Hope and caution during infertility treatment

Many years ago, I worked for a reproductive endocrinologist who hosted a yearly gathering of former patients. It was there that I encountered a woman holding infant twin daughters. When I congratulated her on her twins, she had these thoughts to share: "I'm a psychiatrist and I hope you'll pass this on. Please tell people not to worry about being positive and hopeful. I abandoned hope and went through my last IVF cycle as the queen of negativity." Then she held up her twins and said, "And this is what I got. Please reassure people that they don't have to stay positive."

Over the years, I have come to believe that managing hope is a major challenge during infertility treatment. This story illustrates one facet of the challenge: does it matter if one is hopeful during a treatment cycle? Some patients work very hard to remain positive and to nurture hope, while others, like the mom in the story, ride a wave of negativity. People in both groups have healthy pregnancies. And sadly, there are members of both groups who meet repeated disappointment.

Managing hope is even more challenging when it comes to the big picture, looking beyond a specific cycle and to the question of when enough is enough. During infertility treatments, there are people who remain hopeful when odds are against them and others who lose hope when test results and medication responses seem promising.

Managing hope during infertility

A few factors that contribute to or reduce your sense of hopefulness are:

Personal history. Some people come to infertility with a history of good luck and good fortune, an abiding belief that things work out for them. Their history fuels their hope.

Determination. Threaded throughout the infertility population are some pretty determined people. These hard workers have been rewarded for their efforts on the job and in other areas of their lives. They assume that if they read extensively on infertility, research the best doctors, eat a "fertility diet," and incorporate appropriate alternative treatments, they will succeed in having a baby.

Doctor-patient relationship. Communication between doctors who treat infertility and their patients plays a significant role in fueling or deflating hope. Good doctors do their best to promote an appropriate level of hope. They believe that doing right by their patients means helping them pursue treatment that has a reasonable chance of working, and helping them leave treatment that is unlikely to work. Sadly, there are times when people remain in unsuccessful treatment because their doctors are reluctant to be the bearers of bad news.

Fellow travelers and faith

Fellow travelers. Infertility patients cope with the stresses of infertility by finding each other. Waiting rooms, support groups, and online chats all connect infertility patients. While it can be painful to learn that a fellow infertility traveler has become pregnant against all odds, this sort of news fuels hope. Alternatively, seeing a fellow infertility traveler move happily on to adoption or egg donation can redirect hope. An option that once seemed like "what you do when you give up" now brings new possibilities.

Faith. Faith and spirituality nurture hope for some infertility patients. The nature of this hope may shift from the hope that comes from believing that prayers will be answered, to the hope that comes from believing that some things are meant to be. Guided by faith, these infertility patients have an abiding sense that there are forces beyond them ensuring a safe and positive outcome of this journey.

In working with individuals and couples trying to manage hope and caution as they enter a first or second or fifth IVF cycle, I am always careful to leave it to them to gauge hope. Over the years, it has been humbling to see some people achieve the most unlikely pregnancies while others are mired in disappointment.

These experiences have left me with a profound respect for people's ability to titrate optimism and caution as they make their way through infertility. There are times when a bounty of hope feels right. At other times, infertility travelers need to shelter themselves with caution. This was my takeaway message from the psychiatrist mom I met at that gathering so long ago.