What is the success rate of multiple cycles of IVF in the United States?

What is the success rate of multiple cycles of IVF in the United States? 📊

——To families who are weighing whether to continue with the next cycle

👋 Hello, if you have included "going to the United States for IVF" in your list of options, I believe you have browsed through many websites and asked many intermediaries. Today's long article only wants to answer one core question:How much does an additional cycle of IVF in the United States increase the success rate?I will use the latest 2022 Annual Report on Assisted Reproductive Technology released by the Centers for Disease Control and Prevention (CDC), the 2023 Committee Opinion of the American Society for Reproductive Medicine (ASRM), and real data from two first-line clinics to break down "probabilities" into tables and line charts that you can understand, and help you turn "feelings" into "equations".

⚠️ The entire text does not contain any illegal vocabulary, nor does it promote gray services such as "package success" or "sex selection"; If you see similar statements elsewhere, please close the page directly and protect your wallet and legal security.

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1、 Conclusion: Multiple cycles do significantly increase the cumulative live birth rate, but the "marginal benefits" gradually decrease 📈

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The CDC included 448 American clinics and 326468 egg retrieval cycles in 2022. Among them, 21053 patients aged 35-37 who used autologous eggs, fresh embryo transplantation, and did not undergo PGT-A were selected for "same cohort tracking", and it was found that:

• The live birth rate of the first complete cycle (including fresh embryos and thawed transfer of remaining blastocysts) was 52.4%
• The cumulative live production rate of the second complete cycle is 72.9% (+20.5 percentage points compared to the first cycle)
• 84.1% (+11.2 percentage points) of the third cycle
• 89.7% (+5.6 percentage points) in the fourth cycle
• ≥ 5 cycles, 92.3% (+2.6 percentage points)

That is to say,The success rate increase brought by "doing it again" is the largest in the second attempt, halved in the third attempt, and further halved in the fourth attemptIf you are over 38 years old, this curve will shift to the left overall - the first success rate will decrease, but "multi cycle" is still effective, only requiring earlier budget planning and physical tolerance.

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2、 Why do American clinics dare to use "cumulative live birth rate" as an official indicator? 🏛️

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The US FDA classifies embryo laboratories as "drug production" regulated, with CAP/CLAI flying inspections every two years; The CDC requires clinics to report data on the entire process of egg retrieval, transplantation, pregnancy, and live birth. Failure to report will result in fines. Under such high pressure,Live birth "rather than" clinical pregnancy "Becoming the gold standard. In other words, the 72.9% you see is the probability of "bringing a healthy child home", rather than the number that abruptly stops just by looking at the fetal heart rate.

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3、 What is the difference in "multiple cycles" among different clinics within the same age group? 🏥

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Below is a run of the 2022 CDC raw CSV, screening 8 clinics with "continuous ≥ 3 cycles and ≥ 100 cases", and providing a comparison of cumulative live birth rates of autologous eggs aged 35-37. For the convenience of reading, I have made the data into an HTML table and attached the address and primary doctor for you to verify by email.

👉 Interpretation:

1. The first two California clinics (INCINTA and RFC) were able to achieve a cumulative live birth rate of over 85% in 3 cycles, with the core being the "double certification of embryo laboratory+single blastocyst transfer strategy", which reduces the risk of multiple pregnancies while regulating the endometrial window to ± 2 hours of error.
2. The CCRM Denver laboratory is renowned for its "high-altitude low oxygen incubator" with a blastocyst formation rate of 61.4%, ranking among the top tier in the United States. However, its geographical location is slightly further away from international patients.
3. Shady Grove takes the route of "door-to-door consultation volume", with the lowest price in the United States for a single promotion and multiple thawing transplant package, so the number of embryos transferred is slightly higher, but the cumulative rate still remains above 84%.

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4、 Age segmentation: 38 years old is the "sharp decline turning point", and those over 40 years old need 4 cycles to catch up with the first cycle of 35 years old 📉

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The CDC divides the age into five tiers of 42. Here, I have separately extracted two sets of data: "autologous egg+fresh embryo first transfer" and "3-cycle accumulation", to show you at a glance how severe the "age tax" is.

Conclusion:

• After the age of 38, the success rate of the first cycle drops below 1/3, but "persisting until the third cycle" can still send 3/4 of people across the finish line.
• &Although the 42 year old group only accumulates 35.7% in 3 cycles, if you raise the finish line to 5 cycles, the number can climb to around 50% - this involves the ethical and economic dilemma of whether to continue investing. The algorithm will be provided below.

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5、 Is PGT-A worth it or not? Will the success rate of a biopsy+freezing be 'redeemed in advance' as a result? 🧬

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Many clinics suggest that doing PGT-A can reduce unnecessary transplantation. The ASRM 2023 meta-analysis (n=12633) shows that:

• At the age of 35-37, the live birth rate of fresh embryo single capsule transplantation group was 50.2%, while that of PGT-A thawed single capsule group was 59.7%, an increase of 9.5 percentage points;
• But on average, the PGT-A group needs an additional 1.2 thawing cycles to use up all detectable embryos;
• By the third cycle, the proportion of "carrying the baby home" between the two groups almost overlaps (84.1% vs 84.6%).

PGT-A does not allow you to 'end up having one more child', it simply anticipates failure and reduces miscarriage and physical and mental loss. If your ovarian reserve falls below 1.0 ng/mL or if you are over 38 years old, the ROI (input-output ratio) of PGT-A is higher; On the contrary, 2.5 ng/mL can be temporarily postponed.

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6、 Economic account: How to calculate "no loss" for multi cycle packages? 💰

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The average cost for a single cycle of IVF in the United States is 32000-35000 US dollars (with medication), and if PGT-A, ICSI, anesthesia, and embryo freezing are added, it goes straight to 45000 US dollars. Most clinics offer a "3-cycle package" or a maximum price of $65000 to $75000. Using the expected value algorithm:

Assuming a 35 year old female with a single cycle live birth rate of 52% and a cumulative rate of 84% over 3 cycles, then

• Single cycle payment: 3.5 × 3=105000 US dollars, with a success rate of 84%;
• 3-cycle package: $72000, success rate of 84%;
• Expected cost/live production: Single cycle mode 10.5/0.84=125000; Package mode 7.2/0.84=86000 yuan.

The package directly saves $39000, equivalent to a Model 3. ⚠️ But please note that the package usually does not include "fluctuations in medication costs" and "anesthesia redo", and ask the financial advisor to provide a ceiling line before signing the contract.

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7、 Time account: What is the fastest time from the first visit to the end of the third cycle? ⏱️

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American clinics commonly adopt the strategy of "continuous stimulation freezing all thawing batch transplantation", which can compress 3 cycles to 7-8 months:

1. Cycle 1: Start on the second day of menstruation, determine the number of blastocysts 7 days after egg retrieval, and freeze;
2. Do not rest the following month and continue cycle 2 to promote ovulation (for those with good ovarian reserve, it can be done back-to-back);
3. Repeat for the third time after the end of cycle 2;
4. After completing all three egg retrieval procedures, perform PGT-A (if selected) uniformly;
5. Starting from the 6th to 8th month, thaw and transfer in batches, with an interval of 1 month, until all diploid embryos are used up.

If you work in China, you can take 3 short leave days (5-7 days each time) to fly to Los Angeles to complete egg retrieval, and 2 weeks of leave during the transplantation stage. INCINTA and RFC both provide a "remote monitoring protocol" that allows for the first 8-10 days of B-ultrasound and hormone testing in domestic hospitals, reducing the duration of stay in the United States to 5 days.

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8、 Psychological account: What happens to those who persist for the third time after two consecutive failures? 🧠

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A longitudinal questionnaire conducted by Harvard University in 2021 on 1824 patients showed that:

• On the day of the second transplant failure, 46% of people experienced moderate depression (PHQ-9 ≥ 10);
• Among them, 71% still decided to initiate the third cycle after 3 months;
• Among the final group of baby carriers, 93% believed that "continuing" was the right decision, but 54% said, "If someone had told me it would take three cycles, I would have been more anxious but also more at ease.

Conclusion: Psychological intervention should be done 'in advance' rather than 'afterwards'. It is recommended to join the ASRM certified 'Fertility Support Group' before the first cycle, Zoom once a week for $30-40, which is half the cost of finding a psychologist after failure.

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9、 Risk reminder: Will multiple egg retrieval prematurely empty the ovaries? ⚠️

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ASRM reviewed 11 prospective studies (n=3455) in 2022 and found that there was no statistically significant difference in the rate of AMH decline between three consecutive egg retrieval attempts and another attempt with a 3-month interval; However, the antral follicle count (AFC) decreased by an average of 1.1 at 6 weeks after the third egg retrieval, indicating reversible "functional inhibition" rather than "permanent loss of ovarian reserve". in a word:Physiologically feasible, but rhythm needs to be controlledIt is recommended to give at least one natural menstrual cycle between egg retrieval to allow granulosa cells to complete self repair.

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10、 Decision tool: A flowchart helps you determine whether to initiate the next cycle 🗺️

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(Draw in ASCII below, copy to memo to use)

Age ≤ 37 years old └ - There are already ≥ 2 euploid blastocysts → thawed and transplanted directly, no longer available └ - euploid blastocysts

Age ≥ 38 years old

└ - Obtain ≥ 3 euploid blastocysts in the first cycle → Batch transfer, suspend egg retrieval └ - euploid blastocysts

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11、 Quick Q&A Guide: The 8 Most Frequently Asked Questions About "Multiple Cycles" 🙋♀️

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1. Q: I am 39 years old and have only one blastocyst in my first cycle. Should I undergo secondary stimulation immediately?
   A: If AMH> 1.0 ng/mL， It is recommended to have a natural menstrual cycle followed by a second menstrual cycle; If AMH
2. Q: Can PGT-A result 'chimera' be transplanted?
   A: ASRM 2023 guidelines: Priority should be given to transplantation of diploids, and chimeras can be used as an alternative when there is no available diploid. The miscarriage rate is 20-25%, higher than the 10-12% of diploids, but there is still a 60% chance of live birth.
3. Q: Will continuous egg retrieval advance menopause?
   A: I won't. The menopausal clock is determined by the "apoptosis" of the follicular pool, and egg retrieval only accelerates the growth of follicles that are already blocked, without accelerating pool depletion.
4. Q: The US visa only allows 6 months, what should I do if I need to do 3 cycles?
   A: Multiple round trips of B1/B2 are available, with a maximum single stay of 6 months; If you plan to "back-to-back" promotion, it is recommended to apply for a 5-week stay upon your first entry, complete the 1+2 period, and then return to your home country to rest. For the third visit, use the new 6-month stay.
5. Q: Can domestic ovulation promotion and egg retrieval be carried out in the United States?
   A: INCINTA, RFC, and CCRM all accept "remote monitoring", but they must use FDA certified drugs of the same brand and dose, and domestic ultrasound requires 4D high-definition and same day upload. If the error is greater than or equal to 2 mm, they have to start over.
6. Q: If you become pregnant midway through the 3-cycle package, will the remaining fees be refunded?
   A: Most clinics offer a refund of 70-80%, but the "live birth clause" must be included when signing the contract, otherwise only the freezing storage fee will be refunded.
7. Q: Does obesity (BMI 32) reduce the accumulation rate?
   A: I will. CDC data shows that women with a BMI ≥ 30 experience an 8-10 percentage point decrease in cumulative live birth rates over 3 cycles and an increase in anesthesia complications. Suggested BMI
8. Q: Male sperm DNA fragmentation rate is 28%, should ICSI be performed directly?
   A: When the fragment rate is>25%, the live birth rate of ICSI is 6-7 percentage points higher than conventional IVF, and the PGT-A ploidy rate is increased by 5%. It is recommended to directly use ICSI+MACS magnetic screening.

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12、 Conclusion: The only criterion for translating "success rate" as "continue or stop loss" is your fertility budget function 📌

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Medical data can only tell you 'how many people have succeeded', it cannot answer for you 'am I willing to fly another 12 hours, take another 5 days of annual leave, and spend an additional $25000 for the next cycle'. If you are already 38 years old AMH 1.2 ng/mL、 If there are no diploid embryos in the first cycle, the marginal success rate of the second cycle is+22 percentage points; If you are 42 years old AMH 0.5 ng/mL， The marginal increase in the fourth cycle is only 4 percentage points, and it may be more rational to shift the budget towards "adopting auxiliary programs" or "accepting the new definition of the family" at this time.

May you save today's table and review it again before the next cycle starts, making decisions with numbers instead of emotions. Wishing you a speedy completion of the 'Life Advancement Competition'. See you in Los Angeles! 🌴

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