My husband who is an IMG took step 1 at total # of 5 times. When he went to apply for a medical license in the state we live in now, he was declined because it took him greater than 3 attempts to pass step 1. so my message to you, be careful about taking the exam if you are not ready. The number of attempts do count and can prohibit you from getting a license in the state of your choice. Additionally, some residencies/fellowships make you apply for a license in that state, so watch out--you may be declined from even getting an interview if you are not eligible for state licensure.