What questions should I ask after a failed frozen embryo transfer?

A failed frozen embryo transfer is never easy. It’s normal to feel discouraged or confused about what went wrong. But let’s be clear: one failed transfer does not mean your body can’t do this. It’s a moment to pause, ask the right questions, and reflect on whether anything could, or should, be done differently next time.

My name is Dr. Lucky Sekhon and I am a Reproductive Endocrinologist and Infertility physician based in New York. Through this blog, my Instagram account, and my upcoming book “The Lucky Egg”, I’ve made it my mission to help empower people to take control of their fertility journey with clinically grounded, and scientifically accurate, information. On my Instagram, I often put up a question box to give my followers the opportunity to ask me their fertility related questions. Every time I post one of these question boxes, I get a ton of really amazing questions, which I try to answer in my monthly newsletter. However, I recently received a question from one of my followers, which demanded a more comprehensive answer than would fit in an email:

“What questions should I ask my my doctor after my first failed embryo transfer?”

As an REI, I can’t over-emphasize how important it is to engage with your doctor when your fertility journey hits some turbulence, like that from a failed embryo transfer. There could be any number of reasons why an embryo transfer failed, and its important that you and your doctor talk through the various factors that might be in play. Understanding what these factors are and how they relate to embryo transfer success are really important in deciding how you proceed after a failed transfer. With that in mind, I’ve put together 11 thoughtful, high-yield questions that you should ask your doctor after a failed embryo transfer, and how each answer might inform your next steps.

1. How did my lining look before transfer?

Your endometrial lining is the soil in which your embryo needs to take root. We typically want it to measure at least 7mm, but I’ve seen pregnancies occur with slightly thinner linings. That said, if your lining was borderline and you’ve had prior uterine surgeries like a D&C or fibroid removal, it’s worth investigating whether scarring or adhesions are interfering with implantation.

Understanding how your lining is prepared for transfer, can help you appreciate its role in success. If you’ve had recurrent issues with thin lining despite standard protocols, it might be time to consider alternative approaches to endometrial preparation.

2. What was the prognosis for the embryo we transferred?

Ask about the embryo’s morphology grading and speed of development. These metrics give us insight into embryo potential. I go into the details of what morphology grading actually means, but in short, even “perfect” looking embryos aren’t guaranteed to implant, and “average” ones often do.

Also important to know: even PGT-normal embryos aren’t a guarantee. Sometimes failure has nothing to do with the embryo’s chromosomes and everything to do with how the embryo and uterus are communicating.

3. When was the last time we looked at my uterine cavity?

If you haven’t had a saline sonogram (SIS) or HSG within the last 6–12 months, it may be worth repeating. Polyps, fibroids, or intrauterine scarring can show up over time and interfere with implantation—even in patients with no symptoms and normal bleeding patterns.

4. Have my fallopian tubes ever been imaged?

This one gets overlooked all the time. Even though the tubes are bypassed during IVF, a condition called hydrosalpinx, a buildup of toxic fluid in a blocked tube, can leak into the uterine cavity and sabotage even the most promising embryo.

I’ve seen countless patients come to me for second opinions after multiple failed transfers, only to discover they had a dilated, fluid-filled tube no one ever looked for.

5. Could insulin resistance be playing a role?

Even without a formal PCOS diagnosis, insulin resistance can affect your hormone levels and disrupt the uterine environment. It’s often silent but can be picked up with a fasting insulin, glucose, and hemoglobin A1c. If present, it’s something that can be treated or managed before your next transfer.

6. Could I have endometriosis, even if I don’t have pain?

Yes. Endometriosis doesn’t always show up with classic symptoms like painful periods. It’s one of the most common, and underdiagnosed, reasons for unexplained implantation failure. If suspected, it may be worth discussing whether a laparoscopy or a short course of medication like Lupron could help before another transfer.

7. What type of protocol was used to prepare my lining?

Was it a natural or medicated cycle? Were estrogen and progesterone levels monitored, and how closely? I monitor these levels meticulously, especially progesterone. If it rises before we start supplementation, it can throw off the timing and close the window of implantation before the embryo even arrives.

8. Are there any nutritional deficiencies that need to be addressed?

Low iron, low vitamin D, or B12 deficiency can subtly affect implantation and hormone function. These are easily tested for, and just as easily corrected.

9. Are all of my chronic medical conditions well-managed?

Even conditions that seem unrelated, like asthma, autoimmune disease, or thyroid dysfunction, can interfere with implantation. I once had a patient with two failed euploid embryo transfers and chronically elevated eosinophils on her CBC. Once we treated her underlying inflammation and got her asthma under control with her pulmonologist’s help, her third transfer worked.

10. Am I taking any medications that could be interfering with success?

Some over-the-counter meds and even “natural” supplements can interfere with hormone levels or uterine receptivity. Bring a complete list to your follow-up appointment, this includes herbals, vitamins, and prescriptions.

11. Would my health benefit from weight loss or other lifestyle changes?

This is a sensitive but necessary conversation. Even modest weight loss (5–10% of body weight) can improve insulin sensitivity, hormone balance, and ultimately boost implantation odds. It’s not about blame, it’s about helping your body be in its most receptive state.

Making Sense of What Comes Next

A failed transfer doesn’t mean you’re broken. It doesn’t mean your next one won’t work. But it’s your cue to take a closer look, to ask the right questions and advocate for a plan that’s personalized, thorough, and evidence-based.

Sometimes, all the boxes have been checked and it still comes down to chance. Not all PGT-normal embryos are destined to work (more on that here). But by reflecting on what we know and ensuring nothing is being missed, we move forward smarter, not just hopeful, but empowered.

And if you want a deep dive into how to advocate for yourself, how to decipher what add-on tests are worth it (and which are hype), and how to keep going even when it feels impossible, I encourage you to check out my upcoming book, The Lucky Egg. I wrote this book to be an all-in-one companion to everyone who is going through their fertility journey, and part of that is knowing how to move forward when things don’t go as planned. If you’d like to stay up to date with all of my fertility and reproductive health content, please check out my Instagram, or subscribe to my newsletter. If you are in the NYC area and are interested in booking a consultation in my office, you can submit an appointment request here.