IVF failure causes high financial costs, but especially emotional ones. The loss of a child, no matter at what stage, is always a painful experience in which it is difficult to see the positive aspects. However, it is worth looking at it as an opportunity to understand the possible causes of infertility better and learn lessons before the following approach. The more we know about what could have been the cause, the more opportunities to perform additional tests and modify the treatment plan so that the next attempt can be successful. Many couples go through several IVF attempts before their longed-for child is born. Therefore, you should not be heartbroken by an unsuccessful attempt but hope for success in subsequent cycles.

Summary

• Failed IVF attempts are common, but the chance of success increases with subsequent cycles.
• Many factors affect the effectiveness of IVF, among which age, hormone levels, the quality of the embryo, and the ability of the uterus to accept it, as well as genetic and environmental factors, play important roles. 
• After an unsuccessful IVF attempt, it is important to carefully review the previous cycle with your doctor. The more lessons learned from the previous procedure, the greater the chance of success in the next cycle.
• Do not be ashamed of your emotions. The support of loved ones and professional therapists is essential after a failed IVF attempt and while preparing for the following one.
• Although you have no control over many biological factors, you can increase your chances of IVF success by maintaining a healthy diet, physical activity, and mental health.
• If the basic IVF procedure fails, you still have a chance to have a baby! You can consider gamete donation, surrogacy or adoption. Remember that parenthood is all about relationships, not biology, so a child that does not come directly from your body is still YOUR child that you can love and raise, regardless of its origin.

Understanding IVF Failure

Statistics and Success Rates

The failure of an IVF cycle is not uncommon, with success rates varying depending on multiple factors such as maternal age, ovarian reserve, and overall health. According to the Society for Assisted Reproductive Technology (SART), the overall live birth rate for IVF cycles in the United States in 2020 was approximately 24% for women under 35 years old, but it decreases significantly with age. The rate for women aged 35-37 was 19%, and for women aged 38-40, it was 15%. Similarly, the Human Fertilisation and Embryology Authority (HFEA) in the UK reported that the live birth rate per IVF cycle for women under 35 was 32.5%, which dropped to 11.6% for women aged 40-42.

Data from the European Society of Human Reproduction and Embryology (ESHRE) indicate that success rates vary by country, with an average of 30% for all age groups across Europe. It also reveals a steady and progressive rise in the use of Assisted Reproductive Technology (ART). While Belgium, the Czech Republic, and Estonia have the highest ART availability in terms of cycles per million population with
numbers higher than 2800 cycles per million inhabitants, Spain is the European leader when it comes to the number of performed treatment cycles – stunning 137k in 2019. According to the latest data provided by the Spanish Fertility Society (SEF in Spanish), a total of 165,453 IVF cycles were registered in Spain in 2021. These allowed 40,638 babies to be born, which is equivalent to 12% of the total number of births in the country in that year.

Why Does IVF Fail?

IVF cycles can fail for several reasons, so it is often difficult to isolate one specific reason, as more than one factor may contribute to IVF failure. The causes may overlap and together result in failure of an embryo implantation or subsequent miscarriage. Possible causes are briefly described below. Before the next IVF attempt, it is important to analyze carefully with the doctor all the factors that could have influenced the failure to avoid repeating mistakes and increase the chances of success of the following IVF procedure.

Age and hormones

One of the most common reasons is advanced maternal age, as egg quality declines with age, making it harder for embryos to implant successfully. It was found that age was a major predictor of IVF failure, particularly after age 35, due to the reduced quantity and quality of oocytes. A woman’s age significantly affects her chances of success with in vitro fertilization (IVF). This relationship is closely linked to her ovarian reserve and hormone levels, particularly Anti-Müllerian Hormone (AMH) and Follicle-Stimulating Hormone (FSH). As a woman ages, her ovarian reserve (the number of eggs available in her ovaries) naturally decreases. This decline impacts her ability to produce healthy eggs, ultimately influencing the likelihood of a successful IVF cycle.

AMH and FSH are crucial hormones for assessing ovarian reserve. AMH is produced by small follicles in the ovaries and its levels indicate the number of eggs a woman has remaining. As ovarian reserve declines with age, AMH levels also drop. Research has shown that low AMH levels are often associated with a decreased probability of success in IVF treatments since fewer eggs are available for fertilization. Conversely, FSH is a hormone that stimulates the ovaries to produce eggs. Elevated levels of FSH suggest that the ovaries are not responding well to stimulation, indicating poor ovarian reserve. High FSH levels can lead to lower success rates in IVF, particularly in older women.

For instance, one study found that women over 35 face a significantly reduced chance of IVF success due to the quantity and quality of their eggs deteriorating, as reflected in their AMH and FSH levels. As women age, the eggs they produce are more likely to have chromosomal abnormalities, further decreasing the chances of successful fertilization and implantation. Thus, age, ovarian reserve, and the levels of AMH and FSH provide essential information regarding IVF success, with younger women typically enjoying better outcomes due to higher ovarian reserves and more favorable hormone levels. In summary, as women age, their ovarian reserve decreases, affecting the quality and quantity of eggs. This, combined with lower AMH and higher FSH levels, results in reduced IVF success rates, especially for women over 35.

Embryo quality

Poor embryo quality is another key factor, as embryos may not develop properly or may have chromosomal abnormalities. Research has shown that genetic abnormalities in embryos are common, particularly in older women, and this can result in miscarriage or failed implantation. 

Recent investigations into in vitro fertilization (IVF) outcomes have consistently underscored the importance of embryo quality in determining cycle success. Studies indicate that embryos exhibiting poor morphological features, such as irregular cell division, high fragmentation, and asynchronous development are significantly associated with an increased risk of IVF cycle failure. 

Moreover, advancements in assessment techniques, including time‐lapse imaging and preimplantation genetic testing, have enhanced embryo selection by identifying embryos with optimal developmental kinetics and euploid chromosomal status, which correlate with higher implantation potential and lower failure rates. 

In addition, systematic reviews suggest that while conventional morphological grading remains a valuable predictor, its accuracy is improved when combined with metabolic and genetic markers, supporting a multifaceted approach to embryo evaluation . Collectively, these findings advocate for integrating comprehensive embryo assessment protocols to reduce the likelihood of IVF failure and improve overall clinical outcomes.

Genetics

IVF failure is a multifaceted issue influenced by various genetic factors affecting both male and female gametes, as well as early embryonic development. Understanding these genetic underpinnings is crucial for improving IVF outcomes.

Female infertility can stem from genetic anomalies that disrupt oocyte development, fertilization, and early embryonic progression. Advancements in molecular genetics have identified several genes implicated in these processes. Mutations in genes such as FSH, INHA, FOXO3A, FOXL2, and BMP15 have been associated with primary ovarian insufficiency, leading to compromised oocyte quality and quantity. These genetic defects can result in failed fertilization or early embryonic arrest, contributing to IVF failure. Additionally, chromosomal abnormalities, including balanced translocations, can adversely affect embryo quality. While individuals with balanced translocations are often asymptomatic, their gametes may carry unbalanced genetic material, leading to embryos with chromosomal imbalances that fail to implant or develop properly.

Male genetic factors significantly influence embryo quality and IVF success. Y chromosome microdeletions, particularly in the AZFc region, have been linked to increased rates of sperm DNA fragmentation and chromosomal abnormalities. A study demonstrated that such microdeletions are associated with a higher incidence of embryo aneuploidy, which can lead to implantation failure or miscarriage. Moreover, mutations in the WEE2 gene have been identified in cases of fertilization failure post-intracytoplasmic sperm injection (ICSI). The WEE2 gene plays a pivotal role in oocyte activation; its disruption can impede fertilization even when sperm injection is employed, underscoring the importance of genetic screening in couples undergoing IVF.

Embryo quality is paramount for successful implantation and ongoing pregnancy. Genetic and epigenetic abnormalities during early embryonic development can lead to arrest or failed implantation. Studies have highlighted that defects in genes regulating cell division and differentiation can cause early embryonic arrest, thereby contributing to IVF failure. Epigenetic modifications, such as DNA methylation and histone modification, also play a critical role in gene expression during embryogenesis. Aberrant epigenetic patterns can disrupt normal development, leading to implantation failure or miscarriage. Research into these epigenetic mechanisms offers potential therapeutic targets to enhance embryo viability and IVF success rates.

Other factors: implantation failure, uterine abnormalities, and environmental factors

Furthermore, in some cases, implantation failure may be due to problems with the endometrial lining, preventing the embryo from implanting properly. Other factors include uterine abnormalities, such as fibroids or endometrial conditions, which can hinder embryo implantation. In addition, lifestyle factors such as smoking, obesity, and excessive alcohol consumption are known to decrease IVF success rates.

What to do if you have a failed IVF cycle?

Psychological Support and Counseling

A failed IVF cycle is not only a clinical setback but also an emotionally challenging event for couples. Numerous studies have documented increased levels of anxiety, depression, and stress following treatment failure. Consequently, integrating psychological support—including counseling, stress management interventions, or referral to mental health professionals—into the management plan is recommended. Addressing the emotional dimensions of infertility may not only improve the quality of life but also optimize conditions for future treatment cycles.

Recovery: Building Resilience and Finding Support

Coping with an unsuccessful IVF cycle can be emotionally overwhelming, but research suggests that certain strategies can help manage the psychological impact. Emotional support plays a crucial role, with studies indicating that patients who receive psychological counseling or support from family and friends report lower levels of anxiety and depression after an IVF failure. 

It is proven that:

• women who received psychological support during IVF treatments experienced significantly less emotional distress, 
• allowing time to process the grief associated with an unsuccessful cycle is linked to improved long-term well-being, 
• maintaining a healthy lifestyle through regular physical activity can reduce stress and improve mental health. Moderate exercise reduces anxiety and improves overall psychological resilience during IVF treatment. 

Open communication with healthcare providers is also vital, as discussing future options, such as additional cycles or alternative treatments, can help patients feel empowered and informed about their next steps. These evidence-based strategies can help manage the emotional toll of an unsuccessful IVF cycle.

Planning Your Next IVF Attempt

Planning the next IVF attempt requires a thorough analysis of the previous failure with the doctor, which can clarify the reason for the failure. It is crucial because the more information is collected and analyzed, the greater the chance of success of the next attempt. 

The patient should collect all the tests and visit reports carried out so far in one place and arrange them chronologically, making it easy to analyze. 

Keep in mind that although you have had a large number of tests performed before the previous trial, many of them will have to be repeated to gain up-to-date knowledge of the patient’s and her partner’s health. 

It is also important to report to the doctor any new information, situations, or conditions that could potentially affect the planned IVF procedure, such as current infections or new medications ordered by another doctor. 

If the couple has any doubts about the preparation process or the IVF procedure itself, they should discuss it with the doctor, as any factor, even seemingly insignificant, can affect the procedure’s outcome. It should be remembered that there are no stupid questions, and any ambiguity should be patiently and substantively explained by the doctor. 

Is IVF abroad a better option after repeated failures?

Changing the infertility clinic should be considered when cooperation with the current place is not going well or when the patient has lost trust in the current doctor. The IVF procedure is a long process requiring frequent visits to the clinic, so a place close to home will be the most convenient option. In most European countries, the level of knowledge and capabilities of doctors in the field of infertility treatment is high, which is why it is recommended to try to cooperate with a clinic located in the country of residence of the couple trying to conceive. If all treatment options in the country have been exhausted, it is worth finding out whether foreign clinics can expand the diagnostics or change the treatment protocol. However, it is necessary to take into account the need to go abroad for several weeks or frequent long journeys, which are not only uncomfortable and inconvenient but also increase the costs of the entire procedure.

Comprehensive Diagnostic Reassessment

After a failed IVF cycle, a critical first step is to review and refine the diagnostic workup. Many experts emphasize that a failed cycle may reflect underlying patient factors—such as diminished ovarian reserve, suboptimal sperm parameters, uterine anomalies, or genetic issues—that were not fully appreciated in the initial evaluation. A detailed re‐assessment can help distinguish between problems related to ovarian response, gamete quality, embryonic development, or endometrial receptivity.

This comprehensive evaluation may include repeat ovarian reserve testing (AMH and FSH levels, AFC on ultrasound), hormonal studies, esp. prolactin and androgens levels, a reassessment of male factor infertility (seminogram and other advanced sperm tests), uterine cavity imaging (3D ultrasound, HyCoSy, hysteroscopy, and MRI in selected cases), and, in some cases, genetic or immunologic investigations.
It is crucial to evaluate the general health of both partners, as metabolic, endocrine, and other factors play a significant role in fertility. A comprehensive general work-up should include thyroid function assessment (TSH, fT3, fT4, antibody screen), diabetes and metabolic screening (fasting glucose, HbA1C, oral glucose tolerance test (OGTT) in selected cases) as well as liver and kidney panels, complete blood count, inflammatory markers and nutritional parameters if clinically indicated.

Embryology Laboratory and Embryo Assessment

Laboratory factors, including culture conditions and embryo evaluation techniques, are integral to IVF success. Studies have suggested that subtle variations in culture protocols or embryo assessment methods may influence outcomes. For instance, the adoption of time‐lapse imaging and morphokinetic evaluation has been associated with improved embryo selection, potentially leading to higher implantation rates in subsequent cycles. Reviewing laboratory practices and, if needed, modifying embryo selection criteria may therefore be beneficial after a failed cycle.

Ovarian Stimulation Protocol Modifications

Adjusting the ovarian stimulation regimen is another frequently recommended strategy. Research indicates that the response to stimulation is highly individual. For patients whose initial cycle yielded a suboptimal follicular response, modifications—such as altering the dose of gonadotropins or switching between long gonadotropin-releasing hormone (GnRH) agonist and antagonist protocols—may improve oocyte yield and quality in subsequent cycles. Such protocol individualization, based on a patient’s ovarian reserve and previous cycle performance, is supported by several controlled studies.

Endometrial Receptivity Evaluation

A growing body of evidence underscores the importance of the endometrium in successful implantation. In cases of repeated implantation failure, assessing endometrial receptivity can be informative. Diagnostic tools like the Endometrial Receptivity Array (ERA) have been developed to determine the optimal window for embryo transfer. Studies report that timing transfer according to individual receptivity patterns may improve implantation rates for select patients. Therefore, in patients with prior cycle failures, evaluation of endometrial receptivity may guide adjustments in the timing of embryo transfer or the use of adjunctive treatments aimed at improving the endometrial environment.

Adjuvant Therapies

The use of adjuvant treatments remains controversial, with variable evidence regarding their benefit. Interventions such as low-dose aspirin, heparin, and immunomodulatory agents (e.g. corticosteroids) have been studied to enhance endometrial receptivity or reduce immunologic rejection of the embryo. Meta-analyses and systematic reviews indicate that while some subgroups may benefit from these interventions, the overall evidence is mixed, and such therapies should be applied selectively after thorough patient counseling.

Genetic testing

The identification of genetic causes of IVF failure has significant clinical implications. Genetic screening of both partners can uncover underlying issues that may not be evident through standard assessments. For instance, detecting Y chromosome microdeletions or WEE2 mutations can inform tailored treatment strategies, such as donor gametes or specific fertilization techniques.

Preimplantation genetic testing (PGT) allows for the selection of embryos with normal chromosomal compositions, potentially reducing the risk of implantation failure and miscarriage. However, the application of PGT must be carefully considered, as it involves ethical, financial, and technical challenges.

Counseling on Cumulative Success Rates and Future Options

Data from large national and international cohorts suggest that while a single-cycle failure can be disheartening, cumulative live birth rates improve with successive cycles. It is important to counsel patients regarding realistic cumulative probabilities of success over multiple attempts and to set appropriate expectations. There is no data to back up a common practice of extending an interval between treatment cycles for more than one consecutive cycle. The research found no correlation between the time interval between consecutive oocyte retrievals of 30 up to 180 days and the number of oocytes or mature (MII) oocytes retrieved, neither in patients with low response with up to 4 oocytes retrieved nor those with 5 oocytes or more.

Studies have also shown that high levels of FSH (>10-20 IU/L) and estradiol (>60-80 pg/mL) affect a woman’s response to ovarian stimulation with gonadotropins, a higher risk of IVF cycle cancellation, and consequently lower pregnancy rates. The specificity of the FSH test ranges from 83 to 100%, and the sensitivity from 10 to 80%. Estradiol testing on its own is not conclusive, but in combination with FSH levels, it gives a broader picture of the situation and a given patient’s chances of a successful IVF procedure. 

AFC (antral follicle count) is the sum of the antral follicles in the early follicular phase. With AFC, it is possible to assess the patient’s anticipated response to gonadotropins and the number of oocytes that can be obtained. Low AFC is a poor prognostic factor in the IVF process.

Low serum AMH levels (<1 ng/mL) have been linked to poor response to ovarian stimulation, poor embryo quality and worse outcomes in the IVF procedure. 

In cases of repeated failures, discussions regarding alternative strategies—such as the use of donor gametes, surrogacy, or even adoption—should be initiated as part of a shared decision-making process.

Conclusion

Management after a failed IVF cycle is best approached with a comprehensive, individualized strategy. Key steps include a thorough reassessment of diagnostic findings, optimization of laboratory and stimulation protocols, evaluation of endometrial receptivity, and consideration of selective adjuvant treatments. Equally important is addressing the psychological impact and counseling couples regarding the cumulative likelihood of success and alternative reproductive options. This multifaceted approach is supported by a growing body of literature and consensus guidelines, emphasizing that a failed cycle often represents an opportunity for refining treatment strategies rather than a definitive end to achieving pregnancy.

FAQs: Addressing Common Questions

What is the success rate of IVF?

In general, success rates hover around 30 percent for all age groups. The best chances are for women under 35. The older the patient is, the lower the chance of success for the IVF procedure. It should be kept in mind that the success of an IVF procedure depends on many factors besides age, including genetics, embryo quality, or hormone levels. Hence, each patient’s chance of IVF success is an individual matter. Despite lower success rates, even patients around 40 can hope to succeed and have their biologically own child through IVF. 

Why does IVF fail?

There are many reasons why IVF fails. Often, it is an accumulation of several causes that intermingle. Among the most common causes of failure are genetics, age, the influence of hormones, abnormal structure and quality of embryos, problems with embryo implantation, defects in uterine structure, or environmental factors. It is worth knowing that although most of the factors mentioned above are beyond the prospective parents’ control, there are things that can be done to minimize the risk of another failure. Both parents should eat healthy, lead active lifestyles, and avoid unnecessary exposure to harmful factors, including smoking and drinking alcohol or other intoxicating substances. Parents’ healthy lifestyle has been proven to increase the chances of a successful IVF procedure. 

How do you cope mentally after a failed IVF attempt?

A failed IVF procedure is a huge loss for both partners. Each couple and each person has the right to go through this period in the way that is most appropriate for them. You have the right to intimacy, peace, and time just for yourselves. If you need support from your loved ones or professionals, do not be afraid or ashamed to ask for it. A qualified psychologist or psychiatrist can help you cope with trauma, feelings of emptiness,s and loss. Some people are also helped by redirecting their thoughts to other activities. For example, physical activity may be a good idea, as it not only occupies the mind with something else but also allows you to get rid of accumulated emotions and reduce stress levels. When you are ready, it is also a good idea to talk to your doctor about options for further treatment and subsequent approaches to the IVF procedure. Just remember to do everything on your terms and at your own pace, as each of you may need a different time to bounce back after the loss of a child.

Does my age affect the success of IVF?

Unfortunately, yes. The younger the patient, the greater the chance of success of the IVF procedure. Data from the United States from 2020 shows that in patients under 35, the success rate is 24 percent. In women aged 35 to 37, the rate dropped to 19 percent, and in patients aged 38 to 40, the chance of success of the IVF procedure was only 15 percent. Age primarily affects the quality of both partners’ gametes. In women, ovarian reserve and the quality of oocytes decreases, and thereto, the level of the hormone AMH decreases and FSH increases, which reduces the chances of fertilization, implantation, and proper embryo development. In men, sperm motility and morphology deteriorate, making their quality decline. All the above factors are associated with body aging and the poorer quality of gametes.

What is the procedure after a failed IVF attempt?

The procedure may vary depending on the individual circumstances and the couple’s situation. In the case of a miscarriage, it is possible that the woman’s body will remove the embryo on its own, or it will require a procedure in the hospital. During such a procedure, material may be secured for genetic testing, which may help identify the cause of the failure. Doctors will also perform additional laboratory tests (such as hormone levels, semen tests, or immunology tests) and imaging tests (such as ultrasound examinations, hysteroscopy, or MRI) and analyze the results of previous tests and procedures (including analysis of ovulation stimulation performed or previous genetic tests). Analysis of the above aspects can help identify problems in a specific area, including ovarian response, germ cell quality, embryo development, or endometrial receptivity. The more information collected and analyzed, the better the chance of getting answers about what may have caused the failure. 

Are there any other options besides IVF to have a child?

Although every couple trying to have a child dreams of having a child of their own, sometimes it is impossible for medical reasons. Although it is hard to accept this and consider other options at the initial stage, it is worth considering other paths to parenthood after some time. A chance to have a child genetically related to the parents is surrogacy. This is a method of assisted reproduction that involves developing a child in the body of another woman. A surrogate can be related to the child by allowing her egg to be fertilized or be subject to an embryo implantation procedure for partners who want to have a child derived from their gametes. Another option for having a child is adoption, which is the creation of a family with a child unrelated to the prospective parents.

Is a failed IVF my fault?

No, and the woman should never think so. Even if the cause is on the woman’s side, it is independent of her, and she should never blame herself. Sometimes, despite many attempts, it is impossible to achieve success in the IVF procedure because it is not a method that will work for every woman. It is essential to provide medical-psychological support to a woman who has undergone an unsuccessful IVF attempt, as it is a harrowing experience that many women consider to be their weakness and failure. The support of loved ones and medical staff should focus on providing them with a sense of understanding and full support so that they do not lose themselves in blaming themselves for the failure of the IVF procedure.

How can I increase my chances of IVF success?

Many factors influence the success of an in vitro procedure. Many of these factors depend on the doctors and the plan of action they have prepared, including laboratory and imaging tests, the treatment needed, the procedure for collecting gametes, or the embryo implantation process itself. However, partners can take care of things up to them. It is advisable to lead a healthy and active lifestyle, eating good quality food, playing sports, and avoiding stimulants such as cigarettes and alcohol. The woman should also take care of sleep hygiene and mental health, as a well-rested and relaxed body has a better chance of maintaining a pregnancy. It is important to follow all medical recommendations, including taking certain medications and supplements, as they are essential for the success of the entire IVF procedure.

True stories

Debina Bonnerjee story

Debina Bonnerjee has had many failed IVF attempts, but one was finally successful. In 2022, she became a mother to a baby girl whom she and her partner Gurmeet named Lianna. During her journey to parenthood, she faced social pressures and health problems, including endometriosis. Debrina has some important advice for other women trying to have a baby based on her own experiences. 

• It’s a good idea to choose an infertility clinic close to where you live since all the preparation for the IVF procedure requires numerous and frequent medical visits. 
• You should freeze your ova to ensure that you can have a child later in life, as they may be of poorer quality later on, and you may have problems getting pregnant. 
• It’s also worth testing the level of the AMH, as it correlates with the pool of available oocytes. This can be used to determine the time left to decide on motherhood. 

Her example shows that even a few unsuccessful attempts do not nullify the chance of becoming a parent. Her moving story can be a consolation and a gleam of hope for other couples struggling with infertility and failed IVF attempts.

Gillian Herron story

Gillian has a history of nine failed IVF attempts. Finally, she and her husband, Joe, were unable to become parents. Gilian suffered from polycystic ovary syndrome (PCOS), which makes it difficult to get pregnant. During her IVF attempts, she managed to undergo embryo transfer 5 times, but each attempt ended in miscarriage. Her story shows that even multiple approaches do not guarantee success, and there are women in the world who, despite strenuous attempts, have not become moms. Despite her difficult and traumatic experiences, Gillian argues that it is possible to reevaluate one’s life and accept the fact that one will not have a child. However, it does not mean it is impossible to lead a happy and satisfying life. Gillian has found herself in the role of aunt, who loves spending time with her nieces and nephews, and her relationship with her husband has become even stronger after what they went through together. 

Loree Johnson story

Loree had two pregnancies from natural conception, which unfortunately failed. She, therefore, decided to approach the IVF procedure despite her relatively advanced age for this type of procedure. Two attempts also failed. At the age of 45, she decided to try again, and this time, she succeeded. She became a mother to Soso. However, she points out how much of a physical, mental and financial challenge the entire IVF process is. Loree’s story gives hope for late motherhood and demonstrates the importance of considering freezing egg cells at a younger age. In a world of chasing careers and money, one can lose track of the ticking biological clock that will not stop and wait for any of us.