How Many Times Should You Try IVF Before Giving Up?

18 Dec
4 how many times
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Button - Ask Dr Sher MedBecause of the emotional, physical, and financial toll exacted by IVF, it is preferable that a couple undertake the process with the mindset that they will be in it for more than one attempt. If a couple can only afford one treatment cycle, IVF may not be the right course of action. Recall that on average, with conventional IVF, there is only about one chance in three that it will result in a live birth, and there is a tremendous letdown if it fails. It is thus unreasonable to undergo IVF with the attitude that “if it doesn’t work the first time, we’re giving up.” In vitro fertilization is a gamble even in the best of circumstances.

Statistically speaking, a woman under 40 years of age, using her own eggs, having selected a good IVF program is likely to have a better than 70% chance of having a baby within three completed attempts – provided that she has adequate ovarian reserve, (the ability to producing several follicles/eggs in response to gonadotropin stimulation), has a fertile male partner (or sperm donor sperm) with access to motile sperm, and has a normal and receptive uterus capable of developing an “adequate” uterine lining. Women of 39-43 years of age who meet the same criteria, will likely have about half that chance (35%- 40%).

When the most “competent” embryos are selected for transfer using a new genetic process (introduced into the clinical arena by SIRM in 2005), known as comparative genomic hybridization (CGH), the birth rate per single, completed IVF cycle is likely to exceed 60% (regardless of the age of the egg provider) and, more than 85% within three such attempts.

Unfortunately, there will inevitably always be some women/couples who in spite of best effort at conventional IVF will unfortunately remain childless. In my considered opinion, it rarely advisable to undergo more than three IVF attempts using the same approach each time. There is of course one important caveat: in women where the reason for repeated IVF failure is finally uncovered, it would indeed be justifiable (assuming there are sufficient emotional, physical and financial resources) to continue trying, using a defined and new approach that addresses the reason for prior failures. Simply stated, “the time to stop trying is when there is no remediable explanation for repeated failure to achieve a viable pregnancy”.

One very interesting case comes to mind. It happened a few years back when I consulted with a 42 year old Australian patient (she happened to also be a physician) who had undergone 22 prior failed attempts at IVF elsewhere. After determining that the reason for prior failures (at least in part) was due to a hitherto unrecognized immunologic implantation dysfunction (IID), I took her through yet another IVF attempt using selective immunotherapy. She conceived (using her own eggs) and went on to have a healthy baby boy. This case serves to point out that the time to stop doing IVF should not always be based on the number of prior failed attempts alone.

When conventional IVF (with or without egg donation and/or CGH embryo selection) fails to yield a successful outcome, other options such as ovum donation, IVF surrogacy, or adoption should be considered.

Although it is the right of any healthy women who has a uterus and is capable of producing even one follicle/egg to have the right to decide on doing IVF using her own eggs, given the very low success rate after 43 years of age (less than 10% per attempt and under 25% within 3 tries) it is my opinion that women over 43 years should be advised to rather do egg donor IVF. Here, regardless of the age of the embryo recipient, the IVF birth rate after a single attempt is about 60% – and better than 80% within three IVF attempts.

Couples who choose to undergo IVF should be encouraged to view the entire procedure with guarded optimism, but nevertheless must be emotionally prepared to deal with the ever‑present possibility of failure. It is important for IVF patients to be made to realize from the outset that an inability to become pregnant should never be considered a reflection on them as individuals.


  • G says:

    Hi I am 39 years old I have had 4 failed ivf cycles because the follicles never made it after day 3 and 1 never fertilized. I was diagnosed with diminished /low ovarian reserve, my doctor DR. BROWNE whom I really like has tried the most aggressive to the least aggressive but each time I only produced 1 follicle. My insurance covers 2 more cycles. Is there anything that can be done for me?

    • Geoffrey Sher says:

      I presume you have tried an agonist/antagonist conversion protocol with estrogen priming (LA10-E@V and possibly with added human growth hormone??

      Geoff Sher

      • G says:

        I don’t think I have tried an agonist/antagonist conversion protocol with estrogen priming (LA10-E@V with the human growth, is that something you recommend I talk to my doctor about?

        • Geoffrey Sher says:

          I am not certain that your RE will be full familiar with the protocol.

          Geoff Sher

          • G says:

            What do you recommend I do then? Would I have any results with this protocol? and is it an intensive protocol?

          • Geoffrey Sher says:

            It is an intensive protocol but results can never be fully predicted or guaranteed. However, in my opinion this would give you the best possible shot!

            Geoff Sher

  • Cara says:

    I just turned 44. Tried our first egg retrieval last year, and retrieved 51 eggs. Eight made it to day 5 for genetic testing, three came back as strong contenders. Our first embryo implanted, but we had an empty sac. Second embryo, did not implant. Third and final implanted, split very late — identical mono/mono twins, which we sadly just lost at 15 weeks.
    Given the large number of eggs I retrieved, I’m wondering if it’s worth another cycle of retrieval before we go another route. (My mother did not go through menopause until age 58, for another point of data).
    Thank you for any advice you may have. I realize my age may point to donor eggs at this point, but given my very high ovarian reserve (5.9 to 6.0) it seems like one more cycle might be worth it, if my husband and I can handle it emotionally.

    • Geoffrey Sher says:

      I assume that the embryos transferred were PGS-normal. If I am correct then you need to be looking for an implantation dysfunction. If they were not tested normal, then you need to try again but with CGH selection of embryos (staggered IVF).

      Please go to the home page of this blog, . When you get t there, find the search bar and type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

      1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

      2. Ovarian Stimulation for IVF: The most important determinant of IVF Outcome” (Nov. 2103)

      3. “Agonist/Antagonist Conversion Protocol”

      4. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.

      5. “Thyroid Autoimmune Disease and IVF”

      6. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

      7. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)

      8.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

      9. “IVF success: Factors that influence outcome”

      10. “Use of the Birth Control Pill in IVF”

      11.”Staggered IVF”

      Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization: The ART of Making Babies”. The book is available through “” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

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