VERY SADLY, DESPITE their own absolute best efforts, and those of their fertility team, a minority of individuals/couples will be unsuccessful in achieving their dream of having a family.

They leave our care and are often left to their own devices, faced with the prospect of life without children. This can often be where counselling and support is most needed.

Surprisingly little research has been done on this group. On the other hand, maybe it is to be expected. Once they stop treatment, patients no longer have a reason to attend a clinic, and may even want to get away from the clinic and unhappy memories of failed treatment.

An ESHRE guideline published in 2015 gives lots of information about couples before and during treatment, but it concluded that “the evidence about the behavioural and emotional needs of patients after unsuccessful IVF treatment is too limited for supporting recommendations.” Having said that, they advised that:

• Fertility staff should be aware that former patients who remain childless five years after unsuccessful IVF/ICSI treatment may use more sleeping pills, smoke more often and consume more alcohol than former patients that become parents via adoption or spontaneously.
• Former patients that remain childless five years after unsuccessful IVF/ ICSI treatment are three times more likely to separate than former patients that become parents via adoption or spontaneously.
• Women with a persistent desire for pregnancy three to five years after unsuccessful treatment may experience more anxiety and depression than women who find new life goals or women who become mothers, but women who remain childless 10 years after unsuccessful IVF/ICSI treatment are not more likely to develop psychiatric disorders than women of the same age who never underwent fertility treatment.

What couples go through

A UK study published in 2007 also gives some idea of what people go through after unsuccessful treatment. This study was comprised of 33 interviews with people who had had unsuccessful IVF five years previously.

Of these interviews, 18 were with couples and 15 were with female partners only. Some of the findings were as follows:

• For some, the effects can be traumatic and long lasting.
• Hope was an important factor. Treatment offers hope and this provides the motivation for treatment, alongside the urgent need to avoid future regrets.
• Once the support provided by hope is removed, patients can struggle to make sense of their lives.
• Some form of closure regarding the ending of treatment is required.
• Some couples are able to reinvest in life goals and re-establish their relationships
• However, a significant proportion of couples were still struggling five years after their last treatment.
• Sadly, not all couples recover from the trauma of the inability to parent at will, and some relationships break down.
• There is a lack of psychological support offered to couples going through assisted conception, and findings suggest that more support should be offered on a regular basis to couples going through this process and beyond.

People have different ways of coping

In my experience, different people have different ways of coping with disappointment, heartbreak and adversity. I suppose this is true for every misfortune in life.

Many couples grow stronger in their relationship throughout the fertility journey and are a great support to each other when it doesn’t work. Sadly, I have also seen relationships break down where one or other partner just can’t take it anymore.

It is really important that those of us who work in the area try to help patients protect themselves, their relationships and their lives from the ravages of infertility and its treatments.

Generally, it tends to be women that I see after couples have been unsuccessful with treatment because they may come back for management of an ongoing gynaecological issue such as endometriosis. My impression is that they all eventually find their way.

People’s attitudes are very important

They adjust to their new life without children – some may develop their career or get involved in the arts or voluntary work and others may even move on to new relationships.

No one finds it easy and it is more difficult for some than others. If a person can know deep down that they have tried their best and done all they could, they usually can come to terms with the huge loss and move on.

The person’s situation and attitude right from the beginning can be important. Some, particularly younger, patients may have never contemplated a life without children or considered that they might not be able to conceive. They have often been very successful in their enterprises to date – education, work and even finding a partner. Now – wham! They have come up against a brick wall.

They may spend an absolute fortune – not just in terms of money – but also time, emotions and happiness – seeking after a retreating goal and moving from clinic to clinic. They are also likely to be under immense societal pressure.

They are often in the age group where all their friends are having babies and, because they are young, their friends and family may have no idea that they have a problem. Not surprisingly, their life can become consumed. This is absolutely understandable but can be a recipe for disaster – if they don’t conceive, they have nothing left.

Counselling and support can be invaluable here. Finding new life goals and paths can seem impossible but, with some professional help, it is usually eminently doable.

Deciding to stop treatment is a difficult decision

Older couples and patients are often in a different place. They may have the added pressures of time and their biological clock, but they have also had a longer life experience with more hard knocks and uncertainties.

They may come to the fertility scene with less expectations and a realisation that it may not happen for them – if it does, it is a bonus. They are also more likely to find acceptance and empathy from their peers who are also older.

Often the most difficult thing for any person or couple can be deciding when to stop fertility treatment. People often talk about getting on the treadmill and not being able to stop. Fertility treatments like IVF can certainly do this. The outcome is unpredictable and there is always the chance that the next treatment just might work.

Some couples may get really close to success – they may have decided to do one last cycle of treatment and then they get a positive pregnancy test but suffer an early miscarriage.

It is very hard not to want to try again in this situation, even if there have been many failed attempts in the past. Others get lured or sucked in by new therapies and technologies that are being proposed all the time (not always justified or proven) – they read about someone who tried and tried for years, and then tried a certain thing which worked.

The internet can be very misleading in this regard and can entice people into trying more and more unscientific and spurious treatments.

Some things in life are beyond our control

I am greatly saddened when I see people or couples who have really tried everything and have been unsuccessful. It is often hard as a doctor to know what to say.

Having worked so long in the area, I know that our treatments and technologies work very well in most situations. But there are definitely some patients and couples who are really unlucky. Sadly, science does not yet have all the answers.

I really do believe that we should try fertility treatment and, while most people will be successful, unfortunately some will not. All any of us (patients, doctors and other staff) can do is do our best and, then accept that sometimes in life, “que sera, sera”, and some things are beyond our control.

I’ll finish up with a few insightful quotes from some of our patients.

When we started this journey, my husband and I said that we did not want to look back in 20 years’ time asking ourselves what if, if only we had tried one more time. But we also said we did not want to be one of the those couples who simply could not or would not accept what is meant to be, is meant to be.

“For us our battle is still ongoing and there may be no happy ending, but my husband actually said to me just the other day that he would not change one minute of it – and all things considered, I don’t think that I would either. We have a picture now that we didn’t have before. The picture might not be our favorite one, but it’s clear and we can build a life around it and be proud of it.”

Your journey may be successful. That success may be a family. Or that success may be accepting that you have tried your best to get what you both wanted and life has decided that you are going to follow another path. So plan for both. And enjoy life.

Professor Mary Wingfield is a Consultant Obstetrician Gynaecologist at the National Maternity Hospital in Dublin, Clinical Director of Merrion Fertility Clinic and an Associate Professor at University College Dublin. Professor Wingfield is a leading expert in her field and is widely published and actively involved in research and teaching in the area of fertility. Her work over the last 30 years has helped countless people to maximise their chances of pregnancy.

The Fertility Handbook, published by Gill Books, is priced at €16.99. All royalties from the book will be donated to the Merrion Fertility Foundation which funds fertility treatment.

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