A complete guide from the first assessment and each treatment step through to looking after yourself after embryo transfer — written for patients by Dr. Patsama Vichinsartvichai.
IVF (In Vitro Fertilization), often called the "test-tube baby" method, brings the woman's eggs and the man's sperm together in the laboratory to create embryos before they are transferred back into the uterus.
ICSI (Intracytoplasmic Sperm Injection) is a fertilization technique developed from IVF in which a fine needle injects a single sperm directly into a single egg. It suits male-factor problems, or couples who had poor fertilization with conventional IVF.
You meet the doctor for a history, physical examination, ultrasound, blood tests (AMH, TSH, baseline hormones) and a semen analysis for the male partner, so that a stimulation plan suited to you can be designed.
You inject hormone medication for about 8–12 days so that several eggs mature together. During this time you come in for periodic ultrasounds and blood tests so the doses can be adjusted. When the eggs are large enough, the doctor prescribes a "trigger shot" to make them mature and ready for collection.
About 34–36 hours after the trigger shot, the eggs are collected with a needle passed through the vagina under ultrasound guidance. You receive light sedation and feel no pain. The procedure takes 30–40 minutes, and after 1–2 hours of recovery you can go home.
In the laboratory the eggs are combined with sperm — with IVF the eggs are left to fertilize on their own in the dish, while with ICSI a single sperm is injected directly into each egg. They are then placed in an incubator that precisely controls temperature, humidity and gas.
The embryos grow in the incubator for 3–6 days until the blastocyst stage. Embryologists assess their quality and select the best embryos, and may use EmbryoScope or AI to monitor development continuously.
A few cells are taken from the blastocyst and sent for testing of all 23 pairs of chromosomes, so that chromosomally normal embryos can be chosen before transfer. This helps reduce the chance of miscarriage and increases the chance of a successful pregnancy.
The embryo is placed in the uterine cavity through the cervix with a thin catheter. It takes about 10–15 minutes and needs no anesthesia. It can be done as a fresh transfer, or the embryos can be frozen for a frozen embryo transfer (FET) in a later cycle.
About 10–14 days after the transfer, a blood test measures β-hCG to confirm pregnancy. If you are pregnant, follow-up ultrasounds check the gestational sac and the baby's heartbeat.
The pregnancy rate per cycle depends on many factors, above all the woman's age, which carries the most weight:
Other factors also matter, such as the cause of infertility, sperm quality, pregnancy history and overall health.
Ovarian hyperstimulation syndrome (OHSS), multiple pregnancy if more than one embryo is transferred, procedural risks of egg retrieval, and emotional impact. We review these in detail before consent.
No. Ovarian stimulation in IVF uses eggs that the body was already going to lose in that menstrual cycle; it simply helps that group of eggs mature together. It does not draw on the future egg reserve.
Research shows long periods of bed rest after embryo transfer are not necessary. You can go about daily life as usual, but avoid heavy lifting and strenuous exercise.
We now recommend eSET (Elective Single Embryo Transfer), transferring one embryo at a time to reduce the risks of a multiple pregnancy for both mother and babies.
Current data indicate that the rate of congenital anomalies in IVF babies is close to that of naturally conceived babies, especially once the parents' age and health are taken into account.
Most people can work as usual through almost the whole process. The exceptions are the day of egg retrieval, when you should rest for one day, and the day of embryo transfer, when half a day to a full day of rest can help you relax.
Generally at least 1–2 menstrual cycles, so the ovaries and uterine lining can recover. Your doctor will review why the cycle did not succeed and adjust the treatment plan.
Embryo Journey — the path of an embryo
Grading blastocyst embryos
What mature and immature eggs look like
Starting ovarian stimulation on any day of the cycle (Random-start)
Dr. Patsama Vichinsartvichai, MD, MClinEmbryol, EFOG-EBCOG, EFRM-ESHRE/EBCOG, FACOG is a board-certified reproductive endocrinology & infertility specialist, former head of the Vajira IVF unit at Navamindradhiraj University, and founder of LIFE by Dr. Pat in Bangkok. His published research focuses on the dysmorphic (T-shaped) uterus and uterine-factor infertility.
Meet Dr. Patsama →