Fertility Treatments: When Enough Is Enough

Modern fertility treatments afford women the promise of "having it all" — they can devote their early adult life to launching a successful career, delay childbearing until their career has been established, now having the resources to give their children things they wouldn't have been able to afford had they had they become pregnant at a younger age.

Sounds like the perfect plan, right?

For many women, fertility treatment has been a godsend. It allowed them to bear children when they otherwise would not have been able to do so. What often goes unacknowledged, however, is that there is no guarantee that fertility treatment will be successful. Once a woman turns 40, the odds of becoming pregnant using her own egg are small, and continue to decrease as she ages.

In addition, there are other aspects of fertility treatment that many women don't consider as they make their decision to put off childbearing. If fertility treatment isn't covered by insurance, it's expensive. If it is covered by insurance, you often have to jump through many hoops before being able to proceed with treatment. It is extremely time consuming — the diagnostic procedure alone usually involves many appointments that need to be timed according to your place in your cycle. Many women feel as if they have to drop everything in their lives in order to attend multiple appointments per week, which is a formidable task if you work in a traditional office setting that requires you to be on location during regular business hours. If that's not enough, many women experience the procedures as invasive and humiliating. If you are receiving hormone treatment, you might be coping with unpleasant side effects like weight gain and mood swings.

It can be excruciating to go through all of the time, effort, and expense of fertility treatment, only to have it be unsuccessful. It begs the question: when is enough enough?

The answer might be relatively straightforward if your resources are limited. For example, if your insurance only allows for two cycles of in vitro fertilization (IVF), and you can't afford the procedure otherwise, then you will probably stop after those two cycles. But what if you do have the resources to proceed with additional cycles? Do you just keep going cycle after cycle until it works?

Let me preface the remainder of this discussion by saying there is absolutely no right or wrong answer to this. It's a personal decision that only you and your partner can make. One way to make the decision is to critically examine the advantages and disadvantages of continuing with fertility treatment. Don't just do a cursory job of this; really talk to your partner and write down the advantages and disadvantages on a piece of paper, so that all of the important points are in your visual field. Of course, one advantage will be the promise of having a child, something that is likely of utmost importance to you. But don't forget to consider other areas of your life. How is it affecting your romantic relationship, especially if the two of you differ in your opinions of how far to take fertility treatment? Your relationships with other family members? Your relationships with friends? Your work? Your bank account? And, importantly, your emotional well-being?

Many women say that they continue with fertility treatment because they don't want to be a quitter; someone who just gives up. Let me say right here that you are not a quitter if you decide to discontinue fertility treatment. You have made a decision from a place of strength in order to preserve your own emotional well-being, the well-being of your partner relationship, and other important aspects of your life.

Other women struggle with a sense of inadequacy when they discontinue fertility treatment, perceiving they are failures (or even being punished) because they are not able to do what seems like every other woman is able to. If this describes you, remember that this is just a thought. It's just your neurons firing in a predictable way, given the stress and disappointment that you have been enduring. A thought is not fact. And my bet is if you were to survey 100 random people, not one would view you as inadequate for this reason. Take some time to remember all of the other reasons why you are an adequate, even successful person. 

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It is natural to experience grief associated with the sense of loss of carrying your own biological child. No one expects you to make any major decisions when you are grieving. When you are ready, you can think about the many other ways to be a parent, such as IVF with a donor egg, adoption, surrogacy, and foster parenting. These may not be the routes to becoming a parent that you had envisioned for yourself. There is still uncertainty associated with each one of these options. But each allows you another means to obtain the ultimate goal: having and raising a child.

Don't discount the positive emotions that also may accompany the decision to discontinue fertility treatment. You may experience a tremendous sense of relief, almost as if a black cloud has been lifted from over your head. You may find that you have more time than you have had for many months, which you can devote to valued activities and pursuits. You may find that it brings you closer to your partner, as the pressure of fertility treatment will no longer be the "elephant in the room" when you are together. This may create the freedom to experience intimacy for the sake of intimacy and reignite your connection, as it might have seemed as if your connection was on hold during this stressful period of time.

In my forthcoming book, Infertility, Miscarriage, and Pregnancy Loss: Finding Perspective and Creating Meaning (APA Books, 2014), I encourage people to live their lives according to their values in the face of stress and disappointment. Although the road to becoming a parent, thus far, has been disheartening, be sure to maximize the other areas of your life that contribute to your sense of self. Pursue your athletic side with vigor. Nurture your close relationships. Feed creativity into your artistic side. Develop talents that you have always wanted to attend to, but so far have neglected. These activities will promote active engagement with your environment, which we know is a buffer against negative emotions like depression. But they will also show you that you can live a rich, valued life, even if your road to childbearing does not lead you where you had hoped. You also will have diversified your many sources of gratification and self-esteem, so that your sense of gratification and self-esteem are not solely dependent upon being a parent.

Fertility difficulties can be among the greatest of life's challenges. They threaten a central identity that is carried by many women — that of being a mother. When you decide to discontinue fertility treatments, you will likely endure a period of grieving. But know that there are other ways of becoming a mother, and more generally, that you can live a rich, valued life no matter what the ultimate outcome. Know that it was a decision made out of strength and respect for your own emotional well being and partner relationship.

Dr. Amy Wenzel is a clinical psychologist, author, and consultant who uses cognitive behavioral therapy to help individuals and couples navigate countless interpersonal issues, including infertility. To learn more about Dr. Wenzel, visit her website at http://dramywenzel.com.