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By Andrew Geller, Ph.D.

An Infertility Crossroads: What Do We Do Next?

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Question: We have been in infertility treatment for a while, without having any success. Now my spouse and I can’t agree on which path to take next. One of us wants to continue in treatment through one last IVF cycle. The other wants to stop and explore what other choices are possible for us. How do we stop feeling so “stuck?”

Answer: You’ve clearly come to a decision point. There may still be a number of options left such as using a donor, adoption, a gestational carrier, or some further adjustment to your last IVF effort. The challenge is finding ways to move past your disagreement.

You and your partner face each other as veterans of a prolonged siege and, needless to say, despite “holding the fort,” there has been some fraying around the perimeter. You come to realize that, while the two of you are still in the same battle, you may have different ideas about tactics and direction. One of you seems to want one last attempt with IVF, even if the chances are slight. The other single-mindedly asserts that third party reproduction, or adoption – with guaranteed success – is the only way to go.

A first crucial step is to have a frank talk with your R.E. who can present his or her thoughts about the next best steps to take. Be aware, though, that typically physicians don’t see their role as helping couples work out their differences and understand what’s behind their impasse. You very well may have some strong reactions to the options suggested, and you may be asked to go home and give them your full consideration. Candid, heart-to-heart discussion may help you and your partner find your way to a mutually agreeable plan.

I also strongly encourage you to gather information about whatever options are available to you. There can be many misconceptions about them, and attending a RESOLVE of the Bay State program is an excellent way to educate yourselves and try things on for size.

If it appears that you and your partner still cannot agree on how to proceed, I can’t stress enough the usefulness of taking your situation to a psychotherapist who is knowledgeable about fertility and third party issues. Here are some of the important issues that will likely be discussed in sessions with a mental health professional:

Following either multiple failed cycles with only single digit success rates, or following multiple miscarriages, a woman may not be able to bear going through all that another cycle entails. It may then be the most humane option to explore as a couple why her partner cannot accept a third party conception or a non-genetically related child. Sometimes additional information and careful inner exploration can identify misconceptions or fears that can be addressed. Not infrequently, the husband may not truly appreciate the impact of age on fertility.

One or both partners may have concerns about their ability to bond with a child or feel like a legitimate parent to a child not genetically related to them. A man agreeing to use an egg donor may feel like he’s betraying his wife by having a child with another woman; likewise, a woman may feel she’s betraying her husband if she wants to use donor sperm. Looking through some actual profiles of donors may provide a reality check and highlight distortions or misconceptions. Similarly, fears about using a gestational carrier may be put to rest after you speak with someone knowledgeable about this option.

With all of these choices, many of which are second choices, there are losses to be grieved. A skilled therapist can provide the setting for people to gather information, clear up erroneous ideas, and reflect on the meanings that different choices hold for them. A skilled clinician can help the couple grieve their losses and decide to either be childfree or arrive at a way to fulfill their desires to parent.

RESOLVE New England maintains a directory of psychotherapists who are knowledgeable about these matters, and it can be a good form of insurance to bring your specific situation to the attention of an informed psychotherapist. Many clinics also have their own in-house mental health staff with whom you can discuss your concerns.

About the Author

Andrew Geller, Ph.D., is a therapist in private practice in Newton, MA.

This article originally appeared in our Spring 2007 Newsletter.