Fertility is complicated and influenced by many factors, so diagnosing and treating it can be a complex process. 

You have likely heard of “IVF,” but many people do not know what exactly IVF or fertility treatment entails. Fertility treatments like IVF are not a single treatment, but rather a series of procedures that you and your partner will go through over a period of weeks. It can be difficult to predict exactly how long your fertility treatment will take, since your treatment will be tailored to you and every patient and every cycle is unique.

Even if you’ve gone through some testing before coming to the Fertility Center for care, you’ll likely need to have more tests done. This can feel like an additional delay, but it’s an important starting point to help your care team the situation with you and your partner.

Because this process can take time, it can sometimes be frustrating along the way. Your care team at the Fertility Center will work with you to determine what steps are needed for your individual treatment plan. This article will explain what you can expect if you go through fertility treatment and provides a general outline of what the process might look like.

Initial Consultation

Expect to spend much of your first appointment reviewing your medical history and any prior treatment with your doctor. This visit can be overwhelming, but it is important that your care team understands you and your partner, your health and any questions or concerns that you have.

You can expect a couple of standard next steps:

  • Schedule needed tests or procedures to assess your situation and help guide diagnosis and treatment
  • Identify and schedule any referrals that may be needed, i.e. nutrition, cardiology, social service
  • Review insurance paperwork and schedule financial consultation (if needed). (This is an important step because some insurance plans mandate certain treatments prior to more aggressive treatment.)

Preparation for Treatment

This often take a few weeks. Much of the testing you’ll go through during fertility treatment is tied to your menstrual cycle, so this period may take more time depending on where you are in your cycle.

During this preparation period, you will undergo testing to help your care team find out what might be causing fertility problems for you and your partner. These tests can include:

  • Blood testing
  • Ultrasound
  • Infectious disease testing
  • Uterine evaluation
  • Semen analysis

Medication and Monitoring

Once your testing and any necessary referrals have been completed, you will return and meet with your care team and your physician will determine the best plan for your fertility care. 

Generally, there will be several options for fertility treatment discussed:

  • Continuation of your natural cycle without any medication
  • Controlled ovarian hyperstimulation or “COH”, a process that uses fertility medications such as Clomid, Gonal-F or Letrozole that stimulate your body to mature more eggs than normal. (During a normal menstrual cycle, usually only one follicle will ovulate one egg.) You can expect to take anywhere from 5 to 10 days of medication based on your diagnosis.
  • Intrauterine Insemination
  • In vitro Fertilization

Note that your insurance coverage may play a role in deciding your course of action–some insurance plans will allow you to proceed directly to IVF, while others may require several cycles with COH.

At this point, you’ll also learn about any necessary medications for your care plan, their possible side effects and how to administer those medications through instructional video modules. You’ll also have access to these videos online, so you can revisit them whenever needed.

During this time, you can expect to come in every few days for monitoring visits to keep a close eye on the development of your follicles through different kinds of testing:

  • Blood testing
  • Ultrasound

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is basically a procedure that assists with insemination. During IUI, your partner provides a semen sample, that sample is then washed and a member of your care team will use a small catheter to insert the washed sperm through your cervix into your uterus.

An IUI is completed one to two days after. When monitoring shows that your ovarian follicles have grown to appropriate size, you will have an intrauterine insemination (IUI) completed one to two days after your egg maturation is triggered. Pregnancy testing occurs two weeks later.

The timing of your IUI depends on your follicle growth. When monitoring shows that your ovarian follicles have grown to appropriate size, egg maturation will be triggered and the IUI will then be completed one to two days later. 

You will take a pregnancy test two weeks later.

In Vitro Fertilization (IVF)

With the start of you next menstrual period after testing has been completed, you will begin taking birth control pills to help regulate your menstrual cycle. You will be monitored closely with blood testing and ultrasounds per the specialized protocol that was chosen for you based on the testing results from you and your partner.

Triggering and Egg Retrieval

When monitoring shows that your ovarian follicles have grown to appropriate size, final egg maturation is triggered with human chorionic gonadotropin (hCG) shot.

35 hours later, one of our fertility physicians will perform your egg retrieval. This is an outpatient procedure performed under sedation in the Fertility Center on Mass General’s main campus. There is minimal risk associated with this procedure, but you will want to plan to take the day off and arrange for a ride home.

We will also collect a sperm sample from your partner that day, unless you have made arrangements for freezing of sperm (or using donor sperm) prior to the start of your cycle.

Fertilization

After your eggs and sperm have been collected, our embryologists will combine them in our specialized lab to facilitate fertilization. Some patients choose to take additional steps based on previous testing results that may help to increase chances of success:

  • Intracytoplasmic sperm injection (ICSI) – the sperm is injected directly into an egg
  • Assisted hatching – a hole is poked in the embryo’s outer membrane to increase chances of implantation
  • Preimplantation genetic screening/diagnosis – genetic testing is done on the embryos before they are transferred to your uterus to determine whether any genetic defects are present

Embryo Transfer

After three to six days, we will evaluate to see how things are going and determine how many embryos have been created.

At three or five days after fertilization occurs, your embryos will be transferred back into your uterus (the exact timing depends on the status of your embryos). The embryos are placed using a thin, flexible plastic tube. You will not be sedated for this procedure and it is generally painless, but you may experience mild cramping.

After Your Transfer: Watchful Waiting

After the embryo transfer, you may be given a progesterone supplement that helps support the uterine lining and encourage the embryos to implant.

You’ll then move into a watchful a period of watchful waiting:

  • Approximately 12 days after your transfer, you’ll have your first pregnancy test
  • If that test is positive, you’ll have another pregnancy test two days later
  • If the second test is positive, you will have early obstetrical ultrasounds scheduled at approximately six weeks and eight weeks of gestation

If the results of those ultrasounds are positive, you can transition back to your obstetrician to continue your pregnancy care.