By Dr. Shweta Agarwal, MBBS, DGO Medically reviewed by Dr. Shweta Agarwal, MBBS, DGO Last updated: June 2026
Information on this page is educational and does not replace a medical consultation. Outcomes depend on individual clinical factors.
Aansh Hospital & IVF Center is a government-registered Level-2 ART clinic (Reg. No. MH/AC/2024/15441/L2/Chandrapur/132), part of a growing chain of fertility centers across Vidarbha and northern Telangana, with our headquarters and in-house embryology lab in Chandrapur. Our government ART registration covers IVF, ICSI, embryo culture, and embryo transfer — all performed on-site by Senior Clinical Embryologist Aayush Agarwal, Ph.D. under the clinical leadership of Dr. Shweta Agarwal.
Most people beginning their first IVF cycle arrive with the same anxious questions: How long will this take? How many clinic visits? Will I be able to work? What will the injections feel like? This guide walks through a typical IVF cycle phase by phase — not as a clinical checklist, but as the experience you are actually likely to have, including what each visit involves and how it fits into your daily life.
One thing worth saying at the outset: IVF cycles vary. The timeline below reflects a typical fresh cycle (आईव्हीएफ फ्रेश सायकल) at Aansh. Your protocol may be shorter or longer depending on your ovarian reserve, hormone levels, and how your body responds to stimulation. Your team will walk you through your specific plan before you start.
What happens before stimulation begins — the pre-cycle workup?
Before a single injection is given, both partners complete a focused pre-cycle assessment. This phase typically spans 2–4 weeks and establishes the baseline information your doctor needs to design a stimulation protocol that is right for you.
For the female partner, this includes a transvaginal ultrasound to count antral follicles and check the uterine cavity, blood tests for FSH, LH, AMH (anti-Müllerian hormone), oestradiol, and thyroid function, and — where not already done — a test to confirm the uterine cavity is clear (hysteroscopy or saline infusion sonography, depending on your history). For the male partner, a semen analysis is performed if not recently completed. Dr. Shweta Agarwal reviews all results together and uses AMH, antral follicle count, age, and body weight to calculate the starting dose of stimulation medication.
This phase also includes a consent and counselling appointment — an important session where the full protocol is explained, questions are answered, and injection technique is demonstrated so you feel confident before Day 1. The fertility assessment page explains what the pre-cycle tests involve in more detail.
Practically speaking: this phase requires 2–4 clinic visits, most of which are blood draws and ultrasounds. They are short appointments. Most people manage them before or after work.
What happens during ovarian stimulation — the injection phase?
Ovarian stimulation is the phase most people think of when they picture IVF — the daily injections. It begins on Day 2 or Day 3 of your menstrual period, once the baseline ultrasound confirms the ovaries are quiet and ready.
From that day, you administer daily subcutaneous (under-the-skin) injections of FSH (follicle-stimulating hormone), sometimes combined with LH. These medications encourage the ovaries to develop multiple follicles — small fluid-filled sacs, each potentially containing a mature egg — rather than the single follicle of a natural cycle. The dose is individualised based on your AMH and antral follicle count. You inject into the lower abdomen, usually at the same time each evening. Your nurse will demonstrate the technique at your pre-cycle appointment; the injection itself is a fine, short needle and most people find it much less daunting in practice than they expected.
Stimulation continues for approximately 10–12 days. During this time you attend the clinic every 2–3 days for a monitoring visit: a transvaginal ultrasound to measure follicle size and count, and a blood test to check oestradiol levels. These visits usually take 20–30 minutes. Your doctor uses the monitoring results to adjust your medication dose if needed — this is normal and part of the process, not a sign something is wrong.
From about Day 5 of stimulation onwards, a second daily injection is added: a GnRH antagonist, which prevents premature ovulation before retrieval.
Daily life during stimulation: most people continue working normally. You may feel some bloating and pelvic heaviness as the follicles grow — this is expected. Vigorous exercise (anything that jolts or twists the lower abdomen) is usually paused during stimulation. You are not confined to rest.
When and why is the trigger injection given?
The trigger injection is a precisely timed single shot that signals the eggs to complete their final maturation before retrieval. It is not an ongoing medication — it is given once, at a specific time on a specific night, usually when the leading follicles have reached approximately 18–20 mm in diameter.
The timing of the trigger matters very precisely. Egg retrieval is scheduled exactly 34–36 hours after the trigger — not 33 hours, not 38. Your team will calculate the exact time and confirm it at your monitoring appointment. The injection is typically given between 9 pm and midnight so that retrieval falls the following morning. You will receive written instructions with the exact time. Do not adjust it.
There are two types of trigger: hCG (human chorionic gonadotropin) and a GnRH agonist. The choice depends on your OHSS risk and protocol. For women with high AMH or PCOS, a GnRH agonist trigger is often preferred because it carries a lower risk of ovarian hyperstimulation syndrome (OHSS) — and in those cases, a freeze-all strategy is usually also recommended (see below).
After the trigger, your stimulation injections stop. The next 34–36 hours are a waiting period. Many people feel bloated and tender during this window as the follicles are at their largest. Rest is helpful; the discomfort typically eases after retrieval.
What happens on egg retrieval day?
Egg retrieval is a minor surgical procedure performed under intravenous (IV) sedation. You are asleep for the procedure and feel nothing during it. It takes approximately 15–20 minutes.
You will be asked to fast from midnight the night before. Arrive at the clinic with a companion, as you will not be able to drive home after sedation. When you are ready, an IV line is placed and you are given sedation medication. The procedure itself: a fine needle is passed through the vaginal wall under continuous transvaginal ultrasound guidance to aspirate the fluid from each follicle. The embryologist in the lab receives each aspirate in real time and identifies the eggs immediately. The number of eggs retrieved depends on how many mature follicles developed — this varies by individual and cannot be perfectly predicted in advance.
Recovery in clinic: you typically rest for 1–2 hours after waking up. Most people go home the same day. Mild cramping and light spotting for 1–2 days afterwards are normal and expected. Standard pain relief (paracetamol) is usually sufficient. Avoid strenuous activity for a day or two. Most people return to work the following day, though some prefer to rest at home.
On the same morning, the male partner provides a fresh semen sample. This is processed in the andrology lab by Aayush Agarwal to prepare the sperm for fertilisation.
How are eggs fertilised in the lab — IVF versus ICSI?
A few hours after retrieval, the collected eggs are fertilised in the embryology lab. The method used depends on sperm quality and clinical history.
In standard IVF, the prepared sperm are placed together with the mature eggs in a culture dish and fertilisation occurs naturally, as it would in the fallopian tube — the sperm swim to and penetrate the egg without assistance. This approach is used when sperm parameters are adequate.
In ICSI (intracytoplasmic sperm injection), the embryologist selects a single healthy-looking sperm under high magnification and injects it directly into each mature egg. ICSI is recommended when sperm count, motility, or morphology is significantly abnormal, when sperm has been surgically retrieved, or when a previous IVF cycle had unexpectedly poor fertilisation. ICSI is performed on-site in our embryology lab.
Fertilisation is confirmed 16–18 hours later by checking whether the eggs show two pronuclei — the sign that both the egg and sperm have contributed their genetic material. You will usually receive a call or message on the morning after retrieval with your fertilisation result: how many eggs were retrieved, how many were mature, and how many fertilised successfully. This call is often an emotional moment — it is normal to feel anxious. Try to remember that the number at fertilisation is not the final count; embryos continue to be assessed over the following days.
How do embryos develop in the lab — what is blastocyst culture?
The fertilised eggs are now embryos. They are placed in specialised incubators and monitored daily. The embryology team assesses development at multiple timepoints but keeps the embryos in the incubator as much as possible — stable temperature and gas environment are important for development.
Day 1: Fertilisation confirmed. Two pronuclei visible in normally fertilised embryos.
Day 2–3: The embryo divides into 4–8 cells. This is the cleavage stage. Embryos at Day 3 can be transferred at this point (a Day 3 transfer) or cultured further.
Day 5–6: The embryo reaches blastocyst stage — a more developed structure with a distinct inner cell mass (which becomes the baby) and an outer layer (which becomes the placenta). Blastocyst culture to Day 5 or Day 6 allows the embryology team to select the most competent embryos for transfer, as not all Day 3 embryos reach blastocyst. Whether to culture to Day 3 or Day 5 depends on the number of embryos available and their quality — your embryologist will advise.
Surplus embryos of good quality that are not transferred can be vitrified (flash-frozen) for future use in a frozen embryo transfer (FET) cycle.
What is the decision to freeze all embryos, and when does it apply?
A freeze-all cycle means no fresh embryo transfer is done in the same stimulation cycle. Instead, all suitable embryos are vitrified and transferred in a separate FET cycle, usually 4–8 weeks later, once the uterus has returned to its natural state.
Freeze-all is recommended in specific clinical situations:
- OHSS risk: Women with high AMH, polycystic ovarian syndrome (PCOS), or a very high follicle count are at higher risk of ovarian hyperstimulation syndrome — a serious response to stimulation where the ovaries become swollen and fluid can accumulate. Freezing all embryos and allowing the ovaries to recover before transfer is the safest approach for these patients.
- Elevated progesterone on trigger day: A premature rise in progesterone before retrieval may impair endometrial receptivity — freezing all embryos and transferring when the lining is ready tends to give a better outcome.
- Thin endometrial lining on transfer day.
- Intercurrent illness.
If freeze-all applies to you, your doctor will explain the reason before retrieval day — it should not come as a surprise. A freeze-all cycle is not a failed cycle; it is a strategy to maximise safety and give the embryo the best environment for implantation. The FET cycle itself is a separate, lower-intensity process (no stimulation injections; just endometrial preparation medication) and is covered on the frozen embryo transfer page.
What happens at embryo transfer — and what does single embryo transfer mean?
Embryo transfer is the final step of the laboratory phase and the first step back into your body. It is an outpatient procedure — no sedation in most cases — and takes approximately 10–15 minutes.
The embryologist loads the selected embryo into a fine, soft catheter filled with a small volume of culture medium. You lie on the ultrasound table with a moderately full bladder (which helps visualise the uterus). The catheter is gently passed through the cervix into the uterine cavity under ultrasound guidance, and the embryo is deposited at the optimal site. The procedure feels similar to a cervical smear. You may experience mild cramping. There is no need for rest afterwards — you can resume normal activity the same day.
Single embryo transfer (SET) is the standard recommendation at Aansh. Transferring one embryo at a time does not reduce your overall chances of having a baby — and it avoids the significant health risks a twin or triplet pregnancy carries for both you and your babies. If you have surplus high-quality embryos, they are vitrified and available for future FET cycles. Dr. Shweta Agarwal will discuss the embryo selection and transfer recommendation at your Day 4–5 update call.
After transfer, you begin progesterone luteal support — usually vaginal progesterone pessaries, sometimes combined with oral or injectable progesterone. Progesterone supports the uterine lining and is continued until at least the pregnancy blood test result, and beyond if the test is positive.
What happens during the two-week wait — and how do you get through it?
The 10–14 days between embryo transfer and your beta-hCG blood test are often described as the hardest part of the cycle. There is nothing clinical to do. The embryo either implants or it does not, and no symptom or absence of symptom is a reliable indicator either way — progesterone medication causes many early pregnancy-like feelings (breast tenderness, bloating, mild cramps) regardless of outcome.
A few practical notes for this period:
- Activity: There is no evidence that bed rest improves implantation. Normal daily activity, gentle walking, and light work are fine. Avoid vigorous impact exercise and intense heat (saunas, very hot baths).
- Medications: Continue progesterone as prescribed without missing a dose, even if you have spotting. Spotting in the two-week wait does not mean the cycle has failed.
- Home pregnancy tests: We ask patients not to test at home before the scheduled blood test date. Home urine tests detect the same hormone (hCG) used in the trigger injection — a positive test in the first week after transfer may reflect the trigger, not implantation, and an early negative can cause unnecessary distress if the embryo is still in the process of implanting.
For a much more detailed guide to managing the physical and emotional experience of this period, see the two-week wait after embryo transfer.
When is the beta-hCG test done — and what does the result mean?
The pregnancy blood test is a serum beta-hCG — a blood test that measures the exact level of the pregnancy hormone human chorionic gonadotropin. It is performed 10–14 days after embryo transfer, as your team confirms.
A positive beta-hCG above a threshold value indicates implantation has occurred. A single positive is not the full picture — the level and how it rises over 48 hours matters. A second blood test is typically ordered 48 hours later to confirm that the hCG level is rising appropriately. An early viability ultrasound is then scheduled for around 6–7 weeks of pregnancy.
A negative beta-hCG means the cycle has not resulted in a pregnancy. This is a painful result and there is no way to minimise it. Your team will schedule a follow-up appointment — usually within a week — to review the cycle in detail, discuss what the embryology data showed, and talk through the next steps. A first failed cycle does not predict future cycles; the review is specifically designed to understand what adjustments can be made.
If you have frozen embryos, a FET cycle can usually begin within 4–8 weeks.