Coping with unsuccessful fertility cycle outcomes

When you embark on your first IVF or IUI cycle, it is not uncommon to be full of expectation that this cycle will be successful. While a pregnancy is the case for some, it is not always the case for many. Sometimes people will have to go through many cycles until they achieve a pregnancy and for others, pregnancy will always remain elusive. For those who are faced with unsuccessful cycles, they can often experience a range of emotions that can be both confusing and sometimes frightening.

These emotions can encompass feelings of devastation, disappointment, discouragement, anger, bitterness, and irritation, feeling stuck and jealousy towards pregnant people and those with children. Some people find themselves feeling like a failure and this feeling can then permeate into other parts of their lives.

Why do “great” cycles fail?

Patients often remark that they find it hard to understand why their cycle failed. They may have been told that their cycle went well and that they had excellent embryos, so there seems to be no real explanation for cycle failure.

Unfortunately while science has come a long way in explaining how we reproduce, it still is unable to explain everything. Humans are innately not a very fertile species. For example, if you took the average couple in their twenties with no known fertility issues and who have regular sex every month, they only have a 25% chance of falling pregnant each month.

It can be very difficult to understand why your perfectly formed embryo that is doing everything right does not form a pregnancy. However, while it looks perfect, it is important to remember that we really have no idea that the 30,000 genes it takes to make a human being are all in the right spot and working correctly in that embryo.

Some people get really worried that the stress they are under during an IVF cycle impacts on their ability to get pregnant. They are told by well meaning people that if they relax or go on a holiday they will get pregnant. However, pregnancies occur all around the world in highly stressful situations such as war zones and after rapes, and in households where there is domestic violence. Additionally, nobody is that relaxed when they have to go through IVF, but pregnancy rates for IVF clinics are greater than normal people trying to fall pregnant naturally, and on average one IVF cycle is equivalent to 10-12 cycles of normal intercourse for infertile couples. So it is important that it is not the stress that causes the infertility, it is the infertility that causes the stress.

Tools for coping with failed cycles

Embarking on any fertility treatment is an emotional roller coaster ride. It is stressful and there is no easy way to eliminate all the stress from this experience. However, you can have some impact on how this stress affects your quality of life.

The Tool Box

Tool 1: The starting kit

It can be a good idea to make your orientation a week or two before you start your cycle. During orientation you will be exposed to a lot of new information. If possible, bring your partner or friend so you will have an informed ally as often people can feel a bit overwhelmed at what they feel they may be expected to understand. Another thing you can do is to ask your nurse or treating doctor to explain anything that you feel you are having difficulties in understanding with your treatment.

Tool 2: Organise your life

People vary in how difficult or easy they find their cycles. As a general rule of thumb, the egg stimulation phase is usually well tolerated. The egg retrieval phase, which involves a minor operation, usually requires a day off work and can cause some physical discomfort in some. Emotionally, the research has shown that the two-week wait for the pregnancy test is often filled with anxiety. People often find that they are a bit overwhelmed when they get the news of negative pregnancy tests and may need several days, after receiving this news to feel okay, about facing the world again. It can be useful to organise some time off work during egg retrieval and the two-week break, especially the day that you are expecting to hear the results of the pregnancy blood test.

Tool 3: Create a ‘care package’

The infertility roller coaster is horrible for everyone. Be kind to yourself. You are not abnormal, it is the situation that you find yourself in, which is abnormal. Treatment can be emotionally and physically exhausting. Do not feel guilty about taking time out, Employ your partner/ friend to be your counsel and support and you can get out and back to everyday life when they feel you are ready. Sometimes you may need to hand over the responsibility to someone to  assist you at this time as you have lost focus. It is helpful to discuss these strategies before your next cycle begins so your friend is aware of your needs and is willing to take over at this time.

Tool 4: Create a distraction plan for the two-week waiting period

Consider projects to undertake, such as gardening, painting the house, work projects, and creative pursuits. Distract yourself and your partner: DVDs (feel good and entertaining ones) – e.g. work your way through best 100 movies of all time; distractions that keep your mind and your hands busy – such as crosswords, knitting a complex pattern, sewing, making a wooden project, or gardening. Plan a range of pleasant activities such as eating out, cooking healthy meals, visiting beautiful places, trying a fun new sport  activity or hobby. Plan a list of people who are good to spend time with (you don’t have to discuss where you are at).

Tool 5: Prepare for how to receive the news of the cycle outcome

Try to allow time and space to process the information. For example, some patients ask to phone in for their results and organise to have at least an hour following the news to be somewhere they find comfortable, peaceful, nurturing or to be around someone who can care for them for e.g. some take the afternoon out and have a stash of chocolate, flowers, DVDs. Others have gone to the ocean or a park to get the news. Others just have their partner or a close friend or relative with them. Others have their partner or a friend or family receive the news for them and then gently break it to them.

Tool 6: Take control

In a situation where you do not have the ultimate control on the outcome, take control of what you can control. As an informed patient you can list your treatment options, discard the not acceptable and work with the acceptable. Take a pathway of less regrets so whatever the outcome you will feel you have tried your best. You could also seek to take control of projects or aspects of life that are not related to IVF or infertility, for example, hobbies and interests and/or career.

Tool 7: Find helpful ways to think about the outcome

Everyone is different and their reactions to the cycle outcome can be vastly different. Some people find it helpful to really acknowledge the sadness of the loss; others like to concentrate on the positive or anything in between. For example, some people like to remind themselves that ‘An unsuccessful IVF cycle does not mean the end of the world. It just means that it wasn’t my time this cycle.’ While, others might like to consider IVF as ‘a numbers game, which they must eventually win.’ Again, some like to stay grounded, keeping both clearly focused on the fact that it may not happen for them but keep their fingers crossed for a good outcome’.

Try to avoid: blaming yourself, blaming your partner, becoming overly despondent and assuming that one or two unsuccessful cycles will mean that it will never work. Also try to avoid judging yourself harshly for the feelings and reactions you have, If possible, try to accept and not judge yourself for the emotional reactions you have to the outcome. If the reactions become intolerable or simply difficult, seek support with your infertility counsellor or other helpful friends or family.

Tool 8: Build a support network

Consider who is the best person for different kinds of support jobs. For example, who will cheer you up, who you can cry with, who can contain your sadness and not feel too bad or guilty, who has a comforting energy, who can you confide in. Many patients do not want to inform family / friends / colleagues that they are under going IVF/ART treatment, however research suggests that it can be very helpful. It is not suggested that you announce to everyone that you are undergoing treatment but in many situations a little information can help your anxieties. To have a Boss that is aware of why you are late for work, for example, can make you feel as though you do not need to make up another excuse. Secrecy can cause stress while openness within a private contact can alleviate stress. Partners/ friends and colleagues are there to listen not to provide solutions. Support Groups are sometimes useful to support you outside your friends and family.

Tool 9: Focus on what is

Fertility treatment can cause ‘brain fog’ i.e. many patients say that their mind is constantly preoccupied with where they are in their cycle. Mindfulness exercises and meditation can help manage this natural reaction to the stress of a fertility cycle. Yoga, meditation and Tai Chi can be beneficial to increase your physical and mental wellbeing. Taking one day at a time can help alleviate becoming overwhelmed with fears about the future.

Tool 10: Create your own rituals

For example, the bed and chocolate ritual where you just hang out together, cry, watch DVDs or whatever; mourning, listening to certain songs or playing certain movies, find some comforting books or poems and share with your partner. When you are part of the infertility rollercoaster, and are unsuccessful, there are no tangible signs that you and your partner have suffered any loss. Although you have no  physical signs that you have lost a child or children, the emotional aspects are far reaching. Some patients find it useful to introduce rituals in order to bring closure to their unsuccessful cycle. A ritual could be gathering a small bunch of flowers and tying a ribbon around them and going alone or with your partner down to a river or the sea. Either wade into the ocean or throw the bunch of flowers into the river and say goodbye. The intensity of the emotions might catch you by surprise. You need to take your time and watch the flowers disappear. Some people might say a prayer or whisper their goodbyes. There are many ways one can bring closure to a cycle that was unsuccessful, such as write a letter to the embryo/s that never took and put it in a bottle and let it go in the ocean. Plant a tree or shrub in your garden in order to mark this time. Whatever, you and your partner decide, a ritual to say goodbye is a powerful way to bring a sense of closure to this particular cycle and enable you to move forward.

An unsuccessful cycle does not mean the end of your dreams to have a baby. If you and your partner have come to the end of treatment using your own gametes you might consider other ways to be parents, such as adoption, fostering, egg, sperm or embryo donation. These are other options that can be explored in your own time and with the professional help of your doctor, fertility specialist and infertility counsellor.

B Aronstan Councillor.