A second child after IVF: what changes, and what stays the same

Couples returning for a second child have a real advantage – they know the process – but also a blind spot: they base their thinking on the figures from their first journey, even though two or three years have passed.

If there are any frozen embryos left

This is the simplest and most common situation, and the strongest argument in favour of a freezing strategy during the first cycle. A frozen embryo transfer costs between 900 and 1,800 euros, requires a two- to three-day stay, and involves neither stimulation nor egg retrieval. The mother’s age at the time of transfer does not affect the quality of the embryo, which is the same age as when it was created. The procedure is described here.

Two things to check before you go: that the embryos are still within the legal storage period, and that the signed consent form still reflects your current situation. The article on storage goes into more detail on these points.

The interval after childbirth

Obstetric guidelines recommend a gap of at least eighteen months between a birth and the next conception, and a longer interval following a caesarean section, to reduce the risk of preterm birth and uterine complications. A very long gap, exceeding five years, also increases certain risks.

This guideline conflicts with another: your age. At 39, waiting eighteen months means attempting to conceive at 41. The right decision is made by weighing up both factors with your doctor, rather than by following a single rule. If you are currently breastfeeding, bear in mind that this is not a contraindication for an embryo transfer but may disrupt your cycle and the preparation of the endometrium: most clinics ask you to stop breastfeeding or to reduce it significantly.

If there are no embryos left

A new full cycle will then be required, and this is where the reality of the time that has passed becomes apparent. Your ovarian reserve has declined, sometimes significantly: have another AMH test and an antral follicle count carried out rather than relying on the results from three years ago. The article on AMH explains how to interpret these results.

The good news is that the first cycle provides valuable information. The doctor knows your response to a given dose, the number of eggs retrieved, the fertilisation rate and the embryo quality. A protocol tailored to these results is better than a standard protocol, which is why I always advise taking the full report from the first cycle with you, even if you change clinics.

Secondary infertility

Some couples conceive naturally after IVF — this happens and is by no means unusual. Others find the opposite to be true: a new difficulty that wasn’t present the first time. The usual causes are a decline in ovarian reserve, a deterioration in sperm parameters, a uterine complication linked to a previous delivery — such as adhesions following a uterine curettage or a caesarean scar — or endometriosis that has progressed.

This justifies carrying out a full reassessment rather than simply referring back to the old records: a hysteroscopy and a new semen analysis are the two tests most often useful at this stage.

The situation is no longer the same

With a child at home, the logistics change completely: appointments, injections, and a three-day hospital stay that needs to be organised with childcare arrangements. Many couples underestimate this burden and the exhaustion it causes. Two very practical tips: opt for a hormone-supplemented cycle, the date of which can be set three to four weeks in advance, allowing you to organise childcare with peace of mind; and schedule all the French tests on a single morning. The recommended hospital stays per protocol are listed here.

One final point I often hear, and which is worth mentioning: the guilt of ‘asking for more’ when you already have a child. It’s common, but there’s no need for it. The desire to expand one’s family is a legitimate aspiration, and having succeeded once does not oblige you to show any particular gratitude or to make any sacrifices.

Frequently asked questions

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