IVF – When Is Enough, Enough?

This is one of the most difficult decisions a couple can face together. Often it is much more difficult than the decision to start IVF, which was a time of optimism and expectation. There may have been a gnawing fear deep down that treatment may not work, but this seemed a long way off in the future.

As treatment progresses and after one, two or more attempts real fear may start to set in. One may wonder whether treatment will ever work or whether you will know when to stop. How do you know when you no longer stand a reasonable chance of getting pregnant? What are the signs that the time to stop is near? This checklist suggested by Anne Mullens in her book Missed Conceptions (now out of print) may help in your decision making.

Have treatment options and medical knowledge been explored and given a reasonable chance of working?

It is usually a good idea to return to your doctor to review your past treatment and ask if there are any other reasonable options to explore. It is often much easier for a couple if their doctor could tell them that pregnancy is not possible, but this is rarely the case. As this is such a personal decision, it is very difficult for the doctor to tell a couple what they should do. What is enough for one couple may be too much for another and not enough for a third.

Is infertility treatment making you postpone other things you would like to do, or making you change decisions?

Have you put on hold plans to move house, change job, study, take a holiday or otherwise change your life because you are waiting to get pregnant? If you have answered “yes” to any of these, how much longer are you prepared to wait “until your real life begins”?

Is infertility treatment straining your financial resources?

Do you resent the money you pay for treatment? If financial worries are putting undue stress on your life, it is time to reassess whether further expenditure is really worth it. Although this may seem a little mercenary, this can actually be a blessing in disguise. It may give you a tangible, convincing reason to let go.

Has your relationship drifted or become strained by continued medical investigations and treatment?

Treatment can take its toll on any relationship. It can wear you both down. It is hard to support another person if you are stressed yourself. Men and women often react very differently to infertility and treatment. This can be difficult to understand.

A couple’s sexual relationship often suffers as a result. Years of ‘trying’ warps what should be an expression of love. Having to have ‘programmed sex’ when you have to, rather than when you want to, spoils sex and distorts your natural libido. Stopping treatment removes this pressure and enables couples to rekindle their relationship. If this doesn’t occur you may consider seeking counselling.

Do you resent treatment?

Is it having a detrimental effect on you personally? Do you no longer feel like ‘your old self?’ Is it more and more difficult fronting up for treatment? Maybe you know deep down that it is time to stop, but it is difficult to admit because it feels like failing. Remember it is not you who have failed but the treatment. It takes enormous courage to undertake infertility treatment and enormous courage to also reassess and end treatment.

Have you considered any alternatives to biological parenthood?

These include using donor gametes, adoption, permanent care, fostering, participating in a big brother/big sister programme, being more involved with your nieces and nephews or close friend’s children. Or is childless living becoming more acceptable to you? If you are beginning to be able to imagine a new satisfying future you may be ready to begin that process.

If you are not ready to stop treatment now, then when might you be?

It can be very helpful to plan a timeframe. This may be based on a number of treatment cycles or when you reach a particular age or time of the year. That way when you reach that point you may feel ‘finished’ and be ready to stop and less inclined to “just have one more try”. If your answer to this previous question was “never” you may need to do some serious thinking. What does stopping mean to you?

Some possible reasons for being ‘stuck’

Some couples feel that if they stop this means that all their treatment has been for nothing. Is this really so? Is it possible to look at this another way? Have there been any positives to come out of your treatment even if it is only resolution of your infertility and the knowledge that you have tried?

Some couples believe that persistence will eventually pay off and that eventually treatment will succeed despite the odds. Gambling is a good analogy here and couples are lured but stories of others who conceived after extensive treatment. Unfortunately IVF treatment does not work for everyone and it is important to stand back and assess your real chance of pregnancy, despite how painful this might be.

Some couples may have lost sight of the real reason they started treatment in the first place. Sometimes becoming pregnant can become a goal in itself and the longer you are denied it the more you want it. Is the goal still as relevant and important as when you started? Can you imagine any other paths your life might take that might give you almost as much satisfaction. This can be difficult to answer as nothing may appeal right now.

Some couples may be unconsciously avoiding grief by continuing with treatment. It is an understandable reaction for couples who may feel too vulnerable to face the inevitable grieving process that occurs when treatment ends. But this avoidance of grieving may, unfortunately, extend it and prolong their sadness by repeated cycles of disappointment.

Strategies for moving on

It is never easy to walk away from treatment and the dreams and the plans you had hoped would result from it. There is no easy five-point plan for getting through this. It hurts. As with any grief you experience, there is no easy quick way to fix it. It takes time to heal and you will probably always carry some scars and some regrets. Allow yourself this time. Allow yourself to grieve.

Grieving for an unborn child is complicated, as the loss is so intangible. It is a loss of possibilities. There is no body, no funeral, no ritual to mark this event. Others around you may not be sensitive to your loss or be unaware of what you are experiencing. Yet you may be experiencing a grief as profound as that of a parent whose child has died. You are not exaggerating or overreacting. Allow yourself to acknowledge just what it is that you have lost.

Often this is hard to put into words. It involves a loss of love you would have given to your unborn children; a loss of love you would have received from them in turn; a loss of the experience of being a parent, of passing on your family, or being supported in old age, of being part of a larger network of families with children. These things are worth grieving for.

Sometimes it helps to make these things a little more concrete. Some people have found it helpful to write a letter to their unborn child, or to change the room that was to be the nursery, or to give away any baby things they may have collected. Others have planted a rose or a tree for the children they will never have. Other couples have gone away together to mark the end of their treatment, to review their past treatment and to plan a new beginning together. On their return, they might announce to friends and family that they have finished their treatment.

Resolution is possible

It involves learning to accept a major disappointment in your life. It involves a major reassessment of your life and a major readjustment. This is what can seem so terrifying. You may feel lost. Your life may now become a blank canvas on which to fill any possibility. It can be similar to the choices others face when they retire or when their children leave home. What will give my life meaning? Is it possible to find the same satisfaction I had hoped to find in having children in some other way.

Often nothing appeals until you have given yourself the time and space to grieve. It may involve trying a number of different things (even when you don’t feel like doing them), until you discover what really gives you satisfaction. Often you may have put these activities on hold while you have been on treatment.

Have you considered trying a new creative pursuit, studying, travelling, voluntary work, a new sport, coaching a team, working with animals, gardening, subscribing to the theatre, orchestra, learning to play a musical instrument, writing a book, getting involved with environmental issues or another issue that really matters to you? The List is endless.

One patient suggested a novel approach which focuses on changing your mindset. She felt she had previously been exaggerating the positives that having children bring and ignoring all the negatives. She then started to focus on all those negatives aspects. She began to realise that children alone do not bring happiness. Her other priorities included marriage, family and friends, lifestyle and career.

She will always feel disappointed about not having been able to have children, but she is able to recognise that she has ‘spare resources,’ which she can invest in other areas of her life. She also drew inspiration from her mother who had to reinvent her life after her husband died. She acknowledged that if anyone had told her five years previously that she could be happy without children, she would not have believed them. She now is ” but only after a long and powerful journey.

Remember that the counsellors are available to help you through this journey. Please do not hesitate to contact them to make an appointment. It does not matter if it has been some time since you have stopped treatment.

-Emotional facts’ reproduced with kind permission of Kay Oke ed., from Taking Charge of Your Infertility, Melbourne IVF, 1999

Information in this article was provided by ACCESS, Australia’s National Infertility Network. You can visit their website at https://www.access.org.au for more information.