The IVF ICSI cycle timeline


For hundreds of thousands of couples around the world struggling with infertility, it has been possible to have their own biological children thanks to In Vitro Fertilisation or IVF treatment with Intra Cytoplasmic Sperm Injection (ICSI).

This advanced medical treatment for infertility, however, is not a single procedure, but rather a treatment cycle encompassing a number of steps and procedures completed over a timeline that spans several weeks.

In this article, we take a look at these two therapies, and detail the timeline to complete a cycle of treatment.

What is IVF?

In Vitro Fertilisation (IVF) can be described in the very simplest terms as “eggs are extracted, fertilized in a laboratory and placed in the uterus to hopefully implant and develop into a pregnancy”.

A more detailed description begins to reveal the complexity of this treatment process. During IVF treatment, eggs are surgically removed from the female partner’s ovary. In a glass dish (“in vitro”), outside the body, it is mixed with sperm to be fertilized. The fertilized eggs, called embryos, are then placed in the women’s uterus three to five days later.

What is ICSI?

ICSI stands for “Intra Cytoplasmic Sperm Injection” and it is a revolutionary medical process that makes it possible for nearly every man to have his own biological child, even in the case of severe sperm problems. Practised safely around the world, ICSI has helped thousands of couples to have their own biological offspring.

ICSI is a medical procedure used in specific circumstances when the fertilization of the eggs takes place in the lab during IVF treatment, and it is very effective.

The IVF ICSI timeline

The brief descriptions of IVF and ICSI make the process sound quite simple.

However, a full overview of the steps and procedures involved in a typical 28-day IVF ICSI plan at Cape Fertility, as detailed below, provides a realistic picture of the full process.

Timeline: Day 1

The IVF ICSI timeline commences on the first day of your period, which is Day 1 of your cycle and of your 28-day IVF ICSI cycle.

Timeline: Day 2-3

Your treatment is starts off with medications taken on the first two to three days of your period. These are fertility medications that are taken to stimulate egg growth and may include tablets or fertility injections containing FSH (Follicle Stimulating Hormone).

You will also take medication to suppress normal pituitary function and prevent ovulation prior to the time of the egg collection. Possible side effects of fertility drugs are headaches, nausea, painful breasts, mood swings, bloated feeling and increased vaginal discharge. Most women have no or minimal side effects.

Timeline: Day 8

On Day 8 of your IVF treatment cycle, monitoring through blood tests and ultrasound scans commences. This means that on Day 8 you will have the first scan with your fertility specialist. Using an ultrasound scan, your specialist will be able to see the follicles containing eggs.

Timeline: Day 10

On Day 10 you will have a second scan to closely monitor the development of the follicles and any reaction to the medication.

Timeline: Day 12

On Day 12 you will have a third scan. If the eggs are ready for collection, you will have a trigger injection in the evening.

The eggs are triggered 36 hours prior to the egg collection by using an injection called HCG (Human Chorionic Gonadotrophin).

Timeline: Day 14

Day 14 is an important milestone, as the eggs are retrieved.

The egg collection procedure is performed under sedation in our custom-designed procedure room. An anaesthetist will make sure that you will not feel anything during the procedure, but you will need to stay at the Cape Fertility for approximately two hours after the procedure.

A transvaginal ultrasound is performed, and the eggs are extracted with a fine needle attached to the ultrasound. In our laboratory, right next to our procedure room, the follicular fluid is examined under a microscope to check how many eggs were collected.

Progesterone hormone is given after the egg collection to prepare the lining of the uterus (womb) for embryo transfer.

A fresh sperm sample is also collected on the same day as the egg collection, and the eggs are fertilized in the laboratory after collection. This is where ICSI comes in.

During conventional IVF treatment, the fertilization of the eggs is achieved by mixing the eggs ‘in vitro’ (in glass) with tens of thousands of washed sperm, where they are able to reach and fertilise the eggs. ICSI replaces this procedure.

Instead of the eggs and sperm being mixed and left to fertilise as with traditional IVF treatment, during ICSI, one sperm is injected into the egg using a micromanipulation microscope. The embryologist will choose a single sperm cell – the best and strongest available – and inject it directly into the egg. This circumvents any possible problems with the sperm penetrating the egg.

Timeline: Day 14 – 17 or 19

For the next three to five days, the fertilized eggs – called embryos – are nurtured under controlled conditions in the laboratory.

Thanks to new techniques of embryo culture, embryos can now be grown in the laboratory longer until they reach the blastocyst stage on the fifth day in the lab. This means that embryos that fail to grow can be detected and better quality embryos can be chosen for transfer into the uterus.

Timeline: Day 17 or Day 19

Day 17 or Day 19 is a special occasion – the day the fertilised eggs (embryos) are transferred into the womb!

Fortunately, embryo transfer is a painless procedure performed in our special procedure room. A speculum inserted into the vagina allows the specialist to visualize the cervix and a thin plastic tube is used to transfer the embryos directly into the uterine cavity. To ensure the embryos are transferred into the correct place, an ultrasound scan is performed.

Timeline: Day 28

In a final step on the journey, a pregnancy test can be done around Day 28.

Support every step of the way

As you can see, a full cycle of IVF ICSI treatment can be quite a daunting prospect!

Fortunately, when you embark on the process of IVF ICSI treatment at Cape Fertility, you will have a team of specialists supporting you every step of the way.

We use patient-friendly protocols and provide you with a customised cycle sheet, describing exactly what happens on each day, and when and how each step must be completed – from what medications should be taken and when monitoring needs to be done. You will work closely with your highly qualified and well-experienced reproductive specialist and enjoy the support of your own IVF co-ordinator, with a 4-year University Degree as Bachelor of Nursing (or equivalent) and many years of experience in fertility and IVF treatment.

Your IVF co-ordinator will guide you through every one of the various steps of the IVF process, plan your treatment dates and monitoring, show you exactly how the medications should be taken and answer the practical questions you may have while offering advice and support.

Simply to contact us by clicking here… At Cape Fertility, we value each individual patient and we look forward to providing you with our signature individualised and personalised care.