Most clinics don’t like talking about failure. It’s not great for marketing. But for patients, understanding what can go wrong in a surrogacy program is just as important as knowing what can go right. And yes, even under ideal conditions, surrogacy can fail. Transfers don’t always lead to pregnancy. Embryos that look perfect on day five sometimes don’t implant. The good news is that failure is something that experienced clinics like SILK Medical plan for from the start.
Why a Transfer Might Fail
A failed embryo transfer doesn’t necessarily mean that something is wrong with the surrogate or the embryo. Reproduction is complicated, and even under tightly controlled clinical conditions, it doesn’t always result in success on the first try.
One of the most common reasons is embryo quality. Even when preimplantation genetic testing for aneuploidy (PGT-A) is performed and only chromosomally normal embryos are selected, implantation isn’t guaranteed. Implantation rates for tested blastocysts are generally around 65 to 75%, which still means up to one in three transfers may not succeed.
Another reason is endometrial receptivity. The uterine lining must be thick enough, uniform in texture, and hormonally synchronized with the embryo. If it isn’t, the embryo may not attach properly. Clinics monitor this closely, but small variations can still affect the outcome. Technical factors during the transfer process itself, like uterine contractions or difficulty during catheter placement, also play a role, though rarely.
When the Surrogate Is the Issue
Sometimes, the cause of failure lies with the surrogate’s body not responding as expected to medication. Her endometrium may not build up adequately, or she may not follow the medication protocol properly. In rare cases, previously undetected uterine anomalies are to blame. That’s why SILK Medical conducts detailed screening of every surrogate, including multiple ultrasounds and bloodwork before any transfer.
Occasionally, a surrogate who looked perfect on paper simply doesn’t respond well to protocols, and after a failed attempt, the clinic may recommend choosing another candidate. This isn’t a judgment on the surrogate herself. It’s a recognition that each body reacts differently and continuing with the same match may lower the chances of success.
What Happens After a Failed Transfer
When a transfer fails, the immediate next steps depend on the program the patients are in and how many embryos remain. If the patient used a donor egg cycle and had multiple blastocysts frozen, a frozen embryo transfer (FET) can be scheduled within 1 to 2 months. In most surrogacy programs, this is a separate medical procedure and will incur additional costs unless included in the program structure.
The surrogate’s cycle will need to be prepared again, meaning new medication, monitoring, and hormonal alignment with the embryo. In the meantime, doctors review every part of the previous cycle: embryo grading, thawing process, lining quality, hormone levels, and transfer notes. If any red flags are found, changes are made for the next attempt.
If no embryos are left, another IVF cycle will be needed. This is most relevant in cases using own eggs or when only a few eggs were retrieved. Once new embryos are ready, the program proceeds with remaining transfer attempts. In cases when all attempts are used up, but there are remaining frozen embryos, an additional transfer can be added to the program on a per attempt basis. The surrogate can also be replaced after three attempts at additional costs. In the Guaranteed Program, these are all covered in the total price.
Why Guaranteed Programs Exist
The Guaranteed Surrogacy Program exists for exactly this reason: not every transfer leads to pregnancy, and not every pregnancy results in a baby. This program is designed to absorb that unpredictability. It includes unlimited transfers, full replacement of the surrogate if needed, and covers multiple donor cycles if necessary.
For many couples, the higher upfront price makes sense when weighed against the cost of repeating transfers, replacing surrogates, or starting new IVF cycles. It also removes some of the emotional pressure of getting pregnant on the first try. Statistically, most patients succeed within the first 1 to 2 transfers. But the guarantee exists to protect those who need more.
If It Doesn’t Work the First Time
Surrogacy is successful more often than not. But when it fails, the experience can feel devastating, especially if you weren’t told it was even a possibility. Clinics that gloss over failure do patients a disservice. At SILK Medical, most programs are structured to minimize risk and offer clear next steps in case things don’t go according to plan. Whether you succeed on the first attempt or the third, what matters is that you know what comes next.
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