The IVF Process
Starting your IVF treatment journey can feel overwhelming, but understanding what to expect at each step can help you feel more prepared and confident.
At Women's Health Melbourne (WHM), we're a boutique IVF clinic. We partner with Melbourne IVF to utilise Melbourne’s best IVF laboratory so that our patients have access to the highest possible IVF laboratory influenced success rates.
We approach IVF with care and an excellence driven mindset. CREI lead, our caring specialised staff are dedicated to providing a personalised approach throughout your fertility journey.
In this article, we walk you through the entire IVF process, from your very first appointment right through to that exciting pregnancy test where finally two lines appear.
Think of this as your roadmap. It takes a village to create an IVF baby, and we're here to guide you every step of the way.
Contents
STEP 1: YOUR INITIAL CONSULTATION
On average, one round of IVF treatment costs a patient $10,000 -12,000 for a treatment involving an egg retrieval, however more than half of this total amount is returned to you if you are eligible for Medicare, Pharmaceutical Benefits Scheme (PBS) and +/- private health insurance subsidies.
Stimulated cycle costs are the most expensive part of IVF treatment.
The average out of pocket cost for an embryo transfer cycle is much less. Depending on the type of treatment chosen, this cost is closer to between $2000 and $3000.
It is important to consider that the average number of complete egg collection cycles most Australian couples undergo is 3 with an average of 3 embryo transfer attempts in addition to this to achieve a live birth.
STEP 2: PRE-TREATMENT INVESTIGATIONS
Before we can create your personalized treatment plan, we need a complete picture of your fertility. Think of these investigations as pieces of a puzzle that help us understand what might be affecting your ability to conceive.
For women, the standard tests include:
A pelvic ultrasound (ideally timed at the beginning of your menstrual cycle for an antral follicle count). A specialised version of this test, known as a HyCoSy can be performed to assess whether or not your fallopian tubes are open and functioning well.
Blood tests checking your hormone levels, including the AMH test which tells us about your egg reserve
Karyotype testing—a map of your chromosomes
Pre-pregnancy health checks, documenting your immunity to rubella and chickenpox and checking your immune status for various infections like HIV, Hepatitis B and C, Syphylis, Chlamydia and Gonorrhoea
Baseline health investigations including kidney function, liver function, blood count, thyroid, iron status, and vitamin D levels
For men, we'll arrange:
A semen analysis, often including sperm antibody testing and sperm DNA fragmentation assessment
Karyotype testing
A hormone profile (if needed)
An infectious diseases screening test for blood and sperm born viruses like HIV, Hepatitis B and Hepatitis C
A physical examination or scrotal ultrasound will be performed with consent if abnormalities are suspected or detected
You might be wondering why we check for a karyotype—it turns out that having an abnormal chromosome pattern is a silent fertility issue that's not uncommon in people experiencing infertility, and you'd never know about it without testing.
We'll also discuss reproductive genetic carrier screening with you. In Australia, Medicare covers screening for three common conditions: cystic fibrosis, spinal muscular atrophy, and fragile X. Many couples choose to screen for additional conditions (over 600 can be tested), which while individually uncommon, together represent much of the genetically determined childhood illness burden we see today. This expanded form of genetic carrier screening is available at an out-of-pocket cost that many modern parents choose to prioritise.
Some investigations may be tailored specifically to you—for example, if you're from a Mediterranean background, we might check for the genetic predispositions that cause thalassemia. The good news is that many of these tests can be done with your GP, and some patients arrive at their first appointment having already completed them.
If we have these test results for you, it helps find the answers and plan the most relevant interventions and solutions to get you pregnant sooner.
STEP 3: PRE-TREATMENT PREPARATION AND COUNSELLING
Once we've agreed that IVF is the right path forward, there are a few important preparatory steps. In Victoria, you'll need to complete mandatory counselling before beginning treatment.
Don't worry, this isn't about psychological counselling (though we can arrange that separately if you'd find it helpful). Rather, it's an educational session covering important topics like what it means to have embryos in storage, consent between couples, and the legal aspects outlined in the Assisted Reproductive Treatment Act. These sessions are usually held in a convenient webinar format and can often be scheduled after hours. We always do our best to fit in with your schedule and lifestyle.
At this stage, we will design your personalized IVF treatment plan. This includes deciding which medications we'll use, in what sequence, and at what dosage—all tailored to your specific situation. You'll also attend a nurse education session where you'll learn exactly what to do on each day of your cycle, receive a written plan, and understand all the support channels available to you.
STEP 4: STARTING YOUR IVF CYCLE
When you're ready to begin, the start date depends on your treatment approach.
For fresh embryo transfer cycles, you'll start with day one of your menstrual period. We call this "calling on day one," and it's your signal to contact the clinic. We won't actually start medications until day two or three, but calling on day one lets us organize everything: ensuring your medications are ready to collect, confirming your plan with nursing support, and scheduling your first ultrasound monitoring appointment. We try to provide you with as much notice as possible so you can navigate other life commitments with minimal inconvenience during your IVF cycle. Most patients are able to continue to work and even to exercise nornally most days of their IVF cycle.
For freeze-first cycles (where we'll freeze eggs or embryos rather than transferring one fresh), we have more flexibility—you can actually start at any time. This is possible because we're not doing an embryo transfer in that cycle, so your uterus and ovary don't need to be synchronized. This flexibility can be really helpful if you have work commitments, travel plans, or need to coordinate care and support around a specific timeframe. We’ll design your cycle plan to work around you. Many patients find this approach really helpful in navigating the overall stress of IVF. We’re able to time your cycle at a better time for you in relation to other life events. We’re also able to split the elements of getting pregnant via IVF into shorter and more manageable parts.
There are several reasons we might recommend a freeze-first approach: the most important being to keep you safe if you have a high egg count and risk of hyperstimulation.
We also know that in normal and high-responder patients, frozen transfers often have higher success rates as the natural cycle frozen embryo transfer technique is associated with the statistically highest success rate in IVF.
A freeze first approach may also be used strategically to bank embryos for future pregnancies, or to allow time for genetic testing of embryos for inherited diseases we know parents are at risk of passing on.
Older patients (above maternal age 35) may consider genetic testing of embryos for sporadic chromosomal errors associated with the aging process (PGT-A) called aneuploidies. Chromosomal aneuploidy in an embryo is the most common cause of IVF failure and of miscarriage in both natural and IVF conception. Diagnosing aneuploidy and identifying normal embryos with high pregnancy potential can help women and couples avoid IVF failure.
STEP 5: OVARIAN STIMULATION
Here's where the active treatment really begins. Naturally, your body would mature just one egg each month, to be released when you ovulate. With IVF, we use medications to help multiple eggs mature, which increases your chances of success, or in other words, finding a good egg. It's important to remember that we're working with your body as it is - we can't stimulate follicles that aren't there, so responses vary from person to person and between IVF cycles.
You'll take a series of hormone injections, including follicle stimulating hormone (FSH). Medicines are taken daily throughout an IVF cycle. There are many different types of medicines and combinations of medicines that can be used in IVF. Some IVF medicines are oral, but many are delivered via an injection. Some may be daily, some may be second daily, some may be
given only once during your IVF cycle. The interval at which a medicine is prescribed is simply a reflection of how long the particular medication stays active in your system. Some newer medications last longer and can be given less frequently.
During IVF a type of medication will be prescribed to prevent your body from ovulating prematurely. There are a couple of different ways we can achieve this using different medication options. Some ovulation prevention medicines are given as injections, some are tablets, and some are even given as a nasal spray, depending on your personalized protocol. There are pros and cons of every approach which your fertility specialist will consider based on your goals, medical history, strategic priorities and preferences.
This stimulation phase typically lasts between 10 and 16 days, usually somewhere in the middle. Throughout this time, you'll come in for monitoring appointments where we'll do ultrasound scans to see how your follicles are developing and how your uterine lining is progressing. We try to minimize blood tests because they're uncomfortable, but we may request them when needed.
When we are planning for a fresh embryo transfer, we’ll measure your hormones during your cycle to ensure pur plan is safe and appropriate. If your hormones are running too high, we’ll defer your embryo transfer to happen in another cycle. Our priority will be to safeguard your health and ensure your best chance of pregnancy success with your embryo transfer.
WHAT TO EXPECT: SIDE EFFECTS
We want you to know that every IVF patient experiences some side effects, though how you're affected is quite individual. Here's what's common:
Mood changes: Hormones affect how we feel, and you might notice feeling more agitated, anxious, or emotionally vulnerable. Interestingly, many of the side effects you feel aren't directly from the medications themselves, but from the hormones your own ovaries are producing in response.
Abdominal bloating: Your ovaries are getting larger as follicles develop, and the hormones can make you feel bloated and a bit sluggish in your bowel. Constipation is common, especially later in the cycle with progesterone. It’s a good idea for patients to proactively manage this be focusing on excellent hydration, and using some over the counter pharmacist advised apperients to keep the bowel moving. Some good options include Movicol or Metamucil.
If you've heard IVF described as an "emotional roller coaster," there's truth to that—but it's not just the hormones. The hope and then disappointment if a transfer doesn't work happens alongside significant hormonal changes, which can make the experience feel even more intense.
If you are worried about how you may cope with this, speak to your specialist as they may advise a freeze-all strategy to break the IVF cycle up to be more manageable for you.
STEP 6: THE TRIGGER INJECTION
When your follicles have reached the optimal size, you'll receive your "trigger", usually via one or more injections. This is a once-off medication that signals the final maturation of your eggs before collection. The timing is carefully individualized based on how your specific follicles are developing. We're looking at the whole picture on both ovaries to give you the best possible outcome.
Here's something interesting: even if you come back for another cycle using exactly the same medication protocol, the day we choose for egg retrieval might be different. As we like to say, we're mammals, not machines, and there's natural cycle-to-cycle variation.
STEP 7: EGG COLLECTION
Many patients feel anxious about this procedure, which is completely understandable. It might be your first procedure, the first time you are coming into hospital as a patient or the first time you experience having an anesthetic. But we want to reassure you: collecting eggs is actually very safe, simple, and surprisingly quick.
The egg collection or oocyte pick up (OPU) procedure is performed under what we call a "twilight anesthetic", otherwise known as “conscious sedation”. This is quite different from a general anesthetic.
A general anaesthetic is used for major operations and refers to where the anaesthetic doctor takes over your breathing and makes you totally unconscious.
At an OPU, we just make you rather sleepy. You'll be breathing on your own the entire time (the anesthetist doesn't take over your breathing as they would in major surgery). The sedation makes you feel very drowsy, takes away any pain, and means you won't remember the procedure - but you're not actually under a general anesthetic.
The procedure itself is fast, generally it takes less than 20 minutes. Using an ultrasound probe (similar to your earlier pelvic scans), we guide an ultra fine needle—about the same size as one used for blood tests—to gently aspirate fluid from your ovarian follicles. We drain the follicles from one ovary, then the other, with access via your vagina.
You'll wake up in recovery, and honestly, it feels like you fell asleep 30 seconds ago. In reality the whole egg collection procedure just happened. Your ovaries might be a bit tender, and you might feel a little achy and spacey, the anesthetist will have given you pain relief medication while you were asleep. Within about 10 minutes, we can get you settled in a chair with some food and a cup of tea or coffee (and those post-procedure cups of tea really do taste amazing!).
Everyone is different but most people only need paracetamol for any discomfort when they go home.
STEP 8: SPERM COLLECTION AND PREPARATION
Coordinated with your egg collection, your male partner will provide a sperm sample at the clinic. We've designed our collection rooms to be dignified, comfortable, and not confronting—they're clinical and clean but also not offputting. The sample is collected by masturbation and then taken to our lab. Sometimes men can struggle with this aspect of care feeling performance pressure. If you are nervous about this please speak to your fertility specialist. It happens and there are work arounds available.
Sometimes we can prepare a frozen sample of sperm in the lab as back-up in case it is needed on treatment day.
If needed, we can use frozen sperm instead of fresh—this might be relevant if your partner needs to travel for work, experiences anxiety about collecting on demand, if surgical sperm retrieval was necessary, if donor sperm is used or for other cultural reasons.
Our scientists do important work optimizing the sperm, filtering out the best quality sperm for fertilisation. Depending on your situation, we might use standard insemination or ICSI (where we inject individual sperm directly into each egg). ICSI is particularly helpful for male factor infertility. From your perspective, there's no difference between the two processes, though ICSI does involve additional cost due to the specialised embryo micromanipulation required. This involves special equipment, embryology expertise and significant extra time as each egg is injected with sperm individually.
STEP 9: FERTILISATION
The morning after your egg collection, our scientists check the eggs for signs of fertilisation. We're looking for two pro-nuclei (the tiny structures containing DNA from the sperm and egg) joining together. By around midday, we'll usually be able to update you with your fertilisation results.
If fertilisation signs are not immediately seen, you’ll be informed but a further fertilisation check will happen later in the day. We call this a syngamy check. Occasionally fertilisation signs are delayed however an embryo might ultimately continue its development.
STEP 10: EMBRYO DEVELOPMENT
Once fertilized, your embryos begin an amazing journey of exponential growth: one cell becomes two, becomes four, becomes eight, and keeps dividing. We culture your embryos in special laboratory incubators called embryoscopes with time-lapse imaging, which allows us to monitor their development continuously without disturbing them.
We typically grow embryos to the "blastocyst" stage, which is usually reached on day five or day six. Occasionally an embryo might take as long as 7 days to become a blastocys. This is actually a really helpful selection process—embryos that stop developing before the blastocyst stage wouldn't have resulted in a pregnancy anyway. Culturing to this stage gives us much better information about which embryos have the best potential.
STEP 11: EMBRYO QUALITY ASSESSMENT
Choosing the best embryo for transfer involves both science and technology. Our scientists use the internationally recognized Gardner Grading Scale to assess embryo quality. We also generate AI scores called Ida scores from the time-lapse imaging data. Combining scientific expertise with artificial intelligence helps us identify which embryo has the highest potential for pregnancy. A further triage step can be genetic testing of embryos.
Unfortunately, some embryos that look absolutely perfect may still have serious chromosome concerns that prevent their ultimate success. The only way to find this out is to biopsy the embryo and test a cell sample to check on it’s DNA.
This involves subsequently freezing the embryo, running the test and using the results to help choose an embryo for transfer.
STEP 12: EMBRYO TRANSFER
This is often described as a beautiful procedure, and our hope is that it will be wonderfully straightforward.
For fresh transfers, this happens on day five after your egg collection. For frozen transfers, we time it so your uterine lining is perfectly synchronized with the embryo's developmental stage. Even if your embryo reached blastocyst stage on day six when it was first created, we'll transfer it on day five post your ovulation in a new cycle, because that's when your uterine lining is most receptive.
The procedure itself is quite simple. We use a speculum to visualize your cervix, which we wash and cleanse. We then gently pass a very thin tube (embryo transfer catheter) through the cervix into your uterus. We'll ask you to arrive with a full bladder—this acts as an "acoustic window" for ultrasound, helping us see exactly where to place your embryo. The good news? You can empty your bladder immediately after, since your urinary and reproductive systems are anatomically completely separate. There is absolutely no way by peeing after your embryo transfer that your embryo will be lost or dislodged.
Embryoglue is routinely used in our practice for every fresh and frozen embryo transfer to maximise your chance of IVF success.
STEP 13: LUTEAL PHASE SUPPORT
After your embryo transfer in a stimulated cycle, you'll need to continue taking luteal phase support medication, usually in the form of progesterone. This is really important—IVF stimulation cycles always affect natural progesterone production, and this supplementation supports your uterine lining and any developing pregnancy.
In a frozen embryo transfer cycle, you may also be prescribed luteal phase support. This might be in the form of progesterone, HCG pregnancy hormone, a GnRH agonist nasal spray of a combination of these, depending on your treatment regimen.
Technically in an excellent, hormonally balanced natural cycle, luteal phase support is not a prerequisite to IVF success. We try everything we can however to support your embryo to stick and to form a pregnancy.
STEP 14: THE PREGNANCY TEST
Now comes the waiting period—10 days from embryo transfer to your pregnancy test. We know this is an emotionally challenging time. Everything that can be done has been done, and now it depends on whether the embryo can implant and develop. During these 10 days, your embryo is busy implanting, dividing, and creating a placenta that produces HCG—the pregnancy hormone.
We use a quantitative blood test rather than a home urine test because it gives us specific HCG levels. Our nursing team will communicate your results to you, typically the same day if you test with us. If it's positive, your HCG levels should approximately double every 48 hours as cells continue that exponential division.
STEP 15: EARLY PREGNANCY MONITORING
Once your HCG levels climb above approximately 1,000, we can visualize your pregnancy on ultrasound. We'll schedule your first scan at six weeks—the earliest time we might detect a heartbeat. We're looking for a gestational sac containing an embryo about half a centimeter in size, along with that exciting heartbeat.
When that heartbeat is confirmed, your care transitions from our fertility clinic to obstetric care. You'll have choices about your pregnancy care: private obstetrics, shared care with your GP, midwife care, or public hospital care—whatever feels right for you and your circumstances.
UNDERSTANDING YOUR JOURNEY
We want to be honest with you about expectations. Not every embryo transfer results in pregnancy, even with the best-quality embryos or those that have undergone genetic testing—success rates are approximately 50% per transfer. Most patients who ultimately have a baby may have had a few embryo transfers before they succeed.
Here's something encouraging: at least half the patients we treat get pregnant with one of the embryos they make in an IVF cycle, even if it's not the first one they transfer. For those who don't succeed in the first cycle, many will ultimately succeed with additional stimulation cycles.
The key is to think about IVF success cumulatively, not as the outcome of a single transfer. Just because you don't get pregnant with your first embryo transfer doesn't mean it's game over. Sometimes it's simply about finding the right embryo that does the right thing.
Creating a human being requires an embryo to successfully develop every body system—it's incredibly complex. While we do everything possible to optimize conditions, sometimes things don't work out despite our best efforts. But many people do succeed, and we're here to support you through every step of your journey.
But you should know this, at WHM and at Melbourne IVF, we can honestly say we provide you with your very best chance of IVF success, consistently and significantly ahead of national averages and other IVF units . You don’t have to take our word for it either. Our Melbourne IVF leading success rates are published yearly on the national Your IVF Success website.
Written by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Medical Director of Women’s Health Melbourne and Melbourne IVF.
Co-host of the Knocked Up Podcast, Co-founder of Ellechemy intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.