Changing the narrative for poor-prognosis patients in IVF: unlocking success through a multicycle approach

Recent advances in IVF have shifted the focus towards maximizing treatment efficacy and efficiency. Traditionally, IVF success has been evaluated on a cycle-by-cycle basis. Advancements such as individualized ovarian stimulation protocols, gonadotrophin-releasing hormone agonist triggers, cryopreservation techniques and embryo selection strategies, including preimplantation genetic testing for aneuploidies, have improved precision medicine in IVF, optimizing clinical outcomes. Despite these developments, certain patient groups - especially those with low ovarian response and/or advanced age - still face lower success rates per IVF cycle initiated. Considering the reproductive system's physiology, which often requires multiple attempts for success, and drawing from the experience of intrauterine insemination, a shift from a single-cycle focus to a multicycle strategy is now needed. A multicycle approach, adopting approaches such as oocyte/embryo accumulation from several stimulations or two consecutive stimulations (e.g. DuoStim), enables the advance planning of multiple attempts. It helps shorten time to pregnancy, reduces treatment discontinuation and offers support for patients facing setbacks. To be effective, this strategy must include personalized psychological counselling to manage emotional stress and prepare patients for possible failures, which are major causes of discontinuation. Evidence shows that well-informed, supported patients are more likely to persist in treatment, leading to higher cumulative success rates.