Ending infertility treatment is one of the most gut wrenching decisions an individual or couple has to make. Some of the reasons for ending treatment include multiple unsuccessful outcomes, emotional toll, financial drain and pregnancy. After many years of treatment, patients may feel a deep sense of intimacy with their medical team and leaving the circle of security can produce feelings of loss. The road toward becoming pregnant is long for a patient diagnosed with infertility and it may be a shock to actually become pregnant and then leave what has become so familiar. Pregnancy opens up other dimensions that include physical and psychological changes, confronting the reality of achieving what has been longed for, attachment to the baby and preparing for parenting.
Prior to the advent of assisted reproductive technology, women and men struggling with infertility had no choice but to accept that they would not have a genetically related child. There were no available options to enhance fertility or prolong the period of trying to get pregnant if normal sexual intercourse did not produce a pregnancy. Technological advances to assist in reproduction have elongated the time that women have to attempt getting pregnant and new methods are constantly being researched and tested. As long as there is the potential for something new to be tried, patients are willing to keep going.
For infertility patients, the drive to become pregnant takes on a life of its own and many patients will pursue their desired outcome for as long as they believe there is any chance of hope. Patients who are more unwilling or unable to face alternative family building options have the most difficult time ending fertility treatment. One has to be educated about the chances of success when beginning treatment and then draw on that information when it comes time to make a decision to stop. Emotional energy becomes a limited resource after multiple failed attempts and so the decision to end treatment may come from not wanting to experience the emotional pain of another failed cycle. Lack of additional resources and the pressure on marital/partnership and extended family relationships and the need to move on are other reasons why patients elect to end treatment.
People diagnosed with infertility experience grief and an altered sense of self over not being able to conceive a child in a normal way. When faced with having to stop infertility treatment, that grief is compounded by the loss of hope of ever having a child. Stopping treatment requires facing that loss and mourning the child that will not be. This is an essential step in moving forward with either adoption or a life without children.
When patients become pregnant after infertility, they may be surprised by some of the thoughts and emotions that can arise including ambivalence, fluctuating/opposing states of mind, isolation, fear and loss. Pregnancy after infertility treatment is different than a normal pregnancy in that there may be complications associated with advanced maternal age, multiple pregnancy and issues uncovered during infertility treatment. Pregnancy, after infertility treatment, does not automatically dispel feelings of anxiety and depression. After a protracted period of trying to get pregnant, the event itself is sudden and patients are thrust in to a completely new world. Fears abound about the health of the baby and mother and it is not uncommon for prospective parents to be hyper vigilant about changes going on in the woman’s body. The desire to get pregnant after months and years of trying is profoundly intense and when it occurs, it may not be the ideal that was wished for.
Parenting after infertility treatment presents challenges that differ from parenting after a normal and uncomplicated conception and pregnancy. Patients who have gone through many cycles of infertility treatments often make a bargain with themselves to be perfect parents, if they could only just get pregnant. This bargain leaves parents vulnerable to self-criticism and negative personal judgment when the trials and tribulations of being a parent arise. Parents may find that because they worked so hard to have their child, that now everything must be perfect and they cannot complain. Parents may find that their experience sets them apart from being a normal parent in that they cannot allow themselves to have normal feelings or they tell themselves “I should be so happy and grateful” even though they are angry, tired and frustrated.
There are many challenges associated with ending fertility treatment, the best of which is the desired outcome of pregnancy. When pregnancy does not occur after a protracted period and it is made clear that there is little or no chance of conception, patients need to make a decision to move on to other options such as adoption, having a non genetically related child through surrogacy or remain childless. The tasks that follow after infertility treatment has ended include processing the period of infertility including during the course of a pregnancy. Pregnancy after infertility can be a volatile and frightening time and special consideration needs to be given to address these fears. Parenting after infertility is a life long process of reconciling what had to take place in order to have a child while working to normalize each stage of development as the child grows.