Why does IVF fail? A list of possible reasons

Question mark and exclamation mark

WHEN YOU'VE BEEN DEALT THE HORRIBLE BLOW THAT YOUR IVF FAILED, it's so easy to fall into trap of constantly thinking, “What did I do wrong?” and/or “Where did my doctors fail me?”

Now, if you forgot to take all your medication or you chain-smoked your way through treatment, I'll admit you maaaaybe deserve some of the blame. Likewise, if your doctors mistook your multiple cysts for follicles or accidentally flushed away your petri dish of embryos, they deserve to be, well, struck off.

But IVF failure is SO often just a case of bad luck – just as IVF success is SO often just a case of good luck. I want to emphasise this point so strongly, so I'll put it in bold: much of the time, IVF succeeds or fails because of nothing more than good or bad luck.

Yet it isn't always down to luck. Here's what you need to know…

Contents

Why does IVF fail before egg retrieval?

When IVF fails before egg collection, there's often a reason that your doctors will be able to explain. The main ones are:

  • They might have to halt the process because you're growing too many follicles (which puts you at risk of OHSS).
  • You might not be responding well enough to the drugs, so it's often better to stop the process and start again with a different treatment protocol.

I read lots of comments from people blaming their doctors for these two situations:

  • “They should have known from my baseline tests that I was bound to over-respond!”
  • “I'm so old that the candles now cost more than the cake… any idiot could have told them I'd need a shedload of stimulation drugs!”

To be honest, there can be a bit of truth in these kinds of complaints: I know this to be the case from my own experience.

It's not that doctors are being stupid, of course, but occasionally they don't feel they have the time to read through your notes during your appointment scan. Instead, they'll shove the dildocam up you, scribble some things on a sheet of paper that gets haphazardly shoved inside a ring binder, then adjust your medication without double-checking your medical history. Then they'll say goodbye with one eye on the clock, and you'll walk out dutifully, with a million unanswered questions and fears in your head.

If you had this experience last time, stay where you are next time – and get answers to those questions. After all, you've worn an easy-access skirt and baggy knickers to save time on the “undressing” part (while the patient before you was in lace-up boots and skinny jeans), so you can reclaim some of those minutes on your questions.

Make your doctor explain things you don't understand. Ask about your treatment (here's a helpful list of questions to ask your doctor at every stage of treatment). Get them to go through your notes if you're convinced they're taking the wrong course of action. Stand your ground and make sure that if your treatment gets cancelled before egg retrieval, you'll know it's just a case of bad luck and there's no one to blame.

Why does IVF fail before embryo transfer (but after egg retrieval)?

If your egg retrieval went well and your doctors managed to collect at least a few eggs, it's a great first step. Unfortunately, those eggs still have a bit of a perilous journey ahead of them…

Reason 1: the egg(s) didn't fertilise

When the eggs and sperm are put together in a petri dish, the obvious hope is that the'll fertilise. But just like pandas who really need to mate to ensure the survival of their species, male and female sex cells sometimes don't know what's good for them. And they fail to fuse.

Often, this is simply down to bad luck. It's a thoroughly shitty situation to experience after all the IVF rigmarole that came before it, but there's no one to blame and nothing to change next time. Remember that it often takes perfectly fertile couples a while to get pregnant too: most sources state that somewhere between 15% and 30% of healthy, young couples will conceive within the first month of trying.

But sometimes, there's more to it than “bad luck”. For example:

  • The older you are, the more “poor quality” eggs you'll have in your batch. Poor-quality eggs struggle to fertilise (among other drawbacks), so that could be why there were metaphorical crickets in the petri dish.

    There are a few things you can try to improve your egg quality; read about them here.
  • The issue of poor-quality eggs isn't confined to older women: some younger women suffer from a disproportionate number of them too. While age is the most important determinant, egg quality is also affected by smoking, drug use, endometriosis, ovarian cysts, obesity, some immunological disorders, radiation therapy and chemotherapy.
  • Sorry to bring up age again, but there's another reason it could be a factor. Age affects the number of eggs you have – not just the quality of those eggs. That means you may not produce as many eggs as a younger person would produce.

    That's a problem because fertilisation is largely a numbers game: even good-quality eggs aren't guaranteed to fertilise. If only two eggs are retrieved, you'll have a smaller chance of fertilisation than if 20 eggs were retrieved.

    To give you a real-life example, my egg collection resulted in FORTY-ONE eggs. (Overstimulation will do that to you, and it's not advisable.) Of those 41 eggs, about 30 fertilised. Of those 30-ish fertilised eggs, 18 made it to “Day 5/Day 6” embryos (“blastocyst” stage), ready to be frozen.

    To end up with 18 blastocysts was a fantastic result, but it was only about 44% of all the eggs I started with. That's why the number of eggs you have is related to fertilisation success.
  • It's also possible that your partner's sperm is the issue. (More info here.) He should have already been checked out before IVF, but you can always ask for another test to make sure.

    If it turns out that sperm is causing fertilisation problems, your doctors may recommend ICSI next time (if IVF didn't work this time for sperm-related reasons).
  • Did IVF fail because you didn't eat enough pomegranate or pineapple? Would you have been more successful if you'd bulk-bought CoQ10 or DHEA (likely against your doctor's wishes)? Should you have had more full-fat dairy? Perhaps Brazil nuts? Cut down on coffee? The answer is likely a big fat NO – so stop beating yourself up about it.

Questions to ask your doctor at every stage of IVF treatment: free downloadable guide

IVF isn’t just overwhelming; it can also be a mind-boggling and sometimes terrifying experience because there’s so much to learn and so many rules to follow.

Problem is, doctors are busy – and they often don’t have the time to anticipate your concerns and provide all the information you might need.

This downloadable guide contains questions that will help you understand the process better, get the answers you deserve, and feel more in control of the situation (and your rights as a patient).

Enter your email address to receive it right away.

I won't send you spam. Unsubscribe at any time.

Reason 2: at least one egg fertilised successfully, but it/they failed to develop in the laboratory

As above, this is often just down to bad luck. Not all fertilised eggs will develop into embryos – and that's true whether they're in the “natural” surroundings of the fallopian tube or the slightly more artificial surroundings of the fertility lab.

There's something I want to emphasise again, so I will. Even when pregnancy is attempted the “old-fashioned” way by couples who have zero fertility issues, it doesn't mean pregnancy is a slam-dunk. Sperm will often fail to fertilise the egg, and successfully fertilised eggs will often fail to develop.

So please do remember that before you start shouting “What the f**k have you done to my future babies, you f**king morons???” at the embryologist who's desperately trying to help. (This kind of thing happens, apparently.)

Sometimes, though, “bad luck” isn't the only reason that a fertilised egg fails to develop in the petri dish:

  • Age could again be to blame. The older you are, the more “poor quality” eggs you'll have in your batch. Poor-quality eggs don't just struggle to fertilise: they're also more likely to fail to develop into embryos.

    There are a few things you can try to improve your egg quality; read about them here.

    Note: some embryos are poor-quality but do end up surviving fertilisation and development. Those embryos are likely to fail to implant – but if they do implant, they're likely to be miscarried at some stage.

    One of the most common ways in which an embryo is considered poor-quality is that it has the incorrect number of chromosomes – known as “aneuploidy”. An aneuploid embryo stands very little chance of survival.

    PGS (“preimplantation genetic screening”) can help to determine if any of your embryos are aneuploid, and thus avoid the heartache of transferring any of those embryos.

    But PGS definitely isn't perfect, and it definitely doesn't guarantee success. It's also only available privately. Read more about PGS here.
  • Of course, poor-quality embryos can result from poor-quality sperm too. (More info here.) Your partner should have already been checked out before IVF, but you can always ask for another test to make sure.

    If it turns out that sperm is causing fertilisation problems, your doctors may recommend ICSI next time (if IVF didn't work this time for sperm-related reasons).
  • As mentioned earlier, younger women can also suffer from a disproportionate number of poor-quality eggs. While age is the most important determinant, egg quality is also affected by smoking, drug use, endometriosis, ovarian cysts, obesity, some immunological disorders, radiation therapy and chemotherapy.
  • You or your partner might be a carrier of a different kind of chromosomal abnormality called a “structural abnormality”, which is something you can be tested for. Find out about structural abnormalities here.
  • There's also the issue of “Day 3” vs “Day 5” embryos. The topic is covered in more detail here, but the general gist is as follows:

    In the past, almost all embryos would be transferred (or frozen) three days after successful fertilisation. Today, many clinics prefer to transfer or freeze the embryos five or six days after fertilisation instead (when the embryo is at “blastocyst” stage).

    One of the justifications given by embryologists is that, by the time the embryo has become a blastocyst, it’s already survived a ton of developmental obstacles and is therefore more likely to survive the journey from the doctor’s petri dish to your uterus. (It’s also more likely to survive the freeze-thaw process if it’s being frozen.)

    BUT some embryologists have noted that it’s possible that an embryo wouldn’t survive to Day 5 in the petri dish but could survive in the uterus if transferred at Day 3.

    If your own treatment failed for this reason (that is, because your embryos struggled to survive beyond Day 3 in the petri dish), ask your doctor about transferring a Day 3 embryo next time. This article covers the topic in much more detail.
  • Did IVF fail because you didn't eat enough pomegranate or pineapple? Would you have been more successful if you'd bulk-bought CoQ10 or DHEA (likely against your doctor's wishes)? Should you have had more full-fat dairy? Perhaps Brazil nuts? Cut down on coffee? The answer is likely a big fat NO – so please stop beating yourself up about it.

Reason 3: the embryo had been frozen, and it didn't survive the thawing process

This is one potential risk of embryo freezing, although it's becoming far less common thanks to developments in technology. Read more about embryo freezing here.

Why does IVF fail after embryo transfer?

“BAD LUCK” reminder alert!! “Natural conceptions” often involve an embryo that fails to implant or miscarries.

As for other reasons…

  • I know I'm sounding like a broken record but… unfortunately, age is again an important reason why IVF fails after embryo transfer. The older you are, the more “poor quality” eggs you'll have in your batch.

    Poor-quality eggs are often caused by “chromosomal numerical abnormalities” (see above), and they don't just struggle to fertilise: they're also more likely to fail to develop into embryos. Even if they develop into embryos, they're more likely to fail to implant and/or develop into a foetus. Here's more information about numerical abnormalities.

    If you're over the age of 37, I know this isn't exactly the most reassuring article you've ever read.
  • And – again (sorry for all the repetition) – poor-quality embryos can result from poor-quality sperm too. (More info here.) Your partner should have already been checked out before IVF, but you can always ask for another test to make sure.

    If it turns out that sperm is causing fertilisation problems, your doctors may recommend ICSI next time (if IVF didn't work this time for sperm-related reasons).
  • Also again (sorry sorry), younger women can also suffer from a disproportionate number of poor-quality eggs. While age is the most important determinant, egg quality is also affected by smoking, drug use, endometriosis, ovarian cysts, obesity, some immunological disorders, radiation therapy and chemotherapy.
  • And again… you or your partner might be a carrier of a different kind of chromosomal abnormality called a “structural abnormality”, which is something you can be tested for. Find out about structural abnormalities here.
  • Remember the discussion above about Day 3 vs Day 5 embryos? I mentioned how it's possible that an embryo wouldn't survive to Day 5 in the petri dish but could survive in the uterus if transferred at Day 3.

    Shittingly, the opposite might also be the case: if your clinic decided to do a Day 3 transfer but the embryo didn't implant, it might have been better to let the embryo develop to Day 5. The rationale is that Day 5 is a more natural time for the embryo to be in the uterus. (In a “natural” pregnancy, the embryo would still be travelling down the fallopian tube at Day 3 – and would reach the uterus around Day 5.)

    This is a tricky one to get right, and it also depends on the number of embryos you have: clinics might be reluctant to wait until Day 5 if you don't have many embryos, as there's a risk none of them will make it to Day 5.

    If IVF failed after a Day 3 transfer, ask your doctors if they think a Day 5 transfer might be worth considering next time.
  • There might be an issue with your uterus, which prevents the embryo from implanting successfully.

    You should have had pre-IVF investigations to make sure your uterus is in tip-top condition, but you could ask your doctors if further investigations could be considered. (You can read more about the investigations under “Pre-IVF step 4” here.)
  • One opinion is that your embryo might – for various reasons – struggle to “hatch” when inside the uterus. Successful hatching is necessary for successful implantation.

    Some clinics, therefore, believe that “assisted hatching” is a worthwhile technique for some embryos. It's only offered privately, and it's most definitely not endorsed by everyone. Read more about assisted hatching here.
  • Did IVF fail because you didn't eat enough pomegranate or pineapple? Would you have been more successful if you'd bulk-bought CoQ10 or DHEA (likely against your doctor's wishes)? Should you have gorged on full-fat dairy? Perhaps Brazil nuts? Cut down on coffee?

    Perhaps you ought to have done two days of bed rest after embryo transfer, or stopped exercising? Were those baths too hot? Were you silly for scoffing about acupuncture?

    The answer is likely a big fat NO. Enough already with blaming yourself! Your actions had no impact on the outcome of your treatment, and you're punishing yourself for nothing.

A brief word about “next time”…

On a few occasions in this article, I've said something along the lines of, “Next time you do IVF, ask your doctor to consider…”.

But I know that many readers won't get a “next time”. If that's you and you're reading this, I really hope that your biggest takeaways are the following:

  1. SO much of this is down to luck.
  2. If it's not down to luck, age is a big determinant – and there's nothing you can do about your age.
  3. It's not your fault.

Even if you had another shot at IVF and you did things differently, it doesn't mean you'd be successful. Heck: you could do everything exactly the same and have an entirely different outcome.

So please, please don't blame yourself. And perhaps read this short article about how to cope when IVF fails.

Questions to ask your doctor at every stage of IVF treatment: free downloadable guide

IVF isn’t just overwhelming; it can also be a mind-boggling and sometimes terrifying experience because there’s so much to learn and so many rules to follow.

Problem is, doctors are busy – and they often don’t have the time to anticipate your concerns and provide all the information you might need.

This downloadable guide contains questions that will help you understand the process better, get the answers you deserve, and feel more in control of the situation (and your rights as a patient).

Enter your email address to receive it right away.

I won't send you spam. Unsubscribe at any time.