Lost and lonely: a qualitative study of women's experiences of no embryo transfer owing to non-fertilization or poor embryo quality.

study questionWhat are the experiences of women undergoing IVF who could not receive an embryo transfer because of failed fertilization or poor embryo development? SUMMARY ANSWER: No embryo transfer because of failed embryo development is associated with considerable emotional suffering and the need for an early appointment with a physician to obtain information on what went wrong and new alternatives. WHAT IS KNOWN ALREADY: The psychological and emotional impact of IVF treatments as experienced by IVF patients is well known, particularly following the failure to achieve pregnancy. STUDY DESIGN SIZE DURATION: A qualitative study running from January 2018 to April 2019 was carried out at one public and one private IVF clinic. The invitation to participate was sent to women within 1 month after the cycle failed. PARTICIPANTS/MATERIALS SETTING

methodsThe women undergoing IVF were diverse in terms of cause of infertility, age, number of previous cycles, country of birth and educational level. Nineteen of the 41 invited women who had experienced no embryo transfer because of non-fertilization or poor embryo development took part in a semi-structured interview. Data were analysed by thematic content analysis. MAIN RESULTS AND THE ROLE OF CHANCE: The master theme was identified as: 'Lost and lonely' organized in two main themes 'Experience of the event' and 'Perception of needs from healthcare providers'. Considerable emotional suffering was recognized after no embryo transfer. The need for support was expressed as to be offered an early appointment with a physician for information about what went wrong, looking at new alternatives and, for many women, providing information about counselling. LIMITATIONS REASONS FOR CAUTION: Only women participated, not partners. Of the women invited, 46% participated. Several declined to participate because of high levels of emotional stress. WIDER IMPLICATIONS OF THE

findingsPatients undergoing IVF and not achieving embryo transfer due to poor embryo development are a vulnerable group. They need early feedback concerning reasons for failure and future alternatives. They also require psychological support. This ought to be offered by IVF clinics. STUDY FUNDING/COMPETING INTERESTS: The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-70940). It was also financed by the Local Research and Development Board for Gothenburg and Södra Bohuslän (VGFOUGSB-866771) and by Hjalmar Svensson's research foundation (HJSV-2017012). None of the authors declares any conflicts of interest. LARGE SCALE DATA: N/A.