Although IVF success rates are improving all the time it can often take a number of cycles before a patient will see a successful outcome, if at all. As someone who has experienced a failed IVF treatment cycle, as well as a cycle that ended in an early miscarriage, I know how devastating both outcomes can be. In contrast to the minefield of information that exists on how to prepare for IVF treatment there is very little to advise patients how to deal with a cycle that is not successful, and as a result it can be a frightening and hopeless time for many people. After potentially agonizing over the decision to pursue treatment in the first place, months of preparation, not to mention the physical and emotional side affects, it can be very difficult to accept that there will not be a baby at the end of it all. Unless high-quality embryos have been frozen, which can be used for a Frozen Embryo Transfer (FET), many people find themselves at a complete dead end. They are frightened to pursue further treatment, yet unable to accept that this could be the end of the road.
While many people who write about IVF failure tend to describe their initial devastation and their eventual triumph over it, very few actually write about the practical things they might have done to help them through that period of their lives. Even though it is true that grief is a process that takes its own time, there are things that may help you to cope better with everyday life.
Some of the coping strategies I’ve outlined here are more relevant to those who do wish to pursue further treatment, but others are applicable to everyone, regardless of the next steps.
Avoid the blame game
While some degree of anger is expected in the aftermath of a failed IVF cycle try not to let it take over or it can be destructive.
When we found out that our first cycle had failed we were completely and utterly blindsided. We had put all our faith and hope in IVF treatment, and were convinced that it would work for us first time because we were young. To find out that it had failed, and knowing that we had no frozen embryos with which to attempt a follow-up cycle, was unbelievably heart-breaking.
My immediate reaction was to find someone to blame. At first I blamed the clinic, convinced it was their negligence somewhere along the line that had caused harm to our embryos. I reflected back on every conversation I had had with them, trying to find holes in their processes and signs of their incompetency. Then, inevitably, I turned the blame on myself, analyzing every single move I made during the cycle and wondering what it was that I did to stop my embryos from implanting. Being unable to conceive naturally had already been a harsh prospect to come to terms with, but being unable to get pregnant through IVF made me feel more inadequate and more of a IVF failure than ever before.
However, I soon realized that the anger that I was feeling was not helping the situation. In fact it was dragging me down further and preventing me from moving on in any capacity. In the end, I had to accept that it came down to choice. I could choose to let the failure of our cycles consume me or I could choose to try and move on.
Focus on the follow-up appointment
In the first few days, and possibly weeks, following a failed cycle it can be difficult to contemplate another IVF cycle, especially a fresh one. The grief can be so overwhelming that it’s impossible to fathom putting yourself in such a situation again.
About six weeks after a failed cycle, when emotions have settled down a little, clinics will typically schedule a follow-up appointment to review the cycle and try to understand where it might have gone wrong. Try to hold out for this appointment and avoid making any definite decisions until you have talked to your doctor. You may find that there are changes that can be made to the protocols that might help your odds on a subsequent cycle. There may also be further fertility investigations that can be done, or new techniques that can be tried. However, if egg quality is the suspected cause of IVF failure, it is worth preparing for the possibility that treatment options that you had previously rejected, such as using donor eggs, may now be the best chance of success.
Understand why the IVF treatment failed
Try not to leave your follow up appointment without ensuring you fully understand why your treatment may have failed. Many of the IVF patients I spoke to who experienced failed cycles didn’t realise that there were signs throughout the cycle that their odds of success were low. For example, if the fertilization rates were very low, or the quality of the embryos on transfer day was poor.
On our first cycle my husband and I had a very low fertilization rate, and didn’t make it to a day-five transfer. However, we were so happy that we had an embryo to transfer that we didn’t really listen to or question what we were being told. Had we asked more questions along the way, and had realistic expectations, we may not have been so shocked by the outcome. Moreover, we didn’t really question why the treatment may have failed during our follow-up consultation, and so entered into the second cycle with exactly the same protocols.
Don’t rush into anything
When IVF fails it can feel as though you are back at square one. The back-up plan has failed and it can feel like you’ve run out of options and there is no hope left. Having probably spent many years trying to get pregnant naturally prior to attempting IVF treatment, many people feel as though they need to move on without wasting more time. In order to feel as though they are doing something to get over the IVF failure many rush into a decision about what to do next. Some will decide to close the door on IVF completely, and others leap straight into another cycle. In my experience the immediate aftermath of a failed cycle is not the best time to make big decisions.
We started our second IVF cycle barely three months after finding out that our first had failed. On reflection, this was far too soon. I hadn’t allowed nearly enough time for my head, my heart, or my body to heal properly. I wanted to stop the pain, the anger, and the feelings of despair, and the only solution I could see was to get pregnant as soon as possible. In hindsight, there is no question in my mind that we should have taken a longer break to ensure that we were both in optimum condition, both physically and mentally, to withstand another cycle, but we were desperate to do something to alleviate the anguish and get out of that dreadful limbo. The second cycle was easier in some respects, since we were no longer dealing with the unknown. However, we both found it more physically demanding, possibly because we were still so exhausted from the first cycle. Sadly, this cycle was also unsuccessful and ended in an early miscarriage.
Try to focus on what did go well
Even if the ultimate outcome is negative, there will probably be plenty of aspects of the cycle that did go well. Try to focus on these as much as possible, especially if considering another IVF cycle in future.
Following our second cycle I was continuously told by family and friends that I should focus on the fact that at least I could get pregnant. Initially these comments infuriated me, as it felt as though no one really understood just how much we had invested to make it as far as a positive pregnancy test.
Acknowledging the short-lived pregnancy as a positive thing seemed futile. I couldn’t even contemplate the thought of trying IVF ever again – the pain was just too unbearable.
However, over time I started to realize that those people were right – there were positives to focus on, and I tried to gain strength from them. My body had overreacted to the stimulation medication, which may have compromised the egg quality, but this could be adjusted in a subsequent cycle, and although we had suffered a miscarriage one in four pregnancies ends this way, regardless of whether IVF was used or not. As bleak as things were, we had to acknowledge that there was still hope.
Take time out
In the aftermath of a failed cycle it is important to try and take as much time out to grieve and heal as you possibly can. If you haven’t taken time off work during treatment then you should try and take some time out afterwards. Many people I have spoken to found that, although they had felt unable to talk to their employer about treatment while they were going through it, when a cycle failed they found that they had no choice; going to work and putting on a brave face was impossible. They were grieving and needed time to mourn and come to terms with their loss before attempting to resume normal life.
Find a new distraction
After months of researching treatment options and preparing body and mind, not to mention constant appointments and tests at a fertility clinic, IVF may have started to feel like a full-time job. When it is over many people find themselves at a loose end. Without the joy of a pregnancy on which to focus, life can seem very empty all of a sudden, thus exacerbating the pain. If you feel up to it, try to find something entirely unrelated with which to distract yourself, such as a new activity or hobby.
What really helped me was to make a list of all the things I wanted to achieve in my life, whether I had children or not. It was essentially a bucket list that included all manner of activities, both big and small. I started by ticking off the small things: eating in a restaurant I had always wanted to try and going to a museum I wanted to visit. The act of achieving a goal, no matter how small, and being able to tick something off my list made me feel stronger and more empowered.
Consider all your options
Before plunging ahead with a similar treatment plan, convincing yourself it was just bad luck that the first one failed, or before rejecting a new treatment plan that may seem extreme, spend time researching as much as you can. Many people make uninformed decisions about treatment only to regret it afterwards. Talking openly to your doctors and to other patients who have been in your shoes can provide a new perspective. I have talked to many people who eventually became parents through a treatment option that they had initially rejected, so try not to close any doors before you have fully considered the options.
Just as counselling can offer invaluable help to ART patients before and during treatment, it can also offer support when it fails. A number people who have experienced IVF failure told me that they gained huge strength from attending counselling sessions. Counselling will be particularly helpful for those who are unsure of whether to pursue further treatment or not.
Look after your relationship
A failed IVF cycle can take a huge toll on those who are in relationships. Like all forms of grief the way each individual deals with the loss may be very different; this can lead to tension and even feelings of resentment between a couple. Having gone through three IVF treatment cycles I can understand why so many relationships do not survive IVF failure. Day-to-day living whilst going through the process becomes extremely strained and the relationship itself can become less important than the goal of having a baby. Difficult as it may be, try to spend time talking and understanding each other’s grief, and continue to make time for yourselves as a couple.
The above extract is taken from Five Million Born – An IVF Companion Guide by Anne-Marie Scully. It is available to buy now for Amazon Kindle for a special promotional price of just $1.99.