Is there a point where you should stop?
There is no evidence-based cut-off at three or four cycles. Above 42 the picture is different.
The three-or-four-cycle rule is widely repeated and has been directly tested in the largest cohort ever assembled.
Across 156,947 UK women:
- The live birth rate stayed above 20% per cycle through the fourth cycle, both overall and in women under 40 using their own eggs.
- The cumulative rate kept increasing up to the ninth cycle.
- No age difference was seen at all among women using donor eggs.
- Lower rates in couples with untreated male factor infertility disappeared once ICSI or donor sperm was used.
The authors' conclusion, quoted: these findings support the efficacy of extending the number of IVF cycles beyond 3 or 4.
43: 9.7% · 44: 8.6% · 45: 5.0% · 46: 3.6% · 47: 2.5% · 48 and above: under 3%
And the curve flattened after the fifth cycle at 43 to 44, the third cycle at 45 to 46, and after the first cycle at 47 and above. In the same study, neither day-3 FSH nor AMH predicted live birth in this group.
Two conclusions follow, and they point in opposite directions depending on who you are. If you are under 40 and have had three cycles fail, the evidence does not support being told it is over. If you are 45 and have had one cycle fail using your own eggs, the evidence says another cycle is unlikely to change the outcome, and that is the conversation where donor eggs belong.
Neither of those is a decision about money alone, and neither is a decision anyone else should make for you. But both should be made with the actual numbers in view.