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What's Your IVF Number?

A year after we starting trying to get pregnant, we started IVF. Before our first round, the fertility doctor wanted to prepare us for the fact that we shouldn't expect success on the first try, that it often takes them a couple of cycles to figure out a woman's specific issue and tailor a protocol to it.

"But how many??" I wanted to know. When you're spending that much money, it does not feel like there's room for experimentation. He wouldn't give me an answer, but I pressed him. "Three or four," he finally admitted. "After that, we can reevaluate."

RELATED: How I Found My IVF Doctor

Turned out I got pregnant on my first try, and he was elated. Even though the pregnancy failed—no heartbeat—the team found it encouraging, this first step toward success. (Me? Not so much).

I spent four cycles at that clinic, and four more at another, and it was only at yet another one that I found success on my second try. But I wish I'd known more at the beginning how long to give it. Here's what I would advise:

1. The First Cycle Is a Trial

Even though they've tested your hormones, taken into account your age and specific health issues like endometriosis or short menstrual cycles, fertility is the one field that doctors don't know much until they try. (Can you imagine a brain surgeon saying he needs to do an exploratory surgery first?) For many patients, the first cycle is likely a trial run. It's unfair, but no one really knows how you'll respond to the meds, how your eggs will develop or how they'll fertilize.

2. Never Follow the Same Protocol

After my first cycle, the doctors were like, "Well, she got pregnant the first time, so let's do the same thing and hope for the best!" Turns out that the second time, none of my eggs fertilized, but they hadn't done ICSI (intra-cytoplasmic sperm injection)—a more aggressive fertilization where they insert the sperm into the egg rather than let them meet up in the petri dish—because it wasn't needed on the first round. Lesson: After any failed round, ask your doctor what she or he will do differently. Change your meds? Up your dosage? Stress to them how you don't have time or money to waste on trial cycles.

It's good to know at the start what your plan is: A year of trying? Until your money runs out? Until the doctor says so?

3. Spend Only Three Cycles at One Clinic

By the second round of IVF, your clinic should have enough information about you to tailor a proper protocol. By the third, they should be experts on you. "It's rarely advisable to undergo more than three IVF attempts using the same approach each time," Dr. Geofffrey Sher writes on his blog at Sher Fertility. "The time to stop trying is when there is no remediable explanation for repeated failure to achieve a viable pregnancy."

4. But Is There Really a Number?

Statistically speaking, for a healthy woman under 40 with good ovarian reserve and a partner with viable sperm, there's a 70% chance of having a baby through IVF with three cycles. (For women over 40, it's half that.) But a number of studies have suggested that over a certain number, about 6-7, the odds do not improve, and actually decline.

Of course, there are exceptions to every rule: Once an underlying cause is found for infertility, or for failure of a healthy embryo to implant, you start the count over.

Dr. Sher tells a story of a woman who had undergone 22 failed IVF cycles—but then he found a reason for it, and the next cycle (her first with him), she had a baby.

RELATED: I Never Thought I'd Miss IVF

5. Set a Limit at the Start

IVF is not only a numbers game. There are other factors to take into consideration aside from success rates—resources. How much time, money and effort do you want to put into this? Sometimes, a couple has to stop because their money runs out; sometimes they have to consider other options because the emotional toll is too great.

It's good to know at the start what your plan is: A year trying? Until your money runs out? Until the doctor says so?

These considerations are best discussed at the beginning—even though you may change your mind along the way, at least you have a plan.

Image via Twenty20/briannalivesmore

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