After a failed IVF
A failed IVF cycle is hard, and it is natural to wonder what went wrong. A careful review of what happened often shows what to change, and many couples succeed on a later attempt.
With Datuk Dr. Navdeep Singh Pannu, FRCOG, at Alpha IVF & Women's Specialists, Kota Damansara
- Start with
- A full review of your previous cycles
- Bring
- Cycle summaries, drug doses and embryo reports
- Possible tests
- Hysteroscopy, womb lining tests, immune or genetic tests
- Second opinion
- Welcome, wherever your treatment was done
What it is
IVF does not always work, even when everything is done well. Most failures come from the embryo, often because of chromosome problems that become more common with age. Some come from the womb or from the timing of the transfer.
A review goes through every step of what happened: how your ovaries responded, the number and quality of eggs and embryos, the lining of the womb and the transfer. From there you decide together what to do differently, and whether more tests would help.
When good-quality embryos have not implanted more than once, tests of the womb are sometimes considered. A hysteroscopy looks inside the cavity for polyps, fibroids or scar tissue. ERA (endometrial receptivity analysis) uses a small sample of the lining, taken in a practice cycle, to check whether the usual transfer day is the right one for you. In the same kind of sample, EMMA looks at the balance of bacteria in the lining, and ALICE looks for bacteria linked to chronic inflammation of the lining (chronic endometritis), which can be treated with antibiotics. A lining that stays thin is looked into separately.
Who it can help
- One or more IVF cycles that did not lead to a pregnancy
- Good-quality embryos that did not implant
- Few eggs or poor embryos in earlier cycles
- Pregnancies that ended in early miscarriage
- Treatment elsewhere, and wanting a fresh look
How it works
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Take a break
Give yourselves time to grieve and recover. There is no rush to start again straight away.
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Review your cycles
Your records are gone through in detail: protocol, doses, response, egg and embryo numbers and quality, and the transfer.
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Further tests if needed
Depending on the review: a hysteroscopy, a womb lining test to time the transfer (ERA), tests for infection of the lining, immune or blood-clotting tests, or PGT-A on future embryos.
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A changed plan
This may mean a different stimulation protocol, ICSI, embryo screening, a frozen transfer, or treating a problem found in the tests.
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Support through the next cycle
Closer monitoring and a clear plan, with emotional support whenever you need it.
Good to know
Side effects and risks
- Some extra tests and add-on treatments have limited evidence; you will be told which are worth it for you
- More cycles mean more cost and emotional strain, so it helps to agree a plan and a limit in advance
Implantation tests
ERA, ALICE and EMMA are not needed before a first transfer. Large studies have not shown that they raise the chance of a baby, so they are not routine. If they are used at all, it is after repeated failed transfers of good embryos, once the embryos and the shape of the womb have been checked. See also PRP for a thin lining.
It is not your fault
Walking, going to work or an ordinary meal did not make the cycle fail. The usual reasons are biological, and many are beyond anyone's control.
Look after yourselves
Grief after a failed cycle is real. Lean on each other, and ask for support when you need it. Mental health during treatment.
Lifestyle helps
A healthy weight, no smoking and less alcohol, for both partners, improve the odds for the next attempt.
Questions people ask
How long should we wait before trying again?
Usually at least one normal period, but many couples need longer emotionally. Take the time you need.
We were treated at another clinic. Can we still come?
Yes. Bring your cycle summaries, drug charts and embryology reports so they can be reviewed in detail.
Should we test our embryos next time?
PGT-A can help in some situations, such as repeated miscarriage or failed transfers in women over 35. See PGT embryo testing.
Should I have an ERA test?
Studies so far have not shown that it improves the chance of a baby, so it is not routine. It is sometimes considered after repeated failed transfers of good-quality embryos, when other causes have been checked. It means one extra cycle with a biopsy instead of a transfer. Dr. Navdeep will tell you whether it is likely to be worth it for you.
How many cycles should we try?
There is no single answer. It depends on your age, your results so far, and what you feel able to do.
Further reading
This page is general information and does not take your personal circumstances into account. Please speak to your doctor for advice that is right for you. Disclaimers