Danilo Cimadomo: Moving From Single-Cycle IVF to a Multicycle Strategy
Danilo Cimadomo, Associate Professor at the University of Pavia, shared a post on LinkedIn:
“Rethinking IVF success: from single cycles to a multicycle journey
A new commentary published in Reproductive BioMedicine Online highlights a crucial paradigm shift in IVF: moving beyond the traditional cycle-by-cycle evaluation toward a multicycle approach, especially for patients with poor prognosis.
Despite major advances in IVF—such as individualized stimulation protocols, improved embryo selection, and genetic testing—success per single cycle remains limited for many patients, particularly those with low ovarian reserve or advanced maternal age.
So what needs to change?
The evidence is clear: fertility is inherently a multi-attempt process. Reframing IVF as a planned, multicycle pathway can:
- Increase cumulative live birth rates
- Reduce time to pregnancy
- Lower treatment discontinuation rates
- Improve emotional preparedness and patient resilience
Innovative strategies such as oocyte/embryo accumulation and DuoStim protocols enable clinicians to maximize outcomes within a shorter timeframe—particularly in time-sensitive patients.
But clinical innovation alone is not enough.
A key message from this work is the importance of structured, empathetic counselling. Many patients still underestimate the need for multiple attempts, and inadequate communication remains a major driver of early discontinuation.
Shifting the narrative means:
- Setting realistic expectations from the start
- Supporting patients psychologically during the journey
- Measuring success cumulatively—not per cycle
Ultimately, IVF success should be defined not only by outcomes, but by the entire patient experience.
This multicycle perspective represents a more honest, evidence-based, and patient-centered approach to reproductive care—and a necessary step forward for our field.
Title: Changing the narrative for poor-prognosis patients in IVF: unlocking success through a multicycle approach
Authors: Alberto Vaiarelli, Carlo Alviggi, Juan Antonio Garcia Velasco, Marcos Horton, Peter Humaidan, Antonio La Marca, Marilena Taggi, Danilo Cimadomo, Laura Rienzi, Filippo M. Ubaldi
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