IVF failure occurs when your IVF cycle ends without a pregnancy or live birth. You may not have enough viable eggs or embryos to continue the process, your embryo transfer may fail, or your fertility care team may decide that it is not safe for your body to continue with your cycle. However, IVF failure does not necessarily signal the end of your fertility journey.
In vitro fertilization (IVF) is not a single procedure but a series of complex procedures designed to produce multiple eggs and embryos, each of which is a chance at pregnancy. However, not every follicle will become an egg, not every egg will fertilize and grow into an embryo, and not every embryo will implant. This attrition is sometimes referred to as the “IVF Funnel.”
In other words, because IVF treatment is not a single procedure but a series of complex procedures, there are many points in the process when your IVF cycle may end without a pregnancy or live birth. When this happens, it’s often referred to as IVF cycle cancellation or IVF failure. It’s possible that you may not have enough viable eggs or embryos to continue the process. Another reason for failed IVF is that your fertility care team may decide that it is not safe for your body to continue with your cycle. Below, we’ll outline the points during the IVF process at which this decision may occur, and what your options are if that happens.
IVF begins with ovarian stimulation, when the ovaries are stimulated with hormone medications to produce more eggs than normal during a menstrual cycle. Your reproductive endocrinologist (RE) may decide to cancel your cycle (meaning that egg retrieval doesn’t occur) during ovarian stimulation because of:
In some cases, IVF failure occurs during or after egg retrieval. This can happen for a number of reasons:
Though you may have mature eggs after retrieval, it’s possible that they may not fertilize. Some reasons for this include:
After fertilization, your embryos will grow in culture in the lab for 3-7 days. Usually, fresh embryo transfer occurs after the embryo has grown for about 3-5 days. If you are doing a frozen embryo transfer, your embryologist will likely wait until the embryos have reached the blastocyst stage (which usually occurs on day 5-7) to assess them for quality (also known as “embryo grading”) and select embryos for transfer. However, it’s possible that none of your embryos will grow sufficiently to transfer or freeze.
If you are concerned about chromosomal or genetic abnormalities, which can cause miscarriage or lifelong disability for your child, you may choose to do Preimplantation Genetic Testing (PGT) on your embryos. Your embryologist will take a small section of cells from the outer layer of the blastocyst stage embryo to conduct these tests. It is possible that your test results may show that none of your embryos were chromosomally or genetically normal, in which case you may choose to end your IVF cycle.
If you have embryos to transfer, your RE will likely transfer one at a time. IVF failure may still occur at this stage if the embryo does not implant, or if you miscarry. Some reasons for failed embryo transfer include:
What can be particularly difficult is that failed implantation symptoms can be similar to the symptoms of implantation success: breast tenderness, cramping, headaches, and bloating. This is because you will likely be supplementing with the hormone progesterone, which helps support an early pregnancy, and progesterone can cause those symptoms as well. Because of this, it’s important to wait for your pregnancy test before assessing the success of your embryo transfer.
If you’ve experienced IVF failure, you’re not at all alone. According to the Centers for Disease Control and Prevention’s (CDC) data for 2020, even for patients under 35, only 51.1% of assisted reproductive technology (ART) cycles resulted in a live birth (1). The chance that an IVF cycle will fail increases with age, since age increases the likelihood of diminished ovarian reserve and of aneuploid (chromosomally abnormal) embryos. Below is a chart from the CDC that shows which percentage of intended egg retrievals in the US in 2020 (in other words, among IVF cycles that were started) resulted in a live birth, by age.
Multiple IVF cycles are often necessary before a live birth. Because success rates decrease with age, this is especially true for patients above 35.
Another way to look at this data is to view the average number of intended egg retrievals necessary by age group before the patient had a live birth:
As you can see, on average, patients need more than one egg retrieval before a live birth, and this number increases greatly after age 40.
It’s important to note that success rates are measured by the age of the patient at the time of egg retrieval. If you froze your eggs or embryos and transferred them several years later, you should assess your chance of success by your age when your eggs were retrieved. Along those lines, if you are using an egg donor, your success rates will be measured by the age of your egg donor when the eggs were retrieved.
It’s very difficult to start IVF and not get the much wanted outcome of a pregnancy after so much effort. Knowing some of the reasons why IVF fails can help set expectations and inform your conversations with your clinician. As you can see here, IVF failure can be a single step on your journey through infertility.
“Assisted Reproductive Technology (ART) DataAssisted Reproductive Health Data: Clinic | DRH | CDC.” Nccd.cdc.gov, nccd.cdc.gov/drh_art/rdPage.aspx?rdReport=DRH_ART.ClinicInfo&rdRequestForward=True&ClinicId=9999&ShowNational=1.
Simon, Alex, and Neri Laufer. “Repeated Implantation Failure: Clinical Approach.” Fertility and Sterility, vol. 97, no. 5, May 2012, pp. 1039–1043, https://doi.org/10.1016/j.fertnstert.2012.03.010.
Qublan, Hussein S., et al. “Acquired and Inherited Thrombophilia: Implication in Recurrent IVF and Embryo Transfer Failure.” Human Reproduction (Oxford, England), vol. 21, no. 10, 1 Oct. 2006, pp. 2694–2698, pubmed.ncbi.nlm.nih.gov/16835215/#:~:text=Combined%20thrombophilia%20(two%20or%20more, https://doi.org/10.1093/humrep/del203. Accessed 1 May 2023.
Join the newsletter for IVF education, updates on new research, and early access to Alife products.