You’ve been trying for so long that you’re officially bored of sex, and yet there’s still no bun in the oven. Here’s what happens after your GP has referred you for fertility treatment.
Step 1 of IVF prep: have lots of random appointments about things
Everyone’s route to IVF is slightly different, but it normally involves a referral from your GP and a big ol’ collection of appointments with the fertility department that you were referred to. (If you've decided to be treated privately, you won't need a referral: you can just contact the clinic directly.) There’ll be paperwork, weigh-ins, and possibly a few blood tests and sperm samples to determine if IVF is definitely the right route for you. (Some of the blood tests might then be repeated during Step 3 below.) Your partner will need to be at these appointments with you.
Sometimes, you’ll have an appointment and the doctor will say (after you’ve been waiting 1.5 hours in the waiting room), “I can’t remember why I arranged this appointment with you. Hmmm… no… it’s not coming back to me.” Maybe – hopefully – this just happened to me and it’ll never happen again.
How long does it take to go from “paperwork and weigh-ins” to actually getting started with IVF?
On the NHS, you’re looking at a good few months of waiting, but the timing of the “paperwork and weigh-ins” stage seems to differ between people and hospitals. For example, I did Step 1 and then had the months-long wait, whereas others will wait for months, then do Step 1, and then move straight on to Step 2 (see below).
While you’re waiting, you might also be instructed to make some lifestyle changes: some people need to quit smoking, while others need to get their BMI down or up to an acceptable level.
If you're being treated privately, you'll find that treatment starts a matter of weeks after the initial appointments.
Step 2 of IVF prep: have a period (really)!
Once the clinic or hospital is ready to give you fertility treatment, you’ll probably have another appointment where they welcome you, ask you to sign a few more bits and pieces, and tell you that your very first task will be to get your period.
That’s because you’ll need to have some pre-IVF blood tests and a scan on about day 3 of your period, in order to help the doctors understand a bit more about the workings of your body and its likelihood of responding to various treatments. (There’s more on this in Step 3, below.)
Depending on where you’re getting treatment and your particular situation, you’ll either go about your month as normal and call them up as soon as Aunt Flo makes an appearance, or you’ll go on the contraceptive pill for a month and give them a ring as soon as Fake Aunt Flo makes herself known (“Are you really my Aunt Flo, or are you just some imposter? Eh??”). Some clinics like to get you on the pill purely for reasons of “scheduling convenience” – especially if you have irregular periods.
If you don’t normally get periods (i.e. you have amenorrhea), you’ve probably had a bunch of scans and blood tests already. Whether you have the blood tests and scan will be down to your clinic/hospital – and you may or may not be asked to go on the contraceptive pill beforehand.
Step 3 of IVF prep: “baseline” or “day 3” tests
“Day 3” is the third day of bleeding. What usually happens is this: on the first day that you start bleeding (which means “full flow – not just spotting”), you’ll call up the clinic or hospital and tell them you’ve started your period. They’ll then book you in for your “day 3” tests and scan two days later.
On that day, you’ll go in for some blood tests and a “transvaginal ultrasound scan”. Yep… on your grossest day of the month, you’ll have a doctor probing around in there to check on the state of your ovaries – with smelly, clotted, menstrual blood gushing out everywhere. I exaggerate (hugely), but I encourage you to have that image in your head when you go in for your scan: the real experience will be nowhere as bad, and you’ll come out thinking, “That wasn’t nearly as disgusting as I thought.”
What happens if “day 3” falls on a weekend?
Your clinic might be open for these sorts of things, or they’ll just book you in for the next available weekday. It doesn’t have to be day 3 necessarily – it just needs to be around the time when your ovaries are quiet and your hormone levels are meant to be in their “resting” state. More on this below.
Why do I have the baseline tests?
Before you begin fertility treatment, your doctors will need to know a bit more about the quantity and quality of your eggs. They need to know this for a few reasons:
- So they can create a customised treatment plan (“protocol”) for you. (If you have a small number of eggs, for example, you may need more aggressive treatment to get enough of them growing.)
- So they can identify if you’re at risk of Ovarian Hyperstimulation Syndrome (OHSS), and make amendments to your treatment accordingly.
- In order to assess your likelihood of conceiving via IVF, and make you aware of your chances of success.
The day 3 tests tell them what they need to know.
If you want to know more about why egg quality and quantity matter so much (and they really do), read this.
What gets tested?
Depending on the hospital/clinic, you’ll have some or all of the following:
- FSH levels blood test
- Oestradiol levels blood test
- AMH levels blood test
- Antral follicle count scan (the transvaginal ultrasound scan mentioned above)
The links above give you way more information about why these hormones get tested, and what they indicate about your egg quantity/quality.
Why day 3?
On day 3, your egg-containing follicles haven’t yet started growing, the lining of your uterus should be thin, and everything should be calm and peaceful. As a result, your hormones should be doing very predictable things – and the doctors can accurately assess your egg situation by looking at these hormones and seeing what they’re up to at this stage.
It’s a similar situation with your ultrasound scan: when everything is resting and peaceful, it’s the best time to look at how many follicles there are and what they’re up to.
What happens if my “day 3” test results are abnormal/bad?
Unless you’re over a certain age (in which case you probably wouldn’t be accepted for IVF treatment anyway), an “abnormal” or “bad” result normally means you’ll be put on a certain “protocol” or tested/monitored more closely in case various issues crop up. (For example, if you have sky-high AMH levels, it means you might be at risk of OHSS – so they’ll keep an eye on you for signs and symptoms.)
Remember: if you’re having fertility treatment for reasons relating to your own fertility (rather than your partner’s), it indicates that at least one of these results won’t be perfect anyway – so don’t worry too much if that’s the case with you.
Read the individual pages on each test for more information about the test results and what they mean:
Some doctors will repeat a couple of tests if they’re suspicious that the initial results were inaccurate.
Keep reading… there's more below.
Free email course: guiding you through the IVF decisions you’ll need to make
Please 'scuse the brief interlude. There are a LOT of decisions to make when you start IVF – decisions like:
- Fresh or frozen?
- One embryo or two?
- Who do you tell?
- What should you eat (and not eat)?
- When (if ever) do you give up?
My email course will make you aware of all these decisions and more, and help you become prepared, positive, and self-assured about your IVF treatment.
Enter your email address to receive it right away.
Step 4 of IVF prep (sometimes): various tests to check out your uterus and fallopian tubes
You may or may not have:
- A “dummy embryo transfer”, which is a trial run of the actual embryo transfer. It allows the doctors to determine the best “route” to the ideal embryo landing place in your uterus, and check for any issues that could make for a tricky transfer (like scar tissue).
- A HyCoSy (“hysterosalpingo-contrast sonography” for fans of big words), which checks for blockages in your fallopian tubes. If there are any blockages, it might help to explain your fertility problems: your eggs are unable to enter the fallopian tube when you ovulate. IVF bypasses the fallopian tubes (embryos are transferred directly to your uterus), which means that blocked tubes – while it’s useful to know that you have them – won’t be an issue.
- An HSG (hysterosalpingogram!), which is very similar to a HyCoSy, but involves x-rays rather than ultrasound.
- A hysteroscopy, which is all about looking at your uterus to check that it’s healthy and ready to carry a baby. If any problems are detected (like fibroids or polyps), they’ll need to be dealt with before you start IVF. After all… you wouldn’t want to put your potential bun in a sub-optimal oven, would you?
- A 3D SIS (saline infusion sonography – gotta love these words) is an ultrasound procedure that also checks out the state of your uterus.
All these procedures take place after your period but before you ovulate (usually between day 7 and day 10 of your cycle – where day 1 is your period). You won’t need to be sedated for any of them, but they can be a bit crampy and uncomfortable – and you’ll probably be advised to take paracetamol in advance.
Step 4 of IVF prep: no more prep!
Providing the doctors are happy with the blood tests and scans, and they’re confident about how to treat you, it’s time to move on to “actual” IVF.
You’ll have to wait a little bit longer before you can start growing any eggs, though: “actual” IVF begins with something called “downregulation” – which is pretty much the opposite of egg-growing.