Expert Shares Deets On What To Do If An IVF Cycle Fails?

Sep 29, 2021, 15:36 IST


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For any couple, approaching fertility treatments takes a big decision, to step out of their comfort zone and share the details of their lives with a doctor, make changes and walk the road of assisted conception. Amongst all fertility treatments, IVF appears to the couple as the biggest peak to reach and try conquering. What happens when a couple tries and fails at an IVF cycle though? Dr Richa Jagtap, Clinical Director, Consultant Reproductive Medicine, Nova IVF Fertility, Mumbai tells more on the topic.

In all human beings, each embryo has a fecundity or probability of giving pregnancy, to the tune of 30 per cent. Hence no treatment will offer you a 100 per cent chance of conception.  But there are things, attention to which can help improve your chances of finding success. The failure in the IVF cycle can be due to gametes (egg and sperm quality), embryo quality, Womb environment, or other specific reasons which research has slowly unfolded for us.


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Here are the most common causes of failures and ways to overcome these:

Egg Factor

A woman’s fertility is finite and she is born with all eggs she will ever have. As these are stored in ovaries, with time the number and quality of eggs undergo a slow decline. This means it’s a given that eggs from an older woman will have lesser chances of a successful pregnancy than that of a younger one. Other hormone disturbances like Hypothyroidism, PCOS, Hyperprolactinemia also affect the egg’s capabilities to fertilise and give a competent embryo. 

It makes sense to correct any underlying hormone and health issues for a woman before approaching an IVF. Even more so, when the first IVF has failed. Sometimes vitamins and antioxidants will do the trick to improve the egg and embryo quality and help the conception.



The embryos are made of eggs and sperm which fertilise and divide in an orderly manner. As a woman grows older the capability of the oocyte to do this reduces and more chromosomal abnormalities are seen. These lead to the formation of an embryo that may not have the correct chromosome numbers. If the chromosome numbers are incorrect, the embryo may fail to implant, result in an early miscarriage and or lead to an abnormal foetus. 

For women who have failed multiple times, or those who are on the wrong side of the 30s, it then makes sense to check the embryo formed through IVF and evaluate the chromosomal constitution of the embryo before selecting it for implantation. This is called as Pre-Implantation Genetic testing. 


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Image: Shutterstock


Sperms are formed throughout the life of a male. As one grows older this process does become more inefficient but unlike women, there is no real and absolute Andropause. The quality of sperm may still get affected by any systemic disease, obesity, presence of varicocele, hormonal disturbance and use of habit-forming substances. It’s hence advised to keep healthy and recheck Semen parameters in a good lab.

DNA Fragmentation Index is a form of evaluation that helps us to understand the sperms functional capacity. If the DFI is high, we expect poorer outcomes even in IVF.  The good news is that as sperm production is continuous, antioxidants/Lifestyle changes will help improve the DFI. Selecting the most competent sperm by ICSI, PICSI will help improve the IVF outcomes greatly. 


The Right Embryo: Blastocyst Culture

In the natural course of events, egg and sperm fertilise in the Fallopian tube and the resultant embryo divides and grows in the Fallopian tube. It goes from one cell to two to four, eight, sixteen and finally forms a blastocyst by the fifth day. This blastocyst reaches the womb and hatches out to implant in the womb layer. It’s important to note that not all eggs fertilise and not all fertilised eggs from a blastocyst. 

During IVF, your doctor may choose to transfer the embryo on any of the stages of development, but the best chances of implantation are for a timely developed blastocyst. A blastocyst is a fully developed competent embryo that has better implantation potential than the cleavage state embryos or day 2/3 embryos. For those who have failed an earlier IVF cycle with day 2/3 embryos, it’s very advisable to wait for the embryos to develop till blastocyst before selecting them for transfer. 



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Womb Or The Uterine Factor

A perfect embryo will still need a healthy, hospitable environment to implant and successfully grow in pregnancy. The uterus or the womb has an inner layer called the endometrium. This layer is crucial to implantation. A good healthy endometrium assures a better chance of pregnancy. Any irregularity like a small polyp, fibroid, the septum should be looked for. These can be identified in detailed sonography and corrected by hysteroscopy before embryo transfer. 

Many times, smaller factors like, thin or overly thick endometrium or even infections, adhesions etc can lead to a failure. These finer details may not be seen on sonography and need the endoscopy study called Hysteroscopy to evaluate and correct the said factors.


Endometrial Receptivity

In 80-85 per cent of women, the endometrium is receptive, or ready to receive an embryo after five to seven days of ovulation in a natural cycle or day 5 of starting progesterone hormone in an assisted cycle. However, in some 15-20 per cent of women, this receptivity may be altered to a day more or less. This means these women have an unidentified window of implantation which is different from the standard. In such women, the transfer of a perfectly beautiful and normal embryo may also lead to a failed pregnancy as the embryo comes in at an incorrect time.

Identifying and pinpointing this personalised Window of Implantation can be done by a genomic test called Endometrial Receptivity Array. Transfer of a good embryo in the correct window of implantation can improve the chances of pregnancy in those who have failed IVF previously 



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After The Transfer

There is a whole list of myths that keep going around on what are the advisable dos and don’ts after an embryo transfer. One thing is very clear from all evidence and reports. The most important thing is the progesterone medication and prenatal vitamins. The rest of the medications is mostly empirical and may or may not help much. It’s very much advised to understand each medication given by your doctor and underline its importance.

Another glaring misconception is bed rest. It was proven in large international studies that bed rest does not help implantation in any way. It’s better and healthier to be up and about and go about the usual routine unless there is a medical contraindication. 


Lastly, a stress-free mind is the best thing during the time you are planning the treatment. Stress may not cause infertility but it can definitely add to the problem. Keep your mind occupied with things and activities that make you happy and engaged. This will surely go the extra mile to reach that pink line you hope to find at the end of your treatment journey.


Also Read: Misconceptions About IVF That You Need To Stop Believing In