Understanding and overcoming IVF treatment failures

  • Guides
18 Feb 2024


The journey to parenthood is fraught with highs and lows, especially when it involves In Vitro Fertilisation (IVF). The culmination of an IVF cycle, marked by anticipation and hope, can lead to profound disappointment if treatment does not result in a successful pregnancy. It’s a scenario many couples face, leaving them grappling with a mix of emotions and questions about the future.

The reality of IVF and fertility treatment failures

It’s crucial for couples to recognise that embryo loss at the early stages of pregnancy, similar to natural conception, is both a normal and relatively common occurrence. This understanding doesn’t diminish the pain of loss but situates the experience within a broader, natural context of human reproduction.

When ready, revisiting your fertility specialist can provide clarity and direction. Discussing the specifics of why treatment didn’t succeed is a crucial step in healing and planning ahead. Whether considering repeating the treatment or exploring alternative methods, the guidance of your specialist, grounded in your personal medical history and future aspirations, is invaluable.

Factors Contributing to IVF Treatment Failures

Understanding why IVF treatments may not succeed is complex, encompassing a range of biological and technical factors. Let’s take an in-depth look at some of these factors.

Poor ovarian response

The response of ovaries during IVF treatment is pivotal to the cycle’s success. Ovarian response can be unpredictable, with factors such as age, underlying health conditions, and specific genetic markers playing significant roles. Reduced ovarian reserve, often seen in older women, can lead to fewer eggs being available for retrieval. Conditions such as Polycystic Ovary Syndrome (PCOS) can also affect how ovaries respond to stimulation, sometimes leading to an excessive response or, conversely, an inadequate one. Lifestyle factors, such as smoking and body weight, alongside environmental influences, may further impact ovarian responsiveness, underlining the importance of a tailored approach to stimulation protocols.

Implantation failures

Implantation failure remains one of the most challenging aspects of assisted reproductive technologies (ART). The process of an embryo implanting into the uterus is complex and can be influenced by a variety of factors. These include the quality of the embryo, the receptivity of the uterine lining, and the precise timing of the embryo transfer. Uterine abnormalities such as fibroids or polyps, and immunological factors, where the body’s immune system inappropriately responds to the embryo, can also play critical roles. Advances in endometrial receptivity tests offer hope in identifying optimal timing for embryo transfer, potentially improving implantation rates.

Despite advancements in medical science, human fertility naturally presents challenges. Even healthy couples under 30 have only a 20-30% chance of conceiving each cycle naturally. IVF aims to improve these odds significantly, yet it’s not a guaranteed solution. The path to parenthood, particularly through IVF, is influenced by a myriad of factors, many of which are beyond our control.

Cycle Cancellation: A Hard Decision

IVF cycles can be cancelled for several reasons, each presenting its own set of challenges and decisions:

Ovarian Hyperstimulation Syndrome (OHSS)

OHSS is a potential complication of fertility treatments that stimulate the ovaries. It occurs when the ovaries respond too vigorously, leading to swollen, painful ovaries and an accumulation of fluid in the abdomen and chest. The condition ranges from mild to severe, with severe cases requiring hospitalisation. Factors that increase the risk of OHSS include high levels of administered hormones, the presence of PCOS, and a previous history of OHSS. Innovations in treatment protocols, such as the use of a GnRH antagonist protocol and the administration of a GnRH agonist for final oocyte maturation, have been shown to reduce the risk of OHSS significantly.

Absence of eggs

Occasionally, despite the development of follicles within the ovaries, no eggs are retrieved during the IVF process. This scenario, often referred to as “empty follicle syndrome,” can be deeply disheartening for couples. Possible reasons include premature ovulation, where the eggs are released before retrieval, or issues with the medication used in the stimulation process. Improvements in monitoring and adjusting medication protocols are helping to reduce the occurrence of this challenging situation.

Fertilisation failures

Fertilisation is a key step in the IVF process, where sperm and egg unite to form an embryo. Failures can occur due to poor egg quality, suboptimal sperm function, or issues within the IVF laboratory. Techniques such as Intracytoplasmic Sperm Injection (ICSI) have been developed to assist in cases where traditional fertilisation methods are unsuccessful, offering hope to couples facing this obstacle.

Why embryos may not develop

Embryo development is a delicate process, and failures can occur due to any number of reasons.

1) Poor quality embryos

Embryo quality is a cornerstone of IVF success, influencing both implantation rates and the potential for a successful pregnancy. The assessment of embryo quality, traditionally based on morphological characteristics observed under a microscope, includes factors such as the rate of cell division, the appearance of the cells (blastomeres), and the degree of fragmentation. However, this visual assessment provides limited insight into the embryo’s genetic health, which plays a pivotal role in its ability to develop into a healthy pregnancy.

Genetic factors influencing embryo quality

Recent advances have shifted the focus towards the genetic content of embryos as a critical determinant of quality. Chromosomal abnormalities, such as aneuploidy (an abnormal number of chromosomes), are common in human embryos.

Despite an embryo’s healthy appearance under a microscope, such genetic irregularities can prevent it from implanting in the uterine lining, lead to early pregnancy loss, or result in the birth of a child with a genetic disorder. This discrepancy arises because the visual assessment of embryos does not reveal the underlying genetic health, which is crucial for successful development.

The prevalence of chromosomal anomalies increases with maternal age, making it a particularly pressing concern for older women undergoing IVF. However, advancements in genetic screening techniques, such as Preimplantation Genetic Testing for Aneuploidy (PGT-A), offer a powerful tool for identifying embryos with the best potential for leading to a healthy pregnancy. By selecting embryos with a normal chromosomal number for transfer, clinicians can improve implantation rates and reduce the risk of miscarriage

The role of mitochondrial DNA in embryo viability

Another area of interest is the role of mitochondrial DNA (mtDNA) content in embryos. High levels of mtDNA have been associated with lower embryo viability, possibly reflecting underlying metabolic stress or compromised cellular function. Research in this area is ongoing, with the aim of understanding how mtDNA content can be used alongside other markers to predict embryo viability more accurately.

The impact of environmental factors on embryo development

The environment in which embryos are cultured during IVF also plays a crucial role in their development and quality. Factors such as the composition of the culture medium, oxygen concentration, and incubator temperature can all influence embryo growth. Laboratories, like the one in Ferticentro, continually refine these conditions to mimic the natural environment of the fallopian tubes as closely as possible, supporting optimal embryo development.

Lifestyle factors

Couples undergoing IVF are often advised on lifestyle changes that may enhance embryo quality. This includes maintaining a healthy weight, adopting a balanced diet rich in antioxidants, and avoiding smoking and excessive alcohol consumption. Such measures can improve overall health and potentially influence the quality of eggs and sperm, thereby impacting embryo development.

2) Uterine blood supply

The uterine environment plays a pivotal role in the success of embryo implantation and the subsequent growth of the pregnancy. A key factor in this environment is the uterine blood supply, which delivers necessary nutrients and oxygen to the developing embryo. Compromised blood flow to the uterus can result from various conditions, including uterine fibroids, endometrial polyps, or systemic health issues like hypertension and diabetes. These conditions can impede the embryo’s ability to implant and grow, lowering the chances of a successful pregnancy and increasing the risk of miscarriage.

Improving uterine blood flow has become a focus of fertility treatments, with strategies ranging from medical interventions to improve systemic health, surgical procedures to remove obstructions like fibroids or polyps, and lifestyle modifications to enhance overall vascular health. Additionally, research into the use of certain supplements, such as low-dose aspirin and L-arginine, has been explored for their potential to increase uterine blood flow, though their effectiveness and applicability need to be evaluated on an individual basis.

Moving forward with hope and resilience

Despite the challenges and uncertainties, the majority of couples pursuing fertility treatments will eventually realise their dream of parenthood. The key lies in making informed decisions based on high-quality clinical evidence. At Ferticentro, our commitment is unwavering: to advocate for every couple, using evidence-based approaches to enhance the chances of success in each unique case.

Beyond the medical aspects, the emotional and psychological support for couples undergoing IVF cannot be overstated. Support groups, counselling, and open communication with your healthcare team are essential components of a comprehensive care approach. Nurturing resilience, fostering hope, and maintaining a balanced perspective on the journey to parenthood are integral to navigating the complexities of fertility treatments.

The path to parenthood, particularly through IVF, is a testament to the strength and resilience of those who walk it. While the journey may be marked by setbacks, the advancements in fertility treatments, coupled with a robust support system, illuminate the path forward. As we continue to push the boundaries of medical science and offer compassionate care, the dream of parenthood remains a hopeful horizon for many.