Skip to content
    Reading 0%

    Fertility & Treatment · 1 min

    When IVF has not worked: what good clinics do next, and what to be cautious of

    Reviewed by HHH Clinical Team · April 20261 section · 1 min read

    Top things to know

    There is no single agreed definition; ESHRE 2023 uses three good-quality transfers without pregnancy under 40.

    After repeated failure, a structured evidence-based workup is reasonable, not a long list of add-ons.

    Most expensive add-ons have weak or no evidence of improving live birth rates; ask about evidence quality.

    A good clinic tells you what is unproven and lets you decide; a second opinion is normal.

    What counts as recurrent IVF failure?

    There is no single agreed definition. ESHRE 2023 considers recurrent failure when at least three good-quality embryo transfers in someone under 40 have not led to a pregnancy. Some clinics use different thresholds. The number itself matters less than what the clinic does once the threshold is reached.

    The grey zone

    What investigations are reasonable after repeated failure?

    Standard position · Europe

    ESHRE 2023 supports a structured workup: hysteroscopy if not done recently, repeated semen analysis, thyroid and prolactin, and consideration of preimplantation genetic testing for aneuploidy in selected couples. Most other testing has limited or no evidence base.

    Where it gets more nuanced

    What we honestly do not know

    We do not know why most cases of recurrent implantation failure happen. Best estimates suggest embryo factors account for around half, uterine factors a smaller share, and the rest is unexplained.

    Bottom line

    After repeated failure, a structured evidence-based workup is reasonable. A long shopping list of expensive add-ons is not. If your clinic is offering treatments without telling you the evidence quality, ask. A good clinic will tell you what is unproven and let you decide.

    References

    1. [1] 37377889ESHRE Working Group on Recurrent Implantation Failure. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open 2023.
    2. [2] pmid-rif-immunological-2023Cimadomo D et al. Recurrent implantation failure: a comprehensive summary from current evidence to future directions. Hum Reprod Update 2023.

    Browse the full evidence library →

    If you ever decide to raise it

    Putting it into words

    No words guarantee how an appointment goes. Precise words just make sure what you live with gets described, not rounded down.

    We have had several IVF cycles that did not work. I would like a second opinion or referral for a structured workup. I would also like to understand which extra tests have evidence behind them and which are commercial add-ons.

    Keep it, edit it, or just remember it. Stays on your phone.

    How did this land with you?

    If this helped, someone you know might need it too.

    Read next

    References

    1. [1] 37377889ESHRE Working Group on Recurrent Implantation Failure. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open 2023.
    2. [2] asrm-recurrent-implantation-failure-2024ASRM Practice Committee. Definitions of infertility and recurrent pregnancy loss.
    3. [3] sogc-recurrent-implantation-failure-2024SOGC Clinical Practice Guideline: Recurrent implantation failure, guidance from the Society of Obstetricians and Gynaecologists of Canada.
    4. [4] pmid-rif-immunological-2023Cimadomo D et al. Recurrent implantation failure: a comprehensive summary from current evidence to future directions. Hum Reprod Update 2023.

    Browse the full evidence library →

    Reviewed by clinicians

    Authored and reviewed by clinicians from the founding team. Information only, not personalised medical advice.

    From the team behind Her Holistic Health, founded by Dr Divpreet Sacha, NHS-trained GP.