When you're doing everything "right" — from the meds to the timing to getting those top-grade embryos — an IVF failure can feel like the ultimate betrayal. It's frustrating, heartbreaking, and confusing. If the embryo looked perfect in the lab, why didn’t it stick?

Here’s the truth: even the best-looking embryos can fail to implant. And it's not your fault. IVF is complex, and embryo quality is just one piece of a much bigger puzzle.

Let’s unpack the science behind why IVF can fail even when using good quality embryos, and what options exist if you’re facing this kind of setback.

woman discussing ivf failure with her rei

What is the success rate of IVF with good embryos?

Success rates depend on a few factors, like age, underlying health conditions, and how the embryo was created and transferred. But generally speaking, when using good quality embryos, according to the CDC, live birth rates per transfer hover around:

  • 41-43% for those under 35
  • 33-36% for those aged 35-37
  • 23-27% for those aged 38-40

So while a good embryo improves your chances, it’s not a guarantee. Even with perfect-looking blastocysts, implantation may not happen.

Why do good-quality embryos fail?

"Good quality" in the lab refers to how an embryo looks under a microscope — its shape, structure, and cell development. But appearance isn’t everything. An embryo might look textbook-perfect and still be missing something important, like normal chromosomes or proper metabolic function.

Here are some common reasons good embryos don’t lead to pregnancy:

1. Chromosomal abnormalities

Even high-grade embryos can carry genetic issues that stop them from implanting or developing. According to a 2007 study, nearly 70% of IVF embryos may have some form of chromosomal abnormality. These aren't always visible under a microscope.

2. Uterine environment

The uterus needs to be receptive — meaning, hormonally and structurally ready to let an embryo implant. Issues like polyps, fibroids, thin endometrial lining, or chronic inflammation can all interfere, even if the embryo itself is perfect. Igenomix's EMMA test (Endometrial Microbiome Metagenomic Analysis) can evaluate the balance of good and harmful bacteria in the endometrial lining, helping determine whether the uterine environment supports implantation.

3. Immune system and inflammation

Some research suggests that immune imbalances or inflammatory conditions, like endometriosis or autoimmune disorders, may play a role in repeated IVF failure. While more research is needed, it's something worth exploring if you've had multiple failures with good embryos.

4. Timing of transfer (embryo-endometrial asynchrony)

Implantation depends on a narrow window when the uterus is at its most receptive. If that window is missed — even by a day — implantation may not happen. Tools like the ERA test (Endometrial Receptivity Analysis) can help identify the best day for transfer. Personalized embryo transfer timing using ERA has shown improved implantation rates in patients with recurrent implantation failure, and nearly doubled the live birth rates.

5. Lifestyle and systemic health

“About 1 in 3 patients with recurrent implantation failure have a displaced WOI (window of implantation), meaning their receptive phase occurs earlier or later than expected. Adjusting transfer timing based on ERA can improve synchronization between the embryo and endometrium, thus increasing the chance of successful implantation.”

— Lauren Hurst

BA, BSN, RN, Medical Science Liaison, Igenomix

Factors like chronic stress, smoking, alcohol, high BMI, and unmanaged health conditions can subtly influence implantation and early pregnancy success.

disappointed woman holding a negative pregnancy test

Why would a healthy embryo not implant?

Implantation is one of the most mysterious stages of the fertility journey. Even a genetically normal, high-grade embryo can fail to implant if the environment isn't quite right. Here are a few of the most common reasons why:

  • Progesterone levels: This hormone is crucial for preparing the uterine lining. If it’s not at the right level before transfer, it could impact implantation.
  • Blood flow: Poor blood flow to the uterus can reduce receptivity.
  • Microbiome imbalance: Newer research, like that published in PMC, is exploring how vaginal and endometrial microbiomes impact IVF outcomes. EMMA testing offers a more personalized view of the microbial environment inside the uterus and whether antibiotic or probiotic treatment might help improve chances of implantation.
  • Silent endometritis: A chronic, often symptomless inflammation of the uterine lining. It can be diagnosed with tests like EMMA and ALICE through endometrial biopsy and treated with antibiotics.

Can a good grade embryo be genetically abnormal?

Yes. Embryo grading is based on looks, not genetics. A beautiful-looking blastocyst could still carry chromosomal abnormalities that prevent successful implantation or cause miscarriage.

This is where PGT-A testing (Preimplantation Genetic Testing for Aneuploidy) comes in. It screens embryos for chromosomal normalcy before transfer. It doesn’t guarantee success, but it helps reduce the risk of transferring embryos that are unlikely to implant or lead to a healthy pregnancy.

A study in PubMed found that even with good morphology, embryos may still be aneuploid (abnormal number of chromosomes) and that PGT-A improved outcomes in older patients or those with recurrent IVF failure.

woman giving herself an ivf injection

At what stage does IVF usually fail?

IVF can fail at several stages along the journey, and it varies from person to person. Sometimes, things don’t go as planned right after egg retrieval — the eggs might not fertilize successfully, especially if sperm quality is an issue or the lab conditions aren’t quite right.

Other times, fertilization happens just fine, but the embryos may not continue developing as expected. It’s not uncommon for embryos to arrest before reaching the blastocyst stage (usually around day 5), even if everything appeared to be progressing early on.

For many people who make it to the embryo transfer stage with good-quality or even PGT-A-tested embryos, failure tends to happen during implantation. This is the moment when the embryo attempts to attach to the uterine lining — and it’s one of the most unpredictable and poorly understood stages. Even when implantation happens, some pregnancies unfortunately end in early miscarriage.

So while the lab might give a thumbs-up on embryo quality, the real test often comes during implantation and those first few critical weeks after.

What can be done about failed IVF with good embryos?

If you’ve experienced IVF failure with high-quality embryos, know this: it doesn’t mean your body can’t carry a pregnancy. And it doesn’t mean your next cycle will end the same way.

Here are some steps that could get you some more answers:

1. Get a full uterine evaluation

Request a hysteroscopy or saline sonogram to check for polyps, scarring, or other uterine abnormalities. Consider an endometrial biopsy to rule out infection or inflammation.

2. Explore endometrial receptivity testing

Tests like ERA can assess whether the endometrial lining is receptive at the time of transfer. Timing matters — and a personalized approach can boost the chances of success.

3. Investigate the endometrial microbiome

EMMA testing evaluates the bacterial balance within the uterine lining, identifying potentially harmful bacteria that may be affecting implantation. Combined with ALICE (which screens for chronic endometritis), this can guide targeted treatment before the next transfer.

4. Review your embryo testing options

If you haven't done PGT-A or other genetic testing, talk to your doctor about whether it's right for your next cycle.

5. Check hormone levels and thyroid function

Hormones like progesterone, estrogen, TSH, and prolactin can all influence implantation and early pregnancy.

6. Consider immunological and thrombophilia screening

This is a bit controversial, some fertility clinics offer immune panels to check for factors like natural killer cell activity or autoimmune responses. If those pinpoint something, for some people, immune treatments can make a difference.

7. Prioritize your physical and mental health

IVF is physically draining and emotionally intense. Nutrition, movement, sleep, and mental health support all make a difference. Support groups, therapy, or acupuncture can help with stress and emotional recovery.

woman discussing her uterine health with her rei

When a “good embryo” isn’t the whole story

IVF isn’t just about making a great embryo. It’s about the full picture: your body, your hormones, your environment, and your mental wellbeing. Even a perfect-looking embryo needs the right conditions to become a pregnancy.

If your cycle failed despite using good embryos, you’re not alone — and it doesn’t mean it’ll happen again. What matters is continuing to ask questions, getting the right support, and exploring the options that feel right for your body and your path. There is hope after IVF failure. And there are steps you can take to understand your next move.

Tassia O'Callaghan is an experienced content writer and strategist, having written about a vast range of topics from chemical regulations to parenting, for brands like Peanut App Ltd, Scary Mommy, Tally Workspace, and Fertility Mapper. She's an advocate for realistic sustainable living, supporting small businesses (author of A-Z of Marketing for Small Businesses), and equity across all walks of life. Follow her on LinkedIn or TikTok, or see more of her work on Authory or her website.