IVF can feel overwhelming with all its different stages, but you can count on us to support you every step of the way. Here, we share Dr. Aimee’s high-touch patient approach, detailing the entire IVF timeline to help you understand what to expect before, during, and after your treatment.

About IVF

Dr. Aimee’s goal is to empower you with the knowledge and tools to build a strong foundation for your IVF journey. She guides you through each step, preparing both your mind and body.

Whether this is the first IVF cycle or your eighth, we encourage you to expand your fertility knowledge with Dr. Aimee!

• Read Dr. Aimee’s Intro to IVF and IVF Basics articles
• Watch Dr. Aimee’s IVF Class

By learning more about IVF from Dr. Aimee’s unique perspective, you’ll be better equipped for your IVF treatment.

As you plan for IVF, consider budgeting $30,000 plus medication, per cycle.

Preparing for IVF

Timing is everything in IVF, so being prepared is crucial. Here’s what you need to do and what our medical team will handle to make sure you’re ready!

What You Will Do

Confirm Your IVF Calendar

Dr. Aimee will email you a personalized calendar once you decide to do IVF. Everything begins with your anticipated period start date. Let’s walk through an example together.

If your period starts on a Wednesday, you’ll visit our San Ramon office on Cycle Day 1 or 2 for a Baseline Appointment (30 mins). This is an important visit where Dr. Aimee will assess your ovaries and give you the green light to start injections. Sometimes, patients might not get the all-clear signal at this appointment. It’s important to stay flexible and trust that your body knows what it’s doing. Your ovaries might have their own schedule, and that’s perfectly okay!

If you get the green light, you’ll come to our office on Monday, Wednesday, and Friday for monitoring ultrasounds and blood tests. Your Retrieval Day might be the following Monday, depending on how your body responds to the meds. Because of this, we ask that you keep your schedule flexible, as dates may shift.

Note: This is a sample timeline and may vary based on individual treatment plans and monitoring results.

Order Your IVF Medications

Dr. Aimee will provide you with a personalized list of medications. Here are some common meds used in the process:

Ovarian Stimulation Medications

These hormones stimulate the ovaries to produce multiple follicles, each containing an egg, rather than a single egg that typically develops each month.

• Gonal-F
• Femara
• Menopur
• Follistim

GnRH Agonists and Antagonists

These meds prevent the body from prematurely releasing (ovulating) the eggs before they can be retrieved.

• Lupron
• Ganirelix
• Cetrotide

Trigger Shots

These meds mature the eggs and trigger their final development and readiness for retrieval.

• Ovidrel
• Pregnyl and Novarel
• Lupron

Supportive Medications

These support the overall process and ensure the best conditions for egg retrieval.

• Omnitrope

We recommend Alto Pharmacy if you’re within their courier delivery zone. Other specialty pharmacies that ship nationwide are MDR, Freedom Fertility, and VFP. We work exclusively with these pharmacies, and aren’t able to send prescriptions to non-fertility pharmacies like CVS and Walgreens.  

If you’d like, we can mix your injections for a total fee of $200. Let us know, and we’ll order your meds 5 days before your period is due, so they’ll be ready in our office. 

For at-home concierge services, such as daily injection assistance, contact BayPLS. 

Get to Know the IVF Pyramid

Familiarize yourself with the IVF Pyramid and each stage of the IVF cycle, along with their success rates. So often in IVF, we talk about things in terms of what we’re losing. Let’s reframe that perspective.

Consider this example: you start with 10 follicles at the beginning of the cycle. As the cycle progresses, not all of those follicles may develop eggs. Suppose 9 eggs are retrieved. Out of those, 8 are mature. Of the 8 mature eggs, 6 are fertilized, giving us 3 blastocysts. From those 3, 2 are genetically normal, and ultimately, you go on and have one baby. 

It’s natural to feel a sense of loss as the numbers decrease – from 10 follicles to 2 healthy embryos. But let’s flip that on its head. Instead, you started with ten follicles from which you’ve now gained 2 embryos, potentially leading to a baby. Focusing on what you’ve gained helps set realistic and positive expectations!

Gather Your Fertility Essentials

IVF can be a very emotional journey. It can be riddled with fear, doubt, and full of periods of waiting and wondering. Dr. Aimee’s curated list of Fertility Essentials might help ease emotional or physical burdens. Be sure to focus on the sections dedicated to self-care, nutrition, and comfort management sections for comfort throughout your treatment.

Tell Us When Your Period Starts

Day 1 of your period (or sometimes Day 2) marks the first day of your IVF cycle. This is when you’ll come in for your Baseline Appointment and start your medication. We call this Treatment Day 1. 

As soon as your period starts, email Dr. Aimee with the subject line, “IVF: My period started today!”

If you don’t hear back within two hours, call our office at (925) 277-0600 to schedule your baseline appointment, either for the same day or next. If it’s after office hours and you haven’t heard back, call us in the morning.

What WE’LL Do

Labs

We’ll complete all necessary blood draws and tests for both you and your partner in our office. If you’re out of town, we’ll arrange for you to complete them at a nearby facility. It’s a crucial step that ensures you’re in optimal health and identifies any potential obstacles before starting IVF. These tests include:

• Infectious Diseases (ID): Tests for Hepatitis B surface antigen (HBsAg), Hepatitis C virus antibody (HCV Ab), Human Immunodeficiency Virus antibody (HIV Ab), Human T-lymphotropic virus antibody (HTLV), and Treponema antibody to identify any existing infections in both partners.
• Preconception Labs: Tests for Thyroid-stimulating hormone (TSH), Vitamin D levels, Prolactin levels, Complete Blood Count (CBC), Rh factor, ABO blood type, Measles, Mumps, and Rubella titer (MMR titer), Varicella titer, and Antibody Screen to evaluate overall health and fertility in both partners.
• Ovarian Reserve and Hormonal Levels: Tests for Estradiol (E2), Progesterone (P4), Human Chorionic Gonadotropin (hCG), Anti-Müllerian Hormone (AMH), and Follicle-Stimulating Hormone (FSH) to assess ovarian function, ovarian reserve, and hormonal balance.

Genetic Testing

In addition to comprehensive lab tests you’ll complete carrier screening and chromosome analysis at our office for both you and your partner.

• Carrier Screening: Identifies genetic mutations that could be passed on to your baby, such as cystic fibrosis, spinal muscular atrophy, or fragile X syndrome. (learn more here)
• Chromosome Analysis: Detects chromosomal abnormalities such as translocations, inversions, or aneuploidies (e.g., Down syndrome). (learn more here)

BMI

A healthy BMI is required to start IVF. If your BMI is over 30, we might prescribe medication. Your BMI must be 38 or lower when you start the stimulation phase. Here’s why:

• Optimal Response to Medications: Higher BMI may reduce the response to fertility medications, leading to fewer eggs retrieved or lower-quality embryos.
• Reduced Risk of Complications: Higher BMI is associated with increased risk of pregnancy complications, including gestational diabetes, hypertension, preeclampsia, and cesarean delivery. 
• Impact on Ovarian Function: Obesity can affect hormonal balance and ovarian function.
• Risk of Ovarian Hyperstimulation Syndrome (OHSS): Higher BMI increases risk of developing OHSS, a complication of ovarian stimulation during IVF.

ExEm Foam / HSG / SIS Procedures

Dr. Aimee will determine which of these three procedures is best for you. If you’re planning a FRESH transfer, we’ll check that the procedure was done within 12 months of transfer. If you’re doing a FROZEN transfer, we’ll schedule the procedure before your transfer date.

• ExEm Foam: A less invasive and effective tubal patency assessment performed at Dr. Aimee’s office.
• HSG (Hysterosalpingogram): An X-ray test that outlines the internal shape of the uterus and checks if the fallopian tubes are blocked.
• SIS (Saline Infusion Sonography): A procedure to evaluate the lining of the uterus and the shape of the uterine cavity.

Treatment Day 1: Baseline Appointment

Welcome to the start of your IVF treatment. Today is your Baseline Appointment, which is scheduled for the day your period starts or the day after.

What to expect at your Baseline Appointment

• Ultrasound and Blood Work. Dr. Aimee will do an ultrasound to check for ovarian cysts and estimate the number of eggs she may retrieve. She’ll also do a blood draw.
• IVF Medication Calendar. Dr. Aimee will go over your Baseline Medication Calendar, outlining the meds, dosages, and instructions with you.

Sample Calendar:

Note: This is a sample medication table and may vary based on individual treatment plans and monitoring results.

• Injection Training. Our staff will show you how to mix your medication so you only need to give yourself one injection each night. Record this training with your phone for reference.

• Consent and Payment. You’ll sign your IVF lab order and consent forms to confirm your treatment plan. This is also when your first payment installment is due. Please check the due dates for your 2nd and 3rd installments. Here are our general IVF fees, but the invoices sent to you from our Financial Assistant will have the most accurate pricing.

If your treatment protocol involves luteal phase ovarian stimulation, please let us know when your Ovulation Predictor Kit (OPK) shows a peak. We recommend the Proov Kit, but any brand will do.

What happens the evening after your appointment

• Take your meds between 6-8pm. This timing ensures that Dr. Aimee is immediately available if you need assistance!

• Your first day of injections typically takes the longest. Plan to spend an extra 30 minutes. Most patients will take medication for 8-14 days.

• It’s okay to use tampons, have sex, and enjoy light alcohol, coffee, and exercise. Just use common sense, and don’t worry – there isn’t anything you could eat or do that will affect your success.

Treatment Days 2-14

You’ll continue taking daily medication and have regular monitoring visits to our office to ensure your follicles are growing healthy eggs.

• Take your daily meds. Continue taking your injections daily as scheduled on your Medication Calendar.

• Go to 3-4 monitoring appointments. You’ll have Follicle Check appointments on Treatment Days 5, 7, 9, and possibly a few more visits as some cycles take a bit longer. Each visit will take no more than 15 minutes. At these appointments, Dr. Aimee will check your follicles’ growth and predict how many mature eggs you might have. She’ll do an ultrasound and blood draw to test your hormone levels. (Refer to our Sparkle Checklist to see what we’re checking during these appointments!) She’ll update your Medication Calendar based on how your body responds to the meds.

• Order your meds. You may need to order more meds. Make sure you have the meds you need for the next two nights.

• Potential symptoms. It’s normal to feel twinges in your ovaries or see egg white cervical mucus. You might also feel tired and nauseous – if so, ask for anti-nausea meds.

• Make payment. Your second and third installment are due on Treatment Day 7. Please make payment on time to avoid delays in your treatment plan.

• If you’re using a sperm donor, check with Dr. Aimee to ensure the sperm vial has arrived at the lab.

Trigger Shot Day

As you near the end of your stimulation phase, you’ll take your trigger shot to prepare for the upcoming Egg Retrieval.

• Take trigger shot ~36 hours before retrieval. The Trigger Shot Day is crucial! It’s when we carefully time the trigger shot to prepare for your upcoming egg retrieval. This shot helps your eggs get ready for ovulation, so it’s crucial that it’s administered ~36 hours before the egg retrieval.

• Follow Dr. Aimee’s trigger instructions. Dr. Aimee will send you an Explainer Email with clear instructions on the trigger shot’s timing and dosage, along with how to prepare for the egg retrieval. She’s spent a lot of time reviewing your history to make sure that the plan is perfect for you!

• Engage in low-impact activities only. Light exercise is okay, just don’t overdo it.

Egg Retrieval Day

All of your injections and appointments have led us to the Egg Retrieval! It’s entirely possible to have the best egg retrieval experience with a little preparation. You’re already on the right track by reading this.

• Follow Dr. Aimee’s Explainer Email. To get ready for your egg retrieval, refer to Dr. Aimee’s detailed Explainer Email and follow her instructions closely. This is the day when Dr. Aimee will collect the eggs from your ovaries.

• BMI Protocol. If your BMI is over 30, you’ll take 1 Pepcid and 1 Reglan (aka Metoclopramide) with a tiny sip of water 3 hours before your procedure time.

• Meet Dr. Aimee at the clinic at The Egg Whisperer Lab. This procedure takes place at Dr. Aimee’s lab in San Ramon. The email will give you all the details about the location, what to bring, and the timeline.

• Plan to be at the clinic for about 2 hours and 15 minutes. You must arrive at least 45 minutes before the procedure. Upon arrival, you’ll change into a gown and be connected to an IV. The Anesthesiologist will discuss the anesthesia process with you. Just before we proceed, you’ll empty your bladder. Take this opportunity to receive well wishes from your support person before we enter the procedure room.
  • The procedure is about 30 minutes, during which you’ll be asleep. Using an elaborate system involving test tubes, suction lines, and a foot pedal, Dr. Aimee will perform the retrieval. The eggs are then carefully handed over to the embryologist for identification. (If you’re curious about what happens behind the scenes, Dr. Aimee offers a fascinating glimpse into the world of an IVF lab!)
  • After the procedure, you’ll be moved gently to a gurney and taken back to where you started for a smooth 45-minute rest and recovery.
  • Before you leave, Dr. Aimee will let you know how many eggs were retrieved.

• Have a responsible driver. Due to the anesthesia, you must have a responsible adult drive you home and stay with you for the rest of the day.
  • If you don’t have a companion and need a driver, we recommend Miriam Scott from SilverRide LLC. Contact her at (415) 861-7433.
  • The clinic won’t let you leave unless you have a person you know with you. That person can be in the Uber with you but it can’t be an Uber driver.

• No major decision making. For the next 24 hours, avoid making major decisions, refrain from driving, consuming alcohol, operating machinery, or signing legal documents.

Day After Egg Retrieval

The next day, you may feel tired, crampy, bloated, or notice light spotting. This is completely normal and should improve in a few days. Stay hydrated and get plenty of rest to help your body recover.

• Comfort Management. Here are some things to watch for and how to manage them:
  • Pain Level: On a scale of 1-10, how’s your pain? You can take Tylenol for relief.
  • Bloating: Rate your bloating from 1-10. It should go down over the next few days.
  • IV Site: What does your IV site look like? Make sure it’s not infected.
  • Nutrition: Are you eating well? Eating a balanced nutrition plan helps with recovery.
  • Peeing: Is everything normal when you go to the bathroom? If not, let us know.
  • Bowel Movements: If you’re constipated, consider using a stool softener like Colace.
  • Spotting: Light spotting is common, but if you notice heavy bleeding or anything unusual, contact us.

• Fertilization Report. On this day you’ll get a Fertilization Report. It’ll tell you how many eggs were retrieved, and of those, how many were mature. Mature eggs are the ones we use for embryo development. The report also includes the quality of the sperm used.
  • It’s important to remember that attrition is a normal part of the process. It’s natural to feel a sense of loss or disappointment, but not all eggs are expected to mature successfully.

Day 7 Blastocyst

Over the next few days, we hope to see the embryos develop and reach the blastocyst stage. On Day 7, you’ll receive the Blastocyst Report, detailing  the number of embryos that have reached this stage.

• Embryo Development. In the days following the egg retrieval, we’ll be closely watching for embryo development. Our goal is to see the embryos reach the blastocyst stage. Here are the 8 most important things you should know about embryos.

• Biopsy Report. On Day 7, you’ll get the Biopsy Report, which will include:
  • Number of Blastocysts: The number of embryos that reached the blastocyst stage and will be biopsied and then frozen.
  • Quality of Blastocysts: This indicates the potential for successful embryo transfer.

PGT Genetic Testing. The biopsied cells from your Day 5-7 blastocyst embryos will be sent to a Luminary testing lab for PGT genetic testing. Meanwhile, the embryos themselves will stay frozen in the IVF lab. Starting today, PGT results typically take 7-10 days to arrive. As soon as we get it, we’ll email you the report, and Dr. Aimee will go over the results with you on the phone.

Sample Embryo Development Report from The Egg Whisperer Lab (click to view full size):

PGT Report

PGT stands for Pre-Implantation Genetic Testing. The company we use for PGT testing is Luminary.  Be sure to read more about what PGT is. Understanding the report itself can be tricky, but don’t worry. Dr. Aimee will help you make sense of it!

• The PGT Report includes the gender of each embryo. If you do NOT wish to know the gender, let us know, and we’ll redact it.

• When you receive the report, here’s what to look for:
  • Euploid (Normal) Embryos: We always celebrate when there’s a healthy screened embryo! Euploid embryos will be bolded on the report.
  • Mosaic Embryos: Some mosaics have a good chance of developing into healthy babies. Low mosaics have a lower percentage of abnormal cells and mostly normal cells High mosaics have mostly abnormal cells and a lower percentage of normal cells.
  • Aneuploid (Abnormal) Embryos: These embryos have extra or missing chromosomes, which can lead to health and developmental issues.
  • Inconclusive or No DNA Detected: This doesn’t mean the embryo is abnormal. It just means the technology couldn’t give us clear information.
  • Chaotic: This doesn’t mean the embryo is abnormal. It just means the technology couldn’t give us clear information.

• Genetic Counseling. Dr. Aimee highly recommends speaking with a Genetic Counselor to better understand your results. Once you receive your PGT report, you can schedule calls for further consultation:
  • Luminary offers a free post-PGTA consultation with a Genetic Counselor to review your results. Email gc@luminarygenetics.com to schedule your consult.
  • For further counseling on mosaic and abnormal embryos, we recommend Meaghan Doyle at dnaide.com. She’s not affiliated with any genetic testing company or fertility clinic.

Sample PGT Report:

Post-IVF Consult

After the IVF process, Dr. Aimee will work closely with you to review your options.

During this consultation, Dr. Aimee will:

• Review Implantation Rates: This tells us the likelihood of a successful transfer for each embryo.

• Family Size Goals: Dr. Aimee will discuss whether the number and quality of embryos align with your family size goals.

• Embryo Banking and Implantation Testing: Explore whether embryo banking (freezing embryos to save for future use) or implantation testing might be beneficial for you. She’ll also discuss the timeline for a potential embryo transfer.

• Customized Calendar: Dr. Aimee will create a personalized calendar to guide you through the next steps.

Additional Resources

Fertility Essentials

Dr. Aimee’s curated list of Fertility Essentials might help ease emotional or physical burdens throughout your treatment. Be sure to focus on the sections dedicated to self-care, nutrition, and comfort management.

Hotel

If you’re traveling out of town or prefer to stay near Dr. Aimee’s office and The Egg Whisperer Lab in San Ramon, we recommend Hyatt House or San Ramon Marriott.

IVF Fees

Here are our general IVF fees, but the invoices sent to you from our Financial Assistant will have the most accurate pricing.

Acupuncture

The Acupuncturists we recommend are:

East Bay

• Oakland – East Bay Fertility Wellness
• Oakland – East Bay Acupuncture w/ Aimee Ruiz
• Oakland – Integrative Wellness Center w/ Heidi Kao
• Piedmont – The Oldershaw Clinic
• Albany – Rizes Clinic w/ Dashal Moore
• Pleasant Hill – Earth & Air Wellness w/ Maria Ying
• Lafayette – Stillpoint Healing Arts w/ Dr. Mitsuko (Mimi)

San Francisco

• Nest Acupuncture
• Double Happiness Health w/ Megan Geren
• Blue Ova Health

SF Bay Area

• San Ramon, Orinda, San Francisco, San Mateo, San Jose – Nurture Acupuncture

Concierge Injection Services

For at-home concierge services, such as daily injection assistance, contact BayPLS. 

Transportation Service

We recommend Miriam Scott from SilverRide LLC if you don’t have a companion and need a driver. You can contact her at (415) 861-7433.

Genetic Counseling

After you receive your PGT report, you can schedule calls to further understand your embryos:

• Luminary offers a free post-PGTA consultation with a Genetic Counselor to review your results. Email gc@luminarygenetics.com to schedule your consult.
• For further counseling on mosaic and abnormal embryos, we recommend Meaghan Doyle at dnaide.com. She’s not affiliated with any genetic testing company or fertility clinic.