What Should You Ask Your Clinic Before Your Next IVF Cycle?

Evidence-based · Written by Dr. Lejla Fazlicic, D.Ac, L.Ac · All key claims cited to peer-reviewed research

Most follow-up appointments are spent on the final number. The shape of the cascade is more informative, and your clinic already has it.

Working out which of those questions apply to your history — and which answers should change the next plan — is the hard part to do alone.

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Before anything else: a disappointing cycle is not a verdict on you, and going into a follow-up appointment with a list is not being difficult. Most people leave that appointment with less information than they arrived hoping for, not because anyone withheld it but because twenty minutes disappears quickly and nobody knows what to ask. This page is so you know.

Why does the drop-off point matter more than the final number?

Because "we got no blastocysts" describes six different situations, and they lead to different conversations.

Ten eggs retrieved and three mature is a maturation question, which points at the trigger and the stimulation protocol. Ten mature and two fertilised is a fertilisation question, which points at the sperm and the insemination method. Ten fertilised and none reaching blastocyst is a development question. Six blastocysts and none euploid is a chromosome question, and largely an age question. All four end with a low number and none of them has the same answer.

IVF laboratories do measure this. The ESHRE and Alpha consensus on laboratory performance indicators defines competency and benchmark values across 19 separate indicators — including fertilisation and embryo development — so that a laboratory can tell whether a given result sits inside its expected range or outside it (ESHRE SIG Embryology and Alpha Scientists, 2017). Your clinic holds its own figures. You are entitled to ask how your cycle compared with them.

The cascade, and what to ask at each stage

Where a cycle falls away, what it points toward, and the question that opens the conversation

Stage	If the drop happened here	Ask
Eggs retrieved vs follicles seen	Points toward the trigger, timing, or a retrieval difficulty	"How many follicles were measurable, and how many eggs did we get? Was anything unusual about the trigger or the retrieval?"
Mature (MII) vs retrieved	Points toward trigger type and timing, or stimulation protocol	"How many were mature? Is that in the range you would expect for my protocol, and would you change the trigger next time?"
Fertilised vs mature	Points toward sperm function and the insemination method	"What was the fertilisation rate, and how does it compare with your usual? Was conventional IVF or ICSI used, and why?"
Day 3 vs fertilised	Early cleavage. Often uninformative alone, but worth having	"How many were still dividing, and what were the cell counts and fragmentation?"
Blastocyst vs fertilised	The genome-activation and metabolic window	"Did any compact on Day 4? Were embryos cultured through Day 6, and Day 7 if that is your practice?"
Euploid vs biopsied	Largely chromosome risk, which tracks with egg age	"How many were tested, how many euploid, and how does that compare with expected rates for my age?"
Implantation after transfer	The least explained step in the whole process	"Was the transfer straightforward? Is there any reason to assess the uterine cavity or the timing before the next one?"

Take that table to the appointment and fill it in as you go. A completed column of numbers is worth more than any explanation you will be given without one.

What if the drop was at fertilisation?

This is where the most common follow-up question arises — should we have used ICSI? — and there is a proper answer to it.

An open-label randomised trial assigned 1,064 couples, in whom the male partner had normal total sperm count and motility, to either ICSI or conventional IVF. Live birth occurred in 35% of the ICSI group and 31% of the conventional IVF group — an absolute difference of 3.4% with a confidence interval running from −2.4 to 9.2, not statistically significant. Fertilisation failure occurred in 5% of ICSI cycles and 6% of conventional cycles, also not significantly different (Dang et al., 2021).

So where the sperm parameters are normal, ICSI is not a fix waiting to be applied, and a clinic that declines to switch is not being complacent. Where there is a male factor, the calculation is different — which is exactly why the question to ask is not "can we do ICSI next time" but "given his parameters, what is the case for changing the method?"

If fertilisation was poor with normal-looking sperm, it is also reasonable to ask whether a repeat semen analysis is worth doing, and whether a reproductive urology referral is indicated. The male side of this is covered in what does he actually have to give up before IVF? and sperm DNA fragmentation and IVF failure.

What if the drop was between Day 3 and blastocyst?

First, check the arithmetic before you read anything into it, because this is the stage where expectations are most often wrong.

In a series of 28,959 fresh mature eggs from 2,031 patients, the mean number of mature eggs needed to produce one blastocyst was 2.2 at ages 18–34, 2.5 at 34–37, 2.9 at 38–40, and 3.9 at 41–42 (Murugappan et al., 2025). If you were 39 with six mature eggs, the arithmetic predicted roughly two blastocysts. Getting one is inside normal variation, not a signal.

Second, resist the conclusion that the embryos must all have been abnormal. In a study of thirty good-quality Day 3 embryos cultured on and analysed genetically, eighteen arrested and twelve became blastocysts — and of the nineteen that were euploid, twelve sat in the arrested group and seven in the blastocyst group, a difference that was not statistically significant (Orvieto et al., 2022). Chromosome number alone did not separate them.

Worth asking here: did any embryos compact on Day 4, or did they stop before that? Were any slow rather than definitively arrested? And was culture continued through Day 6? Day 6 euploid blastocysts do perform less well than Day 5 — implantation 48.3% versus 68.8% and live birth 40.4% versus 63.7% in one series of single frozen transfers — but the authors concluded that Day 6 transfer still yields acceptable outcomes (Lang et al., 2025). A slow embryo is not a discarded one. The mechanism behind this whole stage is in why do embryos arrest between Day 3 and Day 5?

What if there were blastocysts but none were euploid?

This is the stage where age does most of the explaining, and where knowing the expected numbers changes how you read your result.

A review of 15,169 consecutive trophectoderm biopsies mapped aneuploidy against the age of the female partner. The figure most useful to you is not the aneuploidy rate but the no euploid embryo rate — the chance that an entire cohort yields nothing transferable:

Probability of having no euploid embryo in the cohort, by age — Franasiak et al., 2014

Age	Chance of no euploid embryo
26–37	2–6%
42	33%
44	53%

Two further findings from the same dataset are worth carrying into the conversation. Aneuploidy rose predictably after age 26 — but it was also above 40% in women aged 23 and under, so it is not a simple line. And among aneuploid biopsies, 64% involved a single chromosome, 20% two, and 16% three or more, with complexity increasing with age (Franasiak et al., 2014).

What to ask: how many blastocysts were biopsied, how many were euploid, and how that compares with the clinic's expected rate for your age. If the answer is close to expected, the cycle told you about arithmetic rather than about a problem — and the useful question becomes how many eggs a future cycle would need, not what went wrong in this one.

What if everything looked fine and it still did not work?

Then you are in the least-explained part of the process, and honesty about that is more useful than a theory.

A euploid blastocyst transferred into a receptive uterus still fails a substantial proportion of the time, and no test currently available reliably predicts which one will. This is the point at which add-ons get sold, and it is worth asking of any proposed extra: what is the evidence that this improves live birth, and what would you expect it to change for me specifically?

Reasonable questions at this stage concern the uterine cavity, the transfer itself, the endometrial preparation protocol, and whether anything about the timing would be done differently. Reasonable answers include "we do not know." The wider version of this conversation is in why did my IVF fail when everything looked normal?

What should you ask about the laboratory?

Not as an accusation. As context for your own numbers.

The consensus on laboratory performance indicators exists precisely so that clinics can compare their results against defined competency and benchmark values. Three fair questions: how did our fertilisation and blastocyst development rates compare with your laboratory's usual figures for patients like us; was anything unusual noted during the culture period; and what blastocyst conversion would you have expected from a cohort of this size and age.

A clinic that answers those readily is telling you something good. A clinic that cannot is telling you something too.

What should you ask about him?

The male side is the most common gap in a follow-up appointment, and it is usually a gap of omission rather than intent.

Worth asking: is a repeat semen analysis indicated; would a reproductive urology referral be appropriate given the fertilisation or embryo development pattern; is there anything in his history — varicocele, fever or illness, medications, testosterone or anabolic steroid use, occupational heat — that should be assessed before the next cycle. Sperm produced for a retrieval three months from now is already forming: the measured figure is a mean of 64 days from start to ejaculate, range 42 to 76 (Misell et al., 2006). If something is going to change on his side, the window opens at the appointment, not the month before.

What the evidence does not show

• That the drop-off stage identifies a cause. It narrows the conversation. It does not diagnose anything on its own.
• That ICSI improves live birth when sperm parameters are normal. The randomised trial found 35% versus 31%, not significant, with equivalent fertilisation failure rates.
• That failing to reach blastocyst means the embryos were abnormal. Euploid embryos arrest, and in the one study that tested it directly they arrested as often as they progressed.
• That one cycle predicts the next. Each retrieval produces a different cohort, and with small numbers chance moves the result a long way.
• That any add-on reliably improves live birth. Ask for the evidence on each one specifically, and treat "some patients find it helps" as an answer that is not about evidence.
• That a difficult cycle means you did something wrong. Nothing in this literature identifies a patient behaviour that determines where a cohort falls away.

What we do with this

1. Request the full numbers in writing before the appointment. Follicles, eggs, mature, fertilised, Day 3, Day 5 and 6, biopsied, euploid. Ask for them by email so you are not writing them down while absorbing them.
2. Identify the single largest drop before you go in. That one observation determines which half of the conversation is worth having.
3. Ask how your numbers compare with the clinic's expected range for your age and cohort size — not with national averages, which will not match your situation.
4. Ask the male-factor question explicitly, because it is the one most likely to go unasked, and the one with the longest lead time.
5. For every proposed change or add-on, ask what it is expected to change and what the evidence is. Both halves.
6. Write down what is still uncertain and let it be uncertain. "We do not know" is a legitimate answer and a more trustworthy one than a confident story.

You cannot make a cycle work by asking better questions. You can make sure the next decision is based on what actually happened rather than on the number you remember most.

Related reading

• Why do embryos arrest between Day 3 and Day 5?
• Why did my IVF fail when everything looked normal?
• Was the failed cycle my fault?
• How should you actually prepare for IVF?
• What does he actually have to give up before IVF?
• Sperm DNA fragmentation and IVF failure
• What nobody can tell you yet about preparing for IVF
• The research library

Frequently asked questions

What should I ask my clinic after a failed IVF cycle?

Start with one question: where did the largest drop-off happen? Ask for the full cascade in writing — follicles, eggs retrieved, mature eggs, normally fertilised, still dividing on Day 3, blastocysts on Day 5 and 6, embryos biopsied and euploid. The stage where the numbers fell away determines which conversation is worth having, because a maturation problem, a fertilisation problem, a development problem and a chromosome problem all end in a low final number and none has the same answer.

Should we have used ICSI instead of conventional IVF?

Where the male partner has normal total sperm count and motility, probably not. An open-label randomised trial of 1,064 couples found live birth in 35% of ICSI cycles versus 31% of conventional IVF cycles — an absolute difference of 3.4% with a confidence interval crossing zero — and fertilisation failure in 5% versus 6%, also not significantly different. Where there is a male factor the calculation changes, which is why the question to ask is what the case for switching is given his specific parameters.

What is a normal number of eggs to get a blastocyst?

It depends mostly on age. In a series of 28,959 fresh mature eggs, the mean number of mature eggs needed per blastocyst was 2.2 at ages 18 to 34, 2.5 at 34 to 37, 2.9 at 38 to 40, and 3.9 at 41 to 42. Work out what your own cohort predicted before reading anything into the result — with small numbers, chance alone moves the final figure substantially, so one or three blastocysts where the arithmetic predicted two is not a signal.

What are the chances of having no euploid embryos?

It rises sharply with age. In a review of 15,169 trophectoderm biopsies, the chance of an entire cohort containing no euploid embryo was 2 to 6% between ages 26 and 37, rising to 33% at age 42 and 53% at age 44. Aneuploidy increased predictably after age 26, though it was also above 40% in women aged 23 and under. Ask how your euploidy rate compared with your clinic's expected rate for your age.

Can a slow-growing embryo still work?

Yes, at lower rates. In a study of single frozen euploid transfers, Day 5 blastocysts gave higher implantation (68.8% versus 48.3%) and live birth (63.7% versus 40.4%) than Day 6 blastocysts — but the authors concluded Day 6 transfer still yields acceptable outcomes. It is worth asking whether your clinic cultured embryos through Day 6, and Day 7 where that is their practice, and whether any embryos were slow rather than definitively arrested.

Should we ask about the laboratory?

It is a fair question when framed as context rather than accusation. The ESHRE and Alpha consensus on laboratory performance indicators defines competency and benchmark values across 19 indicators precisely so laboratories can compare their results against expected ranges. Three reasonable questions: how our fertilisation and blastocyst rates compared with the laboratory's usual figures for similar patients, whether anything unusual was noted during culture, and what blastocyst conversion would have been expected from a cohort of our size and age.

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This article is educational and reflects associations reported in the scientific literature. It is not medical advice, not a diagnosis, and not a way to interpret your own embryology report. As a Doctor of Acupuncture I offer lifestyle guidance that works alongside your physician and fertility clinic — I do not diagnose, interpret laboratory results, or prescribe. Decisions about protocol, fertilisation method, testing and treatment belong with your reproductive endocrinologist and embryology team.

References

1. ESHRE Special Interest Group of Embryology and Alpha Scientists in Reproductive Medicine. The Vienna consensus: report of an expert meeting on the development of ART laboratory performance indicators. Reproductive BioMedicine Online. 2017;35(5):494–510. PMID 28784335
2. Dang VQ, Vuong LN, Luu TM, et al. Intracytoplasmic sperm injection versus conventional in-vitro fertilisation in couples with infertility in whom the male partner has normal total sperm count and motility: an open-label, randomised controlled trial. The Lancet. 2021;397(10284):1554–1563. PMID 33894833
3. Franasiak JM, Forman EJ, Hong KH, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertility and Sterility. 2014;101(3):656–663.e1. PMID 24355045
4. Murugappan G, et al. Clinical utilization and outcomes over eight consecutive years following oocyte cryopreservation. Journal of Assisted Reproduction and Genetics. 2025;42(2):413–421. PMID 39633145
5. Orvieto R, Jonish-Grossman A, Maydan SA, et al. Cleavage-stage human embryo arrest, is it embryo genetic composition or others? Reproductive Biology and Endocrinology. 2022;20(1):52. PMID 35300691
6. Lang J, Hong Y, Yang X, et al. Delayed blastulation and pregnancy outcomes in single frozen-thawed euploid blastocyst transfer. Frontiers in Endocrinology. 2025;16:1686274. PMID 41427036
7. Practice Committee of the American Society for Reproductive Medicine and Practice Committee of the Society for Assisted Reproductive Technology. Blastocyst culture and transfer in clinically assisted reproduction: a committee opinion. Fertility and Sterility. 2018;110(7):1246–1252. PMID 30503113
8. Misell LM, Holochwost D, Boban D, et al. A stable isotope-mass spectrometric method for measuring human spermatogenesis kinetics in vivo. Journal of Urology. 2006;175(1):242–246. PMID 16406920