IVF failure should be examined under 2 headings. First group consists of IVF failures despite acquisition of good quality embryos. Second group consists of women in which good quality embryos can not be obtained.

There is not too much to do for the group with poor embryo quality. Such couples should be screened for any chromosomal abnormality. Either male or female partner can be a carrier of balanced translocation. In these cases, 80% of embryos will be either abnormal or carrier. If ovarian reserve is good and numerous embryos can be obtained, PGD can be obtained to detect healthy embryos. Several methods have been applied to chromosomally normal patients with recurrent IVF failure, but none of them proved useful. Among these methods are cytoplasm transfer, co-cultures, embryo glue and assisted hatching. Recurrent poor quality embryos are usually result of poor quality oocytes. Rarely, poor quality sperm may be a result. Especially, sperms obtained by surgical procedures in azospermic patients may yield poor quality embryos.

Some other diagnostic procedures are required which fail to get pregnant despite good quality embryos. Hysteroscopy may be required to evaluate the uterine cavity. Myoma uteri, polyps or intrauterine adhesions may be diagnosed by hysteroscopy. Treatment of these pathologies is also possible at the time of hysteroscopy. Poor embryo transfer technique may also have an impact on IVF success. Progressive dilatation may be an option for women with recurrent difficult embryo transfers. If hydrosalpinx is detected, salpingectomy should be performed before another IVF attempt. If all the unsuccessful transfers were performed on days 2 and 3, a blastocyst transfer may prove useful. Any benefit of antiphospholipid anticoagulant screening or treatment with anticoagulants has not been shown. PGD does not increase clinical pregnancy rates in these patients.