The 10 Questions Everyone Should Ask When a Fertility Cycle Fails

A negative pregnancy test can be hard for anyone to bear, particularly individuals and couples who are going through fertility treatments. “Disappointing” doesn’t even begin to describe how you feel. And while the first place you usually go is your significant other’s shoulders for a good cry (and for a glass of wine and a bite of unpasteurized cheese), the second should be to your fertility doctor to break down why this cycle didn’t work.

Here are our suggestions on what should be on your list:

Why didn’t it work?

Hands down, this is the most frequently asked question when a fertility cycle is not successful. And while it is a good place to start, in order to get concrete answers, it’s better to break it down into little pieces (a.k.a. your reproductive parts). When you chat with your doctor, make sure to be specific in your line of questioning; the narrower the question, the more useful the answer. You have to be your own advocate, and if you aren’t satisfied with what you’re hearing, go deeper and more specific.  If you don’t understand specific doctor jargon, make sure to ask for an explanation.  And bring a pen and paper!

Did I make a bad egg?

While we are never fans of finger pointing, in many cases, the culprit is an abnormal egg, which resulted in an abnormal embryo, which = no pregnancy (especially if this was an IVF cycle where the embryo did not undergo genetic screening). Unfortunately, barring genetic testing of the embryo, there is not much that we can do to predict if the egg you ovulated or we extracted was normal. While we use hormonal assays (think FSH and AMH) and female age to help guide our treatment plans and analysis of the outcome, they are limited in their abilities to predict the future. This is why we are huge advocates of embryo screening. While it can’t tell us if the extra chromosomes came from the egg or the sperm, it gives us a lot of data about where the “damage” may have started.

Was my partner’s sperm only so-so?

Although men are often sperm-making machines for years longer than we are egg-making machines, as time ticks away, so does sperm quality and quantity. Furthermore, certain medical conditions or recreational habits can hamper your other half’s sperm production. Make sure that your partner has had a semen analysis, and if the results were only so-so, your fertility doctor should refer your partner to a urologist. There are procedures, techniques, and medications that can help improve sperm quantity and quality.

Was my uterus not ready for a guest?

Although the uterus is infrequently the primary cause of infertility or a failed fertility cycle, it should be looked at from a few angles. Routine ultrasounds depict the uterus in two dimensions. And while it can look good in this mirror, it’s important to have a 3D study or a test (HSG or hysteroscopy) that shows the inside of the uterus. Unwanted guests (e.g., fibroids, polyps, or scar tissue) that can interfere with implantation can be lurking!

The reality is that most fertility treatments don’t work the first time you try them

Is a failed IVF cycle a miscarriage?

While a failed IVF cycle is a major bummer it does not actually equal a miscarriage. And although it might feel like one, a miscarriage, by definition, requires that a pregnancy was seen and then not seen within the uterus. A positive pregnancy hormone, without any evidence of a pregnancy on ultrasound, does not make the cut.

On the flip side, a failed IVF cycle includes ANYTHING from no embryos available for transfer to a negative pregnancy test post embryo transfer to a low positive pregnancy hormone post transfer (aka a biochemical pregnancy). And although distinguishing the two may sound like semantics, the difference is important clinically. Women who have recurrent IVF cycle failures may require different treatments than those who have recurrent miscarriages. Therefore, it’s important to regroup with your doctor post IVF cycle—you want to make sure you know what might be happening and what treatment you may need in the future.

Should I repeat the same treatment, and if I do, what is the chance it will work?

Yes and no and maybe. The reality is that most fertility treatments don’t work the first time you try them. You often must try a few attempts before you see success. However, you should 1,000% speak with your doctor between every attempt and ensure he or she breaks down what happened and how he or she can make things happen next time.

This is also the time to talk with your doctor about adjustments to your protocol, small or large.  Whether it’s a minor change, like a slight increase to medication dosage, or a major change, like switching between a medicated and a natural transfer cycle, doing something differently on the next cycle can make the process more empowering.   Additionally, make sure you have an end point. While this road can be long, it shouldn’t be endless. Make sure there is a stop and you know where and when that will be.

When is it time to move on to the next step?

Unfortunately, this one doesn’t have an easy answer. However, we added it to the list to make sure you ask it. And to ensure that you know that there are options, both in what you do and where you do it. You aren’t tied to one type of treatment or one treatment center.

Do you have paper and pen?

Write things down! Whether it be the questions you want to ask or the answers to those questions, remembering everything can be hard. Jotting down what you want to say and what has been said will serve you well in the future.

Can I have my records?

You are your best advocate (and your best record keeper). Asking for your records and speaking up on your behalf does not make you annoying. It makes you smart. And while you don’t need to become a bookkeeper, keep track of what goes into and out of your body. It can ensure that you stay balanced!

What’s next?

We love plans. Just check out our calendars! But we especially love plans when it comes to our patients. Knowing what you are going to do if your day 1, that is, your period, comes can make dealing with D-day somewhat easier. Simply stated, plan for the worst (#period), but hope for the best. That way, you won’t waste any time.

Getting pregnant and having a baby are not easy. Contrary to what we thought in college, you don’t get pregnant every time you have sex! Although people use the word “fail” liberally in this field, remember that you are not a failure. Fertility treatments are hard: emotionally, physically, and financially. Staying in the game when things get tough makes you a success—no matter what that pregnancy test shows.

The information provided above is for informational purposes only and should not be construed as medical advice or a substitute for medical care.

Jaime Knopman, MD FACOG is the Director of Fertility Preservation at CCRM, NY. Sheeva Talebian, MD FACOG is the Director, Third Party Reproduction at CCRM, NY.

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