This is the question nobody asks at the first appointment, yet one that everyone eventually ends up asking themselves. It deserves figures, not words of encouragement.
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.
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:
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.
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.
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 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.
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.
The cumulative birth rate continues to rise up to the sixth cycle. Before the age of 35, it is around 35 per cent after one cycle and 70 to 75 per cent after six. After the age of 40, the curve flattens out much more quickly.
After two cycles cancelled due to a lack of response, two cycles without any embryos being obtained, or three transfers of good-quality embryos without a pregnancy. At this point, an assessment of implantation failure is needed, not yet another identical transfer.
The success rate per attempt remains broadly stable or falls slightly, but the cumulative success rate continues to rise. An initial failure does not predict subsequent ones.
There is no universal medical threshold. Setting a limit in advance — number of attempts, budget, deadline — allows you to make a decision calmly rather than in the heat of the moment following a failure, and to bring the matter to a close with greater peace of mind.
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
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