Fertility treatment (IVF, IUI)

Fertility treatment encompasses a range of medical interventions to help individuals and couples conceive. The two most common procedures are Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF).

60 steps across 12 sections

1. Initial Consultation and Testing (1-4 weeks)

  • Comprehensive fertility evaluation for both partners
  • Female: hormone levels (AMH, FSH, estradiol), ultrasound for antral follicle count, HSG (tubal patency test), infectious disease screening
  • Male: semen analysis, infectious disease screening
  • Both: genetic carrier screening (optional but recommended)
  • Treatment plan created based on results

2. Ovarian Stimulation (8-14 days)

  • Self-administered injectable hormone medications (gonadotropins) to stimulate multiple egg production
  • Common medications: Follistim, Gonal-F, Menopur
  • GnRH antagonist (Cetrotide, Ganirelix) added around day 5-6 to prevent premature ovulation
  • Frequent monitoring: ultrasounds and blood work every 1-3 days to track follicle growth
  • Dosage adjustments based on response
  • Goal: develop multiple mature follicles (ideally 10-20 eggs)

3. Trigger Shot (36 hours before retrieval)

  • When follicles reach mature size (18-22mm), a "trigger shot" (hCG or Lupron) is administered
  • This triggers final egg maturation
  • Timing is critical — retrieval must happen approximately 36 hours later

4. Egg Retrieval (Day of procedure, ~20-30 minutes)

  • Outpatient procedure under light sedation/anesthesia
  • Transvaginal ultrasound-guided needle aspiration of follicles
  • Each follicle is aspirated to collect the egg
  • Recovery takes 1-2 hours; most go home same day
  • Mild cramping and bloating are normal for a few days
  • Partner provides sperm sample (or frozen sperm/donor sperm is thawed)

5. Fertilization (Day 0-1)

  • Conventional IVF Eggs and sperm are placed together in a dish and fertilization occurs naturally
  • ICSI (Intracytoplasmic Sperm Injection) A single sperm is injected directly into each mature egg — used for male factor infertility or prior fertilization failure
  • Fertilization check the next morning: typically 70-80% of mature eggs fertilize

6. Embryo Development (Days 1-7)

  • Embryos are cultured in the lab for 5-7 days
  • Day 3: embryos are at 6-8 cell stage
  • Day 5-6: embryos reach blastocyst stage (most advanced, highest implantation potential)
  • Embryologists grade embryos based on cell division, symmetry, and fragmentation
  • PGT-A biopsy (if elected) is performed at blastocyst stage — a few cells are removed and sent for genetic testing

7. Embryo Transfer (Day 5-6 for fresh, or a subsequent cycle for frozen)

  • Fresh transfer Embryo transferred 5-6 days after retrieval (less common now)
  • Frozen embryo transfer (FET) Embryos are frozen, and transfer occurs in a subsequent cycle — increasingly the standard of care due to better outcomes
  • FET preparation: estrogen and progesterone medications to prepare the uterine lining (2-4 weeks)
  • The transfer itself: thin catheter guided by ultrasound places embryo into uterus (5-10 minutes, no sedation needed)
  • Usually a single embryo is transferred to minimize twin risk (elective single embryo transfer, or eSET)

8. The Two-Week Wait and Pregnancy Test

  • Progesterone supplementation continues (injections, suppositories, or oral)
  • Beta hCG blood test approximately 9-14 days after transfer
  • Positive result: continued monitoring with repeat blood tests and early ultrasound at 6-7 weeks
  • Negative result: follow-up consultation to discuss next steps

9. IUI Step-by-Step

  • Cycle monitoring — Ultrasounds and blood work to track follicle development (days 1-12)
  • Ovulation induction (optional) — Oral medications (Clomid/letrozole) or injectable gonadotropins to stimulate egg production
  • Trigger shot — hCG injection to trigger ovulation when follicles are mature
  • Sperm preparation — Partner or donor provides a sample; lab "washes" the sperm to concentrate the healthiest, most motile sperm (takes ~1 hour)
  • Insemination — Doctor inserts a thin catheter through the cervix and deposits sperm into the uterus (takes 5-10 minutes, similar to a Pap smear)
  • Two-week wait — Pregnancy test approximately 14 days later

10. IUI Success Rates

  • 10-20% per cycle (varies widely by age and diagnosis)
  • Under 35: ~15-20% per cycle
  • 35-40: ~10-15% per cycle
  • Over 40: ~5-10% per cycle
  • Cumulative success 3 cycles provide approximately 30-40% cumulative pregnancy rate for appropriate candidates
  • Success is highest with: unexplained infertility, mild male factor, ovulatory disorders
  • Success is lowest with: severe male factor, tubal damage, advanced maternal age

11. Best Candidates for IUI

  • Unexplained infertility
  • Mild male factor (slightly low count or motility)
  • Cervical factor infertility
  • Single women or same-sex couples using donor sperm
  • Mild endometriosis
  • Ovulatory disorders (when combined with ovulation induction)

12. IUI Costs

  • Basic IUI (no medications): $500-$1,500
  • IUI with oral medications (Clomid/letrozole): $1,500-$3,000
  • IUI with injectable medications: $3,800-$7,000
  • Donor sperm (if needed): $500-$1,000 per vial

Common Mistakes

  • Waiting too long to seek help
  • Not getting a full workup for BOTH partners
  • Too many IUI cycles before moving to IVF
  • Choosing a clinic based only on cost
  • Not understanding what insurance covers

Pro Tips

  • Check SART.org for clinic success rates
  • Ask about multi-cycle and refund programs
  • Use FSA/HSA dollars
  • Batch embryos before transferring
  • Consider employer benefits

Sources

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