My last series of posts fell under the heading “IVF: Commonly Asked Questions, Fears and Concerns”. Because the series was enthusiastically received, I have accordingly decided to address another series of 20 questions under the title of: “My IVF cycle failed… I have questions.”

Given the financial, emotional and physical investment made in IVF, it is understandable that patients will be upset when treatment fails to result in a viable pregnancy. “What went wrong with the treatment?” “Did my doctor screw up or did I do something wrong?”

Some patients deal with this enormous let down in a philosophical manner while others become belligerent, confrontational and even aggressive…….. “After all doctor, you told me that my embryos looked good and that the embryo transfer went so well… so what went wrong?” Don’t for one moment think that delivering such bad news is easy for the treating physician! Believe me, since it is inevitable that at least half the time we will have to convey bad news to patients who entrusted their IVF care to us, breaking the news and then counseling patients after of a “failed cycle” is one of the toughest tasks we as doctors face; and indeed all of us have to do so regularly.

For patients to safely confront such disappointment requires adequate preparation in advance. And here nothing is more important than the treating physician establishing realistic expectations in advance of treatment. If this is done properly, surprises can be avoided and emotional trauma blunted. I always tell my patients in advance of their undergoing IVF treatment to “hope for the best but to prepare for the worst” because optimum IVF treatment does not guarantee an optimum outcome, and no human being can guarantee success. The adage that “man proposes while G-d disposes” is more applicable in the IVF setting than in most other medical situations.

Some doctors, wishing to attract patients, tend to offer inflated promises of success. This is not only a mistake but is also unethical in my opinion. What is needed is a frank candid interaction that realistically presents the chance of success, goes on to address the limitations inherent in IVF treatment and explains those variables that can and do influence the likelihood of success. What is deplorable is that when the cycle fails, some physicians become defensive and deny or limit patients’ access to them. Such behavior can and does often lead to anger, a feeling of abandonment, and profound resentment. A good IVF practitioner should understand the importance of being accessible to his/her patients at all times and the need to address questions and concerns especially after an IVF treatment has “failed”.

Below I have listed the 19 questions that I have addressed through this blog. Hopefully, you will benefit from the responses relating to this important subject matter. Click on the title of any of them to view the full article.

• Could I have done anything to prevent failure?

• Was I adequately evaluated and prepared for IVF by my physician?

• Who is to blame for my failure?

•  Was the IVF medication protocol right for my specific needs?

• I expected more eggs, why were so few eggs retrieved?

• How much could my elevated FSH and/or low AMH levels have contributed?

• Did I fail because I was too old for IVF?

• Was I triggered with hCG at the right time, with the right preparation and at the right dosage; to optimize my chances?

• What about the egg retrieval and its influence on IVF outcome?
• Could my IVF failure have resulted from an error in the embryology lab?

• Why did so few of my eggs fertilize/make it to blastocyst?

• How might the timing/method of embryo transfer (day 2/3 vs. blastocyst transfer) have played a role?

• Did the number of embryos I had transferred play a role?

• Could it have been due to inadequate hormonal support after the egg retrieval and embryo transfer?
• Might my mental state have played a role?

• Why did my beta hCG not rise properly?

• Why didn’t I get pregnant when I used a young egg donor and had perfect looking embryos?

• My fertility clinic reports a high success rate – how could I have 2 failed cycles in a row?

•  Why do I keep having chemical pregnancies and miscarrying?