We are doing MP in November, prior to Quito/Galapagos via SS. Most of the sites I reviewed regarding Cuzco/MP suggested flying to Cuzco and departing immediately for the Sacred Valley and MP. Cuzco is at over 11,000 feet above seal level. Altitude sickness is a problem for many. The Sacred Valley is closer to 8,000. By leaving Cuzco immediately after arrival allows you to avoid some of the effects of altitude sickness. You can acclimate to altitude at the much lower Sacred Valley. After Sacred Valley/MP, we will return to Cuzco and spend a couple days there. From there we will go to Quito to begin the SS phase of our trip. BTW, Quito is at 9,000 feet, but after MP and Cuzco, it should not be a problem.