A negative pregnancy test after an IVF cycle is one of the most painful experiences a couple can have. The weeks of injections, the early morning monitoring appointments, the egg retrieval, the anxious wait for fertilisation results, the embryo transfer, the fourteen days of careful optimism — and then the result that says no. It is devastating. And it is made worse by the inadequacy of the explanation that many couples receive: ‘These things happen. We’ll try again.’
The truth is that a failed IVF cycle, while painful, is not simply bad luck. In most cases, it is information — specific, valuable clinical information about what happened, what the embryo or the uterus needed, and what can be done differently next time. Dr. Krishnakumar’s approach to a failed cycle is to treat it as a diagnostic event. Every failed cycle at his clinic is followed by a thorough debrief consultation in which the couple sits with him and goes through every stage of the cycle in detail.
The most common causes of IVF failure can be broadly grouped into embryo-related factors, uterine factors, and systemic factors. Embryo quality is the single most significant determinant of IVF success. The majority of early IVF failures occur because the embryo — despite appearing normal under the embryologist’s microscope — carries chromosomal abnormalities that prevent it from implanting or developing normally. This is not a failure of the IVF process; it is a reflection of the biological reality that a significant proportion of human embryos, particularly those from older women, are chromosomally abnormal. PGT-A testing, which screens embryos for chromosomal normality before transfer, can address this by selecting only chromosomally normal embryos.
Uterine factors account for a proportion of implantation failures. An undiagnosed endometrial polyp, a small submucosal fibroid, a mild intrauterine adhesion, or a structural abnormality that was not visible on standard ultrasound can all impair implantation. This is precisely why Dr. Krishnakumar recommends hysteroscopy before the first IVF cycle — to identify and correct correctable intrauterine pathology before it causes a treatment failure. In couples who have already had a failed cycle, diagnostic hysteroscopy should be performed if it was not done before the first attempt.
Displaced implantation window is a cause of repeated unexplained implantation failure that is increasingly recognised. ERA testing can identify this. Sperm DNA fragmentation, elevated in some men with apparently normal standard semen parameters, can impair embryo development and increase early pregnancy loss. And occasionally, systemic factors — unrecognised immune abnormalities, thrombophilic disorders, inadequate progesterone support — are relevant in specific clinical contexts.
The message for couples who have experienced a failed cycle is this: you have not failed. A cycle has not succeeded — yet. What you have is information, and a specialist who knows what to do with it. Do not change clinics without a thorough debrief. Do not repeat the same protocol without understanding why the first one did not work. Ask for a comprehensive review. Plan the next step based on evidence, not emotion. And do not give up while there is still a credible path forward.