Taking Next Steps After Failed Fertility Treatment

Hispanic woman looking at a negative pregnancy test with tissues in her hand
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Whether it’s your first Clomid cycle or your fourth IUI, a failed fertility treatment cycle is discouraging. When you're trying to conceive, any cycle that doesn’t lead to pregnancy can feel bad. But when you’ve invested emotional energy, time, and money, your hopes may very well be higher, and that can mean more frustration when you experience a treatment failure.

After a failed fertility treatment cycle, you have several options. You may decide to try again using the same treatment. You may choose to try again with a different treatment. Or you may decide not to pursue further treatment. The path that's right for you will depend on your particular situation and what you have already tried.

What to Discuss After a Failed Cycle

Whatever treatment you’re undergoing, you can expect that your doctor will discuss the situation with you. It's important to talk about the following:

  • What went wrong: Sometimes it’s just a matter of trying again. But in cases of more complex treatments, like IVF, identifying where things fell through may help boost your odds of success next time.
  • What your odds for success are if you try again: Sometimes, they are just as good as the first time. Sometimes, especially after a few to several cycles, the odds of success decrease significantly on the next try. Some clinics offer data analytics tools, which can help predict your odds of success with various treatments.
  • Any possible risks of sticking with the same treatment: For example, Clomid (clomiphene) should not be used for more than six cycles. Repeat IUIs may exhaust your emotional and financial reserves.
  • What additional testing may be recommended, if any: Sometimes it’s testing you’ve had before; sometimes it’s something new, such as genetic screening, karyotyping, testing for reproductive immunology issues, or a more advanced uterine evaluation. 
  • What changes should be made, if any: Your doctor should explain additional risks, costs, and success rates associated with these changes. In some cases, you may want to get a second opinion.

Coping with fertility treatment is not easy. Failed treatments take an emotional and financial toll. It’s normal to feel frustration and sadness. But few people have success on their first or even second try. Remember that one or two failed cycles don't mean things will never succeed. You may just need more time or a different treatment plan.

But don’t be afraid to say “enough is enough” if you’ve reached that point. Deciding to move on from fertility treatment is not giving up. Choosing a childfree life or pursuing options like adoption may be alternatives to continuing with treatments. You don’t have to try every treatment available before deciding to move on if that's what is right for you.

When Clomid or Femara Treatment Fails

Clomid (clomiphene) is the most commonly prescribed fertility drug. Femara (letrozole) is not a fertility drug by design, but it works a lot like Clomid, and it may be better for women who don’t ovulate on Clomid or for women with PCOS.

For female factor infertility with mild to moderate ovulation problems, Clomid can be successful. For those who will get pregnant on Clomid, most will conceive in the first three months. About 71% to 87% of pregnancies conceived with Clomid occur by the third cycle. Beyond the sixth cycle, however, few pregnancies occur.

In fact, with Clomid, having more than six cycles is discouraged (a max of three to four is recommended). Some studies have found an increased risk of certain cancers if Clomid is used more than six times without a pregnancy success, and Clomid can also thin the uterine lining. Therefore, if Clomid or Femara doesn’t work after three to six cycles, injectables with IUI are usually next, if you want to pursue further treatment.

When Injectables or IUI Fail

Gonadotropins are injectable fertility drugs. They may be used alone to stimulate ovulation before timed sexual intercourse. Or, they may be used along with intrauterine insemination (IUI).

Gonadotropins are already expensive, and IUI only adds a small amount of expense while slightly boosting the odds for pregnancy success. So most doctors combine IUI and gonadotropin therapy. Depending on the cause of infertility, success rates for IUI vary considerably, from 7% per cycle up to 20%.

Opinions vary about how many IUI cycles to try. A large research study looked at the ongoing and per-cycle IUI success rates of 3,700 couples. It included over 15,000 IUI cycles.

Over three cycles, 18% conceived. After seven cycles, the on-going pregnancy rate was 30%. After nine, it reached 41%. The study found that the average per-cycle success rate was about 5.6%. The per-cycle success rates for cycles number seven, eight, and nine were close to the average—5.1%, 6.7%, and 4.6% respectively. This means that success rates did not significantly drop after three tries.

More IUI Cycles vs. Trying IVF

Trying up to nine cycles of IUI with mild ovarian stimulation may be reasonable. However, some people prefer to pursue IVF after three cycles of IUI. Why?

  • Emotional well-being: Every treatment cycle that fails takes a toll. The more failed cycles a couple experiences, the more likely it is for them to stop trying. Since per-cycle success rates are higher for IVF than IUI, moving on may make sense.
  • Cost: IUI is less expensive than IVF, but it can cost between several hundred to a few thousand dollars per try, depending on insurance coverage and how many fertility drugs are needed to stimulate ovulation. Going through several IUI cycles may mean a couple can't afford IVF later.

When IVF Fails

IVF treatment may be recommended if the fallopian tubes are blocked, in some cases of male factor infertility, or if previous fertility treatments were unsuccessful. IVF treatment is invasive and expensive. The average out-of-pocket expense for one cycle of IVF is around $19,000.

During conventional IVF, fertility drugs are used to overstimulate the ovaries. Then, eggs are retrieved and put together with sperm. Hopefully, some of the eggs become fertilized with the sperm, and some healthy embryos result. After three to five days, one or two embryos are transferred to the uterus.        

Sometimes, an IVF cycle isn’t able to reach embryo transfer. This is known as IVF cancellation. This is a slightly different situation from when an IVF cycle does get to embryo transfer but doesn’t result in pregnancy. But both have the same end result: No pregnancy. However, one failed IVF cycle doesn’t mean it won’t succeed the next time.

For couples who do conceive, it takes an average of 2.7 cycles to achieve pregnancy. Success rates are better for younger women, but even then, several cycles may be required. One study of over 178,000 cycles found that the cumulative live birth rate after three cycles was 42.3%. After eight cycles, the cumulative live birth rate was 82.4%.

How many cycles of IVF should you be open to trying? Research has found that trying up to six times can be worthwhile. One study found that the cumulative live-birth rate after six cycles was 65.3%.

Repeating IVF Treatment

“Unfortunately, regardless of the age of the patient, many IVF cycles are unsuccessful,” says Michael C. Edelstein, MD, of Shady Grove Fertility in Richmond, Virginia. “After such a cycle, it is important for the physician to review with the patient the events of the unsuccessful cycle to see if any adjustments can be made in the next attempt."

IVF treatment can be altered or enhanced with a variety of additional assisted reproductive technologies. Many times trying again with the same protocol makes sense. But sometimes, adjustments should be made. These include:

  • Different medications
  • Genetic screening like PGD/PGS
  • Immunotherapy
  • Adding in ICSI (which can aid in fertilization of the eggs)
  • Assisted hatching (which may help with implantation)

When Egg Donor Treatment Fails

Egg donor IVF may be recommended in cases of primary ovarian insufficiency (premature ovarian failure), low ovarian reserves (more common in women over age 38), or poor egg quality during previously failed or canceled IVF cycles.     

Egg donor IVF is very expensive, costing as much as $25,000 to $30,000 per egg retrieval cycle. However, it has excellent success rates, better than conventional IVF even for couples with the best prognosis.

“Even with this excellent success rate, one in four women will have two consecutive failures," says Dr. Edelstein. "One in eight will experience three. In general, after two or three failures, it may make sense to repeat or do more testing on the recipient.” Testing may include hormonal blood work (especially checking thyroid and prolactin levels) and uterine evaluations, like saline sonohysterogram or hysteroscopy.

“There is some preliminary evidence that a special biopsy of the uterine lining called an endometrial receptivity assay (ERA) can identify patients that may be having their embryos transferred on a day when the uterus is less receptive, and adjustments to the day of transfer may help,” says Dr. Edelstein. “Sometimes a biopsy can identify a chronic infection (endometritis) that can be treated.”

Testing, however, doesn’t always bring answers to why treatment has failed. “Unfortunately, in many cases, no reason can be identified for the repetitive failure, and the best option would be another embryo transfer—and many patients do conceive on their fourth or fifth transfer cycle.”

When egg donor IVF fails, is a gestational carrier, also known as surrogacy, the next step? Not necessarily. “This is an expensive and complicated alternative that involves many emotional, financial, logistic, and legal issues," says Dr. Edelstein. "Most couples do not quickly move to this option unless there is definite evidence that the intended mother's uterus has a major identifiable issue.” 

A Word From Verywell

Be sure to seek out support from a counseling professional, a support group, and friends and family you trust while you navigate fertility treatment. You don’t need to do this alone, and you shouldn’t. The more support you have, the better.

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