Canceled IVF Cycle? Why It Happens and What’s Next

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In vitro fertilization (IVF) cycle cancellation happens when conditions for a successful pregnancy are not ideal. Often it happens before egg retrieval, but sometimes it can happen afterward. For example, cancellation may occur when only a few follicles (fluid-filled sacs containing immature eggs) develop in the ovaries during the stimulation phase of IVF treatment.

What Are Poor Responders?

During treatment, people whose ovaries don’t produce enough follicles are called "poor responders." Between 5% and 35% of people are poor responders.

In addition, the doctor may delay or cancel your cycle if they retrieve few to no eggs, your eggs don't fertilize, embryos fail to develop normally, or you risk developing ovarian hyperstimulation syndrome (when ovaries become dangerously filled with fluid).

Canceling or delaying your IVF cycle can be heartbreaking. But keep in mind, one canceled or delayed cycle does not mean your next cycle will have the same unfortunate ending. This article explains why IVF cycles are canceled, delayed, or fail and what options are available when it happens.

Cysts

Doctors order a baseline ultrasound and blood work at the start of an IVF cycle (or any fertility treatment cycle). These tests confirm there are no cysts on the ovaries.

Functional ovarian cysts may develop during IVF treatment due to the ovarian stimulant medication you take, such as Lupron (leuprorelin). If you have a cyst, the doctor will likely delay treatment because cysts could negatively impact the number and quality of follicles you have.

These cysts are typically benign and usually go away quickly without additional intervention. Once resolved, you may be able to start the IVF cycle after a short delay, or your doctor may push it off to another month.

Issues With Eggs

If you have too few follicles, no eggs, or your eggs fail to fertilize, you can't continue your IVF cycle.

Too Few Follicles

When the ovaries don’t respond as well as expected to the fertility drugs, they may not develop enough follicles. Ideally, you will have two or more follicles that measure 15mm–18mm. However, some doctors may require more than two. It is also possible to have too many follicles for egg retrieval, so monitoring is done frequently during an IVF cycle.

Sometimes, when a person has too few follicles, you can convert these cycles to intrauterine insemination (IUI) instead. IUI is a more straightforward procedure and involves transferring semen into the uterus with a thin catheter.

Mini-IVF

Doctors give lower dosages and weaker medications for a "natural" IVF cycle or a "mini-IVF" cycle. Therefore, getting just one or a few follicles is expected and is, in fact, the goal.

No Eggs Retrieved

Empty follicle syndrome (EFS) occurs when a mature follicle doesn't produce eggs. It happens infrequently, between 0.6–7% of the time in people undergoing fertility treatment. Researchers suspect EFS may result from a low ovarian reserve, which is when a person has a reduced number of eggs.

Theoretically, you could have a good number of follicles but retrieve no eggs from them. If there are no eggs, fertilization can't happen and the cycle would end.

Eggs Fail to Fertilize

Sometimes retrieved eggs fail to fertilize. Failed fertilization may occur due to a problem with the eggs, the sperm, or both. If the eggs fail to fertilize, the cycle ends. Your doctor will discuss options with you, which could include the use of donor sperm or eggs.

Also, sometimes, eggs fertilize, but the embryos that result are poor in health or "arrest" in development before a doctor transfers them. In addition, preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS) results might show the embryos have genetic or chromosomal problems. If so, your doctor will likely suggest canceling the cycle.

Recap

If you have too few follicles, no eggs are retrieved, or your eggs fail to fertilize after retrieval, the IVF cycle will be canceled.

Problems With Hormones

When estrogen levels are too high or too low, or progesterone levels are too high, your chance for success drops. As a result, your doctor may cancel your IVF cycle.

Low Estrogen Levels

Your body makes several types of estrogen—estradiol being the most predominant. Increased estradiol prompts the egg to mature and release during the menstrual cycle. In addition, it thickens the endometrium (uterine lining) to prepare for implantation. Doctors often prescribe estrogen for people undergoing IVF treatment to improve the chance of pregnancy.

Estradiol levels, especially when compared to mature follicles, can impact pregnancy success. According to a 2014 retrospective review, pregnancy odds are better when the estradiol to mature follicle ratio is between 200 to 299.99 pg/ml.

If estrogen levels are lower than expected during the ovulatory stimulation part of the IVF cycle, this may indicate problems with follicle development. An IVF cycle is rarely canceled solely because of lower-than-desired estrogen levels, but if estrogen levels are low, you may have fewer follicles and it is these factors together that might warrant canceling the cycle.

Expected Estrogen Drop

Some IVF protocols have an expected drop in estrogen before the egg retrieval stage. Research has found that a decline in estradiol after the hCG trigger shot is not associated with a lower chance of pregnancy.

High Estrogen Levels

A 2013 cohort study found that embryo cryopreservation (egg freezing) in people with extremely high estrogen levels at egg retrieval reduced the likelihood of having a baby born small for gestational age or developing preeclampsia during pregnancy.

Due to these risk factors, if your estrogen levels are too high, your doctor may advise canceling your IVF cycle. However, if cancellation occurs after egg retrieval and some healthy embryos develop in the lab, those embryos may be cryopreserved (frozen). Later, they can be thawed and transferred via a frozen embryo transfer (FET) cycle.

High Progesterone Levels

Progesterone is a hormone that rises after ovulation. It helps prepare the endometrial lining, where the embryo will hopefully implant, and helps maintain a pregnancy. Progesterone shouldn’t start to rise until after egg retrieval (or ovulation).

However, some people will experience increasing progesterone levels on egg retrieval and some studies have found that embryo transfer during those cycles is less likely to lead to pregnancy success.

If this happens to you, your doctor may recommend that you freeze the embryos and schedule embryo transfer later. Waiting can be difficult, but it may improve the odds of treatment success.

Recap

Hormones play an essential role in maintaining a healthy pregnancy. Therefore, if your estrogen levels are too high or too low or your progesterone level is too high, you may need to cancel your IVF cycle. If cancellation occurs after egg retrieval, your doctor may advise cryopreservation and FET for your next cycle.

Premature Ovulation

During IVF, doctors give the hormone hCG via injection (also called a "trigger shot") to prompt the eggs to mature and trigger ovulation. The timing of this injection is crucial.

If you have the injection too soon, you may ovulate before your procedure, releasing the eggs before they can be retrieved. Likewise, if you get it too late, once the eggs have already been released into the pelvic cavity, your doctor can't retrieve them for IVF.

Your doctor will give you an exact time to give yourself this injection, approximately 36 hours before the egg retrieval. Some clinics will have you come in to receive the shot because timing is essential. If you take it at the wrong hour, you may need to cancel your cycle.

Ovarian Hyperstimulation Syndrome

Just like it's possible to under-react to fertility drugs, it's also possible to overreact. This overreaction can lead to ovarian hyperstimulation syndrome (OHSS), a condition that occurs when your ovaries fill with fluid from high levels of hCG. Most often, cases are mild and go away with two weeks. However, it can become life-threatening.

If your symptoms, ultrasound, or blood work indicates a high risk of OHSS, your cycle may be canceled or postponed. That's because it could be dangerous to transfer the embryos if you're developing a bad case of OHSS. In addition, it takes longer to recover from OHSS when you are pregnant so it's often better to wait for another cycle.

Your doctor will offer options, such as cryopreservation and FET. However, suppose OHSS occurred before embryo retrieval, or you choose not to freeze embryos. In that case, your doctor may be able to use lower dosages of fertility drugs or a different protocol in the future to avoid another hyperstimulation response.

Illness

If you or your partner come down with an illness during treatment, your cycle may be canceled or delayed. High fever can negatively impact sperm counts. It can also interfere with follicular development. So, be honest with your doctor if you or your partner have a high fever or are coming down with something during your treatment month.

It can be disappointing to cancel or delay treatment, but some illnesses can decrease your odds of success and may even put your overall health at risk.

Options After a Failed or Cancelled Cycle

After so much anticipation and financial investment, having your cycle canceled can leave you wondering—should you try again? This question is not easy to answer and depends on your particular situation.

In many cases, yes, if you have the financial means, it’s worth trying again. Your doctor can offer options to better treat your next cycle based on what went wrong the first time.

Proceed With Few Follicles

Some doctors are willing and may even encourage you to go ahead with egg retrieval even when you only have a few follicles. In some situations, this is a best-case scenario. For example, if you have diminished ovarian reserves and don't want to use an egg donor, going through with a cycle even with low odds for success may still be your best chance for pregnancy.

Not every doctor will give you an option to go ahead with egg retrieval if your follicle numbers are considered too low. Others will provide you with their opinion on what to do but leave the final decision in your hands.

Poor responders have half the chance of getting pregnant if they go through with egg retrieval: 7.6% to 17.5% chance of achieving pregnancy compared to a 25.9% to 36.7% in normal responders. In addition, those over 37, those with higher weights, and those with elevated FSH levels had significantly lower chances of success.

The actual number of eggs retrieved matters, with fewer eggs leading to lower pregnancy rates. For example, people with one egg retrieved had pregnancy rates between 0% and 2.3%, while those with two eggs had pregnancy rates between 4.3% and 15.2%, and those with five eggs had pregnancy rates at 22%.

Try Again

In some cases, a canceled cycle is a fluke. Sometimes fertility testing predicts a poor response. Other times all the tests look good, and things don’t go as expected. In these cases especially, another try may be worthwhile.

One study found that when poor responders tried two more times, 54% of them responded normally in at least one of the following two cycles. In addition, unexpected poor responders had a cumulative pregnancy success rate of 25.9% to 47% over three IVF cycles combined.

If, on the other hand, you over-responded to the fertility drugs, your doctor can lower the dosages or use a different protocol next time.

Trying Other Methods of Assisted Reproduction

There are, however, times when a poor response, in combination with other factors, is a sign you should try something different. Depending on the problem, this may mean moving onto IVF with donor eggs, IVF with donor sperm, or considering other methods of assisted reproductive technology (ART).

Even in the case of a poor response, there may be a different protocol that could help, including:

Switching to IUI Mid-Cycle

Another option your doctor may offer is to switch your cycle from an IVF to an IUI cycle. This option might be especially beneficial if you ovulated prematurely, in which case IUI could potentially fertilize the already released eggs.

Whether this is a good choice will depend on cost, your reasons for infertility, and what male factor issues are at play. For example, IUI may not be possible if you have blocked fallopian tubes, your partner's sperm counts are very low, or IVF with ICSI is needed.

Sometimes, there are too few follicles for IVF but still too many for IUI. Undergoing IUI when you have three to five follicles means that you are at risk of having multiples, and carrying multiples increases health risks to you and your babies.

Recap

When an IVF cycle is canceled, you still may have options, including trying again, proceeding with fewer follicles, trying different ART methods, or switching to IUI mid-cycle.

Summary

IVF cycles are sometimes canceled when conditions are not ideal for pregnancy. These situations may include ovarian cysts, issues with eggs, sub-optimal hormone levels, premature ovulation, OHSS, or illness. Options after a failed cycle include trying again, modifying your approach to IVF, or trying another ART method.

A Word From Verywell

No one goes into an IVF cycle expecting not to make it through to embryo transfer. It’s normal to experience different emotions, including sadness, disappointment, and anger, especially if you could only afford to try once. But rest assured that even a canceled cycle is not a waste. Hopefully, your doctor will use the data collected to help make the next cycle or family-building step better.

Reach out for support from friends and family. Talk to your doctor about the canceled cycle, listen to their recommendations, and then decide what your next steps will be after you have time to process the experience.

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