In-vitro fertilization requires more time than other fertility treatments. Several appointments are required to complete the process. The woman's egg reserve is tested using a baseline follicle-stimulating hormone test on day three of her cycle. If the FSH is extremely elevated, the expected egg quantity is usually lowered. Antral follicles, or follicle visible on an ultrasound, are counted and measured. The higher the number of follicles, the higher the chance of success will be.
After the ovaries are examined to determine their health and ability to respond well to the procedure, injectible medications are given to help development of the follicles, similar to gonadotropin injections. Blood work and ultrasounds are done every one to three days to monitor the development of each follicle. Three is generally considered the minimum number of follicles required to continue with the procedure.
When the follicles are mature, egg retrieval begins. Under anesthesia, a small needle is placed through the vaginal wall into the ovary. The fluid surrounding the egg is sucked out through the needle; the egg detaches from the wall of the follicle and is pulled out through the needle. This usually takes less than twenty minutes.
After the eggs are removed, they are rinsed and kept in a specialized incubator. After four to five hours, sperm is mixed with the eggs, or directly injected into the egg. They will be checked the following morning to fertilization, and if successful, placed into the woman's uterus within two to five days. Two weeks later, a blood test to confirm pregnancy hormones are present is conducted.
Side effects from the injections and trigger shot are the same as those for other injected fertility medications. Waiting to hear whether all of the work was successful, and feeling let down when it is not can be exhausting and stressful.
IVF is the most expensive fertility treatment. In the United States it can cost from $9000 - $15,000 USD.