The Unfinished Journey:multifactorial analysis of untransferred cycles in IVF

Abstract In vitro fertilization (IVF) cycles that do not progress to embryo transfer—termed untransferred cycles—are frequently overlooked in outcome reporting, despite their potential clinical and psychosocial implications.This 14-year retrospective study analyzed 30,731 untransferred IVF cycles from a tertiary fertility center (2011–2025). Cycles were categorized by type (fresh vs. frozen-thawed) and by cause (medical vs. non-medical). Reasons included OHSS risk, no embryos or oocytes, failed fertilization, uterine abnormalities, and patient-level factors. Temporal trends were also examined.Of 81,723 IVF cycles, 37.6% were untransferred. Fresh cycles accounted for 98.1% of these, with 90.2% attributed to medical reasons. Frozen-thawed cycles showed a more balanced distribution of causes. Over time, OHSS-related cancellations declined, while uterine cavity issues and PGT-related interruptions increased. Personal, psychological, and social factors accounted for nearly 10% of untransferred cycles.The journey from IVF initiation to embryo transfer is influenced by biological, emotional, and social complexities. Recognizing and addressing these multidimensional barriers may reduce untransferred cycles, enhance patient-centered care, and prevent unnecessary resource loss.