1. Hormonal Stimulation: In a typical menstrual cycle, one egg (ovum) matures about a day before ovulation. To stimulate the ovaries so that more eggs will mature for IVF, a woman needs eight to twelve days of hormonal injections, which she can administer herself. At this time, she also takes medications to ensure that she does not ovulate prematurely, and tracks follicular development with a combination of bloodwork and ultrasounds.
A trigger shot is then used to stimulate ovulation at the optimal time.
The hormonal injections and medications prior to ovulation can lead to some uncomfortable side effects, and bloodwork and ultrasounds require clinic visits. Many women find that they can keep up most of their regular schedule during the injection phase, but it can be helpful to arrange for more flexibility and some extra support at this time.
Halachic Implications: Some of the hormones may lead to staining or inter-menstrual bleeding. Taking precautions in line with the laws of stains can help a woman avoid disrupting her clean days or becoming niddah unnecessarily at this stage. She should seek individualized guidance if she has concerns about performing bedikot.
2. Egg retrieval: Ovulation is followed by egg retrieval, a short outpatient procedure often performed under local anesthesia, in which a suction needle is inserted through the vaginal wall to draw ova in their fluid directly from the ovaries.
Recovery can be painful, and doctors generally recommend taking a day or two off after egg retrieval. Egg retrieval is likely to cause vaginal bleeding. (See Halachic Implications, below.)
3. Fertilization: In IVF, eggs (ova) retrieved from the wife’s ovaries are placed in a petri dish with sperm from the husband and allowed to combine. In ICSI, a sperm cell is inserted directly into an egg cell. Sperm cells usually undergo special preparation before fertilization, in order to increase the chances of success.
Following fertilization, the embryo’s development is tracked in the lab. Although this stage is often conducted without the couple’s involvement, some couples may find it helpful to open a channel of communication with the embryologist, to understand more about the process.
Embryos not being used immediately are usually frozen for future use.
4. Embryo transfer: With a catheter inserted vaginally and through the cervix, the embryo is implanted into the uterus. This is a very brief procedure, tracked by ultrasound, and usually not very painful. A fresh embryo transfer generally takes place three to five days after egg retrieval, sometimes six. Frozen embryo transfer is scheduled based on the condition of the uterine lining.
Halachic Implications: It is permissible for all stages of IVF to take place during niddah. These procedures do not render a woman niddah or invalidate her clean days.
As above, egg retrieval is likely to cause vaginal bleeding. Bleeding may sometimes also follow embryo transfer. In either case, the bleeding is attributed to physical trauma from the procedure, and is thus considered dam makkah, which does not make a woman niddah or invalidate her clean days.
Reviewing the laws of stains can also help a woman reduce uncertainty following the procedure about becoming niddah or invalidating her clean days.
If a woman has egg retrieval or embryo transfer during the clean days, she should perform her bedikah in the morning, prior to the procedure, omit any other bedikah that day, and seek personal halachic guidance about subsequent bedikot of the clean days.
