IVF: 7 steps to getting pregnant

Been trying to conceive and have decided to take the IVF route? Here’s what to expect on your journey…


If things don’t seem to be happening after several years of trying to conceive, a couple will very likely see a fertility specialist to figure out what’s going on. This should be done sooner rather later, doctors say, as a woman’s age plays a crucial role in fertility. 

If she is younger than 35, a couple should see a doctor after a year of regular, unprotected sex. If she is 35 and above, they should do so after six months. This is because a woman’s fertility starts to decline more rapidly after her mid-30s because her egg quality is reduced. At 35, a woman has a 15 to 20 per cent chance of getting pregnant naturally per month.

Hormonal issues, ovulatory disorders such as polycystic ovary syndrome, endometriosis and fibroids can also stand in a woman’s way of conceiving. As can diabetes and low sperm mobility and motility in a man.  

The good news is that assisted reproductive technology has improved by leaps and bounds as compared to 30 years ago when procedures like in vitro fertilisation (IFV) as well as fertility medication were  still in their infancy. 

Risks aside, each year, millions of people around the world ― who might not have been able to conceive otherwise ― are able to realise their dreams of parenthood, thanks to this phenomenal procedure.

“In Singapore, women under the age of 40 are eligible to undergo 10 cycles of IVF,” says Dr Kelly Loi, a gynaecologist and fertility specialist at Health & Fertility Centre for Women. “Those over 40 are allowed five cycles.” Government assistance is applicable to those under 40 only. “For women over the age of 45, IVF is not allowed in Singapore and a special request must be made and permission granted from the Ministry of Health,” she adds.

With as many as one in seven couples in Singapore facing infertility, you may know of someone or even be that person who is about to go down the IVF route. And while many have heard of IVF, only a handful actually know what the procedure is like. If you are clueless about this process and what it entails, here’s what it looks like from start to finish.

STEP 1: Initial tests

Once you’ve made up your mind about IVF, you will first be sent for a series of blood tests to check for infections like hepatitis B and C, HIV, syphilis and rubella. Your hormone levels will also be assessed and an ultrasound scan of your pelvis done to determine the health of your uterus and ovaries. Men will also go through a similar infection screening, plus they will have to produce a semen sample that will undergo a quality check.  

The couple will also be required to attend counselling as the IVF journey will likely take a toll on their physical, mental and emotional health. Since the average success rate is only between 40 per cent and 60 per cent per cycle, therapy helps to manage the couple’s expectations and gives them tools to handle disappointment.

The couple will also be required to attend counselling… The average success rate is only between 40 per cent and 60 per cent per cycle, therapy helps to manage the couple’s expectations.

STEP 2: Woman starts on fertility drugs

Once you’ve been given the all clear, the woman will go through a two-week downregulation "long Lupron” protocol ― this is administered as an injection under the skin in her thigh or abdomen area. The main purpose of this drug is shut down your body’s natural ovulation process and stop the egg from being released. 

After this, she will go on a 10-12 day course of hormone shots. Carried out after her last menstrual cycle, this stimulation phase (also known as stims) will require her to inject herself twice a day with hCG (human chorionic gonadotropin) hormones to stimulate her ovaries and boost egg production.

As with any kind of hormonal therapy, you may experience some common mild side effects such as bloating and fatigue. There’s also a risk of Ovarian Hyperstimulation Syndrome (OHSS), where too many eggs are produced as a result of the injections.

“This in turn leads to abdominal pain, nausea and vomiting, and dehydration,” notes Dr Loi. “In 1 per cent of cases, it can be severe and require hospitalisation.”

Severe OHSS can affect kidney and liver function, and also cause fluid to build up in the abdomen and lungs. Fortunately, these days, patients identified as being at high risk of OHSS can be given specific hormone injections and medication to prevent the condition from occurring.

STEP 3: Egg retrieval

After the 10 to 12 days of hormone shots, scans are done to confirm if the egg follicles are sufficiently large in size and ready for collection. The woman is then sedated in order that her eggs may be retrieved during a 15- to 20-minute-long procedure.

“A transvaginal ultrasound probe with a fine needle attached will be used to retrieve all the eggs from the ovaries,” Dr Loi notes. “Occasionally, some abdominal cramps may be felt after and the woman may suffer some giddiness and nausea from the anaesthetic used.” A specially-trained embryologist will then inspect the eggs to determine their quality and if they can be used for fertilisation.