IVF Guide: The Complete Patient Resource
In Vitro Fertilisation (IVF) is a fertility treatment in which eggs are retrieved from the ovaries, fertilised by sperm in a laboratory, and the resulting embryo is transferred into the uterus. It is the most effective fertility treatment available — accounting for over 8 million births worldwide since 1978.
This guide covers every stage of IVF based on ASRM 2023, ESHRE 2023, and ACOG 2022 guidelines.
Who Needs IVF?
| Indication | Guideline |
|---|---|
| Bilateral tubal blockage | ASRM 2023 — first-line, no alternative |
| Severe male factor (TMSC <5M) | ASRM/ESHRE 2023 — with ICSI |
| Failed ovulation induction + IUI (3–6 cycles) | ASRM 2023, NICE CG156 |
| Age 38+ with unexplained infertility | ASRM 2023 — time-efficiency argument |
| Moderate-severe endometriosis | ESHRE Endometriosis Guideline 2022 |
| Diminished ovarian reserve (DOR) | ASRM 2023 — IVF more efficient than IUI |
| Embryo genetic testing required (PGT-A/M) | ASRM 2023 — only possible via IVF |
| Recurrent implantation failure | ASRM/ESHRE 2023 |
IVF Success Rates
Per ESHRE EIM Consortium 2023 and SART 2022 — live birth rates per egg collection, own eggs:
| Age | Live Birth Rate per Cycle | Cumulative (3 cycles) |
|---|---|---|
| Under 35 | 40–50% | 65–75% |
| 35–37 | 30–40% | 55–65% |
| 38–40 | 20–28% | 40–55% |
| 41–42 | 10–15% | 25–35% |
| 43–44 | 5–8% | — |
| Donor eggs (any age) | 40–50% | — |
Cumulative rates include frozen embryo transfers from surplus blastocysts created in one egg collection.
Stage-by-Stage: The Complete IVF Process
Stage 1 — Pre-Treatment Assessment
Both partners are investigated before starting: AMH, Day 3 FSH/LH/E2/prolactin/TSH, antral follicle count, uterine cavity assessment, and infectious disease screen for women; semen analysis ×2, hormonal panel if low count, and genetic testing if severe oligospermia for men.
Stage 2 — Ovarian Stimulation (Days 2–12)
Daily FSH injections (Gonal-F, Menopur, Fostimon) at individualised doses based on AMH/AFC:
| AMH | Starting Dose | Expected Eggs |
|---|---|---|
| >3.5 ng/mL (PCOS/high) | 100–150 IU | 15–25 |
| 1.5–3.5 ng/mL (normal) | 150–225 IU | 10–15 |
| 1.0–1.5 ng/mL (low-normal) | 225–300 IU | 7–12 |
| <1.0 ng/mL (DOR) | 300–450 IU | 3–8 |
From Day 5–6, a GnRH antagonist (Cetrotide, Orgalutran) prevents premature ovulation. Monitoring ultrasound every 2–3 days tracks follicle growth. Target: 8–15 follicles reaching 17–20mm. Per ESHRE Ovarian Stimulation Guideline 2023: doses must be individualised — not standardised — to optimise response while minimising OHSS risk.
Stage 3 — Trigger Injection (Day 10–12)
When lead follicles reach 17–20mm, a trigger injection finalises egg maturation. Egg retrieval is timed exactly 34–36 hours later.
- hCG trigger (Ovitrelle/Pregnyl): standard trigger; mimics natural LH surge
- GnRH agonist trigger: used instead of hCG in high-responders (PCOS, AMH >3.5, >20 follicles) — eliminates late-onset OHSS risk; requires freeze-all strategy. Per ASRM OHSS Prevention Guideline 2023: agonist trigger + freeze-all is the safest approach for high-responders
Stage 4 — Egg Retrieval (OPU)
A 15–20 minute procedure under IV sedation. A transvaginal ultrasound-guided needle aspirates each follicle. An embryologist immediately identifies eggs. Patients go home the same day with mild cramping.
Stage 5 — Fertilisation
Only mature (MII) eggs — typically 75–85% of retrieved eggs — can be fertilised.
- Conventional IVF: 50,000–100,000 prepared sperm placed with each egg; natural fertilisation
- ICSI: single sperm injected directly into each egg — used for male factor, low counts, previous fertilisation failure, PGT cycles
Fertilisation confirmed 16–18 hours later: fertilised eggs show two pronuclei (2PN). Normal fertilisation rate: 70–80%.
Stage 6 — Embryo Culture (Days 3–6)
Per ESHRE Istanbul Consensus 2023: blastocyst (Day 5) transfer is preferred over Day 3 because implantation rates are significantly higher (40–60% vs 20–35%) and natural selection identifies only developmentally competent embryos.
Blastocysts are graded: expansion grade 1–6 + inner cell mass A/B/C + trophectoderm A/B/C. A 4AA–4BB blastocyst carries ~60–70% implantation rate per transfer.
Stage 7 — Preimplantation Genetic Testing (Optional)
Blastocysts can be biopsied for:
- PGT-A: screens for chromosomal errors. ASRM 2023 best indications: women ≥38, recurrent miscarriage, recurrent implantation failure
- PGT-M: tests for specific inherited conditions (BRCA1/2, thalassaemia, SMA, cystic fibrosis)
- Results take 7–14 days → embryos vitrified → transferred in a subsequent frozen cycle
Stage 8 — Embryo Transfer
One embryo placed into the uterus via a thin catheter — a painless 10-minute outpatient procedure.
Single embryo transfer (SET): Per ASRM/ESHRE 2023, SET is strongly recommended for most patients. Twins double maternal and neonatal complications. SET with surplus frozen embryos achieves the same cumulative success with only 1–2% twin rate vs 25–30% for double transfer.
Fresh vs frozen transfer: Per ESHRE 2023, frozen embryo transfer (FET) achieves equal or superior live birth rates for most patients — the uterus recovers from stimulation, endometrial preparation is optimised, and OHSS risk is eliminated.
Stage 9 — Luteal Support and Pregnancy Test
Progesterone (vaginal pessaries or gel) supports the uterine lining after transfer. Beta-hCG blood test 11–14 days after transfer. If positive, progesterone continues to 10–12 weeks while the placenta establishes.
IVF Medications at a Glance
| Medication | Type | Purpose |
|---|---|---|
| Gonal-F / Menopur / Fostimon | FSH injections | Stimulate multiple follicles |
| Cetrotide / Orgalutran | GnRH antagonist | Prevent premature ovulation |
| Ovitrelle / Pregnyl | hCG trigger | Final egg maturation |
| Cyclogest / Crinone 8% | Progesterone | Luteal support |
| Progynova / Estradot | Estrogen | Endometrial prep (FET only) |
IVF Costs in India 2025
| Component | Typical Cost (INR) |
|---|---|
| Stimulation + monitoring + OPU + embryology | ₹1,20,000–₹2,00,000 |
| Gonadotropin medications | ₹40,000–₹1,20,000 |
| ICSI | ₹15,000–₹35,000 |
| Blastocyst vitrification | ₹15,000–₹30,000 |
| Frozen embryo transfer (FET) | ₹45,000–₹85,000 |
| PGT-A (per embryo biopsied) | ₹20,000–₹35,000 |
| Complete fresh cycle (no PGT) | ₹2,50,000–₹3,50,000 |
Detailed Articles in This IVF Series
- What Is IVF? Step-by-Step — the procedure in detail
- IVF Cost India 2025 — complete pricing breakdown
- IVF Medications Guide — every injection explained
- IVF Two-Week Wait — what to expect after transfer
- Frozen Embryo Transfer Guide — FET process
- PGT-A Embryo Testing — genetic testing
- IVF Multiple Cycles Budget — financial planning
- IVF Success Rates India — clinic data
Reference: ASRM Practice Committee — In Vitro Fertilisation, 2023. ESHRE Guideline — Ovarian Stimulation for IVF/ICSI, 2023. ESHRE Istanbul Consensus on Embryo Assessment, 2023. ACOG Practice Bulletin No. 197 — Infertility, 2022 (reaffirmed). ESHRE EIM Consortium 2023. SART National Summary 2022.
Frequently Asked Questions
What is IVF and how does it work?▾
IVF (In Vitro Fertilisation) retrieves eggs from the ovaries after hormone stimulation, fertilises them with sperm in a laboratory, and places the resulting embryo into the uterus. One cycle takes approximately 5–6 weeks. Live birth rates per cycle range from 40–50% under age 35 to 5–8% at age 43–44 (ESHRE 2023).
How many IVF cycles does it take to succeed?▾
Most successful IVF pregnancies occur within 3 cycles. Cumulative live birth rates across 3 cycles reach 65–75% for women under 35 and 40–55% for ages 38–40 (ESHRE 2023). Frozen embryo transfers from surplus blastocysts allow multiple transfer attempts from a single egg collection, significantly improving cumulative outcomes.
Who needs IVF?▾
IVF is recommended per ASRM 2023 for: bilateral tubal blockage, severe male factor (TMSC <5 million), failed IUI after 3–6 cycles, women 38+ with unexplained infertility, moderate-severe endometriosis, diminished ovarian reserve, and any couple needing embryo genetic testing (PGT-A or PGT-M).
What is the IVF success rate in India?▾
At quality accredited centres in India, IVF success rates are broadly comparable to international data: 40–48% live birth rate per cycle for women under 35, 30–38% for ages 35–37, 20–27% for ages 38–40. Rates vary significantly by clinic — always ask for age-stratified live birth rates per egg collection cycle, not just per transfer.