IVF: the consultation, and what happens where

When the tubes are blocked on both sides, no amount of ovulation or timing can bring the egg and sperm together, and IVF does that in the laboratory. When the count is very low, the laboratory can inject a single sperm into each egg, which IUI cannot. When the earlier steps have had a fair run without success, IVF answers questions they cannot, because it shows how the eggs fertilise and how the embryos grow. When endometriosis has damaged the ovaries, or when age has narrowed the window, moving to IVF sooner is often the right call. Each of these is a reason, and you are told which applies to you.

Stimulation. Daily injections for about ten days to grow several follicles rather than the usual one. Scans every few days to watch them, with blood tests, and the dose adjusted as you go. The planning and the monitoring of this part are done here.

The trigger. When the follicles are the right size, one injection timed to the hour, and the collection is scheduled for about thirty-six hours later.

Egg collection. Done at the ART centre, under sedation, through the vagina with a fine needle guided by ultrasound. About twenty minutes. Home the same day, sore for a day or two.

Fertilisation. The same day, in the laboratory, the eggs meet the sperm, either by being placed together or, where the count or the history calls for it, by injecting one sperm into each egg, which is ICSI.

Embryo culture. Three to five days of watching the embryos grow, with a daily report.

Transfer. One embryo, occasionally two, placed in the uterus through a soft tube. No anaesthetic. Any embryos that are suitable and not transferred are frozen.

The wait. Two weeks, with progesterone support, and then the test. The follow-up, and everything that comes after, is here.

ICSI is the laboratory injecting a single sperm into each egg instead of leaving them together. It is used where the count, movement or shape is poor, where a previous cycle showed poor fertilisation, or where the sperm has had to be retrieved surgically. It is not routinely better for everyone, and it is used when there is a reason.

Freezing embryos means that one stimulation can give more than one chance. An embryo frozen from this cycle can be transferred in a later cycle without injections or collection, which is gentler on you in every way. Sometimes all the embryos are frozen and the transfer is deliberately done a month or two later, because the uterus is in better condition then. What is frozen, for how long, and what happens to embryos that are not used are all explained before the cycle starts, and your decisions on them are put in writing.

An IVF cycle is six weeks of injections, scans, waiting and hope, and the hormones affect mood as well as ovaries. It is harder than it looks from outside. You will be told that plainly, and you will be told what the medicines do and what side effects to expect, including the rare but real one of the ovaries over-responding, which is watched for at every scan.

A cycle that does not lead to a pregnancy is not nothing. It has shown how your ovaries respond, how the eggs fertilise, and how the embryos grow, and each of those changes the plan for the next one, if there is a next one. The conversation afterwards is about what was learned, what would be done differently, whether frozen embryos remain, and whether another cycle is the right thing or whether it is time to stop. Stopping is a real option and it is discussed as one.

You will not be given a percentage, here or on this website. Published rates describe groups of people, counted in ways that vary from clinic to clinic, and none of them is you. What you will be told is what your own age, your own reserve, your own findings and, after a cycle, your own embryos mean for you, in words; and you will be told what they do not mean. That is the honest version, and it is the only one worth having.