Chapter 29
When Enough is Enough - The Decision to End Treatment

from the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.

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One of the most difficult aspects of infertility treatment may be examining the question of when to stop medical therapy. You may find yourselves asking, " When should we stop? When will we know that we have done all that we can?"

Only you can tell when you have had enough - you need to make the final decision for yourself. Everybody has a different limit - but it needs courage to recognise when you have reached it. Some couples start planning for alternatives early on in medical treatment and when they reach their limits, they are prepared to try something else. Others may keep going to a point which pushes them beyond their final limits - and sometimes even further !

There are several reasons why infertile couples have trouble stopping treatment. First, there always seems to be a new medical option bringing hopeful opportunities , and patient’s hopes are kept alive by new developments. The pace of change in this field has been very rapid, so that was just a possibility a few years ago quickly becomes a standard treatment that is being offered to a lot of people today. When it seems all the medical possibilities have been exhausted, researchers come up with a new solution, offering another chance to people who dream of bearing children. How can you pass up a new treatment when you've been willing to try everything else? Some couples also seem to get "hooked" onto treatment, and are willing to give up everything to pursue their dream of a baby - they live on hope. Many couples cling to the fantasy that "one more try" would have resulted in a healthy pregnancy. Another reason is that some physicians may not recommend ending treatment. Physicians are generally optimistic that treatment will eventually work and this biases their ability to provide advice about ending treatment appropriately ( to say nothing of their financial motives ). Some couples also feel guilty about stopping treatment even when they have had enough, because they feel they have let their doctor down by not getting pregnant - especially when the doctor has tried so hard! Many couples have lived a lifetime with the notion that if they try hard enough, they will succeed, so that the decision to end treatment seems like "giving up" or a lack of ability to persevere and beat the odds.

How will you recognise when you have had enough? Watch out for some of these factors:

• Do you feel emotionally and physically tired all the time?
• Do you feel sad or depressed much more than you used to?
• Are you finding it harder to be optimistic about your next treatment?
• Do you glumly anticipate a treatment's failure in order to fend off disappointment?
• Are you finding it harder to follow the doctor's instructions?
• Has your relationship with your spouse started to deteriorate even further? Are you fighting a lot more?
• Do you find yourself wondering why in the world you are doing all this?

There are positive reasons to consider ending treatment too - you don't have to wait till you are a wreck before making this decision!

• Are you beginning to focus more on the child, but not your genetic contribution to the child?
• Does the idea of stopping seem like a relief to a lot of your troubles?
• Are you directing attention to other areas of your life - and enjoying it?
• Do you feel proud of how hard you tried, and don't feel the need to do any more?
• Is your curiosity about alternatives increasing?

If you're considering ending treatment, you and your partner will probably find that one of you is ready to stop before the other reaches that point. Remember, it's perfectly natural for people to move at different paces, especially through a process as complex and challenging as infertility and its treatment.

Facing the Decision

If you do find yourself faced with the decision to end fertility treatment, but you're not sure how to go about finalizing it, there are several steps that may help you determine what's best for you. Consider establishing a time frame. It sometimes helps to make a schedule for yourself, even if you decide to modify it later. You could decide, for example, that you will try for another year, or until your next birthday.

Another step that might be helpful is to take a brief " vacation" from treatment. Depending on your feelings after a break, you may realize that you're not ready to stop op - or that now is the time to end treatment.

Infertility, with its endless tests and treatments, has probably meant that so far your life has been put on "hold". But, through grieving and resolving your grief, you can move on again. Remember, you need to finish mourning for the loss of your child before making this decision. Grieving is letting go - letting go of unfulfilled dreams and replacing them with a comfortable reality, to allow resolution.
Talk to others who have decided to move on. This is especially helpful if you are having difficulty deciding what to do next. Ask others how they made the decision and how they feel about it now. Additionally, professional counseling can be very helpful in assisting you with decision making.

Finally, accept and expect that your infertility will remain a part of you. The decision to stop treatment brings resolution and closure, but it may not necessarily remove the ache of infertility. However, once you do accept your decision, you may find that your disappointment gradually disappears.

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Other IHR Web sites: 
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Professionals: InfertilityProfessionals.com
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