Waiting, interruptions and more waiting. That’s the life of an individual or couple trying to conceive with fertility challenges. Fun, right? If you’re about to start or you’ve just begun IUI or IVF you might be curious to know the common reasons your cycle might be cancelled and further extend that wait.
Or, you just had a cycle cancelled and you want to know if it was due to something common. Then read on.
First off, I’m so sorry if your cycle was cancelled. It’s heartbreaking to hear that news that ‘we need to stop.’ I’ve had it happen. It’s devastating. Second, it might be informative to learn that it’s not uncommon to have your first one cancelled. Third, for those of you who pay for medication out of pocket this cancellation may be expensive. Usually your cycle procedures are rolled over to a new round or you’re reimbursed but the fees associated with your medication you took may have gone down the drain. Again, I’m sorry if this is the case. Infertility really isn’t a fair playing field.
Now for some good news. When it comes to cancelling, the positive in this situation is you’ll likely move on to another cycle with more knowledge for how to have a successful next cycle. I know it’s hard to see that right now and there’s no need to rush to gain that perspective. Take good care of yourself first and foremost.
When you’re ready, here’s the list to ease your mind that you’re just joining a list of many others who have had their cycles cancelled and will move on to more treatment again.
Common reasons for IUI or IVF cancellation
These aren’t in any specific order.
Polyp. It’s not uncommon to have a polyp. They can be missed in the initial ultrasound or something seen in the beginning and monitored. This partly depends where the polyp(s) are located and how big they are. Sometimes you go through the cycle and need to have it removed after egg retrieval and before embryo transfer or IUI. The procedure is relatively fast and typically recovery is short. Sometimes you need to wait to start any treatment before it is removed.
Low response to medication. In your first medicated IUI or IVF round you will learn how your body responds to medication. You learn every time you have a round but the first can be most revealing. If you’re doing IVF and have gotten close to egg retrieval and the doctors just aren’t seeing enough follicles to proceed they may cancel and provide a whole new protocol for the next round and/or may suggest an IUI for this cycle instead. As disappointing as it may be, experiencing that can be very helpful for doing a new round because your protocol will change to give you a better chance for more follicles to grow. Likely it will be a higher dose and/or additional medication or a new one. But if this was your one and only chance, then it can be devastating and I’m so sorry if this is the case for you. I really am.
Already ovulated. If it’s confirmed you missed the window for the IUI to be successful, it may be cancelled. This is not usually applicable to IVF or some medicated IUI cycles where your ability to ovulate is highjacked by the medication but it can happen. In some cases with medicated IUI you might have the option to turn it into an egg retrieval instead.
Thyroid issues. It can be a big surprise to learn about having a thyroid issue. It will show up on a blood test. A common symptom is fatigue. Usually it is a relatively quick fix by going on medication and then proceeding to have your levels monitored and medication adjusted as needed. It can just take a bit of time to figure out which medication and what dosage. This would continue into your pregnancy and beyond most likely.
Cyst. There are a few types of ovarian cysts. They sound scary, but most aren’t a huge bother. Some can interrupt fertility but quite often they do not. They can sometimes form in response to the medication you’re taking for your IUI or IVF cycle. It just might be too big and too much of a risk to carry on so some need to have the fluid drained out or surgery before you move on. Others are just monitored and may shrink on their own.
Covid-19 or Covid-19 symptoms. Contracting Covid-19 or developing symptoms that are common with Covid-19 — e.g. a fever and cough — and even if you’ve had a negative Covid test may cause you to cancel your whole cycle. Check with your clinic policies and your contract. Your clinic probably discussed this with you upfront. In these Covid-19 times it’s even more challenging to go through fertility treatment.
Fibroid. These are benign (usually) tumour tissues and are very common. Most women will one get one or more over their lifetime and not necessarily know it. What matters is the type, size and location of the fibroid(s). When a troublesome fibroid is found they usually need to be removed before embryo transfer or IUI because they can cause bleeding and/or other issues. Usually you recover after 2 or 3 months and then can continue on.
Lining is not thick enough. This can happen when you’re all set for embryo transfer but your uterine lining isn’t thick enough or conducive to a successful stick. Most clinics want a 7mm or 8mm or higher. If you’re lower, your transfer may be cancelled.
OHSS risk is too high. For IVF, if the risk of severe OHSS is too high you might have your cycle canceled in the middle or near egg retrieval. Usually it’s due to very high levels of estrogen. It’s more likely to happen if you have too many good sized follicles and/or PCOS. You’d may be considered a high responder. It’s safer to cancel and start a new protocol than proceed and have severe OHSS if you can help it. In the next round you may have a different or lower dosage of stimulation medication.
Fluid in the uterus. This might require medication that will result in the cycle not being cancelled, but it might not have been noticed in time or treatable.
Finding endometriosis (endo). This is not a common reason to stop before IUI or an egg retrieval. Endo can cause a delay if it’s found for the first time or if there’s a flare up, ie inflammation before an embryo transfer. It’s tricky. There’s more understanding than there has ever been about endo and fertility but it was such a mystery for so long that having progress only means so much. Endo inflammation can flare up and then retreat and other times it’s worth it to cancel before transfer or IUI and have surgery to remove it.
That’s the end of the list but this does’t mean that your reason for cancellation isn’t common or valid. Those are just some common reasons for an IUI or IVF cancellation.
Positive perspective (ignore this if you’re not interested in another perspective, and that’s OK!). You might rather save the heartache, time and money by waiting to proceed when it’s the best chance for you to get that BFP — a Big Fat Positive pregnancy test. But when it’s your decision, you have every right to choose the option that’s right for you.
If you want more support or to learn more about questions to ask your doctor and what’s next, book a call with me. I’ve got your back.
May your IUI or IVF cycle be as smooth, comfortable and relaxing as possible and you have success getting pregnant and beyond.