One cycle of IVF takes about two to three weeks from start to finish and involves five main phases: ovarian stimulation, egg retrieval, fertilization, embryo development, and embryo transfer. The total cost typically ranges from $15,000 to $30,000, with medications alone accounting for up to 35% of that figure. Here’s what each phase looks like and what you can expect along the way.
Ovarian Stimulation: Weeks 1 and 2
A natural menstrual cycle releases one egg. IVF aims to produce many at once, so the cycle begins with daily hormone injections that stimulate your ovaries to grow multiple follicles (the fluid-filled sacs that contain eggs). These injections start around day two or three of your period and continue for one to two weeks.
During this phase, your clinic will monitor you with blood tests and ultrasounds every few days to track how your follicles are growing. Your medication dose may be adjusted based on how you’re responding. The goal is to grow follicles to about 16 to 18 millimeters in diameter before moving to the next step.
You’ll also take a second medication to prevent your body from releasing the eggs too early. The timing of this drug depends on which protocol your doctor uses. In one common approach, it starts before stimulation begins. In another (the antagonist protocol), it’s added around day six of stimulation or when follicles reach about 14 millimeters. Your doctor will choose a protocol based on your age, hormone levels, and how your ovaries are expected to respond.
The Trigger Shot
Once your follicles reach the right size, you’ll receive a “trigger shot,” a precisely timed injection that tells your eggs to complete their final maturation. This shot is given exactly 36 hours before your egg retrieval. The timing matters enormously: too early and the eggs aren’t ready, too late and they may release on their own.
Egg Retrieval
Egg retrieval is a short procedure, typically lasting 15 to 30 minutes, performed at your fertility clinic. You’ll receive IV sedation, so you’ll be comfortable and unlikely to feel pain during the process. Your doctor uses a thin, ultrasound-guided needle inserted through the vaginal wall to reach each ovary and gently suction fluid from the follicles. A lab technician works alongside the doctor, immediately examining the fluid under a microscope to identify and count the eggs.
Afterward, you’ll rest at the clinic for about an hour while the sedation wears off. You’ll need someone to drive you home. Some cramping, bloating, or spotting in the following day or two is normal. Most people return to regular activities within a day, though your clinic will give you specific guidance based on how many follicles were retrieved.
Fertilization in the Lab
On the same day as retrieval, your eggs are fertilized. There are two main methods. In conventional IVF, eggs are placed in a dish with a concentrated sample of sperm and left to fertilize on their own, mimicking the natural process. In ICSI, an embryologist selects a single sperm and injects it directly into each mature egg. ICSI is typically used when sperm count or motility is low, or when previous conventional fertilization attempts have failed.
By the next morning, the lab checks for signs of successful fertilization. A fertilized egg will show two small round structures called pronuclei: one containing 23 chromosomes from the egg and one containing 23 from the sperm. Over the next several hours, these fuse together to form a single nucleus with the full set of 46 chromosomes. Not every egg will fertilize, so it’s normal for the number to drop at this stage.
Embryo Development: Days 1 Through 5
Once fertilized, embryos are kept in a carefully controlled incubator that mimics conditions inside the body. They develop on a predictable timeline. The fertilized egg divides into a two-cell embryo within about 30 hours. From there, cells divide roughly every 10 to 12 hours: a four-cell embryo on day two, an eight-cell embryo on day three, a tightly packed ball of cells (called a morula) on day four, and a blastocyst on day five.
The blastocyst stage is a significant milestone. At this point, the embryo has differentiated into two distinct cell types: an inner group that will become the fetus and an outer layer that will form the placenta. Many clinics aim to grow embryos to the blastocyst stage before transfer because it helps them identify which embryos have the strongest developmental potential. Not all embryos will make it to day five, and your clinic will update you on how many are progressing.
Embryo Transfer
The transfer itself is one of the simplest parts of the cycle. A doctor threads a thin, flexible catheter through the cervix and places one embryo (sometimes two, depending on your situation and clinic guidelines) into the uterus. The procedure takes just a few minutes, requires no anesthesia, and feels similar to a Pap smear for most people.
You’ll have a choice, or your doctor will recommend one of two approaches. A fresh transfer happens on day three or day five after egg retrieval, during the same cycle. A freeze-all approach means all viable embryos are frozen and a transfer is scheduled in a later cycle, giving your body time to recover from stimulation. Research suggests that freezing all embryos and transferring one later may improve pregnancy rates and reduce complications, particularly for women at higher risk of ovarian hyperstimulation. Any remaining embryos from either approach are frozen for future use.
The Two-Week Wait
After transfer, you enter the most psychologically challenging part of the cycle. For the next 10 to 14 days, you’ll take progesterone supplements to support the uterine lining and give the embryo the best chance of implanting. Progesterone can be given as vaginal suppositories, oral capsules, or injections, and some clinics use a combination. Side effects from progesterone (bloating, breast tenderness, fatigue) can mimic early pregnancy symptoms, which makes this waiting period especially nerve-wracking.
If implantation is successful, the embryo attaches to the uterine lining about 6 to 10 days after egg retrieval. Around 12 to 14 days after retrieval, you’ll have a blood test that measures levels of hCG, the hormone produced by early placental cells. This confirms whether the cycle resulted in a pregnancy.
Possible Side Effects and Risks
The most significant medical risk during a cycle is ovarian hyperstimulation syndrome, or OHSS, which happens when the ovaries overreact to stimulation medications. Mild symptoms like bloating and pelvic discomfort are relatively common and resolve on their own. Moderate OHSS, which can involve more pronounced swelling, nausea, and fluid buildup in the abdomen, occurs in roughly 3% to 6% of cycles. Severe OHSS, which may require hospitalization, affects 0.1% to 2% of patients. Modern protocols have reduced these numbers over time, and clinics monitor for warning signs throughout stimulation.
Other common but temporary side effects include soreness at injection sites, mood swings from hormonal fluctuations, headaches, and fatigue. After egg retrieval, mild cramping and bloating typically resolve within a few days.
What One Cycle Costs
A single IVF cycle in the United States generally costs between $15,000 and $30,000. Medications make up a significant portion, sometimes as much as 35% of the total. The rest covers monitoring appointments, the retrieval procedure, lab work for fertilization and embryo culture, the transfer, and follow-up blood tests. Genetic testing of embryos, egg or embryo freezing, and frozen embryo transfer cycles may carry additional fees. Coverage varies widely by state and insurance plan, so it’s worth checking your specific benefits before starting.