Recurrent IVF Failure: Causes and Solutions to be Parents

By (embryologist), (embryologist) and (babygest staff).
Last Update: 01/11/2020

A negative pregnancy test after several embryo transfers and different in vitro fertilization (IVF) cycles can cause great frustration in couples or women who have been trying to become pregnant for some time.

When the assisted reproduction treatments do not give the expected result after several failed attempts, the reproductive options are finished and the moment of having a child is more and more delayed.

This situation is often the reason that leads those patients to consider surrogacy as the last option to become parents.

Infertility and assisted reproduction

When a couple is planning to have children, they first try to have children naturally, and if they do not succeed after a year of unprotected habitual sexual intercourse, it is recommended that they go to a fertility clinic.

There are different fertility treatments indicated to each patient depending on the cause that prevents them from having children:

  • Artificial Insemination
  • IVF or ICSI

In addition to those basic techniques, there are other complementary techniques to improve the success rate and achieve the desired pregnancy. Egg donation, sperm donation or preimplantation genetic diagnosis (PGD) are some of those techniques.

If even with all this and after several attempts, the pregnancy does not occur, surrogacy may be the definitive solution that allows future parents to achieve their desire to have a child.

Causes of IVF failure

Sometimes it is not possible to know exactly why a woman cannot carry a pregnancy to term after several fertility treatments. The accumulation of failures, especially in the case of IVF, wears patients down physically and emotionally.

The number of attempts that should be made for each treatment is not fixed, as it will depend on the personal, medical and economic situation of each woman or couple.

Most often, attempts of IUI are up to 4 times since its success rate is cumulative. If after 4 cycles of IUI a pregnancy has not been produced, it would be necessary to move on to IVF. In this case, most specialists recommend a maximum of 3-4 IVF attempts.

It is important to emphasize that each IVF attempt involves ovarian stimulation. Therefore, if several embryos are obtained in one cycle, the successive embryo transfers would not correspond to new IVF cycles.

Repeated failure after several IVF cycles is one of the reasons a couple considers surrogacy.

The main causes of IVF treatment failure are fertilization failure and implantation failure. This can be caused by the woman's age, the quality of the embryos, the ovarian reserve, etc.

It is also possible for a woman to become pregnant after IVF, but this may result in a miscarriage. If this occurs frequently, the woman is considered to have repeated miscarriages.

Each of these impediments to success with IVF is explained below:

Fertilization failure

When the union of a woman's egg with a man's sperm does not result in a viable embryo, fertilization failure is said to have occurred.

Usually, after obtaining an adequate number of eggs in the follicular puncture of an IVF, a total fertilization failure does not occur. In other words, there will almost always be some embryo left that can be transferred. However, it may happen that there is no embryo after fertilization, forcing the IVF cycle to be canceled.

The causes that do not allow the fertilization of the embryo are the morphological and/or genetic alterations of the gametes: eggs and spermatozoa. Therefore, the first approach to this situation is to resort to IVF with egg donation or sperm donation as the case may be.

If there is no other cause of infertility in the woman that prevents pregnancy, the success rate of the treatments increases considerably with donor gametes.

Implantation failures

The case of embryo implantation failure is more common than that of fertilization. It takes place when, after the right development of the embryos and their transfer to the uterus, it fails to implant and results in a negative pregnancy test.

In this case, fertilization has taken place, but endometrial receptivity or communication between the embryo and endometrium fails.

The causes of implantation failure may be genetic alterations of the embryo as in the previous case, although uterine malformations or endometrial alterations also have a huge influence.

The presence of myomas, polyps, infections, endometriosis, congenital anomalies, etc. are some examples of uterine problems. You can continue reading here for more information about this: Uterine Anomalies.

On the other hand, implantation failure may also be due to systemic causes, that is, alterations in the function of systems other than the reproductive system. These include some thrombophilic diseases and disorders of the immune system in the mother since they generate rejection of the embryo.

Related topic: Embryo Implantation Failure: Causes, Symptoms & Treatments

Repeated miscarriage

Finally, there are couples who do get pregnant, either through IVF or even naturally. However, a miscarriage occurs after a time that can be days, weeks, or months.

When pregnancy loss occurrs more than twice or 3 times, the woman gets diagnosed with recurrent miscarriage.

This is something truly hopeless and hard for future parents because after the joy of the positive beta-hCG test confirming the pregnancy, comes the sadness and despair of abortion.

Although in the majority of cases it is not possible to clarify the real cause why the pregnancy ends in a miscarriage, it is generally associated with:

  • Genetic factors in the sperm, egg, and/or embryo
  • Immune alterations
  • Coagulation problems
  • Uterine alterations
  • Infections
  • Endocrines alterations

You can read more about recurrent miscarriage and the causes that can cause it by clicking on the following link: What is recurrent miscarriage?


The surrogacy technique consists of transferring the embryos of the intended parents, who cannot carry a pregnancy for various reasons, to the uterus of a healthy woman to carry the pregnancy to term.

The surrogate does not have any genetic link with the embryo that will develop in her uterus and, after birth, will give the baby to the parents of intention that will carry out the appropriate filiation process according to the country.

Surrogacy is not a legal practice in every state or country. It is legal in UK and some states of the United States and some countries in Europe as Greece or Ukraine. Nevertheless, it is essential to take into account the legislation of the destination country since not everyone accepts just any family model.

Surrogacy is the most challenging of all fertility treatments. For this reason, it's crucial that you rely on well-versed professionals. Therefore, we recommend you to visit this article to read some tips before getting into this process.

FAQs from users

How many IVF attempts would it take to get pregnant?

By Zaira Salvador (embryologist).

It is difficult to predict the exact number of IVF attempts that a couple should make before considering surrogacy, as it depends very much on the characteristics of each patient.

Some studies state that a woman should have become pregnant before reaching the third or fourth cycle of IVF. This will vary depending on the number of eggs obtained in each ovarian stimulation. However, it is considered that after 4 failed IVF cycles, the likelihood of success in a subsequent IVF will no longer increase.

Can I carry out a surrogacy process with my own eggs?

By Zaira Salvador (embryologist).

Yes, as long as there is a good ovarian reserve and the oocyte quality allows to obtain embryos with the capacity to implant in the uterus of the surrogate. If this is not the case, it will be necessary to resort to the eggs of a donor. In no case is it recommended to use the oocytes of the surrogate.

When do we speak of recurrent implantation failure?

By Marta Barranquero Gómez (embryologist).

According to most fertility specialists, a recurrent implantation failure occurs when pregnancy is not achieved after the transfer of at least 3 good quality embryos. However, at present there is no exact criteria for this term.

It is a condition that is attributed when there is failure of a successive number of IVF cycles.

What do I do after a negative IVF?

By Marta Barranquero Gómez (embryologist).

When a patient obtains a negative result from her pregnancy test after performing an in vitro fertilization (IVF) treatment, it is advisable to undergo a personalized study to evaluate the cause of the failure and improve the probability of success in the next IVF attempt.

After a failure in an IVF cycle, it is not necessary to wait long to try again. A new cycle can be started as soon as the woman's period is over, unless the doctor indicates otherwise for some reason.

Suggested for you

In order to know more about the countries where is it possible to get through a surrogacy process, we recommend you to read the following post: International Surrogacy – Laws & Options for Surrogacy Abroad.

If you want to know the approximate number of attempts to achieve success with a fertility treatment, you can continue reading here: Number of Attempts in Assisted Reproduction.

We make a great effort to provide you with the highest quality information.

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Jacobs M, Klonoff-Cohen H, Agarwal S, Kritz-Silverstein D, Lindsay S, Garzo G. Predictors of treatment failure in young patients undergoing in vitro fertilization. J Assist Reprod Genet. 2016 Aug;33(8):1001-7. doi: 10.1007/s10815-016-0725-1. Epub 2016 May 6.

Zhang R, Xu A, Wang Q, Zhang L, Zhu L, Zhao S, Xiong W. Fertiloscopy improves in vitro fertilization for women with repeated implantation failure. J Gynecol Obstet Hum Reprod. 2017 Dec;46(10):743-746. doi: 10.1016/j.jogoh.2017.07.001. Epub 2017 Jul 8.

FAQs from users: 'How many IVF attempts would it take to get pregnant?', 'Can I carry out a surrogacy process with my own eggs?', 'When do we speak of recurrent implantation failure?' and 'What do I do after a negative IVF?'.

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Authors and contributors

 Marta Barranquero Gómez
Marta Barranquero Gómez
Graduated in Biochemistry and Biomedical Sciences by the University of Valencia (UV) and specialized in Assisted Reproduction by the University of Alcalá de Henares (UAH) in collaboration with Ginefiv and in Clinical Genetics by the University of Alcalá de Henares (UAH). More information about Marta Barranquero Gómez
 Zaira Salvador
Zaira Salvador
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia (UPV). Embryologist specializing in Assisted Procreation, with a Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI). More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Romina Packan
Romina Packan
Babygest Staff
Editor and translator for the Babygest magazine in English and German. More information about Romina Packan

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