In vitro fertilization explained step by step

Have you ever heard of in vitro fertilization (IVF)? This medical procedure involves replicating the development of an embryo in a laboratory. To learn more, May sheds light on the topic.

What are the criteria for undergoing in vitro fertilization?

IVF is one of the options available as part of medically assisted reproduction (MAR). It helps couples, individuals facing infertility, and single women with a desire to conceive. As you can see, it is available to heterosexual couples, same-sex female couples, and single women. Of course, consent from each person is required.

Even when consent has been given, certain circumstances can interrupt the process, such as separation, divorce, the death of a partner, or written withdrawal of consent by one of the individuals.

It’s important to note there is a maximum age for undergoing IVF:

• Up to age 45 for the woman carrying the child.
• Up to age 60 for the partner.

If you meet all these criteria, you can undergo IVF.

How does in vitro fertilization work?

IVF involves several steps, here they are in order:

Ovarian stimulation

The aim of this first stage is to stimulate the patient’s ovaries (monitored by ultrasound) using hormonal medication, with the hope of developing multiple follicles and producing oocytes.

Ovulation triggering

Once the follicles have reached a sufficient size, the doctor can trigger ovulation using another hormone injection.

Oocyte retrieval

Thirty-six hours after ovulation is triggered, the healthcare professional will collect the oocytes (= oocyte retrieval) from the patient by aspirating the follicular fluid.

At the same time, the patient’s partner provides a sperm sample (sexual abstinence is recommended for a few days beforehand). Donor sperm can also be used.

Fertilization of the oocytes

After retrieving the oocytes and the sperm, the IVF process begins. The lab technician or biologist places the oocyte in contact with the sperm and waits for fertilization. ICSI (intracytoplasmic sperm injection) can also be used, where a single sperm is selected and injected directly into the oocyte. Once this procedure is done, the laboratory allows the embryos to develop for a few days (2 to 5 days) in preparation for transfer.

Embryo transfer

Then comes the transfer of one embryo (sometimes two) into the uterus. This is a painless injection performed with a catheter inserted into the cervix. The other embryos that are not transferred are preserved for future use.

Pregnancy test

Two weeks after the transfer, a blood test is performed to confirm that the embryo has implanted into the patient’s endometrium and is developing correctly. It helps detect the presence of HCG, the hormone specific to pregnancy. A few days later, an ultrasound is performed to confirm the result.

As mentioned in the transfer step, if the pregnancy test is negative, a conversation with a healthcare professional is necessary to discuss a possible new IVF attempt.

What are the success rates of IVF?

A study conducted in 2021 by the National Institute for Demographic Studies (Ined) revealed that “48% of couples became parents thanks to IVF or another medical treatment in France.” The study was carried out in multiple MAR centers and reflects the entire journey of the couples (not just after one IVF attempt).

It’s important to know that unfortunately, there are several risks associated with IVF, such as:

Ovarian hyperstimulation syndrome

This occurs when the ovaries are enlarged and fluid may leak into the abdominal cavity. The causes of the syndrome are still not well understood, but it can cause abdominal pain, bloating, nausea and vomiting, or a higher risk of ovarian torsion (due to its weight). Hospitalization may be required.

Multiple pregnancy

With medical advancements, multiple pregnancies are now less common. Previously, it was typical to transfer several embryos. Today, the focus is on transferring just one. However, that embryo can still split, resulting in identical twins — though this remains rare.

Miscarriages

IVF slightly increases the risk of miscarriage. In MAR cases, it’s often detected very early.

Malformations

The rate of malformations is slightly higher than in a spontaneous pregnancy (they are usually detected early during prenatal diagnostics).

What is the cost of in vitro fertilization?

IVF is fully covered by Health Insurance, up to four attempts.

Reimbursement is also possible if IVF is carried out in the European Union or Switzerland. In that case, an authorization request must be submitted to the National Center for Foreign Care (CNSE), which will then send a form with the necessary reimbursement details.

How to prepare for IVF?

You can prepare for IVF mentally, physically, and logistically.

First of all, keep in mind that IVF is a tiring process for both the body and the mind, and it might not work on the first try — which can cause frustration (according to Ined, one in four couples gives up after the first attempt). It’s recommended to talk to your doctor, midwife, or MAR center in advance, ask all your questions, and be supported by trusted people.

The IVF journey is far from simple. That’s why it’s often recommended to join a support group or to be accompanied by a psychologist.

Preparing your body for IVF can also help optimize your chances and ease the process, particularly through:

• Regular physical activity.
• A healthy and balanced diet.
• Reducing caffeine consumption (including sodas, tea, and chocolate).
• Getting quality sleep.
• Reducing or eliminating alcohol intake.
• Cutting down or quitting smoking.

To go through IVF with greater peace of mind, organization is key. That’s why it’s important to mention that you may be eligible for authorized time off from work, without loss of pay. The partner is also entitled to this leave for up to 3 medical appointments. Of course, a justification must be sent to the employer, which may raise confidentiality concerns.

When can you know if in vitro fertilization has worked?

It’s during the final stage — the pregnancy test via blood test — that you can confirm whether a pregnancy has begun, two weeks after the embryo transfer.

Does IVF increase the chances of a multiple pregnancy?

To repeat, IVF increases the likelihood of a multiple pregnancy. Why? During the transfer into the uterus, the doctor often transfers multiple embryos to increase the chances of pregnancy. As a result, several embryos may develop, increasing the chance of multiples.

However, thanks to improved analysis techniques, single embryo transfers are now more commonly offered specifically to avoid multiple pregnancies.

How is medical follow-up handled after a successful IVF?

YES! The blood test is positive, the ultrasound has confirmed the pregnancy… No special follow-up is needed beyond this point. The monitoring will be the same as for a non-IVF pregnancy, including ultrasounds, check-ups, and consultations.

Want to learn more? Feel free to download the May app, where you’ll find plenty of resources to support and guide you throughout your pregnancy.

What are the differences between IVF and other assisted reproduction techniques?

To recap, IVF is one of the techniques used in MAR. There are two others: artificial insemination and embryo donation. But what are the differences? Let us explain ⬇️

• Artificial insemination: unlike IVF, this method does not require surgical treatment to retrieve oocytes, and fertilization does not happen in a lab. It involves triggering ovulation after stimulation and injecting the prepared and optimized sperm into the uterine cavity to maximize the chance of “natural” fertilization.
• Embryo donation: in this case, it involves a frozen embryo from a donor couple or woman who has decided to give up their parenthood project. The embryo is then placed in the patient’s uterus. This can be seen as a form of adoption.

Mother testimonials

To help you better understand what IVF really involves, several mothers have agreed to share their stories with us. We believe that real experiences are a powerful way to support (future) parents who may have doubts or are looking for something they can relate to.

Julia’s story

Julia underwent IVF in June 2021. After numerous attempts to transfer frozen embryos, she gave birth to little Camille on December 10, 2023. She tells us about her journey.

“We’ve been together since 2007. In 2018, we decided to stop birth control to start a family.

After months of trying, I had no periods and no positive tests.

In 2019, we consulted a gynecologist at a private hospital who suggested assisted reproduction. We began with insemination protocols but they didn’t trigger ovulation. She referred us to the Intercommunal Hospital of Créteil and their fertility center.

We paused for a year because we weren’t ready to start a new protocol. In assisted reproduction, the psychological aspect is key, and you have to feel ready.

In May 2020, after the lockdown, we had our first teleconsultation with Créteil. It was a blow: the gynecologist told us our case wasn’t that serious because we were young (both 29). We felt she couldn’t relate to us at all…

After this bad experience, we were offered psychological support by the hospital, which helped us through these three long years of ART. We underwent heavy testing to check for fertility problems — they found nothing. It was frustrating to hear there was no explanation.

Between Sept. 2020 and Feb. 2021, I did 3 insemination protocols involving many injections and hospital visits every two days to monitor follicles.

In May 2021, we asked to move on from inseminations to egg retrieval for IVF. Again, the gynecologist commented that I was too young to go through IVF. Thankfully, the psychologist was there to pick up the pieces.

The retrieval was very successful — I had 16 oocytes, which gave us 8 embryos. We were hopeful again.

Between June 2021 and June 2022, I had 5 embryo transfers. Each time we hoped it would work, and each time we faced the heartbreak of a negative result after 10 days. After so many failures, we started to lose faith. The care team was supportive when we needed to talk.

In summer 2022, I changed gynecologists, and we took another one-year break — we only had one frozen embryo left and lacked the strength to face another failure.

During that year, we focused on therapy, travel, and enjoying time together.

In January 2023, our new gynecologist kindly suggested starting fresh with updated tests. She found I wasn’t ovulating and proposed a new hormone injection protocol. We started in March 2023 without much pressure, since we were busy with house renovations, a family celebration trip, and I was also best woman at my best friend’s wedding.

The embryo transfer happened on Easter. I didn’t dare believe in it. I was ready for another failure and another egg retrieval.

In the end, the blood test in late April was positive and kept rising every week. I gave birth to little Camille on December 10.

During our journey, I only opened up to my friends — not close family. I didn’t want them to ride the emotional rollercoaster or to see their disappointment. But in hindsight, I think their support would’ve helped a lot. Now they all know and are very proud of us.

My advice to future ART parents: don’t hesitate to talk about it. There’s no shame in going through this process. It takes strength and perseverance. And when you finally hold your baby in your arms, you feel proud of having gone through it together. Don’t hesitate to take breaks — it’s important to recharge.”

Estelle’s story

Estelle discovered she had a half uterus (unicornuate uterus) and a low ovarian reserve. She entered assisted reproduction in 2021 and welcomed her baby girl, Victoria, in the summer of 2023. Here is her story:

“In 2020, I was 30 years old. I knew I wanted kids one day — but not right away. I was happy, fulfilled, no urgency.

A few months later, I experienced unexplained bleeding outside of my periods. The gynecologist ordered an MRI, and that’s when they discovered a malformation that had never been noticed before — I had a unicornuate uterus (and asymptomatic endometriosis, which explained the bleeding). The doctor sat me down and said having a baby would be complicated but not impossible. I left the appointment lost and devastated. I wanted kids — suddenly it felt urgent.

Blood tests confirmed that in addition to the malformation, my AMH levels were quite low for my age. My ovarian reserve wasn’t great. I immediately booked a fertility consultation — I was lucky it moved quickly. Then came more tests, many of them, which really impacted the spontaneity in our intimacy. My first appointment was in March, and we started inseminations in May. Because yes, IVF is expensive for the healthcare system, so even with a tiny chance of natural success, they start with inseminations.

The first one worked on the first try, but I had a very early miscarriage. It was hard to process, but once you enter assisted reproduction, I think you go into autopilot. You just keep going.

I went through 3 more inseminations. The center was a bit like a factory. We were dozens of women waiting in line for bloodwork and transvaginal ultrasounds. There was no time for questions, there were too many of us, and the gynecologist didn’t have time for empathy if she wanted to see everyone. In 5 minutes you had to take off your underwear, have the ultrasound, and be out the door. Results were explained later by phone. The doctors did what they could (especially since it was a different gynecologist every day), but the staff shortages meant no real psychological support. You have to be tough, and you need a go-to doctor who can keep you going. Also, you can’t be shy — there’s no time for modesty.

After the failed inseminations, we moved on to IVF! The hormone doses were stronger, I felt more tired, and I had terrible acne. I was afraid of the retrieval procedure — I’d never been in a hospital before. In our center, egg retrieval is done with local anesthesia (which terrified me), so your body can recover faster.

On the big day, an ultrasound showed 10 follicles of the right size. I was hopeful. In the operating room, I was crying and shaking, but the team was amazing. They listened and waited until I was calm before starting. I didn’t feel anything despite the needle size. They managed to retrieve 5 oocytes. I was disappointed — I knew we’d lose some during development. Only 2 embryos survived, were transferred, and failed to implant.

I took the hit and had another egg retrieval three months later. I switched gynecologists. The new one was wonderful and gave me back my strength. She was vibrant and always found the words to make this feel like an adventure toward our baby. The appointments and injections felt more manageable, and we took time to travel too. She kept saying at each visit: “You’ll have your baby soon.”

The second retrieval was a success — we changed the protocol, and they retrieved 13 oocytes, 8 of which became high-quality embryos. We were overjoyed! The first was implanted, and I got pregnant. We were so happy — it felt like our time had come. At 7 weeks, I decided to get a blood test, just to see my HCG levels skyrocket. But then my heart sank. Another miscarriage. At the ER, they confirmed there was no embryo: “You can see the residue.” Residue. They were talking about my baby. I burst into tears — it was too painful. The gynecologist told me it would feel like a heavy period. Devastated again. Thankfully, we were two — I felt supported and loved. The miscarriage was incredibly painful. Every contraction paralyzed me.

I refused to continue with more transfers without doing further testing. My gynecologist hugged me and said I could take time to process, but I wanted to move on quickly. I wanted out of this cycle. We ran many tests. In the end, we discovered I had a gene that poorly synthesized a hormone essential to embryo development. I took medication for two months and tried another transfer. And this time, it worked. I was 32. Our light baby was on the way. 39 weeks later, I held in my arms a 4 kg baby girl with a face that could melt the whole world. All the struggles we went through — we forgot them. It sounds crazy, but it’s true. Every minute, every tear, every effort… we knew why we did it. The joy of being parents.”

Pauline’s story

Pauline gave birth to a baby boy who is now 10 months old. Before that, she described her ART journey as an “emotional roller coaster.” Here is her story:

“At the end of 2020, I stopped taking the pill, assuming that after 10 years on birth control, it would take time for things to get back to normal and I’d need a few months to conceive. I quickly became worried when my natural cycle didn’t return. After 3 months without a period, I saw my gynecologist. I knew getting pregnant could take time, and 3 months wasn’t much, but since I wasn’t having periods, I had very little chance it would happen by miracle.

That’s when we stepped into a world we knew nothing about. My gynecologist ordered the first standard tests — ultrasound and bloodwork — which showed slightly polycystic ovaries. I started treatment (Duphaston) to trigger periods and restart my cycle. But Duphaston soon became my worst enemy since I had to take it after each failed attempt to get my period — meaning no pregnancy.

After 3 more months (6 months post-pill), I wasn’t pregnant and was far from it. My gynecologist referred me to a reproductive endocrinologist at La Pitié Salpêtrière. Living in Paris was a stroke of luck — I got an appointment 2 months later. I can only imagine the delays outside big cities. My appointment was in July — not great timing in ART, when summer and the holiday season are feared because most fertility centers close.

ART is a long process, not just because it doesn’t always work the first time, but because many attempts and treatments are often needed, and each failure means a lost month — or more. So months pass quickly, and sometimes your body needs a break between cycles. That’s helpful for some women and certainly their bodies, but for me, it was terrible to watch time go by without being able to try again.

My husband and I went through several methods before starting IVF: first a GnRH pump that caused severe hyperstimulation and failed (2 months wasted), then 3 failed inseminations. I always had hyperstimulation, so each time we had to stop mid-cycle to avoid risks. Almost a year after our initial hospital consult, the doctor said the silver lining to hyperstimulation was that I had many follicles and oocytes — meaning high IVF success potential. So we moved forward.

The first IVF attempt started like the inseminations — nightly injections to mature follicles. I was used to it. The hormones caused major side effects: I gained weight (water retention), lost hair, had acne, was exhausted — and emotionally down, although maybe not just from the meds. IVF takes a massive toll on your energy and time. At the start, I had to go to the hospital every other day for ultrasounds and bloodwork. I spent countless hours in that windowless waiting room, looking at posters about alcohol and smoking during pregnancy. After the tests, I’d wait for the hospital’s midday call to adjust treatment or tell me when to start ovulation-blocking injections. Then it was two injections per day — one to mature follicles, another to block their release. I imagined the conflicting signals in my body like a cartoon — “Once Upon a Time… Life” style. After 10 days, I went in daily for close monitoring to avoid hyperstimulation. But that first IVF cycle didn’t happen: they called me while I was in a work meeting to say it had to be canceled due to dangerous overstimulation. Worst of all — right before the Christmas break, so we had to wait a month to try again. Another bead on the calendar necklace.

On the second try, we used much lower hormone doses — it took longer, but was safer. After daily visits and dual injections, I finally got the call: we could trigger ovulation. Egg retrieval was scheduled. Under general anesthesia, it went well — they retrieved 18 oocytes, an excellent result. We left full of hope — we’d never been this close.

But three days later, a Saturday morning, we got the call: only 3 embryos had formed from 18 oocytes, and none survived. I collapsed — literally fell to the ground like my body had melted. Even now, with a happy ending, I remember that moment as one of the most painful emotions I’ve ever experienced.

We were advised to take 2 months to recover emotionally and physically — another two months added. But this time, the break helped. I found a new job, regained energy, the side effects faded, and life slowly came back. But I still counted every day until the next try.
The next cycle was in June — important, because the center closed in August. We had just one shot; otherwise, we’d have to wait until September. Three more months gone. Plus, we were moving to Belgium for my job, so it was our last chance to try IVF in France. We already had a fertility appointment booked in Brussels for September.

This time, I wanted to maximize my chances. I asked my GP for a two-week medical leave so I could focus on the process. Balancing hospital visits, side effects, pain, and stress with work had been draining. I didn’t want to keep making excuses for being late or crying in the office bathroom after hospital calls.

We started slowly — same process as before. Retrieval gave us 12 oocytes — a slightly lower number, but maybe better quality?

This time, we tried ICSI — directly injecting sperm into the eggs to boost fertilization. In standard IVF, you let nature take its course, but apparently my husband’s sperm lacked vigor. ICSI gave us better chances.

It worked. Three days after retrieval, we had 6 good embryos. We waited until Day 5 for transfer, to select the strongest one. Two days later — the transfer. Finally. At that moment, no matter what happened next, I was pregnant. I didn’t move for 3 days. I was afraid even going to the bathroom might dislodge the embryo.

I waited the full 14 days before testing. I watched for symptoms, but I knew Ovitrelle (the ovulation trigger shot) could cause false positives — I’d experienced that before. This time, I was disciplined. I waited for the blood test. My husband and I opened the result together — we hugged silently. We were expecting a baby — finally.

My advice: talk about it. That’s why I’m sharing my story now. We started our ART journey in secret — dreaming of a magical pregnancy reveal for our loved ones. We thought it would be short, and we wouldn’t need outside support. But after our second failed IVF, we had to open up. No one around us had been through it, so true understanding was rare. But at least our sadness made sense to others. People understood why we were tired, why we socialized less. Why I broke down when friends announced pregnancies (never in front of them, of course).

I also recommend working with experienced professionals. I can’t say for sure it made the difference, but for my last IVF, I saw an incredible osteopath in Paris, specialized in women’s health. I went before and after the retrieval to “prepare the ground.” Even if it wasn’t a miracle fix, it eased my pain from the retrieval and hyperstimulation.

I also saw an amazing acupuncturist midwife, before and after transfer. Whether or not it helped the embryo implant, it was time well spent — being heard and cared for. He used acupuncture to manage my stress and fatigue — it was a game-changer. I’ll be forever grateful to both of them.

And of course, my husband — who never gave up and always picked me up after every setback. Today, he’s the most wonderful dad.

As with everything in life, care depends a lot on the person in front of you. We met many healthcare professionals — gynecologists, midwives, anesthetists, interns… some were awful, others brilliant. But overall, I often felt like a car being repaired. Few talked to me, few asked how I felt. The goal was to get me pregnant. Time was tight, and it showed. We were a file, not a couple longing for a child. Everything was fast, rushed. Our heartbreaks were just bad stats. You show up, put your feet in the stirrups, and leave.

I had to take charge of my own journey. I learned to understand the numbers, the hormone levels in blood tests, the ultrasound images — because if the doctors made a mistake, it meant failure. Every hour mattered. For my last attempt, I even adjusted my hormone doses myself because I felt it was going too fast and I was close to hyperstimulation. I’m not saying everyone should do this, but understanding the treatments and process — that was the key for us.

I know this is a long message — once I started writing, the memories came flooding back. But this is a part of our story, mine and my husband’s. Even months later, even with a beautiful baby, this time in our lives leaves me shaken. The fear of never becoming a mother was overwhelming. I was deeply, painfully jealous of every pregnant woman. I still feel a bit ashamed that I’m not one of those “fertile” women meant to repopulate France. I sometimes feel broken, like I’m missing part of my femininity. And I’m already anxious at the thought of going through this again if we want a second child. Honestly, it might be what makes me not want one.

Thank you for everything you do at May — you made my pregnancy and the early days of motherhood so much softer. It was a May midwife who predicted my labor in March — and she was right!”

The IVF journey can be long and difficult, but it holds the power to fulfill the wish of building a family. Don’t hesitate to talk to others who have been through it, and to health professionals who are here to listen ❤️.

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Photo: Envato

This text was translated from French by an artificial intelligence. The information, advice, and sources it contains comply with French standards and may therefore not apply to your situation. Make sure to complement this reading by visiting the May ES/UK app and consulting the healthcare professionals who are supporting you.