IVF Explained: The Steps, the Waiting and the Questions to Ask

TL;DR: IVF moves through five main stages: ovarian stimulation, egg collection, fertilisation in the lab, embryo transfer and the two-week wait before a pregnancy test. Age is the biggest single factor in success, so ask every clinic for its results by age, a fully costed treatment plan and its embryo freezing policy. Contact your clinic urgently if you have severe tummy pain, breathlessness or swelling after egg collection.

If you are reading about IVF, you have probably already been on a long road. Months or years of trying, tests that did not quite explain things, maybe a referral that took longer than it should have. Then someone says "IVF" and suddenly there is a new vocabulary to learn, a new set of costs to weigh, and a lot of waiting. This guide walks through what happens, step by step, so that when you sit down with a clinic you can focus on the decisions that matter for you.

If you are not sure yet whether it is time to see a specialist, start with when to see a fertility specialist. And because fertility is shared work, it is worth reading about male fertility too, since sperm tests are part of the picture from the start.

What is IVF?

IVF, or in vitro fertilisation, means eggs are collected from the ovaries and fertilised with sperm in a laboratory, and a resulting embryo is placed in the womb. According to the NHS, one full cycle usually takes between three and six weeks from the first medicines to the pregnancy test.

The HFEA lists blocked fallopian tubes, ovulation problems, low sperm count, unexplained infertility and older age among the reasons it is used. When sperm quality is the issue, a variation called ICSI is often used, where an embryologist injects a single sperm directly into each egg.

The five stages of IVF

1. Stimulation

Normally your ovaries release one egg a month. In IVF, you take fertility hormones, usually as daily injections at home for around two weeks, to encourage several eggs to mature at once. Many protocols also use medicine to stop you ovulating too early. You will have scans and sometimes blood tests so the team can watch how your follicles (the fluid sacs holding the eggs) are growing and adjust your dose.

2. Egg collection

When the follicles are ready, you have a final "trigger" injection to ripen the eggs, timed carefully before collection. The eggs are then collected through the vagina with a fine needle guided by ultrasound. The NHS describes this as taking around 20 minutes under sedation, and you may feel a little sore or bruised afterwards.

3. Fertilisation

On the same day, the eggs are mixed with sperm from your partner or a donor, or injected with sperm using ICSI. Over the next few days the embryologists watch which eggs fertilise and how the embryos develop. Not every egg will fertilise, and not every embryo will keep growing. That drop-off is normal, though hard to watch.

4. Embryo transfer

A few days later, one embryo is placed in the womb through a thin tube passed through the cervix. It is usually quick, and you will not normally need any anaesthetic. Any good-quality embryos left over can often be frozen for a future transfer. In the UK, 84 percent of embryo transfers in 2024 were single embryo transfers, which has brought the multiple birth rate down to 3.2 percent, its lowest ever. Twins and triplets carry higher risks for both mother and babies, so transferring one embryo is now the standard advice for most people.

5. The two-week wait

Then comes the part many people say is the hardest: waiting for your pregnancy test date, which the NHS says is around 16 days after transfer. You will usually be using progesterone, often as a pessary or gel, to support the womb lining. Every twinge can feel like a sign, one way or the other. Try not to test early, since the HFEA warns this can give a false result. Plan small, kind distractions, and decide in advance who you want with you when you get the result.

How much does age affect IVF success?

Age is the single biggest factor when you use your own eggs. Data from the UK fertility regulator, the HFEA, shows that in 2024 the birth rate per embryo transferred was 38 percent for patients aged 18 to 34, falling to 8 percent for those aged 43 to 44. Egg number and quality decline with age, and that shows up clearly in the results.

This does not mean IVF will or will not work for you. Your own chances also depend on the cause of your fertility problems, your BMI, and lifestyle factors such as smoking and alcohol. But it does mean that if you are in your late thirties and thinking about treatment, it is worth getting assessed sooner rather than later.

What are the risks of IVF?

The main medical risk to know about is ovarian hyperstimulation syndrome, or OHSS. This happens when the ovaries over-respond to the fertility drugs and become swollen and painful. Mild OHSS can cause bloating, tummy discomfort and nausea. Severe OHSS is uncommon: UK clinics reported 53 severe or critical cases in 2023/24, less than 0.1 percent of cycles. An ASRM guideline on preventing OHSS identifies people with PCOS, a high egg count or a previous episode as being at higher risk, and clinics can use gentler stimulation or freeze all embryos to reduce it. If you have PCOS, our guide to PCOS and fertility is a good companion read.

The NHS also lists multiple pregnancy and ectopic pregnancy, where an embryo implants outside the womb, as possible complications.

Get urgent help (call 999 in the UK, or go to the nearest emergency department) if during or after IVF you have: difficulty breathing, chest pain, severe tummy pain, pain low down on one side, shoulder tip pain, swelling of your body, or you are very thirsty but passing little urine. Call your clinic for any milder symptoms you are unsure about.

Questions to ask a fertility clinic

Clinics vary a lot, and the HFEA notes that the same treatment can cost two or three times more depending on where you go. Bring these to your first consultation:

• What are your success rates for someone my age? Ask for births per embryo transferred, not just pregnancy rates, and how many patients those figures are based on.
• Can I have a fully costed treatment plan? It should include tests, drugs, scans, egg collection, transfer, embryo freezing and storage. Some quotes leave out drugs or freezing, which can add a lot.
• Which add-ons do you offer, and what is the evidence? The HFEA says that for most patients, routine cycles of proven treatment are effective without any add-ons, and it rates the evidence for each one on its treatment add-ons page.
• What is your embryo policy? How many embryos will you transfer, how do you decide which ones to freeze, how long can they be stored, what does storage cost each year, and what happens to unused embryos?
• How do you reduce OHSS risk? And who do I call out of hours?
• What emotional support is available? The NHS recommends counselling for anyone having IVF, before, during and after treatment.

Can I get IVF on the NHS?

Possibly, but it depends where you live. National guidance says women aged 39 or under who have been trying for two years, or had 12 cycles of artificial insemination, should be offered up to three full cycles, and women aged 40 to 42 one cycle. In practice, as the NHS explains, funding is decided by local integrated care boards, and some only offer IVF if you meet extra criteria, such as being under a certain age, a healthy weight, a non-smoker, or not already having children. Ask your GP what applies in your area.

What about IVF in Nigeria, Kenya and elsewhere in Africa?

The WHO notes that IVF and other assisted reproduction is still largely unavailable, inaccessible and unaffordable in many low and middle-income countries, and is rarely covered by public health financing. Across much of the continent, it is offered mainly by private clinics in big cities, and you usually pay yourself. Regulation and reporting of results differ from country to country. That makes the questions above even more important. Ask to see the clinic's own results by age, check who the lead embryologist and doctor are, and ask for every cost in writing before you start. If your family is splitting costs or you are travelling for treatment, factor in extra trips for scans.

Our earlier guide on getting pregnant touches on the wider challenges of fertility care in Africa, including stigma that often falls hardest on women.

Looking after yourself through it

IVF asks a lot of your body, your bank account and your relationship. It is common to feel hopeful, anxious, numb and exhausted in the same week. Lean on people who will not ask "any news?" every day, and give yourself permission to step back from social media if pregnancy announcements sting.

Keeping notes helps too. Asele's cycle tracking and symptom logging let you record your cycles, medicines and how you feel, and the Health Brief turns that into a pre-visit summary you can take to your consultation. Amara, our in-app assistant, can talk through terms like "trigger shot" or "blastocyst" in Yoruba, Hausa, Igbo, Swahili, French or English. You can find us at Asele.

This post is education, not medical advice. Your fertility team knows your history and is the right place for decisions about your treatment.

References

1. NHS. IVF. nhs.uk
2. Human Fertilisation and Embryology Authority. Fertility treatment 2024: trends and figures. hfea.gov.uk
3. Human Fertilisation and Embryology Authority. State of the fertility sector 2023/24. hfea.gov.uk
4. Human Fertilisation and Embryology Authority. Costs and funding. hfea.gov.uk
5. Human Fertilisation and Embryology Authority. Treatment add-ons with limited evidence. hfea.gov.uk
6. Human Fertilisation and Embryology Authority. In vitro fertilisation (IVF). hfea.gov.uk
7. Practice Committee of the American Society for Reproductive Medicine. Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertility and Sterility, 2024. pubmed.ncbi.nlm.nih.gov
8. World Health Organization. Infertility fact sheet. who.int