When should I consider other options after fertility treatments?
Infertility is a medical condition like any other. Once a diagnosis is received, the next logical step is to weigh all of one’s options. Some infertility patients go through progressively more involved and invasive measures, while others are limited in their options from the beginning. In the event of premature ovarian failure or zero sperm production, for instance, the decision to consider third party reproduction, adoption, or remaining child-free comes much sooner than for those who are able to upgrade to more advanced medical treatments, or who receive the inconclusive diagnosis of unexplained infertility.
Many patients go from attempting natural conception with the assistance of hormonal support to intrauterine insemination (IUI) to in-vitro fertilization (IVF). Those who are able to try IUI or IVF are often the ones who struggle the most with the next step. As long as their test results indicate that conception is possible, they have to decide how many attempts are reasonable before they reassess their situation. This becomes especially true if their only likely chance of conception is via IVF.
While it is possible for some patients to go through an IUI or even IVF cycle naturally (that is, without hormonal support), many patients do engage some level of estrogen and/or progesterone support. Some fertility clinics operate on tight schedules, which do not allow for flexibility when it comes to correctly-timed insemination, egg retrieval, and/or embryo transfer. In these cases, women are often on birth control pills for a period of time in order for these dates to be artificially controlled by the reproductive endocrinologist ahead of time, and then move on to estrogen and progesterone support. Such hormonal therapy is not without risks, and ovarian hyperstimulation syndrome–a complication that can lead to death–is not unheard of. Therefore, it makes sense to limit the number of cycles during which such hormones are taken into the body.
In addition, many women have to endure daily injections over the course of weeks to months, as not every clinic offers non-injectable options. No one enjoys injections, some of which can be especially painful, so it makes sense to want to have an end in sight when going through daily poking and prodding.
Finally, there is the consideration of cost. Many patients do not have health insurance coverage of fertility treatments, and those who do have a set limit to the number of attempts that will be covered. With a single IUI cycle costing a couple of hundred dollars, one may be in a position to repeat several cycles each year. However, medication alone can run into the thousands of dollars per cycle, depending on one’s region. If IVF is the only option, the average cost per cycle is $10,000. Only the very rich could continue with this course of treatment as long as it takes.
But perhaps the most important consideration, one that applies to fertility patients across the board, is psychological. With every attempt, the couple gets their hopes up that this will be the time it will work. And with each failed attempt, the couple is crushed. There comes a time when enough is enough. This sort of state of the unknown, of constant trying with no known time of resolution, cannot last long-term. Each couple is different in how much they can handle, but eventually, they come to a place where they realize they want control of their lives back.
It is at this moment, when lack of control is no longer bearable, that couples must reconsider their options. The first step is to truly dissect their desire. Is it necessarily to have a mutually biological child together? If this no longer seems plausible, then perhaps making peace with childlessness is the best alternative. Is it to experience pregnancy? In this case, maybe third party reproduction becomes an option. Is it simply to parent a child together? Adoption may be the way to go if this is the case.
A couple may initially opt for fertility treatment but eventually realize that while a mutually genetic child or pregnancy may have been nice, their desire to parent is even greater. Or perhaps they’ll agree that parenting together would be nice, but not at the expense of other areas of their lives. Therefore, going into any treatment option, it is a good idea to agree on a number of tries up front, after which, if success is still elusive, the couple agrees to discuss their options again. Perhaps they will choose to try again, and that’s fine. But having a sense of control is very important in what is otherwise a situation completely out of one’s grasp. Staying open to the possibility of re-imagining one’s original dream is the only way to come through the journey of infertility in one piece.