When an IVF cycle is started, you have to be regularly monitored by ultrasound scan in order to check if ovarian stimulation develops adequately, and if you are a good responder. Otherwise, the risks involved would be higher.
IVF may be cancelled due to a poor or excessive response of the ovary to fertility drugs. In these cases, there is no alternative but to cancel the cycle, irrespective of whether it is a classical IVF or ICSI cycle.
Another IVF cancellation phase is the moment of the embryo transfer, the last step of the process. A FET may be cancelled due to several reasons. In any case, there are various things to be done in case your IVF cycle has been cancelled.
IVF cancellation reasons
A complete IVF cycle encompasses the following phases:
Each one of these phases is crucial to achieve IVF success. For this reason, any problem or abnormality that may arise during the process, can lead to cancelling the cycle. Depending on the phase, a cycle can be cancelled totally, if there are no eggs or embryos, or partially, if at least you have eggs and embryos to freeze for future cycles.
When a woman or couple find themselves in any of these scenarios, they ask themselves questions such as Why has my IVF cycle been cancelled? What would be the risks if it were not cancelled? When should an IVF cycle get cancelled?, etc.
What follows is a list of factors that can affect the normal development of an IVF cycle, and leaving the specialist no choice but to delay it:
A key phase in every IVF cycle is ovulation induction. It is done using ovarian stimulation drugs, which cause the ovaries to produce multiple ovarian follicles at the same time instead of just one.
In this phase, there is the risk that the ovary has a poor response to fertility drugs. In such case, your doctor may consider the possibility of cancelling the cycle if:
- The number of follicles is insufficient
- Your hormonal levels are too low or altered, indicating poor egg quality
- Early ovulation and loss of mature eggs occurs
If no mature egg develops or if they degenerate because ovulation occurs earlier than expected, the cycle would be cancelled to try again in a new cycle, with a new stimulation and medication protocol.
It should be noted that, in cases of IVF cancellation due to early ovulation, you should avoid intercourse or at least use a birth control method, as the risk of multiple pregnancy is considerably high.
When the number of eggs collected is too low due to low response o poor ovarian reserve, it is your decision whether or not to continue the cycle or cancel it. Although no health risk are associated, the success rates are too low.
Accumulation of oocytes during various cycles is another option. This method allows multiple oocytes to be fertilized all at the same time to create the embryos when the number is considered acceptable.
If you found this interesting, why don’t check out the following post? Click here: Poor Responders in IVF Cycles – Management & Best Protocols.
IVF cycles can be cancelled due to high response as well. Being a high responder translates into overstimulation, which can lead to Ovarian Hyperstimulation Syndrome (OHSS) in the most serious cases.
Too elevated levels of estrogens as a result of overstimulation can cause the ovaries to grow excessively. Moreover, it can cause the follicular fluid to leak from the ovaries into the abdominal cavity, which is associated with more serious side effects.
Last but not least, OHSS increases the risk for the blood vessels to become “leaky”. This can compromise the renal and respiratory systems, cause liver damage, and alter the production of blood. In short, OHSS can become a life-threatening side effect in the worst cases.
A woman is considered a high responder to IVF meds when 15 or more eggs are retrieved or if the levels of estradiol in blood are above 3,000 pg/ml on the day of ovulation.
In cases of IVF cancellation due to overstimulation with risk of OHSS, there exist two possible solutions to prevent the situation from becoming worse:
- Cancellation before egg retrieval
- The cycle is stopped during the stimulation and hormone administration phases. At this point, it is crucial that you avoid unprotected sexual intercourse, as the risk of multiple births and late OHSS is high.
- Embryo cryopreservation
- In this case, the specialist carries the egg retrieval procedure, but the eggs collected will be fertilized and frozen for being transferred in future cycles. If the cycle were continued and pregnancy occurred, the increase of hCG levels could cause the woman to develop OHSS.
It should be noted that, if you opt for the latter strategy, what we freeze are embryos and not eggs because, by doing it, we make sure that they are high-quality embryos, that is, embryos that have been able to survive the freezing-thawing process.
Failure to provide sperm sample
An IVF cycle may be cancelled due to inability of the male partner to provide a sperm sample.
Once the eggs have been retrieved from the IVF patient, they should be fertilized within the next 4 hours. After this timeframe, they will be too “old” to be used.
So, in short, after egg retrieval, having the sperm specimen from the partner or donor ready for fertilization is crucial.
Potential problems that may occur at this stage include:
- Performance anxiety or inability to ejaculate via masturbation
- Semen without sperm in patients with severe oligospermia
- Decreased sperm quality or presence of dead sperm post-thaw
Cancelled embryo transfer
Oftentimes, even though the previous steps of IVF have been successful, the process might be cancelled prior to the last step, that is, the embryo transfer.
The following are the main causes why you may not get to the embryo transfer stage:
- No embryos available for transfer
- Due to failure of eggs to fertilize or embryonic arrest during embryo culture, especially in cases of blastocyst culture.
- Inadequate uterine lining
- If the embryo or embryos are transferred in a moment other than the implantation window, it is possible for them to be unable to attach to the lining of the uterus (IVF implantation failure).
You may like: 6 Effective Ways to Increase Endometrial Thickness Naturally.
Implantation failure occurs rarely and can be related to male infertility, female infertility, or a combination of both. If it occurs, the specialist will look for the cause prior to give you the green light to start an IVF cycle anew.
As for embryonic arrest, it is likely to be due to genetic abnormalities that prevent them from developing. Embryonic arrest may occur in cases of culture to blastocyst stage, too. Developing into a blastocyst embryo is a critical process that not all embryos are able to complete.
If no embryos make it to the transfer due date, there would be no alternative but to cancel the cycle and start a new one.
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FAQs from users
Is it possible that an IVF cycle is cancelled due to cyst on ovary?
Yes, if a cyst on the ovaries is found, treatment may need to be delayed. Fortunately, cysts are typically benign and usually go away on their own. Once resolved, you may be able to start the IVF cycle after a short delay.
How often are IVF cycles cancelled?
It is not possible to provide a precise answer to this question. However, being a poor responder is a common cause of IVF cancellation, which is estimated to occur in 5-35% of women.
Suggested for you
As explained above, an IVF cycle has various phases and the average duration is about one month. If you liked this story, you may want to go through this: The IVF Process Step by Step.
As in the case of IVF, women who undergo Intrauterine Insemination (IUI) cycles may experience certain issues that leave them no choice but to cancel or delay the treatment. Click here to read more: Complications of Intrauterine Insemination or IUI.