How to Know If You’re Repeating the Same IVF Mistake
QUICK SCAN
• Protocol changes without biological changes often produce the same embryo and implantation outcomes
• Unexplained IVF failure is a clinical category, not a complete investigation
• Time pressure is real, but urgency is not a substitute for new information
• Inflammatory markers, thyroid optimization, ferritin, insulin stability, and male DNA integrity are not part of standard IVF pre-screening
• Repeating a cycle before the biology has changed is one of the most common patterns in recurrent IVF failure
KEY TAKEAWAY
Protocol optimization on top of unevaluated biology does not consistently change outcomes.
If your previous IVF cycle showed low egg maturity, significant Day 3 to Day 5 drop-off, poor blastocyst conversion, or failed implantation, and no systemic contributors were assessed, changing the medication protocol alone may not change the result. The question before the next cycle is not what to adjust. It is what has actually changed.
WHY REPEATING WITHOUT REVIEWING IS A PATTERN, NOT A PLAN
Most people do not go into IVF lightly. By the time a second or third cycle is being discussed, you have already done significant preparation, spent significant money, and absorbed significant emotional weight.
What we see repeatedly in the cases we review is this: the protocol changes, the biology does not. The medication is adjusted. The trigger is switched. The timing is refined. But the underlying factors that contributed to the failed cycle, including inflammation, thyroid function, iron sufficiency, metabolic stability, and male DNA integrity, were never assessed.
That is not a criticism of the clinic. Standard IVF protocols are designed for population-level outcomes. Functional evaluation is a different layer. When both are working together, you have a more complete picture.
3 PATTERNS WE SEE BEFORE A REPEAT CYCLE FAILS
1. The Protocol Changed. The Physiology Did Not.
Dose adjustments, trigger changes, and timing shifts are legitimate clinical decisions. But if the previous cycle showed any of the following, and no systemic contributors were assessed, the underlying biology is likely unchanged:
• Low egg maturity at retrieval
• Significant Day 3 to Day 5 embryo drop-off
• Poor blastocyst conversion rate
• Failed implantation with a viable embryo
From a functional fertility perspective, we look at inflammatory markers, thyroid optimization, ferritin adequacy, insulin stability, and male DNA integrity. These are not part of standard IVF pre-screening. If they were not reviewed after the failed cycle, the physiology is likely the same, even if the protocol has changed.
2. Unexplained Was Accepted Without Deeper Review
When a cycle is labeled unexplained, the next step is often to move quickly to another round. But unexplained means no obvious structural problem was found. It does not mean all biological systems were evaluated.
Ask whether the following were assessed:
• Was high-sensitivity C-reactive protein tested? (We want it below 1 mg/L.)
• Was thyroid function optimized, not just normal?
• Was ferritin adequate? (We look for 80 to 100 ng/mL. Many people come to us at 20 to 30 ng/mL.)
• Was blood sugar and insulin stability reviewed?
• Was sperm DNA fragmentation tested if there was embryo arrest or pregnancy loss?
If the answer to most of these is no, the investigation stops at the clinic layer. That is not wrong. It may be incomplete. If you have not gained new information since the last cycle, you are not making a new decision. You are making a faster version of the old one.
3. Urgency Moved Faster Than Interpretation
Age pressure is real. The instinct to keep moving is real. But urgency can create momentum that overrides analysis. If nothing about the internal environment has changed between cycles, the probability landscape is likely similar.
Egg development, inflammatory tone, metabolic stability, and regulatory balance do not shift automatically between cycles. Proceeding is not the problem. Proceeding without new information, while inflammation markers are off, thyroid is suboptimal, ferritin is low, or male DNA integrity has not been assessed, is where the pattern repeats.
Not sure what’s been fully evaluated? Download the Embryo Audit Checklist here to map your past cycles and labs, so you can see what has been reviewed and what may have been missed.
WHAT THE SCIENCE SAYS
The research here supports what we see in practice.
Thyroid function and IVF outcomes
TSH above 2.5 mIU/L is associated with reduced IVF success rates in multiple studies, despite falling within the conventional normal range. Thyroid optimization for fertility falls below the cutoff most clinics use. If thyroid was described as normal but TSH was not reviewed against fertility-specific thresholds, it may not have been optimized. Read more here.
Ferritin and egg quality
Ferritin below 50 ng/mL is associated with impaired egg development. Most labs flag deficiency at 12 to 15 ng/mL. We look for ferritin between 80 and 100 ng/mL. A result that reads normal on a standard lab report may still be insufficient for optimal fertility. Read more here.
Inflammation and implantation
Elevated inflammatory markers, including high-sensitivity CRP and homocysteine, are associated with poorer blastocyst development and implantation outcomes. Standard IVF pre-screening does not routinely include these. Inflammation can come from food sensitivities, gut dysbiosis, environmental toxin exposure, a dysregulated nervous system, or blood sugar instability. Read more here.
Sperm DNA fragmentation and embryo outcomes
Elevated DNA fragmentation is associated with lower blastocyst rates, impaired embryo development, and increased miscarriage risk. Sperm can appear normal on count, motility, and morphology while still carrying DNA damage that affects embryo progression from Day 3 onward. If there has been recurrent embryo arrest or pregnancy loss and DNA fragmentation was not tested, part of the picture is missing. (Evenson et al., Human Reproduction Update) Read more here.
Insulin and metabolic stability
Blood sugar dysregulation and insulin resistance are associated with poor egg quality and implantation failure, including in women without a formal PCOS diagnosis. Metabolic stability is reviewed as part of a complete functional fertility evaluation and is not routinely assessed in standard IVF pre-screening. Read more here.
WHAT A MORE COMPLETE REVIEW LOOKS LIKE BEFORE ANOTHER CYCLE
A standard pre-IVF workup is a starting point, not a complete picture. A more thorough review before repeating a cycle includes:
• High-sensitivity C-reactive protein (below 1)
• Thyroid panel reviewed against fertility-specific thresholds, not just lab normal ranges
• Ferritin reviewed against fertility-specific targets (80 to 100)
• Fasting insulin and blood sugar stability
• Sperm DNA fragmentation and oxidative stress markers if there has been embryo arrest, failed transfer, or pregnancy loss
• Full blood work review including nutrient sufficiency and inflammatory load
• Gut microbiome, vaginal microbiome, and toxin exposure history where relevant
• Nervous system patterns that may be driving hypervigilance and impacting biomarkers
When we work with couples at Fab Fertile, we look at both partners together. Most of the time, couples have already made some changes. Without targeted testing, those changes are generalized rather than directed. Knowing what is actually driving the pattern changes the approach completely. Book your functional fertility second opinion here.
KEY TAKEAWAYS
• Protocol changes without biological changes often produce the same outcome
• Unexplained IVF failure is frequently a gap in investigation, not a complete diagnosis
• Thyroid, ferritin, inflammation, insulin, and male DNA integrity are not routinely assessed before a repeat IVF cycle
• Urgency is not a substitute for new information
• Repeating a cycle is not the problem. Repeating it before the biology has been evaluated is where the pattern continues.
• A functional fertility review looks at both partners together, not in isolation
FAQ
If my clinic said everything looks fine, why would I need more testing?
Standard IVF pre-screening looks at a specific set of structural and hormonal markers. It does not routinely evaluate inflammatory load, thyroid optimization against fertility-specific thresholds, ferritin adequacy for egg development, insulin stability, or sperm DNA integrity. A normal result on standard testing does not mean all systems relevant to fertility have been assessed.
Is unexplained IVF failure actually a diagnosis?
Clinically, unexplained means no obvious structural cause was identified. It does not mean every biological contributor has been ruled out. In many of the cases we review, unexplained is followed by a protocol change rather than a deeper investigation. If the same pattern continues across cycles, it is worth asking what specifically has been evaluated and what has not.
Does this mean my clinic made a mistake?
Not necessarily. Clinics work within a standardized protocol designed for population-level outcomes. Functional fertility evaluation is a different and complementary layer. The goal is not to assign fault but to make sure the full picture has been reviewed before committing to another cycle.
We have already made diet and lifestyle changes. Isn’t that enough?
Most of the couples we work with have already made significant changes by the time they find us. Without testing, those changes are generalized rather than targeted. Knowing what is specifically driving poor outcomes, whether inflammation, thyroid function, ferritin, insulin, male DNA integrity, or something else, changes the approach from broad to precise.
How do I know if my thyroid has been optimized rather than just normalized?
Most labs flag TSH as normal anywhere up to 4.0 or 4.5 mIU/L. Fertility-specific research supports a TSH below 2.5 mIU/L for optimal reproductive outcomes. If your TSH was described as normal but was not reviewed against fertility thresholds, it may not have been optimized. This is one of the most common things we see missed in pre-IVF evaluations.
My partner’s semen analysis was normal. Should we still look at the male side?
A normal semen analysis measures count, motility, and morphology. It does not evaluate DNA fragmentation, oxidative stress, or mitochondrial function. If there has been recurrent embryo arrest, poor blastocyst conversion, failed transfers with viable embryos, or pregnancy loss, and DNA fragmentation has not been tested, the male side may not have been fully assessed.
What is the first step if I want to review my case before repeating another cycle?
Download the Embryo Audit Checklist here to map what has been assessed in your prior cycles and identify what may have been missed. If you want a full case review with your partner before your next step, the Functional Fertility Second Opinion is designed for exactly that.
TIMESTAMPS
• 00:00 Why persistence and repetition are not the same thing in IVF
• 01:00 What it means to deploy IVF at the right time and make informed decisions
• 02:00 Mistake 1: Protocol changes without biological changes and why outcomes often stay the same
• 03:00 Functional markers that are rarely assessed before a repeat cycle: inflammation, thyroid, ferritin, insulin, male DNA integrity
• 04:30 Mistake 2: Accepting unexplained IVF failure without deeper investigation
• 05:30 What ferritin, high-sensitivity CRP, and thyroid optimization actually mean for IVF outcomes
• 06:30 Mistake 3: How urgency and time pressure override interpretation and what to do instead
• 07:30 Embryo development as shared biology and when male factor needs to be revisited
• 08:30 The three questions to ask before committing to another IVF cycle
• 09:30 How the Embryo Audit Checklist and Functional Fertility Second Opinion can help you make an informed decision before your next round
NEXT STEP
Not sure what’s been fully evaluated? Download the free Embryo Audit Checklist to map your past cycles and labs so you can see what has been looked at and what may have been missed.
Or if you want support reviewing your case before repeating another cycle, the Functional Fertility Second Opinion is designed to look at your labs, IVF history, and full health picture alongside your partner before your next step.
ABOUT SARAH CLARK & FAB FERTILE
Sarah Clark is the founder of Fab Fertile and host of Get Pregnant Naturally, a podcast with over 1 million downloads. Our team works with couples navigating low AMH and failed IVF, reviewing functional lab results, including gut microbiome, food sensitivity, vaginal microbiome, nutrigenomics, HTMA, DUTCH, toxin testing, and bloodwork, alongside nervous system work, to help identify patterns that may not have been considered. We work alongside your medical team, not instead of them.
For over a decade, Sarah and the Fab Fertile team have reviewed hundreds of complex fertility cases, helping couples understand why outcomes stalled when standard testing appeared normal. Their approach emphasizes pattern recognition across both partners, functional testing, and informed collaboration with medical providers.
Fab Fertile provides education and lifestyle-based support alongside medical care. It does not replace diagnosis or treatment by a licensed physician.
TRANSCRIPT
[00:00:00] If you're preparing for another IVF cycle, this episode is important because sometimes what looks like persistence, your superpower is actually just repeating the same thing over and over again, expecting different results. So repetition without interpretation, leases, same outcome. So let's talk about the difference and really why this matters when you're doing IVF.
Let's go. So in this episode we're gonna talk about the three signs. You may be repeating the same IVF mistake. Why minor protocol tweaks don't always change the biological outcome and how to decide whether you're. Actually moving forward, or you're just in momentum without actual real change. I'm Sarah Clark, founder of Fav Fertile.
After my own fertility diagnosis and over a decade of reviewing complex IVF cases, one pattern shows up repeatedly. Cycles are often repeated before the biology has changed. Today we're gonna talk about how to recognize that. [00:01:00] Before you commit to another round, mistake number one, everything is a learning piece, but obviously with IVF, it can be very expensive learning when you are told to just go again, it's your age or you're told poor egg quality and you need to rush the next cycle.
So we need to. Deployed at the right time and make informed decisions. Most people do not go into IVF lightly. You've already done a lot of the prep work, and so now we need to understand what's happening and then make an informed adjustments using the team at the clinic, as well as listening to your own body and looking at things from a functional fertility perspective that the clinic is not gonna actually look at.
So it's very clear comment to hear, let's increase the dose. Change the trigger, tweak the timing. While some of those adjustments can be appropriate, if your previous cycle showed low egg maturity changes between day three and day five with the embryos resting. I've done a [00:02:00] podcast episode on embryo rest and why the timing matters, why that's important.
If it's not making it to blasis, if you've had a poor retrieval. Or the transfer, you had a beautiful embryo and then it does an implant or it implants, pregnancy loss. So all this piece, you have spent a lot of time and money and emotional investment, and then all the hormones you're on. This can be devastating, frustrating.
All of these motions all at once, and being able to figure out exactly what's happening and look at this in a logical manner. Sometimes it's hard to see our own stuff, right? So that's why we look at patterns here, to be able to help you make informed decisions. From a functional fertility perspective, we're looking at the inflammatory markers to talk to a lot about the high sensitivity.
See reactive protein. So you wanna make sure that's below one. So where's the inflammation coming in from? A whole host of different things. From food sensitivities, the environmental toxins to a dysregulated thyroid blood sugar nervous system. Just be careful [00:03:00] about chasing this thing around a circle, like where's it coming from?
In our fertile method, we will look at this in a target manner. High level patterns, what's being missed? Inflammatory markers, the thyroid optimization. People tell me over and over again that their thyroid is normal or that they've been told to take thyroid medication. Okay? We're not opposed to thyroid medication, but why is the thyroid low?
Or you're being told you've got low iron, so you're doing a whole bunch of iron infusions and supplementing with iron, but why is your iron low or your insulin is inable? Or the male partner where we got low, major high FSH. And there's issues with your partner's sperm and no one's even looked at the DNA fragmentation if you've had pregnancy loss.
I see this a lot where people continue to try and then we haven't really done a deep dive with the partner. Things are, have the low edge of normal for his semen or his motility morphology. No one's looked at the DNA fragmentation and 70 to 80 days for the lifecycle of the sperm. So we've gotta look at all this piece, even if it's covered by insurance, the IVF before we [00:04:00] deploy it, when the layers are not assessed.
Even if you're changing the protocol, if the biology IE, your health is not. Optimized, then the results may not be what you're looking for. Pattern number two or mistake number two is accepting that unexplained without a deeper review. Okay, wait. They're just telling you to move quickly. There's nothing that's really out of the ordinary here.
Let's just change the protocol. They're looking structurally, everything's fine. There's no polyps or fibroids, or the uterus looks beautiful and the embryo looks lovely. It's not implanting or the retrieval didn't work. The transfer didn't work, and it's not even making it. But instead of digging into why they're saying it's unexplained, we need to do more medication so you don't have a medication deficiency.
Something's going on from the egg and the sperm and your biology to implant. We just talked about was inflammation assessed. So this is like a broken record I feel like on some of these things. And again, multiple episodes [00:05:00] on all this piece. So definitely check out the one on the highest sensitivity. C reactive protein.
Was the thyroid optimizer, was it just normal? Was the ferritin adequate? Done many episodes on that. We like ferritin between 80 to 100. I see it regularly at 20 to 30. Or lower. Did we look at the blood sugar? Was your metabolic stability reviewed? The clinic is going to look at basic blood work, but what's the reason why this hasn't worked to begin with?
Their piece here is to push this with medication. We're not against it, but we need to deploy it at the right time. Unexplained. Being told just to move again, we wanna make sure we've got the right information. Looking at the data, what are the high level patterns? At each stage and unexplained is a lazy diagnosis and not where we need to just accept it.
If you're here listening to this, you already know something's missed. This is not your first kick at this. You have made all the 90 day [00:06:00] prep changes. You've kicked out the toxins, changed your diet, meditation, yoga, read the books. People tell me all the time. I already know you've already made a lot of these changes.
But now we need to look at this high level patterns, what is being missed? And a lot of times it might just be you're feeling hypervigilant, being able to trust the team around you and your body's, I don't feel safe. So the nervous system's on high alert, which then impacts all your other biomarkers. And then in the clinic situation, mistake number three.
Pattern number three is the urgency piece. So yes. We don't wanna be blind to your age, to a quality time. Pressure is real. Age pressure is real, but we need to be careful about momentum without analysis, we just keep rushing forward. Oh, they've told me I have to hurry that my fertility's falling off a cliff.
We need to move forward looking at the data [00:07:00] and being able to make informed decisions. Otherwise, you can just be brushing and there's a whole bunch of. Low hanging fruit that has been missed. If there's inflammation markers, if your blood sugar's unstable, your thyroid is wrong, at each stage, things may not work.
You'll be able to get a retrieval and then, but when you transfer, it doesn't implant. Or the embryos, the resting at day five. 'cause we forgot to look at the male partner or the aid quality. We've done the 90 day prep piece, but we've missed some other things where we're being told everything is normal.
The thyroid, the inflammation, your ferritin, all these things are off. We're not losing time. We are looking at your data to make an informed decision. Has your biology been optimized since the last attempt or did we just change the medication? See it all the time. Off we go, cycle after cycle, back to back.
Flying all over the world to go and do these things. PRPs and stem cells. When we haven't looked at the biology of you. The egg and the sperm [00:08:00] as well. Egg development, the inflammation side of things. Your nervous system, if nothing has changed about the internal environment, IE your biology, where this is gonna implant, that probably hasn't changed either.
So looking at the same results, it's not about not proceeding with IVF, it just means we need to be informed. And so making those informed decisions, which is empowering. And listening to your intuition. If you're on a podcast right now listening to this, you already know something's being missed and to be educated about your own health, bring in IVF when it's going to make sense.
Or you can't get pregnant naturally and say it spend tens of thousands of dollars on that. Some questions to ask, what did we learn from the last cycle? How far did you get? Did we look at your blood work? What has changed since then? If the answer is very little, do we really wanna go to another IVF is your signal to pause.
It's not to stop but to interpret high level patterns, what [00:09:00] has been missed, and to really have a team to be able to help you do that. 'cause sometimes we can't even see the forest for the trees because it's our own health. And your Chad GP Ting and trying to figure this out yourself. And what does the top REI say we just had GBT the wrong thing and it's important to look at this from a functional standpoint.
And then having a team looking at patterns and being able to help you interpret this and educate you to then make informed decisions. If you wanna have a structured way to evaluate whether your next IVF cycle is going to be different from your last one. We've got an embryo audit checklist. Go to the show notes.
You can download that, or you can go to hello@fabforall.ca, subject line checklist and I'll send it over to you before. Committing to another round. And then if you like our help reviewing your case after you've had a failed IVF, that's exactly what the functional fertility second opinion, or you've been trying for a couple years and you wanna have someone look at this before you go into IVF and start spending money there.
So we'll look at your cycles. We'll [00:10:00] look at your blood work. If you have blood work or testing, again, the high levels. So then you can see what are some things, 'cause it's not just one little piece, Ooh, I took the thyroid medication. That's it. No, this is like overall arching patterns and it's multifactorial and it's not just one little thing.
Just being careful about not doing this in a silo. The body all works together. The eczema, the bloating, the high stress you're under, it's all connected. It's not just one thing doesn't affect the other. We need to be very mindful about that, about looking at this in a targeted manner, repetition, doing Another IVFF is not always wrong is we need to make sure we're gonna do it in the right time.
Go to the show notes and click on book a functional fertility, second opinion with your partner. Load some testing, load some blood work, and we'll look at the high level patterns. Or send me a message. hello@fabfertile.ca, subject line fertile. Tell me a little bit about your situation and then we will get you and your partner on a call and we'll review and give you some options to help take care.
