Why did my in vitro fertilization (IVF) cycle fail?
Not all patients conceive with their first IVF procedure, which can be a devastating blow, both emotionally and financially. Couples undergoing IVF may need more than one cycle because of the cumulative nature of conception. Although the pregnancy rates for subsequent cycles are slightly lower than the first cycle (if the first cycle is negative), many issues seen in a first IVF cycle can be addressed and improved upon in subsequent cycles. IVF is, therefore, both a diagnostic and therapeutic procedure and helps to diagnose problems of fertilization and embryo development that cannot be assessed by any other method.
After a failed cycle, the couple usually meets with their doctor to discuss the details of the treatment and their options, which likely includes either a frozen embryo transfer or a fresh IVF cycle.
During this meeting, the doctor reviews the ovarian stimulation process, any issues with the egg retrieval, egg quality or quantity, embryo grades, and any problems with the transfer procedure. Often there are issues in one or more of these areas. IVF can fail for several reasons and can be broken into the following categories:
- Advanced age and low ovarian reserve may lead to fewer embryos and embryos that are not chromosomally normal; this is one of the leading causes of failed IVF cycles.
- Poor egg and embryo quality will lead to a lower chance of the embryos implanting, most likely again due to chromosomal abnormalities.
- Some medical diagnoses may lead to a lower chance of success.
- Uterine issues may prevent implantation.
- Immune and blood clotting factors may prevent implantation or cause early miscarriage.
- Sperm factors may produce abnormal embryos that do not implant.
- Stimulation protocols may not be optimal and may not produce the necessary number of eggs for success.
- An embryo transfer procedure may disrupt the uterine lining if it was extremely difficult.
- Clinic and laboratory procedures may be poor.
- Errors with medication/instructions may cause the uterine environment to be out of synchrony with the embryo.
At times, the doctor finds no reason why the IVF cycle failed and may attribute it to bad luck. Fertility involves many factors. It’s not always easy to identify where the problem originated after a negative outcome.
One way to improve your chances of success, especially if you are older than 38, is to test the chromosomes of the embryos before they are transferred into the uterus through preimplantation genetic screening (PGS). This ensures that only normal embryos are transferred and these have a much higher chance of success.
Another thing to try is an endometrial scratch before the embryos are transferred. This is where the doctor takes a very small biopsy from the lining if the uterus usually around day 21 of the cycle before the embryo transfer. This has been shown in some studies to improve the lining and help the embryos to implant.
Supplements may also help to improve the egg quality but most have to be taken for at least 3 months before your egg collection to have the desired benefit.
Most importantly, talk with your doctor about his/her ideas for why the cycle failed and what can be done to improve your chances next time.