IVF Explained for Men: What to Expect, Stage by Stage

When our doctor first started talking to us about IVF, I understood the general concept. They take my wife’s eggs, fertilize them with my sperm, create embryos, and hopefully one of those embryos eventually becomes a baby. Pretty straightforward.

What I didn’t understand was everything that happens between those steps, what I need to do versus my wife, what results to expect, and how emotionally attached we would become to numbers that a few months earlier I didn’t even know existed.

If you’re a husband or male partner about to start IVF, this is basically what I wish someone had explained to me before our first cycle.

There are so many terms I had never heard before: Follicles. Mature eggs. Fertilization rate. Day 3. Day 5. Blastocysts. Grading. PGT-A. Euploid. If any of those stop you, the glossary has them in plain language, sorted by the stage you’re actually in.

I remember sitting in appointments and understanding maybe half of what was being discussed. My wife usually understood more than I did, partially because most of the treatment was happening to her and she had no choice but to understand it.

Looking back, I don’t think a husband needs to know every medical detail of IVF before starting. You’ll learn a lot of it along the way anyway, and your specific treatment might be different from ours.

But I do think you should understand the process well enough that your wife doesn’t have to be the person going through all of it physically and also the person responsible for explaining to you what the hell is going on.

In our case, I was very confident in our first cycle that everything would go well, so I felt comfortable not being in full control and not understanding all the details. I think that approach backfired when I learned that all the high quality embryos we had were genetically abnormal, too many or too few chromosomes, and we couldn’t use any of them for transfer.

So looking back, this is how I would have wanted someone to explain IVF to me before our first cycle.

IVF is not one procedure

This was probably my first misunderstanding.

You don’t really “do IVF” on one specific day. It’s a process with multiple stages, and each stage creates another result that determines what happens next.

The purpose is basically to get multiple eggs to mature at the same time.

In a normal cycle, usually one egg matures and is released. In IVF, you want more than one because, as I learned later, the number of eggs you start with and the number of embryos you actually end up being able to use can be VERY different numbers.

It’s a LOT of shots

Your clinic will give you a specific protocol, but generally your wife will need to take shots for 8 to 14 days. Sometimes it’s one a day, sometimes it’s three times a day, or three at the same time. They need to happen at specific times, and in some cases you need to do a couple of steps to get the shot ready, and it’s stressful to get it wrong or forget a step. For most women it’s the first time they inject themselves, and that can be very stressful and emotional. Some people find it easier to do it themselves and control it, and some prefer their partner to do it for them. It’s tough mentally and physically. Especially not knowing whether you will actually see any success from this, and who knows when that will happen.

Those hormones also affect her emotionally and behaviorally, so try to keep things calm and stress free during that time. In our case, we decided not to see friends and family, ordered DoorDash whenever we wanted, and came back early from work so we could have some quality time before and after the shots.

During this period she will also be going back to the clinic constantly for blood tests and ultrasounds. They’re checking how the follicles are growing and what her hormone levels are doing, and based on that they may adjust the shots or tell you when to come back.

At first I didn’t understand why we cared so much whether something was 12mm or 16mm or 20mm. Eventually you realize these measurements help the doctor decide when enough follicles may contain mature eggs, and when it’s time for the next step.

The schedule can also move around. You might think retrieval will happen on Tuesday and suddenly it’s Wednesday. Medication doses can change. Another blood test gets added.

This is one of the first points where IVF starts controlling your calendar more than you expected.

The trigger shot and egg retrieval

Once the doctor thinks the follicles are ready, your wife takes what’s called the trigger shot.

This one has very specific timing, because the egg retrieval is scheduled around it. You’ll get precise guidance on when it has to happen.

The retrieval itself is a medical procedure where the doctor collects the eggs from the ovaries. Your partner will usually be under sedation or anesthesia.

As you can understand by now, women go through so much during this process while we’re not doing much. I felt useless a lot of the time, and upset that I couldn’t do more for her.

My wife had gone through days of injections, blood tests, ultrasounds, hormones, and now a procedure.

My major physical contribution was providing sperm.

That doesn’t mean there’s nothing for you to do. Along the way you can do plenty to make it easier for both of you. What I did was take ownership of everything around the house, and the annoying bureaucratic stuff like submitting receipts to insurance and comparing medication prices between pharmacies. I decided to be the good vibes person, the one who no matter what happens keeps the energy up and tries to see the light at the end of the tunnel. I kept repeating the same mantra: “I know that it will work, I have no doubt. It’s just a question of when.”

The number of eggs isn’t the number of embryos

This is probably the most important thing I wish I’d understood going into IVF.

In our case the protocol was to grow the embryos for five days. In some cases clinics freeze them after three days instead, which lowers the risk of ending up with nothing to freeze or transfer, since some embryos stop developing between day three and day five. Growing to day five gives the lab more information about which embryos are actually developing well, which is why many clinics prefer it, though the evidence on which approach produces more babies is more mixed than I assumed at the time.

When the egg retrieval happens, some of those eggs might not be mature. Of the mature eggs, not all will fertilize. Of the ones that fertilize, not all will continue developing. Of the embryos that continue developing, not all will necessarily make it to the stage where they can be transferred or frozen. And depending on your situation, there may be another step after that.

You can go from being excited about the number of follicles, to the number of eggs retrieved, to mature eggs, fertilized eggs, blastocysts, and then potentially genetically tested embryos.

Nobody had really prepared me for how emotionally weird that would feel.

You start celebrating numbers while simultaneously being scared of the next phone call, because you know the number can drop again.

Traditional IVF vs. ICSI: What’s the Difference?

This was also confusing to me in the beginning, because people sometimes use “IVF” and “ICSI” almost interchangeably.

ICSI is not an alternative to IVF. ICSI is one way of doing the fertilization part of IVF.

With traditional IVF, the embryology lab puts an egg together with thousands of sperm and basically lets fertilization happen from there. One of the sperm still has to penetrate the egg.

With ICSI, the embryologist doesn’t leave that part to chance. They select a single sperm and inject it directly into the egg.

That’s the main difference.

Traditional IVF: egg + lots of sperm, hopefully one sperm fertilizes the egg.

ICSI: egg + one sperm injected directly into it, hopefully the egg fertilizes.

Notice that I still said hopefully.

ICSI helps get the sperm inside the egg. It doesn’t guarantee that the egg will fertilize normally, or that you’ll eventually get a healthy embryo.

After fertilization, the process is basically the same. The embryos are grown and monitored in the lab to see which ones continue developing.

Embryo Grading: Quality and Chromosomes Are Not the Same Thing

You’ll probably hear your embryos described with grades like 4AA, 5AB, 4BB.

At first these looked like random license plate numbers to me.

The grade is basically the embryologist’s visual assessment of how the embryo is developing.

For a blastocyst, the number describes how expanded the embryo is, and the two letters describe the appearance of two different groups of cells: the ones that eventually develop into the baby, and the ones that eventually contribute to the placenta.

Generally an A looks better than a B, and a B looks better than a C.

So naturally, when someone tells you that you have a bunch of high quality embryos, you think: great, we have healthy embryos.

Unfortunately, that’s not necessarily what it means.

Grading tells you what the embryo looks like under the microscope. It doesn’t tell you whether the embryo has the correct number of chromosomes.

You can have an embryo that looks great and still has a chromosome problem. And you can have a lower graded embryo that is chromosomally normal and absolutely worth transferring.

I wish I’d understood that distinction before we got those results.

What that looked like for us

In our first IVF, they retrieved 19 eggs. About 15 of them fertilized, and I thought: awesome. We’re completely fine even if some of them don’t survive.

Then five days later the doctor called to say that only 9 had made it to day five, and that they’d do the genetic testing and freeze them. She said they were all graded high quality and we should be happy with the results. It sounded great to me. We’d already done genetic testing on ourselves and had nothing to worry about, so why would we worry about the embryo testing?

Guess what. Two weeks later we got a call telling us that all of the embryos were chromosomally abnormal, which means they can’t be used. Complete shock. But very quickly we talked to some experts and decided to do a second round.

19 eggs. 15 fertilized. 9 blastocysts. All of them graded high quality. None of them usable.

Fresh vs. frozen transfer

Another thing I didn’t understand before IVF was that egg retrieval and embryo transfer don’t necessarily happen in the same month.

Sometimes an embryo is transferred a few days after retrieval. That’s called a fresh transfer.

Other times the embryos are frozen and transferred in a later cycle. That’s called a frozen embryo transfer, or FET.

In both our IVFs we froze the embryos and waited about a month before doing the transfer.

My recollection is that our doctor didn’t want to put my wife’s body through a transfer immediately after all the stimulation and hormones from the retrieval cycle. I don’t remember the exact medical explanation he gave us, so I don’t want to pretend I do.

But that’s another useful thing to understand: getting embryos doesn’t necessarily mean you’re transferring one next week.

Depending on your situation, her hormone levels, how her body responded to the stimulation, whether you’re doing genetic testing, and your doctor’s recommendation, the transfer may happen later.

At the time, another month felt like forever.

By that stage you already feel like you’ve been waiting forever, so hearing “we’re going to wait another cycle” isn’t exactly what you want to hear.

But IVF has a lot of that. You keep thinking you’re almost at the next step. And then you discover another step.

Transfer doesn’t mean you’re pregnant

This one sounds obvious when I write it now, but before fertility treatment I knew almost nothing about embryos or implantation.

An embryo transfer means the doctor places an embryo into the uterus.

Then the embryo still needs to implant.

After that comes another waiting period before the clinic can test whether pregnancy occurred.

By this point you’ve already gone through so many milestones that it’s easy to mentally treat the transfer as the finish line.

It isn’t. It’s another step.

One thing fertility treatment taught me is that there always seems to be another milestone you didn’t know existed.

First you want eggs. Then fertilization. Then embryos. Then a transfer. Then a positive pregnancy test. (Amen!) Then the number needs to rise appropriately. Then the ultrasound. Then the heartbeat. Then more ultrasounds and more tests.

At some point you realize it’s a never ending rollercoaster of hope, stress, expectation, disappointment, guilt, happiness, and other emotions nobody outside it really understands.

What I think the husband’s role should actually be

Most IVF treatment physically happens to the woman. There’s no way around that.

But I think it’s very easy for that physical imbalance to accidentally turn into an information and responsibility imbalance too.

She takes the medication, so she learns the medication. She goes through the procedure, so she researches the procedure. She talks to the nurse, so she knows what’s happening next.

And suddenly she becomes the project manager of IVF while you’re waiting for updates.

I don’t think that happens because husbands don’t care. I think a lot of us simply don’t know where we’re supposed to fit into the process. In the first IVF, I definitely didn’t.

In retrospect, I would have gotten involved earlier:

• Know the basic timeline.
• Know what medications she’s taking and why.
• Know when the appointments are.
• Understand what the doctor is trying to achieve at the current stage.
• Go to the important appointments when you can.
• Write questions down.
• When you don’t understand something, research it yourself instead of automatically asking your wife to explain it. She’s already doing enough.
• Own the house chores and be the good vibes person.
• Make sure you both do what makes you feel good, even if that means two weeks straight at home.

You don’t need to understand everything on day one

If you’re reading this because your wife sent it to you and you’re about to start IVF, don’t panic and spend the next six hours researching embryo grading.

You’ll get there if you need to.

The more important thing is understanding that IVF isn’t one and done. It’s not a two week process. It’s a series of stages, and every stage can change what happens next. There will probably be moments where you feel completely clueless, and hopeless. There will be terminology you don’t understand.

There may be disappointing phone calls. There may also be really good ones.

You don’t need to become the fertility expert in your relationship.

But you should know enough that you’re actually going through this together.

For the wider picture, including the parts of this that aren’t medical, see What I Wish I Understood Before I Stepped Into a Fertility Clinic.

Support that isn’t from me

Fertility Action, a UK charity, runs free support groups for people going through fertility treatment, partners included: Fertility Action support groups. More at fertilityaction.org.