My IVF failed. What happens next?

When an IVF cycle fails, the next step is a review with your specialist of how your ovaries responded, the eggs and embryos, the womb lining and the transfer. The most common reason is a problem with the embryo, not anything you did. Further tests are only worth doing if they could change the plan, and most paid "add-ons" have not been shown to raise the chance of a baby.

This page explains what the review should cover, what guidelines say about extra tests and treatments, and how to look after yourselves. Sources are listed at the end.

Why do IVF cycles fail?

There is often no single reason. The main ones are:

• The embryo. Chromosome errors in the embryo are the main cause of embryos not implanting or of very early miscarriage, and they become more common as the woman gets older. An embryo can look good under the microscope and still carry one.
• The ovarian response. Fewer eggs than expected, or eggs that did not fertilise or develop well, leave fewer embryos to choose from.
• The womb. Less often, something in the womb gets in the way: a polyp, a fibroid that bulges into the cavity, scar tissue, a lining that stays thin, or a blocked tube filled with fluid (hydrosalpinx).
• Chance. Even a healthy embryo transferred into a healthy womb does not always implant. One failed transfer, on its own, does not mean something is wrong.

It is not your fault. There is no evidence that going to work, climbing stairs or an ordinary meal causes a cycle to fail.

What should a review after a failed cycle cover?

The UK fertility regulator (HFEA) advises asking your doctor why treatment did not work, whether a different approach might help, and for an honest opinion on your chances if you try again. A good review usually goes through:

• Stimulation: the protocol and doses, how many follicles grew and how many eggs were collected.
• The lab: how many eggs fertilised, how the embryos developed, their grades, and whether any were frozen.
• The transfer: the day of transfer, how many embryos, the thickness of the lining, and whether the transfer itself was straightforward.
• Both partners' health: weight, smoking, alcohol and any medical conditions. The European Society of Human Reproduction and Embryology (ESHRE) recommends reviewing lifestyle for both partners after repeated failure, because habits can change during treatment.
• What to change next time, and whether any test could change that plan.

If you were treated elsewhere, ask that clinic for copies of your cycle summaries, drug charts and embryology reports.

When is it called "recurrent implantation failure"?

There is no fixed number of failed transfers. In 2023 ESHRE described recurrent implantation failure (RIF) as the point where embryos thought to be viable have failed to implant often enough that further tests or treatment are worth considering. ESHRE suggests working this out for each couple: once the transfers you have had would usually have been expected to lead to implantation, and there is still no positive test, you should be counselled about further investigation. Because the woman's age and the embryos transferred matter so much, that point comes sooner for some couples than others.

Which tests have evidence after repeated failure?

ESHRE's 2023 recommendations on RIF sort tests into three groups.

Recommended:

• reviewing lifestyle for both partners;
• re-checking the thickness of the womb lining, and reviewing the oestrogen treatment if it stays thin;
• testing for antiphospholipid antibodies (a cause of blood clotting problems) if you have other risk factors for clotting.

Can be considered:

• a hysteroscopy (a camera look inside the womb), especially if a scan suggests a problem;
• a scan or X-ray test of the tubes if a hydrosalpinx is suspected;
• a chromosome test (karyotype) for both partners;
• thyroid tests and progesterone levels;
• testing for chronic inflammation of the lining (chronic endometritis), with antibiotics if it is found.

Not recommended: commercial endometrial receptivity tests such as ERA (as a routine test), womb and vaginal microbiome tests, natural killer (NK) cell tests, other immune blood tests, and sperm DNA fragmentation tests. (The European urology guideline does recommend a sperm DNA test after failed IVF; see semen analysis results.)

The UK's National Institute for Health and Care Excellence (NICE) went further in its 2026 fertility guideline: it advises against endometrial receptivity testing as an add-on for embryo transfer, including microbiome and chronic endometritis tests, and against hysteroscopy as a routine step before IVF unless a problem in the womb is suspected. Where ESHRE and NICE differ, as they do on chronic endometritis, it is because the evidence is weak either way. Ask your specialist what a test would change before you have it.

If a hydrosalpinx is found, NICE advises removing or blocking the tube by keyhole surgery before IVF. See keyhole surgery.

What are IVF "add-ons", and which ones work?

Add-ons are optional extras offered alongside IVF, often at extra cost. ESHRE's 2023 add-ons guideline made 42 recommendations on them, and none could be based on high-quality evidence. The UK regulator, the HFEA, rates add-ons with a traffic-light system, last reviewed in September 2026. Here is where the common ones stand:

Add-on	HFEA rating (chance of a baby, most patients)	ESHRE 2023
Endometrial receptivity test (ERA)	Red: may reduce effectiveness	Not recommended
PGT-A (testing embryos' chromosomes)	Red	Not for routine use
Platelet-rich plasma (PRP)	Red	Not recommended
Steroids, IVIG (immune treatments)	Red	Not recommended
Intralipid infusions	Grey: not enough evidence to rate	Not recommended
Endometrial scratching	Yellow: unclear	Not for routine use
Embryo glue (hyaluronate transfer medium)	Yellow: unclear	Recommended, with monitoring of twin rates
Freezing all embryos (freeze-all)	Yellow: unclear	Not for routine use
Time-lapse imaging	Black: no effect	Not recommended to improve live births
Assisted hatching	Grey	Not recommended
Sperm DNA fragmentation test	Grey	Not for routine use

The table is about adding these things routinely to improve the chance of a baby. Some have a proper medical use in specific situations. For example, PGT is used when a parent carries a chromosome rearrangement or a genetic condition such as thalassaemia, and ESHRE says PGT-A can be considered after repeated implantation failure, while NICE (2026) advises against offering PGT-A to improve live birth rates. See PGT embryo testing.

ESHRE's RIF recommendations also advise against heparin, intralipid, IVIG, G-CSF, PRP and hCG washes into the womb for repeated implantation failure. NICE (2026) says immune treatments, including intralipids, IVIG and steroids, should not be used in fertility treatment.

The HFEA's advice is simple: if an add-on is offered, ask why, and ask whether it may benefit you specifically. Your clinic should be able to show you the evidence. If you are paying yourselves, the HFEA suggests weighing whether the money would do more as a further full cycle.

What might change in the next cycle?

Depending on the review, your specialist may suggest:

• a different stimulation protocol or dose;
• ICSI, if fertilisation was low and there is a sperm problem (ESHRE does not recommend ICSI when there is no sperm problem);
• growing embryos to day 5 (blastocyst) before transfer, which ESHRE says can be considered after repeated failure;
• treating something found in the tests, such as a polyp, a fibroid in the cavity, a hydrosalpinx, a thyroid problem or a clotting disorder;
• weight, smoking and alcohol changes for both of you.

The number of embryos you can transfer is limited by Malaysian rules, whatever happened before: see IVF law in Malaysia. If you have frozen embryos left, a frozen embryo transfer may come before a new egg collection. If your egg numbers were low, see IVF after 40 and low AMH. If you have had pregnancies that ended in miscarriage, see repeated miscarriages: which tests help.

How long should we wait before trying again?

There is no fixed rule, and the right time is partly emotional. Your specialist can tell you when your body is ready. The HFEA advises taking time to come to terms with the result and to let your body recover before deciding. If you are planning to use KWSP (EPF) savings for another cycle, see paying for fertility treatment.

Looking after yourselves

A failed cycle is a real loss, and grief is normal. ESHRE's psychosocial care guideline says patients feel high distress when told treatment has not worked, and that some go on to have significant depression or anxiety. It recommends that clinics offer a chance to talk through what the result means, and refer people at risk to a counsellor or psychologist. NICE also says counselling should be offered before, during and after treatment, whatever the outcome.

Things that help:

• Talk to each other about how you are both feeling.
• Decide together what you will tell family. "We're taking a break" is enough.
• Ask your clinic whether it has a counsellor, or ask your doctor or klinik kesihatan for a referral.
• If you feel low most days, can't sleep or feel hopeless, talk to someone. The Ministry of Health's Talian HEAL 15555 is run by its counselling officers, daily from 8am to midnight.

It can also help to agree in advance how many more cycles you will try, and to revisit that together. See also mental health during fertility treatment and after a failed IVF.

Sources

• ESHRE Working Group on Recurrent Implantation Failure, ESHRE good practice recommendations on recurrent implantation failure, Human Reproduction Open, 2023.
• ESHRE Add-ons Working Group (Lundin et al.), Good practice recommendations on add-ons in reproductive medicine, Human Reproduction, 2023.
• Human Fertilisation and Embryology Authority (UK), Treatment add-ons with limited evidence, last reviewed 28 September 2026.
• HFEA, Coping if treatment doesn't work.
• NICE, Fertility problems: assessment and treatment (NG257), March 2026.
• ESHRE, Routine psychosocial care in infertility and medically assisted reproduction, 2015.
• The Star, Malaysia's mental health helpline received more than 230,000 calls since launch, July 2026 (Talian HEAL 15555 hours).

This page is general information, not medical advice for your situation.