How long should you wait between IVF cycles?

This is something that has changed recently. For many years, we were recommending the patients take a break for at least 2 months between cycles. We wanted the body to recover from the stimulation and start again. Nowadays, it is the opposite. Even in cases, for example, in which we do embryo banking, which means that we are going to collect embryos from different cycles too, carry out a PGT-A on all these embryos, we recommend starting the period right after you finish your previous one.

The reason is that seemingly the first stimulation can help to recruit more small follicles that can potentially grow when you stimulate the patient again. This is something that has been noted in patients who had several cycles for freezing the eggs before, for example, chemotherapy for breast cancer. These cases were done in a hurry to collect as many eggs as possible before starting the chemotherapy. The doctor found that in the second and third cycles, whenever it was possible to do more than one, the average number of eggs that were collected was higher than in the first one.

This initially was called Shanghai protocol, now, it’s a standard protocol in which we do DuoStim. We stimulate the patient, they have their first egg collection if you want to go through another round to cumulate eggs or embryos, the patients work with a protocol in which they have a period 7 days after the egg collection, so it is a really short cycle, and we recommend starting again on that cycle, and it’s true that on average we get more eggs and more embryos for the next treatments.

There is no real reason to recommend a break between cycles unless you are trying to change the protocol from short to long, then you need that cycle in between to start down-regulation before starting the stimulation.

The attitude towards this question is developing and changing rather dramatically in the past two or three years. The rule used to be between two stimulations of the ovaries, not necessarily to transfers. If we’re talking about transfers of previously frozen cryopreserved embryos then, the response might be quite different and there are truly no strict limits but if we talk about two stimulations of the ovaries, the recommendation used to be let’s wait for two or three months, two or three cycles, 60 through 90 days if you will. However, the experience with the currently used DuoStim protocols which have been developed mainly for oncological patients at first, we’re actually following the oocyte pickup, three days later, another stimulation has started and the number of eggs, the quality of the eggs obtained through this second stimulation is, in most studies, even higher than during the first stimulation. We see that there are really or truly no restrictions that the ovaries are capable of great things but it’s unnecessary actually to push in most cases and to rush this fast. It’s also a question of the patient’s comfort, of her psyche. So usually we still recommend between two stimulations at least a month or two of a resting period.

There’s really no waiting time between one cycle and another as far as there was no complication in the previous cycle, as far as the scans show normal ovaries. We check scan images. It depends which cycle number we are talking about because at some point we should make some break between cycles just to carry on with a new exam. For example to clarify a little bit which could be the reasons why cycles are not working properly. If everything is fine, cycles can run in a row we can say.

It is really two questions, so it depends on what you mean by a cycle of IVF. If we’re talking about: if you have a cycle of IVF, have eggs collected, embryos created and transferred and then have a negative pregnancy test and don’t have anything frozen at all and you’re looking at having another cycle of treatment, it’s worthwhile waiting at least until you’ve had a natural period before starting again and the reason why is that, IVF medications stimulate the ovary to grow lots of eggs and some of those little follicles that grow the eggs, may have been punctured or had eggs collected from and it’s worthwhile just giving it a month or two for those to recuperate before going back and stimulating the ovaries again.
If you’re looking at doing a frozen transfer after an unsuccessful IVF cycle, there really isn’t an optimal break time between them. It’s like what’s right for you. Going through IVF is sometimes described as an emotional treatment rather than just a physical treatment and going sort of back to back into cycles isn’t necessarily what you want to do. Sometimes it’s helpful to come back and reflect or prepare for the next cycle emotionally and so there isn’t an optimal breaking sense of the chances of it being successful. It really depends on what’s right for you

I think for every patient it is different as some patients react well to the treatment and they are not too stressed, they can proceed back to back cycle. They can directly go back and have the hormones and try another cycle. I think that it can be useful when you are more than 36 years old, as age does not get better especially for the eggs. I think that in that case going back to back is a really good idea. I must say that if you are very stressed this will have an impact on the eggs and sometimes it is better to have a break for a month. I know it is hard not to think about the whole process and just to do it again as long as you remember that not every cycle would be the same. Maybe you had the first failed cycle and it will not necessarily be the same second time. We do see differences there. It depends on the patient and really depends on you: if you feel that your body can react again to hormones again or if your body needs a break.

Today I would like to explain how long it is recommended to wait after we have had one failed IVF cycle until we can start another IVF attempt. We have different options because if we have an IVF cycle that has not been successful but you have some frozen embryos from this cycle, you can have them transferred in the next period and only wait when your doctor wants to do specific tests such as ERA, endometrial test, or other blood tests where you have to wait longer for the results.

By contrast, if we need to have another stimulation, another IVF cycle, we should wait around 2 months so your ovaries are completely normal without any cysts from the last stimulation and all follicles are less than 10 mm and we can start with the maximum possibilities.

After failed embryo transfer, we try to find the problem. If there were more than 2 or 3 failed IVF transfers, the first thing to do is understand why. One of the options can be a problem with the embryos. Another option could be a problem with the uterine cavity or endometrium. Then, we can do two things.

First, we can check the endometrium receptivity with a test called the ERA test, which can help us find the best time for embryo transfer. The time for the embryo transfer can variate during the menstrual cycle in each woman. It can also change from time to time. The ERA test helps to find the best time for embryo transfer and improves treatment success.

If we had repeated failed embryo transfers, the second option is to check the uterine cavity. We need to make sure that there are no endometrial polyps, submucosal myomas, or other pathologies like adhesions in the cavity. Then, it is helpful to do a hysteroscopy.