Part of the “Before You Start Your IVF” series
There’s a strange kind of waiting that happens in the early weeks of IVF. You’ve made the decision. You’ve had the consultations, signed the forms, maybe cried in a car park after a particularly heavy appointment. And now you’re just taking the pill. Waiting for a period. Waiting for a scan date. It doesn’t feel like anything is happening yet. But it is.
This is the part of the journey nobody really prepares you for, not because it’s the hardest physically, but because it’s the part where your body starts belonging, a little, to a protocol. A calendar. A clinic’s timeline instead of your own. I see this stage in the clinic more than any other, and I want to walk you through what’s actually happening in your body during these first few weeks, and where the space is for you in it. We call this ‘The Space Between’ in our clinic as there will be alot of times you are in ‘The Space Between’
The Space Between The Contraceptive Pill Phase
For many women, IVF begins with something that feels almost backwards: taking the contraceptive pill.
I know. You’re trying to get pregnant, and the first instruction is often “start the pill.” It’s a strange first ask, and I’ve sat with more than one patient who found this genuinely disorientating. They have spent so much of their life trying to not get pregnant with the pill, now its part of their protocol to have a baby.
Clinics use the pill in the lead up to an IVF cycle for a few practical reasons, mainly for scheduling purposes. It lets them schedule your stimulation start date around clinic capacity, suppress any ovarian cysts that might interfere with monitoring, and create a more predictable, even starting point across your ovaries before stimulation begins. And yes, we ask well should the clinic be working around me rather than my body working around them. That’s the debate.
It’s schedules and capacity, not biology working against you. But the schedule doesn’t always feel that way when you’re the one taking the tablet every morning, waiting for the next stage of your IVF cycle to begin.
The Space Between Your Down Regulation: Turning the Volume Down Before Turning It Up
Not everyone goes through down regulation, there are so many different types of IVF protocols, its not just one, so it depends on your protocol. If your clinic has you on a long protocol, this is usually the next step after the pill. If you’re on a short protocol or antagonist protocol, you may skip straight to stimulation, and all this is a different protocol. Typically they are trying to find the protocol that works best for you, there’s a lot of experience here, knowledge and a mix of guesswork. But no one will admit this.
For those who do go through it: down regulation uses a GnRH agonist (common brand names include Buserelin, Prostap, or Suprecur) to temporarily switch off your natural hormone signalling. Your pituitary gland stops sending the usual signals to your ovaries, essentially pausing your natural cycle. Its kinda putting you into a simulated menopause
Why deliberately switch things off before switching them on? Because it lets your clinic start stimulation from a completely quiet baseline, with more precise control over how your follicles respond, rather than working against whatever your body happens to be doing that month.
Physically, this phase as I mentioned can feel a lot like early menopause, hot flushes, headaches, mood changes, disrupted sleep. That’s not your imagination and it’s not you being “too sensitive.” You are, in a very real hormonal sense, temporarily paused. It’s a strange, foggy stretch, and it’s one of the phases where the emotional weight of treatment can hit hardest, precisely because your body feels unfamiliar and your mind is still fully present for all of it. Even though its typical 10-14 days, it can feel like you are being turned upside down, and inside out.
The Space Between Your Stimulation: Where Your Body Starts Doing the Work
This is the phase most people picture when they think of IVF those daily injections.
Once your baseline is confirmed by scan and blood test, you’ll start injectable gonadotropins (medications like Gonal-F, Menopur, Puregon, or Fostimon, depending on your clinic and protocol). These directly stimulate your ovaries to grow multiple follicles in a single cycle, rather than the one your body would typically release naturally.
This usually runs eight to fourteen days, with your dose adjusted along the way based on how your follicles are responding. Physically, it’s common to feel bloated, tender, tired, and by the later days genuinely uncomfortable as your ovaries enlarge with the growing follicles.
This is also, interestingly, the window where research into acupuncture’s role in IVF has focused some of its more promising attention. A number of studies have looked at how acupuncture during controlled ovarian stimulation specifically rather than just around transfer may support ovarian blood flow and follicular development, and help regulate the stress response during a phase that is, frankly, a lot for your nervous system to carry. The research here is still developing and the evidence isn’t conclusive, but the mechanism makes physiological sense: better circulation to the ovaries, a calmer nervous system, and a body that isn’t fighting itself while it’s being asked to do something quite extraordinary.
This is exactly the kind of phase the breathwork sessions in the app were built for not to fix anything, but to give your body somewhere to land between injections. Your Space Between.
The Space Between your Monitoring: Scans, Bloods, and the Anxiety that comes with this
Throughout stimulation, you’ll be back at the clinic every few days for ultrasound scans and blood tests, tracking the size of your growing follicles.
This is where a particular kind of anxiety tends to creep in the anxiety of numbers. How many follicles. What size? Is that a good estradiol level? Am I responding well. I hear this from almost every patient in this phase, a quiet, persistent comparison against numbers you don’t fully understand, delivered by a nurse on a 5 minute call, that somehow come to feel like a verdict on your body.
I want to gently push back on that thought framing. These scans aren’t a test you pass or fail. They’re simply how your clinical team fine tunes your dose in real time more medication, less medication, an extra day, a trigger date moved. Your body isn’t being marked. It’s being listened to, closely, by people whose only job is making sure this phase goes as well as it possibly can for you specifically. And this is amazing, how well cared for you will be. So look at it as support not a test.
The Space Between The Trigger Shot
Stimulation ends with a single, precisely timed injection the trigger shot (commonly hCG, sometimes a Lupron trigger, depending on your protocol) which sets off the final maturation of your eggs.
Timing here really really really matters. Your clinic will give you an exact hour to take it, because egg collection is scheduled precisely thirty four to thirty six hours later. It’s a small, strange moment where one injection, at a specific hour, begins to closes this whole chapter and opens the next part of your IVF cycle..
The Space Between the Injections
If there’s one thing I want you to take from this phase, it’s this: so much of what’s asked of you here is physical compliance to a timeline you didn’t choose and can’t control the pill on schedule, the injection at the same hour each night, the scan on the day they tell you. That’s a lot of surrender for anyone.
The work I do with patients in this phase and the whole reason the breathwork sessions in the app are built the way they are isn’t about adding one more thing to your todo list. It’s about giving you somewhere to actually be, in your body, in the minutes around the needle and the scan and the waiting room. That’s the space between. It’s small, but it’s yours.
In the next post, I’ll walk you through what happens after collection, fertilisation, the days that follow, and how your clinic decides between a day 3 transfer, a day 5 transfer, or freezing your embryos altogether.
Let your Doctors take care of your Embryos, let us take care of you and remember ‘The Space Between’ everything you do, to just be.
This post is written from my clinical experience as a fertility acupuncturist and is intended as general information and emotional support alongside never instead of the medical guidance from your own fertility clinic. Protocols, medication names, and timings vary between clinics and countries; always follow your own clinic’s specific instructions.