Emotional Considerations

In Vitro Fertilization Program

IVF patients have often stated that they were unprepared for the overwhelming emotional experience of IVF and that they needed to know what to expect both physically and emotionally. A number of research studies have explored the emotional aspects of IVF and the results are summarized for you on these pages.

Couples who choose IVF have long been on an emotional roller coaster of alternating hope and disappointment, both in each monthly cycle and with each new treatment.  The IVF experience is similarly described, with hope and elation followed by letdown and sometimes extreme disappointment.  Each step of the treatment brings new and increased stress and anxiety.  The following is one patient's account of IVF:

It's like a steeplechase.  One hurdle after another.  First you worry that you will not be accepted in the program.  After you are accepted, you worry about all that waiting and the enormous cost.  Once you start the program, you worry that you might do something wrong or that you will not understand the instructions.  Then you worry that they will not get eggs.  Or that the eggs won't fertilize.  Finally they do the implant and you are hit with what you feared all along - that you won't get pregnant (1).

Many IVF couples report feelings of desperation--most believe this to be their last chance to achieve a pregnancy.  They also report optimism to "beat the odds," understanding the chance of success.  Couples must perform a balancing act to keep their expectations realistic while retaining enough hope to carry out the treatment.

IVF couples report feeling isolated both during the earlier infertility treatment and during the IVF process.  Many have kept the decision to obtain infertility treatment a secret from family and friends, people who would otherwise be sources of support.  If it is necessary to stay in a motel during IVF, being in a strange city away from familiar comforts increases feelings of being alone.

One of the stresses often reported by IVF couples is "loss of control."  The long hoped-for dream of having a child that is biologically yours is in the hands of scientists and fate.  Multiple blood samples, injections, examinations and procedures give rise to feelings that your body also is subject to the control of others.

While studies have demonstrated that women generally have a more pronounced emotional reaction to infertility than do men, extreme worry is reported by IVF male partner’s more often than by the female partner.  One source of worry is the anxiety-provoking task of providing semen at a critical time.  But most of their worry is about their female partner, who undergoes so many procedures and assumes all of the physical risks.  For couples that live too far away to commute, the male partner may not be present for much of the process and the "unknown" increases their worry.

(1) Greenfeld, D. and Haseltine, F.: Candidate Selection and Psychosocial Considerations of In Vitro Fertilization Procedures. Clin. Obstet. Gynecol., 29(1):119, March, 1986.

For women who are students or who have jobs that are anything less than extremely flexible, an IVF cycle is a major life disruption.  Two weeks must be largely freed from work or study with relatively short notice.  This is followed by an additional two weeks of restricted activity.  Couples who would prefer secrecy may be forced to explain IVF-related absences and activity limitations to employers.

As technology advances and more choices become available the stress of decision-making may override all other concerns.  While most IVF couples say the decision to do IVF was not difficult, some couples agonize over whether to invest considerable time, money and energy in a gamble with no guaranteed pregnancy.  Decisions will be required regarding whether to fertilize all eggs, freeze the additional embryos, how long to keep them frozen, what to do with them if you don't use them.  Individual moral and ethical issues must be addressed and personal choices made.  Religious and social pressures must be dealt with.  Agreement between couples must be reached.

Most difficult of all is when pregnancy does not occur.  Couples may experience a grief reaction similar to that, which follows a miscarriage.  Anger and depression are common responses.  When IVF has been kept a secret the support system of the couple may be inadequate.

When pregnancy does occur, while balanced by joy and celebration, there are new concerns.  There may be fears of miscarriage or tubal pregnancy.  If multiple gestation occurs (triplets or greater), a decision regarding multifetal reduction must be made. Women over 35 must decide about testing for chromosome problems that may cause birth defects.  It is important to know that all couples have mixed feelings about pregnancy and parenthood.  The fact that pregnancy was greatly desired and pursued does not erase the fact that there are discomforts involved.  Changes such as increased responsibilities and decreased freedom are distressing to couples whether or not they have experienced infertility.

What Helps?

1.   Know what to expect.  Eliminating as many unknowns as possible reduces stress.  Information increases feelings of being in control.  With good understanding you'll know what questions to ask and you can be a more active partner in managing your treatment.  You should know that at each step the treatment could be canceled.  You should know that IVF might not succeed in the first attempt.  Be realistic, based upon your age, diagnoses, treatment available and success rates.  If pregnancy is not achieved a lot has been learned about you and what else might be tried in the next cycle, plus there is evidence that repeated attempts at IVF increases the overall chance for pregnancy.  The first and last IVF cycles are the most stressful--the first because of the unknown, the last because so much is at stake when all current options for a biologic child have been exhausted.

2.   Cushion yourself with as many sources of emotional support as possible.  We have a counselor available to you throughout the treatment cycle and after you leave.  The medical and nursing staff expects to be sources of ongoing emotional support.  Possibly the best support persons are other infertile friends or patients.  Identify a support person near home that you can talk to after you leave.

3.   Working through decisions before starting the treatment will decrease stress during the IVF cycle.  Clarify the position you and your partner will take on fertilizing all eggs, freezing embryos, and multifetal reduction.  Have an idea of how many treatment cycles you will do.  Consider what you will do if treatment is not successful.  Consider your feelings toward donor eggs, donor embryos and adoption.  It is important that couples leave the program glad that they took the chance; confident that they have done everything they could to achieve a pregnancy, relieved that they have finished the task of infertility treatment.  They can then go on with their lives, exploring the other alternatives to achieving parenthood or remaining childfree.