The IVF Guide
Everything you need to understand your fertility journey — how treatment really begins, what each step involves, and clear answers to the questions couples ask us most.
How treatment really begins
First consultation
You and your husband meet the IVF consultant together. We take a full history for both of you — how long you have been trying, your cycles, any previous pregnancies, surgery or treatment — and examine you. Nothing is decided yet: this visit is about understanding your situation.
- Come together — fertility is assessed as a couple
- Bring previous reports, scans and treatment records
- Ask anything: there are no small questions
Evaluation by the IVF consultant
Before any treatment, the consultant evaluates both partners to find the cause. For the wife: AMH, FSH, LH, TSH, prolactin, vitamin D, HbA1c and a pelvic ultrasound, with a check of the tubes where needed. For the husband: a semen analysis and, where indicated, DNA fragmentation and hormone tests.
- The results decide the plan — not the other way round
- Most tests are simple blood tests and a scan
- One abnormal semen result is always repeated
Your personal plan
The consultant explains what the tests found and recommends the simplest treatment likely to work for you. Many couples need lifestyle changes, treatment of a thyroid or hormone problem, or help with ovulation — not IVF.
- A written plan you can take home
- Costs and insurance cover explained before you start
- You decide together, with your consultant
Ovulation induction
Usually the first active treatment. Tablets such as letrozole, or low-dose injections, help the ovary release an egg, and ultrasound tracking times ovulation precisely. Several cycles are often tried before moving on.
- Monitored by ultrasound to keep it safe
- The aim is one mature egg, to avoid twins
- Often the treatment that works
IUI — when suitable
Prepared, concentrated sperm is placed directly in the uterus at the time of ovulation. It suits mild male factor, unexplained infertility, or ovulation problems that have not responded to tracking alone.
- A quick clinic procedure, no anaesthetic
- Needs at least one open tube
- Usually combined with ovulation induction
IVF / ICSI — when needed
Recommended when the tubes are blocked, the sperm count is low, age or ovarian reserve calls for it, or simpler treatment has not worked. Stimulation injections for about 10–14 days are followed by egg collection; the eggs are fertilised in our laboratory — by ICSI, where a single sperm is injected into each egg.
- Egg collection takes 15–20 minutes under light sedation
- You go home the same morning
- Your consultant follows you through every stage
Embryos in the laboratory
Embryos are watched from day 1 to day 5, when the strongest become blastocysts. They are graded and the best is chosen. Genetic testing (PGT) is offered when indicated, and good embryos not transferred are vitrified for later.
- We call you with an update each day
- Freezing does not reduce the chance of success
- Grading guides, it does not guarantee
Transfer and pregnancy test
Usually one embryo is transferred — a quick, painless procedure without sedation. A blood pregnancy test (beta hCG) follows about 10–14 days later.
- One good embryo is how we avoid twins
- Normal activity is fine after transfer
- Use the blood test, not a home kit
Five days that begin a life
Each embryo is watched from the moment of fertilisation until it becomes a blastocyst, ready for transfer.
- Day 0Egg and sperm
- Day 1Fertilised (2PN)
- Day 24 cells
- Day 38 cells
- Day 4Morula
- Day 5Blastocyst
Understand every part of the journey
Choose a topic to read. Every answer is written by our team in plain language and follows international fertility guidelines.
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When to see a specialist
If you are under 35, see a specialist after 12 months of regular unprotected intercourse without pregnancy. If you are 35 or older, come after 6 months; over 40, come straight away.
- Irregular or absent periods
- Two or more miscarriages
- Known endometriosis, fibroids or PCOS
- Previous pelvic surgery or infection
- Husband with previous chemotherapy, testicular surgery or mumps in adulthood
Sources: NICE fertility guideline (CG156) · American Society for Reproductive Medicine (ASRM)
Tests before treatment
Infertility has a female cause in about a third of couples, a male cause in a third, and both or no clear cause in the rest — so both partners are tested from the start.
- AMH and antral follicle count — how many eggs remain; they predict response to stimulation, not natural fertility
- FSH, LH and oestradiol on day 2–3 of the cycle
- TSH and prolactin — both can stop ovulation and are easy to treat
- Pelvic ultrasound, and a tubal test (HSG) where needed
- Semen analysis read against WHO 2021 reference values
Sources: NICE fertility guideline (CG156) · World Health Organization (WHO)
Age and fertility
A woman is born with all the eggs she will have. Their number and quality fall with age, slowly at first and faster after 35. It is the age of the eggs, not the uterus, that matters most.
Approximate chance of success per IVF cycle by the wife's age:
- 25–35: above 50%
- 35–37: 30–50%
- 38–40: 15–30%
- Over 40: 10–15%
- Figures vary with each couple's history
Sources: American Society for Reproductive Medicine (ASRM) · UK Human Fertilisation & Embryology Authority (HFEA)
Cost and insurance
Fertility cover varies more between policies than any other area of medicine. Many policies cover investigation and consultation but not IVF itself; some exclude medication, which is a large part of the cost.
- Call 920012342 with your insurance card
- We confirm cover in writing before you start
- Self-funded costs are explained at your plan visit
Male factor infertility
A semen analysis looks at volume, count, movement and shape. WHO 2021 lower reference values include a concentration of 16 million per mL, 30% progressive movement and 4% normal forms. One abnormal result is always repeated after about three months.
- Varicocele, infection and hormone problems can be treated
- Smoking, heat and some medications lower quality
- Severe cases are treated with ICSI
- Sperm can be retrieved surgically when none is in the sample
Sources: World Health Organization (WHO) · NICE fertility guideline (CG156)
Ovulation disorders and PCOS
Polycystic ovary syndrome is the most common reason for irregular or absent ovulation. It is diagnosed from irregular cycles, signs of raised male hormones, and the appearance of the ovaries or AMH.
- Even 5–10% weight loss can restore ovulation
- Letrozole is the first-line tablet for ovulation induction
- Monitoring keeps the risk of twins low
- Thyroid and prolactin problems are checked too
Sources: International Evidence-based PCOS Guideline (2023) · American Society for Reproductive Medicine (ASRM)
Endometriosis
Endometriosis is tissue similar to the lining of the uterus growing outside it. It affects around one in ten women of reproductive age and can cause painful periods, pain during intercourse and difficulty conceiving.
- Diagnosis may need ultrasound or laparoscopy
- Treatment depends on symptoms and fertility goals
- Cysts on the ovary need careful, ovary-sparing surgery
- IVF is often effective when other treatment has not worked
Sources: World Health Organization (WHO) · European Society of Human Reproduction and Embryology (ESHRE)
Fibroids, polyps and the uterus
Fibroids are common benign growths of the uterine muscle. Their effect depends on position: those bulging into the cavity reduce implantation, while those on the outer surface usually do not. Polyps and adhesions can also stop an embryo implanting.
- Assessed by ultrasound or hysteroscopy
- Cavity fibroids and polyps are removed hysteroscopically
- Treatment before transfer improves the chances
- Not every fibroid needs surgery
Sources: American Society for Reproductive Medicine (ASRM) · European Society of Human Reproduction and Embryology (ESHRE)
Blocked tubes and unexplained infertility
The fallopian tubes carry the egg to meet the sperm. Infection, endometriosis or previous surgery can block them, so they are checked with an X-ray dye test (HSG) or an ultrasound test. When every test is normal, infertility is called unexplained — this is common, and treatment still works.
- IVF bypasses blocked tubes
- A swollen, fluid-filled tube (hydrosalpinx) may be treated before IVF
- Unexplained infertility often responds to ovulation induction with IUI
- IVF is offered if simpler treatment has not worked
Sources: NICE fertility guideline (CG156) · American Society for Reproductive Medicine (ASRM)
Recurrent miscarriage
Losing a pregnancy is common and is rarely caused by anything you did. After two or more losses we recommend investigation, because a treatable cause is sometimes found.
- Antiphospholipid antibodies and thyroid tests
- A scan of the uterine cavity
- Genetic testing of the parents or pregnancy tissue where appropriate
- Many couples go on to a successful pregnancy with support
Sources: European Society of Human Reproduction and Embryology (ESHRE)
Ovulation induction and IUI
Ovulation induction uses tablets or low-dose injections to help one egg mature, timed by ultrasound. IUI adds prepared sperm placed in the uterus at ovulation.
- Suits ovulation problems, mild male factor and unexplained infertility
- Needs at least one open tube
- Several cycles are usually tried
- Close monitoring keeps twin pregnancies rare
Sources: NICE fertility guideline (CG156) · American Society for Reproductive Medicine (ASRM)
IVF and ICSI
Daily injections from day 2 of the cycle stimulate several follicles, monitored by scans. A trigger injection matures the eggs, which are collected 34–36 hours later. In ICSI a single sperm is injected into each egg, and embryos grow in the laboratory for up to five days.
- Egg collection is done under light sedation
- The trigger injection must be taken at the exact time given
- Usually one embryo is transferred
- The full cycle takes about three to four weeks
Sources: UK Human Fertilisation & Embryology Authority (HFEA) · NICE fertility guideline (CG156)
Embryo freezing and genetic testing
Vitrification freezes embryos in seconds, avoiding the ice crystals of older methods, so survival after thawing is now high. A frozen transfer can be gentler and is often just as successful. Preimplantation genetic testing (PGT) checks embryos before transfer when it is indicated.
- PGT-A checks the number of chromosomes
- PGT-M checks for a specific inherited condition in the family
- Freezing all embryos is safer where there is a risk of OHSS
- Frozen embryos can be stored for future pregnancies
Sources: UK Human Fertilisation & Embryology Authority (HFEA) · European Society of Human Reproduction and Embryology (ESHRE)
Egg freezing and fertility preservation
Eggs can be vitrified for use later — before cancer treatment, or for other medical reasons. Results depend mainly on the age at freezing: eggs frozen before 35 give the best chances.
- One stimulation cycle of about two weeks
- Urgent preservation can be arranged before cancer treatment
- Sperm can also be frozen
- Your consultant discusses expected results honestly
Sources: American Society for Reproductive Medicine (ASRM) · UK Human Fertilisation & Embryology Authority (HFEA)
A lifestyle that supports fertility
Small, steady changes help both partners. Aim for 7–9 hours of sleep, a balanced diet of colourful vegetables, whole grains, healthy proteins and good fats, and regular gentle exercise such as walking or swimming.
- Folic acid 400 micrograms daily, starting before pregnancy
- Stop smoking — both of you
- Keep caffeine moderate and avoid energy drinks
- Aim for a healthy weight
- Take supplements only on your doctor's advice
Sources: NICE fertility guideline (CG156) · World Health Organization (WHO)
Emotional wellbeing
Fertility treatment is emotionally demanding, and feeling anxious is normal. Talking openly with each other, keeping hope, and holding to your faith all help. A simple breathing exercise can calm the body in minutes: breathe in slowly through the nose for 4 seconds, hold for 4, breathe out slowly through the mouth for 6, and repeat 5–10 times.
- Share the journey — you are a team
- Limit searching online late at night
- Ask us about counselling support
- «أَلَا بِذِكْرِ اللَّهِ تَطْمَئِنُّ الْقُلُوبُ» (Ar-Ra'd 28)
The two-week wait and warning signs
After transfer, carry on with normal daily life and your progesterone support. Wait for the blood test, because home kits can mislead after a trigger injection. Bloating and mild discomfort are common after stimulation.
- Call 920012342 at any hour for severe abdominal pain
- Rapid weight gain or marked swelling
- Shortness of breath
- Greatly reduced urine — these can signal ovarian hyperstimulation (OHSS)
Sources: UK Human Fertilisation & Embryology Authority (HFEA) · NICE fertility guideline (CG156)
When IVF has not worked
A failed cycle is painful, and it is not the end of the road. When good-quality embryos have not implanted after several transfers, we review everything again before the next step.
- A detailed look at the uterine cavity
- Review of embryo quality and laboratory findings
- Genetic testing where indicated
- A revised, personal plan — discussed with you
Sources: European Society of Human Reproduction and Embryology (ESHRE)
This guide is general education about fertility treatment, not medical advice for your own case. Your consultant will plan your treatment from your history, results and examination.
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