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Implantation Failure: Why In Vitro Fertilization Sometimes Doesn’t Work

Authored and medically reviewed by Dr. Eli Reshef

Dr. Eli Reshef is a reproductive endocrinologist and fertility specialist who sees patients in Chicago and the greater Chicagoland area.

IVF is a revolutionary advancement in reproductive medicine, offering hope to countless individuals and couples struggling to conceive. However, even with the best medical care, IVF does not always result in a pregnancy. Experiencing a failed cycle can be incredibly frustrating and emotionally exhausting. Understanding why implantation sometimes fails can provide clarity and help guide the next steps in your fertility journey. However, it’s also important to understand that implantation failure often cannot be explained. 

The IVF Implantation Equation

The success of an IVF cycle largely depends on two key factors:

• Embryo Quality

• Uterine Lining Receptivity

Together, these determine the likelihood of successful implantation and pregnancy. While many assume that a failed IVF cycle is due to an issue with the uterus, the most common reason is actually embryo quality.

Why Do Some Embryos Fail to Implant?

During IVF, embryos develop in a lab before being transferred to the uterus. However, not all embryos will make it to this stage:

• Many embryos arrest (stop developing) before reaching day 5.

• Even after day 5, some embryos that appear healthy under a microscope may not continue developing after transfer.

• On average, only about 25% of transferred embryos successfully implant and result in a live birth.

• Implantation rates vary by age:

  • Under age 35: ~43% of transferred embryos implant.

  • Age 41-42: ~9% of transferred embryos implant.

You can find SART’s 2022 National Summary linked for additional details on embryo implantation and live birth rates. 

How Embryo Quality Affects Implantation

One of the primary reasons IVF cycles fail is the high rate of chromosomal abnormalities in embryos, which increases with age.

• In a woman’s early 30s, chromosomal abnormalities in eggs begin to rise.

• By the mid-40s, over 75% of embryos may be chromosomally abnormal.

• The egg’s spindle apparatus, responsible for properly separating chromosomes, becomes less efficient with age, leading to errors that cause embryo abnormalities.

By contrast, sperm chromosomal abnormalities are much lower—typically only 1-2% of sperm have chromosomal issues, compared to 20-90% of eggs, depending on maternal age.

Genetic Testing for Better IVF Success

Advancements like preimplantation genetic testing (PGT) allow fertility specialists to evaluate embryos before transfer, increasing the chances of selecting a chromosomally normal embryo. This can improve implantation rates and reduce the risk of miscarriage.

Other Potential Causes of Implantation Failure

While embryo quality is the most common issue, researchers continue to investigate additional factors, including:

• Other genetic mutations that may affect implantation.

• Immune system responses that might interfere with embryo development.

• Uterine conditions, such as thin endometrial lining or undiagnosed abnormalities.

• Unknown factors, accounting for at least 50% of implantation failure.

With ongoing research, new discoveries will help improve IVF success rates and provide better insights into why implantation sometimes fails.

Common Questions About Failed IVF

“Was it my fault that I didn’t conceive?”

It’s natural to wonder if there was something you could have done differently. Please know that implantation failure is not your fault. Things like activity after embryo transfer, stress levels, diet, and common household exposures are not linked to the outcome. Be kind to yourself—blaming yourself only adds to the emotional weight of the journey. 

“Why didn’t the embryos stick? Did you place them in the right spot?”

It’s completely understandable to wonder if something went wrong during the embryo transfer. However, embryo placement is a very precise procedure, and in most cases, the transfer technique itself is not the issue, especially when performed by an experienced specialist. The most likely reason for implantation failure is an underlying issue with the embryo that prevents it from continuing to develop.

“What’s wrong with my uterus? Is it not accepting the embryos?”

Hearing that an embryo didn’t implant can make you feel like your body is rejecting it—but that’s rarely the case. While the uterine environment plays an important role, implantation failure is most often due to embryo quality rather than an issue with the uterus itself, especially if the integrity of the lining has been investigated ahead of embryo transfer. If there were concerns about your uterine lining, your doctor would work with you to address them before your next transfer.

“Do I need a surrogate because my uterus can’t carry a pregnancy?”

Many people assume that if IVF fails multiple times, the next step is surrogacy. While surrogacy is an option in some cases, for most patients, switching to a surrogate will not necessarily improve success rates. What we’ve learned from egg donation is that embryo quality—especially egg health—is the biggest factor in implantation success. If IVF hasn’t worked, your doctor may discuss additional testing or alternative approaches before considering surrogacy.

Next Steps After a Failed IVF Cycle

If you've experienced IVF failure, you're not alone. Your fertility specialist can review your case and suggest potential adjustments, such as:

• Genetic testing of embryos before transfer

• Adjusting your treatment protocol to improve egg or uterine quality

• Exploring alternative options like donor eggs if needed

• Studying the uterine lining for inflammation and other negative implantation factors

At AFCC, we understand how difficult a failed IVF cycle can be, and we're here to support you. If you have questions or want to discuss the next steps, schedule a consultation with one of our specialists today.

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