Answer from: Raúl Olivares, MD
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.
Answer from: Laura García de Miguel, MD
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.
Answer from: Kristine Kempe, MD
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.