What happens in IVF, day by day? Your plan at Jananam.

Both of you are tested, anything treatable is corrected, and you get the plan in writing.

We check her egg reserve (AMH and a scan), his semen, and the womb, plus routine blood tests. Thyroid, blood sugar, blood pressure, weight and vitamin D are corrected first, and folic acid is started. The egg reserve result shapes the whole plan. If reserve is low, we may plan more than one stimulation from the start rather than raise the dose.

You have daily hormone injections for about 8 to 12 days, with blood tests and scans that tell us how to adjust the dose.

Call us on day 1 of your period. On day 2 you have a blood test (FSH, LH and estradiol) and a scan; injections start once the lining is thin and there are no cysts. After 5 days of injections you have a fasting blood test, and on day 6 your first scan. Scans then follow about every 2 days. When the largest follicle reaches about 14 mm, a second injection (the 'antagonist') is added to stop the eggs being released early; this is why it is called an antagonist protocol. [CONFIRM: timings] We usually aim for about 8 to 10 eggs, because more is not always better and raises the risk of overstimulation. Please avoid sex during the treatment cycle.

Egg collection takes about 20 minutes under light anaesthesia, 34 to 36 hours after the trigger injection, and you go home the same day.

When the follicles are ready, a trigger injection ripens the eggs; its exact time decides the time of collection. Come in at 7am, or the night before if you live far away. After collection you may have mild tummy pain and a little bleeding. You can eat and drink about 4 hours later, and you receive one dose of antibiotic. His semen sample is given the same morning. He should ejaculate once about 3 to 4 days before, then not again until the sample. [CONFIRM: all steps]

The eggs are fertilised the same day, and we tell you the next day how many fertilised.

Fertilisation is by conventional IVF or ICSI, chosen for your reason. The embryos then grow in our lab at Neelankarai, and many are grown to day 5 or 6 (blastocyst). We tell you how they are developing and what their grades mean. Not every egg is mature, not every mature egg fertilises and not every embryo reaches day 5; the numbers drop at each step, and that is normal. Where it is indicated, embryos are tested (PGT) in selected cases, discussed with you, and then must be frozen while results come back.

Most of our embryo transfers are frozen, and we never transfer more than two embryos.

Stimulation pushes hormone levels well above normal, which in some women may make the lining less ready. Freezing lets us prepare the lining in a calmer, later cycle. Freezing all embryos is also safer for women at risk of overstimulation, often with PCOS, and it is needed if embryos are tested. A fresh transfer on day 3 or day 5 is still used in selected cases. On transfer day come with a full bladder; there is no anaesthesia, you lie down for about 15 minutes, then go home.

You go back to normal life, keep taking the progesterone as prescribed, and have a blood pregnancy test on the date we give you.

Bed rest is not needed after the transfer and does not raise the chance of pregnancy. The blood test (beta hCG) is usually about 12 days after a blastocyst transfer and 14 days after a day-3 transfer. [CONFIRM: test day] If the test is negative, we meet to read what the cycle showed and plan the next step without a long gap.