After an unsuccessful IVF cycle, the most useful next step is not automatically another test or supplement, but a careful review of where treatment fell short—a central message from Dr Dimitrios Dovas – Medical Director at New Life IVF Greece.
Hosted by: Jessica Bourke – Founder of The Fertility Detective, with 20+ years of experience supporting individuals through fertility challenges and pregnancy loss.
A failed cycle does not, by itself, establish that egg quality was the problem. Eggs and sperm can both contribute to difficulties with fertilisation and embryo development, while the stimulation protocol can influence egg maturity. Even a first cycle can provide valuable information about reproductive potential and which stage needs closer attention.
The distinction matters because different problems call for different responses. A large number of degenerated eggs identified before fertilisation is direct evidence of poor egg quality. But if only two of 10 eggs were mature because stimulation was not properly tailored, the concern is more likely to be the stimulation approach than an inherent problem with the eggs.
Before repeating treatment, the review should establish how many eggs were mature, how fertilisation progressed and how many embryos reached the blastocyst stage. After repeated failures, embryo quality, the number available for selection and their genetic potential all deserve attention. Moving into another cycle without understanding those details leaves the central question unresolved.
Egg quality has both genetic and structural aspects. Age mainly influences genetic quality, the most important component, while lifestyle, nutrition, smoking, high alcohol consumption and other health factors can affect the egg’s structural integrity. That distinction helps put preparation into perspective: improving general health is worthwhile, but it should not be presented as a guaranteed solution to poor egg quality.
Changes also need time, because egg maturation and development take about two to three months. The most evidence-based preparation centres on general health rather than an elaborate supplement regimen. Practical priorities include:
In a healthy woman with normal nutrition, vitamins and supplements are unlikely to have a major effect on egg quality. Coenzyme Q10, multivitamins and myo-inositol have been discussed for possible effects on inflammation, oxidative stress and cellular energy, but human evidence has not established a definite improvement in treatment outcomes. They should not be sold as a way to reverse very poor egg quality, and invasive anti-ageing infusions should not be recommended without evidence.
Weight discussions require the same balance of honesty and respect. Severe obesity can affect treatment outcomes, egg and embryo quality, and pregnancy risks. Those risks need clear discussion, but increased body weight alone should not mean automatic denial of treatment.
After repeated disappointment, tests can seem to offer a route to certainty. Yet receptivity testing, including the ERA test, has not shown the improvement in success rates once anticipated. It is not a routine next step after failed transfers, although selected cases involving a very poor endometrium may still warrant assessment of receptivity markers.
NK testing has similarly limited practical value. Testing may refer to blood or uterine NK-cell levels, but uterine levels at the time of embryo transfer cannot actually be sampled. More importantly, there is no evidence that suppressing the immune system because NK cells are high benefits the patient.
A normal result may provide reassurance, but that is different from identifying an effective treatment. Immunosuppressants are not justified for improving implantation without a clear indication from an autoimmune condition, and later studies have not supported routine steroid use for unexplained recurrent miscarriage. High-dose steroid use during pregnancy can also increase the risk of gestational diabetes.
Embryo testing requires a separate discussion. PGT-A is a diagnostic test, not a treatment that improves embryo quality, and it does not consistently improve outcomes, particularly in younger women. When several blastocysts are available, it can help prioritise which embryo to transfer first.
The balance changes when few embryos are available. Biopsy carries a small risk of damage, and testing can produce no result or mosaic results that are difficult to prioritise. With only one good-quality blastocyst, transferring it may be preferable to exposing it to biopsy; embryo number and quality should therefore sit alongside parental age in the decision.
An egg-focused explanation can overlook an important contributor to poor outcomes. Very poor sperm quality or high DNA fragmentation can affect fertilisation, embryo quality, implantation and miscarriage risk. Before acting on a fragmentation result, the team needs to understand exactly what the test assessed and how reliable it is.
A younger donor sample may perform better than sperm from an older partner with very high fragmentation, but donor sperm is not automatically the only route forward. Reviewing whether the partner’s sperm can be improved should come before an immediate recommendation for donation. Decisions about donor eggs likewise should not follow automatically from age or an expectation of abnormal embryos.
New sperm-selection interventions deserve scrutiny rather than automatic acceptance. Routine IVF methods already select morphologically healthy, highly motile sperm, which makes the independent benefit of newer approaches difficult to establish. Costly or potentially harmful additions should not be recommended simply because they are new.
Psychological support is relevant from the first IVF cycle, not only when donor treatment is being considered. Injections, testing and invasive procedures can leave people feeling vulnerable, and support needs to be individualised rather than confined to general information. New Life IVF Greece has a network of collaborating psychologists accredited for infertility cases who support women and couples.
After a stillbirth, preparation for another cycle requires a distinct medical review as well as emotional care. Treatment should not restart before the obstetrical records have been reviewed and feedback received about what happened. The review should consider whether conditions such as poorly controlled diabetes, preeclampsia or hypertension could recur.
That process should provide information without blame. Even when no clear explanation emerges, further assessment may help identify conditions relevant to a future pregnancy, and frequent pregnancy checks can offer reassurance when development is progressing well. Single embryo transfer is especially important rather than transferring both embryos when two are available.
Trying again should mean more than repeating treatment or adding interventions. A useful plan connects the previous cycle’s findings with realistic changes, explains what additional testing can and cannot achieve, and allows time for decisions. Hope and evidence belong together: patients deserve clear information, psychological support and care without hype or judgment.
