A cycle that did not work leaves two kinds of questions: what to do in the next few days, and what to decide later. The first set is short and practical. The second can wait until a follow-up visit, where you go through the cycle step by step with your doctor. If you are having thoughts of suicide, go straight to getting help now.
Right after a negative result
Wait for your clinic's result. Some clinics give you a home test and a date to use it. Others check your blood. If you test at home before the date you were given, the trigger medicine can still be in your blood and make the test positive when you are not pregnant. Treat the result your clinic gives you as the answer.
Keep taking your medicines until your clinic tells you what to change. UW Medicine, for example, tells patients to keep using estradiol and progesterone until the clinic says to stop. Call or message your clinic with your result, and ask about each medicine by name before you stop anything.
Expect your period once your clinic confirms the result. After your clinic confirms the result and you stop your medicines as told, your period may come within a few days. It may be heavier than usual because of the medicines.
Give future decisions time. Your body needs a chance to recover from the medicines, and you do not have to choose a next step right away.
If you are having thoughts of suicide
You do not need to wait for a follow-up visit, or for the feeling to last, to ask for help.
Was it something I did?
An unsuccessful cycle is not, by itself, evidence that you did something wrong. Failure is common in any one IVF cycle. The most common reason treatment does not work is that embryos do not develop in the uterus, and often there is no obvious explanation. Possible reasons include an egg that did not mature or divide properly, and embryos that look healthy but have chromosome problems.
Your team may be able to identify things that played a part. Ask the question out loud at your follow-up visit.
What kind of result was it?
"Failed IVF" can mean different things, and each one leads to different questions.
- The cycle stopped before retrieval or transfer. The ovaries responded too little or too much, or no eggs were found. See cycle cancellation.
- Eggs did not fertilize, or embryos stopped growing in the lab. There was no embryo to transfer. Ask what the lab saw at each step and whether the lab method would change.
- A transfer did not lead to a pregnancy. Ask how the embryo was assessed, whether the transfer went as planned, and what is known about your uterus.
- An early pregnancy ended. A biochemical pregnancy shows up on a blood or urine test but is never seen on ultrasound. Miscarriage can also happen after a pregnancy is seen on ultrasound. Ask what follow-up care you need now.
The follow-up visit: what to expect
Your clinic may offer a meeting after a cycle that did not work. At Guy's and St Thomas', an NHS hospital in London, you see a senior doctor within 4 to 6 weeks. You talk about why the cycle may have failed and whether your chances could improve. If the doctor thinks your chances are very low, they say so and may suggest stopping.
Researchers who studied grief after unsuccessful IVF suggest a structured final talk, with time to go over your results and whether other treatments are available. If your clinic does not offer one, you can ask for it.
To get ready:
- Ask for a copy of your cycle records ahead of time.
- Write your questions down, and tell the doctor at the start which matter most.
- Bring your partner or a friend if you can. They can take notes.
Our first consultation guide has more tips for any appointment.
Questions about your results
- How did my body respond to the medicines?
- How many eggs were retrieved, and how many were mature?
- How many fertilized, and how many embryos kept growing?
- How were the embryos assessed?
- Did the transfer go as planned?
- Do I have frozen embryos left? How many, and how were they assessed?
- Was anything about this cycle different from what you expected?
Questions about what could change next time
- What do you think may have played a part this time?
- Would you change my medicines, my protocol or the lab method?
- Would you suggest new tests for me, my partner or my uterus?
- Should we think about genetic testing of embryos?
- What would you not change, and why?
Your doctor may suggest keeping the same plan. If so, ask why, so you understand what they looked at.
If you are offered an add-on. Add-ons are optional extra treatments or tests on top of standard IVF. They often cost extra, and for many the evidence that they help is unclear or missing. The HFEA, the UK fertility regulator, rates add-ons on its website. Before you agree to one, ask:
- Would this improve the chance of a live birth for someone with my results?
- What are the risks?
- What does it cost?
Questions about next steps
Write the answers down. You can decide later.
- If I have frozen embryos, should I use them first?
- How long should I wait before trying again, and why?
- What are my chances with another cycle, based on my own results?
- What are my other options, such as donor eggs, donor sperm or other ways to build a family?
- What will the next cycle cost, and what does my insurance cover?
- What happens to my frozen embryos if I take a break or stop?
Taking a break or stopping is a real choice. Some people keep trying, and others move on from treatment sooner. ASRM says decisions about when to stop should weigh many factors, including money and emotional reserves, and your team can talk through other options with you.
A simple debrief table
Copy this into a notebook and fill it in during or after the visit.
| Topic | What the doctor said | What I want to think about |
|---|---|---|
| What kind of result it was | ||
| What may have played a part | ||
| What would change | ||
| Add-ons offered, with risks and cost | ||
| Frozen embryos | ||
| When we could try again | ||
| A break, stopping, other options |
Questions about support
Grief after unsuccessful IVF can last a long time. In a small Swedish study of 19 women and men who stayed childless after IVF, most were still working through it three years later.
- Does the clinic have a counselor who works with fertility patients?
- Can my partner come to counseling with me?
- Are there support groups you suggest? (ASRM's patient site names RESOLVE, a national support group.)
Partners may grieve in different ways, and you may want different next steps. ASRM suggests a mental health professional can help a great deal with depression that does not lift or bitterness and anger that last, and when you are at a treatment crossroads.
Key takeaway
Wait for your clinic's result, and change your medicines only as it tells you. If you have thoughts of suicide, get help now. When you are ready, ask for your records, go through what kind of result it was, and weigh every option, including a break.