When an IVF Cycle Doesn’t Work: What’s Next?

Facing an In Vitro Fertilization (IVF) cycle that did not result in pregnancy is undoubtedly a very difficult moment for couples dreaming of starting a family. It is normal to feel a mix of sadness, frustration, and perhaps confusion. But it is important to know: a failed IVF cycle does not mean the end of the road. In fact, many couples achieve their pregnancy in subsequent attempts.

This article will guide you through the options and strategies available after such a result, helping you to better understand the process and make decisions with more confidence.

A Quick Overview:

• It’s not the end: A failed IVF cycle does not indicate that future attempts will not work. Most IVF pregnancies are achieved after several attempts.
• Learn from the past: Each failed cycle provides valuable information. A detailed medical evaluation can help us understand what happened and how to adjust the plan for the future.

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What Does a "Failed IVF Cycle" Really Mean?

Medically, we refer to a "failed" IVF cycle when, after the transfer of embryos, a clinical pregnancy is not confirmed. It can also occur if viable embryos are not obtained for transfer from the outset.

It is essential to understand that this technique, although very effective, does not guarantee pregnancy on the first attempt. The Spanish Fertility Society (SEF) indicates that around 70% of IVF cycles do not result in pregnancy on the first attempt [^1]. This does not diminish the effectiveness of IVF; it simply underscores that persistence is often key.

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After a Cycle: What is Evaluated?

After an unsuccessful IVF cycle, the next crucial step is a comprehensive evaluation. This helps us understand the "whys" and adjust the plan for the next attempt. Here are the key points we review:

1. The Quality of the Embryos

Our embryologists closely analyze the embryos from the previous cycle: their shape (morphology), how quickly their cells divided, and how they developed to the blastocyst stage. This analysis can indicate whether medication for ovarian stimulation needs to be changed or if techniques such as Intracytoplasmic Sperm Injection (ICSI) might be more suitable.

2. Uterine Preparation (Endometrial Receptivity)

For an embryo to implant, the inner lining of the uterus, called the endometrium, must be at its optimal state. After a failed cycle, we may suggest tests such as:

• Ultrasound: To measure the thickness of the endometrium.
• Uterine Doppler: To assess blood flow to the uterus.
• Hysteroscopy: A minor procedure to view the inside of the uterus and rule out structural problems such as polyps or fibroids that may hinder implantation.

These tests help us find the perfect timing for transfer or identify if there is something that needs to be treated in the uterus.

3. Immunological Factors

In some cases, the body may "reject" the embryo due to immune system responses. A study in Fertility and Sterility suggests that up to 20% of repeated implantation failures may have an immunological component [^2]. Specific tests can be performed to look for:

• Alterations in cells called "natural killer" (NK).
• Immunological compatibility issues between the couple and the embryo.

Your Options After a Failed Cycle

After the evaluation, there are several paths you can consider, always tailored to your situation and medical findings:

1. Repeat the IVF Cycle

This is the most common option and often the most effective. Statistics show us that the chances of success significantly increase with each attempt. The European Society of Human Reproduction and Embryology (ESHRE) reports that the cumulative success rate after three complete cycles can exceed 60% in women under 35 years old [^3].

2. Transfer Frozen Embryos (if you have them)

If additional embryos were obtained in your previous cycle that could be frozen (cryopreserved), using them is an excellent alternative. It is less invasive and generally less expensive than starting a new cycle from scratch. Thanks to advanced freezing techniques such as vitrification, success rates with frozen embryos today are very similar to those of fresh embryos.

3. Egg or Sperm Donation

When the quality of eggs or sperm is the main obstacle, gamete donation (eggs from a donor or sperm from a donor) may be the most effective option. It is particularly relevant in cases of older women or low ovarian reserve, where the chances with own eggs are lower.

Egg donation, for example, offers success rates that often exceed 50% per transfer, regardless of the age of the recipient woman [^4].

Adjustments in Your Next IVF Protocol

Based on the evaluation of your previous cycle, your specialist may suggest very specific changes to improve the odds in the next attempt:

Adjustments in Ovarian Stimulation

How and how much hormonal medication is used to stimulate the ovaries can be modified. This includes:

• Doses of gonadotropins: Adjusting the amount of hormones.
• Duration of stimulation: How many days the medication is applied.
• Timing of "trigger": Precisely timing the moment for the final maturation of the eggs.

The goal is to achieve the optimal quantity and quality of eggs, avoiding both a very low response and hyperstimulation.

Advanced Laboratory Techniques

There are additional tools that can be used in the laboratory:

• Blastocyst culture: Allowing embryos to develop longer (up to Day 5 or 6) enables the selection of the strongest ones with the highest implantation potential.
• Preimplantation Genetic Testing (PGT): Analyzing embryos for chromosomal abnormalities before transfer. This is crucial to reduce implantation failures and miscarriages in specific cases.
• Assisted Hatching: A little help for the embryo to "break out" of its protective layer (zona pellucida) and implant more easily.
• Advanced sperm selection techniques: Such as MACS (magnetic-activated cell sorting) or PICSI, to choose the highest quality sperm.

Improving Uterine Preparation

To optimize the endometrium, the following can be considered:

• Deferred transfer cycles: Preparing the uterus with hormones in a cycle different from ovarian stimulation.
• Support therapies: Supplements such as Vitamin D, Folic Acid, or Coenzyme Q10, always under medical indication.
• Improving uterine blood flow: With low doses of acetylsalicylic acid in specific cases.
• Immunological therapies: In very selected situations, immunoglobulins or corticosteroids may be considered if an immunological factor is suspected.

The Vital Role of Emotional Support

The psychological impact of a failed IVF cycle is immense and should not be underestimated. Feeling stress and anxiety is part of the process, and it can influence outcomes. Studies in Human Reproduction have shown that stress and anxiety can negatively affect treatment outcomes [^5].

Therefore, it is highly recommended:

• Seek psychological support: Infertility specialists can provide tools to manage emotions.
• Join support groups: Connecting with people experiencing similar situations can be very comforting.
• Practice stress reduction techniques: Mindfulness, yoga, or meditation can be very helpful.
• Maintain communication: Openly discussing your feelings and expectations with your partner is essential.
• Take breaks: Sometimes, a pause between treatments is necessary to recover emotionally and return with renewed strength.

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Frequently Asked Questions

How long is it recommended to wait between a failed cycle and the next attempt?

Most specialists suggest waiting at least one complete menstrual cycle before starting a new treatment. This time allows your body to recover and provides space for any additional tests we may need to perform. Emotional recovery is also crucial.

How many IVF cycles are considered reasonable before exploring other alternatives?

There is no magic number that applies to everyone. The decision depends on many factors: your age, the quality of the embryos obtained, the specific cause of your infertility, and, of course, what you and your partner feel emotionally and financially. Statistically, cumulative success rates tend to increase significantly up to the third or fourth attempt.

Can diet and lifestyle influence the success of an IVF cycle?

Yes, definitely. Several studies suggest that good nutrition, moderate exercise, avoiding tobacco and alcohol, maintaining a healthy weight, and managing stress can positively impact the quality of eggs and sperm, as well as the receptivity of your uterus. A Mediterranean diet rich in antioxidants and Omega-3, along with a balanced lifestyle, is recommended.

Can supplemental medications or alternative therapies improve success rates?

Some supplements, such as folic acid, vitamin D, CoQ10, or Myo-inositol, have shown promising results in studies. However, it is crucial to consult with a specialist before taking any supplement. Not all are suitable for every case, and some could interact negatively with your fertility treatment medications.

In Summary

A failed IVF cycle is a significant challenge, but it does not mark the end of your journey towards parenthood. Evidence shows us that many couples achieve their dream in subsequent attempts, especially when personalized adjustments are made based on previous experience.

The approach after a failed cycle should be comprehensive: from a thorough medical evaluation and possible changes in the protocol to ongoing emotional support. There are various options, from repeating the cycle with new adjustments, using frozen embryos, considering egg or sperm donation, to exploring paths like adoption.

Making well-informed decisions, having the right professional support, and maintaining a perspective that combines realism with hope are key to navigating this process. Each cycle, even if unsuccessful, provides valuable information that can bring you closer to your goal.

Are you thinking about starting fertility treatment or need guidance after a cycle? At Avida Fertility, we accompany you with personalized attention and all the care you deserve. Schedule your consultation today and take the first step towards your dream of starting a family.

References:

[^1]: Spanish Fertility Society (SEF). (2023). Report on assisted reproduction treatment results in Spain. 

[^2]: Coughlan, C., et al. (2021). Immunological aspects of recurrent implantation failure. Fertility and Sterility, 115(2), 263-273.

[^3]: European Society of Human Reproduction and Embryology (ESHRE). (2024). ESHRE publishes latest ART data. 

[^4]: European Society of Human Reproduction and Embryology (ESHRE). (2024). Data on oocyte donation success rates. 

[^5]: Frederiksen, Y., et al. (2022). The impact of psychological interventions on fertility treatment outcomes: A systematic review and meta-analysis. Human Reproduction, 37(1), 105-119. 

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