Why Some People Choose NOT to Seek Infertility Treatment

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I have dealt with a lot of bewilderment, questioning, and even outright anger over our choice. I have been told by other women, in infertility communities, that I "must not want a child enough" if I'm not willing to put everything on the line in order to get pregnant and have a baby. I have had heated, difficult discussions about the matter with family members who disagree with our choice.

But it is our choice to make, just like it is every individual's, whether to become a parent or not—be it naturally, be it through adoption, be it through medical assistance. I wanted to write this article to explain some of the extremely valid and important issues every person dealing with infertility must consider seriously, and why some of us choose to say no to medical intervention. Fertility treatment is not the easy, simple and "surefire" cure that much of the fertility industry and commercial media would like you to believe it is today.

Image creditFertility treatment is considered an elective, non-essential group of procedures and practices. Therefore, it is not covered by many insurance plans or only in a limited fashion (see RESOLVE's Fertility Scorecard which shows the statistics state by state). Some countries do allow for testing and perhaps 1-3 round of in vitro fertilization for free, depending on meeting certain qualifications, but after that, couples and individuals are on their own. And trying to have a baby when it's not happening naturally doesn't come cheap.

How much do common infertility treatments tend to cost? A chart of national averages in the U.S. gives a good breakdown for various typical procedures, including:

• $50 - $3,000 for various diagnostic tests (each), initial doctor's evaluations, bloodwork, etc.
• $800 - $4,000 for a monitored Clomid cycle
• $300 - $1,000 for Intrauterine Insemination
• $11,500 In vitro fertilization (IVF)
• $28,000 IVF with donor eggs

Many couples end up going through round after round of various procedures and praying that this time it will work, that the odds will be in their favor—even if it has failed them 3, 4 or 10 times already. Couples have been known to drain their entire life savings, sell their homes, even go into bankruptcy while chasing the dream of having a child of their own. There is even a growing trend of using crowd-funding websites to ask random strangers on the internet to fund couples' fertility treatments. (See: recent New York Post and New York Times articles on the subject.)

Some of us? Just don't have that kind of money to burn chasing a dream. Or the financial cost on a gamble with bad odds doesn't seem worth it.

Image creditFertility treatments generally have the greatest rates of success for women who are younger: in their twenties and early thirties. After that the chances of a successful treatment begin to drop rapidly. The CDC compiles national statistics annually on Assisted Reproductive Technology (ART) success rates, and the 2012 results online give just some of the following statistics:

Percentage of cycles resulting in live births using fresh embryos from non-donor eggs:

• Women < 35 years of age: 40.5%
• Women 35-37 years: 31.3%
• Women 38-40 years: 22.2%
• Women 41-42 years: 11.7%
• Women 43-44 years: 4.5%
• Women > 44: 1.8%

For older women, percentages are better if donor eggs are used, and many clinics will set an upper age limit of 42 to 45 for the use of one's own eggs. But again, donor eggs adds to the cost of procedures, still are no guaranty of success, and do involve making the choice of not having a child that is genetically one's own. Plus there can be ethical considerations involved—more on that later in this article.

I was 36 before I even began to think I might have a fertility issue. I had only met my partner when I was 34; by the time we were getting serious and the idea of starting a family was in the picture, I was coming up on 40 (and he near 50). For us the odds just didn't seem good enough to take the financial risk, let alone the other risks potentially involved.

Image creditThe fertility industry tries to assure everyone that treatments are safe but evidence about longterm side effects are not entirely conclusive. Some studies suggest that all is well, others suggest that there could be an IVF Timebomb ticking away—not just affecting womens' health but the health of babies conceived through Assisted Reproductive Technology (ART).

Fertility treatments generally involve hormonal injections, stimulation of the ovaries to induce ovulation, and/or surgical treatments which can induce scarring and carry standard surgical risks. One medical professional in the UK in recent years has urged clinics to utilize more "natural IVF" processes and reduce the hormones pumped into women during treatment:

"This is the only area of medicine where drug dosages are not regulated, and that's wrong. We have recommended doses but they are not binding and some clinics are exceeding these levels." - Geeta Nargund in The Independant

A person may simply feel that there is too much uncertainty yet to go forward with these therapies, or have family/personal histories of illness that make the risk not seem worth the possible reward. Is it worth it to, perhaps, risk developing ovarian or uterine cancer just to have a baby, whom you then might not be able to see grow up? Some people may at the time convince themselves it's worth the risk but then have great fears about their future.

Image creditThere is also the fact that the hormonal ups and downs during treatment can be terrible for womem. Mood swings, headaches, weight gain, bloating, depression, ovarian cysts, ovarian hyperstimulation syndrome and menopause-like symptoms including hot flashes are just some side effects that may have to be suffered through.

I have personally heard from several women who were driven to almost suicidal levels of depression after repeated failed IVF cycles, others who have told me they wish they'd never gone through the nightmare of treatment even when they did eventually conceive and give birth to a child.

Image creditSome religions and religious groups have objections to certain types of fertility treatment or only approve of methods which fit church doctrine on the creation and sanctity of life. (See: "IVF: Religion & Third-Party Reproduction".)

IVF generally produces multiple fertilized embryos which may or may not be implanted for a chance at life. For those who believe that life begins at the moment of conception, wasting fertilized embryos is no different than abortion—therefore not acceptable within their religion. There may also be the aspect of "playing God" instead of allowing God to be the one responsible for creating and giving the gift of life.

I'm not passing judgement one way or another on these beliefs, but they are very real among many and why some couples may choose not to seek certain types of fertility treatments.

Should one's desire to become a mother potentially put the health and future fertility of other women at risk? If a woman requires donor eggs in order to potentially conceive—which often can be the case for older infertility patients or those who otherwise lack healthy eggs of their own—that's a question she should ask herself.

There is growing concern that the practice of donating eggs, which young women may see as an "easy" way to earn some extra cash while helping infertile couples, can cause health problems for those women in the future. Some have faced complications which have cost them their own fertility, and the long term health risks, such as for cancer, are largely unknown. A recent documentary, eggsploitation, explores this topic in detail and the way healthy young women are treated as a commodity to be exploited by the fertility industry.

Image creditSeeking fertility treatment is a huge undertaking for all of the reasons listed above. It's also something that both people in a committed relationship must be on board for fully, in order for their relationship to survive the effort, time, inconveniences and expenses that are involved.

Intimacy often suffers as intercourse becomes focused solely on baby-making and tight schedules of maximum fertility, doctor's appointments and injections. A husband may be more willing to accept a future without children than his wife is, or vise-versa. If both people aren't on the same page about wanting to seek treatment, how far they are willing to go with treatment and how much they are willing to spend on it, then it could lead to significant relationship strain, even potentially divorce. Studies have shown that couples are three times more likely to divorce after failed fertility treatments.

Many if not most adoption agencies require couples seeking child placement to not be undergoing fertility treatment. There may even be a wait period required between last fertility treatment and the time at which you can begin the adoption process; in the UK it generally is 6 months (according to First4Adoption).

Both adoption and fertility treatment generally require time and money that may be in limited supply, especially for a couple in their later 30s or early 40s. Such a couple might choose to pursue adoption instead of medical treatment as a more likely successful path toward family building.

Every individual or couple facing infertility must make extremely personal choices about how they want to move forward. The decision to pursue fertility treatments, or not to pursue them, must be made carefully, thoughtfully, and with full awareness of the potential risks as well as potential rewards. Treatment is not a guaranty of a "miracle baby"—and neither is receiving that miracle baby a guaranty of a happily-ever-after life. Some decide to choose the path of remaining childless and embracing the childfree life, even if they may always wonder "what if". Some will never feel satisfied or able to move on until they feel they have exhausted every possible treatment, all financial resources, and the last of their physical and emotional stamina.

We should not judge a person based on their choices in this matter. If someone chooses not to pursue treatment, or stops after a first or second failed treatment, that is her choice. It does not mean she did not "deserve" to have a child. It does not mean he would not have been a good father. It just means that person made the choice that was best for them, and it might not be the same choice you would make. All we can do is educate ourselves, open up our minds, and accept that we each must walk our own paths in life.