Going through in vitro fertilization (IVF) – or any infertility process – can feel like an endless cycle of waiting. You try unassisted – you’re waiting. Maybe next you try timed intercourse – you’re waiting. Next, perhaps you move to intrauterine insemination (IUI) – waiting. Next still, IVF – more waiting. Waiting for cycle day 1, waiting for the first scan, first injection, first blood draw.
If you’ve seen the movie Beetlejuice, you might start to identify with the souls in the waiting room of limbo: “Now calling number 9,998,383,750,000.” I know I did.
And then, during that tedious, energy-draining wait, you get the dreaded call: your IVF cycle has been canceled. What? Why? And how can you possibly be expected to get through this?
Reasons Why IVF Cycles Get Canceled
Every IVF cycle is as different as the person going through it. We all have various reasons for being here, so it seems obvious that there would be many different causes for canceling an IVF cycle. Here are a few common reasons why IVF cycles get canceled:
1. Illness
There are several communicable illnesses, particularly those that come with a fever, that may cause your IVF cycle to be canceled. Prior to 2020, the most common was the flu. In 2020, however, COVID-19 changed everything. From cycles being postponed indefinitely to negative tests needed before important IVF procedures, there's no doubt that the pandemic has added a whole other layer of stress for infertility patients.
2. Ovarian cysts, uterine fibroids, or polyps
My first IVF cycle was canceled due to an ovarian cyst. Having an ovarian cyst could decrease the growth of your eggs, which is not ideal for cycle continuation. Many are found on day 2 of your cycle, but mine wasn’t found until mid-way through (sneaky). If this happens, you might be given oral contraception or antibiotics to help suppress the growth of the cyst. If it’s gone by the following month, you can usually proceed with IVF.
I also had an IUI cycle canceled because of uterine polyps. These, and fibroids, are generally removed through a hysteroscopic myomectomy – a procedure using a tiny camera and a small instrument – or a dilation and curettage (D&C), a dilation of the cervix and scraping to remove the polyp or fibroid.
3. Poor response to IVF medication
A poor response to IVF medication means that either none or too few, follicles (those tiny, fluid-filled sacs that contain eggs) grew in response to the medication. There are usually two options for moving forward in this case:
a) If your AMH levels are good, your caregiver might opt to switch this to an IUI cycle and change the protocol for your next IVF cycle (if the IUI is unsuccessful).
b) If your AMH levels are low, your caregiver might opt to continue with the cycle and collect as many eggs as possible over a few IVF cycles.
4. Hyper-response to IVF medication
There is a difference between hyper-response and Ovarian Hyperstimulation Syndrome (OHSS). A hyper-response can lead to OHSS but doesn’t always. Hyper-response is most common in younger people or those with polycystic ovarian syndrome (PCOS). The symptoms range from mild to severe and can include abdominal pain or heaviness ranging from mild to severe, “bloating, nausea, vomiting, diarrhea, decreased urine output, or develop clots in legs.” When this happens prior to egg retrieval, it is often safest to cancel the cycle out of an abundance of caution.
5. Premature Ovulation
This can occur when the medications that are supposed to prevent you from ovulating fail to do so, or the “trigger shot” is given too soon. Timing is everything during IVF, so in this unfortunate circumstance, your clinic will either have to move up the time of your egg retrieval or be forced to cancel the cycle altogether.
6. Sub-optimal hormone levels
If there is an unexpected drop or increase in your estrogen or progesterone levels, or if your follicles stop maturing, your provider might make the difficult decision to cancel your cycle with the hope of having better luck next time.
7. Too-thin endometrium/uterine lining
Several people I asked listed a too-thin uterine lining as the reason for their canceled embryo transfer cycle. Yes, everything can go great during the cycle, but if your uterine lining isn’t the required thickness or appearance during a transvaginal ultrasound, your doctor may decide the success rate of a transfer isn’t good at this time and cancel.
What's Next After a Canceled IVF Cycle?
From ovarian cysts to uterine polyps, I have been no stranger to a canceled IVF cycle on my path to parenthood. However, it’s important to note that a canceled IVF cycle, while devastating, can give you insight into what didn’t work — and what might work for you in the future.
How to Cope with a Canceled IVF Cycle
In the meantime, these are some coping strategies that helped me after a canceled cycle, and I hope they can help you, too:
- I indulged myself in what I loved. Every time a cycle was canceled, or an IUI didn’t work, or the time none of my 14 embryos made it past day-5, I decided to talk to some food and wine about it. Food I wouldn’t have been able to eat if I were pregnant: Sushi. Soft cheese. Rare steaks. I’d call my friends who also weren’t pregnant and we’d go dancing and drink colorful cocktails.
- I embraced self-care. I took long, hot baths and spent entire afternoons reading a book. I’d go to yoga in the middle of the day, or work from a coffee shop while I ate a yummy lunch. I put on face masks and said yes to myself when otherwise I might have said no. I treated myself.
- I took opportunities to feel alive. This is different for each of us. For me, living in Colorado, I’d go for a hike with my husband or my friends and look at the beauty all around. I took walks in the cold air. I booked trips to places I’d always wanted to go (and also knew would be that much more difficult with a baby or child in tow). I went to Southeast Asia for a month. Spent a week in the South of France. Went to London for a weekend with my friend. While so many of my friends got their babies, I got stamps on my passport.
- I went to therapy – thousands of hours of it. I cried, I vented, I raged, I rationalized. A lot of people say they can do this with friends, but therapy is different: therapy is taking all of this to a trained professional who is objective and knows how to help. There’s no shame in going to therapy, or in taking medication. This is HARD.
- I asked for help. I am more transparent about – well, everything – than most people I know, and that included, and still includes, my infertility and mental health. I needed my people to be with me to help me get through this, and why wouldn’t they want to? They’re my people, and I am theirs. We’re all in this life together for times like these. And the ones who aren’t? The ones who might judge you, or feel like it’s too much, aren’t your people. And you deserve to know that and let them go.
- I grieved. I grieved until I couldn’t cry another tear and until my stomach was raw from the unjust rage of it all. I still grieve – for me, for all of us. Do what you need to process this grief. Everything you are feeling is valid and true. No, it’s not fair. You don’t need to feel or do anything you don’t want to do right now. You are grieving, and some days are going to be okay while other days are going to be really hard.
But there are going to be more days. And someday, there will be really good days.
Cheers to you, number 9,998,383,750,000.
Kristin Diversi is a writer and versatile creative. She is passionate about reproductive health and justice and lives in Longmont, Colorado, with her husband and their son.