IVF is kind of a miracle. It always astounded me when I was going through fertility treatment after treatment that someone figured out how to take a process that has been happening for as long as there has been human life and make it happen in a lab. I was told once that I was going to have to fertilize my eggs “in exile” from my body and that is exactly what I did with my IVFs.

There are so many steps to an IVF and something could go wrong at any point. You just never know until you do it yourself. But when everything seemingly goes right;

Your body responded to the medications!

You were able to collect quality eggs!

They fertilized and made it to blastocyst, maybe you even had them tested for chromosomal abnormalities!

Your uterine lining was perfect!

…and it still doesn’t work.

When all that is looking good and you still get the dreaded BFN it’s impossible not to wonder what happened. Was it something you did wrong? Did the doctor miss something? Should you try again? If yes, when?

The biggest reason an IVF doesn’t work is embryo quality. Even though they might look good in the lab, many embryos aren’t strong and healthy enough to implant and lead to a successful pregnancy. They have defects that we cannot see or cannot be screened for with PGS.

One of the highest risk factors for poor embryo quality is the age of the mother when the eggs were collected. We know that the quality decreases with age as well as the quantity. On average, only about 25% of transferred embryos will result in live births of babies. Women under 35 using their own eggs for IVF have an implantation rate of about 45 percent. Women 40 to 42 years old using their own eggs have only about a 15% chance of implantation.

As a Fertility Doula I have had many conversations with women who have had a failed cycle and are now trying to decide if they should stay with the same clinic for another cycle. I almost always recommend that they do. Unless there was something egregious during the first cycle (like they lost your embryo in the lab or you had a major personality clash with your doctor) it is a good idea to give the same doctor and clinic another go. There are two questions I counsel women to ask:

1. What did we learn?

After going all the way through and IVF cycle your doctor will have a better understanding of you and your body and particular circumstances. She or he will have seen how your have responded to medications and what your mental state was throughout your treatment. They will also have an understanding of how your eggs did or did not turn into embryos and their health in the lab. Once your doctor has done a full cycle with you they will have learned a great deal about you so that you are able to ask your next question:

2. What can we do differently next time?

Now that your doctor knows more about you and they way you responded to treatment they can make some changes to your next cycle, if they think it will be useful. Perhaps they will use medications in different doses. Maybe they will add something or take something away. Or it could be that they don’t wish to make any changes at all. Asking the question keeps you in a partnership with your doctor and allows you to take some agency over your cycle.

Another thing to keep in mind is that our fertility can fluctuate somewhat dramatically from month to month. Each cycle we have a new “batch” of eggs from which to try to collect via IVF. The quality of those eggs can also be influenced by the decisions your doctor makes, such as the choice to ovarian stimulation protocol, the choice of hormone medications, and the timing of the ovulation trigger. Because there are normal variations from cycle to cycle and your doctors ability to make changes based on what they learned about you from previous IVF attempts, in most cases IVF is worth trying again.

It takes an average of 3 IVFs to bring home a baby. Although this may sound discouraging as you are getting ready for your first cycle, it’s important to keep in mind so that you can manage your expectations accordingly.

I am always available to talk you through your options if you ever wish to discuss them.