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

Poor Responders, Canceled Egg Retrieval, and Delayed Embryo Transfer

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IVF cycle cancellation usually refers to when a low number of follicles develop in the ovaries during the stimulation phase of treatment, and the egg retrieval is canceled. Women whose ovaries don’t produce enough eggs (or follicles) during treatment are called “poor responders.” Between 5 and 35 percent of women are poor responders.

While failure to develop enough follicles worthy of egg retrieval is one reason for a canceled IVF cycle, your cycle may be cut short, delayed, or fail to be completed for other reasons as well. Some examples include having few to no eggs retrieved, failure of eggs to fertilize, failure of embryos to develop normally, or risk of developing ovarian hyperstimulation syndrome. (Additional causes for IVF cycle cancellation or delay are listed below.)

Having your IVF cycle canceled or delayed can be heartbreaking. By this point, you have invested time, emotional energy, and significant funds. Not getting to the embryo transfer stage can be painful.

That said, having one canceled or delayed cycle doesn’t mean your next cycle is destined for the same unfortunate ending. And, sometimes, you may be able to go through with the cycle despite recommendations to cancel or indications of a poor prognosis.

Here’s what you need to know to understand IVF cycle cancellation and make informed decisions.

Why Your IVF Cycle May Be Cancelled, Delayed or Fail to Complete

Just about every person who starts an IVF cycle knows that pregnancy and a live birth are not guaranteed. But many are surprised if they don’t make it to the embryo transfer.

Here are some possible reasons your IVF cycle may be delayed, canceled, or fail to reach the embryo transfer.

Baseline ultrasound or blood work problematic: At the start of an IVF cycle (or any fertility treatment cycle), a baseline ultrasound and blood work are ordered. This is primarily done to confirm there are no cysts on the ovaries. If a cyst is found, treatment may need to be delayed.

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

Not enough follicles are developing: Mentioned earlier, this is when the ovaries don’t respond as well as expected to the fertility drugs. How many is “not enough” follicles? The definition of “too low” varies between doctors, but usually, three or fewer follicles will lead to cancellation. Some doctors will cancel a cycle if there are fewer than five follicles.

If you don’t have enough follicles, the egg retrieval may be canceled by your clinic, or your doctor may recommend cancellation but allow you to make the final call on how to proceed. Your doctor will also likely recommend that you schedule a follow-up consultation appointment on what to consider for a future treatment cycle.

(This all, by the way, assumes you’re having conventional IVF treatment. If you’re having a “natural” IVF cycle, or a “mini-IVF” cycle, getting just one or a few follicles is expected and is in fact the goal.)

Low estrogen levels: If estrogen levels are lower than expected during the ovulatory stimulation part of your cycle, this may indicate problems with follicle development.

A cycle is rarely canceled only because of lower-than-desired estrogen levels—usually, it’s a decision made based on this and how many follicles you have.

Estrogen levels are too high: Just like it’s possible to under-react to fertility drugs, it’s also possible to overreact. This can lead to ovarian hyperstimulation syndrome (OHSS), a condition that if left untreated can become dangerous. In severe, rare cases, it can result in loss of fertility and even death.

If your estrogen levels are too high, your cycle may be canceled. This may occur before the trigger shot, before the egg retrieval, or after egg retrieval. If cancellation occurs after egg retrieval, and some healthy embryos develop in the lab, those embryos may be cryopreserved. They can later be thawed and transferred via a frozen embryo transfer cycle, or FET.

It could be dangerous to transfer the embryos if you’re developing a bad case of OHSS. Pregnancy can make it harder to recover from OHSS. It’s better to wait for another cycle and do the FET.

In the future, your doctor may be able to use lower dosages of fertility drugs or a different protocol to avoid another ovarian hyperstimulation response.

Unexpected dropping estrogen levels: Some IVF protocols have an expected drop in estrogen before the egg retrieval stage. This is not a problem, according to the research.

However, if estrogen levels drop unexpectedly before egg retrieval, this may be a bad sign. Your doctor may recommend you cancel the egg retrieval, to save money and emotional energy on continuing a cycle that is unlikely to succeed.

Not taking the hCG/trigger shot at the right time: The fertility drug hCG is taken via injection approximately 36 hours before the egg retrieval. The timing of this injection is crucial. If it’s taken at the wrong time, the eggs may ovulate before your procedure. Once the eggs are released into the pelvic cavity, they can’t be retrieved for IVF.

Your doctor will give you an exact time to give yourself this injection. (Some clinics will have their patients come into the clinic to receive the shot because timing is so important.) If you take it at the wrong hour, however, your cycle may need to be canceled.

No eggs retrieved: Theoretically, every follicle should contain an egg. But it doesn’t work like that. Sometimes, the follicles are empty. You could have a good number of follicles, but not retrieve any eggs from them.

If there are no eggs, fertilization can’t happen. The cycle would end here.

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

However, some women will experience increasing progesterone levels on the day of egg retrieval. 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 cryopreservation of any embryos and scheduling at a later date a frozen embryo transfer. Waiting can be difficult, but it may improve the odds of treatment success.

No embryos to transfer: Sometimes, even after a good number of eggs are retrieved, fertilization doesn’t happen. This means there will be no embryos to transfer.

Also, sometimes, eggs fertilize but the embryos that result are poor in health or “arrest” in development before they can be transferred. Another reason you may not have embryos to transfer is if PGS/PGD genetic screening results show the embryos have genetic or chromosomal problems.

Showing signs of OHSS risk: As mentioned above, ovarian hyperstimulation syndrome can be very serious if left untreated. If your symptoms, ultrasound, or blood work indicates a high risk of OHSS, your cycle may be canceled or postponed.

This may occur before egg retrieval or after retrieval but before embryo transfer.

Illness unrelated to IVF: If either partner comes down with a serious illness in the midst of treatment, the cycle may be canceled or delayed. High fever can negatively impact sperm counts.

Be honest with your doctor if you have a high fever or are coming down with something during your treatment month. It can be disappointing to need to cancel or delay treatment, but some illnesses can decrease your odds of success and may even put your overall health at risk when combined with the physical stress of treatment.

Can You Go Through With Egg Retrieval Even With a Few Eggs/Follicles?

The very first IVF baby was conceived with just one aspirated egg. In natural and mini-IVF treatments, one or just a few follicles are desired. So, why not just go ahead with the egg retrieval during conventional IVF even if you only have a few follicles developing?

This is a controversial issue. There are some doctors who are willing and may even encourage you to go ahead with egg retrieval. In some situations, this is a best-case scenario for that particular woman. If she has diminished ovarian reserves and doesn’t want to use an egg donor, going through with a cycle even with low odds for success may still be her best chances for pregnancy.

However, it’s important to know that poor response to fertility drugs is not the same situation as someone who has only been stimulated to developing one or a few eggs for retrieval. The fact that high dosages of hormones were not enough to significantly stimulate the ovaries may indicate that egg quality is poor.

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

Here are some statistics to help you make a choice:

  • According to a variety of studies, “poor responders” who go through with egg retrieval have between 7.6 to 17.5 percent chances of achieving pregnancy (compared to a 25.9 to 36.7 percent chance for those that respond normally).
  • When considering the data as a whole, poor responders have half the chance of getting pregnant if they go through with egg retrieval.
  • Age matters. Poor responders who were 36 years or younger had pregnancy rates between 13 and 35 percent. Poor responders age 37 and up had significantly lower success rates: between 1.5 and 12.7 percent.
  • Weight matters. Women whose BMI was over 30 were significantly less likely to get pregnant when compared to poor responders at a normal weight.
  • Women who had elevated FSH levels were significantly less likely to get pregnant after a poor response, compared to poor responders with normal FSH levels. (High FSH women had only a 4 percent pregnancy rate, compared to 14.8 percent for those with normal FSH levels but a poor response.)

The actual number of eggs retrieved matters, with fewer eggs leading to lower pregnancy rates. Three studies looked at pregnancy rates based on the number of oocytes.

  • Women who got just one egg retrieved had pregnancy rates between 0 and 2.3 percent.
  • Those who got two eggs retrieved had rates between 4.3 and 15.2 percent.
  • One study found that women who had five oocytes retrieved had pregnancy rates at 22 percent.

Switching From IVF to IUI Mid-Cycle

Another option your doctor may offer is to switch your cycle from IVF to an IUI cycle. This, of course, would only be if your ovaries did not respond as favorably as hoped. You would not want to switch to an IUI cycle if your ovaries hyper-responded.

Whether this is a good choice for you will depend on cost, your reasons for infertility, and what male factor issues are at play.

For example, if you have blocked fallopian tubes, IUI is not going to be an option. If your partner’s sperm counts are very low, or IVF with ICSI is needed, switching to an IUI cycle may not be possible.

Sometimes, there are too few follicles for IVF but still too many for an IUI. Having three to five follicles means, with an IUI, you are at risk of getting pregnant with triplets, quadruplets, or even quintuplets. This could put your health and any conceived babies health at risk.

What’s Next? Should You Try Again After IVF Cancellation?

After so much anticipation and financially investment, to have 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 learn how to better treat your next cycle based on what went wrong the first time.

For example, if you over-responded to the fertility drugs, your doctor can lower the dosages or use a different protocol next time. If none of the eggs fertilized, your doctor can try IVF with ICSI next time. Even in the case of a poor response, there may be a different protocol that could help.

One study found that 54 percent of women who had a poor response in one IVF cycle went on to respond normally in the next. (It’s important, however, to point out that the pregnancy success rates were still on the low side in this study: only a 10.1 percent pregnancy rate in the next normal-response cycle.)

In some cases, a cancelled cycle is a fluke. Sometimes fertility testing predicts a poor response. Other times all the tests look good and things just don’t go as expected.

In these cases especially, another try may be worthwhile. Research has found that unexpected poor responders have cumulative pregnancy success rate of 25.9 to 47 percent when looking at the odds over three IVF cycles combined.

There are, however, times when a poor response, in combination with other factors, is a sign you should move on. Depending on the problem, this may mean moving onto IVF with donor eggs, IVF with donor sperm, or considering adoption or a childfree life.

A Word From Verywell

No one goes into an IVF cycle expecting to not make it through embryo transfer. It’s normal to experience sadness, disappointment, and even some anger. This is especially true if you could only financially afford to try once.

Be reassured that even a canceled cycle is not a waste. Your doctor will hopefully be able to use the data collected to help make the next cycle or family building step better. Even if a canceled cycle does nothing except confirm you should consider IVF with an egg donor, or move on beyond fertility treatments, this is information you didn’t have before.

Remember that your first cycle is not a sign of how the next will go, and you can always get a second opinion. 

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

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