How many IVF attempts should you plan for, and when should you stop?

IVF is almost never a one-off procedure. Data from the UK and the US, which track entire cohorts over several years, show that the live birth rate continues to rise up to the sixth cycle and sometimes beyond. In other words: an initial failure doesn’t predict much. Knowing this before you start changes the way you experience it.

What the cumulative rates tell us

Counting every egg retrieval and all the resulting transfers – both fresh and frozen – the figures for a woman using her own eggs are as follows:

• Under 35: around 35 per cent after one cycle, 60 per cent after three, 70 to 75 per cent after six.
• Aged 35 to 37: approximately 30 per cent after one cycle, 50 to 55 per cent after three.
• Aged 38 to 40: approximately 20 per cent after one cycle, 35 to 40 per cent after three.
• Aged 41 to 42: approximately 10 per cent after one cycle, 20 per cent after three.
• Over 42 years of age: less than 5 per cent per cycle, and the cumulative curve flattens rapidly.

With egg donation, the picture changes completely: around 50 per cent after one transfer, and over 80 per cent after three, regardless of the recipient’s age. These figures are registry averages; your own will depend on your individual assessment. How to interpret these rates is explained in another article.

When it still makes sense to try again

Repeating the same protocol is only worthwhile if something has worked. Signs that justify continuing: a good response to stimulation, embryos obtained that are of adequate quality, a transfer that resulted in a pregnancy (even if it did not progress), being under 40 years of age, or an identified factor that has been corrected between the two attempts.

Signs that suggest a change of strategy rather than repeating the same approach: two cycles cancelled due to lack of response; no embryos obtained on two separate occasions; consistently poor embryo quality; or three transfers of good-quality embryos without resulting in a pregnancy. In the latter case, an assessment of implantation failure is required, not a fourth identical transfer. The relevant article is here.

What exactly should be changed?

Changing strategy does not mean changing clinics. It may mean: modifying the stimulation protocol, accumulating embryos from several egg retrievals before a single transfer, adding PGT-A after the age of 38, investigating the uterus via hysteroscopy, treating sperm DNA fragmentation, or considering egg donation. Changing clinics without changing strategy often simply means repeating the same cycle elsewhere, at a higher cost.

The constraint that nobody likes to mention

The budget. In France, four attempts are reimbursed up to the age of 43; abroad, you are responsible for the cost of each cycle. I ask every couple, right from our first discussion, to set a total budget before starting, rather than on a per-attempt basis. Those who fail to do so end up making medical decisions under financial pressure at the worst possible moment – after a failure. Deciding calmly that you will go as far as two egg retrievals and three embryo transfers, even if it means reassessing later, offers better protection than a decision made whilst exhausted. Details of the costs are available here.

Deciding to stop

There is no universal medical threshold that says ‘it’s over’. What does exist is a point at which the probability becomes very low, where the cost — financial, physical, and relationship-related — becomes very high, and where the two curves intersect. That moment is not the same for everyone, nor does it need to be.

What I can say, after twenty-four years, is that the couples who cope best with stopping are those who decided to do so, rather than those who stopped out of sheer exhaustion. Setting a limit in advance — a number of attempts, a budget, a deadline — is not a lack of hope. It is what allows you to carry on calmly until that limit is reached, and to put the matter to rest afterwards without endlessly wondering whether you should have tried one more time.

There are also other options: embryo donation, adoption, or choosing a child-free life. These are decisions that deserve to be made with time and, often, with psychological support — which most clinics offer but which far too few couples make use of.

Frequently asked questions

Source: https://fertilitegrece.com/en/blog/how-many-ivf-attempts/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on

Triada Baloukoudis
Independent IVF patient coordinator in Thessaloniki, with 24 years of experience supporting patients travelling from abroad. More · Contact · Facebook