You go into IVF brimming with hope. You do all the research and most times, you tightly grip on to the positive odds. Even if – at the back of your mind – you realise that this may not work, that failure is possible at each and every step, you will it to work. You are buoyed by your partner, doctors, nurses, family and friends who tell you stay positive. You pray.
Sometimes, it fails anyway.
While Elizabeth’s story is a sad one, her message is a positive one, and one that resonates.
“…know that you can foster resiliency in yourself and others. By taking the time to mourn the loss of your fertility. By communicating your feelings effectively with a partner. By investing in family and friends who support you without criticism. By finding an infertility support community. And by developing an action plan ― whether that means trying IVF again, turning to donor eggs or sperm, looking into adoption or living a child-free life.”
If you’re reading this, thank you for being a part of my support community.
The piece, in full, follows:
By Elizabeth Merill
My partner and I flew from Illinois to a New York City fertility clinic in spring 2017 to thaw the 20 eggs I froze when I was 37 years old.
We felt confident we’d succeed, mainly because our doctor assured us we’d produce at least one child from my frozen eggs. And also because we’d bought into what we saw all around us in the media, like magazine covers featuring celebrities who’d given birth to twins after age 40, presumably via in vitro fertilization.
I think about this trip often, but particularly during National Infertility Awareness Week, which runs from April 22-28 this year and marks the one-year anniversary of our experience.
During IVF, a woman injects hormones into her body for several days; this enables her ovaries’ follicles (which house her eggs) to quickly mature. Multiple eggs are then extracted, fertilized with sperm in a petri dish, and allowed to grow for several days until they are finally transferred into a woman’s uterus.
I’d already gone through the hormone injections and egg extraction process in my late 30s; however, to ensure success, our doctor suggested I do one more IVF cycle. Then, we could thaw my original 20 eggs and fertilize them along with the eggs we retrieved from the fresh cycle ― and transfer an embryo.
Sounds straightforward, right?
In my case, it wasn’t. Only six of the 20 frozen eggs thawed properly, and our doctor was only able to retrieve six additional mature eggs from my fresh cycle.
My partner and I started feeling anxious. What happened to the other 14 frozen eggs we’d intended to thaw and use? The eggs I’d relied upon as my fertility insurance policy for the past two years?
“Not to worry,” our doctor reassured us. “Of your 12 eggs remaining, 11 have fertilized into embryos.”
But seven days later, our doctor called with bad news.
“I’m afraid that none of your embryos have grown normally. We will have to discard them.”
Our IVF cycle had failed.
Approximately 12 percent of women in the U.S. between ages 15 and 44 experience infertility, defined as the inability to conceive after 12 months of regular sexual intercourse. If you are older than 35, the timeline used to diagnose infertility is much shorter ― six months of timed intercourse.
The inability to reproduce can be extremely distressing in and of itself, and my experience has been no exception. Women are socialized, often beginning at an early age, to assume we will become mothers at some point during adulthood (if we so choose). When this dream is disrupted by the newfound knowledge that we are infertile, an identity crisis often results ― the “self” that would become a mother, caregiver and family member is suddenly in question.
My partner and I were advised by another doctor to invest in a second IVF cycle at a different fertility clinic ― just in case that first lab was to blame for our poor results. We still had reason to hope. So we attempted two more rounds of IVF.
And we weren’t alone. According to the latest numbers from the Centers for Disease Control and Prevention, fertility clinics in the U.S. performed 231,936 IVF cycles in 2015, but only 60,778 of those cycles resulted in deliveries. That means only 26 percent of IVF cycles produced babies ― and this percentage was considerably lower for women over age 40.
The emotional impact of a failed IVF cycle is overwhelming and cannot be overstated. Infertile women have been found to have elevated anxiety and depression levels similar to women with heart disease and cancer. To many, infertility means loss ― loss of reproductive capacity, loss of a child, loss of genetic continuity, loss of a pregnancy experience, and/or loss of the potential to reproduce biological offspring with an intimate partner. With each failed IVF cycle, my partner and I were forced to grapple with the loss of our fantasy family and a loss of faith in science.
Many couples find themselves in grief or in mourning after a failed IVF cycle. After our first failure, I felt hopeless. I’d assumed I was going to become a mother. When that didn’t happen, I felt as if someone close to me had died. After all, IVF was supposed to be a miracle cure, allowing me to pursue my career and ultimately build my family.
Initially, I was in shock. The knowledge that those 20 eggs I’d frozen at age 37 were suddenly gone was baffling to me. I avoided phone calls from expectant friends. I declined baby shower invitations. When a television program showcased babies or toddlers, I quickly switched the channel. I couldn’t associate myself in any way with pregnancy, childbirth or motherhood, because they reminded me of what I’d lost ― and what I still desperately wanted. I sought comfort in my partner, the one person I knew could truly understand my anguish.
Unfortunately, cycle failure can be a major source of marital strain. A 2014 study by the Danish Registry identified women who were diagnosed with infertility or undergoing fertility treatments and followed them for an average of seven years. Researchers found the women who remained infertile were three times more likely to have split from their partner than the women who had successfully given birth.
Many men and women seeking assisted reproductive technology like IVF have presumably been trying to conceive on their own for an extended period of time, and this psychological pressure can have a negative effect on a couple’s sexual relationship. Couples often feel exhausted and frustrated by this change in their sex lives; each session reminds them of what they haven’t yet “achieved,” causing excessive guilt and shame.
A failed IVF cycle also frequently leads to exclusion (or perceived exclusion) from peer groups. Friends of childbearing age are focused on family-centric activities and schedules, which can isolate infertile individuals and couples. This only amplifies that damaging internal narrative that the rest of us are “childless” or “incomplete.”
I am a clinical psychologist, so I assist individuals and families in processing loss. I am also a woman struggling to conceive, so I understand that mourning IVF failure and redefining oneself requires time, patience and reflection. This can be particularly challenging in a society where dialogues about one’s infertility are largely forbidden or, at the very least, uncomfortable.
My partner and I ultimately turned to other friends who were going through similar struggles and could speak our language. After IVF failure, strong support systems are paramount to developing the emotional tools to forge ahead ― on whatever path that might be.
If you find yourself in similar shoes this National Infertility Awareness Week, know that you can foster resiliency in yourself and others. By taking the time to mourn the loss of your fertility. By communicating your feelings effectively with a partner. By investing in family and friends who support you without criticism. By finding an infertility support community. And by developing an action plan ― whether that means trying IVF again, turning to donor eggs or sperm, looking into adoption or living a child-free life.
Elizabeth Merrill is a clinical psychologist for the Department of Veterans Affairs. She has a Psy.D. from The Wright Institute in Berkeley, California, is board certified in clinical psychology and is a certified group psychotherapist.