Repeated IVF failure is a perplexing problem which is extremely disheartening to both patient and physician. Once a decision to proceed to IVF has been made, treatment is undertaken with great enthusiasm and expectations. Proper IVF treatment places huge emotional, financial, and time commitments on the patient as well as her family. Work and family schedules are disrupted and daily life must be rearranged to accommodate doctor visits, injections, and planned procedures. Repeated failure to conceive requires a diligent review of all aspects of the patient’s evaluation and treatment to be sure that adjustments in treatment may be made to optimize prospects for future success. This process must be comprehensive and should include a thorough review of the patient file, conferencing with all members of the IVF team and should be followed up with a comprehensive, well thought out consultation with the couple.