IVF Stimulation Explained — Day-by-Day Through the Cycle

IVF stimulation involves daily injections, frequent monitoring, and significant emotional engagement. This page walks through what to expect day-by-day through a typical antagonist stimulation cycle.

1. Cycle day 1-2 — start

First day of menstruation. Baseline transvaginal ultrasound to confirm no functional cysts. Baseline blood work (FSH, LH, estradiol). FSH injection started day 2 or 3 evening. Dose calibrated to AMH, AFC, age. Subcutaneous injection (abdomen typically). Self-administered after training.

2. Days 3-5 — early stimulation

Daily FSH continuing. Mild bloating begins. Mood changes possible. Minimal symptoms typically. Continue normal activities. Light exercise. Avoid extreme physical activity. Adequate hydration. Limit caffeine and alcohol. Patient self-administering injections at home.

3. Day 5-7 — first monitoring

First transvaginal ultrasound. Estradiol blood level. Count developing follicles. Measure leading follicle size. Adjust FSH dose if needed. If lead follicle 13-14 mm — start GnRH antagonist (Cetrotide, Orgalutran). Add to evening injection schedule. Now 2 injections daily.

4. Days 7-10 — peak stimulation

Continued daily monitoring every 1-2 days. Multiple follicles developing. Visible bloating. Some discomfort. Possible mood swings. Estradiol rising rapidly. Adjustments to FSH dose if response too brisk or slow. Continued daily injections (FSH + antagonist).

5. Day 10-12 — trigger preparation

Follicles approaching mature size (17-18 mm). Final monitoring scan. Trigger injection scheduled when adequate maturation. Choice of trigger — hCG, GnRH agonist (Lupride), or dual trigger. Trigger administered evening, exactly 36 hours before retrieval. Critical timing.

6. Trigger to retrieval — 36 hours

No more FSH after trigger. Trigger drives final oocyte maturation. Patient prepared for retrieval — fasting after midnight, comfortable clothing, transport arranged. Avoid strenuous activity. Sometimes pre-retrieval evaluation.

7. Retrieval day

Day-care procedure under sedation. Transvaginal ultrasound-guided aspiration of follicles. Lasts 20-30 minutes. Mild discomfort during recovery. Discharge same day. Some bloating, mild cramping. Eggs immediately delivered to embryology laboratory for assessment. Begins luteal phase support.

8. Post-retrieval recovery

Rest day 1. Light activities day 2-3. Avoid heavy lifting or intense exercise for 1-2 weeks (ovarian torsion risk in enlarged ovaries). Hydration. Monitor for OHSS symptoms — increasing pain, breathing difficulty, weight gain. Mild bloating normal. Updates from embryology lab over next 5-6 days.

Frequently Asked Questions

Dr. Priyadatt Patel

Senior Gynecologist · Advanced Laparoscopic Surgeon · IVF and Endometriosis Programme Lead

MS OBGyn · Pregnancy Care · Advanced Gynaecological Ultrasound · Fertility Preservation

ESHRE / ESGE / AAGL / ASRM guideline-aligned practice. 3D Karl Storz precision technique. Fertility-preservation-first philosophy. Evidence-based decisions, honest counselling, long-term outcomes orientation.