Recurrent IVF Failure

Recurrent IVF failure is defined when a patient undergoes multiple cycles of embryo transfer without resulting pregnancy. This is one of the most frustrating and stressful conditions for both patient and physician.

Several reasons may explain failed implantation. It could be due to the embryo or endometrium or both. Other co-factors may be involved. However, in many cases we cannot explain the reason for recurrent IVF failure.

The most known causes of IVF failure are:

  • Advanced maternal age
  • Slow embryo development in the IVF Lab
  • Thick shell on the embryo and difficulty in hatching
  • Intrauterine abnormalities like; polyp, fibroid, scaring or inflammation.
  • Fluid collection inside Fallopian tubes
  • Fluid collection inside uterine cavity
  • Difficult embryo transfer technique
  • Immunological factors
  • Chromosomal abnormalities in the embryos
  • Maternal medical illnesses
  • Suboptimal ovarian stimulation during IVF cycle
  • Poor sperm quality


Management of recurrent IVF failure is a challenging process and has financial impact of couples. Several investigations are required in this kind of women to identify possible treatable causes or factors.  

Common investigations include:

  • Thyroid Function
  • Thrombophilia screen
  • Immunological testing
  • Hysteroscopy
  • Chromosomal testing
  • Diabetes Screen
  • Endometrial Receptivity Array (ERA)

  Usually, the management is directed towards the cause if recognized. However, commencing treatment improves the outcome but it doesn’t always mean the pregnancy will occur. In many circumstances, no cause is identified (unexplained recurrent IVF failure) but your physician may try empiric therapy hoping it may improve the outcome.  

Treatment modalities

The following treatment modalities are widely used for recurrent IVF failure based on your assessment by your physician:

  • Endometrial scratching
  • Endometrial receptivity array (ERA)
  • Prednisolone
  • Intralipid therapy
  • Freezing all Day 5 embryos in fresh cycle and replacing them in non-stimulated cycle
  • Proper management of male factor by an andrologist to improve sperm quality before attempting IVF cycle

Not all women with recurrent IVF failure are the same. Therefore, planning future IVF cycle with your physician depends on careful review of your condition and the records of your previous cycles.