Over Before It’s Begun
In vitro fertilization (IVF) is an effective strategy for couples struggling with infertility. The procedure consists of creating embryos in a fertility laboratory using harvested eggs and sperm. One or more embryos are then implanted into the womb for pregnancy. IVF requires multiple steps, and there are many medical and logistical requirements. As a result, there is a risk of an IVF cycle being cancelled. At least 13% of cycles are cancelled. Having an IVF cycle cancelled can be confusing and devastating for patients, but there are many reasons why cancellations can occur. Understanding the reasons for an IVF cancellation can help create effective next steps.
Cancelled for medical reasons
IVF requires the management of specific hormones to increase the follicles necessary for producing multiple embryos. This happens using specific injectable hormones over several days, which helps to stimulate mature follicles. A poor ovarian response can occur where the ovaries do not respond to medication, leading to fewer follicles. In some cases, a poor response leads to IVF cancellation. Sometimes, the eggs are released unexpectedly before planned retrieval due to unforeseen hormone imbalances or poor synchronization with the menstrual cycle. As the eggs are no longer available for retrieval, the cycle is canceled.
OHSS and other risk factors
For some patients, there is a risk of ovarian hyperstimulation syndrome (OHSS), a potentially risky condition. Hormone medication used in IVF can cause the ovaries to respond abnormally. The ovaries swell and take on excess fluid, which leaks out into the abdomen. OHSS can be painful, cause several unpleasant symptoms, and may prompt the postponement of the IVF cycle. Another cancellation reason can be elevated progesterone levels before egg retrieval. Abnormally high progesterone levels will make implantation difficult, reducing endometrial receptivity and pregnancy rates. An IVF cycle can be cancelled to manage progesterone levels first. Other potential risk factors include unexpected uterine issues or sudden health conditions that can impact pregnancy.
Embryo development challenges
Even with a successful retrieval of multiple follicles, challenges in the embryo development stage can arise. Poor fertilization rates due to poor egg or sperm quality can lead to an IVF cancellation. In other words, there are insufficient healthy embryos developed to justify proceeding with implantation. Patients who opted for preimplantation genetic testing (PGT) may discover an underlying abnormality. Sometimes, the embryos can go through embryonic arrest, where normal development stops abruptly, mainly due to genetic factors. A successful IVF cycle requires the selected embryo to be as healthy as possible.
Logistical or practical reasons
IVF has several steps that are non-medical related. A change or breakdown in this process can lead to delays, essentially stopping the cycle from progressing. For instance, there can be hormone medication shortages or logistical issues where the medication cannot be dispensed in time. Patients who need insurance support or financial aid can face rejections or delays in the distribution of funds. These issues can impact the IVF timeline or cancel cycles completely. There are also practical, unavoidable reasons, such as sudden patient illness, financial emergencies, or equipment failure in the fertility clinic.
Alternative treatment options
Patients must understand that IVF cycle cancellations are a potential risk factor when pursuing fertility support. The first step is to understand the reason for the cancellations through a consultation with the medical team. During the debrief session, ask about the reasons for the cancellations, and what are the next steps. Patients should take time to process the news, as having an IVF cycle cancelled can place an emotional toll on couples. From there, come up with a new action plan. This plan may involve additional fertility testing, medical treatment, adjusting hormone medication, or lifestyle changes before attempting another cycle. Some couples need alternative treatment options to increase pregnancy rates. Donor eggs, donor sperm, or intracytoplasmic sperm injection (ICSI) are examples of adjusted protocols.
Don’t give up hope
An IVF cycle can be cancelled unexpectedly. Issues can happen at any stage, from hormonal and embryo development to implantation. Even access to medication, financial challenges, and unforeseen personal circumstances can delay or cancel a cycle. The average IVF patient needs 2-3 cycles to see success, which can increase with age. The goal is to find the root cause, take action, and work toward a successful future.
