There’s no sugarcoating it: receiving the heartbreaking news that the IVF cycle you’ve just gone through has failed is absolutely devastating. This experience can leave you feeling not only shattered, but exhausted: physically, emotionally, and often, financially. 

It may be difficult to immediately shift your focus to “next steps” following such a distressing loss, and that’s okay. It’s important to give yourself space and time to grieve, process, and heal following an unsuccessful IVF cycle. In the aftermath of loss, it’s vital to keep in mind that a “failed” cycle in no way constitutes “failure” on your part. Infertility, or an IVF cycle that does not lead to pregnancy, is not your fault. 

When we talk about IVF failure, there are a few common reasons that may be worth looking into whether you’re headed into the world of fertility treatments for the first time, or preparing for another cycle. For a deeper dive on what can affect IVF failure, we spoke to Reproductive Endocrinologist & Infertility Specialist Dr. Bruce Lessey. 

What Causes IVF To Fail?

IVF Failure Due to the Embryo

Rescripted: What are some of the most common reasons for failure due to the embryo? 

Dr. Lessey: In general, the embryo’s quality diminishes with age. The number of the retrievable eggs decreases as does the viability of those eggs and subsequent embryos. In addition, as a woman ages, we see an increase in chromosomal abnormalities all which can lead to IVF failure. Increasingly, preimplantation genetic diagnostic testing is being performed, but not all “euploid” embryos lead to pregnancy and a live birth, suggesting other possible causes of failure.

IVF Failure Due to the Endometrium

Rescripted: What are some of the common reasons for failure due to the endometrium?

Dr. Lessey: In my research and clinical practice, as well as dozens of independent studies, the single biggest reason for IVF failure may be related to progesterone resistance. This is most commonly thought to arise from inflammation secondary to the presence of endometriosis. The reasons behind this are complex and remain poorly understood, but creates a situation where the endometrium is only available and receptive to the embryo for a very short window, and this window is delayed in its timing. Progesterone is the primary hormone that regulates uterine receptivity. Without adequate progesterone response, estrogen becomes a dominant hormone in the endometrium. Progesterone resistance prevents the endometrium from developing appropriately to receive the embryo, leading to implantation defects or miscarriage, both of which result in IVF failure.

What is the next step after IVF failure?

Rescripted: What testing do you suggest to improve outcomes? 

Dr. Lessey: For embryo quality, the most common test is called PGT-A (preimplantation genetic testing for aneuploidy). While it significantly improves the chances for pregnancy, it does not address all the issues an aging embryo can harbor. However, statistics show that doing PGS testing for older patients can improve success rates  25%. Another tool is transvaginal ultrasound which reveals the amount of follicles in a woman’s ovaries. If there are a good number of follicles present, this suggests a healthy ovarian reserve and many viable eggs available, however this will not directly improve her chances since the woman has a given number of eggs prior to IVF. 

For detection of endometriosis and general inflammation of the uterine lining, one of the most studied biomarkers is called BCL6 (offered at ReceptivaDx), performed through an endometrial biopsy. Laparoscopy is a surgical procedure that is the gold standard for diagnosis of endometriosis, but it is invasive and expensive. In our practice in North Carolina, the use of BCL6 to identify endometriosis including asymptomatic endometriosis followed by treatment has improved our success rates significantly. Studies show a 5 fold increase in success from untreated BCL6 positive patients versus treated. 

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It’s Always Good to be Prepared

It goes without saying that anyone wading through the waters of infertility and the IVF process want their chances of a successful cycle to be as high as possible. With the ReceptivaDx test, you’re able to quickly determine whether an underlying condition like endometriosis could affect the success of your procedure. 

The ReceptivaDx test is the first of its kind, as it was developed to test for inflammatory conditions including silent endometriosis, which is the most common cause of unexplained infertility. It’s estimated that 75% of women with unexplained infertility will test positive for BCL6, or B-cell CLL/lymphoma. And high levels of BCL6 indicate inflammation of the uterine tissue, often associated with endometriosis. 

Before ReceptivaDx, the only way to test for endometriosis was via surgical laparoscopy. Laparoscopy is an expensive and invasive procedure, and is not usually offered by medical professionals unless major physical symptoms are present.

Patients can visit any Reproductive Specialist or their own Ob-Gyn to be tested, with the list of ReceptivaDX Endometriosis Testing Partners growing every day. If you’re interested in taking charge of your endometrial health prior to your IVF cycle, ask your doctor about the ReceptivaDxTM collection kits.

Lindsey Williams is a library worker and writer who lives in Arizona with her husband and their dog, Peaches. After 5 years of trying to conceive with dual-factor infertility, she is currently expecting her first child conceived with the help of IVF.