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Every so often, a reader of this column writes to me with a specific request about a topic they may wish to read about. Due to the nature of my work, I receive many requests related to infertility. But as this column is meant for the wider public, I tend to mostly honour requests on topics of general interest. But this week, I feel compelled to honour a recurring request on failed fertility treatments.
Those who have ever suffered infertility will be well versed with all the trauma that comes with the diagnosis. It all starts with the frustrations of not getting pregnant, when everybody else appears to be getting pregnant, if when they don’t want to. Then there are seemingly endless diagnostic evaluations, followed by proposed treatment options. Some will get pregnant quickly following specific interventions. But others will not. Failure is associated with psychological and physical trauma, all on top of the vast financial burden inevitably associated with fertility treatments.
When a diagnosis of infertility is made, simple interventions will be tried first if applicable. Others may require complex treatments from the word go. In vitro fertilisation (IVF) ends up as the ultimate recommendation in couples with complex diagnoses, or when all else fails. IVF success rates have continued to rise since the 1980s; however, failures persist.
So why do fertility treatments fail? It all starts with the actual diagnosis and the apparent remedial options. Some infertility causes cannot be modified, an obvious example being advanced age, which contributes to recurrent failures. Human reproduction is also very inefficient; most eggs and sperm are not destined to lead to a pregnancy, and this is also reflected in fertility treatments. And then there is the complexity of advanced treatments, clinical experience and competency, and all the infrastructure that must be in place for efficient fertility services.
Once a completed fertility treatment attempt has failed, a detailed review is usually warranted. Your fertility team should invite you for a critical recap of all that transpired. This may sometimes pinpoint why the failure occurred and form the basis for further treatment with appropriate adjustments. Sometimes, nothing specific is apparent, with the failure attributed to hypothetical possibilities, adding to frustrations.
Such a review helps couples gain closure and decide whether to continue treatment.If you find yourself at the end of the road, other options may open up. You could choose to live childless and still find fulfilment. Others may take the path of adoption, which continues to enrich many families. Psychological support after failed treatments cannot be gainsaid.
Dr Murage is a Consultant Gynaecologist and Fertility Specialist.
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