A failed frozen embryo transfer (FET) cycle can feel like a crushing blow. After months of preparation, emotional ups and downs, and getting through the two-week wait, the disappointment of seeing that negative pregnancy test can be overwhelming.
We know how incredibly tough it can be, and it’s understandable to feel heartbroken, disappointed, and unsure of what comes next. Understanding why it happened and how to move forward can give you the strength to keep going.
In this post, we’ll explore some common reasons why FETs fail and provide guidance on the next steps you can take to help increase your chances of success in future FET and IVF cycles.
Why Do FET Cycles Fail?
Before diving into the next steps, it’s crucial to understand the reasons behind a failed FET cycle. While every situation is unique, there are common factors that could contribute to failure.
1. Embryo Quality
The health of your embryo plays a significant role in the success of FET. Sometimes perfectly graded embryos have hidden genetic issues such as chromosomal abnormalities that prevent them from implanting in the uterus. Was your embryo PGT-A tested? Preimplantation genetic testing (PGT-A) can help identify such issues early, allowing you to transfer healthy, genetically tested embryos.
2. Uterine Conditions
Now that we’ve covered the embryo, let’s consider the condition of the uterus. For implantation to occur, your uterus must be ready to support the embryo. Conditions such as a thin endometrial lining, fibroids, or polyps can make it harder for the embryo to implant.
To ensure your uterus is properly prepared, tests like ImMap® (assessing your uterus immunology) and ERMap® (assessing your endometrial receptivity) can help evaluate whether your lining is ready for implantation.
3. Sperm Quality
While we’ve discussed embryo quality and uterine conditions, it’s also important to remember sperm quality. Though it’s less often the primary cause of failure, abnormal sperm can lead to fertilisation issues or genetic problems in embryos, making them less likely to implant. If sperm quality is a concern, checking for DNA fragmentation as well as treatments like ICSI (intracytoplasmic sperm injection) or using donor sperm may be worth considering.
4. Endometriosis
Another potential reason for failure could be Endometriosis – an invasive disease that causes chronic and debilitating pain and is estimated to be a contributing factor in 30-50% of infertility cases.
Tissue that is similar to the lining of the uterus grows inside the pelvic cavity and beyond, causing inflammation and oxidative stress which can affect the ovaries, uterine lining and egg quality, thereby lowering the chances of successful implantation.
In some cases, symptoms can go unnoticed and endometriosis is only discovered when investigating potential causes of infertility. A laparoscopy is the only way to make a 100% confirmed diagnosis and can often support the IVF process by enabling the doctor to identify and remove any cysts or scare tissue creating a better environment to support embryo implantation.
5. Immune Rejection
A strong, balanced immune system is critical in pregnancy as it helps the uterus accept and nurture the embryo. The immune system is responsible for triggering certain blood vessels necessary for creating and growing the placenta to facilitate the healthy development of your baby. A weakened immune system can not only increase the risk for infection and disease but may also contribute to the inability to support a pregnancy. Autoimmune disorders and the presence of antibodies in the mother’s blood can cause implantation failure, repeat miscarriages, delayed foetal growth, and placental insufficiency. If you have been trying to conceive for a long time and are experiencing infertility or recurrent miscarriages here are some tests that you could discuss with your doctor:
- Thrombophilia Panel Antiphospholipid Antibidy Panel – checks for blood clotting disorders
- Natural killer (NK) Cell test – checks for overactive immune cells that might attack an embryo
- TH1/TH2 Cytokine Ratio – and elevated TH1 response may be linked to inflammation
- HLA matching / DQ Alpa Genotyping – checks for genetic similarities that could cause rejection
- Reproductive Immunophenotyping – checks for immune balancing
- Thyroid antibodies test – checks for autoimmune thyroid conditions
6. Hydrosalpinx (Blocked Fallopian Tubes) and Toxic Embryonic Fluid
Another potential but not always examined issue is hydrosalpinx, where the fallopian tubes become blocked and filled with fluid. This condition can lead to embryo implantation failure as the fluid is toxic to the embryo, creating an inhospitable environment in the uterus. After the FET, the toxic fluid leaking into the uterus can prevent the embryo from attaching properly. If hydrosalpinx is present, your doctor will likely recommend removing the affected tubes before proceeding with IVF to improve your chances of success. Tests like HyCoSy or HSG can help determine if you have hydrosalpinx, but can also in some cases be detected on an ultrasound test.
7. Timing of the Transfer
Finally, timing is everything. If the embryo is transferred too early or too late in the cycle, it may not be able to properly implant. Your fertility clinic will carefully time the transfer based on your cycle, but even slight timing errors can impact success. The ERMap® test helps determine the ideal timing of your transfer by assessing your unique implantation window.
What To Do After a Failed IVF Cycle - The Next Steps
While the medical factors behind a failed FET cycle are important, it’s equally essential to acknowledge the emotional toll it can take on you. Remember to give yourself time to process your emotions – this will help you move forward with a clearer mindset and renewed strength for the journey ahead. Everyone heals at their own pace, so be kind to yourself during this time.
As you start to consider your next steps, here are some pointers to help guide you after a failed FET cycle:
1. The 'WTF' Appointment
After a failed FET, your fertility clinic will schedule a follow-up appointment with your doctor (aka the “WTF appointment”). This is your opportunity to gain insights into what went wrong and to ask questions to move forward with confidence. Remember, you know your body best so don’t be afraid to ask as many questions as necessary.
We recommend preparing for the WTF appointment. For a full preparation guide for this appointment, check out our XXX blog or downloadable sheet. Some helpful questions to ask include:
- What would you (the doctor) change in the next cycle and why?
- Are there any tests or treatments we should consider, such as ImMap® or ERMap®?
- Should we look into additional tests like blood tests, laparoscopy, hysteroscopy, HyCoSy, HSG or immune rejection tests
- If you are starting another round of IVF should PGT-A testing be done?
- Are there any lifestyle changes that could improve our chances?
2. Take Your Time to Consider Your Options
After your WTF appointment, it’s time to reflect on your options. Take your time to make informed decisions, whether it’s:
- Taking a break from treatment to rest and recharge.
- Trying another FET if you have more frozen embryos with a different or similar protocol
- Starting another round of IVF with the same or a new clinic.
- Exploring alternatives such as egg, sperm, or embryo donation.
It is normal to want to rush into the next treatment but sometimes a few months off can give you the mental, physical and emotional space to evaluate your next steps. You may also want to use the following months for additional testing before deciding how to proceed.
3. Consider Lifestyle Changes
Consider making lifestyle changes that could support your fertility. Small tweaks such as eating more fruits, vegetables and reducing sugar can make a difference. (Check out Blog XXX for more details or Recipes). Yoga, meditation or journaling are also good ways to help manage stress levels.
Additionally, practices like acupuncture and red light therapy (LLLT) can help balance your hormones while you prepare for your next steps.
4. Take Care of Yourself
The IVF process can be both physically and emotionally exhausting. After a failed FET, self-care is essential to give yourself space to process what’s happened. . Prioritise rest and activities that help you reconnect with yourself. Whether that means canceling plans to get some sleep, doing something you love, or talking to a friend, make sure you’re taking the time to care for your body and mind.
Taking time to process your emotions can help you move forward with a clearer mindset and renewed strength for what lies ahead.
Everyone heals at their own pace, so be kind to yourself during this time.
Final thoughts – Gaining Knowledge and Finding Positives After a Failed FET
While a failed FET cycle can feel like a major setback, it is far from the end of your journey. Understanding the potential causes behind the failure will give you the knowledge and power to take the next steps with clarity and confidence. By addressing any medical factors, considering lifestyle changes, and taking time for emotional healing, you can move forward and optimise your chances of success in future cycles.
Research resources:
The information in this blog is supported by peer-reviewed studies and scientific research. If you’d like to learn more or explore the details, feel free to check out the sources below.
- Kuang, Y., Tian, Y., Zhang, S., Li, H., Mao, X., & Guo, Y. (2015). Comparison of different stimulation protocols used in in vitro fertilization: impact on ovarian response and outcomes. Human Reproduction, 30(7), 1616–1624. Retrieved from https://academic.oup.com/humrep/article/26/7/1616/2913872
- Tarín, J. J., Sampaio, M. C., Calatayud, C., Castellví, R. M., Bonilla‑Musoles, F., & Pellicer, A. (1992). Relativity of the concept “high responder to gonadotrophins”. Human Reproduction, 7(1), 19–22. Retrieved from https://pubmed.ncbi.nlm.nih.gov/1551952/
- Lewis, C. (2018, August 28). No benefit to frozen embryo transfer for IVF in low and intermediate responders. Duke Health. Retrieved from https://physicians.dukehealth.org/articles/no-benefit-frozen-embryo-transfer-ivf-low-and-intermediate-responders
- Bosch, E., Labarta, E., Crespo, J., Simón, C., Remohí, J., Jenkins, J., & Pellicer, A. (2001). A randomized clinical trial comparing embryo transfer in fresh versus frozen cycles. Fertility and Sterility, 76(1), 77–82. Retrieved from https://www.sciencedirect.com/science/article/pii/S001502820102893X
- Acharya, K. S., Acharya, C. R., Bishop, K., Harris, B., Raburn, D., & Muasher, S. J. (2018). Freezing of all embryos in in vitro fertilization is beneficial in high responders, but not intermediate and low responders: An analysis of 82,935 cycles from the Society for Assisted Reproductive Technology registry. Fertility and Sterility, 110(5), 880–887. https://doi.org/10.1016/j.fertnstert.2018.05.024
