Questions to Ask After a Failed IVF Cycle
Questions to take to the follow-up appointment after an IVF cycle that did not work. They cover egg and embryo numbers at each stage, grading, the transfer itself, protocol changes, frozen embryos, added tests, costs and second opinions. These are questions for your clinician rather than answers.
20 questions, each with the reason to ask it · includes a conversation guide
The questions
Open any question to see why it works.
- 1
What do you think happened in this cycle?
This opens the review on their terms and shows you where their attention is. Ask them to distinguish between what the cycle actually demonstrated and what is being inferred, because those get blended together easily.
- 2
How many eggs were collected, and how many of those were mature?
These are two separate numbers and clinics sometimes quote only the first. The gap between them is one of the things a protocol change would be aimed at, so it is worth having both figures written down.
- 3
How many fertilised, and by which method?
Conventional insemination and ICSI produce different conversations about what to do next. Ask what fertilisation rate they were expecting for your situation, so the number you were given has something to sit against.
- 4
What happened to the embryos between fertilisation and transfer, day by day?
The pattern of attrition across the days is where most of the information in an IVF cycle sits. A summary figure hides it, so ask for the daily numbers rather than the headline.
- 5
How were the embryos graded, and what does that grading mean at this clinic?
Grading systems are not standard between clinics, so a letter or number means little on its own. Ask what the grade describes and how strongly it predicts anything, because clinicians vary in how much weight they put on it.
- 6
Was the transfer itself straightforward?
Difficult transfers are recorded in the notes and are not always mentioned afterwards. If yours was, ask what would be done differently next time and whether anything would be checked in advance.
- 7
What was my lining doing, and were you satisfied with it?
Ask for the measurement and the target rather than a general reassurance. If it was borderline, ask what the options are for addressing it and how confident they are that it made a difference.
- 8
Did I respond to stimulation the way you expected?
Response is the clearest measurable thing in the cycle and the most common reason a protocol is changed. Ask whether you were on the low or high side of what they hoped for, and by how much.
- 9
Would you change the protocol next time, and what specifically?
Ask for the specific change rather than the intention to adjust. If the answer is that nothing would change, ask what result would have to be different before they would alter anything.
- 10
Are there embryos in storage, and what is the plan for them?
This affects whether the next step is a frozen transfer or a full cycle, which are very different in cost and time. Also ask about storage fees and how long your consent forms run for, since those have dates on them.
- 11
Would you recommend genetic testing of embryos, and what would it not tell us?
The second half of the question is the important one. Asking what a test cannot rule out keeps the discussion realistic and gives you a sense of how strongly the clinician actually believes in it for your case.
- 12
Are there tests you would suggest now that we did not do at the start?
Frame it as which test would change the plan, and for what result. That keeps the conversation on decisions rather than on the general possibility of more investigation.
- 13
Are there any extras you would advise against in our case?
What a clinician declines to offer, and their reasoning, is often more revealing than what they suggest. It also lets you raise things you have read about without asking them to comment on a particular product.
- 14
Has anything in my results changed since we began?
Some of your original workup may be more than a year old by now. Ask which numbers the clinic currently treats as up to date and which they regard as historic.
- 15
Given all of this, what would you put our chance at with another cycle?
Ask for a figure that reflects your own circumstances and ask what it is based on. Whether the number comes from clinic data, national data or clinical impression changes how much weight it deserves.
- 16
How many cycles would you usually suggest before we talk about other routes?
Other routes may mean donor eggs or sperm, surrogacy, or stopping. Hearing the criteria now means the conversation will not arrive without warning, and you can think about it outside an appointment.
- 17
How long would you want us to wait before starting again, and why that long?
Reasons for a gap range from practical scheduling to specific medical ones. Knowing which applies to you affects how you plan the next few months and whether the wait is negotiable at all.
- 18
What did this cycle cost in total, and what would the next one cost?
Ask for the full figure including medication, freezing, storage and laboratory charges, since headline cycle prices frequently exclude some of these. Ask also what portion of any funded or insured allowance has now been used.
- 19
Would a second opinion be reasonable, and can I take my records with me?
This is a routine request and does not need to be justified. A clinician who is comfortable with it is a good sign, and having your own records makes any second consultation considerably more useful.
- 20
What support does the clinic offer, and is counselling included?
Many clinics have counselling available and mention it only if asked. Finding out what exists, and whether it is charged separately, is easier now than at the point you want it.
The follow-up appointment
Practical guidance for the conversation itself.
Before you go in
Before you go in
- Request your cycle notes in advance, including the embryology report. Reading the numbers beforehand means the appointment can be about what they mean.
- Ask how long the appointment is, and whether it is with the consultant or a member of the team. That shapes how many questions are realistic.
- Mark the three questions you most want answered. These reviews move fast and it is very common to leave having asked none of the ones you planned.
- Bring someone whose only job is to write things down. Almost nobody retains the detail of these conversations unaided.
- Write down anything that has changed since the cycle: illness, new medication, weight change, a change in your partner's health.
Getting usable answers
Getting usable answers
- Ask for numbers and for the target that number was measured against. A figure on its own does not tell you whether it was expected.
- When you hear that something was normal, ask whether that means within range, or unremarkable given your specific situation.
- For every suggested addition, ask what it would show and what would be done differently for each possible result.
- Ask what would have to change before they would alter the protocol. It is more useful than asking whether something went wrong.
- Read the plan back to them before you leave. Misunderstandings surface immediately when repeated out loud and are very hard to correct later by email.
- You do not have to decide anything in the appointment, and saying so is a complete answer.
Practical matters
Practical matters
- Storage of any remaining embryos: fees, renewal dates, and what your consent forms currently say.
- The full cost of a frozen transfer compared with a fresh cycle, since the difference is usually large.
- How much of any funded or insured entitlement remains, and whether there is a time limit on it.
- Notice periods for booking the next cycle, and how that fits with work, travel and anything you have already planned.
- How to obtain your records if you want a second opinion, and how long the clinic takes to release them.
- Whether counselling is included, and how to book it without going through the medical team if you would rather not.