When previous IVF cycles have not worked

What a failed cycle can tell you

A cycle that did not result in pregnancy usually failed at an identifiable step: too few eggs, eggs that did not fertilise, embryos that stopped developing, embryos that did not implant, or a pregnancy that ended early. Each of those points toward different causes and different responses.

The first thing I do with a new patient after failure is reconstruct the previous cycle from the records — stimulation protocol, doses, egg numbers, fertilisation rate, embryo grades, transfer details, luteal support. Much of the time the cycle was reasonable and the outcome was chance. Sometimes something is visible that was not addressed. Occasionally the answer is that the treatment offered was not the right one.

Bring everything from your previous clinic. The more complete the record, the more useful the conversation.

Recurrent implantation failure

Recurrent implantation failure means good-quality embryos have been transferred more than once without a pregnancy. There is no single test that explains it.

Investigation typically covers the uterine cavity (hysteroscopy, to look for polyps, adhesions or a septum), the endometrium, and factors in both partners that can affect embryo quality. Some causes, such as a structural problem in the uterus, are treatable. Others are not identifiable with current testing.

What I will not do is add a list of unproven treatments in the hope one works. Where the evidence is weak, I will say so.

Poor ovarian response

Poor response means fewer eggs than expected were collected despite stimulation. It is more common with age and lower ovarian reserve, but it also happens in younger women.

Options include altering the stimulation protocol, changing the timing or type of medication, or accepting a smaller number of eggs per cycle and planning accordingly. Sometimes the honest answer is that ovarian reserve is the limiting factor and no protocol changes that; the conversation then turns to what is realistic and what alternatives exist.

Unexplained infertility — and what "unexplained" often misses

"Unexplained" means the standard tests were normal. It does not mean nothing is wrong.

My own research at Liverpool found that a substantial proportion of men with a normal semen analysis still had significant sperm DNA fragmentation, which a routine report does not measure. Elevated DNA damage is associated with poorer embryo development and higher miscarriage risk. For couples labelled unexplained, particularly after failed cycles, I routinely look beyond the standard semen parameters.

The uterine cavity and the tubes are the other places a routine work-up can miss something.

Recurrent early pregnancy loss

Repeated early loss after IVF is investigated differently from failure to implant. Assessment covers chromosomal factors in embryos and parents, uterine anatomy, thyroid and endocrine function, and clotting disorders. Some causes have specific treatments; many losses remain unexplained even after full investigation, and the plan then becomes one of managing risk rather than removing it.

What can change, and what cannot

Things that can change: the protocol, the laboratory, the timing, the investigation of the uterus, the assessment of sperm beyond the standard report, and the honesty of the conversation about odds.

Things that cannot: age, and the biological ceiling that comes with it. I will not pretend otherwise.

When I think a further cycle is unlikely to succeed, I will say so, and I will talk you through the alternatives — including stopping.

Common questions