Three failed IVF cycles. Same protocol. Same outcome. Different problem.

When your fertility specialist says “unexplained failure” or “let’s try another cycle,” you’re left without answers. And repeating the same process without investigating why it failed doesn’t change the outcome—it just extends the exhaustion.

Here are three overlooked factors that could be blocking your IVF success—and what to do about them.

1. Sperm DNA Fragmentation (Even When the Semen Analysis Is Normal)

Standard semen analysis checks count, motility, and morphology. What it doesn’t check: DNA integrity inside the sperm.

High sperm DNA fragmentation means the genetic material is damaged—leading to poor embryo quality, failed implantation, or early miscarriage. Your partner’s sperm report may say “normal,” but at a molecular level, it’s compromised.

Signs you might have this:

• Fertilization happens, but embryos stop developing by day 3-5
• Multiple biochemical pregnancies (positive test, then immediate loss)
• Male partner has lifestyle factors: smoking, high stress, poor sleep, or obesity

How to investigate:

Request a sperm DNA fragmentation (DFI) test. In India, this is available at select fertility centers in metro cities—ask if your clinic offers it or can refer you.

If DFI levels are high, targeted interventions work: antioxidant therapy (CoQ10, vitamin E, zinc), lifestyle modifications, or surgical sperm retrieval in severe cases. Studies show this can improve fertilization and pregnancy rates significantly.

2. Chronic Inflammation No One Tested For

Your uterus may look structurally perfect on scans, but biochemically, it could be creating an environment that rejects embryos.

Chronic inflammation—from undiagnosed thyroid dysfunction, insulin resistance, or autoimmune activity—interferes with implantation. Your body might be fighting a low-grade immune response you don’t even know about.

Clinical indicators:

• Recurrent implantation failure despite good-quality embryos
• Elevated inflammatory markers (CRP, homocysteine) that weren’t routinely checked
• History of joint pain, fatigue, PCOS, or digestive issues dismissed as “stress”

Next steps:

Before your next cycle, ask for comprehensive inflammatory and autoimmune panels:

• Thyroid function (TSH, T3, T4, TPO antibodies)
• Insulin resistance markers (fasting insulin, HbA1c)
• Inflammatory markers (CRP, homocysteine)
• Autoimmune screening (ANA, antiphospholipid antibodies)

Managing inflammation through diet, supplements (omega-3, vitamin D), or medication can shift your uterine environment from rejection to receptivity. One patient with three failed cycles corrected subclinical hypothyroidism and insulin resistance—her fourth cycle resulted in successful implantation.

3. “Silent Endometriosis”—The Disease You Don’t Feel

You don’t have painful periods. You’ve never heard you might have endometriosis. So it never came up in your fertility workup.

But endometriosis doesn’t always announce itself with debilitating cramps. Silent endometriosis—minimal or no symptoms—can still destroy fertility outcomes. Even Stage 1 or 2 endo, often dismissed as “mild,” significantly reduces IVF success rates.

Why it matters:

Endometriosis creates inflammatory mediators (cytokines, prostaglandins) that:

• Alter immune function in the pelvic cavity
• Damage egg quality before retrieval
• Disrupt embryo implantation even when embryos are chromosomally normal
• Reduce ovarian response to stimulation

This isn’t about pain severity—it’s about biochemical disruption. The inflammation from endo affects your eggs, your uterine lining, and your immune response during the critical implantation window.

How to recognize it:

• No endometriosis diagnosis, but unexplained infertility
• Ovarian reserve is decent, but egg/embryo quality is consistently poor
• History of ovarian cysts (even if resolved), painful intercourse, or irregular spotting
• Family history of endometriosis or autoimmune conditions

Diagnostic pathway:

Diagnostic laparoscopy is the only definitive way to diagnose endometriosis. Scans and blood tests can suggest it, but they miss subtle disease.

In India, this may require referral to a surgical fertility specialist; waiting periods and costs vary by city and hospital. If endometriosis is confirmed, treatment—surgical excision or medical management—before IVF can improve implantation rates by addressing the underlying inflammatory environment.

Don’t just keep cycling. Clear the underlying issue first.

Why “Unexplained Failure” Isn’t Good Enough

IVF is physically, emotionally, and financially exhausting. More cycles without investigation won’t fix a hidden problem.

If you’ve had one or more failed cycles with good embryos, pause. Run tests your clinic may not offer by default. Question “unexplained” diagnoses. Get second opinions from fertility specialists who focus on recurrent implantation failure.

Success isn’t about trying harder—it’s about trying smarter with precision diagnostics.

What to Ask Your Fertility Specialist Before Your Next Cycle

• ✓ What changed between my last failed cycle and this protocol—or are we repeating the same approach?
• ✓ Should we test sperm DNA fragmentation, even if semen analysis was normal?
• ✓ Have we ruled out chronic inflammation, thyroid dysfunction, insulin resistance, or autoimmune factors?
• ✓ Could silent endometriosis be affecting my results? What’s the diagnostic pathway if we suspect it?
• ✓ Which of these three factors is most likely given my specific case history?

Push for answers. Your fertility journey deserves precision—not repetition.

Frequently Asked Questions

Can endometriosis cause IVF failure even without painful periods?

Yes. Silent endometriosis (minimal symptoms) still creates inflammatory mediators that damage egg quality and disrupt implantation, even in Stage 1-2 disease.

How accurate is sperm DNA fragmentation testing?

DFI testing is highly predictive of embryo development failure and miscarriage risk. It’s more informative than standard semen analysis for recurrent IVF failure.

Are inflammatory markers routinely checked before IVF?

No. Most protocols focus on ovarian reserve and uterine structure. You need to specifically request comprehensive inflammatory and autoimmune panels.

Is diagnostic laparoscopy covered by insurance in India?

Coverage varies. Check with your insurer. Many patients pay out-of-pocket; costs range depending on hospital and surgeon expertise.

About Dr. Vivek Salunke