Why IVF Fails: Reasons, Tests To Do & Treatment Options After IVF Failure

IVF failure is one of the hardest outcomes a couple can face. But what can be even harder is the confusion that follows. Many couples are not given a clear reason for why their IVF failed, while others are moved into another cycle without evaluating what went wrong the first time.

Before trying again, understanding what happened in the previous cycle can help identify what needs to be addressed or changed.

In this blog, we’ll explore the reasons behind IVF failure, the tests to consider after a failed cycle, and what can be done differently to improve the chances of success next time.

Why Does IVF Fail?

Let's explore the common IVF failure reasons and the factors that may affect embryo development and implantation.

It is very important to have a healthy egg and healthy sperm to develop a healthy embryo. If either egg or sperm quality is affected, the quality of the embryo can also be affected, which may lead to IVF or implantation failure.

What can affect egg and sperm quality?

• Age: Egg quality declines with age, particularly after 35. Sperm quality can also change with age.
• Lifestyle: Smoking, excessive alcohol, poor diet, lack of physical activity and obesity can affect reproductive health.
• Overall health: Conditions such as diabetes, hormonal disorders and other health problems can affect egg or sperm quality.
• Genetic factors: Certain genetic or chromosomal abnormalities in either partner can affect the resulting embryo.
• Environmental factors: Exposure to certain toxins, chemicals and high levels of heat may affect sperm quality.

Sometimes, an embryo may not have the genetic makeup needed to implant and develop into a healthy pregnancy.

Chromosomal abnormalities can happen naturally as eggs, sperm and embryos develop. The chances of these abnormalities increase with maternal age.

This means an embryo can look good under a microscope but still have a chromosomal abnormality that affects its ability to implant.

The uterus needs to provide the right environment for the embryo to implant and continue developing.

Conditions that can interfere with implantation include:

• Fibroids, particularly those that affect the uterine cavity
• Polyps
• Septate uterus
• Scar tissue or adhesions inside the uterus
• Adenomyosis
• Endometriosis, in some cases
• Hydrosalpinx

If IVF has failed, evaluating the uterus can help identify whether there is a structural or uterine factor that needs to be addressed before another embryo transfer.

The hormonal and metabolic environment also matters for successful implantation and early pregnancy.

Factors that may need to be evaluated include:

• Thyroid disorders
• Diabetes or poor blood sugar control
• High prolactin levels
• PCOS and associated hormonal or metabolic changes

If any of these conditions are present, getting them under control before another IVF cycle may be an important part of treatment.

Blood-clotting and immune-related factors may be considered, particularly when IVF failure happens repeatedly.

One established condition is antiphospholipid syndrome (APS), an autoimmune condition that can affect pregnancy.

Other immune-related factors have also been studied, but not every immune test or treatment has enough evidence to be routinely recommended. These tests should therefore be considered based on the individual's history and clinical situation.

The uterus needs to provide the right environment for an embryo to implant and continue developing. Problems with the uterine cavity, structure, or endometrial lining can sometimes interfere with implantation.

These may include:

• Abnormal endometrial thickness or development
• Fibroids, particularly those that affect the uterine cavity
• Endometrial polyps
• Septate uterus
• Scar tissue or adhesions inside the uterus
• Other abnormalities of the uterine cavity

The important step is to identify whether there is a uterine or endometrial problem that can be treated or managed before another embryo transfer.

After IVF failure, it is important to do the right tests to understand which of the above factors, or a combination of them, could be behind the failed implantation.

• Transvaginal ultrasound — Scan
• 3D ultrasound — Scan
• Hysteroscopy — Camera-based procedure to examine the uterine cavity
• MRI — Imaging scan, where required

• Karyotyping of both partners — Blood test
• Embryo genetic testing (PGT) — Genetic test on embryo cells, where clinically appropriate

• Thyroid profile — Blood test
• Prolactin — Blood test
• Blood sugar / HbA1c — Blood test
• Other relevant hormonal tests — Blood test

• Antiphospholipid antibody testing — Blood test
• Lupus anticoagulant — Blood test
• Anticardiolipin antibodies — Blood test
• Anti-beta-2 glycoprotein I antibodies — Blood test

• HLA typing — Blood test
• KIR typing — Blood test
• Endometrial immune profiling — Endometrial tissue/sample-based test

At EPIA, we treat IVF failure by first identifying what may have affected implantation and then addressing the factors that can be treated or optimised.

We have helped 1,000+ couples with a history of IVF failure, with a reported 70% success rate, meaning around 7 in 10 couples went on to have a live birth.

Here is how we approach treatment based on the underlying cause.

• PGT-A: May be considered in selected patients to screen embryos for chromosomal abnormalities before transfer.
• PGT-M: May be considered when a specific inherited genetic condition is known.

Treatment is aimed at correcting abnormalities that may interfere with implantation.

This may include:

• Septate uterus: Hysteroscopic septum resection
• Endometrial polyps: Hysteroscopic polyp removal
• Submucosal fibroids: Hysteroscopic removal where appropriate
• Intrauterine adhesions: Hysteroscopic adhesiolysis
• Other uterine abnormalities: Treatment based on the specific finding

The underlying condition is treated or optimised before another embryo transfer.

This may include:

• Thyroid disorders: Appropriate thyroid treatment and optimisation
• Hyperprolactinaemia: Treatment of the underlying cause
• Diabetes or high blood sugar: Optimisation of blood glucose control
• PCOS-related metabolic issues: Individualised metabolic management

Treatment depends on the specific diagnosis.

• Antiphospholipid syndrome (APS): Anticoagulant treatment, often with low-dose aspirin and heparin, may be used during pregnancy based on the clinical situation.

Immune-related findings require individualised assessment. Not all immune tests or treatments are routinely recommended for IVF failure.

At EPIA, selected patients may be considered for immunomodulatory treatments such as LIT or IVIG, based on their clinical history and evaluation.

Treatment focuses on optimising the conditions needed for implantation.

This may include:

• Endometrial lining: Addressing an identified abnormality affecting endometrial development
• Hormonal support: Adjusting progesterone or other hormonal support where indicated
• Embryo transfer timing: Reviewing the timing of transfer in relation to endometrial preparation
• Endometrial conditions: Treating an identified condition before the next transfer

Where relevant, doctors may also recommend:

• Stopping smoking
• Limiting alcohol
• Achieving a healthy weight
• Improving nutritional habits
• Managing existing medical conditions

Why Choose EPIA for IVF Failure?

IVF failure requires a detailed evaluation, clinical experience, and a treatment plan based on why implantation may have failed.

At EPIA, our IVF failure program brings together:

40+ years of experience in reproductive medicineDecades of experience managing complex fertility and IVF cases.

1,000+ couples helped after IVF failureMore than 1,000 couples have been evaluated and treated after previous IVF failures.

99+ tests across six diagnostic axesA comprehensive diagnostic approach to investigate factors that may affect implantation and pregnancy.

A cause-based treatment approachTreatment is planned around the findings from your evaluation, rather than repeating the same IVF protocol.

Global specialist expertiseEPIA works with specialists from across the world when a case requires additional expertise.

A failed IVF cycle does not mean you cannot have a successful pregnancy. What matters is understanding why the previous cycle may not have worked and what can be done differently next time.

At EPIA, we look beyond the failed cycle to identify factors that may be affecting implantation and build a treatment plan around your individual findings.

If you have experienced IVF failure, take the next step with a detailed evaluation at EPIA. Understanding what happened can help you approach your next attempt with greater clarity and a more personalized plan.