A structured review after unsuccessful IVF — stimulation response, laboratory report, embryo quality, endometrial and immune factors, and male-factor reassessment — before any new cycle is planned.
Repeating the same IVF protocol after a failed cycle, in the hope that the next one behaves differently, is the most common and most expensive mistake in fertility treatment. A failed cycle contains a large amount of information: how the ovaries responded, how the eggs matured, how fertilisation went, how embryos developed day by day, and what the endometrium looked like at transfer. That information deserves to be read before anything is repeated.
Failure has distinct addresses, and treatment differs at each one. A cycle can fail at recruitment (too few follicles), at maturity (follicles that do not yield mature eggs), at fertilisation, at embryo development, at implantation, or after implantation as an early loss. Grouping all of these under 'IVF failure' obscures the fact that each has different remedies.
Poor response points towards protocol and dosing changes, or towards a candid conversation about ovarian reserve. Fertilisation failure points towards sperm factors and ICSI technique. Arrest at day 3 points at egg or sperm quality. Repeated failure to implant with good blastocysts points towards the uterus, the immune interface, or embryo genetics — which is where the investigation moves next.
Chronic endometritis — a low-grade inflammation of the uterine lining — is present in a substantial minority of patients with repeated implantation failure and is usually silent. It is diagnosed on endometrial biopsy with CD138 immunostaining and is treated with a course of antibiotics. It is inexpensive to test for and routinely overlooked.
Structural factors matter as well: submucous fibroids, polyps, adhesions and adenomyosis all change implantation and are best assessed by hysteroscopy or three-dimensional imaging rather than a routine scan. Endometrial receptivity array testing is available and is sometimes helpful, but the evidence remains limited and it is discussed as an option rather than presented as a solution.
Intralipids, steroids, growth hormone, endometrial scratch, assisted hatching, embryo glue, PRP instillation and immune therapies are all offered widely in Indian IVF, and most have weak or contested evidence. The HFEA in the UK maintains a public traffic-light rating for these add-ons, and it is a useful reference point for patients being offered them.
The approach here is to state the evidence grade for anything suggested, price it separately so it can be declined, and not present an unproven treatment as the reason the last cycle failed. Where an add-on is genuinely reasonable in a specific situation, the reasoning is written down.
No. Many patients take a review, discuss the revised plan with their existing team and continue there. The purpose is a clear read of the data, not recruitment.
Physically, often just one cycle. The practical reason for waiting is to complete the investigations that will change the next protocol — starting again before those results are in tends to repeat the same outcome.
Stimulation charts with drug names and doses, every monitoring scan, the embryology report including day-by-day grading, the transfer note and any prior test results. The embryology report is the most informative and the most frequently missing.
45-minute consultation, booked directly with Dr. Sana on WhatsApp. She consults at Apollo Fertility, Hyderabad. No referral needed.