When Should You Stop Fertility Treatments? Here's How Specialists Decide

Deciding when to stop fertility treatment is one of the hardest conversations a couple or individual faces. There is no single "magic number" that fits everyone. Instead, clinicians use a mix of objective tests, evidence about likely benefit, and careful consideration of personal, emotional and financial costs. The goal of a specialist is to give realistic chances while preserving dignity and choice. Clinical judgement is guided by a few simple rules. Age is the main factor. The chances of a live birth decrease gradually with the increase of the mother's age, especially after the middle of the 30s, and a number of national guidelines set age-based limits for routine treatment.

Apart from that, assessment of ovarian reserve, most probably anti-Mullerian hormone (AMH) and antral follicle count (AFC), tells us how the ovaries would react to the stimulation. Low AMH or extremely low AFC is a sign that the response will be weak and hence, the chances of live births will be low; whereas, higher AMH levels indicate that the number of oocytes retrieved will be higher and the likelihood of success will be greater. These tests are commonly performed to establish real expectations and to decide whether it is worth going on with autologous (own-egg) treatment.

Previous treatment response is still behind age and ovarian reserve in terms of importance. The number of eggs retrieved, the number of embryos created and embryo quality are very strong predictors of success. If someone goes through several IVF cycles and each time produces very few embryos or none that are good enough to transfer then the chances of achieving a live birth using their own eggs drops to almost zero very quickly.

What does the evidence say ?

Several large observational studies of cumulative live-birth rates show most of the gain is achieved in the first few complete cycles. For many women, cumulative chances increase with up to three or four stimulated cycles but then show diminishing returns; in certain "low prognosis" groups, benefit appears to plateau after about 3.5 years or after roughly six frozen-embryo transfer cycles, at which point further treatment gives little added probability of success and exposes the patient to cost and stress. These findings are a useful empirical guide when discussing "how many cycles" to try.

Equally important is the psychological and financial burden. Studies on treatment discontinuation show that emotional fatigue, treatment burden, relationship strain and money pressures are major reasons people stop, even when some medical chances remain. A responsible care plan must therefore weigh the likely clinical gain against real-world harms and recognise that continuing at all costs is not always in the patient's best interest.

So how do specialists put this into practice? A sensible, compassionate approach looks like this:

1. Use objective thresholds but individualise. Discuss age-related probabilities early on and use AMH/AFC and previous cycle data to estimate expected yield. Where national guidance is clear (for example about limited cycles around age 40-42), explain these recommendations and what they mean for that person.
2. Set an evidence-based stopping rule together. Many clinics work with a "shared stop plan": for example, agree to review after three full stimulated cycles (or after a set number of transfers), unless a reasonable embryo yield suggests continuing is worthwhile.
3. Watch for clear futility signals. If a patient reaches an age or ovarian reserve where the expected live-birth probability is negligible, for instance most experts advise discouraging IVF with own eggs after age 45 because success is extremely unlikely, it is reasonable to recommend stopping own eggs/ sperms attempts and discussing alternatives.
4. Discuss alternatives early. Options may include donor eggs/sperms (which can substantially improve success rates), where permitted, adoption, or choosing a fulfilling life without children. Financial counselling about costs and likely outcomes helps couples make informed choices.
5. Place the greatest emphasis on mental health and offer realistic hope. It should be a standard practice to refer fertility patients to psychologists. Counselling supports those who are grieving, helps them understand their decision-making based on their values, and assists in planning a new, purposeful chapter if they choose to cease treatment. Research indicates that very often people stop treatment due to the emotional burden - thus, if support is provided, it may be a way to avoid regret and keep good mental health.
6. Commit to openness regarding the chances over a number of cycles. Having clear figures diminishes the setting of unrealistic expectations and gives the patients an opportunity to decide if the small increase in the chance is worth the cost.
7. Consider time-sensitive options in advance. For those not ready to stop but worried about age, egg freezing earlier in age can be a preventive strategy that should be discussed before ovarian reserve declines.

In short, there is no one single "stop" threshold that fits everyone. Age, ovarian reserve, number of eggs/embryos, cumulative live-birth data and the patient's emotional and financial resilience all matter. National guidance and recent studies give clinicians useful stopping rules - for instance, restrictive limits around the forties and little benefit from self eggs and sperms IVF beyond the mid-forties - but the best approach remains a shared, evidence-based decision made with honest counselling, clear probabilities and compassionate emotional support.

Age restrictions for IVF in India

In India, the ART (Assisted Reproductive Technology) Act, 2021 sets age limits for fertility treatments: women must be 21-50, and men 21-55, to ensure the child's welfare.

(By Dr. Kalyani Shrimali, Clinical Director and Fertility Specialist, Nova IVF Fertility, Indore)

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