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Is IVF Painful? What to Expect at Each Stage

Most stages of IVF are not painful. Injections cause brief stinging and sometimes local bruising; the retrieval is performed under sedation, and cramping afterwards is common and usually settles within a few days; embryo transfer is comparable to a smear test and does not require sedation. [1] What varies most is bloating and pressure during stimulation, when the ovaries are enlarged. Severe or one-sided pain, rapid abdominal swelling, breathlessness or reduced urine output are not part of a normal cycle and need prompt medical assessment. [2]

Written by: Nikolay Kornilov, MD — Medical Director

Medically reviewed by: Valentina Denisova, PhD, Head of International Unit, fertility specialist

Published: 27 August 2024 · Updated: 31

Last medically reviewed: 31

A woman calmly preparing a subcutaneous medication pen for IVF stimulation at home

Medical disclaimer

This article is for educational purposes and does not replace individual medical advice, diagnosis or treatment from a qualified healthcare professional. Seek urgent medical care for severe or one-sided abdominal pain, rapid abdominal swelling, breathlessness, reduced urine output or fainting.

Key Takeaways

    • Retrieval is done under sedation; embryo transfer usually needs none. [1]
    • Injections and stimulation commonly cause bruising, bloating and a feeling of pressure. [1]
    • Cramping for a few days after retrieval is expected and usually mild. [1]
    • Pain relief should be agreed with your doctor in advance rather than managed on your own.
    • Severe, worsening or one-sided pain is a reason to contact the clinic, not to wait. [2]

    In This Article

      Which Stages of IVF Are Painful, and Which Are Not

      Here is the honest, stage-by-stage answer, because "is IVF painful?" does not have a single yes or no.

      • Injections (stimulation): brief stinging, sometimes a small bruise. Not what most people would call pain.
      • Ovarian stimulation: as the ovaries enlarge, bloating and a feeling of pressure are common. Uncomfortable rather than painful.
      • Egg retrieval: done under sedation, so you do not feel it during the procedure; afterwards, mild cramping and bloating for a day or two are expected. [1]
      • Embryo transfer: usually painless, comparable to a cervical smear (Pap test); no sedation needed. [1]

      So the accurate summary is: most of IVF is tolerable, some of it is uncomfortable, and the parts that sound most alarming (the retrieval) are the ones you are sedated for. What matters more than the everyday discomfort is knowing which sensations are not expected — covered in sections 5 and 6.

      Injections and Ovarian Stimulation

      Stimulation involves self-administered hormone injections over roughly a couple of weeks. The needles are fine, so the injections themselves usually cause only brief stinging, and sometimes a small bruise or local redness at the site. [1]

      As the medication does its job, several follicles grow and the ovaries enlarge, which commonly causes bloating, a feeling of fullness or pressure, and mild mood changes. These are expected effects of the cycle, not signs that something is wrong. They are also temporary and settle after the cycle.

      One point to hold onto for later: mild, gradual bloating is expected — but rapid swelling, or pain that is severe or one-sided, is not, and belongs in the urgent-care section below.

      Egg Retrieval: Sedation and Recovery

      This is the step people worry about most, and it is the one you are sedated for.

      During the procedure. Egg retrieval is done under sedation (or light anaesthesia), so you do not feel the needle or the collection. It is short — typically around 15-30 minutes — and guided by ultrasound. [1] Studies find that the pain people anticipate beforehand is usually greater than what they actually experience. [1]

      Afterwards. As the sedation wears off, it is common to have mild cramping (similar to period pain), bloating and some spotting, because the ovaries are enlarged. For most people this is mild and eases over a day or two, and normal activity is usually resumed within that time. [1]

      If pain after retrieval is severe, worsening, or one-sided rather than a general cramp, that is different — see section 6.

      Patient resting comfortably in an embryo transfer procedure room with a doctor nearby

      Embryo Transfer

      Embryo transfer is usually quick and painless, and does not require sedation. A thin, soft catheter is passed through the cervix to place the embryo in the uterus, and most people describe the sensation as similar to a cervical smear (Pap test) — mild pressure rather than pain. [1] You can usually return to ordinary activity straight afterwards.

      What Is Normal and What Is Not

      This is the heart of the page: telling expected sensations apart from ones that need attention.

      Usually expected (part of a normal cycle) Needs prompt medical assessment
      Brief stinging or small bruises from injections Severe or rapidly worsening abdominal pain
      Mild, gradual bloating and pressure during stimulation Rapid abdominal swelling or rapid weight gain over a few days
      Mild cramping and spotting for a day or two after retrieval Severe or one-sided (one-sided) abdominal pain
      Transfer feeling like a smear test Reduced urine output
      Tiredness, mood changes Shortness of breath, chest pain, or fainting
      Fever, or heavy vaginal bleeding

      The left column is about discomfort that settles; the right column is about symptoms you should not try to interpret yourself — contact your clinic.

      The single most useful rule: judge by severity, speed and side. Mild and gradual and general is usually expected; severe, fast-worsening or one-sided is a reason to call.

      When to Seek Urgent Medical Care

      Contact your clinic promptly, or seek emergency care, if you experience:

      • severe or rapidly worsening abdominal pain
      • rapid abdominal swelling or rapid weight gain over a few days
      • severe one-sided abdominal pain (which can indicate ovarian torsion — the enlarged ovary twisting — a surgical emergency)
      • reduced urine output
      • shortness of breath, chest pain or fainting
      • fever, or heavy vaginal bleeding
      A woman calling her fertility clinic helpline from home to discuss recovery symptoms
      Doctor conducting an urgent pelvic ultrasound examination in a fertility clinic

      Two conditions are the reason this section matters:

      • Ovarian hyperstimulation syndrome (OHSS) — the ovaries over-respond to stimulation, swell, and can leak fluid. Its warning signs are exactly those above: rapid weight gain, a quickly swelling abdomen, reduced urination, breathlessness. [2] Do not try to judge whether your case is "mild" or "severe" yourself — that is precisely what you cannot reliably tell, because it can worsen. Contact the clinic and let them assess.
      • Ovarian torsion — because the ovaries are enlarged during stimulation, they can twist, causing sudden severe one-sided pain. This is an emergency and needs immediate assessment. [2]

      The instruction here is deliberately simple: for any of these, contact the clinic rather than waiting, resting or increasing pain medication on your own.

      Managing Discomfort

      For the ordinary, expected discomfort of a cycle, a few sensible measures help — but the important principle is that anything you take is agreed with your doctor in advance, not managed on your own.

      • Pain relief. Ask your clinic ahead of time what you may take for cramping and what to avoid, because some pain relievers are limited at certain points in the cycle. Two reasons this matters: strong pain relief can mask a symptom (like worsening OHSS or torsion) that the clinic needs to know about, and some medicines are not suitable around the time of transfer. So the rule is: agree it in advance, and treat severe pain as a reason to call rather than to take more. [2]
      • Gentle comfort measures. Rest as you feel you need to, stay hydrated, and use whatever your clinic has approved. This page does not prescribe diets, supplements, or herbal remedies — abdominal pain in a cycle is not something to manage through food, and specific products should be discussed with your doctor rather than started on your own.

      There is no need for strict bed rest — see the note on activity below.

      The Emotional Side of Treatment

      IVF is emotionally demanding, and difficult feelings — anxiety through the process, and grief after an unsuccessful cycle — are common and understandable. They are not a weakness or a sign you are doing anything wrong.

      You do not have to stay positive or "keep hope" to make treatment work; that is not how it works, and it is not a fair thing to ask of yourself. What is worth watching for is persistent low mood, loss of interest in things you normally care about, or thoughts that frighten you — if any of these appear, reaching out for support matters, and it is a strong step, not a failure. Your clinic can help with a referral to appropriate psychological support.

      A woman having a supportive counseling session with a female psychologist in a clinic office
      Fertility doctor providing an aftercare and pain management plan to a female patient

      What You Can Discuss With Your Doctor

      • What can I take for cramping or discomfort, and what should I avoid, at each stage?
      • Which symptoms should make me call you rather than wait?
      • What level of activity is right for me after retrieval and after transfer?
      • What kind of pain relief will I have for the retrieval?
      • Where can I get emotional support if I need it?

      These questions help you understand your own situation. Decisions about medication, activity and timing are individual and belong with your specialist.

      Summary

      Most of IVF is not painful. Injections sting briefly and can bruise; stimulation brings bloating and pressure as the ovaries enlarge; the retrieval is done under sedation, with mild cramping for a day or two afterwards; and the transfer feels like a smear test. The discomfort is real but generally mild and short-lived.

      What matters more than the everyday discomfort is recognising what is not part of a normal cycle: severe, rapidly worsening or one-sided pain, rapid swelling or weight gain, breathlessness or reduced urination. These can signal OHSS or ovarian torsion, and the right response is always to contact the clinic — not to rest, wait, or increase pain medication and try to judge the severity yourself. Agree pain relief with your doctor in advance, look after yourself without pressure to feel optimistic, and ask for support, medical or emotional, whenever you need it.

      Doctor's Perspective

      When patients ask me if IVF hurts, I tell them the truth: most of it is more uncomfortable than painful, and the step people dread most, the retrieval, is the one we sedate them for. But I always turn the conversation to the more important question, which is not how much it hurts but what kind of pain to act on. A general, gradual cramp after retrieval is expected. A pain that is severe, that is getting worse, or that is sharply on one side is the kind that makes me want to see the patient that day — because that is how OHSS and ovarian torsion announce themselves. I would always rather a patient called me about a pain that turned out to be nothing than tried to wait it out.

      — Dr Nikolay Kornilov, MD, Medical Director, NGC

      What the Evidence Shows / What Remains Uncertain

      Supported by evidence:

      • Egg retrieval under sedation is safe and, for most, associated with only mild, short-lived discomfort afterwards. [1]
      • Bed rest after transfer does not improve outcomes; normal activity is appropriate. [3]
      • The general side-effect profile of stimulation (bloating, pressure, mood changes) is expected and usually temporary. [1]

      Not established:

      • That diet affects pain sensations during a cycle.
      • That abstaining from intercourse affects implantation.

      Clinical Practice at NGC

      • Pain relief for retrieval. Egg retrieval at NGC is performed under sedation (or light anaesthesia), so the procedure itself is not felt.
      • Monitoring after retrieval. After the procedure you rest and are observed in the clinic while the sedation wears off, and are discharged the same day once you are comfortable, with advice on the mild cramping and bloating that are normal in the following day or two.
      • Contacting the clinic about pain. If you have pain that is severe, worsening or one-sided, contact the clinic promptly rather than waiting; for severe symptoms outside clinic hours, seek emergency care.

      Discuss Your Treatment With a Specialist

      If you are anxious about pain during IVF, or unsure which symptoms to act on, an NGC specialist can explain what to expect at each stage and what to watch for.

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      FAQs

      What pain relief can I take during an IVF cycle?

      This should be agreed with your doctor in advance, because some pain relievers are limited at certain points in the cycle, and strong pain relief can mask a symptom the clinic needs to know about. Rather than deciding yourself, ask your clinic ahead of time what is suitable for cramping and what to avoid. Importantly, severe pain is a reason to contact the clinic, not to take a higher dose. Your team will give you a plan that fits your cycle.

      How long does discomfort after egg retrieval usually last?

      For most people, mild cramping and bloating after retrieval ease over a day or two, and normal activity is usually resumed within that time. [1] The discomfort is often described as similar to period pain, and can vary with how many eggs were retrieved and your own pain threshold. If pain is severe, worsening, or one-sided rather than a general cramp, that is different and should prompt a call to the clinic.

      Is embryo transfer painful?

      Usually not. Embryo transfer is a quick procedure that does not require sedation, and most people describe it as similar to a cervical smear (Pap test) — mild pressure rather than pain. [1] A soft, thin catheter is used to place the embryo in the uterus, and you can normally return to ordinary activity straight afterwards. If you are anxious about it, tell your clinic; they can talk you through what to expect.

      When should pain make me call the clinic?

      Call if pain is severe, rapidly worsening, or clearly one-sided, or if it comes with rapid abdominal swelling, rapid weight gain, reduced urination, breathlessness or fainting. [2] These can be signs of OHSS or ovarian torsion, which need prompt assessment. The key point is not to try to judge the severity yourself or wait it out — contact the clinic and let them assess. Mild, gradual cramping and bloating, by contrast, are usually expected.

      Does bed rest help after embryo transfer?

      No. There is no evidence that bed rest improves outcomes, and normal daily activity is appropriate. [3] You do not need to lie down or avoid household activity to protect the cycle. Gentle everyday movement is fine, and there is also no evidence that abstaining from intercourse improves implantation. If you are unsure what activity suits your situation, ask your clinic.

      References
      1. Egg retrieval is performed under sedation with only mild, short-lived discomfort (cramping, bloating) for a day or two afterwards; embryo transfer is comparable to a cervical smear and needs no sedation; anticipated pain typically exceeds actual pain. Patient-facing clinical guidance (CCRM; CNY Fertility) and: Why do women choose to undergo oocyte aspiration without sedation? Hum Reprod Open (anticipated vs actual pain). PMC8812437.
      2. Royal College of Obstetricians and Gynaecologists. The Management of Ovarian Hyperstimulation Syndrome. Green-top Guideline No. 5; plus Practice Committee of the ASRM, Prevention of moderate and severe OHSS: a guideline (Fertil Steril. 2024;121:230–245). OHSS warning signs and the need not to self-triage severity; ovarian torsion risk with enlarged ovaries (sudden one-sided pain, surgical emergency).
      3. Gaikwad S, et al. Bed rest after embryo transfer negatively affects in vitro fertilization: a randomized controlled trial. Fertil Steril. 2013;100(3):729–735. PMID: 23414920. Plus Craciunas L, et al. systematic review/meta-analysis, PMID: 31520259; ASRM (bed rest not recommended).
      4. Reviews of outcomes in children born after ART: general condition of most children is reassuring, though ART is associated with somewhat higher obstetric risks (hypertensive disorders, preterm birth, low birth weight), largely attributable to multiple pregnancy and reduced by single embryo transfer. J Assist Reprod Genet / review, PMC3385632; Perinatal outcomes after ART, PMC7720966.

      About the Author

      Nikolay Kornilov, MD

      Medical Director · Reproductive Medicine

      Member of the American Society for Reproductive Medicine (ASRM) since 2004 and of the European Society of Human Reproduction and Embryology (ESHRE) since 1998, with continuous participation in ASRM and ESHRE congresses. An active supporter of the practical implementation of evidence-based medicine in reproductive care in Russia since 1998.

      Has contributed to meta-analyses and to publications in the Reproductive Medicine Guidelines, with more than 100 publications, lectures and presentations at Russian and international conferences.

      Trained at the 1st Leningrad Medical Institute (Pavlov), with clinical residency and postgraduate studies in Obstetrics and Gynecology in St. Petersburg, and further training and internships in Cambridge (UK), Tampere (Finland) and IVI-Valencia (Spain).

      View profile

      Medically Reviewed By

      Valentina Denisova, PhD

      Obstetrician-Gynecologist · Fertility Specialist

      Member of the International Society of Gynecological Endocrinology (ISGE) and the European Society of Human Reproduction and Embryology (ESHRE). Winner of the Young Scientists' Contest at the 16th World Congress of Gynecological Endocrinology (2014) and laureate of the Ott Prize for best research in Human Reproduction among young scientists (2015).

      11+ years of experience, 55+ scientific publications and 2 patents for invention, with frequent participation in Russian and international conferences.

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