Unplanned exits and changing plans
While we always hope that fertility treatment will be a simple process that goes exactly according to plan, it’s useful to understand that this won’t always be the case. Knowing that less straightforward routes in IVF do occur may help you cope with unexpected results or diversions on your journey.
Rather than thinking of your IVF as a direct path from initial consultation to pregnancy, it may be useful to think of IVF as a roundabout with multiple different exits depending on the type of cycle you’re doing. You will always know the on-ramp but you might not always know the exit you'll use because that will depend on your responses to the medication and procedures used during IVF. The good news is that all of these exits can still lead to a pregnancy.
Unplanned exits can happen for different reasons during different phases of the IVF cycle
Before Stimulation
- Too many follicles before starting fertility medication
- Ovarian cysts were identified baseline scan
- Hormone levels that are outside the expected range
- Unexpected ovulation before treatment begins
- A new medical concern or illness that makes treatment unsafe
Stimulation phase
- Too few or too many follicles develop during the stimulation phase
- A hormone surge at the wrong part of the cycle
Egg collection
- Follicles are empty
- No suitable eggs are collected or there’s a problem accessing the ovaries to collect eggs
- The eggs that are collected aren’t mature
- Ovarian Hyperstimulation Syndrome (OHSS)
Ovarian Hyperstimulation Syndrome (OHSS)
Ovarian Hyperstimulation Syndrome (OHSS) is a condition where the follicle stimulating hormone injections that are used during the stimulation phase of IVF can cause the ovaries to produce too many follicles. This results in enlarged ovaries that release higher levels of hormones than is healthy.
OHSS affects about one in three women, but only around one in a hundred will get moderate or severe symptoms. It’s important to contact your IVF clinic if you experience any of these symptoms:
- abdominal bloating and discomfort
- nausea or vomiting
- dehydration, producing very little dark urine
- difficulty breathing, or sudden leg or chest pain
Fertilisation & Development
- No sperm is produced or a sperm sample can’t be used
- The eggs don’t fertilise
- Embryos don’t develop, or don’t continue to develop
Embryo transfer
- The uterine lining is too thick or not thick enough for transfer
- Embryos are too low quality/not suitable for transfer
- It is not possible to place the embryos into the uterus as planned
Treatment specific problems
- In a frozen cycle, the embryo might not survive the thaw process
- In a PGT cycle, the embryos might not survive biopsy or might be too low quality to send away for testing
Clinic staff need to provide patients with updates about how treatment is progressing, whether the news is positive or negative. Read more about the types of feedback you may receive during treatment.
An unplanned exit doesn’t mean that your treatment journey is over
It may just mean that you will have to take a different route. Lisa began her IVF journey with plans for a fresh embryo transfer cycle, but ended up taking an unplanned exit.
Lisa’s Story
My first cycle went well… until it didn’t! I responded well to the medication, had a very good egg pickup (12 eggs, 10 were mature, 8 fertilised, 5 embryos) and was getting excited about my embryo transfer. But on ultrasound my endometrial lining wasn’t thick enough and wasn’t growing. My doctor said we should freeze the embryos and do a frozen embryo transfer later.
I was initially devastated. But I talked a bit more with my partner and my doctor and decided I’d take a short break, let my body get back to normal, get a bit less stressed, and come back in 2 months for the frozen transfer. It was a good lesson that IVF doesn’t always go to plan, but sometimes you can make a new plan.
If your treatment takes an unexpected turn your doctor will discuss your options and suggest a change of route if one is available.