What happens if fertility treatment doesn't work?

In this extract from Small Miracles: Coping with Infertility, Miscarriage, Stillbirth and Premature Birth, Rachel Stanfield-Porter discusses how to cope when fertility treatment doesn't work.

Wanting to start a family of your own and not conceiving as quickly, or naturally, as you might have expected can be something that a couple will face. With the average age of women having their first baby now standing around 30, the issue of infertility is becoming more common. Considering the possibility of infertility or difficulty in conceiving a baby brings into play a number of options to consider, such as Assisted Reproduction Technology (ART), fertility surgery, or In Vitro Fertilisation (IVF). A part of considering the options of how to deal with infertility is also making the decision as to when to stop medical treatments and consider other options for having children, such as adoption or surrogacy, or adjusting to a life without children.

Facing infertility

When a couple sets out to have a baby, they are filled with hopes, excitement, wishes, and the usual fears about becoming parents. When getting pregnant doesn't come as easily or quickly as expected, feelings of grief or loss or regret come into play. It can be difficult to manage these feelings and sometimes the focus on falling pregnant can become quite intense and all-consuming. These kinds of reactions can range anywhere from normal reactions to the uncertainty about falling pregnant to intensely yearning to become pregnant.

Not only are there the physical effects and outcomes of not falling pregnant, there are also the emotional aspects that will arise and make dealing with not becoming pregnant difficult. Infertility has a strong impact on self-esteem. Suddenly your life, which may have been well-planned and successful, seems out of control.

Medical treatment for infertility

One of the most challenging aspects of the infertility experience is dealing with the ups and downs relating to medical treatment and the uncertainty of the outcome. There is also the challenge of deciding when "enough is enough". It is important to learn how to take care of yourself, make sure that you get the support you need and manage your emotions so that your outlook remains as positive as possible.

Women will have very different responses to infertility. Some women may feel angry and frustrated at not being able to have children and others might feel guilty or to blame if their body is not doing what they expected it to do. In some instances, women can feel that they have no control over their body and this is spilling into their everyday life. Some women may also find it difficult to be around children or resent pregnant women.

Choosing medical treatment to deal with infertility brings another set of challenges in that a woman feels that her life is on hold, yet strongly dictated by the different stages in the infertility treatment. The idea of falling pregnant naturally is controlled by the very precise monitoring of a woman's cycle along with invasive medical procedures, such as injections, ultrasound scans, and possibly surgery. It is an extremely emotional time and a woman can feel that she is hopeful one minute, despairing the next.

With medical intervention, men can feel isolated from the "conception" because the focus of the treatment is about the woman and her cycle. If the problem of conceiving is due to male infertility, some men can feel less like a man.

Alternative treatments for infertility

Alternative or natural treatments for infertility are suitable for those who are not comfortable with conventional fertility treatments. People who have not had success with IVF may choose to try alternative therapies. These treatments include acupuncture, homeopathy, naturopathy, herbs, reflexology, cranial osteopathy, and stress management. These treatments can also be long-term and the rate of success will depend on how the individual responds to the treatment. Natural therapies can also be used in conjunction with conventional IVF to support the fertility cycle and strengthen the immune system and the health of the woman undergoing the treatment.

As men and women deal in different ways with infertility, the relationship between a couple can become strained and it is important for each of the partners to remain supportive and to keep communicating with each other.

If IVF, medical intervention or alternative therapies prove not to be a solution to a couple's infertility, then they need to look at options outside of having children who are biologically theirs.

Life without children

For some women and their partners, there will sadly come a time when they make the decision to stop their efforts to have a baby. While some may be trying to complete their family, for others this means stopping their attempts to have their first child.

Thinking of facing life without children or without completing your family can raise many new questions and can be quite a confusing and emotional time. These questions can range from what to do in your spare time to what to do with the rest of your life. Sometimes these issues and questions cannot be resolved without the help of a counsellor; however, most couples do learn to adapt and live a creative and fulfilling life with each other, even if it is not necessarily how they had visualised their future together.

Coming to terms with not having children can give you the ability to regain control of your life as a couple again. Infertility often leaves people in a holding pattern as they wait to fall pregnant or undergo treatment. A life without children might be difficult to think about, but it does allow you to reconnect with your partner and work on goals and dreams that can be achieved together.

There is no right way of coping with infertility. It is important to allow you and your partner to have time to accept that children may not be a part of your future. There will be times when it is easier to accept and manage this than others. Continue to express your feelings and emotions with your partner. Think about how you have survived together and how your relationship with your partner can get stronger. It is time to think about what you want for yourself.

Moving on from the dream of having children does not happen instantly. It is a journey that involves changing  a mindset and building a new life with a different focus.

Learning to cope with infertility

Infertility can be a devastating shock to a couple but it is important to realise that it is not only a physical condition, it also affects people emotionally - in very different ways. Understanding that people cope differently with infertility helps to accept that individual reactions are normal. Identifying the positives of your situation and how you are coping will help you deal with the stress and grieving that may be felt.
Live for the present. Make the most of the resources you have. Think about your situation now and recognise the positives of life rather than thinking about how much of a difference having a child will make to your life. You may not be pregnant, but think about the things you do have, the things that you enjoyed doing before trying to fall pregnant. Devote time and attention to your partner or to others who may need your help.
Gather information. if you are involved in fertility treatment, make sure that you are well-informed and empowered by  the knowledge you have to assist you in falling pregnant and also by being aware of what can happen if pregnancy does not occur.
Understand the emotions associated with infertility. Become familiar with the emotional stages that you may go through during infertility. These stages can include denial, shock, anger, guilt, sadness, and grief, and these feelings can occur in any order. Remind yourself that these feelings are normal and you have a right to feel them during this time.
Find support. Infertility can be lonely and isolating, but it doesn't have to be. Support is available from many sources, such as your general practitioner or health professional. There are also online support groups, chat rooms, and counselling available. Find a supportive social network to help you get through difficult times.
Communicate with your partner. Emotional support from your partner is very important. Ask your partner how you can support him or her, and tell them what kind of emotional support you need. Think of ways to nurture your relationship and make it your number-one priority. Be aware of each other's emotional responses to stressful situations.
Set achievable goals that are not related to having children. Think and plan for things that you can do as a couple, such as travelling together or long-term plans for sharing the future together, rather than putting your life on hold waiting to fall pregnant.

INFERTILITY: COMMON QUESTIONS

What is infertility and when should I seek medical help?

Most experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have repeated miscarriages may also be said to be infertile.

Most healthy women under the age of 30 shouldn’t worry about infertility unless they’ve been trying to get pregnant for at least a year. At this point, women should talk to their doctors about a fertility evaluation. Men should also talk to their doctors if this much time has passed.

In some cases, women should talk to their doctors sooner. Women in their thirties who’ve been trying to get pregnant for six months should speak to their doctors as soon as possible. A woman’s chance of having a baby decrease rapidly every year after the age of 30, so getting a complete and timely fertility evaluation is especially important.

How does age affect fertility?

From the age of 30, the per month chance of conception is a little over 20%. By the age of 36, a woman’s chance of conceiving per month decreases to 15%. The downward slope continues until about age 45, with the average natural fertility rate per month being approximately 1%.

What causes infertility?

There are many reasons why a couple may not be able to conceive naturally. After a woman’s age, male infertility is the biggest single factor.

Other causes of infertility might include ovulation disorders, tubal disease, endometriosis, and a combination of male and female reproductive issues.

What are the options for treating infertility?

There are a number of medical options for treating infertility. It is best to talk to your health professional to seek advice on the steps to take to deal with the infertility and also to work out what is causing the infertility.

There are also non-traditional medical treatments, naturopathic or holistic treatments some couples can consider trying. Couples may also seek counselling if there is no medical reason as it may be a psychological issue.

When do I decide to stop the fertility treatments and think about other options?

Some couples decide that as much as they want to have a baby, they won’t go to extreme measures or pursue invasive fertility treatments. Others spend years and thousands of dollars exhausting all of their options.

No one can tell you when to stop trying to conceive – that’s a decision you need to make with your partner and your health professional. You need to think about how far you are willing to go to get pregnant and if you only want a biological child rather than looking at the option of adoption or fostering. Some couples experience a clear moment when they make their decision; others may find themselves changing their decision several times, revisiting it as their feelings shift. 

Small Miracles: Coping with Infertility, Miscarriage, Stillbirth and Premature Birth, by Rachel Stanfeld-Porter and the Bonnie Babes Foundation, is a landmark self-help book offering practical advice, inspiration, and comfort for anyone coping with the loss of a baby through miscarriage, stillbirth, or prematurity, and related issues such as infertility.