You’ve probably heard the saying, “If at first you don’t succeed, try and try again.” Well, when it comes to in vitro fertilization (IVF, a form of assisted reproductive technology whereby doctors combine egg and sperm in a lab dish before transferring the embryo to the uterus, the saying is likely “try, try, and try some more. And maybe you’ll get the result you want.”
I might sound less-than-reassuring, but IVF can be challenging. Though it’s one of the most successful forms of assisted reproductive technology, the live birth rate from one IVF cycle is about 55.6% for people under 35, and 40.8% for folks between the ages of 35 and 37, according to the Society for Assisted Reproductive Technology (SART). The live birth rate falls to 4.1% for people over 42 years old, SART explains. And even for those who undergo in vitro fertilization treatment and become parents, it takes an average of 3.6 IVF cycles to achieve pregnancy, according to the National Institutes of Health (NIH).
As it turns out, I’m “above average.” At the time of publication, my husband and I have undergone four unsuccessful IVF cycles. We diligently followed the rules—setting alarms for medications, administering the daily cocktail of injections at their respective times, going to the clinic for monitoring appointments that involved bloodwork and ultrasounds every other day without fail—and it had gotten us nowhere. Three cycles resulted in negative pregnancy tests, and one embryo transfer was canceled altogether due to too much fluid in the uterine lining, creating an inhospitable environment for the embryo.
My fertility issues stem from blocked Fallopian tubes, most likely caused by scar tissue from a myomectomy to remove nearly 20 fibroids. When I think about my reproductive journey overall, it seems like one blow after another. What’s more? I didn’t actually realize failure was an option until our first unsuccessful cycle last spring. We were devastated. Here we’d invested all of this time, money, and energy, and we had nothing to show for it. But then I read that Chrissy Teigen’s first round was unsuccessful, too (she’s my IVF hero). Her story helped me find solace, a renewed sense of hope, and the will to get back in the ring.
As it turns out, I’m not alone. Eleven percent of U.S. women within reproductive age have experienced fertility issues, according to NIH. And as if that weren’t enough, I’d also learned that Black women like me are around twice as likely to experience infertility compared to white women. Sure, there’s comfort in numbers, but that did nothing to reassure me that IVF would be successful for us.
“The biggest pain point of infertility is dealing with the sense of uncertainty,” Marissa Nelson, L.M.F.T., a Washington, D.C.-based licensed marriage and family therapist who specializes in couples and infertility, tells SELF. “Because you don’t know what the next steps are. Where do we go from here? How do we deal with this? Should we adopt? Should we not? Should we stop? It all becomes very overwhelming.”
No two people nor cycles are the same, but there are a few lessons I’ve learned that I wish I’d known at the start of this journey:
1. There are common reasons an IVF cycle might be unsuccessful.
Chromosomal abnormalities are common (in embryos and live births alike). Still, they can contribute to IVF cycle failure, according to Roohi Jeelani, M.D., a Chicago-based reproductive endocrinologist and infertility specialist. According to the National Human Genome Research Institute, chromosome abnormalities are either numerical or structural. With a numerical abnormality, there are too many or too few chromosomes in a cell. With a structural abnormality, the chromosome’s structure has been altered. There’s mixed evidence about just how much chromosomal abnormalities impact IVF success rates, but they are a factor (and one that, unfortunately, you can’t control).
Another major reason that IVF cycles might be unsuccessful involves endometrial receptivity. It might sound simple, but a lot of factors have to align for an embryo to successfully attach to the uterus during a successful IVF cycle. As noted by the National Center for Biotechnology Information, the endometrium (the membrane lining the uterus) plays a pivotal role during the implantation window, the time during which your lining is at its most optimal state to receive an embryo properly. “We administer all this medication, but maybe the [uterine] lining isn’t receptive enough to latch on to the embryo. So they’re out of sync,” Dr. Jeelani explains.
And finally, there’s simply an element of good luck involved. “I call it my black box,” Dr. Jeelani says. “We put the embryo in there, we think the lining looks perfect, and then we hope that all the right magic happens for it to implant.”
2. Genetic testing is an option.
Given that chromosomal abnormalities are a factor, you can opt for something called preimplantation genetic testing (PGT) if you feel comfortable, it’s available to you, and it’s within your means. During this procedure, technicians take a sample of cells from each day-five embryo and send them to a lab to check for chromosomal abnormalities. Embryos that are considered abnormal are not transferred, according to Washington University Physicians Fertility and Medical Reproductive Medicine Center.
Because our doctor recommended PGT on our remaining embryos, we ended up doing a second egg retrieval as about half of the embryos were deemed genetically normal. It’s important to note that PGT doesn’t necessarily guarantee successful implantation or a newborn without any genetic abnormalities, according to the American College of Obstetrics and Gynecology (ACOG). Additionally, PGT typically isn’t covered by insurance and can be pretty costly (exact numbers vary, but it can be $200 or more per embryo). Still, I wish we’d considered it at the beginning of our IVF journey because it may have saved some time and heartache. But hindsight is 20/20.
Even though we had seven healthy embryos between our two egg retrievals, only four were deemed chromosomally “normal.” We felt optimistic about our January transfer with a chromosomally normal embryo, but that cycle also failed.
3. Make significant space for IVF in your schedule if you can.
This is a marathon, not a sprint. And as a friend once told me, IVF is a full-time job on top of your actual full-time job. Plan and prepare accordingly, but not too much. IVF is wildly unpredictable, so it’s best to clear your calendar as much as you can to accommodate appointments and procedures. After all, everything depends on how your body responds to the medication. Every body and every cycle is different. What worked for your friend or what worked for you last time may not work this time.
If possible, take the day of the transfer and the next couple of days to relax. Your body has been through a lot—hormones, planning, and prepping—and you could likely use the time to rest. You may also want to take off the day of your pregnancy test, so you can process the results without having to worry about Slack if possible.
4. You can take breaks between cycles.
My husband and I opted for a break after our first cycle to regroup physically, emotionally, and mentally. There’s no solid scientific proof that a break helps or hurts your chances of conceiving, Dr. Jeelani says.
When deciding whether or not you need to take a pause, “It’s a little bit of medicine and a lot about how you feel emotionally,” Dr. Jeelani says. “There’s no change in outcome if you take a break. Some patients think, ‘If I go back-to-back, then I have a higher success rate,’ and that’s not true either.”
Whether to try again or wait depends on your specific needs (including financial considerations). If you have embryos in the bank, you don’t need to rush another transfer. “But if you don’t have any embryos … time and fertility kind of go hand-in-hand,” Dr. Jeelani shares, as the quantity and quality of eggs decreases with age. You might’ve heard that fertility takes a steep decline after 35, but that’s not entirely true. Yes, there will likely be a noticeable change in your fertility after that point, but, as SELF previously reported, the 35-year-old mark isn’t the sheer fertility cliff that many people think it is.
By late August of 2020, we were back to the routine of daily injections and doctor’s appointments. We were all set for another embryo transfer at the end of September when things weren’t looking good. There was too much fluid in the uterine lining, creating an inhospitable environment for the embryo, and our doctor made the call to cancel the procedure. We prepared for another transfer in October, but it also failed.
5. Build up your support squad.
As reported in a 2017 study published in Human Reproduction, 41% of the 416 respondents who grappled with infertility dealt with depression. So it’s essential to seek out support beyond your medical team, whether through therapy, family/friends, church, or support groups (Fertility for Colored Girls, Broken Brown Egg, Infertile AF). IVF is an emotional rollercoaster, and you’ll need something different from each person on your support team along the way.
While a support group can provide comfort in being surrounded by people experiencing the same thing, other days, you may crave a quiet girls’ night in with your best friends, complete with carryout and romcoms—no infertility talk allowed.
6. Think through how you’ll update your squad.
Having support is one thing, but you’ll probably need to teach your family and friends how to help you. Perhaps your mom isn’t the best at talking through emotions, but she does make the world’s best fried chicken. Don’t hesitate to ask for a large helping of soul food to ease the pain.
I’ve found it helpful to have a plan in place for communicating various steps of the cycle, especially in the event of failure. You could say, “if you don’t hear from me by 5 p.m. the day of the results, assume the cycle didn’t work,” to prevent having to call everyone and repeat the bad news.
7. Expect emotional triggers (and give yourself grace).
You may think you’re taking everything in stride until you’re cussing out everyone within a 10-foot radius once you scroll upon yet another baby bump photo. Remember, it’s okay to decline the baby shower invite. It’s okay to “mute” your pregnant friends on social media. It doesn’t make you a bad person. You can still support them without subjecting yourself to daily reminders of what you don’t have. This goes double for Mother’s Day or any other holidays that may be triggering.
“There’s trauma around infertility and everything that goes into it,” Nelson explains. “There’s this sense of injustice, but there’s also some trauma around your process to parenthood. It’s almost a PTSD [post-traumatic stress disorder] response to … everything you’ve gone through up to this point. So you may experience an elevated amount of anxiety or depression; racing thoughts; the hypervigilance; the hopelessness and possibly helplessness, feeling powerless over the situation.” Your mix of emotions is valid.
8. Remember how far you’ve come.
After four failed cycles, you’d think I’d feel like giving up. And I do, some days. I hold on to hope and cling to faith, but there are times when I lose my grip. During those moments, I scream, I cry, I shut out the world, and I come back to a poem by Yasmine Cheyenne that reminds me that there’s so much strength in continuing to try. “You lay out your dreams and believe,” she writes. “Revel in your literal magic.”
IVF–much like grief—is not always linear. And it’s certainly not for the faint of heart. There are ups, and there are plenty of downs. Something that has helped me is remembering: 1. I’m not alone; 2. I’m strong as hell (but I don’t always have to be); 3. Everything in due time. So, for now, I’ll keep the faith.