For women and men undergoing medical treatment for infertility, one thing is clear: it is impossible to take this journey without confronting the emotional component. The quest to become parents is simply too important, and the stakes of treatment too high, to be nonchalant about the process or the outcome. I’ve yet to meet a patient who has told me that if the treatment is unsuccessful, she would be just fine with that.

For physicians and their staff who spend their professional lives treating infertility, the emotional overlay of infertility is likewise ever-present. We understand that our patients come to us in crisis, and that we are charged with helping them to attain one of the most important milestones in life. And, though it may seem otherwise, we are cognizant that what we ask them to do adds to the stressors that they already feel. Treatment protocols are especially demanding for women, as it is they undergo the day-to-day poking and prodding of exams, blood testing and injections, all the while uncertain of the outcome. Needless to say, when treatment is rendered outside of insurance coverage, the financial stress is an additional stressor for all involved.

An Emotional Perfect Storm

This mixture of highly demanding treatment, huge life consequences and uncertain outcomes present a potentially toxic mix. Of course, when all goes as planned and the outcome is positive, our patients perceive us as miracle workers (which, of course, we are not). Psychologically, every difficult aspect of care quickly recedes; every bump on the journey to pregnancy is in retrospect smoothed over.  But, so too, when the outcome is negative, the difficulties and indignities of medical care are magnified. In retrospect, the wait for the monitoring appointment was unacceptable, a late phone instruction was an intolerable delay, the injections were more painful than anticipated, the information given was insufficient. Overall, the caregivers are diminished, and the care labeled inadequate.

The trusted doctor-patient relationship, on which so much depends, may be thrust into turmoil. The formerly trusting patient perceives that, because pregnancy has not resulted, something must have been done wrong. And if the failure is not the first, that perception may morph into anger not only at one’s personal circumstances, but also at the process itself. The doctor’s judgment is called into question. The performance of the staff is impugned. Indeed, when treatments fail repeatedly, the caregivers can become the enemy. The vitriol that laces the online reviews of virtually all physicians – including those loved and respected by most who bother to post on these sites – is reflective of the inner conflict that failure ignites, a cathartic attempt by patients to win a battle or, worse still, to “even the score.”

Online reviews used as a weapon

Of course, sophisticated patients will grab hold of their emotions and understand that their interests are actually aligned with those in whom they have entrusted their care. No doctor or nurse finds pleasure in failure; our patients’ success is our success as well. Still, no matter how serious the commitment to medical excellence, no matter how cutting-edge the care rendered, regardless of how many details are covered and, indeed, despite the best training and the longest experience in managing infertility, the process of fertility treatment often does not succeed with the first attempt, and sometimes – depending on the patient’s circumstances – it does not succeed at all. To put it plainly, there simply are too many unknowns in the treatment of infertility over which even the experts have no control. And, while this is true for all patients, those who enter the treatment process with unrealistic expectations and demands typically are the angriest and unsettled when failure must be confronted.

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In her book, The Upside of Down, Megan McArdle explains the difference between those who fail in life’s many endeavors and those who succeed. Using many examples, she describes how those who are successful in life have achieved their success. It is not because success has come easily to them or at little cost, because there is no such thing as a straight road to success. Rather, it is because those who succeed in life understand the principle of “Failing Well”.  In essence, they perceive failure not as an end to their goal but as an opportunity to learn and prepare differently for the road ahead.

The logic of failing well escapes too many who are engaged in fertility treatment. They come to their first consult with a problem and expect that, with the high recommendations of others, their physician will surely bring their problem to closure easily and with alacrity. Most would like to be pregnant yesterday; many expect that. Sometimes, their physicians are complicit in that thinking.

When life collides with treatment

But just as longstanding and seemingly complex fertility issues often resolve with a pill or a short procedure; so, too, even what appear to be simple problems may not be so and ultimately require aggressive interventions. Until physicians become clairvoyant, none can predict what will work or when. It is crucial, therefore, for patients as well as their caregivers to set realistic expectations and, most certainly, for anger never to insinuate itself into their relationship. While it is understandable that failure can evoke such feelings, they are best directed towards the circumstances, not to those trying so diligently to change them. We are not miracle workers or magicians. We are doctors, and we do this work because we truly care.