Natural Pregnancy After IVF: Why Spontaneous Conception Still Happens
Key Takeaways
Natural conception can happen after IVF, but no single rate applies to everyone. One review found that about 20% of women had a naturally conceived pregnancy after a baby born through IVF or ICSI. A separate study counted births: within five years, 17% of women whose treatment had failed and 15% of women who had a baby through IVF or ICSI had a baby conceived without treatment. Your own chance depends on your age, the original diagnosis, the time since treatment and whether the tubes are open.
Key evidence: Thwaites et al. (2023) Systematic Review on Natural Conception Post-ART ElMokhallalati et al. (2019) Cohort Study on Post-IVF Live Births ASRM Practice Committee Opinion on Fertility Evaluation in Women
On this page
- Natural Conception After IVF
- Video: Clinical Insights from Dr. Senai Aksoy
- What Does the Scientific Evidence Show?
- Why Does Natural Conception Still Occur?
- Factors Associated With a Greater Likelihood of Natural Conception
- Practical Implications: Contraception vs. Family Planning
- Frequently Asked Questions for Dr. Aksoy
- FAQ: more questions about natural pregnancy after IVF
- Sources
Natural Conception After IVF
Yes, you can conceive naturally after in vitro fertilisation (IVF), whether the treatment ended with a baby or without a pregnancy. Needing IVF once does not mean that natural conception is impossible for good.
Infertility is rarely a simple choice between fertile and sterile. Many couples who need IVF have a lower chance of conceiving in any given month (doctors call this reduced fecundability), but they have no complete barrier to pregnancy. For them, a natural pregnancy can still happen later.
Video: Clinical Insights from Dr. Senai Aksoy
The video is in French. Subtitles in several languages and other audio tracks can be selected in the player settings.
What Does the Scientific Evidence Show?
Two studies give the most useful figures. In both, a sizeable minority of women later conceived or had a baby without treatment, but the studies counted different outcomes in different groups.
- After a baby born through assisted reproduction (ART): A 2023 review of 11 studies pooled data on 5,180 women. About 20% of them later had a pregnancy conceived naturally.
- After IVF or ICSI, whether it worked or not: A study of 2,133 women treated at one Scottish clinic counted births, not pregnancies. Within five years, 17% of women whose treatment had not worked had a baby conceived without treatment. So did 15% of women who had already had a baby through IVF or ICSI.
Because one study counted pregnancies and the other counted births, the two figures cannot be merged into one number. Neither tells you your own chance; that depends on the factors further down this page.
Evidence box: how the two studies were done
Thwaites et al., 2023 (systematic review and meta-analysis). A systematic review searches for every study on a question; a meta-analysis then combines their results. This one pooled 11 studies and 5,180 women who had a live birth after IVF or ICSI. The pooled proportion with a natural-conception pregnancy was 20%, with a 95% confidence interval (the range in which the true figure most likely lies) of 17–22%. The estimate at three years was 18%. The longest follow-up in each study ranged from 2 to 15 years, and the studies differed in methods, populations, causes of subfertility and treatment outcomes. Four studies reported only live births, which undercount pregnancies.
ElMokhallalati et al., 2019 (retrospective cohort). A retrospective cohort study looks back at records for a defined group of patients. This one followed 2,133 women treated with IVF or ICSI at a single regional unit in Aberdeen, Scotland, between 1998 and 2011. Within five years, the treatment-independent live-birth rate was 17% (95% CI 15–19%) after unsuccessful treatment and 15% (95% CI 12–17%) after a live birth. The study had no data on whether women were using contraception or actively trying to conceive, and a single centre may not reflect other populations.
Why Does Natural Conception Still Occur?
IVF is used for many different diagnoses, and they do not all block conception in the same way. In unexplained infertility or milder male-factor infertility, the monthly chance of conceiving may be lower but still present. In other conditions, an anatomical or biological barrier makes natural conception extremely unlikely or impossible.
Factors Associated With a Greater Likelihood of Natural Conception
The original diagnosis decides whether natural conception is still biologically possible. Age and how long infertility has lasted then affect how likely it is.
In the Scottish study, younger women and women with a shorter history of infertility had higher rates of natural conception that ended in a birth. After unsuccessful treatment, women with tubal-factor infertility had a lower rate. These are patterns across groups and cannot predict what will happen to one person. The ASRM fertility-evaluation guidance supports checking ovulation, whether the tubes are open and the male partner, rather than judging current fertility from IVF history alone.
| Factor | May leave some chance | Greatly reduces or rules it out |
|---|---|---|
| Age and duration | Younger age and a shorter history of infertility were linked to higher rates in the Scottish study | The chance generally falls with age and longer infertility, but there is no fixed cut-off |
| Tubes | At least one open, working tube | Both tubes removed, or both confirmed completely blocked: egg and sperm cannot meet without treatment |
| Male factor | Sperm in the semen may leave some chance, depending on count and movement | No sperm in the semen: fertilisation cannot happen without treatment |
| Original diagnosis | Unexplained infertility or some ovulation disorders may leave some chance | Other diagnoses may still need treatment; ask for yours to be reviewed rather than relying on this table |
Practical Implications: Contraception vs. Family Planning
What this means in practice depends on whether you want another pregnancy.
- If you would like another child: You may be weighing natural attempts against using stored embryos. The right choice depends on your age, the original diagnosis, how many embryos are stored, the time since treatment and your family plans. The studies above do not set a standard 6- or 12-month wait before returning to treatment.
- If you do not want another pregnancy: Past infertility is not contraception when natural conception is still possible. A clinician can help you choose a method that suits you after a recent birth, your medical history and your preferences.
Frequently Asked Questions for Dr. Aksoy
Can you get pregnant naturally in the days after egg retrieval, and what do you advise about intercourse and contraception?
Yes, although it is uncommon. At egg retrieval we try to collect the eggs from the follicles that have developed, but we cannot guarantee that every egg is collected. Sometimes a follicle that was left behind ovulates, and if the tubes are open, natural fertilisation can happen. Unprotected intercourse in the days before retrieval can also lead to this (Gurbuz et al., 2015, case report).
For this reason I do not advise patients to have unprotected intercourse during ovarian stimulation. When many follicles have developed, there is also the risk of an unexpected multiple pregnancy.
After retrieval there is another point. The ovaries may still be enlarged and tender, and the procedure can cause some light bleeding or pain. I therefore usually ask patients to avoid intercourse for the first one to two weeks, and then to follow the advice of the clinic that is providing the treatment. This period can vary with the patient and the treatment given.
In short, do not assume that a natural pregnancy is impossible in that period just because the eggs have been collected. But my main priority is to prevent an unexpected pregnancy and to let the ovaries recover safely.
If you do not want another pregnancy after an IVF baby, when and how should you start contraception?
Patients sometimes ask me: “Doctor, we tried for years and finally had our baby through IVF. Do we still need contraception?”
I explain that having conceived through IVF does not completely rule out a natural pregnancy.
The cause of infertility matters here. If both tubes have been removed, for example, we do not expect a natural pregnancy. But when IVF was done because of unexplained infertility, irregular ovulation or mild sperm problems, a pregnancy can occur on its own in the following years. Some studies suggest that this is more common than we thought (Thwaites et al., 2023).
For this reason I prefer, where possible, to talk about contraception before the birth with couples who do not want another pregnancy. Ovulation can start after delivery even before the first period.
Breastfeeding is also often misunderstood. It can suppress ovulation, but it is not a reliable method of contraception in every situation. It protects to a certain degree only in the first six months, if periods have not returned and the baby is fully or almost fully breastfed (CNGOF guideline, 2018).
For contraception we can consider condoms, an IUD or progestin-only methods. When choosing, we take into account whether the mother is breastfeeding, how long it is since the birth and her health. We generally avoid oestrogen-containing contraceptive pills, particularly in the period straight after the birth (US MEC, 2024).
What I tell my patients is this: needing IVF for your first baby does not mean the second pregnancy will necessarily need IVF too. If you do not want another pregnancy, it is best to plan a suitable method of contraception rather than leaving it until after the birth.
After a failed IVF cycle or a miscarriage, does it make sense to try naturally for a while?
For some couples, yes, it can make good sense. What decides it for me is why the couple needed IVF.
Take a young couple with open tubes and acceptable sperm results who had IVF for unexplained infertility. A failed first attempt does not mean that a natural pregnancy is no longer possible. With such a couple we can discuss trying naturally for a while.
I would not make the same suggestion to a 41-year-old patient whose ovarian reserve has fallen markedly, because the chance of pregnancy can fall as time passes. In the same way, for a couple with both tubes blocked or a severe male factor, spending months on natural attempts may not make much sense.
After a miscarriage the situation is somewhat different. There is no evidence that you must wait three months before trying again after an uncomplicated early pregnancy loss (Kangatharan et al., 2017). Once we are sure that the miscarriage is complete, the bleeding has settled and there are no complications, a new pregnancy can be planned when the couple feel ready. In special situations such as an ectopic pregnancy, the waiting time and follow-up may be different.
I would also remind couples that after a failed IVF cycle or a miscarriage, they do not have to start a new treatment straight away. A short break can sometimes help, both physically and emotionally.
What matters to me is not to dismiss the chance of a natural pregnancy completely, but also not to lose valuable time because of it. I prefer to decide together, looking at the couple’s age, the cause of infertility and the results of earlier treatment.
FAQ: more questions about natural pregnancy after IVF
Does a natural pregnancy after IVF mean the original diagnosis was incorrect?
Not necessarily. The original condition may have lowered the chance of conceiving without making it impossible. A later natural pregnancy does not, by itself, show that the diagnosis was wrong.
Does IVF “cure” infertility for future pregnancies?
No. IVF does not by itself remove the original cause of infertility. A later natural conception may mean the chance was lower rather than zero, or that something relevant has changed since treatment.
Can women with blocked tubes get pregnant naturally after IVF?
Not if both tubes have been removed or are confirmed to be completely blocked: egg and sperm cannot then meet without treatment. An HSG (an X-ray test that checks whether the tubes are open) can sometimes suggest a blockage when the tube is only in spasm. Ask a fertility specialist to review what an earlier result really showed.
When should I consult a doctor if I suspect a spontaneous pregnancy?
If you miss a period or have a positive home test, contact your clinician. Depending on your history, they may recommend a blood test that measures the pregnancy hormone (quantitative serum beta-hCG) and an early transvaginal ultrasound. These show where the pregnancy is and how it is developing.
Related Reading
- Can IVF Babies Be Delivered Naturally? Modes of Delivery and Safety
- Unexplained Infertility: Diagnostic Evaluation and Treatment Strategies
- PCOS and Fertility: Ovulation, Egg Quality, and Management
- Cumulative IVF Success Rates Over Multiple Cycles
Sources
- Thwaites A, et al. How common is natural conception in women who have had a livebirth via assisted reproductive technology? Systematic review and meta-analysis. Hum Reprod. 2023;38(8):1590-1600.
- ElMokhallalati Y, et al. Treatment-independent live birth after in-vitro fertilisation: a retrospective cohort study. Hum Reprod. 2019;34(8):1470-1478.
- Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021;116(5):1255-1265.
- Gurbuz AS, et al. Absence of luteal phase defect and spontaneous pregnancy in IVF patients despite GnRH-agonist trigger and “freeze all policy” without luteal phase support: a report of four cases. Gynecol Endocrinol. 2016;32(1):18-20 (published online 2015).
- Kangatharan C, et al. Interpregnancy interval following miscarriage and adverse pregnancy outcomes: systematic review and meta-analysis. Hum Reprod Update. 2017;23(2):221-231.
- Hassoun D. Natural family planning methods and barrier: CNGOF contraception guidelines (in French). Gynecol Obstet Fertil Senol. 2018;46(12):873-882.
- Nguyen AT, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep. 2024;73(RR-4):1-126.
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The content has been created by Dr. Senai Aksoy and medically approved.