IVF Explained: Process, Success Rates, Risks, Timeline and Everything Else You Need to Know
In vitro fertilization (IVF) can come with a lot of questions. A fertility specialist explains what happens at each stage and what to know before getting started.
From managing medications and appointments to the mix of emotions a fertility journey can bring, in vitro fertilization (IVF) may seem like a daunting process.
“IVF can feel like a lot to take in at first, but it’s a very individualized process and there’s a lot of support in place for patients,” says Dr. Alexis P. Melnick, a reproductive endocrinologist at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at Weill Cornell Medicine and NewYork-Presbyterian.
IVF has become increasingly common: More than 100,000 babies were born in the United States in 2024 through IVF, according to data from the Society for Assisted Reproductive Technology.
“IVF affords patients the opportunity to be parents in situations where they may never have been able,” Dr. Melnick says. “It also gives them choice and control over their reproductive timeline and decisions. Knowing what to expect from start to finish can ease some of the uncertainties.”
Dr. Melnick spoke with Health Matters to explain how IVF works, why it’s used, and what to expect physically and emotionally through the process.
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What is IVF and what should you know before you start?
What exactly is IVF?
Dr. Melnick: IVF is the fertilization of an egg outside of the body in a lab to create an embryo. This embryo can subsequently be transferred back into a uterus.
Why might someone choose IVF?
Dr. Melnick: IVF can be used for all kinds of fertility issues, including male infertility. In about half of all fertility cases, a male factor is a cause.
Female infertility can be caused by age-related infertility or by medical conditions including:
- Endometriosis
- Fibroids
- Blockages in the fallopian tubes
- Polyendocrine metabolic ovarian syndrome (PMOS)
IVF can also be an option for people who don’t have infertility — for example, people who have had multiple miscarriages and want to test the embryos for a chromosomal abnormality, or prospective parents who carry a gene for a disorder (such as Tay-Sachs disease) and want to test the embryo for the disease.
Same-sex couples or people without a partner who want to have a baby, and women who want to freeze their eggs for the future may also choose IVF.
When should you see a fertility specialist?
Dr. Melnick: A person should consider seeing a fertility specialist if they’re under age 35 and have been trying to conceive for one year, or over age 35 and have been trying for six months. There’s no downside to seeing a specialist earlier if there are any concerns.
How much does IVF cost?
Dr. Melnick: Depending on the location, IVF can cost between $15,000 to $30,000 per cycle.
Is IVF covered by insurance?
Dr. Melnick: Insurance coverage for IVF varies significantly, depending on the particulars of your plan and your location, as some states mandate coverage. Navigating the insurance landscape can be one of the most challenging parts of this process, so it’s important to understand your plan details early on.
What’s the step-by-step process for IVF?
Dr. Melnick: The IVF process can vary in length, depending on the overall treatment plan, such as whether someone is freezing their eggs or plans to have an embryo transfer.
From the time that somebody comes in for their new patient visit to the start of IVF cycle is typically two to three months.
What should you expect during the fertility workup?
Dr. Melnick: IVF starts with a basic fertility workup, which includes:
- Bloodwork to check hormones, thyroid levels, immunities, and infectious disease testing.
- Ovarian reserve testing, which gives a sense of egg quantity.
- An exam of the fallopian tube and uterus. This often includes a test called a hysterosalpingogram to evaluate the uterine cavity for conditions like polyps or fibroids, and the fallopian tubes for abnormal shape or blockages.
- Semen analysis.
- Preconception genetic screening to see if the prospective parents are carriers of a genetic disease.
What should you expect during ovarian stimulation?
Dr. Melnick: Once the workup is complete, the typical IVF course involves ovarian stimulation with medications and monitoring.
As a first step, some patients may take birth control pills or estrogen patches for two to three weeks to time their menstrual cycle, level out hormones, and reduce the risk of ovarian cysts.
The patient will then take between one to three injected fertility medications per night for 10 to 14 days. In a normal menstrual cycle, one egg grows. The self-administered injections stimulate your ovaries to produce multiple eggs. Another medication prevents your body from releasing the eggs too soon, so your doctor can retrieve them at the best time.
Patients come to appointments every 1 to 2 days for bloodwork and ultrasounds, but these appointments are typically quick.
A final “trigger shot” matures the eggs in the ovary and gets them ready for retrieval.
What should you expect during egg retrieval?
Dr. Melnick: About 35 to 36 hours after the trigger shot, the patient will undergo the egg retrieval, which is a surgical procedure done under intravenous (IV) sedation that can take about five to 10 minutes.
This is the one day that I usually tell patients they’re going to be out of commission. Some patients will require more time off from work.
During the procedure, which is done through the vagina, an ultrasound probe guides a needle connected to a light suction device that withdraws the eggs from the ovaries. The eggs are then frozen for future use, if the patient has chosen that option, or brought to a lab for fertilization.
What should you expect during fertilization?
Dr. Melnick: The eggs are mixed with sperm from a partner or donor. In certain cases, such as if sperm motility or counts are low, one sperm is directly injected into each egg.
What should you expect during embryo transfer?
Dr. Melnick: An embryo can be transferred “fresh” three to five days after a retrieval, or frozen and then thawed and transferred in a subsequent cycle. During the transfer, a thin catheter is inserted into the cervix. A syringe attached to the catheter carries the embryo, which is then injected into the uterus. After 10 to 14 days, a patient takes a blood test to determine pregnancy.
What are the most frequently asked questions about IVF?
How successful is IVF?
Dr. Melnick: IVF is not a guarantee, and every patient and scenario are different.
The success rates are dependent largely on age. It’s a huge range.
Conservatively, the highest rates of success for a live birth can be between 55% and 65% per embryo transferred for patients under 35, ranging down to under 5% for patients who are doing IVF in their early 40s.
What role does age play in IVF success?
Dr. Melnick: Age is a significant factor. People talk about age 35 as if it’s this magic number, but you really start to see a drop-off in success rates in the late 30s. The slope of the curve starts to steepen around age 37 or 38, and from that point on, every year makes a difference.
That’s why we strongly recommend that patients be proactive if they decide they might want children later in the future. We’re seeing people freeze eggs much earlier, even in their late 20s.
While these numbers may seem discouraging, pregnancy in women over 40 is possible both naturally and with fertility treatment. It is always worth seeing a fertility specialist to discuss options.
How many eggs or embryos is a good number?
Dr. Melnick: The average number of eggs retrieved in a cycle is between five and 15 with tremendous standard deviations on either end.
There is no official target number as it really depends on the patient and their goals.
Age also matters, because egg number and quality go down over time. Somebody who is younger, for example, will require fewer eggs than somebody older to get to the same ultimate outcome of a live birth, and it depends on the quality of the eggs for how successful those numbers are. Ten eggs in a 30-year-old are going to yield very significantly different results than 10 eggs in a 40-year-old.
What happens if you get fewer eggs than the target?
Dr. Melnick: After a retrieval, we regroup with our patients to look at the number of eggs or embryos they have, how the embryos developed, and their ultimate goals for family building to determine whether or not another cycle is warranted.
How many IVF cycles does it usually take to get pregnant?
Dr. Melnick: While about three IVF cycles is average, the number a patient goes through is highly variable.
When a cycle yields a low number of eggs or the quality of embryos is poor, another round may be recommended. Some patients may want to test the embryos for a genetic disease or freeze embryos for the future because they’re not ready to have a child. In both cases, we’d want to make sure we have enough healthy embryos.
Even if a cycle is not successful, which of course can be discouraging, we’re learning from each one.
With my patients I try to be straightforward and say, “We’re going to make some changes moving forward. I think there’s a good chance of this working,” or, “I think we should start thinking about alternatives.”
It’s important to be upfront and open with patients throughout the process.
How long should someone wait between IVF cycles?
Dr. Melnick: The data does not show any downside or benefit to doing back-to-back cycles. However, for many patients, taking a break — even if it’s only for one month — can be both physically and mentally restorative.
Is IVF painful?
Dr. Melnick: Overall, IVF is described as uncomfortable rather than painful.
Certain aspects like nightly injections and bloating can be bothersome. Abdominal pain and cramping post-retrieval are normal but typically short-lived. Severe pain is rare and likely would indicate some type of complication. Most patients say they are pleasantly surprised by the experience.
What are the risks of IVF?
Dr. Melnick: Though the chance is small, the risks of IVF include:
- Bleeding and infection from the egg retrieval.
- Ovarian torsion, or twisting of the ovary.
- Ovarian hyperstimulation syndrome, in which the ovaries over-respond to the medications and become swollen.
What are common side effects of IVF medications?
Dr. Melnick: Bloating, fatigue, and mild cramping are common side effects.
What are the emotional side effects of IVF?
Dr. Melnick: There definitely can be some mood effects, and a lot of exhaustion. Some patients say they feel more anxious, moody, and teary, and others say they feel great and don’t notice a difference. For most part, most patients are pleasantly surprised.
What happens if IVF fails?
Dr. Melnick: If the embryos are good quality and it’s more of a uterus implantation issue, the embryos could be used in a surrogate, or gestational carrier. If it’s an egg quality issue, the patient could use donated eggs. For those who don’t want to consider egg donation or a gestational carrier, adoption is an option. Some couples also say, “We’re going to keep trying on our own,” and we’ve seen cases where they do get pregnant.
How important is emotional support during IVF?
Dr. Melnick: There are many aspects of going through fertility treatment, being diagnosed with infertility, or undergoing fertility preservation. It can take a huge toll.
For many patients, this may not be what they thought they’d be doing, or it’s not their ideal scenario. It can be very stressful, and there is so much misinformation out there, which can make it more difficult.
I encourage patients to connect with a psychologist, social worker, or psychiatrist if needed. Friends and support groups can also provide emotional support.
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