What Could Go Wrong? The Not-So-Fun Side of Fertility Treatments

In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols pulls back the curtain on the often-unspoken truth: fertility treatments don’t always go as planned. From failed ovulation and sperm no-shows during IUI, to egg retrieval curveballs, fertilization failures, and embryo transfer nightmares in IVF—this episode covers the chaos that can catch patients off guard.

But don’t worry, this isn’t about fear—it’s about power through preparation. Dr. Amols shares real-world scenarios, explains the why behind the “what the heck just happened,” and helps you walk into treatment with eyes wide open and expectations aligned.

Because hope isn't blind optimism—it's knowing the risks and choosing to try anyway.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

Stay connected with us for updates and fertility tips – follow us on Facebook. For more resources and information, visit our website at www.NewDirectionFertility.com.

Have a question or a topic you'd like us to cover? We'd love to hear from you! Reach out to us at TBFT@NewDirectionFertility.com.

Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Chapters

• 1:23 What Could Go Wrong with Timed Intercourse Cycles
• 2:48 What Could Go Wrong with IUI Cycles
• 9:15 What Could Go Wrong with IVF Cycles

Transcript

0:01

Today we talk about something most clinics don't like to dwell on. What can actually go wrong during fertility treatments. I'm Dr. Mark Amols and this is Taco about Fertility Tuesday. Now my goal today is not to scare you. My goal is just to prepare you. Because not everything always goes perfect. We'll break this into three sections. The first section will be simple treatments like timed intercourse. The second part we will talk about artificial inseminations such as IUIs. And the third part we'll talk about IVF. If you ever heard me in some of the other podcasts you hear that I sometimes say setting expectations helps reduce the stress. And thats s what we'trying to do today. Help reduce the stress. Now don'worry Im, not here to scare you out of doing treatment. Im here to prepare you for reality, not fairy tales. Because sometimes fertility treatment isnt sunshine, rainbows and too pink lines. Sometimes its more like wait, how did that go wrong? So let's talk about it. What could go wrong with timed theco course cycles? Sometimes when you take the medication for ovulation induction cycles, the medication doesn't work. I'm talking about people with polycystic ovarian syndrome. Sometimes Clomid and letrozole are not enough to get you to ovulate. And so what can happen is you're taking this medication that maybe someone gave you and you're having time in intercourse between cycle days 10 and 20 and you think you're ovulating but you're not. And usually that will show up as not getting imme menses on time. And's one of the reasons that some people will check for ovulation just to make sure it's working. So if you take something like that and you don't get your period at the normal time, like 28 days from starting it, there's a possibility it didn't work. Now other things that can happen is sometimes it's hard to be able to have relations every other day for 10 days. Maybe the younger version of your husbands might be able to. But sometimes for other people can be hard. And sometimes they're not able to be able to have intercourse that night. The disappointment on your face will definitely not help it, I can assure you. They feel horrible. That pressure just mounts and makes it that much harder. It happens. And if it's happened before, when even not trying to get pregnant, sometimes it's worth getting a medication like Viagra. So that way if that happens, they can take that and be able to perform. Next up, IUI simple, right? Sperm meets egg, fall in love, make an embryo. Done. But no, let's break down what can really happen. Timing is everything. It's hard to believe, but even with monitoring, the egg might release early or maybe later than expected. And if the sperm arrives to the party too early or too late, potentially it could be a problem. Now, if you'heard me say before, early usually isn't that bad, but five days early, that could be a problem. So although it's not common, there are times that you can ovulate too early and that can make the, IUI not work. And it can be very disappointing, especially if you're using donor sperm, since that's the only sperm that's ever going to be seen by your eggs. And so we monitor to try to watch for this. But it's not perfect. If you are using donor sperm or have limited sperm and you do pre ovulate, it may be worth not even proceeding with that cycle because the sperm will get there too late. One thing you wouldn'expect is that when we wash the sperm, you would think, oh, well, if they start with a good number, we should have a good number afterwards. But sometimes after we watch the sperm, there's not as much left. And unfortunately, that sperm count of 40 million that he felt, that was supermanish. Like, unfortunately, there's just not enough sperm now to do the iui or it's so low, the chances go down tremendously. It's frustrating and there's nothing you can do about it. Unfortunately, sometimes the sperm is so poor quality that during the wash you can lose a lot of sperm. And just like with timed intercourse, there are times where men can sometimes have performance anxiety and they're not able to perform a sample. And as I mentioned earlier, the worst thing is telling them, how dare you not give sperm? And so that can make it harder. And so I want you to be prepared that this can happen. There is a lot of pressure. They know they need to give that sample and they just can't. Now, there are some things you can do. So I'm just taking a break, going home, maybe trying at home. I've literally told people, do whatever you have to, just get the sperm. Even though we tell them don't use lubricants and stuff like that, I say do whatever you have to, because some is better than non. Sometimes there can even be things in the sperm that we see that were not expected, such as the sperm count was much lower than we anticipated, not because of the wash, but just because he had a bad day. When that happens, guy's sperm fluctuates a lot. And so if you're one of those people where maybe it wasn't high, high numbers, but he was in a normal count, it's very possible in the day of the IUI it won't be enough. Another thing that can happen on the day of the IUI is that it is very difficult to place the catheter inside the uterus. You know, you would think it's just this open tube, just go put it in. But it doesn't work that way. It's actually quite difficult sometimes to place a catheter into certain uteres because the cervix can be quite circuitous. Maybe you have fibroids or maybe you have cervical cyst, and that's causing the canal to bend and curve in ways that are not easy to get the cathet in. And so sometimes it can take a long time for them to play the catheter in. It can sometimes even be quite uncomfortable. Now, the good news is, if they can get the catheter to where it needs to be past the cervix, chances are still the same no matter how long it took. But if they can never get it past that cervix, it's very possible they might have to cancel your IUI that day. Now, some places will just shoot the sperm into the cervix or into the vagina, but technically that didn't benefit you. You really need to get past the cervix to really improve the chances for an artificial insemination to work. Another thing that can go wrong is that sometimes you don't respond as well as you want it to. So you take the medication that give you a lot of medication, and you still make one F. That's pretty frustrating because you feel like, well, I can do that on my own. Why am I paying you to do this? If you're just giving me the same thing I get on my own. And that's not because they didn't want to make another egg. That's because sometimes some bodies don't respond as well. And so unfortunately, even though that intempt was to make more follicles, your body only made one. And again, it can be frustrating. Now, if your reason for doing the IUI is because there is male factor, well, then keep doing it, because that was really what you're fixing. But if it's unexplained and you're trying to make more eggs ob'viously, that could be very frustrating. The other issue is what if they do too good of a job? What if you make too many follicles and now they're concerned about having multiples? Well, in your mind. In my mind, when we were going through, we'like, yeah, fine, three babies, four babies, five babies. Hit me with them. My own'care I want to be pregnant. And I get that. But the thing is, that is not something that the doctor can be okay with. And so if there are too many follicles and it's too dangerous for you, they will cancel your cycle. Now, every clinic is different, and it doesn't make them wrong. There are some clinics, you have three ficles, they may cancel you. Others may before others, six. The point is, it's going to be in the hands of the doctor and what they feel is safe for you. If you're 44 and you got six follicles, I don't even care. You're going ahead, not worried at all. Because I know the chance of all those embryos being genetically normal or low. But if you're 22 and this is your first IUI cycle, I'm going to be very concerned, even if there's over three. And it's very frustrating when you went through a whole cycle and then all of a sudden they cancel it and you feel like, well, it's no fault of my own. You're the doctor. Why did you screw up and make so many eggs? Now, that can be very frustrating. One of the things that are so frustrating about it is that you didn't cause it. You listened to the doctor, you took the medication they prescribed, and yet now they're canceling your cycle. And if you're held financially responsible for it, it's even more frustrating because you're like, you did this, not me. You're the doctor. But the point is, it truly is no one's fault. It's just one of those the things that we can never know if someone's going to over respond. And our goal is always to be the safest for you. Now they do it two times in a row. Well, then, yeah, they're a bad doctor and you should really be upset. But one time it happens because sometimes people just over respond. Okay, so now we're diving into the big links here. Ivf, the most advanced, controlled and expensive, option. And yes, still not immune to failures. Now, similar to IUIs, you can potentially over respond or under respond, meaning your doctor tries to make lots of follicles, but you don't make any. And that can be frustrating because you're like, I took all this medicine. Sometimes it's your body that even though they give you the highest doses, that's all your body can do matter. In fact, there are months where you can go through IVF three times in a row. One month you might get 15 eggs. Next month 12 eggs. Then one month, only five eggs. It's possible your body can just all of a sudden not do as well. One month on the same token, your bit can over respond. And now all of a sudden you're at risk for ovarian hyperstimulation. We're not worried about multiples now because we can take those eggs out of you and we can put back an embryo individually. But the issue here is that now you've made too many and it actually could be dangerous for you. There are things we do to try to prevent that. But the point is, I want you to know these are things that can go wrong that we weren't planning for. One thing you may have never thought of is not being able to get, to the ovary. Sometimes the ovaries can be behind bowel. Sometimes they're stuck behind the uterus. And although they thought they could get to the ovary, at the time of surgery, they realized, I can't get to it. It's too difficult or too dangerous. They're not going after because they're not willing to try. It's because it's too dangerous for you. And so sometimes they'll actually not go to an ovary and pull the eggs, which seems crazy to think you went through all this and there was the possibility that they may not get to an ovary. I tend to try to tell patients if I think there's a troubled ovary. But the point is that it can happen. It's no one's fault. But it's very frustrating to wake up and find out only one ovary was retrieved because the other one they couldn't get to. And as you know how life goes, sometimes that's the best follicle OV you have where most of the eggs were on it. And now you're even more frustrated. If you ever listen to my episode, on fertilization, you'll know that sometimes they don't fertilize at all, that you have total feled fertilization and that they had to do rescue icy. That is absolutely a tough pill to swallow. What's even crazier is even with icsi, it can still happen. Now you're guaranteed a, sperm cana in the egg, but you can't guarantee it's going to fertilize. If the sperm is very poor quality, it's very possible that they may look like they're going to fertilize. But the next day you come in and none of them did or didn't fertilize normal. That brings me to the point of fertilization again, which is they can fertilize. But so weird is they didn't fertilize normal, which is strange because it means it underwent the division, it made the polar body, which tells you to fertilize. But then they tell you, oh, they were three PN'or 0Ps, which is an, abnormal fertilization. Which again, comes out of the left field thinking, wait, I had to just not only have fertilization, but it has to be perfect. It can be frustrating when that happens. Another thing that's shocking is even development can change. Sometimes you get told, oh, my goodness, you have 16 embryos and you're feeling great. It's definitely going to go fine, because you know that 50% percent of those embryos are going to make it to the blastocyst stage. At least that's what you're anticipating. And then all of a sudden they tell you none of them end up making to the full blastocyst stage. It can happen. It's not common, but it can happen. Just like they can go to PGT testing and all of them can come back abnormal. There are things, unfortunately, we can't predict, and these are some of those things that can happen. Now, obviously, if you've been through a cycle and your doctor has set up expectations, you may be knowing these things can happen, right? If you only make three eggs, there's a higher chance you can come away with no embryos or no normal embryos. But even when people have very good cycles, this stuff can still happen. It's just less likely. And just like with IUIs, we talked about how it can be difficult sometimes to do the iui. Well, now it's even worse because now you're talking about transfers. A tilted uterus, a stubborn cervix. All that can potentially be an issue of getting that catheter in the right spot. That's why sometimes we'll do what they're called, mock transfers. When we're doing the saline sono histogram, we can figure out there's problems there, and if there is, we can be prepared for it. But sometimes things can still be different. On the day of, you can get in there and all of a sudden the Catheter won't go past the cervix. What do you do? Do you force it? Or if you force it, you get in into bleeding and that can mess up the whole thing. Now, although it doesn't happen often, it can happen. Some clinics like ourselves will do what's called an AF afterload technique where we'll actually put the catherine first, make sure it's in the place it needs to be and then bring in the inner catheter to do the transfer. That way we don't have to worry about running any issues when doing the transfer. But I've been in other places where you bring in the cather with the embryo and you put it in and if you start struggling, that means that embryo is sitting out longer and longer. And so that's why a lot of places go to that afterload technique. It's important to understand it's not needed, it's not wrong that they do it a different way. It's just important to understand that there can sometimes be issues when trying to do the transfer. And sometimes those issues can be things as simple as the ultrasound is very difficult to see or your bladder is not very full, maybe there's a fibroid that's making it hard to see. The point is sometimes things we don't think about can later come up. And the one thing we all worry about is that when everything looks perfect and still no pregnancy, sometimes implantation can fail, sometimes the uterus isn't receptive, sometimes it's just bad luck, and sometimes we honestly don't know. Unfortunately, it is a possible outcome. The rarest thing though, and extremely rare, is going to be a lab error. The labs are very good and honestly I think labs are actually quite amazing. I know there's stories out there and there's news articless where labs have made mistakes, but when you really think about the sheer number of how many eggs and embryos that they work with, the fact that there are just so few mistakes is astounding. But it's also important to understand that we're dealing with humans. And yes, it is possible there can be a mix up, it is possible there can be contamination. It is possible when they're thawing an embryo, someone can have a mistake and something can go wrong. We are re all human and it can happen and hopefully clinics should be honest with you and let you know that. But unfortunately, anytime there are humans involved, there is always the possibility for something to go wrong. This is why when people ask me can I guarantee them 100% that there's no way that they could end up getting a mix up. I tell them, I can guarantee you 100%, we do everything we can to make sure that never happens by having multiple checks and by having certain policies in place to prevent that. But nobody can guarantee you that there can't be a mix up when you're dealing with humans. The last part that people can't predict isn't a fyscal one, but it's still painful. And that's the emotional curveballs. Sometimes you can end up getting stress when you never thought you will, because when it fails, and no one can tell you why, it can be extremely emotionally difficult. You'got friends who are sneezing and get pregnant, and yet your hope turns to heartbreak for the third, fourth, maybe even the fifth time. This is why it's important to have a support group which includes your doctor, maybe a therapist, a fertility community, or just your partner. Now, here's the thing. Complications don't mean you failed. They don't mean your body is broken. They just mean fertility is complex. The goal of this episode isn't to make you feel anxious, is to empower you. When you know what could happen, you can plan, you can pivot, and you can push forward. So remember, hope isn't blind optimism. Hope is knowing the risk and doing it anyway. You got this. Thanks for joining me again on, this week's Talk About Fertility Tuesday. You'like this episode, Drop us a rating, share it with a friend, or scream out loud in our waiting room. I don't mind. Stay hopeful, stay informed, and as always, keep coming back. I look forward to talking you again next week on Taco Bout Fertility Tuesday.