IVF didn't work. What to look at before the next cycle.

Most often because the embryo could not implant, and less often because the cycle ended before a transfer.

The HFEA describes two kinds of failure. In the first, an embryo is transferred and does not implant. The commonest reason is the embryo itself, often a chromosome problem that you cannot see under a microscope. In the second, the cycle stops early: too few eggs, eggs that did not fertilise, or embryos that stopped growing. Each kind points somewhere different.

The whole cycle, in order: the stimulation, the eggs, the lab, the transfer, and tests for both of you.

Look at the drug chart and how your ovaries responded. Check how many eggs were mature, and how many fertilised with IVF or ICSI. Read how the embryos grew each day, and where they stopped. Then the transfer: fresh or frozen, which day, the lining. Finally, the gaps: a semen analysis that is years old, or a womb that was never checked, matters as much as any result.

Usually soon: the review can happen as soon as you feel ready, and the next step often starts after your next period.

Your body needs a period to reset, and you may need longer than that to grieve. Both are fine. But a long gap without a plan costs time, and time is part of the prognosis, especially over 35 or with low reserve. If you have frozen embryos, a frozen transfer may be possible in a following cycle once the review is done. [CONFIRM: Jananam's usual gap]

It depends on where the cycle stopped; the same plan again makes sense only if the file shows it was working.

Few eggs may call for a different stimulation, or collecting eggs over more than one round (dual stimulation). Eggs that did not fertilise may call for ICSI. Good embryos that fail more than once call for an implantation failure review: ESHRE recommends checking both partners' chromosomes (karyotype), and a hysteroscopy may be considered. Embryo testing (PGT) may be considered in selected cases, discussed with you. If the same problem keeps returning after changes, that is the stopping conversation.

Not by itself. An add-on should answer a question your file raises, not replace finding the cause.

After a failure, many couples are offered extras: a receptivity test, immune treatment, embryo glue, a scratch. The UK regulator rates most of them grey, amber, black or red for improving the chance of a baby. Before you pay for one, ask what the result would change.

If nobody has explained why the cycle failed, yes: a fresh read of the whole file is worth having.

A second opinion looks at what happened, not just what is next. We never name another clinic or say it got something wrong. We say what the file shows. Sometimes the answer is a different plan. Sometimes it is to stay where you are, with one change.