Is 2nd cycle of IVF more successful?

This is quite a common thing. There’s a lot of patients that tell us that I’m pretty sure that the first cycle is not going to work, and the second one is going to be much better. That’s not true if you invest time if you gather all the medical information if you adjust the protocol, the chances of the first and the second cycle are going to be very similar. It’s true that in some cases if the first cycle does not go as expected because you don’t get the number of follicles you were expecting or the quality of the embryos was not that you thought it was going to be, and you may modify the protocol, you may decide to trigger the ovulation later, and so on.

There are different things that you can do in your second cycle to try to solve the problems that you had in the first one. I usually say IVF is a really good treatment, and the first thing we are aiming for is having a baby. It’s also sometimes a diagnostic test, in a sense that it’s the only way in which we can see things like the quality of the oocytes, the fertilization rates, the embryo quality, and things like that. If those different parts of the IVF are not as good as they should, we sometimes can do things in the second cycle, but on average, I would say that our first cycle offers the same pregnancy rates as the second one in most patients.

The pregnancy rates in IVF cycles with oocytes are sixty percent. At this rate the decrease is linked to the mothers age. However statistically, we have a sixty percent pregnancy rate per cycle and ninety percent cumulative pregnancy rate in four cycles. This does not mean that we have ninety percent in the fourth cycle, but that often couples who do IVF cycles, ninety percent of them achieve pregnancy on the fourth attempt. Obviously we are not going to reach a fourth cycle to determine the cause of why we didn’t achieve pregnancy. If we have not achieved it in the second cycle we stop to rethink everything.

As the IVF treatments go on, the chances of getting pregnancies are not increasing. In fact they are decreasing because most pregnancies arrive in the first, second maybe the third treatment. Statistically, we can say that the chances of getting pregnant for every embryo transfer that is done remains the same. It is different when we talk about the cumulative rate of pregnancy. That maybe patients have known or read at some point that around 70-80 % of pregnancies arrive at some point during the first three cycles. The live birth remains the same all over the world so I mean the live birth for every embryo that is transferred is at some point around 25-30 % maybe a little bit higher if the patient is younger and it goes down as the patient gets older. It remains practically the same all over the world

The first thing we should know is that egg quality is very important in fertility and that is related with age.  We cannot test the quality of the eggs so the more eggs we have the better options we have. What happens in a natural cycle without any infertility treatment? What happens is we have different follicles that are available in the beginning of our cycle, and we have hormones to make one of them grow. So one of the follicles will grow, we will ovulate one egg, and that’s the reason why we normally get pregnant with one embryo at a time.

But, with an IVF treatment what we want to do is increase the chances, so we try to have a good number of eggs, so we give external hormonal medications to try to make the number of follicles grow, this will give us a better option of finding more oocytes, which will in turn give us the correct embryo, which will then lead to the pregnancy, and that is the outcome we want. So, if we do 2 cycles, we will have 6 eggs in the first one and 6 eggs in the second, we will have a higher possibility of getting what we want with 12 eggs. But the probability of finding this one good egg is the same in the first cycle and in the second cycle. This is what has been scientifically demonstrated to this moment.