a dull, deep ache in the pelvis. Mild cramping, bloating, and fatigue are all normal in the hours following the procedure. Most people feel well enough to return to work or normal activities within one to two days, though taking the rest of the retrieval day off is standard. The discomfort typically resolves within a day or two for straightforward cases.
Progesterone Shots: Often the Worst Part
After retrieval, you’ll start progesterone supplementation to prepare the uterine lining for embryo transfer. If your clinic prescribes progesterone in oil (many do), this means daily intramuscular injections into the upper buttock or hip area, using a longer and thicker needle than the stimulation shots. These injections continue for weeks, sometimes up to 10 to 12 weeks if pregnancy is achieved.
Many IVF patients say this is the single most painful part of the entire process. The oil-based solution is thick and absorbs slowly, which can cause hard lumps, soreness, and swelling at the injection sites. Repeated injections into the same area damage fat cells and can trigger localized inflammation, creating painful nodules under the skin. Warming the oil before injecting, rotating injection sites, and applying a heating pad afterward can reduce the buildup, but the discomfort tends to accumulate over time. Some clinics offer vaginal progesterone suppositories as an alternative, which avoid the injection pain entirely but come with their own messiness.
Embryo Transfer: Surprisingly Mild
The embryo transfer is the step people tend to dread the least once they’ve been through it. The procedure is performed without anesthesia. A speculum is placed, the cervix is cleaned, and a thin, soft catheter is threaded through the cervix to deposit the embryo into the uterus. The whole thing takes a few minutes. Most people compare it to a Pap smear or a slightly uncomfortable pelvic exam. In straightforward transfers, no force or additional instruments are needed, and the catheter is flexible enough that you may feel only mild pressure.
Occasionally, transfers are more difficult. If the catheter doesn’t pass easily through the cervix, the doctor may need to use a firmer instrument to stabilize the cervix or adjust the angle, which can cause sharper cramping. But even in those cases, the discomfort is brief.
When Discomfort Crosses Into Something Serious
Normal post-retrieval bloating and cramping can look a lot like ovarian hyperstimulation syndrome (OHSS) in its early stages, and knowing the difference matters. Mild OHSS causes abdominal bloating, nausea, and tenderness near the ovaries. These symptoms overlap with typical post-retrieval recovery, which is why they’re easy to dismiss.
The warning signs of severe OHSS are more distinct:
- Rapid weight gain of more than 2.2 pounds in 24 hours
- Severe, persistent nausea and vomiting
- Noticeable decrease in urination
- Shortness of breath
- A tight, visibly enlarged abdomen
- Pain in the legs, which could indicate a blood clot
Severe OHSS is uncommon but requires prompt medical attention. If post-retrieval discomfort is getting worse rather than better after the first couple of days, that pattern alone is worth reporting to your clinic.
The Emotional Pain Is Real, Too
Physical discomfort is only part of the picture. Research consistently shows that women undergoing IVF report higher levels of anxiety and depressive symptoms than women conceiving without medical assistance, particularly during active treatment. The two most stressful points in the cycle are the egg retrieval itself and the two-week wait before the pregnancy test, a stretch where there’s nothing left to do but wait and wonder.
The hormonal shifts from stimulation medications can amplify mood swings, irritability, and emotional sensitivity on their own. Layer that on top of the financial pressure, the physical toll, and the fundamental uncertainty of whether any of it will work, and the psychological strain becomes significant. Couples often describe feeling powerless during the waiting period, which is a particularly difficult form of stress because there’s no action that can relieve it. For people going through multiple cycles, the emotional weight compounds in ways that the physical discomfort doesn’t.
Putting It All Together
If you’re trying to calibrate your expectations, here’s a rough scale. The stimulation injections are a minor daily nuisance that gets old fast. The egg retrieval itself is painless under sedation, but recovery feels like a bad period day for most people, with an average pain peak around 5 out of 10. Embryo transfer is one of the easiest parts physically. Progesterone injections, if prescribed in oil form, are a slow-building source of genuine soreness that many people rank as the worst sustained discomfort of the whole process.
Nothing about IVF is pain-free, but very little of it involves the kind of acute, sharp pain people tend to imagine. The harder parts are the chronic, low-grade discomfort, the hormonal side effects, and the emotional weight of the process as a whole.