The IVF process can feel like being handed a medical protocol without a map. You know there will be injections. You know there will be appointments. You know — somewhere at the end — there will be a transfer and a wait. But the lived experience between those landmarks: the bruising from injections, the bloating of stimulation, the strange calm of a sedated retrieval, the odd intimacy of an embryo report — these are rarely described in the clinical leaflets.
This guide is a week-by-week companion to your IVF cycle. It explains what is happening clinically at each stage, what you’re likely to feel physically and emotionally, and what genuinely helps. For the clinical framework, see our complete IVF guide for South Africa. This guide is the human layer.
| Every IVF cycle is different. Protocol variations, individual responses, and clinic differences mean your exact experience will not be identical to this guide. What is consistent is the shape of the cycle — the phases, the landmarks, the feelings — and it is those patterns this guide describes. |
Before the Cycle Starts: The Investigation Phase
Before any stimulation begins, you’ll have had a full fertility workup — AMH, FSH, AFC for you; semen analysis for your partner. If you haven’t yet had this, our guide to fertility test results explains what each test measures. Your specialist uses these results to design your specific protocol: which medications, at what doses, for how long.
This phase also typically involves a baseline scan — a transvaginal ultrasound confirming the ovaries look quiet and ready — and a trial (mock) embryo transfer, which maps the path the catheter will take during the real transfer. This is brief and typically painless.
For a detailed walkthrough of what happens at your initial specialist appointment, see our first fertility consultation guide. For cost planning, our IVF cost guide covers what is and isn’t typically included in clinic quoted prices.
Week 1: Suppression or Priming (Protocol-Dependent)
Depending on your protocol, Week 1 may involve either suppression (a GnRH agonist like Lucrin/Synarel, which temporarily switches off your natural hormone cycle to give the clinic full control of your stimulation) or priming (oestrogen or progesterone tablets to prepare the uterine lining). Not all protocols include a suppression phase — increasingly, antagonist protocols begin stimulation directly on Day 2 of your natural cycle.
What you’ll feel
Suppression, if used, can cause menopausal-type symptoms: headaches, hot flushes, mood changes, and disrupted sleep. These are unpleasant but temporary — your hormones are being temporarily suppressed, which is exactly what the medication is designed to do. They typically ease once stimulation begins.
What helps
- Staying hydrated reduces headache intensity
- Informing your partner or support person that mood changes are medication-related, not you
- Keeping a brief daily note of how you’re feeling — it helps contextualise the experience and gives you something to report accurately to the clinic
Weeks 2–3: Stimulation — The Heart of the Cycle
This is the phase most people think of when they imagine IVF. Daily self-administered subcutaneous injections (typically into the abdomen or thigh) of gonadotrophins — FSH, sometimes with LH — stimulate the ovaries to develop multiple follicles simultaneously, rather than the single follicle of a natural cycle.
The monitoring rhythm
During stimulation, you’ll attend the clinic every 2–3 days for a combination of blood tests (oestradiol, LH, sometimes progesterone) and transvaginal ultrasound scans to count follicles and measure their growth. The clinic calls or messages later in the day with your results and adjusted injection instructions for that evening.
This monitoring rhythm becomes the structure of your days during stimulation. For most people, it’s both reassuring (there is data, there is progress) and consuming (the appointments, the waiting for results, the adjustment of doses). For international patients staying in Cape Town for this phase, the appointments are manageable — most clinics are well-organised for this schedule.
What you’ll feel
- Abdominal bloating and heaviness — the ovaries are enlarging as follicles grow, and this is physically noticeable
- Tenderness in the lower abdomen — particularly from mid-stimulation onward as the ovaries become larger
- Emotional intensity — the hormones of stimulation, combined with the weight of the process, produce a heightened emotional state for most people. This is not a sign that something is wrong.
- Fatigue — stimulation is physiologically demanding
- Visible injection site bruising — normal and manageable with rotating sites and correct technique
| A note on OHSS: in a small number of cases — most commonly in women with PCOS or high ovarian reserve — stimulation can cause ovarian hyperstimulation syndrome: excessive follicle growth causing fluid accumulation, bloating, and in severe cases requiring medical management. If you develop sudden severe bloating, shortness of breath, or are unable to keep fluids down, contact your clinic immediately. Good clinics monitor closely for early OHSS signs and adjust protocols accordingly. |
What helps
- Wearing loose, comfortable clothing throughout stimulation — waistbands become uncomfortable quickly
- Light walking as tolerated — avoid vigorous exercise, twisting movements, or anything that risks ovarian torsion
- Staying well hydrated, particularly with electrolyte drinks in the later stimulation days
- Saving your questions for the daily result call rather than Googling — the fertility concierge service exists precisely for the interpretive gap between data and understanding
The Trigger Injection
When the lead follicles reach approximately 17–20mm on scan and oestradiol levels are appropriate, the clinic instructs you to take the trigger injection — typically hCG (Ovitrelle) or a GnRH agonist (Lupron), timed precisely to 36 hours before your scheduled egg retrieval. This injection completes the final maturation of the eggs.
The timing of this injection is precise and non-negotiable. Set an alarm. Don’t adjust it without clinic instruction.
What you’ll feel
The 36 hours between trigger and retrieval can be uncomfortable — increased bloating and pelvic pressure as follicles reach their maximum size. Rest is appropriate.
Egg Retrieval — The Procedure
Egg retrieval is a day procedure performed under conscious sedation (not general anaesthesia at most SA clinics). The procedure takes 15–30 minutes. Using transvaginal ultrasound guidance, the specialist passes a fine needle through the vaginal wall into each follicle, aspirating the fluid and with it the eggs. You are sedated and feel nothing.
Most people describe waking up from sedation feeling groggy but comfortable. You’ll be in recovery for 1–2 hours before being discharged. You need someone to drive you home.
The retrieval number
In recovery, or later that day, the clinic tells you how many eggs were retrieved. This number is the beginning — not the end — of the attrition process. Mature eggs: typically 80% of retrieved. Fertilised eggs (using ICSI): typically 70–80% of mature. Embryos reaching blastocyst (Day 5): typically 40–60% of fertilised. These rates are normal and expected — not a sign that something has gone wrong.
What you’ll feel after retrieval
- Cramping and pelvic soreness, similar to significant period pain — typically managed with over-the-counter analgesia
- Bloating, which may increase slightly in the 24–48 hours post-retrieval before resolving
- Fatigue — rest is appropriate for 24 hours
- Emotional crash — the adrenaline of the retrieval phase is over, and the waiting phase begins. This is normal and almost universal.
Days 1–5: The Embryo Report Days
This is, for many patients, the most psychologically demanding period of the entire cycle. You are at home (or at your Cape Town accommodation), and in a laboratory nearby, your embryos are developing. Or not. You cannot influence this. You receive daily updates.
What the updates mean
- Day 1: Fertilisation report — how many eggs fertilised normally. Normal fertilisation: 70–80% of mature eggs.
- Day 3: Early embryo report — cell division progress. Some clinics report on Day 3; others go straight to Day 5.
- Day 5/6: Blastocyst report — how many embryos have reached blastocyst stage, and their grading. Blastocysts are graded by expansion (1–6) and inner cell mass and trophectoderm quality (A/B/C). A 3BB is a good blastocyst. So is a 4AB. The grading is a guide, not a guarantee.
| Embryo grading is a guide to selection — not a prediction of success. A grade B blastocyst has produced more live births than any grading system can account for. Don’t catastrophise a B grade or over-interpret an A grade. |
What helps during the embryo wait
- Avoid calculating odds from forum posts — the sample sizes are anecdote, not data
- Active distraction — something that genuinely engages your full attention, not passive scrolling
- If the reports are confusing or distressing, this is exactly the moment a fertility concierge is most useful — walking you through what the numbers actually mean
Embryo Transfer
The embryo transfer is typically done on Day 5 (blastocyst stage). One embryo is placed into the uterus via a thin catheter passed through the cervix — a procedure with no sedation required at most clinics, described by most patients as feeling similar to a smear test. It takes approximately 10–15 minutes.
The embryo is loaded into the catheter under ultrasound guidance. The transfer is visible on the screen as a brief bright flash — the moment of placement. Most patients describe this as unexpectedly moving.
After transfer
After transfer, you’ll rest briefly at the clinic before going home. Bed rest is not required or recommended — multiple studies confirm it does not improve outcomes. Normal gentle activity resumes the same day. You will begin the two-week wait — the 14 days between transfer and your blood test.
Remaining viable embryos are frozen (vitrified) for future use in frozen embryo transfer (FET) cycles. These frozen embryos are an important asset — they give you multiple transfer opportunities from a single retrieval. For FET costs, see our IVF cost guide.
The Two-Week Wait
The two-week wait is covered in detail in our dedicated guide — including why progesterone symptoms are not reliable indicators of outcome, why early testing is emotionally risky, and practical strategies for getting through the 14 days. This is not a section to skip.
The Result
Your clinic schedules a serum beta-hCG blood test on a specific day — typically 9–14 days after a Day 5 transfer. This quantitative blood test is more sensitive and accurate than a home test and gives a number, not just a positive/negative.
- If positive: a repeat test 48 hours later confirms appropriate rise. A first scan is scheduled at approximately 6–7 weeks. Our guide to pregnancy after infertility is where the next chapter begins
- If negative: the loss is real and deserves to be grieved. Our failed cycle guide and what to do after a failed cycle guide cover what comes next — when you’re ready
People Also Ask
Q: How long does an IVF cycle take from start to finish?
A: A complete IVF cycle — from the start of stimulation to the pregnancy blood test — takes approximately 4–6 weeks. The stimulation phase alone is 10–14 days. Egg retrieval and embryo culture add another 5–6 days. The two-week wait follows transfer. In South Africa, international patients typically need 3–4 weeks in-country for a fresh cycle.
Q: How many injections are involved in IVF?
A: During stimulation, typically one to two injections per day for 10–14 days, plus the trigger injection. Total: approximately 15–30 injections over the stimulation phase. Most are subcutaneous (under the skin, not into muscle) and use very fine needles — most patients describe them as far less daunting than anticipated.
Q: Is IVF painful?
A: The injections cause mild stinging rather than significant pain. Stimulation causes abdominal bloating and pressure that is uncomfortable but manageable. Egg retrieval is performed under sedation — patients are unaware of the procedure and typically describe waking up feeling groggy rather than in pain. Cramping after retrieval and transfer is normal and usually resolves within 24–48 hours.
Q: Can I work during an IVF cycle?
A: Most people work throughout stimulation, reducing activity only around retrieval (typically 1–2 days off) and transfer (1 day off). The monitoring appointments (2–3 per week) need to be accommodated — most clinics offer early morning appointments for this reason. The two-week wait is fully workable for most people, though emotionally demanding.
Practical Takeaways
- The IVF cycle has a clear shape: suppression (if used), stimulation, trigger, retrieval, embryo culture, transfer, two-week wait, result. Understanding each phase reduces the anxiety of the unknown.
- Attrition from eggs retrieved to blastocysts is normal and expected — it does not mean the cycle is failing
- Bed rest is not required after transfer — multiple studies confirm it doesn’t improve outcomes. Normal gentle activity is fine
- The two-week wait is the hardest part for most patients — our dedicated guide covers how to get through it
- If you’re doing your first IVF cycle in South Africa and want support throughout, a fertility concierge provides real-time accompaniment at every stage
Disclaimer: This article is for educational purposes only and does not constitute medical advice. Individual IVF protocols vary significantly. Always follow the specific guidance of your treating clinic and specialist and always consult with a qualified healthcare provider before making decisions about fertility treatment.
About the Author
Leigh-Ann Geydien is the founder of Fertility Solutions, South Africa’s only dedicated fertility directory. With a deep commitment to patient advocacy, she built the platform to bridge the gap between those navigating fertility challenges and the clinics and reproductive health specialists best placed to help them.
