Myth
ICSI is better for everyone.
Fact
ICSI helps with certain fertilisation problems. It is not a proven upgrade for every IVF cycle.
Source: HFEATreatment
IVF & ICSI
Fertilisation assisted in the laboratory, then an embryo returned to the uterus. It is the most involved fertility treatment, and for some situations it is the only one that addresses the problem.
The difference between IVF and ICSI
In conventional IVF, eggs and prepared sperm are placed together in a dish and fertilisation is left to happen on its own.
In ICSI, an embryologist selects a single sperm and injects it directly into an egg. It is used where sperm count, movement or shape would make natural fertilisation in the dish unlikely, or where a previous IVF cycle showed poor fertilisation.
Everything else — the stimulation, the egg collection, the embryo culture and the transfer — is the same. ICSI is not a better version of IVF; it is a solution to a specific problem, and it is not needed for everyone.
The cycle
What an IVF cycle involves
From the first injection to the pregnancy test is usually six to eight weeks.
Stage one
Ovarian stimulation
Daily hormone injections for around 10 to 14 days encourage the ovaries to mature several eggs rather than the single egg of a natural cycle. Most people learn to give these at home.
Stage two
Monitoring
Ultrasound scans and blood tests every few days track how the follicles are growing, so the dose can be adjusted and the timing of collection judged accurately.
Stage three
Trigger and egg collection
A final injection matures the eggs. Collection happens about 36 hours later — a short procedure under sedation, using ultrasound guidance through the vaginal wall. It takes around 20 minutes and you go home the same day.
Stage four
Fertilisation
The same day, eggs are fertilised by IVF or ICSI in the laboratory. You are told the next day how many fertilised — not every egg collected is mature, and not every mature egg fertilises.
Stage five
Embryo culture
Embryos are grown in the incubator for two to five days and assessed each day. Some stop developing; this is normal and is part of what the culture period reveals.
Stage six
Transfer, then the wait
One embryo is usually placed into the uterus through a fine catheter — a quick procedure needing no anaesthetic. Suitable remaining embryos can be frozen. A blood pregnancy test follows about two weeks later.
Who IVF is suitable for
IVF is generally the appropriate route where:
- Both fallopian tubes are blocked or have been removed — IVF bypasses the tubes entirely
- There is significant male factor infertility, usually with ICSI
- Endometriosis is affecting fertility and other approaches have not worked
- Ovulation treatment or IUI has been tried without success
- Infertility is unexplained and has persisted
- Genetic testing of embryos is indicated
- Age makes the more gradual approaches an expensive use of time
Whether it is right for you is a judgement your specialist makes after reviewing your history and investigations — not something that can be decided from a website.
Single embryo transfer
Where a good-quality embryo is available, transferring one rather than two is usually the safer decision. Twin pregnancies carry substantially higher risks of prematurity, low birth weight, pre-eclampsia and neonatal complications. Freezing the remaining embryos preserves the additional chances without concentrating them into one risky pregnancy.
Genetic testing of embryos (PGT)
Preimplantation genetic testing examines a small number of cells from an embryo before transfer. It is considered in specific circumstances — a known inherited condition in the family, recurrent miscarriage, or repeated failure of good embryos to implant.
It is not a routine part of IVF, it does not improve outcomes for everyone, and it adds cost and complexity. Your specialist will explain whether there is a reason for it in your case.
Legally required notice. Preimplantation genetic testing is never used to determine or select the sex of an embryo. Sex determination and sex selection are prohibited under the PCPNDT Act, 1994 and the ART (Regulation) Act, 2021.
Risks worth knowing about
Ovarian hyperstimulation syndrome (OHSS) — an excessive response to the stimulation medicines, causing swollen ovaries, abdominal discomfort and fluid retention. Mild forms are fairly common; severe OHSS is uncommon and is largely avoided by adjusting doses, choosing the trigger carefully, and freezing all embryos for later transfer where the risk is high.
Multiple pregnancy — reduced substantially by transferring a single embryo.
Egg collection — a minor procedure, but it carries small risks of bleeding, infection and a reaction to sedation.
Cycle cancellation — occasionally a cycle is stopped because the response is too poor or too strong. It is disappointing, but it is a clinical decision made in your interest.
Emotional strain — consistently reported by patients as the hardest part. It is worth planning for, not just enduring.
Please note. This page is general information, not medical advice. What is appropriate for you depends on your history, your investigations and a specialist assessment. No fertility treatment can guarantee a pregnancy.
Common questions
IVF questions
It varies enormously with age and ovarian reserve. Numbers in the region of eight to fifteen are common, but fewer eggs of good quality can be better than many of poor quality. Your monitoring scans give an indication before the day.
It is done under sedation, so you will not feel it. Afterwards most people have cramping similar to period pain for a day or two.
There is attrition at every stage — not all eggs are mature, not all mature eggs fertilise, and not all fertilised eggs develop to day five. Being told this in advance makes the daily updates much less alarming.
Modern freezing by vitrification gives survival and success rates comparable to fresh transfer, and in some situations a frozen transfer is actively preferable — for example where there is a risk of OHSS, or where the uterine lining is not ideal in the collection cycle.
No. Bed rest has not been shown to improve outcomes. Normal activity, work and gentle exercise are fine unless you have been told otherwise.
Many people who succeed with IVF do so within the first three cycles, counting frozen transfers from the same collection. But this depends heavily on age and diagnosis, and your specialist can give you a more meaningful picture for your own situation.
A little clarity
Myth vs Fact
Fertility can come with a lot of advice. Here is what the evidence helps us understand.
Myth
IVF always leads to twins.
Fact
Twins are not inevitable. Transferring one embryo lowers the risk of a multiple pregnancy.
Source: HFEAGeneral information. Your clinician can explain what applies to you.
Discuss whether IVF is right for you
A first consultation is a conversation, not a commitment. Bring your questions and any previous reports.
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Fertility care is a personal series of decisions. It begins with your history, your questions and the findings that matter to your treatment.
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