When you are "stuck"--impasses in infertility treatment

Infertility treatment is often a long and complicated process, sometimes involving difficult choices and courses of action. Naturally, individuals in infertility treatment may need to stop and take time to consider their choices. In addition, sometimes a complete break from treatment, to recover both emotionally and physically from its demands, is necessary in order to continue in the long run.

However, sometimes what starts out as a break or a time of contemplation can turn into in an impasse, in which the individual or couple is unable to move forward. Unfortunately, such impasses are common. The noted psychologist Alice Domar, Ph.D., who specializes in working with infertility issues, recently published a study that examined the reasons people drop out of infertility treatment. She predicted that financial or insurance reasons would be the primary reason for dropping out of treatment. Instead,she found that emotional stress was the most common reason, with 50-65% of couples citing it as their main reason for ending treatment. I suspect that many of the couples who dropped out of treatment despite having the financial resources to continue were at an impasse in their treatment.

What makes an impasse different from a break? In my mind, there are a few defining characteristics. One is the duration of time involved. For example, if the planned break of a couple of months now extends to the better part of a year without other extenuating circumstances changing, it is likely that an impasse has occurred. Also, if the topic of infertility treatment is avoided or rarely discussed, this may be another sign that you are at an impasse. Conversely, if infertility issues are frequently discussed, but in an a ruminative fashion, with the same content and the same outcome, this could be another indication that there is an impasse.

Experiencing an impasse can cause delays in infertility treatment. Of course, delays can be very problematic from a biological perspective, as a woman's ovarian reserve and egg quality tends to decline as she ages, sometimes quite rapidly. But biology aside, delay can also be problematic from a developmental perspective. Having children can be seen as a developmental milestone which produces increased psychological growth. Also, people can feel left behind watching their peers create create families and have new experiences, when they have so far been unable to achieve this goal. Thus, delays caused by an impasse can have damaging and far-reaching effects.

In this post, I will discuss a few of the common causes of an impasse, and offer some suggestions for addressing this problem.

Denial

In my practice, I have seen impasses occur when someone wants to deny a painful truth about their infertility. As an example, I once worked with a married woman in her mid-forties who desperately wanted to have a child. Despite her age, history of infertility, and extremely elevated FSH level, she refused to consider the possibility that she could not use her own eggs to start her family. She became enraged when RE after RE suggested that she consider using donor eggs or adoption. Instead, she chose to try some risky alternative treatments, and was very disappointed when they did not produce a pregnancy. When I suggested that she needed to mourn the loss of having a genetic connection to a child, she became angry with me as well. Although this example is a bit extreme, it demonstrates how denial can keep us stuck and unable to move forward with a treatment plan that has the best chance of success.

Fear of failure and the defense of withdrawal

Another very common cause of an impasse in infertility treatment is the fear of failure. Feeling that you would be unable to cope with another failure or loss can sometimes cause an emotional paralysis, in which you know you want to continue in treatment but nonetheless are unable to move forward. You might withdraw from infertility treatment, and even from discussing the topic of infertility. I experienced this myself when I reentered infertility treatment after the adoption of my oldest child. Although I knew I wanted to try again, it took me over a year to make an initial appointment with a new RE. Many times during that year, I started to make the appointment, but was flooded with memories of all of my previous failures, and was unable to complete the phone call. When I finally did make the appointment, I was surprised at how relieved and peaceful I felt--a sign that the impasse was gone.

Unresolved couples issues

Sometimes, when a couple is unable to move forward with a decision or with the next step of their treatment plan, it can be a sign that there are other issues involved. If the couple is feeling disconnected from each other, for example, they may be unable to feel safe discussing emotionally charged issues. Or if one member of the couple is having doubts about continuing the relationship, they may start dragging their heels in terms of making decisions or beginning a treatment cycle. Alternately, there may be differences in terms of decision-making styles or core values that might cause an impasse in treatment. Usually, once the issue is resolved, the couple is able to move forward in their treatment.

Diagnosing and dealing with an impasse

How can you tell if you are experiencing an impasse? My first suggestion is to evaluate your treatment path, choices, and current timeline using this perspective. If there are delays that are not caused by other identifiable factors, then you might indeed be stuck.

If you do feel you are experiencing an impasse, it is then important to closely examine your feelings about your current situation. Is there something going on that is difficult to accept? Are you afraid of moving forward because you won't be able to handle it if treatment fails? Can you think of any couples issues that might be affecting your relationship?

As a final suggestion, if you are stuck at an impasse, you may want to consider discussing this with a third party, such as a good friend or a therapist. By this point, if you could have resolved things on your own, you probably already would have. Sometimes getting another perspective can really help you realize how you are stuck, and what you can do to start moving forward again.