NEGATIVE IVF: Everything you need to know after a failed IVF

Infertility is considered a disease that affects 17% of Spanish couples of reproductive age according to the Spanish Society of Fertility (SEF). For the affected couples, in vitro fertilization (IVF) either with own or donated eggs (egg donation) often represents the most effective treatment to fulfil their greatest desire: a healthy baby at home. However, there is some risk that these treatments can fail.

Are there any symptoms or signs after the embryo transfer that indicate that IVF will be negative pregnancy test?

The only reliable diagnostic test to establish the success or failure of assisted reproduction treatment is the pregnancy test. It can be done either in urine or through a blood test to determine the level of β-hCG hormone (“beta”).

The presence of certain symptoms similar to those that appear at the beginning of pregnancy, around performance of this test, are not indicative of the result. Many of them, such as the feeling of abdominal discomfort, nausea, tiredness or sleepiness are related to the effect of the drugs used in the treatment and may appear even if there is no pregnancy.

On the other hand, the absence of symptoms does not rule out a positive result, since gestation at its beginning is often asymptomatic.

If I have vaginal bleeding, is it indicative of a negative result? Should I go for the β-hCG test?

Vaginal bleeding is a symptom that does not necessarily imply treatment failure. In fact, it may even indicate that implantation has occurred. This is called embryo implantation bleeding.

Therefore, even if the vaginal bleeding occurs in the days around the β-hCG test, it should be performed on the scheduled day informing the specialist of this circumstance.

Due to the frequency with which this symptom appears in cases of positive pregnancy test, we should NEVER abandon the prescribed treatment until the result of the ?-HCG analysis is known.

What will the period be like after a negative pregnancy test?

The time when menstruation appears depends mainly on the treatment used. For example:

• In patients who have undergone an embryo transfer in a natural cycle, the period usually starts on the usual and expected day.
• When we administer hormonal medication, it will start two or three days after the treatment has been discontinued. If it does not appear after two or three days, it is recommendable to consult the doctor.

It may be that the first period is different in duration and intensity than usual.

Causes of IVF failure

Since there are many causes of infertility and often several of them are combined, it is very risky to establish a common prognosis for all the cases. It, therefore, implies a personalized evaluation of each case.

It is important to differentiate between the factors to be studied before treatment and the factors that would have a prognostic value when another IVF attempt is carried out after a failure.

Most relevant pre-treatment factors:

• Maternal age. As we explained in this post, the effect of advanced age causes a decline in the number and quality of oocytes.
• If the starting point of the treatment is an altered massculine factor.
• Body mass index (BMI). In women, the ideal BMI is between 19 and 30. Its deviations, especially BMI >30, can lead to a low rate of fertilization and pregnancy. In this case, the patients tend to have ovulatory problems and present a higher risk of miscarriage. In men, obesity adversely affects their reproductive system and it has been observed to tend to increase oestrogen level and reduce testosterone level.
• Cause of infertility. Whether it is single or multiple.
• Having endometriosis.
• Antral follicle count (AFC). It is directly related to maternal age and anti-mullerian hormone (AMH) values. With increasing age, we observe a decrease in the follicle count and AMH values.
• Toxic factors. Habits of use of harmful substances, such as tobacco and alcohol, as well as environmental factors, impair treatment outcome.
• If the cause of the sterility is of unknown
• Anatomical abnormalities that may difficult the pregnancy.
• Suffering from a tubal factor.

Post-failure factors:

• Ovarian factor. Depending on the ovarian response in a previous cycle, we can modify and/or customize a new attempt based on certain hormone levels. Also, progesterone levels can help us know if endometrial receptivity is optimal.

• Endometrial factor. Abnormalities in the intrauterine cavity, poorly proliferated endometrium, endometritis, immunological factors and blood coagulation abnormalities are the causes of repeated implantation failure (learn more)

• Semen quality. Although with a low number of spermatozoa we can carry out an ICSI, there are certain parameters that could influence the rate of fertilization and that must be considered in a new attempt.

• Embryonic quality. Embryos that reach the blastocyst stage are classified according to their degree of expansion and the quality of their cells. Consequently, a good quality embryo will have a higher pregnancy prediction rate (learn more)

• Laboratory quality control. This category includes air quality, pH, type and characteristics of incubators, use of dim light and type of media in which embryos are cultured. The IVF laboratory must guarantee the best conditions for embryo development

• Experience of embryologists.

When to try again after a negative negative pregnancy test

In cases where the strategy to be followed is another ovarian stimulation, it is recommended to allow 2 to 3 months to pass. During this time, the medical team and the embryologists will always work together to try to find the cause of the negative β-hCG and the patient will be allowed to make decisions with more calm and let her ovaries rest after the previous stimulation.

Alternatively, and without any doubt, it is not necessary to wait if the plan is to perform a frozen embryo transfer after the negative IVF . In this case the ovaries are “not necessary” and with menstruation the endometrium will have regenerated completely. Therefore, an endometrial preparation will be carried out and thawing of the embryo and its transfer will be performed.

Similarly, each case will be individualized taking into account the situation and medical history of each patient.

Emotional support: negative IVF and… now what?

When you wish to see a positive result and you receive negative news, a whole lot of emotions run through your body. Having invested time, energy, emotions, plans, savings etc. makes us experience frustration in this delicate moment.

How do I feel after a negative attempt?

• SHOCK: my mind is not ready to receive this news and goes into a “blocked” mode in order to cope with the situation. It is a time when I cannot understand even the explanation that the doctor gives me.
• EMPTYNESS inside my body: it is like a small mourning that is feeling pain caused by not having been able to get pregnant in this treatment.
• SORROW: accompanied by the feeling of not being able to continue, with the thought that it is unfair, and it comes to my mind repeatedly: Why me?
• GUILT: I look back and analyse, again and again, what could have been the cause of the negative result, if I have done something that has influenced it, if I have not followed the treatment well or if I had started looking for it earlier…
• FEAR: I look to the future and worry that I will never be able to achieve it. This thought tortures me…

What can I do? Recommendations of a psychologist after a negative β-hCG result

• LISTEN TO YOUR BODY AND LET IT FLOW. Give yourself time to “digest” the situation, everyone needs a different rhythm.  Let the emotions emerge as they come, without judgment, without expecting to feel a particular way, let them flow and your energy adjust gradually. Look after yourself and listen to your body.
• FOCUS THE ATTENTION ON YOURSELF. Observe your sensations, your emotions and perform activities that generate internal peace. Try not to recreate the thoughts of the following type: “What could I have done wrong“, “if I had not done such a thing…” because they are accompanied by guilt, and they can generate discomfort in you.
• CONNECT WITH THE PRESENT MOMENT. After a negative β-hCG it is not necessary to make decisions, nor to ask ourselves questions about the future in absolute terms such as: “what if I never become a mother?“. On the contrary, it is time to channel your energy based on the day to day. Redirect your thinking to: “Today I have possibilities, I will continue trying”.
• TRUST in yourself. Trust in your body, in the chosen professionals and in the possibilities and opportunities that in vitro fertilization allows us to have.
• GET READY FOR A NEW WELCOME. Check if you are ready for the next transfer. Check your eating habits, physical exercise, sleep, mental hygiene… to improve them if necessary. They will help you to feel better.
• MAKE DECISIONS. After a few days and with a medical explanation of your diagnosis, it’s time to make decisions. Plan your next transfer or next steps.

Our Psychology Unit offers you the emotional support you need to get through the difficult times.