Failed IVF and a Second Medical Opinion: What to Do Next
Key Takeaways
A failed IVF cycle still leaves useful clinical information. A second opinion works best when you bring the records held about your care: stimulation charts, embryology reports and transfer notes. ESHRE recommends an individual approach to recurrent implantation failure. ASRM's 2026 opinion does not use a fixed number of cycles. It looks at the estimated chance of a positive pregnancy test across the good-quality embryos transferred. In Turkey, Article 16 lets you inspect and copy records that contain information about your health.
Key evidence: ASRM Practice Committee — Recurrent Implantation Failure Opinion (2026) ESHRE Guidelines — Recurrent Implantation Failure Patient Rights Regulation, Article 16 (Republic of Türkiye, Ministry of Health)
A failed IVF cycle is never a neutral event. It weighs on emotional resilience, finances and trust in the process, so wanting a thorough second opinion is reasonable.
A second opinion is only as good as the data behind it. Without your previous records, a new specialist cannot see in detail what happened. The same steps are then easier to repeat. Every cycle leaves clinical information, and the records held about your care let those details shape the next plan.
Video: Second Opinion in IVF and Retrieving Your Medical File
(Note: The video was recorded in French. English and Arabic audio tracks and subtitles are available in the YouTube player settings.)
What is the modern definition of Recurrent Implantation Failure (RIF)?
Recurrent implantation failure (RIF) describes a patient in whom transfers of embryos considered viable have failed to produce a positive pregnancy test, often enough to justify looking for a cause. It no longer rests on one fixed number for every patient. For years, most definitions simply counted embryo transfers without a pregnancy, often two to three transfers of good-quality embryos, as ESHRE’s 2023 recommendations summarise.
The European Society of Human Reproduction and Embryology (ESHRE) recommends identifying RIF from each patient’s own predicted chance of implantation rather than from a fixed count, and suggests considering further investigation once the cumulative predicted chance has passed 60% without success. The American Society for Reproductive Medicine (ASRM) defines RIF using the estimated number of good-quality blastocysts (embryos grown for about five days) needed to reach a 95% cumulative chance of a positive pregnancy test. That endpoint is a pregnancy test result, not a live birth (a baby born after the pregnancy continues). The evidence behind these definitions is still imperfect.
Instead of only counting attempts, clinicians review age, ovarian reserve, embryo stage and appearance under the microscope (morphology), whether embryos were genetically tested, the uterine cavity, and the details of each transfer. A negative transfer may justify a more focused review earlier when the outcome is clearly different from the expected prognosis. That does not automatically mean extensive testing is needed.
For patients whose expected chance is already lower because of age, ovarian response or other factors, the same approach helps avoid expensive or invasive investigations after a single result that may still fit the expected range.
Which uterine and inflammatory factors may need review?
Three factors are worth reviewing before an IVF protocol is repeated: cavity lesions, chronic endometritis and hydrosalpinx. Further assessment is most useful when the history, imaging or previous cycle details raise a specific question:
- Fibroids and Polyps: Polyps or submucosal fibroids that distort the cavity may affect implantation. Hysteroscopy can confirm the finding and allow treatment of selected cavity lesions; it is not used for every fibroid or every failed cycle.
- Chronic Endometritis: Evidence here is limited, and definitions are not fully consistent. In selected patients with recurrent implantation failure, an endometrial biopsy with appropriate pathology review may be considered. Whether antibiotics or a follow-up test are needed depends on the result and the clinical context.
- Hydrosalpinx: A fluid-filled fallopian tube may affect implantation, especially when it communicates with the uterine cavity. If a communicating hydrosalpinx is confirmed, two options may be considered before transfer: removing the tube (salpingectomy) or blocking it close to the uterus (proximal tubal occlusion). The choice depends on the full clinical picture. A Cochrane review found moderate-quality evidence that salpingectomy probably raises the clinical pregnancy rate and low-quality evidence that tubal occlusion may; it reported no live-birth data.
What can an embryology report tell you about a previous cycle?
It shows at which stage development slowed. On its own, it does not identify a single cause:
- Day 3, the cleavage stage: The report may record how the cells have divided, how many cells the embryo has and its fragmentation (small pieces of cell material that break away from the cells).
- Day 5 blastocyst development: The report records whether embryos reached the blastocyst stage and how they were graded. A marked drop between Day 3 and Day 5 can have several biological or laboratory explanations. That is why it is read together with the stimulation, fertilisation and transfer records.
Which add-on tests and treatments are supported by evidence?
After IVF failure, patients are often offered commercial “add-ons.” ASRM and ESHRE both favour targeted evaluation after a detailed review. The Almohammadi et al. umbrella review, a review of earlier systematic reviews, assessed 47 of them. It concluded that some immunomodulatory treatments (including intralipid infusion) and intentional endometrial injury are likely to be effective, but it rated 88% of those reviews as low or critically low quality and urged caution. ASRM’s 2026 opinion is more cautious on several of these options, and the table follows its wording. The table shows when each option is usually considered. It is not a sequence to work through:
| Intervention / Test | Evidence Tier | Clinical Reality |
|---|---|---|
| Cavity assessment and treatment of a confirmed abnormality | 🟡 Targeted | Hysteroscopy or other imaging may be appropriate when recurrent implantation failure or a cavity abnormality is suspected; treatment depends on the finding. |
| Parental karyotyping (a chromosome check on a blood sample) | 🟡 Selected cases | May be considered for structural chromosomal rearrangements after a clinical review; genetic counselling is needed if a rearrangement is found. |
| PGT-A (aneuploidy testing) | 🟡 Shared decision | May help investigate embryo chromosome number (ploidy) in selected patients with untested embryos. ASRM reports no evidence that it increases live birth in RIF. |
| ERA testing (endometrial receptivity analysis) and endometrial scratching | 🔴 Not routine | ASRM finds the evidence insufficient for routine ERA testing and does not recommend endometrial injury (scratching) in RIF. |
| Empirical immunotherapies (intralipids, IVIG) | 🔴 Not routine | ASRM finds the evidence insufficient to recommend intravenous fat emulsion (intralipid) and does not recommend intravenous immunoglobulin (IVIG). Potential harms and costs should be discussed. |
What are your legal rights to your medical records?
In Turkey, Article 16 of the Patient Rights Regulation (Hasta Hakları Yönetmeliği) allows a patient, directly or through a proxy or legal representative, to inspect the file and records containing information about the patient’s health and obtain a copy. For a second opinion, you can ask the centre for relevant records such as:
- Stimulation monitoring charts and the prescribed doses of stimulation hormones (gonadotrophins).
- Egg retrieval records, including the number and maturity of the eggs (oocytes) where recorded.
- Embryology culture reports, including the fertilisation method, developmental observations, and blastocyst grades.
- Embryo-transfer notes, including the catheter, ultrasound guidance, and any documented technical difficulty.
Article 16 does not specify document formats or response deadlines. A written request can help create a clear record of what you asked for. If the centre does not respond, ask for the reason in writing and seek advice from the relevant patient-rights authority or a qualified lawyer. Rules may differ when treatment took place outside Turkey.
Dr. Aksoy’s Approach: Why We Never Start from a Blank Page
Dr. Aksoy’s Clinical Perspective
“When a couple consults me for a second opinion, the first question I ask is not simply ‘how many eggs did you have?’ but where did the cycle encounter its biological bottleneck?
Were the gonadotrophin dose and the number of follicles in line with the number of eggs retrieved? What was the mature oocyte ratio? Was there a sharp drop at fertilization? Did embryo development stop at Day 3 or on the way to Day 5? Was the embryo transfer smooth or technically difficult? Were the endometrial thickness and the luteal progesterone support adequate?
These granular details may change my recommendation—for example, by prompting an adjustment to the stimulation protocol or trigger timing, the use of ICSI when clinically indicated, or an embryo-banking strategy.
A common misconception is that every failed transfer means ‘my uterus rejected the embryo.’ Unless embryos were genetically tested, maternal-age-related chromosomal aneuploidy is an important population-level explanation, but it is not the only possible explanation for an individual transfer.
Before starting a new cycle, I begin by reviewing the prior embryology and transfer records. Depending on the history, an updated pelvic ultrasound, cavity assessment, or review of sperm parameters may be appropriate. I avoid subjecting patients to unproven immune panels or generic add-on packages.
Our objective is not to add treatments blindly, but to identify which part of the previous attempt needs review and adjust only what the evidence and clinical context support.”
— Dr. Senai Aksoy
Related Reading
- Failed IVF: What to Review Before the Next Cycle
- IVF Success Rates: How to Read ESHRE and SART Data
- Hydrosalpinx and Infertility: Diagnosis and Management
- Chronic Endometritis Before IVF: Diagnosis and Treatment
- Fibroids and IVF: When Treatment Before Transfer Matters
Frequently Asked Questions for Dr. Aksoy
When should a couple seek a second opinion after IVF failure?
I do not think every unsuccessful IVF attempt means a couple needs to change clinics. Even when treatment has been carried out correctly, pregnancy is never guaranteed. If several attempts have failed, if we repeatedly obtain very few eggs or embryos, or if the reason for poor results remains unclear, a second opinion can be helpful.
I also encourage patients to seek another opinion if they feel their questions have not been answered, or if they are being offered additional treatments without a clear explanation of the benefits. You do not have to wait for three failures to ask for another perspective.
For me, the purpose of a second opinion is not necessarily to change clinics. It is to understand what happened and whether anything could genuinely be improved.
Which medical records do you need for a useful IVF second-opinion review?
I first want to see the complete records of previous IVF attempts, not just the embryo-transfer report. The stimulation protocol, medication doses, number of eggs retrieved, number of mature eggs, fertilisation results and embryo development tell me a great deal about what happened.
I also review embryo grades, any genetic-testing results, the endometrial preparation, progesterone treatment and details of the embryo transfer. Previous ultrasound examinations, uterine assessments and semen analyses are equally important.
Sometimes the explanation is already in these records. Before ordering new investigations, I prefer to understand what has already been done, what worked well and where the difficulties occurred.
After one failed transfer of a good-quality embryo, do you recommend more testing immediately or another attempt?
Usually, I start by reviewing the previous transfer rather than ordering a long list of new tests. A beautiful embryo under the microscope is not necessarily chromosomally normal, and even a chromosomally normal embryo does not implant every time.
If the endometrium was appropriately prepared, the transfer was uncomplicated and there are no other concerning findings, another carefully planned attempt may be perfectly reasonable.
If I identify a possible uterine abnormality, difficulties during transfer, a problem with progesterone exposure or another specific concern, I would investigate that before proceeding.
One failed transfer is disappointing, but it is not automatically evidence that something is wrong with the uterus or the treatment. I believe investigations should answer a real clinical question, rather than simply add more procedures after an unsuccessful attempt.
Sources
- Practice Committee of the American Society for Reproductive Medicine. Recurrent implantation failure: a committee opinion. Fertility and Sterility 2026;126:277–293.
- ESHRE Working Group on Recurrent Implantation Failure; Cimadomo D, de Los Santos MJ, Griesinger G, et al. ESHRE good practice recommendations on recurrent implantation failure. Human Reproduction Open 2023;2023(3):hoad023. doi:10.1093/hropen/hoad023.
- Almohammadi A, et al. Interventions for recurrent embryo implantation failure: an umbrella review. International Journal of Gynecology & Obstetrics 2025;169(2):539–556. Published online 2024. doi:10.1002/ijgo.16066.
- Melo P, Georgiou EX, Johnson N, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database of Systematic Reviews 2020;(10):CD002125. doi:10.1002/14651858.CD002125.pub4.
- Republic of Türkiye, Ministry of Health. Patient Rights Regulation, Article 16. Resmî Gazete 1 August 1998, no. 23420. Official Turkish text.
Add as a Preferred Source on Google
You can add draksoyivf.com as one of your preferred health information sources on Google.
The content has been created by Dr. Senai Aksoy and medically approved.