Two Failed Embryo Transfers: What It May Mean and What Comes Next

Two failed embryo transfers do not mean IVF has failed, but they may be a reason for a closer evaluation before another attempt. Additional testing can help identify uterine, embryo-related or medical factors that may be affecting implantation and determine whether any treatable issues should be addressed first.

Your fertility specialist can also help you understand how another transfer may affect your chances of success. When healthy embryos are available but carrying a pregnancy appears to be the primary challenge, gestational surrogacy may also become an option worth considering.

Two Failed Embryo Transfers Don’t Always Mean IVF Has Failed

Two failed embryo transfers can be discouraging, but they do not necessarily mean IVF will not work. Even good-quality embryos do not implant successfully with every transfer, and several factors can influence the outcome.

After two unsuccessful transfers, your fertility specialist may recommend looking more closely at your previous cycles before repeating the same approach. This can help identify factors worth addressing and determine whether testing, treatment changes or another transfer may be appropriate.

What Causes Two Failed Embryo Transfers?

Failed embryo transfers can be related to embryo quality, the uterine environment, hormonal timing or underlying medical conditions. In some cases, no clear cause is found even after a thorough evaluation.

Identifying possible contributing factors can help your fertility specialist determine whether testing or treatment changes may be appropriate before another transfer.

Embryo Factors

Chromosomal abnormalities, or aneuploidy, are a common reason embryos fail to implant or develop normally. An embryo can appear healthy under a microscope while still have chromosomal abnormalities.

Preimplantation genetic testing for aneuploidy (PGT-A) can provide information about the chromosome status of an embryo before transfer. Embryo development and laboratory factors, including culture conditions and freezing and thawing, can also influence outcomes.

Uterine Factors

Conditions affecting the uterus or endometrium can interfere with implantation. Your fertility specialist may evaluate for factors such as:

• Scar Tissue: Intrauterine adhesions can affect the uterine cavity and interfere with implantation.
• Adenomyosis or Severe Endometriosis: These conditions may be associated with lower implantation rates in some patients.
• Thin Endometrium: A persistently thin uterine lining may make successful implantation less likely.
• Uterine Abnormalities: Polyps, fibroids or congenital abnormalities may affect the uterine environment.

Medical Conditions

Certain medical conditions can also affect implantation or early pregnancy. Thyroid disease, poorly controlled diabetes and chronic endometritis may be considered during an evaluation after repeated unsuccessful transfers.

Autoimmune or clotting disorders may warrant additional evaluation in select patients based on their medical and pregnancy history. These factors are typically investigated when there is a specific clinical reason rather than as routine testing for every failed transfer.

Is Two Failed Transfers Considered Recurrent Implantation Failure?

Historically, clinics defined recurrent implantation failure (RIF) as three consecutive failed transfers with high-grade embryos. That standard is evolving as embryo selection technology improves.

Today, many reproductive endocrinologists evaluate for RIF after two failed transfers of euploid (chromosomally normal) embryos. Euploid embryos eliminate chromosomal status as the primary variable.

When two genetically normal embryos fail to implant, focusing investigation on the uterine environment becomes the logical priority. You do not need to wait for a third failure before requesting targeted diagnostics.

What Testing Is Recommended After Two Failed Embryo Transfers?

After two failed embryo transfers, additional testing may help identify treatable uterine or medical factors before another attempt. The evaluation your fertility specialist recommends will depend on your previous cycles, medical history and existing test results.

Imaging the Uterus

Imaging can identify structural conditions that may interfere with implantation. Common options include:

• Saline Sonogram: Uses saline and ultrasound to evaluate the uterine cavity for polyps, fibroids, scar tissue or other abnormalities.
• Hysteroscopy: Uses a small camera to examine the uterine cavity directly. Certain polyps, fibroids or adhesions may also be treated during the procedure.

Endometrial Evaluation

An endometrial biopsy may be recommended to evaluate the uterine lining for conditions such as chronic endometritis, which can typically be treated with antibiotics when identified.

Receptivity testing may also be discussed to evaluate embryo transfer timing. However, evidence supporting its routine use is mixed, so whether it is appropriate depends on your individual circumstances.

Medical Evaluation

Blood work may be used to identify medical or hormonal factors that could affect implantation or pregnancy. Your fertility specialist may evaluate:

• Thyroid Function
• Blood Sugar and Diabetes
• Hormone Levels
• Autoimmune or Clotting Disorders (when clinically appropriate)

Not every test is necessary after two failed transfers. Your fertility specialist can determine which evaluations are most relevant based on your previous treatment and medical history.

Should You Try a Third Embryo Transfer?

A third embryo transfer may make sense, but the decision should reflect what you learned from your previous attempts. Consider these factors with your fertility specialist:

• Untreated Uterine Issues: Did testing identify a condition that should be treated before another transfer?
• Age: How might your age, particularly the age of the eggs used to create your embryos, affect your chances of success?
• Remaining Embryos: How many embryos remain, and what is known about their quality or chromosome status?
• Financial Considerations: What would another transfer cost, and would another IVF cycle be needed if it is unsuccessful?
• Emotional Readiness: Do you feel prepared for another transfer and the uncertainty that comes with it?
• Physician Recommendations: Does your fertility specialist recommend another attempt or changes to your treatment plan?

There is no set number of failed transfers that determines what you should do next. Your test results, remaining embryos and previous treatment can help you and your fertility specialist decide whether a third transfer is a reasonable next step.

What Are the Success Rates After Two Failed Embryo Transfers?

A third embryo transfer can still be successful after two failed attempts. In one study of patients using frozen euploid embryos, live birth rates were 64.8% after the first transfer, 54.4% after the second and 54.1% after the third.

Across up to three transfers, the cumulative live birth rate reached 92.6%, while sustained implantation reached 95.2%. Cumulative success reflects outcomes across multiple attempts, while per-transfer success measures the chance from each individual transfer.

These results apply specifically to the patients studied and will not reflect everyone’s chances. Embryo characteristics, uterine health and other medical factors can affect live birth rates, and additional transfers may offer diminishing returns in some circumstances.

When Is It Time to Consider Surrogacy?

Gestational surrogacy may be worth discussing when healthy embryos can be created but carrying a pregnancy appears to be the primary barrier. A fertility specialist may recommend exploring surrogacy in situations such as:

• Repeated Implantation Failure: Good-quality or euploid embryos have repeatedly failed to implant despite further evaluation.
• Uterine Factor Infertility: Severe scarring, adenomyosis or other uterine conditions continue to interfere with implantation or pregnancy.
• Persistent Endometrial Issues: The uterine lining remains too thin or otherwise unsuitable for transfer despite treatment.
• Serious Health Conditions: Heart, kidney, autoimmune or other medical conditions may make pregnancy unsafe or worsen during pregnancy.

The number of failed transfers alone does not determine when to pursue surrogacy. The discussion becomes more relevant when your medical evaluation suggests that transferring another embryo to your uterus may not address the underlying problem.

Questions to Ask Before Choosing Another IVF Transfer or Surrogacy

Talking with your fertility specialist can help you understand whether another transfer or gestational surrogacy better addresses the challenges identified during your previous cycles. Consider asking:

The answers can give you a clearer picture of whether another transfer is medically reasonable or whether a different approach may be worth exploring.

Explore Whether Surrogacy Is the Right Next Step

After two failed embryo transfers, you may be wondering whether another attempt or a different path makes more sense. If carrying a pregnancy is the primary barrier, surrogacy may give you another way to continue building your family.

Connect with a surrogacy professional to learn what moving forward could look like for you.