IVF, or In Vitro Fertilization, has helped countless patients and couples overcome their struggles with infertility worldwide. Despite being a popular and effective treatment, IVF cycles sometimes fail, and one common reason is implantation failure. Understanding IVF implantation failure—its causes, symptoms, and solutions—can better prepare patients on their journey toward parenthood.

Dr. Maria F. Costantini-Ferrando, a Reproductive Endocrinologist at Reproductive Medicine Associates, specializes in fertility treatments and provides expert opinions on the impact of failed IVF cycles below.

What causes an IVF cycle to fail?

There are several reasons why an IVF cycle can fail. It’s a complex process; its success depends on multiple factors working together correctly. Here are the most common causes for an IVF cycle to fail:

  1. Poor Ovarian Reserve: The quantity and quality of a woman’s eggs can significantly affect the chances of successful fertilization and implantation. Women over 35 often have a lower ovarian reserve, and the eggs they do have may be considered lowered quality upon egg retrieval.
  2. Abnormal Embryos: Embryos might not develop normally even if the eggs are retrieved and fertilized successfully. Embryo abnormalities, often due to genetic or chromosomal issues, commonly cause failed IVF cycles. These abnormalities can prevent an embryo from implanting in the uterus or cause an early miscarriage once it does implant. Abnormal embryos are called aneuploid.
  3. Endometrial Issues: The endometrium, or the lining of the uterus, is where the embryo must implant for a successful pregnancy. If this lining is not of optimal thickness or has other issues, like fibroids or polyps, it can prevent a successful embryo implantation.
  4. Embryo Transfer Problems: The embryo transfer process, which refers to the placement of an embryo inside the uterus, must be done correctly for implantation to occur. If the catheter (the thin tube used to transfer the embryo) encounters resistance or the embryo is not placed in the right spot within the uterus, the chances of implantation can decrease.
  5. Lifestyle FactorsSmoking, excessive alcohol use, stress, and obesity can also all negatively impact the success of an IVF cycle.
  6. Age: The age of the woman undergoing IVF is also a significant factor—as a woman ages, there is a decrease in egg quality and quantity that leads to embryos with an increased risk of genetic abnormalities.

Remember, it’s essential that you speak to your fertility specialist about any questions you may have if you experience a failed IVF cycle. They can address any concerns, clear any doubts, and dismantle any myths or misconceptions. They can guide you through every step of this challenging process and offer the resources needed for emotional support through your journey.

Identifying the cause of IVF implantation failure

A failed IVF cycle can be a devastating experience, but it is crucial to understand its causes to help you plan future treatment. Diagnostic tests, such as Preimplantation Genetic Testing (PGT), can detect chromosomal abnormalities in embryos, aiding in selecting genetically healthy embryos for transfer.

Symptoms of IVF failure

The implantation failure rate in IVF varies widely, largely depending on a woman’s age and the embryo’s quality. On average, the failure rate ranges from 10-25%.

Symptoms of IVF implantation failure often resemble those of a woman’s period: cramping, bleeding, and a decrease in pregnancy symptoms like nausea or breast tenderness. However, not everyone experiences noticeable symptoms.

After a failed embryo transfer, your doctor will review the cycle, discuss possible reasons for the failure, and suggest ways to improve chances of success in subsequent cycles.

Why do good embryos sometimes fail to implant?

Even with seemingly good-quality embryos, implantation can fail. This could be due to issues with the uterus, such as fibroids, polyps, or a thin endometrial lining. Alternatively, the embryo may appear healthy but carry undetected genetic or chromosomal issues.

As the future of genetic testing unfolds, fertility specialists and genetic counselors will be able to identify more genetic abnormalities and further increase the success rate of implantation.

Is there bleeding if the embryo fails to implant?

Bleeding can occur if the embryo fails to implant, often resembling a regular menstrual cycle. It’s worth noting that not everyone will experience bleeding.

Is an implantation failure considered a miscarriage?

While it can be disheartening, a failed implantation is not technically considered a miscarriage, which is a pregnancy loss after the embryo has successfully implanted.

Understanding IVF implantation failure rates

Preimplantation Genetic Testing (PGT) is a procedure used alongside IVF to screen embryos for genetic or chromosomal abnormalities before transfer to the uterus. Research suggests the implantation rate for embryos screened with PGT is approximately 50-70% per transfer.

However, it’s important to remember that while PGT improves the chances of success, it does not guarantee a pregnancy or live birth.

By only transferring embryos determined to be chromosomally normal (euploidy), PGT can increase the likelihood of successful implantation and pregnancy and decrease the risk of a miscarriage.

However, the exact implantation rate with PGT varies based on factors, including the quality of the laboratory, the woman’s age, and overall health.

Additionally, medical technology and procedures are constantly improving, and specific success rates can vary from clinic to clinic. Always consult with your healthcare provider or a fertility specialist for the most accurate and up-to-date information.

Can implantation be successful and then fail?

Yes, sometimes an embryo can successfully implant and then later fail. This is often classified as an early pregnancy loss or chemical pregnancy.

Chemical pregnancies 

A chemical pregnancy is when an egg is successfully fertilized and implants in the uterus, resulting in the production of enough hCG (human chorionic gonadotropin, the hormone produced in early pregnancy) to trigger a pregnancy test to display a positive result, but then the pregnancy fails to progress. This usually occurs before the pregnancy is visible on an ultrasound—typically around the fifth week of gestation.

Early miscarriage

Early miscarriage can happen after a confirmed clinical pregnancy (where a gestational sac or even a fetus can be seen on ultrasound), usually up to the 12th week of gestation. It can occur for various reasons, including chromosomal abnormalities, hormonal imbalances, structural issues with the uterus, immune disorders, or infections.

Experiencing either a chemical pregnancy or an early miscarriage can be both physically and emotionally challenging, and it’s essential to seek medical and emotional support during this time.

Remember that a chemical pregnancy or early miscarriage doesn’t necessarily mean you’ll have difficulties achieving a successful pregnancy in the future. If you experience multiple miscarriages, however, it’s essential to work with your healthcare provider or a fertility specialist to identify any potential underlying issues.

Improving IVF success rates

Several strategies can enhance your chances of IVF success, including lifestyle changes like maintaining a healthy weight and avoiding smoking and alcohol. Medical interventions may involve treatments to improve uterine health or using PGT to ensure the transfer of genetically healthy embryos.

How long should you wait between failed IVF cycles?

Many patients ask if they should take a break between failed IVF cycles. On average, many doctors suggest waiting for one to three menstrual cycles before starting another IVF cycle. This waiting period allows your body to recover from the hormonal effects of the previous cycle.

The waiting period between in vitro fertilization cycles can vary greatly and is influenced by various factors, including your physical health, mental well-being, the specific circumstances of the failed cycle, and the protocols advised by your fertility specialist.

Your emotional well-being is also an important consideration. Going through an IVF cycle can be emotionally taxing, and a failed cycle can add to the stress. Giving yourself enough time to process the experience and prepare for another cycle emotionally is extremely important.

What to do if you have a failed IVF cycle

For those facing IVF failure, it’s crucial to seek guidance from your trusted fertility specialist. Engage in open discussions to understand the reasons behind the unsuccessful IVF cycle and to explore potential adjustments to your fertility treatment plan for future attempts. Additionally, prioritize emotional well-being by seeking support from loved ones, participating in support groups, or considering counseling.

Exploring alternative fertility treatment options can offer renewed hope for those struggling with IVF treatment. Consider avenues such as using donor eggs, sperm, or embryos, or even gestational surrogacy, which may present viable alternatives to traditional approaches. Lifestyle factors also play a significant role in fertility outcomes. Review and assess parts of your lifestyle, including diet, exercise habits, and stress levels, as these factors can impact your fertility journey.

Support for couples following a failed IVF cycle

Failed IVF cycles can be emotionally challenging. Fortunately, several support programs offer counseling, support groups, and resources to help patients cope. Many fertility clinics offer these services, and numerous online communities and resources are available.

Reproductive Medicine Associates (RMA) works explicitly with the private Facebook group FertiliFriends. Membership is open to RMA patients and non-patients for free. Join the support community today.

IVF implantation failure can be a challenging obstacle to face in the journey to parenthood. Still, with understanding and guidance, it is possible to navigate these challenges and increase your chances of success in subsequent IVF cycles.