Is There an Advantage to Waiting In Between Embryo Transfers?

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Is there a statistically significant medical advantage to waiting between frozen embryo transfers to “recalibrate”? What are your thoughts on returning to a body baseline without medications before attempting another transfer? It seems like clinics will move forward as long as hormone and lining levels are within range.

—Playing the Waiting Game

Several studies have looked at the question of going straight from a failed fresh embryo transfer to a frozen embryo transfer cycle and, similarly, from an IVF stimulation cycle into a frozen transfer. A 2020 meta-analysis of 12 studies, including over 18,000 cycles, showed no differences in pregnancy rates between an immediate transfer (meaning the menstrual cycle that directly follows the failed fresh transfer or IVF cycle) or waiting a few months to do a transfer. Another 2021 meta-analysis came to the same conclusion and even found there was a slightly higher pregnancy rate with an immediate transfer.

While medically there may be no reason you can’t move forward with your next period following a negative test, many doctors, including myself, take into consideration the emotional, physical, and financial toll a failed embryo transfer can have on a patient. Sometimes the “waiting game” can worsen psychological stress (because patients feel like they’re wasting time), and, therefore, we can say with confidence there is no negative effect on your chances of pregnancy in proceeding directly to another transfer.

Depending on your underlying medical conditions and how many transfers you may have done in the past, it may be beneficial to regroup with your physician to discuss your transfer protocol or update any labs or imaging studies if you haven’t already done so. If your last transfer pregnancy ended in a miscarriage or ectopic pregnancy, then when you can attempt again depends upon the treatment you received and ensuring everything is back to “normal” again before moving forward.

Ultimately, the best predictor of success is trying again if you are able (of course, not everyone may have the ability to try again based on the number of embryos they have, finances, or insurance coverage). A study of over 4,000 women at one fertility clinic showed that 95% of patients should conceive after three transfers of a chromosomally normal embryo.

There are many aspects of fertility treatment in which there is no one best answer. Having an open dialogue with your doctor about what is best for you both physically and mentally is paramount.