After unsuccessful fertility treatment

If you come to us after IUI or IVF that didn’t work, we’re dedicated to giving you the attention you need to reach a healthy pregnancy.

Starting with your history

First, we review your previous records thoroughly, looking for possible improvements in:

• How your ovaries responded to fertility medications
• Embryo quality
• The lining of the uterus (endometrium)
• The embryo transfer itself

Additional tests

We may also recommend tests such as:

• A karyotype (chromosome analysis) for both partners
• Saline sonography to look for abnormalities in the uterine cavity
• An endometrial biopsy to check for inflammation of the uterine lining
• An endometrial receptivity analysis (ERA) to see whether the lining is ready for implantation at the usual time
• A review of ultrasound and hysterosalpingogram (HSG) images to look for a dilated fallopian tube (hydrosalpinx), which should be removed before treatment

We address any abnormality we find before starting further treatment.

Adjusting ovarian stimulation

Your treatment plan depends on your situation, and we consider a range of changes.

If your response was low

We start by getting a thorough understanding of your ovarian reserve, so we can choose the stimulation protocol most likely to improve the number and quality of your eggs. Options include:

• A different stimulation method
• Synchronizing the follicles before stimulation, by preventing early follicle growth before your period starts, which improves egg yield
• Changing the dose of medication, encouraging your body’s own FSH production, or adding LH activity
• Reducing the dose of gonadotropins and combining them with oral medications (Clomid or letrozole) or growth hormone
• Changing the timing of the trigger shot (hCG), which may improve egg quality
• Minimal stimulation, natural cycle IVF or in vitro maturation

If you produced many eggs

For women with high ovarian reserve who produce many eggs but haven’t become pregnant, even after transfer of good-quality embryos, changing the stimulation protocol often helps. It can reduce the number of eggs while improving egg maturity and embryo quality. In vitro maturation may also be considered.

Improving the lining and the transfer

We may work to improve the thickness and pattern of your uterine lining, or transfer embryos in a later frozen cycle. We also study the direction and path of your cervical canal so the embryo transfer goes smoothly.

Genetic testing of embryos

Testing embryos may be a good option for women who produce a moderate or large number of eggs and embryos but still haven’t become pregnant, or when either partner has an abnormal chromosome arrangement. Genetic testing makes it possible to select chromosomally normal embryos for transfer. Learn more in genetic screening and PGT.

When a gestational carrier may help

For women with uterine abnormalities that can’t be corrected, such as Asherman syndrome (scarring inside the uterus), a gestational carrier may be considered.

If you’ve had difficulty with past fertility treatment, contact our team to set up a consultation about your situation.

This article is general information, not medical advice. Every situation is different, so talk with your doctor about yours.