Medically reviewed by Dr. Rajeev Agarwal, MBBS, Medical Director: Infertility Specialist, IVF Expert and Gynaecologist at Renew Healthcare, Kolkata
Last updated: July 2026
In brief: Most of what goes wrong in an IVF journey is not medical. It is a couple who budgeted for one cycle instead of three, who did not know how much the numbers shrink at each stage, who paid for add-ons with no evidence behind them, and who never asked the clinic a single hard question. This article is the conversation you should have before you sign anything.
Before the injections, before the money
By the time most couples reach IVF they are exhausted. They have been trying for years, absorbing advice from relatives, and hoping each month would be the one. IVF arrives as relief: finally, a plan.
That relief is exactly when people stop asking questions.
So here is what to settle first, while you still have the clarity to do it.
1. Complete the workup, both of you, before you start
IVF is not a substitute for a diagnosis. Starting a cycle without knowing why you have not conceived means you cannot tell what to change if it fails.
Before a first cycle, you should have:
- Semen analysis for the male partner, repeated if abnormal. Not optional, not later.
- Ovarian reserve assessment: AMH and antral follicle count together.
- Assessment of the uterine cavity, fibroids, polyps, adhesions and septa affect implantation and are correctable.
- Tubal assessment, where relevant to the plan. A hydrosalpinx in particular reduces IVF success and is usually treated first.
- Thyroid function, prolactin, and blood sugar.
- Infection screening for both partners, as required.
- Rubella immunity and pre-pregnancy essentials such as folic acid.
- Genetic testing where indicated, particularly in severe male factor, recurrent loss, or relevant family history.
If any of these are missing from your plan, ask why. "We can check that later" is rarely the right answer when you are about to spend a great deal of money.
2. Understand what a cycle actually involves
Nobody explains the calendar properly, and the vagueness causes enormous anxiety at work and at home.
| Stage | Roughly | What happens |
|---|---|---|
| Preparation | Before the cycle | Tests, consents, sometimes contraceptive pill or other priming |
| Stimulation | Around 8 to 12 days | Daily injections; ultrasound and blood monitoring every few days |
| Trigger | One evening, timed precisely | An injection that matures the eggs; timing is exact and non-negotiable |
| Egg collection | About 36 hours after trigger | Short procedure under sedation; most women rest that day |
| Fertilisation | The same day | Conventional IVF or ICSI |
| Embryo culture | Days 1 to 5 or 6 | Daily updates on how many are developing |
| Transfer | Day 3 or 5, or a later frozen cycle | Quick, usually no anaesthesia |
| Wait | Around 9 to 14 days | Then a blood pregnancy test |
Practical planning points most clinics forget to mention: monitoring visits are frequent and often early in the morning; the trigger injection time cannot be moved for a meeting; you will want the day of egg collection off work entirely; and the two-week wait is the hardest part emotionally, not the injections.
3. Know how much the numbers shrink
This is the single most useful thing to understand in advance, because the drop-off feels like failure when it is simply how the process works.
Eggs collected → only the mature ones can be fertilised → only some fertilise → only some keep developing → only some reach a transferable or freezable stage.
A cycle that collects ten eggs and produces three good blastocysts has not gone wrong. That is an ordinary outcome. But a couple told to expect ten eggs and then given three embryos will experience it as a catastrophe unless someone prepared them.
Ask your clinic directly: "Given my results, what should I realistically expect at each stage?" Write the answer down. It will steady you when the phone calls start.
4. Budget for a plan, not a cycle
Most couples who run out of money do so because they budgeted the advertised cycle price.
Ask for an itemised quote covering:
- Consultation and pre-cycle tests
- Stimulation medications, the largest variable, and often excluded from headline prices
- Monitoring scans and blood tests
- Egg collection and anaesthesia
- Laboratory fees, and ICSI separately if applicable
- Embryo freezing, plus annual storage
- Each frozen embryo transfer
- Genetic testing, if planned
- Any add-ons
Then ask the question that matters: "What is the realistic total for three complete cycles?"
Infertility treatment has historically been excluded from most Indian health insurance policies, though the position is evolving. Check your own policy wording and any corporate cover rather than assuming.
Current pricing at Renew Healthcare: the Freedom From Infertility package covers the inclusions below for a total of Rs 1,00,000, against a standard clinic price of Rs 1,50,000 for the same list.
| SL | IVF package inclusions | Standard clinic price | Freedom From Infertility package at Renew |
|---|---|---|---|
| 1 | Consultations with the Consultant, Counsellor or Coordinator after registering for the package, from Day 2 till ovum retrieval | 3,000/- | Yes |
| 2 | TVS for folliculometry and endometrial preparation (average 4 scans) | 3,000/- | Yes |
| 3 | Stimulation injections (urinary, fixed dose) | 40,000/- | Yes |
| 4 | Antagonist (fixed dose) | 5,000/- | Yes |
| 5 | Pre-anaesthesia checkup charges | 1,000/- | Yes |
| 6 | Oocyte retrieval and embryo transfer charges, including OT charges, consultant charges, anaesthesiologist charges, embryologist charges, nursing team charges and all consumables used in the fresh IVF cycle | 85,000/- | Yes |
| 7 | Daycare bed charges | 8,000/- | Yes |
| 8 | Fresh embryo transfer (Day 3 or 5 from OPU) | 10,000/- | Yes |
| 9 | Intracytoplasmic sperm injection (ICSI) | 10,000/- | Yes |
| Total | 1,50,000 | 1,00,000 |
Full inclusions and payment guidance are on the packages page.
If a clinic offers a multi-cycle or refund package, read the exclusion criteria before the headline. Some packages are structured so that most couples never qualify for the refund.
5. Learn to say no to add-ons
You will be offered extras. Some are appropriate for specific situations. Many are sold well ahead of the evidence.
Common examples include assisted hatching, embryo glue, endometrial scratch, time-lapse imaging, various immunological treatments, and genetic screening of embryos offered to couples with no specific indication.
One filter cuts through all of it: ask whether the evidence shows improvement in live birth rate, not fertilisation rate, not embryo grade, not "quality". Live birth is the only outcome that matters.
The UK regulator maintains a public traffic-light rating for IVF add-ons because this problem is global. It is entirely reasonable to ask your clinic where a proposed add-on sits in that kind of assessment.
6. Understand the two real medical risks
Ovarian hyperstimulation syndrome (OHSS). An excessive response to stimulation, ranging from uncomfortable to serious. Modern practice has reduced it substantially: antagonist protocols, alternative trigger medications, and freezing all embryos rather than transferring in a high-risk cycle. Ask what your clinic does to prevent it, especially if you have PCOS or a high antral follicle count.
Multiple pregnancy. Transferring two embryos raises the chance of twins, and twin pregnancy carries materially higher risks for both mother and babies, prematurity above all. Many couples ask for two embryos hoping to improve their odds or "get it over with in one go."
Twins are a complication, not a bonus. Where you have good-quality embryos, single embryo transfer with the rest frozen usually gives a comparable cumulative chance with far lower risk. Have this conversation explicitly.
7. Choose the clinic carefully, and know the red flags
Good signs:
- Registered under India's ART (Regulation) Act, 2021; ask to see it
- Willing to quote success rates per complete cycle, for your age group, and to explain how they calculate them
- Gives you an itemised cost sheet without being pushed
- Explains why each recommended step applies to your results
- Raises difficult topics, donor gametes and stopping criteria, before you have spent everything
- Has a functioning embryology laboratory with stable staffing, and will tell you about it
Red flags:
- Headline success rates with no age breakdown, or rates that seem implausibly high
- Pressure to decide today, or "offer valid this month"
- A long list of add-ons presented as standard
- ICSI for everyone regardless of semen analysis
- Reluctance to give written costs
- Guarantees. Nobody can guarantee a baby.
8. Prepare for the emotional load, honestly
The injections are not the hard part. The hard parts are the waiting, the phone calls with numbers in them, and the way the whole thing quietly takes over your calendar and your conversations.
A few things that genuinely help:
- Decide in advance who you will tell. Managing other people's hope is its own burden, and relatives asking weekly is corrosive.
- Agree how you two will handle bad news before you get any. Partners often cope differently, and that difference gets misread as not caring.
- Ask about counselling. Most good clinics offer or can refer for it. Using it is not weakness; it is the same as physiotherapy after surgery.
- Protect one part of life that has nothing to do with treatment.
- Agree stopping criteria together, early, when you are calm. Not in the corridor after a failed cycle.
9. The questions to take to your first appointment
- Based on our results, why is IVF the right treatment for us rather than something simpler?
- What is your live birth rate per complete cycle for someone my age?
- How many eggs should I realistically expect, and how many embryos from those?
- Which protocol will you use, and why that one for me?
- Will we need ICSI, and which of our results makes it necessary?
- What is the itemised cost, including medications, freezing and storage?
- What is the realistic total across three cycles?
- What do you do to prevent OHSS?
- Will you recommend single embryo transfer?
- Which add-ons will you propose, and what is the live birth evidence for each?
- What would you change if this cycle fails?
- At what point would you advise us to stop, or to consider donor gametes?
Take this list in. A clinic that welcomes these questions is the clinic you want.
Frequently asked questions
How long does one IVF cycle take from start to finish?
Roughly four to six weeks from the start of stimulation to the pregnancy test, plus preparation time beforehand. A frozen transfer cycle afterwards adds several more weeks.
Is IVF painful?
The injections cause minor discomfort. Egg collection is done under sedation. Bloating and cramping during stimulation are common. Most women describe the emotional strain as harder than the physical side.
Do I need bed rest after embryo transfer?
No. Prolonged bed rest is not recommended and has not been shown to improve outcomes. Normal daily activity is appropriate.
Can we choose to have twins?
It is not advisable. Twin pregnancy carries significantly higher risks of prematurity and complications for mother and babies. Single embryo transfer with the remaining embryos frozen is the safer route to the same cumulative chance.
What if the first cycle fails?
It is a common outcome and provides information that improves the next attempt. Ask for a review appointment specifically to discuss what will be done differently.
Should we do genetic testing of embryos?
It has clear value in specific situations, such as recurrent pregnancy loss or a known genetic condition. Offered routinely to everyone, its benefit is far less established. Ask what indication applies to you.
Can we work normally during treatment?
Most people do, with flexibility for frequent early-morning monitoring visits and a day off for egg collection.
The bottom line
Go in with a complete diagnosis, a realistic picture of how the numbers shrink, a budget built for three cycles rather than one, a list of add-ons you have already decided to decline, and a clinic that answers hard questions without flinching.
None of that changes your biology. All of it changes your experience, and it is the difference between a couple who feel informed and a couple who feel processed.
Start with an honest consultation
Dr. Rajeev Agarwal sees couples at Renew Healthcare, Kolkata for full pre-IVF assessment: complete workup for both partners, realistic expectations set before you begin, itemised costs, and no pressure.
Book a consultation: 062922 69060 | renewhealthcare.in | Ground Floor, 18 C, Mandeville Gardens, Ekdalia, Ballygunge, Kolkata, West Bengal 700019
This article is for general education and does not replace individual medical advice. Please consult a qualified specialist about your own situation.