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Cancellation of IVF, In Vitro Fertilization Cycles for Poor Ovarian Follicle Response Prior to Egg Retrieval

Advanced Fertility Center of Chicago Illinois
Gurnee and Crystal Lake

How many follicles are needed to do IVF treatment and proceed with the egg retrieval procedure?

Our criteria for cancellation are very objective:

1. The stimulation must result in a minimum of 3 mature (or close to mature) follicles (we consider follicles to be mature if they are 16-20mm in average diameter on the day of HCG).
2. Alternatively, if there are 2 follicles 16-20mm and at least 2 more that are 13-15mm, we can proceed to the egg retrieval.
   

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We know that all you want is to have a baby and we want the same thing. There is only one reason that we cancel IVF stimulations for poor response: Delivery rates from IVF cycles when there are less than 3 mature size follicles present on ultrasound are much lower than with at least 4 mature follicles. We consider this to be the best "break-point" for deciding whether to proceed with egg retrieval - or cancel the cycle. This is considering that:

1. The IVF process has some medical risks involved
2. The substantial additional economic costs of proceeding with the egg retrieval, fertilization, embryo culture, etc.

Unfortunately, when only a few follicles develop in response to the ovarian stimulation, there is usually, but not always a problem with egg quantity (sometimes also with egg quality). In other words, we get fewer eggs and they are sometimes also of lower quality as compared to the eggs obtained from women that respond normally to the ovarian stimulation. 

For more information on number of eggs retrieved at IVF and IVF success and egg quality issues:

        Egg numbers at IVF and success rates         Ovarian reserve issues: Egg quantity and egg quality

Prediction of probability of cancellation before starting the cycle

We can predict the ability of the woman's ovaries to respond adequately to ovarian stimulation with 2 simple and inexpensive tests. Antral follicle counts on ultrasound and day 3 FSH and clomiphene challenge test.

There are other general indicators of the risk of cancellation such as previous response to injectable gonadotropin stimulation, and female age.

The relationship between ovarian reserve test results, female age, and risk of IVF cycle cancellation
Ovarian antral follicle counts

IVF cancellation rates by antral count, female under age 35	IVF cancellation rates by antral count, female 35-39	IVF cancellation rates by antral count, female 40-42

IVF cycle cancellation rates increase with increasing female age and with decreasing antral follicle counts (they are independent risk factors for cancellation)

All data and graphs are from unpublished data from our IVF program

Occasionally, we might need to cancel an IVF cycle because of overstimulation. In these cases, which are very rare in our experience, the ovaries are making too many follicles and too much estrogen and other hormones and growth factors. There can be some potentially serious health risks for the woman if the HCG injection is given and the cycle completed when the ovarian response to stimulation is very high. If the ovarian stimulation dosing process is handled very carefully by the physician, cycle cancellation for over-response should be quite rare.

Our charges for cancelled cycles

If the cycle is cancelled before the egg retrieval, the cost for the cycle is $500 (cycle management fee) plus $65 per blood assay performed and $175 per ultrasound performed.