When IVF fails it is devastating. Fertility treatments offers hope to many, so to engage physically and emotionally with such a demanding and expensive treatment can leave you feeling very empty when it doesn’t work.

The reality of fertility treatments is that they don’t have a 100% guarantee of success. It is often not fully appreciated that the majority of IVF cycles will not work. About two-thirds of fertility treatment cycles fail. Obviously this statement is a huge generalisation and some patients will have higher chances of success than others.

If you are embarking on fertility treatment for the first time, or have had an unsuccessful cycle already, how should you prepare for the day when treatment doesn’t work? The inevitable sadness that comes when a cycle fails is normal. The best advice is not to panic but to begin to talk constructively to someone about how you are feeling and agree on the next steps.

If you are going through treatment with a partner it may be difficult to talk openly about your feelings, as you may both have different views on the treatment process. It is not unusual that partners disagree and the feelings of sadness can turn to blame and sometimes regret. This is all part of coming to terms with the reality of a failed treatment cycle.

The frustration of not being able to make fertility treatment work can affect relationships, friendships and individual happiness. The after care in every fertility clinic when an IVF cycle fails should involve a review consultation with a doctor to discuss the treatment cycle in detail and offer you further emotional support with counselling.

When IVF doesn’t work there are so many factors to consider. A structured review appointment with a doctor should look in detail at your recent treatment cycle and look at how things went overall. Taking the birds eye view of things is as important as getting into the detail as it gives context to the situation and helps you make sense of the outcome. A successful IVF cycle relies on every piece of the jigsaw being correct. Studying the detail of the treatment cycle and breaking it down the different phases helps to plan future treatment.

Fertility counselling is not to be underestimated and is a big part of helping people to move forwards when an IVF cycle fails. The sense of loss and emptiness that follows a failed IVF cycle is tough. All clinics offer fertility counselling to help you come to terms with an unsuccessful cycle and this resource is as important as planning the next steps.

The embryo is critical to the success of the cycle. Embryos are simply a collection of cells. Half of the chromosomes in the embryo have come from the sperm and the other half have come from the egg. Research has shown that on average around half the embryos created in IVF cycles are abnormal and have incorrect numbers of chromosomes. This becomes more problematic as you get older and explains why age is so critical to fertility success rates. The embryo undoubtedly makes up a large part of the jigsaw puzzle and the picture of success.

The endometrium (womb lining) is also critical to the implantation window and we know that optimally the thickness of the womb lining should be above 7-8mm. This has been recognised in studies and when the endometrial thickness falls we see a drop in success rates. Checking that the endometrium develops normally during the stimulation phase of the cycle or in a frozen embryo replacement cycle is important

The eggs are absolutely crucial to the quality of the embryos that result from the treatment cycle. Aging affects eggs and this is one factor you can’t change, but talk to your doctor about whether you might benefit from making changes to your stimulation drug regimen or adding supplements to your next treatment approach. Check which supplements might benefit you by reading our article here unscrambling the evidence behind nutritional supplements.

The sperm is important too and must be optimised for fertility treatment. There are a number of factors that can impact on the quality of your sperm. Something really simple such as your occupation or even your recreational habits may be affecting sperm quality. We have written an article outlining all of the important things to consider when you are looking to optimise sperm for an IVF treatment cycle.

Womb factors can affect whether an embryo implants successfully. Usually most patients will have had any obvious structural abnormalities with the womb identified early, such as fibroids and uterine anomalies and had these excluded.

Blood factors have incomplete evidence currently for their role in contributing to failed implantation. However, if you are having multiple failed cycles then it is important to discuss this with your doctor and to find out if there are any blood tests that might explain the repeated failed implantations. Key areas to focus on are the thyroid gland and the inherited and acquired thrombophilias.

A follow up consultation with your doctor is an important step to progressing and to understanding your IVF results. The objective of the consultation should be to be listened to and supported, to have your questions about the failed cycle answered and to then make a clear plan for future treatment. Some patients will have frozen embryos from their first cycle to use but some will need to start again with a fresh stimulated IVF cycle.

It is important to remember that only a third of IVF cycles are successful and so it may take a few attempts to have success. You are not alone.