Causes & Treatment

What to Do After a Failed IVF Cycle?

Eloise Edington  |   2 Nov 2021


A failed cycle doesn’t have to be the end of the IVF journey. Fertility Help Hub have spoken with Dr. Guy Ringler (a fertility specialist partner at California Fertility Partners) to get to the bottom of IVF and surrogacy success.

Read on to discover how new tests following a failed first round of IVF could potentially help to counter a second failure.

By Dr. Guy Ringler

When utilizing IVF and/or surrogacy to help people build their family, we approach every pregnancy with the utmost care and focus on (IVF) success.

Yet despite all the advancements in IVF over the last four decades, not every embryo transfer results in an ongoing pregnancy or live birth.

A failed cycle does not have to be the end of your fertility journey, but just the latest step that will hone everyone involved and lead to an even greater chance of IVF success on the second attempt. It’s important to learn as much as possible after a failed transfer in an attempt to determine a possible cause, or factors that may have been responsible.

In general, there are three possible areas to focus on: the embryo, the uterine environment, or the systemic environment.

The role of embryo quality

After a failed cycle we’ll start by reviewing the quality of the transferred embryo. Was it PGT-tested? What was the grade at the time of freezing? Did it become a blastocyst on day five, six or seven of culture?

If embryo quality is of concern, the next question is how to improve that. Was there an egg or sperm-quality issue? If we suspect a sperm issue, we may run additional fertility tests, such as sperm DNA fragmentation for additional insight.

For egg-quality issues, we look at the ovarian stimulation protocol and ovarian response to see what can be improved in a future cycle.

For both egg and sperm quality issues, it’s important to look at diet and lifestyle factors that can have an impact. A change in diet to a more Mediterranean-style diet, with additional vitamins and antioxidants, can be helpful for both egg and sperm quality.

These are all important questions to be asking as we examine the possible role the embryo quality has played in the failed cycle.

Of course, it’s entirely possible the embryo was of the highest quality and that doesn’t appear to be a concern.

The uterine environment

The next component we’ll look at is the uterine environment. We may repeat a uterine evaluation to make sure there are no structural lesions that prevent embryo implantation.

We’ll also review the hormone levels during the treatment cycle, to make sure they were appropriate.

A mock cycle for the endometrial receptivity assay can be helpful. It allows us to fine-tune the hormone protocol for the transfer cycle to optimize IVF implantation success rates.

The systemic environment

As a third step we’ll review the surrogate’s systemic environment, or overall health level, to see if any issue could be making the process more challenging.

We’ll check her thyroid hormones to confirm they are normal. We’ll make sure she doesn’t have any untreated medical issues that might interfere with conception. We’ll review her stress levels during the cycle, as stress can be a powerful deterrent of IVF success.

Basically, we’re looking for clues to see if anything can be improved upon before another transfer.

Some things like smoking, alcohol and drug use should have been screened out, so those shouldn’t come into play here.

Changing surrogates

Most of the time, after these reviews we find success on the second try.

Yet the reality is, for some people, that everything checks out and there is still a failed second or even third attempt.

Traditionally, we have opted to change surrogates after that third failed attempt. However, with PGT testing, I now consider changing surrogates after the second failed cycle. We know so much more going into each attempt than we did a decade ago, and it simply may be that a change of surrogate will yield IVF success.

It’s not a decision anyone takes lightly, as it can have an emotional toll on everyone involved. Still, it’s a consideration we may have to make to help the intended parents (IPs) have the family of their dreams.

Dr. Guy Ringler is a partner at California Fertility Partners, where for three decades he has helped people around the world have children through IVF and surrogacy. If you would like to learn more about the partners at CFP, click the link and see for yourself why they are renowned for excellent fertility care.

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