How long after an In Vitro Fertilization (IVF) transfer failure can a woman start another IVF cycle?

Timing of Next IVF Cycle After a Failed Transfer

After a failed IVF transfer, a woman can start another IVF cycle immediately in the next menstrual cycle, as immediate frozen embryo transfer results in higher ongoing pregnancy and live birth rates compared to delayed transfers.

Evidence on Timing Between IVF Cycles

The timing of a subsequent IVF cycle after a failed attempt is a critical decision that impacts both clinical outcomes and patient well-being. Recent evidence provides clear guidance:

• A multicenter randomized controlled trial demonstrated that immediate frozen embryo transfer (FET) in the first menstrual cycle following a failed IVF-ET attempt resulted in higher clinical pregnancy rates (41.7% vs 34.1%) compared to delayed FET 1
• After adjusting for confounding factors like depression and stress levels, immediate FET showed significantly higher ongoing pregnancy and live birth rates compared to delayed FET 1
• A systematic review and meta-analysis found a significant advantage for immediate FET with a pooled adjusted odds ratio of 1.20 (95% CI 1.01-1.44) for live birth rate 2

Psychological Considerations

An important finding from the research is that delayed FET was associated with significantly higher rates of moderate to severe depression (10.6% vs 6.1%) and high stress levels (30.3% vs 22.4%) compared to immediate FET 1. This psychological impact should not be overlooked when counseling patients.

Optimal Timing Window

While immediate cycling is beneficial, some evidence suggests specific timing windows may be optimal:

• One study found significant increases in clinical pregnancy rates at 2-, 3-, and 4-month intervals after a failed attempt 3
• The highest rate of ongoing pregnancy (27.2%) was observed in women who had their second attempt after the next menstrual cycle following IVF failure 3

Special Considerations

For Poor Responders

Poor responders who have failed stimulated cycles may benefit from considering natural cycle IVF combined with in-vitro maturation (natural-cycle IVF/IVM) as an alternative approach 4.

For Patients with Poor Fertilization

If the first IVF cycle resulted in poor fertilization (≤20% of oocytes fertilized), the recurrence rate in a second cycle is high (50-75%). In these cases, intracytoplasmic sperm injection (ICSI) should be considered for the subsequent cycle 5.

Practical Algorithm for Timing the Next IVF Cycle

1. For patients with frozen embryos available:

   • Proceed with FET in the first menstrual cycle following the failed attempt
   • Use hormone replacement cycles for endometrial preparation

2. For patients requiring a new stimulation cycle:

   • Begin ovarian stimulation in the next menstrual cycle (within 1-2 months)
   • Consider natural cycle IVF/IVM for poor responders
   • Consider ICSI if previous cycle had poor fertilization rates

3. For patients with specific medical concerns:

   • If ovarian hyperstimulation syndrome occurred in the previous cycle, delay until complete resolution
   • If other medical complications arose, ensure these are fully addressed before proceeding

Conclusion

The traditional practice of postponing FET for at least one menstrual cycle after a failed IVF attempt is not supported by current evidence. Starting the next IVF cycle immediately not only improves clinical outcomes but may also reduce psychological distress for patients.