Find out why IVF may not have been successful and explore the options that can still help you achieve your dream of pregnancy.
Key Facts
- Less than half of women become pregnant after the first IVF cycle
- Multiple factors can influence IVF outcomes, including the quality of the eggs and sperm, uterine conditions, genetic factors and immune responses
- Fibroids, polyps, endometriosis and hormonal imbalances may prevent embryo implantation
- Chromosomal defects in eggs or sperm can lead to embryos that are non-viable
- Immune reactions can prevent embryo acceptance, and coagulation disorders may also hinder implantation
Introduction
The experience of a failed IVF cycle can be incredibly challenging, and it's natural to feel a mix of sadness, frustration, or even helplessness.
Take the time you need to process your feelings without putting extra pressure on yourself. Lean on your partner, close friends, or family, who can help you navigate these emotions. Support groups and therapists can also provide a safe space to share your experiences and receive understanding.
Though this may feel like a setback, try to stay hopeful. A failed IVF cycle doesn’t mean your dream of having a child is out of reach.
The Most Common Causes of Unsuccessful IVF
For many couples struggling with infertility, in vitro fertilisation (IVF) represents a hopeful path toward achieving the dream of having a child. However, the reality is that IVF success may not happen on the first try. In fact, less than half of women become pregnant after the initial embryo transfer, and multiple cycles are often needed for a successful implantation.
The reasons behind unsuccessful IVF are varied and typically involve a complex interaction of several factors. Here are some common causes:
Reason 1: Suboptimal Ovarian Response to Hormonal Stimulation
Hormonal stimulation is crucial in IVF, as it promotes the maturation of multiple eggs simultaneously. However, individual responses to hormones vary. If monitoring reveals that few or no eggs are maturing, adjustments can often be made to the dosage or type of medication to enhance the response.
Reason 2: Follicles Lack Eggs (Empty Follicle Syndrome)
In some cases, the follicles that grow during IVF treatment may contain no eggs. Known as Empty Follicle Syndrome (EFS), this condition affects approximately 1–7% of IVF cycles.
While the exact causes of EFS remain unclear, genetic and hormonal factors likely play a role. Adjusting hormone stimulation protocols can sometimes reduce the risk of EFS and improve outcomes.
Reason 3: Incorrect Timing of the 'Trigger Injection' for Ovulation
Precise timing is essential for successful egg retrieval. The "trigger injection," which stimulates ovulation, is typically given about 36 hours before the planned retrieval. This timing ensures that the eggs are at the ideal stage for collection. Your doctor will guide you on the exact timing to maximise the chances of a successful retrieval.
Reason 4: Reduced Ovarian Reserve
In some cases, retrieving a sufficient number of eggs can be challenging, particularly for women with a reduced ovarian reserve. A low egg count decreases the likelihood of successful embryo transfer. Age is also a factor, as both egg quality and ovarian reserve naturally decline over time, especially after age 35, making conception more difficult.
Occasionally, IVF treatments result in fewer eggs than expected—or none at all—which can affect the overall chances of success.
Reason 5: Eggs Cannot Be Fertilised
Even if egg retrieval is successful, fertilisation in the lab is not guaranteed. With standard IVF—where eggs and sperm are placed together in a culture dish—fertilisation fails in about 10–20% of cases.
When this happens, an procedure called emergency ICSI (intracytoplasmic sperm injection) can be used, in which a single sperm is injected directly into each egg. This technique can improve the chances of fertilisation, particularly if there are issues with the sperm or egg.
Reason 6: Fertilised Eggs Fail to Develop
After fertilisation, the egg should begin dividing and developing into an embryo. When cell division doesn’t occur or stops, a few factors may be responsible:
- Egg and Sperm Quality: Chromosomal abnormalities in the egg or sperm can halt cell division. The quality and quantity of retrieved eggs are crucial for successful fertilisation, with factors like the woman’s age and certain medical conditions significantly impacting egg quality.
- Laboratory Conditions: Ideal lab conditions, including optimised temperature and culture media, are essential for embryo development. However, in some cases, the exact cause of arrested cell division remains unclear.
Reason 7: Embryo Fails not Implant
- Changes in the uterus and uterine lining: Successful implantation depends on a healthy uterine lining. Anatomical issues such as fibroids or polyps can create obstacles, preventing the embryo from embedding properly.
- Low progesterone levels: Hormonal balance is crucial for IVF success, and progesterone is key in preparing the endometrial lining for implantation. If progesterone levels are too low, the lining may not be sufficiently prepared for the embryo.
- Endometriosis: Endometriosis, a chronic condition where tissue similar to the uterine lining grows outside the uterus, can lower IVF success rates. Careful diagnosis and, if needed, surgical or medical treatment may improve outcomes before starting a new cycle.
- Autoimmune and clotting disorders: The immune system and blood clotting play significant roles in implantation. Certain autoimmune disorders or coagulation issues can cause the body to recognise the embryo as “foreign” and reject it. Thrombophilia, a condition that increases blood clotting, can reduce blood flow to the uterine lining, complicating implantation.
- Genetic abnormalities: In some cases, chromosomal abnormalities in the eggs or sperm lead to embryos with genetic defects, which may struggle to implant or maintain a stable pregnancy.
Reason 8: Early Miscarriage
Even after a positive pregnancy test, an early miscarriage can occur, just as in spontaneous pregnancies, and the risk increases with the woman’s age. However, studies show promising insights: one study found that women who experienced an early miscarriage or biochemical pregnancy had higher pregnancy rates in the following cycle compared to those with no prior pregnancy loss (37.3% vs. 27.3%).
Another study highlighted that sperm from men whose partners had recurrent miscarriages exhibited twice the DNA damage compared to a control group. This suggests that sperm quality can significantly influence pregnancy outcomes, making it essential to investigate potential causes of recurrent miscarriages in both partners.
Amy Stocker
What to Do After a Failed IVF Attempt
Multiple IVF attempts are often necessary to achieve a successful pregnancy, with pregnancy rates per cycle ranging between 25–45%. Here are some steps you can take after a failed attempt:
Talk to Your Doctor
A thorough consultation with your doctor can help identify potential causes of the unsuccessful IVF cycle and plan your next steps. Additional tests or adjustments in treatment may improve your chances for a future attempt.
Learn about the next steps after a failed ivf cylce in this video with OBGYN Dr. Natalie Crawford:
Diagnostic Options After Failed IVF
- Genetic testing: Pre-implantation genetic diagnosis (PGD) allows embryos to be screened for genetic abnormalities before transfer, helping identify embryos without chromosomal or genetic issues. PGD can improve pregnancy success rates, especially in women over 35, couples with recurrent miscarriages, or those with known genetic risks.
- Hormone analysis: Although you may have already had a hormone test, a repeat analysis can reveal fluctuations or imbalances that could impact implantation success.
- Checking the immune system: Sometimes, an overactive immune response can cause the body to reject an embryo. For example, increased activity in natural killer cells can lead to the embryo being recognised as “foreign” and attacked. Specific blood tests can detect such immune responses.
- Hysteroscopy: A hysteroscopy involves inserting a thin, flexible endoscope into the uterus to closely examine the uterine lining and, if necessary, take tissue samples. This procedure can reveal structural issues that might impact embryo implantation.
Alternatives and Other Ways to Conceive
- Adjusting the stimulation protocol: Your doctor can adjust the stimulation protocol to optimise egg maturation and improve the number and quality of eggs. This may involve changing medications, adjusting doses, or modifying the timing of doses to best support your body’s response.
- ICSI (Intracytoplasmic Sperm Injection): ICSI involves directly injecting a single sperm into an egg. This approach is particularly helpful if sperm quality is an issue or if fertilisation didn’t occur in previous IVF cycles.
- Sperm donation: For couples where the male partner does not produce sperm or the sperm quality is very low, sperm donation may be an option to consider.
- Egg donation: For women who cannot produce viable eggs or have a low egg quality, egg donation offers another route. However, egg donation is currently prohibited in Switzerland.
- Embryo donation: Embryo donation allows couples to receive embryos that other couples no longer need after fertility treatments. Like egg donation, embryo donation is not permitted in Switzerland.
- Lifestyle changes: Fertility is affected by lifestyle choices. Smoking reduces fertility in both men and women, and maintaining a healthy weight supports hormone balance and ovulation. Chronic stress can also impact fertility, so incorporating relaxation techniques like yoga, meditation, or progressive muscle relaxation can be beneficial.
Musfira Shaffi
- Complementary medicine: Some couples explore complementary therapies like acupuncture, homeopathy, or traditional Chinese medicine (TCM) to support their fertility journey. While scientific evidence is limited, many couples report positive experiences with these methods.
Takeaway
The decision to try again or pursue another IVF cycle is deeply personal and entirely up to you. Many women need multiple IVF attempts to achieve pregnancy, and your doctor will be there to offer compassionate, expert support, working closely with you to improve your chances on the next try.
