One of the hardest things for an infertile couple to deal with is the failure of an IVF cycle. In fact, it's the fear of failure which often puts off a lot of infertile couples from even attempting an IVF cycle. They are petrified that if they try and fail, they will have nothing to fall back on, which is why they refuse to even make the attempt in the first place!

You are likely to go to pieces when you cycle fails, because all your hopes come

Shattering Down. Please give yourself time to recover - and then seek a follow up appointment with the doctor, so you can assess what you learned from the cycle. Sadly, the quality of IVF medical records in most Indian clinics is abysmally low. It's important that you proactively ask for all your IVF medical records and documentation while the IVF treatment is going on, rather than beg for these papers after the cycle fails.

The rule is simple - You must demand a printed treatment summary for your IVF treatment at the time of the embryo transfer itself.

This should include basic details such as:

• What were the meds which were used for superovulation?
• What was their dose?
• How many follicles did you grow?
• How many eggs were collected?
• What was the E2 (estradiol) level in the blood?
• What was the endometrial thickness?
• How many embryos were transferred?
• What was the embryo quality?
• Were any embryos frozen?

Please insist that your clinic provides you with photos of your embryos. You have a legal right to your medical records - every hospital has to provide them by law! Please make a request for this in writing. If you are well-prepared, you will not go to pieces even if your first IVF cycle fails. You need to analyze your medical records and do your homework, so that you can ask your doctor intelligent questions at the time of your visit.

• What went right?
• What went wrong? Why?
• What does he plan to do differently in the next cycle?
• Were there issues with superovulation?
• Egg retrieval?
• The embryo transfer?
• Embryo quality?
• Do you have spare frozen embryos?

It's very helpful to have pictures of your embryos to make sure this is an intelligent discussion. If your doctor tries to fob you off by just airily saying that the embryos were of good quality and refuses to give you photos of your embryos, this should raise a red flag!

Many issues seen in a failed first IVF attempt can be addressed in order to eliminate or reduce the likelihood of the same issue occurring in a second try with in vitro fertilization. Not all issues are "fixable" - but they should be studied and discussed, so that you are educated about your options and can make a well-informed decision. After a failed IVF cycle, the commonest question is

• What is the success rate with a second cycle of IVF? This is a simple question - but there is no easy answer. As with most things in medicine, the truthful answer is - It depends. Many couples will have a successful second IVF.

The chances depend upon many factors, including:

• Egg quality and egg quantity which depends upon your age; and the skill of your IVF doctor in managing your superovulation.
• Sperm quality, though this is much less of an issue when we do ICSI.
• IVF lab quality.
• Egg retrieval skills of the physician.
• Embryo transfer skills of your IVF doctor.
• Uterine issues.
• Genetic and chromosomal competence of the embryos.

In order to maximize the chances for a successful second IVF try to make sure that your doctor has carefully reviewed the issues above. If there were difficulties with the ovarian stimulation or low numbers of eggs - consider modifications to the drug protocol. If there were good looking embryos, but none implanted, try IVF a second time at the same IVF clinic. If there were significant embryo quality issues, it is most likely due to an IVF lab quality control problem. Therefore, consider changing the IVF clinic to a program with higher in vitro fertilization success rates to see if these issues can be corrected by a better IVF lab.

Using donor eggs, or donor embryos could be future considerations, but these are usually part of Plan C. While many patients feel surrogacy is a useful solution for treating failed IVF, the truth is that the uterus is very rarely the problem. Implantation failure is almost always because the transferred embryos were too weak to implant and continue normal development. The uterus is almost always receptive to embryo implantation.

• What about ordering more tests, to try to find out why the cycle failed?
• What about using supplements to try to improve egg quality?

Is it reasonable to use experimental unproven treatment options, such as immune therapy to "treat" high NK cells, which allegedly prevent embryos from implanting by causing immune rejection? While patients can get frantic in their search for answers, the truth is that because embryo implantation is still a black box area about which we know precious little, we cannot determine the commonest cause for IVF failure, which is why we use the catchall term, "failed implantation." This is actually a waste-paper basket diagnosis, because it provides precious little useful actionable information for the patient. It's just a "scientific" dressed up label, which doctors use to pacify their patients. All it means is - that the embryos did not implant, and we do not know why.

The good news is that if you had a perfect IVF cycle (good embryos; good uterine lining; and an easy transfer) then just because the first IVF cycle fails, the chances of success remain equally good in the second and third cycle! In fact, the fact that you created good embryos emphasizes the fact that you are capable of getting pregnant - and sometimes you just need to be patient to have a baby. Remember that most IVF babies would never have occurred if the couple had stopped at the first cycle of IVF. There is data, however, that suggests that after 4 failed cycles, the chances of conception do become lower and lower and you should start considering third party options (such as donor eggs or donor embryos or surrogacy).

Remember, that the failed IVF cycle will not just teach you about how to improve your chances of success in your next IVF cycle - it will also teach you a lot of valuable life lessons! Whenever you step outside your comfort zone and try something new like IVF, failure is always a possibility. However, the fear of failure can be a much bigger burden to carry - and even if you fail, you will have peace of mind that you did your best.

Each failure brings you one step closer to reaching your goals - and also allows you to put your life in perspective. Life does not end just because the cycle failed - and a failed cycle does not mean you are a failure either ! Each failure makes you stronger, bigger and better and making mistakes is not a big deal as long as you learn from them and avoid repeating them. No matter how often you fail, you are not a failure as long as you don't give up - and each time you fail, your fear of failure becomes smaller, which allows you to take on even bigger challenges.

Overall, IVF success rates are about the same on the average for second attempts as compared to the first IVF tries. Good IVF doctors can learn a lot from the failed IVF cycle, and they can intelligently use this information to make adjustments to maximize success for the second in vitro fertilization attempt. They understand that while they cannot control the outcome, they can control the process.