What Should I Expect From My First IVF Cycle?

IVF doesn’t exactly begin with injections, as one might think. In reality, an IVF cycle often starts weeks (if not months) before the first injection, with many preparation steps such as:

• infectious disease screening (HIV, chlamydia, herpes, gonorrhea etc.)
• hormone panels and other miscellaneous bloodwork (thyroid, androgens)
• baseline intravaginal and/or trans-pelvic ultrasound
• uterine evaluations and (sometimes) imaging, including “HSG”⁵ and “SIS”⁶
• birth control or estrogen priming (depending on your protocol)

This prep phase matters because your doctor is trying to make sure that your hormone levels are stable and appropriate, that your ovaries are synchronized, that your uterus and fallopian tubes are structurally sound … so that your first IVF cycle can start and be completed in the most predictable and efficient way possible.

Each person’s protocol will be different, but most IVF cycles will follow the same overall structure:

These are injectable hormones that stimulate your ovaries, to grow many eggs at once. You may have one or several of those, depending on your protocol. We commonly find:

• FSH-based meds: those are “follitropins”, and the most common are Gonal-F, Follistim, Rekovelle, and Puregon.
• FSH + LH combination meds: they are often used together with the FSH meds; and used especially for low responders, older patients, or poor prior response. They include Menopur, Meriofert, Pergoveris.

These are the “main event” meds and are usually taken daily. Possible side effects include bloating, mood swings, and mild abdominal discomfort. 

As your eggs are growing with stims, your clinic must prevent you from ovulating too early, or the retrieval is cancelled. Common options include:

• Antagonists: they are usually stared midway, until trigger day. Most common ones are Ganirelix, Cetrotide, generic ganirelix/cetrorelix acetate, Orgalutran
• Lupron (in agonist suppression protocols): they are sometimes used earlier in the cycle. Lupron (or leuprolide acetate) is commonly used in the US, but in other countries you may find, Buserelin
• Oral medications such as Provera (medroxyprogesterone): more and more commonly used during stimulation instead of an antagonist. Provera suppresses the LH surge (which is what triggers ovulation), and so is used to avoid premature ovulation. It is increasingly used in egg freezing cycles, cost-sensitive cycles, and some DOR protocols.

This is one of the most important injections of the entire cycle. Timing matters enormously. Your clinic will tell you the exact minute, and you should do it exactly at the minute instructed. Common trigger types are:

• hCG¹¹ trigger: hCG is the “pregnancy hormone” that is naturally present in your body when pregnant. A high dose of synthetic hCG is commonly used as “trigger”. Brand names include Pregnyl, Novarel, Ovidrel
• Lupron trigger: it is often used for patients at risk of OHSS (which can be exacerbated with hCG).
• A dual trigger is also common, by combining both hCG + Lupron. It is also often used for maturity issues or borderline response.

After retrieval, many clinics prescribe support meds (as needed depending on the situation), such as:

• pain meds
• stool softeners
• antibiotics
• cabergoline (if OHSS risk)
• progesterone and/or estrogen (especially if doing a “fresh” transfer; if you are not doing a transfer immediately after retrieval, no hormonal support will be needed)

• Ovarian PRP (Platelet-Rich Plasma): an emerging and still investigational practice with mixed evidence. A small amount of your blood is processed to concentrate platelets and growth factors, and the PRP is then injected into the ovaries under ultrasound guidance. Some studies and patient experiences report measurable increases in AMH levels and ovarian activity following PRP, but whether these changes consistently translate into improved egg yield or live birth rates remains under investigation.
• Growth hormone (Omnitrope, Zomacton, Saizen): used by some clinics for poor responders or suspected egg quality issues.
• Letrozole (Femara): used in estrogen-sensitive patients (such as endometriosis patients) to keep estrogen low; sometimes used combined with IVF stims in poor responders.
• Clomid (Clomiphene Citrate, Serophene): an older IVF approach sometimes used in some patients (and commonly used for IUI protocols)
• Levothyroxine (Synthroid, Levoxyl, Unithroid) for thyroid hormones regulation. Very commonly used by fertility clinics to maintain a healthy TSH level < 2.5 mIU/L (normal adult range = 0.4-4.5 mIU/L, ideal range for pregnancy is <2.5mIU/L)
• Low-dose aspirin: sometimes added for blood flow or inflammation protocols. A very common and generally safe add-on.
• Steroids (such as Prednisone, Medrol, dexamethasone): occasionally added to help control immune/inflammatory issues, which can possibly impact egg quality.
• Metformin: used in PCOS¹⁵ patients to reduce hyper-response risk, as well as to improve insulin sensitivity (which can impact egg quality)
• Sildenafil (Viagra) and/or Pentoxifylline: sometimes used for lining and/or building blood flow; not routinely prescribed (used only in very specific cases)
• LDN (low dose naltrexone): reduces inflammation and helps balance immune tolerance and endorphin balance. Limited research data, but generally considered low-risk, and increasingly discussed in recurrent implantation failure and autoimmune cases.
• Androgen Priming with DHEA and testosterone: sometimes used for diminished ovarian reserve, and for low androgen levels, though results are mixed. Often requires labs monitoring.
• Rapamycin (Sirolimus, Rapamune): a fairly new one in IVF territory because of recent research, thought to be helpful for premature ovarian insufficiency, diminished ovarian reserve and mitochondrial function modulation (to help egg quality). Not standard IVF practice, very experimental, and evidence is very limited (and mostly on animals).
• CoQ10: not a pharmaceutical drug, but a supplement often recommended to support egg quality (especially in patients over 35). Research has generally shown efficacy to support egg quality, and fertility clinics increasingly recommend it.

Beyond pharmaceutical add-ons, IVF patients very often add a number of various supplements – whether following their clinics’ advice, or simply following trends on their IVF groups/forums. We will publish an article soon on “fertility supplements”. Stay tuned!

Beyond medications and supplements, clinics can also offer some add-ons that are thought to help obtain more and better embryos. Similar as for meds and supplements, some of the below techniques are more backed up by research that others.

And once again, before deciding for an add-on, always ask your clinic: “Is this evidence-based for my diagnosis?”

• ICSI: a lab method where a single sperm is selected and then injected manually with a syringe into each egg. It is often recommended for male factor infertility, low fertilization history, unexplained infertility
• Assisted hatching: a method where the embryologist delicately opens the outer shell of the embryo to “help it out”. It is more and more commonly used, and is presumed to help “fast track” the hatching process (when the embryo gets out of its shell to attach to the uterus lining).
• EmbryoGlue: this is a special “transfer medium” in which the embryo is placed before transfer. Evidence is mixed on it; a lot of clinics now use it as standard.
• Zymot sperm sorting: a sperm selection device used before fertilization to sort and select the best sperm. It mimics the natural sperm selection process by allowing the most motile sperm to swim through a specialized chip, potentially reducing DNA fragmentation and oxidative stress exposure.
• PGT-A / PGT-M¹² / PGT-SR¹³: see section below.
• Artificial oocyte activation (AOA, aka calcium ionophore): a lab technique used to chemically stimulate egg activation. It helps trigger the calcium release inside the egg that normally happens after sperm entry - the signal that tells the egg to begin dividing. Useful in specific cases of fertilization failure, but not used routinely in first-time IVF cycles.
• Time-lapse embryo monitoring (EmbryoScope): some clinics use incubators that monitor embryo growth continuously.

• PGT-A / PGT-M / PGT-SR testing: those are genetic screening of embryos, which happens at the clinic’s embryology lab before they are frozen (pending results) and then transferred.

  In practice, a few cells are carefully removed by the embryologist from the outer layer of the blastocyst (the part that becomes the placenta), on day 5–7 of development, and those cells are sent for genetic testing while the embryo itself is frozen.

  Such testing adds sometimes heavy costs, which include clinics’ biopsy costs and the genetics labs’ high costs (anywhere from a few hundred dollars per embryo, to thousands for a limited number of them).

  Also, PGT is not allowed in all countries, notably due to ethics concerns: some countries forbid all 3, some allow some.

  • PGT-A (Preimplantation Genetic Testing for Aneuploidy):
    • Genetic testing of embryos to screen for chromosomal abnormalities (that is, extra or missing chromosome).
      • Use cases are usually age 35+, to reduce miscarriage risk, to select a single embryo confidently, recurrent miscarriage or multiple failed transfers.
      • Important note : PGT-A does not “improve” embryos, it only helps select among them. Also, w hile genetics labs put forward reliability of up to 97-98%, there is on-going debate as to the value, reliability and safety of doing such testing – see our upcoming article on PGT-A testing .
    • PGT-M (Preimplantation Genetic Testing for Monogenic Disease): this tests embryos for a specific inherited genetic disorder: when one or both partners carry a known mutation (such as cystic fibrosis, BRCA mutation, muscular dystrophy). PGT-M targets that known mutation to confirm if the embryo carries it or not. It does not screen the entire chromosome set unless combined with PGT-A.
      • Important note: PGT-M requires prior identification of a specific genetic mutation in one or both parents through genetic testing (called “genetic carrier screening” or “or known mutation testing”)
    • PGT-SR (Preimplantation Genetic Testing for Structural Rearrangements): this testing is done on embryos when a parent carries a chromosomal structural issue (for instance, a “balanced translocation”). The goal is to find those embryos with a normal chromosomal structure to reduce miscarriage risk.
      • Important note : PGT-SR requires parental karyotyping to diagnose a structural chromosomal rearrangement before embryo testing can be performed.
  • Uterine biopsies: a uterine (or “endometrial”) biopsy consists in inserting a swab through the cervix in the uterus to collect tissues of the uterus lining. The tissues collected are then analyzed for different purposes:
    • ERA / EMMA / ALICE: those are endometrial and microbiome tests. While they are increasingly common, they are not cheap, and research has shown conflicting results in term of reliability and usefulness. Those are usually done later in an IVF journey and not before first cycle - unless the patient’s history suggests.
    • ReceptivaDx biopsy: quite commonly used if endometriosis is suspected. Very commonly used, although not 100% reliable, as it can give false positive or false negative results. It is the best diagnosis tool before a (diagnostic) laparoscopy surgery, which is the gold standard to diagnose (and remove) endometriosis.
    • “CD138 immunostain” for chronic endometritis: CD138 is a marker used on endometrial biopsy tissue to identify plasma cells, which indicate chronic inflammation of the uterine lining (= chronic endometritis). The presence of plasma cells on CD138 staining helps diagnose this often-subtle condition, which can be associated with implantation failure or recurrent pregnancy loss. This test is most often allowed by most insurances, unlike others.
  • Hysteroscopy: a procedure using a small camera inserted through the cervix to directly visualize and treat abnormalities inside the uterine cavity. Often recommended after failed transfers, abnormal imaging, or suspected polyps/adhesions, and therefore rarely done for a first embryo transfer – unless the patient has some existing known conditions calling for it.
  • Uterine PRP: similar to ovarian PRP, but instead of being injected into the ovaries, PRP derived from your own blood is infused into the uterine cavity (and in rare cases, injected into specific areas of the uterine wall). It is thought to help improve endometrial thickness, blood flow, and receptivity prior to embryo transfer, particularly in patients with thin lining or recurrent implantation failure. While some small studies suggest potential benefits in select patients, high-quality evidence demonstrating improved live birth rates remains limited, and it is generally considered an emerging or adjunctive therapy.

And … what about surgeries? Sometimes, in specific situations, some IVF patients may require surgical treatment before proceeding with embryo transfer. These are not routine “add-ons”, but rather targeted interventions needed when a clear structural issue is identified . Examples include:

• Diagnostic laparoscopy (for suspected endometriosis , pelvic adhesions or fibroids )
• Tubal removal if a hydrosalpinx (fluid-filled tube) is present
• Fibroid removal if fibroids distort the uterine cavity
• Correction of uterine structural abnormalities, such as a uterine septum, intrauterine adhesions ( Asherman ’ s ), or significant cavity abnormalities identified on imaging .

The good news is, for a first-time IVF patient, it is highly unlikely you will need any surgery at all. Surgery is typically recommended only when there is evidence that a structural condition could reduce implantation rates, increase miscarriage risk, or negatively affect IVF outcomes. Most IVF patients do not require surgery ; but when indicated, addressing the underlying issue can significantly improve the chances of a successful transfer.