A cancelled in vitro fertilization (IVF) cycle occurs when treatment is stopped before the egg retrieval procedure, typically during the ovarian stimulation phase. The medical team makes this decision when conditions are not ideal for a successful retrieval or to protect the patient’s health. Although it can feel like a setback, cancellation is a medical choice intended to maximize the chances of a healthy outcome in a future attempt. Statistics indicate that between 5% and 17% of IVF cycles are canceled before retrieval.
Primary Reasons for Cycle Cancellation
The decision to stop a cycle prematurely is rooted in biological factors. One of the most frequent reasons is poor ovarian response, where the ovaries do not produce enough mature follicles despite the stimulation medication. Clinicians typically aim for a specific number of developing follicles to justify the medical risk and cost of proceeding to retrieval; a low yield often results in cancellation.
Conversely, an excessive response to the hormone medication can also lead to cancellation due to the risk of Ovarian Hyperstimulation Syndrome (OHSS). OHSS is a condition where the ovaries become overly stimulated, swell, and leak fluid, causing pain and complications. If monitoring shows a patient is at high risk for severe OHSS, the cycle is stopped to prevent complications.
Premature ovulation is another reason for cancellation, occurring when the ovaries release the eggs before the scheduled retrieval. This is often detected by a surge in Luteinizing Hormone (LH) during monitoring, indicating the eggs are no longer available to be collected. Unforeseen circumstances, such as a patient developing an acute illness like the flu, can also necessitate halting the cycle to ensure the patient’s health and safety.
Immediate Medical Protocol After Cancellation
Once the decision to cancel is made, the immediate medical protocol focuses on the patient’s safety and returning the body to a baseline state. The first step involves stopping all ovarian stimulation medications. The medical team provides specific instructions on how to discontinue these drugs to begin the recovery phase.
If the cycle was cancelled due to a high risk of OHSS, the patient will be closely monitored for several days following the cessation of medication. This monitoring may include blood tests and ultrasounds to check the size of the ovaries and track symptoms. The goal is to manage symptoms and ensure the ovaries begin to regress to their normal size.
A follow-up appointment is scheduled to confirm that hormone levels, particularly Estradiol, have returned to their pre-treatment baseline. This is usually confirmed through blood work and an ultrasound to ensure any cysts that developed have resolved. Patients are advised to use barrier contraception or abstain from intercourse during this recovery period, as the stimulated ovaries may still release an egg.
Financial and Administrative Considerations
The financial impact of a cancelled cycle is often a major concern, as the cost structure changes significantly when the procedure does not reach egg retrieval. Patients typically avoid the substantial fees associated with the retrieval, laboratory work, and embryology, but they are still responsible for costs incurred up to that point. This includes all monitoring appointments, such as frequent ultrasounds and blood work, as well as the cycle management fee charged by the clinic.
The most significant non-recoverable expense is the cost of the stimulation medications already administered. These high-cost injectable drugs are purchased by the patient and are non-refundable once used, representing a loss regardless of the cycle’s outcome. Clinics have varying refund policies, with some billing only for services rendered, while others may require a partial payment of the total cycle fee, even for a cancellation.
Navigating insurance coverage after a cancellation can be complex, as coverage often depends on the specific reason for stopping the cycle and whether the insurer requires certain documentation. Patients should request clear administrative documentation from the clinic detailing the services performed and the medical justification for the cancellation. This paperwork is necessary for processing claims for the monitoring and diagnostic portion of the cycle.
Options for Future Treatment Cycles
A cancelled cycle provides the medical team with valuable data that informs the strategy for the next attempt. The most common next step involves protocol modifications, where the doctor adjusts medication types, dosages, or the overall schedule based on the previous response. For example, a patient who had a poor response might switch from a short antagonist protocol to a micro-dose flare protocol, or receive higher doses of gonadotropins.
A waiting period is required before starting a new IVF cycle to allow the body to recover fully and the ovaries to return to a quiescent state. This recovery time often lasts for one to three menstrual cycles, allowing the medical team to re-evaluate the patient’s hormonal and follicular status. This break is also beneficial for the patient’s emotional well-being before undertaking the demands of another treatment cycle.
If the reason for cancellation is a recurrent issue, such as consistently poor ovarian response despite protocol changes, the doctor may discuss alternative treatment paths. These options can include exploring the use of donor eggs or considering a different clinic. Emotional recovery and psychological support are significant factors, and patients are encouraged to take time to process the experience before committing to a new plan.