What are the symptoms of a failed implantation?

IVF involves placing an embryo fertilised and grown in a lab (the "in vitro" part) back into a woman's uterus. The goal is that it will successfully attach to the uterine wall and continue to develop into a healthy pregnancy. In the weeks following your embryo transfer, you may find yourself scrutinising every sensation in your body, hoping for a sign the treatment worked. Implantation is a crucial step in the process of pregnancy, but despite all efforts, embryos sometimes fail to implant. 

Unsuccessful implantation can be a challenging experience for women and couples hoping to conceive, but it's not the end of your IVF journey.

How common is implantation failure?  

It's not uncommon for IVF to result in implantation failure, but that doesn't make it any less disheartening. Unfortunately, IVF doesn’t work for around 5% of people during at least two consecutive attempts, and about 75% of these cases are due to implantation issues. If this happens three or more times, it's called "repeated implantation failure." 

It's understandable to feel discouraged when embryo implantation during IVF doesn't go as planned. Various factors can contribute to the lack of success, such as poor embryo quality, the age of the eggs, or embryo transfer technique. And people who undergo IVF may already have complications that make it more challenging to conceive. So, it's hard to determine the exact chances of a successful implantation or why it might have failed.

Symptoms and signs of failed implantation and early pregnancy loss

The only surefire way to know if implantation happened is by taking a pregnancy test, but some signs and symptoms might indicate that things didn’t go to plan. It’s worth remembering, however, that not everyone will experience all (or any) of these symptoms. 

Absence of pregnancy symptoms

It's normal to feel a little worried after IVF. However, some subtle signs can indicate a successful implantation. Light bleeding, stomach cramps, bloating, and breast tenderness are common early pregnancy symptoms. If you don't experience any of these symptoms a few weeks following your embryo transfer, it might mean that the process wasn't successful.

It's important to remember that sometimes a successful implantation doesn't show symptoms, so you shouldn't rely on them alone. It can also be hard to distinguish between signs of failed implantation and those that indicate successful implantation because they are very similar — just to make matters all the more confusing.

Delayed period

A failed implantation can result in a "chemical pregnancy", a type of pregnancy loss that happens very early on and occurs when the fertilised egg doesn't fully implant in the uterus. A chemical pregnancy can cause a missed or delayed period, and even a positive pregnancy test. Yet, the pregnancy won't be detectable when you go for an ultrasound scan. 

Mild cramping or spotting

You might notice some light spotting or cramping during the time of implantation. It can feel similar to the common symptoms of a normal menstrual cycle, so it could be hard to tell what's happening. If you experience cramping that feels like menstrual pain, it might be a sign of failed implantation. Cramping and spotting after a failed implantation is your body expelling the embryo after it failed to attach to the uterine wall.

Listen to your body and pay attention to any unusual sensations during this time. You should talk to your healthcare provider or fertility advisor for guidance if you notice any cramping or spotting. 

Negative pregnancy test

The best way to find out if an IVF cycle worked is to take a pregnancy test. The test looks for a hormone called human chorionic gonadotropin (hCG), dubbed the "pregnancy hormone." 

Your body produces hCG after the embryo implants in your uterus. If implantation is unsuccessful, the test won't detect any hCG and comes back negative. 

After your embryo transfer, it's important to wait a bit before taking the test, as even the best pregnancy tests may not accurately detect hCG levels in the early stages of pregnancy.

Your period arrives

Another telltale sign that implantation failed is if your period shows up. You might notice premenstrual symptoms like breast tenderness, bloating, and cramping, followed by menstrual flow. It's extra frustrating because sometimes these symptoms overlap with a successful implantation. 

Emotional disappointment

Discovering that implantation didn't happen can be incredibly difficult. Even if you do your best to keep expectations low, it's okay to feel disappointed when things don't go as planned. 

A failed IVF cycle can feel like pregnancy loss for many couples, and it's normal to feel a sense of grief. You might want to give your body and mental health time to process, heal, and reach out to friends, family, and professionals for emotional support. 

Failed fertility treatment can be a challenging experience, but you don't have to face it alone. If you need help figuring out where to start, reaching out to a counsellor can be a great first step. Many clinics offer the support of a dedicated counsellor (some clinics may offer this service for free, while others may charge a fee). 

Your clinic can connect you with support groups where you can connect with others who are going through similar experiences. The Human Fertility and Embryology Authority (HEFA) also has an extensive list of support groups and more advice on their emotional support page. Help is available; you don't have to go through this alone.

Consulting with a healthcare professional

When you're ready, speak to your doctor about whether to try again and your chances of conceiving. They may suggest different treatment options or ways to increase your chances of success. If implantation failure is the issue, there are ways to improve the chances of embryo transfer. 

If you've decided not to have more treatment or are unsure about what to do next, talk to your doctor about alternative options, such as surrogacy or adoption. 

It can be disappointing and upsetting when IVF doesn't work. However, other options are available, and your journey towards having a child doesn't have to end there. Sometimes, it takes a few attempts before IVF is successful, so don't lose hope. 

References

1. Bashiri, A., Halper, K. I., & Orvieto, R. (2018). Recurrent Implantation Failure-update overview on etiology, diagnosis, treatment and future directions. Reproductive Biology and Endocrinology, 16, 1-18. https://rbej.biomedcentral.com/articles/10.1186/s12958-018-0414-2 

2. (n.d.). Local Endometrial Trauma (Endometrial Scratch): A Treatment Strategy to Improve Implantation Rates (Scientific Impact Paper No. 54). Royal College of Obstetricians & Gynecologists. https://www.rcog.org.uk/guidance/browse-all-guidance/scientific-impact-papers/local-endometrial-trauma-endometrial-scratch-a-treatment-strategy-to-improve-implantation-rates-scientific-impact-paper-no-54/ 

3. (n.d.). Signs and symptoms of pregnancy. NHS. https://www.nhs.uk/pregnancy/trying-for-a-baby/signs-and-symptoms-of-pregnancy/ 

4. (n.d.). Chemical pregnancy. Tommy's. https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/types-of-miscarriage/chemical-pregnancy-information-and-support

5. Betz, D., & Fane, K. (2022). Human chorionic gonadotropin. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532950/