The Cruelest Part of Fertility Treatment Is 'Time' | IVF Clinic Visit Schedule
In vitro fertilization (IVF) is...
'If I start treatment, I'll get results right away'
Do you think that?
In IVF, egg retrieval, fertilization, embryo culture, and embryo transfer are carried out according to your menstrual cycle and physical condition.
With frozen embryo transfer, the egg retrieval cycle and the transfer cycle are separate, so it can span multiple menstrual cycles from egg retrieval to pregnancy testing.
However, not every stage proceeds as planned.
Egg retrieval was canceled.
Even after egg retrieval, no eggs were collected.
Eggs were collected, but they did not fertilize.
They fertilized, but the embryos did not develop.
The endometrial thickness or hormone levels were not optimal, so the transfer was postponed.
The transfer was performed, but pregnancy did not occur.
If treatment stops at any stage, you must wait for the next menstrual cycle.
The next attempt will be next month.
In fertility treatment,this 'one more month' piles up again and again.
*The duration of treatment and the number of clinic visits vary depending on age, physical condition, treatment method, and the policies of the medical institution.
IVF clinic visit schedule | From egg retrieval to pregnancy testing
In IVF, egg retrieval, fertilization, and embryo culture are first performed during the egg retrieval cycle. Fresh embryo transfer is performed in the same cycle as egg retrieval, while frozen embryo transfer is usually performed in the following cycle or later.
Generally, treatment proceeds in the following flow.
Consultation after the start of menstruation
Once menstruation begins, visit the medical institution for an ultrasound and hormone tests. The condition of the ovaries and hormones will be checked to decide whether egg retrieval can be performed in that cycle and what method will be used to grow the follicles.
How many clinic visits are required until egg retrieval?
The number of clinic visits until egg retrieval is not uniform. You will visit the clinic multiple times before egg retrieval to check the growth of the follicles. During these visits, ultrasound examinations and blood tests are performed to check the size of the follicles and hormone levels.
Since there are individual differences in how follicles grow, the next clinic visit and the egg retrieval date are determined based on the examination results. The actual number of visits depends on the ovarian stimulation method, follicle growth, and the medical institution's policies.
Egg Retrieval
Once the follicles have grown to a state where eggs can be retrieved, the egg retrieval procedure is performed.
The date of egg retrieval is determined by monitoring follicle growth and hormone levels, so the exact date cannot be known at the start of treatment.
Fertilization and Embryo Culture
The retrieved eggs undergo either in vitro fertilization or intracytoplasmic sperm injection, and the development of the fertilized eggs is monitored.
Not all retrieved eggs are guaranteed to fertilize. Furthermore, even if they do fertilize, not all fertilized eggs will develop into embryos suitable for transfer or freezing.
Preparation for Frozen Embryo Transfer
When performing a frozen embryo transfer, the embryo transfer is carried out in a menstrual cycle different from the one in which the eggs were retrieved.
Frozen embryo transfer can be done by timing it with natural ovulation or by using medication to prepare the endometrium. The date of the embryo transfer is decided while checking the condition of the endometrium and hormone levels.
Embryo Transfer
The embryo is returned to the uterus in accordance with the condition of the endometrium and the developmental stage of the embryo.
Pregnancy Test
After the embryo transfer, you will visit the medical facility on the date specified by them to receive a pregnancy test.
As described, IVF is not a treatment that is completed in a single visit. Multiple clinic visits are required from egg retrieval to the pregnancy test. If a frozen embryo transfer is performed, visits for the transfer cycle are added in addition to the egg retrieval cycle.
Furthermore, since the next visit date is determined based on the examination results, it is necessary to adjust work and family schedules well in advance.
How many months does it take from egg retrieval to embryo transfer and pregnancy test?
In a fresh embryo transfer, the embryo transfer is performed in the same menstrual cycle as the egg retrieval.
On the other hand, in a frozen embryo transfer, the transfer is performed in a menstrual cycle different from the cycle in which the eggs were retrieved. Therefore, the process from egg retrieval to pregnancy test may span multiple menstrual cycles.
However, if there is a cancellation of egg retrieval, cessation of embryo development, or postponement of the transfer, it will take even longer.
This is why it is difficult to answer the duration of IVF with a single number.
Cases where IVF does not proceed as planned
What I have explained so far is the general schedule from egg retrieval to embryo transfer.
In reality, treatment may stop midway, and you may have to wait for the next menstrual cycle.
Egg retrieval is canceled or no eggs are retrieved
If follicles do not grow sufficiently, hormone levels are not in a state where treatment can proceed, or ovulation occurs earlier than expected, the scheduled egg retrieval may be canceled.
Also, even if you proceed to egg retrieval, it does not guarantee that eggs will be obtained. If no eggs are retrieved, the treatment for that cycle ends there.
If you decide to undergo egg retrieval again, you will need to re-evaluate your treatment plan while checking your physical condition.
Failure to fertilize or failure of embryos to develop to a transferable stage
Not all retrieved eggs can necessarily be used for fertilization. Sometimes eggs are immature, and you may not obtain mature eggs that can proceed to fertilization.
Even if mature eggs are obtained, there are cases where they do not fertilize via IVF or ICSI. Also, even if fertilization is confirmed, development may stop midway, and they may not develop into embryos suitable for transfer.
If there are no embryos available for transfer, you will have to start over from egg retrieval.
Transfer is postponed or pregnancy is not achieved
Even if you can freeze embryos for transfer, it does not mean you can transfer them immediately.
You wait for menstruation and determine the transfer date while checking the condition of the endometrium and ovulation. Depending on your physical condition, the transfer may be postponed to the next cycle or later.
Even if you undergo embryo transfer, it does not guarantee pregnancy.
If the result is negative, you will proceed to the next transfer if there are frozen embryos remaining. If no frozen embryos remain, you will have to start over from egg retrieval.
Even if the pregnancy test is positive, it does not necessarily mean the treatment is over
Even if the pregnancy test is positive, it does not mean everything ends immediately.
You need to monitor progress until the gestational sac and heartbeat can be confirmed. If a miscarriage occurs after that, you will have to wait for your body to recover and for menstruation to resume.
Even if you get a positive result, it does not mean that the anxiety or the 'time spent waiting' will end immediately.
This is also one of the things I didn't know until I experienced fertility treatment.
Fertility treatment is a series of 'one more month' after another.
In IVF, treatment can stop at any stage—egg retrieval, fertilization, embryo culture, or embryo transfer—resulting in 'next month again'.
If you look at just one month, it might feel short. However, if that one month piles up three times, it's three months; if it piles up six times, it's half a year.
Since the treatment period can extend in this way, I believe fertility treatment is a process where 'months' accumulate, not just days.
Choosing a clinic with age and time in mind
A woman's age is related to treatment outcomes such as pregnancy rates and miscarriage rates. *Reference: Japan Society of Obstetrics and Gynecology 'ART Data Book 2023'
https://www.jsog.or.jp/activity/art/2023_JSOG-ART.pdf
Of course, treatment outcomes do not change drastically just because one month has passed.
Even so, in fertility treatment, that one month piles up many times over.
No matter which clinic you choose, there is no guarantee that treatment will proceed as you wish. Changing clinics does not necessarily mean you will be able to get pregnant.
Nevertheless,
whether they can explain a treatment plan that suits your current age and test results
whether they can explain the next course of action if the treatment is unsuccessful
whether you can continue clinic visits while balancing work and home life
whether treatment results by age are publicly available
It is important to check points like these.
The money spent on treatment might be earned back by working again.
But the time that has passed cannot be recovered.
Regarding fertility clinics in Tokyo, I have compiled an article comparing the treatment results and number of cases published by each medical institution.
Note: Even medical institutions with a high number of treatments and pregnancy rates do not guarantee pregnancy or childbirth. Please consider a medical institution that suits you, taking into account treatment policies, ease of access, and compatibility with the doctor.
Summary: In fertility treatment, 'one more month' adds up
In vitro fertilization (IVF) is a treatment that proceeds through stages: consultation after the start of menstruation, follicle confirmation, egg retrieval, fertilization, embryo culture, embryo transfer, and pregnancy testing.
In frozen embryo transfer, the egg retrieval cycle and the transfer cycle are separate, so the process from egg retrieval to pregnancy testing may span multiple menstrual cycles.
Furthermore, if egg retrieval is canceled, fertilization stops, embryo development stops, or transfer is postponed, you will have to wait for the next menstrual cycle.
Even if each instance is just 'one more month,' that one month adds up many times over.
Starting treatment does not guarantee immediate results.
That is why I believe it is important to know not only the clinic visit schedule for when things go as planned, but also how much time it might take if treatment is interrupted along the way.
Sources and References
Japan Society of Obstetrics and Gynecology 'ART (Assisted Reproductive Technology) Registry Data'
https://www.jsog.or.jp/activity/art/
Japan Society for Reproductive Medicine 'Reproductive Medicine Guidelines'
https://www.jsrm.or.jp/guideline-statement/
Note: There are individual and facility differences in how treatment is conducted, the duration, and the number and schedule of clinic visits. Please check with the medical institution you are attending or considering for details.
Note: This article is based on the personal perspective of someone who has experienced fertility treatment and information published by public institutions and academic societies.
For those who want to further compare fertility clinics in Tokyo
・Clinic comparison by 23 wards
・Number of egg retrievals, ICSI procedures, and frozen embryo transfers
・Results by age group and for those over 40
・Number of reproductive medicine specialists and embryologists
Please see the list of articles summarizing these topics.
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