10 Reasons IVF can fail and What to Do Next

Why IVF fail: Although in-vitro fertilization (IVF) can help many people who weren’t able to conceive naturally have a child, there’s unfortunately no 100% guarantee of success. If the conditions for a healthy pregnancy aren’t quite right, the cycle can be canceled, either before or after egg retrieval.

After undergoing weeks of hormonal treatments and appointments, on top of however long you and your partner were trying to conceive before turning to IVF, finding out that your treatment cycle didn’t work can be totally devastating. Not to mention the high financial burden of each IVF cycle. If you’re in this boat right now, we’re so sorry that this happened.

It’s important to realize that it isn’t your fault: There are many medical reasons that an IVF cycle gets canceled or fails. Lots of factors determine how your ovaries will respond to the medication and if fertilization and implantation are successful – and these are out of your control. Overall, successful IVF on the first try only happens around 25-30% of the time. But remember that having one canceled or failed IVF cycle doesn’t mean that the same thing will happen on the next cycle. In most cases, it’s worth trying again (if that’s possible for you)

Learning about the possible reasons an IVF cycle can fail can help you regain a feeling of control and empowerment over your fertility journey as you start to think about what to do next.

10 reasons for a canceled or failed IVF cycle

1. The hormonal medication was taken incorrectly

For the treatment to be successful, it’s critical to take the medication as instructed. The timing, dosage, sequence, and how you give yourself the injection all play a part. Be sure to watch any training videos you’re given and follow along when a fertility nurse demonstrates how to take the medication at your clinic. If you have questions, don’t hesitate to call the emergency hotline at your fertility center.

Here are a few tips for injecting fertility medications:

• Create a routine (set up a reminder on your phone for when it’s time to give the injection)
• Store medications as instructed (some may need to be kept in the fridge)
• Follow the instructions carefully
• Sanitize the injection area with an alcohol swab and wash your hands
• Switch up the injections sites when it’s getting sore (butt, stomach, upper thigh)
• Ask a loved one to support you throughout your therapy to help you administer the shots and avoid mistakes (four eyes are better than two!)

2. Problem with ovulation trigger

A key part of IVF success is the “trigger shot” with the hormone hCG which matures your eggs and induces ovulation. If the timing is off or the syringe is inserted incorrectly, the cycle may be canceled. Some clinics give instructions on how and when to give yourself the shot (about 36 hours before egg retrieval) or they’ll set an appointment for them to do it for you, because the exact timing is so important.
If you get the shot too early, it can lead to premature ovulation. This is when you ovulate too soon before your egg retrieval procedure. If the shot is given too late, after the eggs have already made their way down into the pelvic cavity, your doctor won’t be able to retrieve them.

3. Reaction to hormonal medication

Everyone’s bodies are different and each IVF cycle is unique. Sometimes, the ovaries don’t respond as expected to the medication, signaling that something needs to be adjusted for the next cycle. 

Not Enough Follicles

When the ovaries under-respond to the medication, too few follicles develop. Multiple follicles (at least two measuring between 15mm-18mm) are needed to move forward to the fertilization stage. Your AMH levels will give your doctors a clue about how many follicles to expect, which can vary a bit from cycle to cycle. If there aren’t enough follicles, the medication plan should be altered – either the dosage or the drug itself. Your doctor may suggest trying a lower dose or what’s called a “natural IVF cycle” (where the aim is to get just one follicle), followed by egg retrieval and IVF or ICSI.

Ovarian Hyperstimulation Syndrome

On the other hand, when the ovaries over-respond to the drugs, women can develop ovarian hyperstimulation syndrome (OHSS). This is a rare reaction in less than 5% of women who have IVF treatment which causes the ovaries to fill up with liquid which leaks into the body. The vast majority of the time, symptoms are mild and any discomfort is short-term. Severe cases are much more rare but can be life-threatening. If your ultrasound, symptoms, or blood tests show you may get OHSS, the cycle can be delayed or canceled. In case eggs are retrieved, they can be frozen for use in a later IVF cycle.

Finally, hormonal therapy can result in poor quality eggs for some women. The first IVF cycle is a big learning process for your doctor to figure out the drug dosage, protocol, and medication that will work best for your body, age, and medical background to give you the highest possible chances of taking a baby home at the end.

4. Hormonal levels aren’t ideal

Estrogen and progesterone are two key pieces of the pregnancy puzzle. When they’re in the right amount, they help prepare the womb for implantation by thickening the uterine lining. If estrogen is too low or progesterone is too high, your doctor may recommend freezing the eggs/embryos until your hormones are in balance. A 2017 study published in the Fertility and Sterility journal found that women with a progesterone concentration of  >1.0 ng/mL had much higher pregnancy rates when they froze the embryos and did the transfer later on. 

5. Fertilization was unsuccessful 

In some cases, sperm doesn’t fertilize the eggs when they are combined in the lab. This could be due to poor quality eggs, sperm, or both. But there’s hope for the next time! When fertilization fails and/or sperm quality isn’t ideal, it’s recommended to try ICSI, which stands for intracytoplasmic sperm injection. ICSI is an additional step in an IVF cycle where an embryologist selects a single sperm to inject into the egg. This increases the success of fertilization compared to traditional IVF: the American Society for Reproductive Medicine reports that 50%-80% of eggs are fertilized through ICSI.

6. Poor quality embryo

Sometimes an egg will fertilize but grow into a poor quality embryo. This could be due to egg or sperm quality or random chromosomal abnormalities. When an embryo isn’t healthy, it may not implant or grow as it should in the womb, and can lead to miscarriage. Preimplantation genetic testing is available in some clinics to check the health of an embryo before transferring it to the womb to reduce the chances of pregnancy loss, but unfortunately doesn’t guarantee that a baby will be born without genetic defects. 

7. Sickness

If you or your partner come down with an acute illness during treatment such as Corona or another type of infection, your cycle will likely be discontinued until you get better. A high fever can interfere with follicular development and decrease sperm counts, and some illnesses can reduce the chances of IVF success. 

8. Lifestyle factors

Your BMI, diet, and whether you smoke can also influence if an IVF cycle works or not. Several scientific studies show that women who are overweight or obese tend to have worse outcomes in assisted reproduction treatments: the ovaries don’t respond as well to the hormones, and there are lower chances of a live birth while the chances of miscarriage go up. Getting to a healthy weight with a pro-fertility diet and plenty of exercise, and quitting smoking if you smoke, are great ways to boost your fertility naturally. 

9. Health conditions which complicate fertility treatment

Endometriosis

Endometriosis can cause IVF failure by reducing the egg reserve and embryo quality and making the uterine lining less receptive to implantation. Some good news though: A 2020 study published in Reproduction Biomedicine Online found that women who received pretreatment with a medication called Dienogest had significantly better IVF outcomes after a previous failed cycle. 

PCOS

PCOS causes imbalances of reproductive hormones and can interfere with IVF success. Thankfully, IVF success rates for women with PCOS are still quite high (around 60% according to a 2020 study), and many women whose IVF fails due to this condition are eventually able to have a successful pregnancy with a later cycle. 

Autoimmune disorders

Autoimmune disorders can cause IVF to fail because the body incorrectly perceives the embryo as a threat and attacks it. Treatment with medication can help reduce the immune system’s over-activity to improve fertility.

10. Structural problems

Thin uterine lining

If your uterine lining (endometrium) is less than 7 millimeters thick, the embryo can fail to implant. Different medications including hormonal treatment with estrogen and GnRH-agonist, vitamin E supplements and other drugs can help to thicken the endometrial lining. A 2019 study including 40 women with implantation failure published in The Journal of Maternal-Fetal & Neonatal Medicine found that taking vitamin E supplements over 12 weeks significantly increased endometrial thickness.  

Scar tissue

Scarring in the uterus from a past surgery can also cause IVF to fail by reducing blood flow to the uterine lining, interfering with implantation and increasing the risk of miscarriage. Scar tissue can be surgically removed prior to the next IVF cycle to increase the chances of success.

Polyps

Uterine polyps are growths on the inner wall of the uterus that can go into the uterine cavity. These can make the uterus less receptive to an embryo and increase the risk of miscarriage. A 2016 study published in Current Opinion in Obstetrics and Gynecology states that surgically removing polyps with a hysteroscopy after a failed IVF can increase the chances for success the next time around. 

Fibroids

Fibroids are commonly found in women who have assisted reproduction treatments, and certain types (submucosal fibroids) can affect IVF success. Having multiple and large fibroids reduces the chances that an embryo will implant successfully. But studies show that when they are surgically removed prior to IVF treatment, it boosts the chances of having a successful pregnancy.

Cysts

Cysts may form on the ovaries throughout the course of IVF treatment in response to the stimulation medications, which can harm the quantity and quality of your follicles. If your doctor finds cysts in an ultrasound, your cycle may be delayed until they go away (which they usually will on their own).   

Next Steps After Failed IVF

Before making any choices about how to proceed after a failed IVF, it’s important to give yourself some time to come to terms with what happened and let your body and mind recover. It’s totally normal to experience a range of emotions right now. Allow yourself to feel whatever you’re feeling fully. You may find it helpful to talk it through with a fertility counselor: some clinics offer access to counselors and there are mental health professionals who specialize in dealing with infertility. Turn to family, friends, and online groups for emotional support too.

When you feel up for it, have a conversation with your doctor about your chances of success if you go through another IVF cycle. Discuss if they suggest any changes to your treatment, or if you can do anything differently to maximize the likelihood of a healthy pregnancy. 

The thing to remember is that just because IVF failed this time, it doesn’t mean that it’ll happen again. IVF is a learning journey and your doctor can utilize the data and knowledge from this cycle for a future treatment. 

There’s also still a chance that you can get pregnant naturally after a failed IVF cycle. A 2019 study published in the Human Reproduction journal found that 17% of 2133 UK women who had a failed IVF or ICSI had a natural pregnancy and live birth within 5 years. 

When you’re ready, you can start considering your options about how to continue your fertility journey. If it’s possible for you, you can try IVF again, perhaps with a modified hormone therapy plan and/or adding ICSI to boost the chances of fertilization. 

If sperm or egg quality were a problem in this cycle, you can also consider searching for a donor. If you need an egg donor, IVF clinics outside of Germany can help you there. Surrogacy and adoption are other options to help you become a parent, which both involve other costs and considerations. 

It’s not an easy decision to make, so take your time and do what feels right. Everyone is different and what worked for someone else or how they decided to move forward after a failed IVF may not necessarily be the right call in your situation. Above all, trust your gut – you know in your heart what’s best for you. 

• Coping if treatment doesn’t work. Human Fertilisation & Embryology Authority. Accessed 10 March 2022.
• Why Did Our IVF Treatment Not Work? British Fertility Society. 
• IVF: If at first you don’t succeed, should you try again… University of Southern California Fertility. Accessed 10 March 2022. 
• Failed IVf can be devastating. Here’s what to do next. LA IVF Clinic. Accessed 10 March 2022.
• Multiple IVF Failures: What are the next steps? LA IVF Clinic. Accessed 10 March 2022. 
• Why IVF Sometimes Fails. Elite IVF. Accessed 10 March 2022.
• Why Does IVF Fail? The Fertility & Gynaecology Academy. Accessed 10 March 2022. 
• Preimplantation Genetic Testing. American College of Obstetricians and Gynecologists, Committee Opinion Number 799, March 2020. 
• ElMokhallalati Y et al.: Treatment-independent live birth after in-vitro fertilisation: a retrospective cohort study of 2,133 women. Hum Reprod. 2019;34(8):1470-1478.
• Feichtinger W et al.: Smoking and in vitro fertilization: a meta-analysis. J Assist Reprod Genet. 1997;14(10):596-9.
• The Practice Committee of the American Society for Reproductive Medicine: Smoking and infertility. Fert Stert. 2008;90(3).
• Vural F et al.: The Role of Overweight and Obesity in In Vitro Fertilization Outcomes of Poor Ovarian Responders. Biomed Res Int. 2015: 781543.
• Fedorcsák P et al.: Impact of overweight and underweight on assisted reproduction treatment. Human Reproduction. 2004;19(11):2523-2528.
• Hashemi Z et al.: The effects of vitamin E supplementation on endometrial thickness, and gene expression of vascular endothelial growth factor and inflammatory cytokines among women with implantation failure. J Matern Fetal Neonatal Med. 2019;31(1): 95-102.
• Lebovitz O & Orvieto R: Treating patients with “thin” endometrium – an ongoing challenge. Gynecol Endocrinol. 2014;30(6): 409-14.
• Kodaman PH: Hysteroscopic polypectomy for women undergoing IVF treatment: when is it necessary? Curr Opin Obstet Gynecol. 2016;28(3):184-90.
• Uterine polyps. Mayo Clinic. Accessed 18 Mar 2022. 
• Lass A et al.: The Effect of Endometrial Polyps on Outcomes on In Vitro Fertilization (IVF) Cycles. J Assist Reprod Genet. 1999;16(8):410-415.
• Sarıdoğan E & Sarıdoğan E: Management of fibroids prior to in vitro fertilization/ intracytoplasmic sperm injection: A pragmatic approach. J Turk Ger Gynecol Assoc. 2019;20(1):55-59.
• Ovarian Hyperstimulation Syndrome (OHSS). Cleveland Clinic. Accessed 18 March 2022.
• Immune Problems in Infertility. LA IVF. Accessed 18 March 2022. 
• IVF und ICSI in München. Die Kinderwunchärztin. Accessed 20 March 2022.
• Oudendijk JF et al: The poor responder in IVF: Is the prognosis always poor?: A systematic review. Hum Reprod Update. 2012;18(1):1-11.
• Patient education: In vitro fertilization (IVF): Beyond the basics. UpToDate. Accessed 30 Mar 2022.
• Gun Eryilmaz O et al.: Ovarian cyst formation following gonadotropin-releasing hormone-agonist administration decreases the oocyte quality in IVF cycles. Balkan Med J. 2012;29(2):197-200.
• Al-Azemi M et al.: Elevated progesterone during ovarian stimulation for IVF. Reprod Biomed Online. 2012;24(4):381-8. 
• Awwad J et al: Fever in women may interfere with follicular development during controlled ovarian stimulation. Int J Hyperthermia. 2012;28(8):742-746. 
• Details about how to give fertility shots – subcutaneous injections for infertility treatment and IVF. Advanced Fertility Center of Chicago. Accessed 30 Mar 2022.
• Hershko Klement A, Shulman A.: hCG triggering in art: An evolutionary concept. IJMS. 2017;18(5):1075.
• Wang, MD A et al.: Freeze-only versus fresh embryo transfer in a multicenter matched cohort study: contribution of progesterone and maternal age to success rates. Fert Stert. 2017;108(2):254-261.  
• What is intracytoplasmic sperm injection (ICSI)? Fact Sheet From ReproductiveFacts.org, from the American Society for Reproductive Medicine.
• Uterine Scarring. USC Fertility. Accessed 30 Mar 2022. 
• Liu S et al.: Pregnancy Outcomes of Women With Polycystic Ovary Syndrome for the First In Vitro Fertilization Treatment: A Retrospective Cohort Study With 7678 Patients. Front. Endocrinol. 2020.