Our IVF Cycle Failed—Now What?
Patient: Dr Malpani, we’re devastated. Our IVF cycle just failed, and we have no idea what went wrong. We’re confused and heartbroken. Is this normal?
Dr Malpani: I’m really sorry you’re going through this. Yes, it’s completely normal to feel this way. A failed IVF cycle is emotionally exhausting, and the first reaction is usually confusion and self-doubt. Many patients start questioning everything—was it the doctor? The clinic? Did we do something wrong?
Patient: Exactly! And now we’re wondering—should we continue with the same clinic? Do we need more tests? Everyone’s telling us different things.
Dr Malpani: You’re not alone. Sadly, what often happens after a failed cycle is a knee-jerk reaction. Doctors sometimes start ordering more tests—immune testing, genetic tests, endometrial receptivity analysis—many of which are expensive and not necessarily helpful. Unfortunately, this often benefits the clinic more than it helps the patient.
Patient: Yes, we were already advised to do more tests. But no one is clearly explaining why. It feels like they’re just guessing.
Dr Malpani: That’s exactly the problem. Rather than reacting emotionally or blindly following suggestions, this is the time to pause, reflect, and analyse the failed cycle rationally. Think of it like a postmortem—what worked, what didn’t. Let’s break it down using what I call the “McKinsey method”.
Patient: That sounds interesting. What’s that?
Dr Malpani: It’s a way to simplify complexity. In IVF, there are only four key variables we can control:
- The clinic/lab
- The eggs
- The sperm
- The uterus
Everything else—protocols, medications, even your diet—is just a way to influence these four.
Patient: That makes it easier to think about. How do we know which of those went wrong?
Dr Malpani: We start by reviewing your embryo quality. Were they good-quality blastocysts? Were they transferred into a receptive endometrium? If yes, and the embryos still didn’t implant, we call this “failed implantation”.
Patient: Isn’t that just another way of saying “we don’t know”?
Dr Malpani: Exactly. That’s the frustrating part. Despite all our technology, we still can’t always explain why an embryo doesn’t implant. It’s a black box. But we can still learn from it and adjust.
Patient: So what do we change in the next cycle?
Dr Malpani: That depends on what we uncover. Let’s go through each variable:
- Eggs: If your ovarian response was poor, or the embryos looked fragmented or didn’t reach blastocyst stage, we might consider changing your stimulation protocol—or in rare cases, explore donor eggs.
- Sperm: If the fertilisation rate was low or embryos arrested early, the sperm could be the issue. We might consider advanced sperm function tests or using surgically retrieved sperm.
- Uterus: If the lining was thin or irregular, we can work on improving it. But remember—embryo quality is usually the most critical factor.
- Clinic/Lab: This is the most overlooked yet most important variable. If the clinic’s lab is not good, even the best eggs and sperm won’t result in healthy embryos. One simple way to assess the lab’s quality is by looking at embryo photographs. If your doctor didn’t give you images of your embryos, that’s a major red flag.
Patient: That’s exactly what happened! They never showed us any embryo images. We were told they looked “okay”, but we have no proof.
Dr Malpani: That’s very concerning. Transparency is a basic right in IVF. If a doctor doesn’t share embryo photos, it’s usually because the lab performance is poor, and they don’t want patients asking tough questions. In cases like yours, switching clinics might be the most sensible next step.
Patient: So what should we definitely not do?
Dr Malpani: Don’t jump into new treatments blindly. Avoid doctors who immediately suggest donor eggs, surrogacy, or a bunch of new tests without first analysing what went wrong. These are emotionally and financially draining decisions—and often unnecessary.
Patient: Thank you, Dr Malpani. This makes so much sense now. So what’s the next step?
Patient: That sounds exactly like what we need. We just want to make informed decisions now.
Dr Malpani: And that’s the right approach. IVF is a journey, and while failures are painful, they also teach us. Let’s use that knowledge to improve your chances next time—and make sure no more time is wasted.