The call you dreaded. The test was negative, or the heartbeat never appeared, or the transfer didn't work. Your IVF cycle failed. Right now, you might feel devastated, angry, confused, or numb. All of those feelings are valid.
But once you've had time to grieve — and you should take that time — there are real questions to answer. Why didn't it work? What can be done differently? Should you try again, and if so, when?
This guide walks you through what happens after a failed cycle: the reasons IVF fails, the tests that might help, protocol changes to consider, and how to decide whether to continue with your own eggs or explore other options.
💜 First: Be Gentle With Yourself
IVF failure is a loss. You've invested money, time, physical discomfort, and enormous emotional energy. Grief is appropriate. There's no timeline for when you "should" feel ready to think about next steps. Take the time you need.
Why IVF Cycles Fail
The hardest part of IVF failure is often not knowing why. The truth is that even in the best circumstances, IVF doesn't work every time. Only about 25% of transferred embryos successfully implant and result in live birth.
The Most Common Reason: Chromosomal Abnormalities
By far the most common cause of IVF failure is chromosomal abnormalities in the embryo — aneuploidy. These are random errors in cell division that happen during the earliest stages of embryo development.
Research from Columbia University found that most embryo failures are due to spontaneous DNA replication errors in the first few cell divisions. These errors happen by chance, not because of anything you did or didn't do.
Chromosomal Abnormality Rates by Age
- Under 35: ~30-40% of embryos aneuploid
- 35-37: ~40-50% aneuploid
- 38-40: ~50-60% aneuploid
- 41-42: ~60-75% aneuploid
- 43+: ~80-90% aneuploid
This is why age is such a strong predictor of IVF success — and why even "perfect" embryos sometimes don't work.
Uterine Factors
Even if the embryo is chromosomally normal, it needs a receptive uterus to implant. Studies have found that up to 50% of women with recurrent implantation failure have undetected uterine abnormalities that weren't visible on standard ultrasound.
Issues that can affect implantation include polyps, fibroids (especially submucosal ones that distort the cavity), uterine adhesions (Asherman's syndrome), adenomyosis, thin endometrial lining (less than 7mm), and chronic endometritis (infection).
Poor Egg or Sperm Quality
Quality issues may not be obvious from appearance alone. An embryo can look perfect under the microscope but have DNA damage or mitochondrial dysfunction that prevents normal development. Sperm DNA fragmentation can cause embryos to arrest or fail to implant even when fertilization occurs normally.
Timing Issues
The implantation window — the days when the uterine lining is receptive to an embryo — varies between women. In about 25% of women, this window is shifted earlier or later than the standard protocol assumes.
Sometimes It's Just Bad Luck
This is frustrating to hear, but it's true. Sometimes a cycle fails without any identifiable cause. The embryo was normal, the lining looked good, the timing was right — and it still didn't work. IVF is playing probabilities, and probabilities don't guarantee any individual outcome.
The Failed Cycle Review Meeting
Your clinic should schedule a follow-up consultation to review what happened and discuss next steps. This is sometimes called a "WTF appointment" — "what's the finding?" (or other interpretations).
Questions to Ask
- "What do you think caused the failure?" — Get their honest assessment, even if it's "we don't know."
- "What would you do differently next time?" — Protocol changes, timing adjustments, additional tests?
- "Are there tests we should do before trying again?" — Hysteroscopy, ERA, immune testing?
- "What are my realistic chances in another cycle?" — Ask for honest numbers based on your specific situation.
- "At what point would you recommend considering donor eggs?" — Better to discuss this early than be surprised later.
⚠️ Red Flag: No Review Offered
If your clinic doesn't automatically schedule a review meeting after a failed cycle, request one. If they won't discuss what happened or won't adjust the protocol, that's a sign you may need a second opinion.
Diagnostic Tests After Failed IVF
Depending on your situation, your doctor may recommend additional testing before another cycle. Here are the most common options:
Uterine Evaluation
Hysteroscopy
A camera is inserted through the cervix to directly visualize the uterine cavity. This is the gold standard for detecting polyps, fibroids, adhesions, and other structural problems that may not appear on ultrasound.
ERA (Endometrial Receptivity Analysis)
A biopsy of the uterine lining that analyzes 248 genes to determine if your implantation window is shifted. The test tells you if transfer timing should be adjusted.
The ERA test was very popular a few years ago, but recent randomized controlled trials have questioned its benefit. A 2022 study found ERA did not significantly improve outcomes for most patients. It may still help women with multiple failed transfers of chromosomally normal embryos, but it's no longer recommended as a routine test.
Endometrial Biopsy for Chronic Endometritis
Tests for low-grade infection of the uterine lining that can interfere with implantation. If positive, antibiotics can treat it before your next transfer.
Genetic Testing
PGT-A (Preimplantation Genetic Testing for Aneuploidy)
If you haven't done PGT-A before, testing embryos for chromosomal abnormalities before transfer can significantly improve implantation rates per transfer by avoiding transfers of embryos destined to fail.
Karyotype (Parental)
Blood test checking both partners' chromosomes for structural abnormalities like balanced translocations that could cause recurrent pregnancy loss or implantation failure.
Male Factor Testing
Sperm DNA Fragmentation
Measures the integrity of sperm DNA. High fragmentation (>30%) is associated with lower implantation rates, higher miscarriage risk, and poor embryo development — even when standard semen analysis looks normal.
Immune Testing
Immune testing for IVF is controversial. Some clinics offer extensive immune panels (NK cells, cytokines, etc.) and recommend treatments like intralipids, steroids, or immunoglobulin infusions. The evidence for most of these interventions is weak, and ASRM does not recommend routine immune testing.
That said, some conditions like antiphospholipid syndrome are well-established causes of pregnancy loss and should be tested after recurrent miscarriages.
Protocol Changes for Your Next Cycle
If you're trying again, your doctor may suggest modifications based on how your body responded.
Stimulation Adjustments
- Change medication doses: Higher doses if you didn't produce enough eggs; lower doses if you over-responded or had poor egg quality despite many eggs
- Change medication type: Adding LH (Menopur) for women who didn't respond well to FSH alone; trying mini-IVF for poor responders
- Adjust trigger: Dual trigger (hCG + Lupron) can improve egg maturation in some cases
- Extended stimulation: Some women need longer stimulation; don't rush to retrieval if follicles need more time
Transfer Protocol Changes
- Freeze-all: If you had elevated progesterone at trigger or signs of OHSS, freezing all embryos and doing a later transfer may improve receptivity
- Natural cycle FET: Some women have better outcomes with natural cycle transfers rather than medicated protocols
- Personalized transfer timing: Based on ERA results or adding extra progesterone days
- Assisted hatching: Laser thinning of the embryo's outer shell may help with implantation in some cases
Cumulative Success Rates: How Many Cycles to Try?
One of the hardest questions is knowing when enough is enough. Here's what the data shows about cumulative success rates:
| Age | 1st Cycle LBR | Cumulative (3 cycles) | Cumulative (6 cycles) |
|---|---|---|---|
| Under 35 | ~44% | ~70% | ~80-90% |
| 35-37 | ~36% | ~60% | ~70% |
| 38-40 | ~22-27% | ~45-50% | ~50-60% |
| 41-42 | ~10-12% | ~25-30% | ~31.5% |
| 43+ | <5% | ~10-15% | <20% |
What this table shows is that persistence pays off — up to a point. For younger women, cumulative success over multiple cycles is quite high. For women over 40, there's a point of diminishing returns.
General Guidelines by Age
- Under 38: 3-6 cycles is reasonable if financially/emotionally feasible
- 38-40: 3-4 cycles; serious discussion about donor eggs after 2-3 failures
- 41-42: 2-3 cycles; donor eggs often recommended after 2 failures
- 43+: Donor eggs typically recommended upfront; own-egg IVF rarely successful
When to Consider Donor Eggs
This is one of the most difficult decisions in fertility treatment. Donor eggs mean giving up the genetic connection to your child. That's a significant loss that deserves time and consideration.
But donor eggs also dramatically improve success rates. While a 43-year-old might have less than 5% success with her own eggs, donor egg IVF achieves 50-65% live birth rates regardless of the recipient's age.
Signs It May Be Time to Consider Donors
- Multiple failed cycles with few or no embryos
- Very low ovarian reserve (AMH <0.5, AFC <3)
- Repeated chromosomally abnormal embryos on PGT-A
- Age 43+ (unless you have exceptionally good reserve)
- Multiple miscarriages from own-egg embryos
Donor Egg Success Rates
| Recipient Age | Own Egg LBR | Donor Egg LBR |
|---|---|---|
| 38-40 | 22-27% | 50-55% |
| 41-42 | 10-12% | 50-55% |
| 43-44 | 4-5% | 45-55% |
| 45+ | <2% | 40-50% |
The success with donor eggs reflects the young age of the egg donor (typically 21-29). The recipient's age affects the pregnancy, but egg quality — the main driver of embryo chromosomal status — is determined by the donor.
💚 There's No Shame in Donor Eggs
Using donor eggs doesn't make you less of a mother. You'll carry the pregnancy, give birth, and raise your child. Many women who initially resisted the idea later say they can't imagine their family any other way.
Emotional Recovery
IVF failure can feel like grief — because it is. You're mourning the cycle that didn't work, the baby that wasn't, and possibly the easier path you hoped to take.
Normal Responses to IVF Failure
- Sadness, crying, feeling hopeless
- Anger at your body, the clinic, or life in general
- Jealousy toward pregnant women or families with children
- Withdrawal from friends and social situations
- Difficulty concentrating at work
- Relationship tension with your partner
- Questioning whether to continue treatment
All of these are normal. Give yourself permission to feel them without judgment.
When to Seek Professional Help
Consider talking to a therapist — ideally one who specializes in infertility — if you experience:
- Persistent sadness or hopelessness lasting more than two weeks
- Panic attacks or severe anxiety
- Inability to function at work or in daily life
- Relationship breakdown with your partner
- Thoughts of self-harm
- Substance use to cope
RESOLVE (resolve.org) offers a directory of fertility-specialized mental health professionals and peer support groups.
Deciding Whether to Try Again
There's no right answer. Some couples decide to try "one more time" many times. Others decide one failed cycle is enough. Both choices are valid.
Consider:
- Financial resources: Can you afford another cycle without creating serious hardship?
- Emotional capacity: Do you have anything left in the tank, or are you running on empty?
- Realistic odds: What do the statistics say about your chances with another try?
- Alternative paths: Are you open to donor eggs, adoption, or living child-free?
- Timeline: How much time do you have before age further reduces your chances?
Need a Fresh Perspective?
Sometimes a second opinion helps. We can connect you with Colombian clinics for an independent review of your case and honest assessment of your options.
Get Second OpinionConsidering Treatment Abroad After Failed Cycles
Some couples turn to international fertility treatment after failed cycles at home. Reasons include:
- Cost: You may be able to afford 2-3 cycles abroad for the price of one at home
- Fresh perspective: Different clinics may have different approaches
- Donor availability: Shorter wait times and lower costs for donor eggs
- Mental reset: Treatment in a new environment can feel less burdensome
If you're considering this path, make sure to transfer your medical records, including embryology reports, to any new clinic. A good international clinic will want to review your previous cycles before making recommendations.
The Bottom Line
A failed IVF cycle is devastating, but it's not the end of your story. Most women who ultimately succeed with IVF have at least one failed cycle along the way.
Take time to grieve. Then, when you're ready, work with your doctor to understand what happened and what can be done differently. Get additional testing if indicated. Consider a second opinion if you're not getting answers.
And know that whatever you decide — to try again, to pursue donor eggs, to explore other paths, or to stop treatment — it's your choice to make. There's no wrong answer, only what's right for you.
Read more: Donor Egg IVF in Colombia | IVF Mental Health Guide | Choosing a Clinic