We Did Two IVF Cycles, Both Failed, and the Doctor Never Really Explained Why — What Should I Ask Next?

Short answer: two unexplained failures is the point where you ask for a hysteroscopy, a full review of both embryology reports, and a conversation about PGT-A or ERA testing — these aren’t offered automatically in a standard first-round workup, so you may need to request them directly.

Why “unexplained” often isn’t actually unexplained

A failed cycle without a clear reason doesn’t necessarily mean there’s nothing to find — it often means the standard workup didn’t look at the right thing yet. PGT-A, sperm DNA fragmentation testing, ERA, EMMA/ALICE, and immunological testing are not part of a standard IVF workup — they’re specifically for cases like yours, after repeated failure, and typically have to be requested rather than happening by default.

The three things worth asking for directly

The embryology report from both cycles. Ask specifically for embryo grading, and whether the embryos were already tested with PGT-A. If they weren’t, chromosomal quality is a real unknown rather than a ruled-out cause. If they were tested and euploid (chromosomally normal) embryos still failed, that shifts the likely explanation toward the uterus or implantation rather than the embryo itself.

A hysteroscopy. This is regularly recommended after two failed cycles specifically to check for polyps, scarring, or chronic inflammation in the uterus — issues that don’t always show up on a standard ultrasound.

PGT-A or ERA, depending on your case. These check different things and are done in different cycles, so your clinic should explain why they’d recommend one over the other for you specifically:

PGT-A biopsies the embryo during an IVF cycle to check its chromosomes — relevant if embryo quality hasn’t already been ruled out.
ERA is a mock cycle with a biopsy at your usual transfer timing, checking whether the endometrium is receptive, pre-receptive, or post-receptive at that point. Studies cited by fertility clinics suggest 20-30% of patients with repeated failed transfers have a displaced implantation window — though independent evidence on how much ERA-guided timing actually improves outcomes is less settled, so treat it as one option to discuss, not a guaranteed fix.

There’s no single correct order — some clinics run PGT-A first on the assumption that embryo quality is the likelier issue; others, especially for patients under 38, often run ERA first. Ask your clinic which they’d choose and why, rather than assuming either is automatically the next step.

Other details worth having in hand

Progesterone level and endometrial thickness on each transfer day, and your TSH and vitamin D results if they were checked — these are the kind of specific data points a second opinion would want to review, and having them ready saves a round of back-and-forth if you do seek one.

Getting Started

Ask your current clinic for the embryology reports and a clear explanation of what they’d test next and why — and if the answers stay vague, a second opinion is a reasonable next step, not an overreaction. See verified IVF clinics in Spain, or ask our AI assistant to help think through which test might matter most for your specific case.

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Common questions

What tests come after two failed IVF cycles?

Commonly recommended next steps include a hysteroscopy (to check for polyps, scarring or chronic inflammation in the uterus), a full review of the embryology report from both cycles, and depending on the case, either PGT-A (embryo chromosome testing) or an ERA test (checks whether the endometrium is receptive at the expected transfer timing). None of these are part of a standard first-round IVF workup — they're specifically for repeated failure.

Should I ask for PGT-A or ERA testing first?

There's no single agreed order — it genuinely varies by clinic and patient. Some clinics prioritize PGT-A first, reasoning that chromosomal quality is the most likely issue with apparently good embryos. Others, especially for patients under 38, often run ERA before PGT-A. Ask your clinic directly which they'd do first for your case and why.

Is it normal not to get an explanation after a failed IVF cycle?

It's common, but not something to just accept. Roughly 20-30% of patients with repeated failed transfers are found to have a displaced implantation window on ERA testing, and hysteroscopy regularly finds polyps or inflammation that weren't previously visible — meaning explanations usually exist, they just require the right follow-up test to surface.

What should I bring to the conversation with my clinic?

Specifically ask for the embryology report from both cycles (embryo grading, whether PGT-A was already done), the progesterone level and endometrial thickness on each transfer day, and your TSH and vitamin D results if tested. These specific data points are what a second opinion or a new clinic would want to review first.