1. Ovarian stimulation-Typically, medications (hormonal injections) are given from day 2 or 3 of the cycle for 10 to 14 days to stimulate the growth of multiple follicles in the ovaries The follicles grow in size throughout the course of stimulation. Each follicle potentially contains an egg.

2. Monitoring – is done to assess the response to medication and adjust the doses. Blood tests are done to assess the hormonal levels and a follicular study by ultrasound is done to measure the size and number of the follicles. Different women will respond differently to the medications and so, one type of medication or dose is not suitable for every woman.

3. Trigger– A trigger injection is given for the maturation of the eggs when the follicles reach a certain size.

4. Egg collection– Eggs are retrieved through a minor surgical procedure 34-36 hours after the trigger injection. Under ultrasound guidance, through the vagina, the doctor uses a needle connected to a suction device to gently aspirate the follicular fluid which will contain the egg. This is a day care procedure done under sedation/anaesthesia to minimize discomfort. The patient is observed for a few hours and sent home the same day.

5. Semen collection– The husband will be asked to provide a fresh semen (sperm) sample which is processed in the lab and used to fertilise the eggs. A previously frozen sample or a surgically extracted sample can also be used when indicated.

6. Egg Fertilisation. The mature eggs are then identified, separated and are then combined with the sperm in the lab to form embryos. The following day, the eggs are checked to confirm is fertilisation has taken place. Not all eggs collected are mature and not all mature eggs fertilize.

7. Embryo development – The embryos are carefully cultured /grown in very controlled conditions in the laboratory for 3- 5 days in the incubator. A day-2-3 stage embryo is called a cleavage stage embryo and a day-5 stage embryo is called a Blastocyst. All the fertilized eggs may not continue to develop into good-quality embryos. The growth and development depend on the quality of the eggs and sperm. The patients are informed regarding the progress of the embryo growth.

8. Embryo Transfer- The doctor and the embryologist will decide when it is best to transfer the embryo(s) to achieve the highest chance of a successful pregnancy. After 3-5 days of culture, the embryos are graded according to their external appearance and one or more of the good-quality embryos are transferred into the uterus in the same cycle if there are no other factors adversely affecting the outcome. This is called a Fresh embryo transfer.

In this procedure, the doctor slides a thin soft catheter through the cervix into the uterine cavity and gently releases the embryo(s) under ultrasound guidance. The procedure is usually painless and does not require anaesthesia. The patient can be sent home after 30 minutes.

9. Embryo Freezing – The surplus embryos if any can be frozen and utilized if and when necessary, in a later cycle and such a transfer is called a frozen embryo transfer. If the condition of the uterus or the hormonal levels of the patient is not optimal for a fresh transfer, the doctor will recommend a Frozen embryo transfer in a subsequent cycle.

10. Hormonal Support – Medication is prescribed for a period of 14 days for hormonal support which the patient can take at home.

11. Pregnancy test – Pregnancy happens when the embryo(s) are implanted in the lining of the uterus. A blood test is performed 2 weeks after the embryo transfer to check for levels of S.BHCG.

12. Review with the doctor– The S.BHCG report is interpreted and according to the result, the patient is guided for further follow-up.