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How Do You Know When Enough is Enough?

By Bonnie Cochran, LCSW
Published in Resolve for the journey and beyond, Summer 2014

When pursuing infertility or the world of assisted reproductive technologies, how do we know when to shift gears from “full speed ahead” to “stop the engines” or “enough is enough?” With all the latest technologies, new sciences and miracle baby stories that we see at our local grocery store checkout stands and view on social media, the idea of giving up or stopping treatment becomes more unfathomable or unacceptable for many couples. After all, couples are frequently told, “hang in there – stay positive and you will get pregnant.”

I recently posed the question, “How do you know when enough is enough?” to our monthly drop-in infertility support group. As standard protocol, I gave them a heads up via email reminder about our date, time, location, etc. along with the topic for this month. I also prefaced this topic with: “Please think about what this means to you psychologically, socially, spiritually, emotionally, financially, etc. Be gentle with yourselves, as I believe this is a tough piece to think about, but also important to address.”

Traditionally we have ten to twelve people on any given month but this time we had a total of seven women walk through the door. I wouldn’t have thought much about our group being a little smaller this month because people do have busy schedules, especially when engulfed in fertility related treatments. After all, there will be times when our group is a little larger and even possibly somewhat smaller.

Standard protocol for most support groups begins with welcoming any new people, (in our case, we are exclusively an all women’s group) followed with what we call checking-in. This is an opportunity for everyone to get reacquainted and to catch up from the previous month – it also serves as a chance to revisit and retell their stories. Getting settled-in and comfortable with the energy of the group also supports and promotes group cohesiveness. After check-in, we share all the trials and tribulations from what had transpired from the previous month.

Our group this particular evening moved ever so smoothly right into catching us up. Everyone was very engaging, offering support and validation when appropriate. Some stories were very long and detailed, and some were shorter and to the point. Some people added humor to their struggles while others shared tears. Their stories could have been anyone’s stories – anyone dealing with infertility that is.

I am getting ready for my next IUI.”
I just had another ectopic, resulting in losing my other fallopian tube.”

We have decided to go the IVF route. We think our chances are promising. ”

I just got demoted because I was told I am not focusing on my job like I should be.

My husband has a low sperm count.” 

…and so on. Of course, all very difficult stories to tell and absorb. Everyone in the group was touched with heartfelt emotion. After all, the messages were filled with hope, false hope, and/or heartache. How much more confusing can that be?

After everyone finished checking-in and catching us up, I then posed the question to the group about “When do you know when enough is enough?” To my dismay, especially to a group that had been very connected up to this point – chatting away with advice, validation, support and suggestions suddenly switched gears of engagement to – a big halt! The room became silent. The energy had shifted. And as I looked around the room, I noticed heads were facing forward with turned down eyes. People were staring at the floor, at their feet or anywhere that suggested we had just brought up a topic that was clearly not comfortable – I suddenly felt like I was in a room with strangers.

I asked the group what they thought about the evenings’ topic, and several people blurted out without hesitation, “I almost didn’t come because of the topic.” I was somewhat taken back, yet not convincingly surprised.

Fear of not being able to emotionally handle such a decision is a common reaction for so many, especially for women. Fear is what I felt from the support group that evening. In working with families dealing with grief and loss, we often say that women carry the emotionality for the family. I believe fear really is another way to camouflage the underlying grief associated with such a tumultuous and daunting decision as well. After all, who would choose grief over hope?

The decision to end fertility related treatment is not to be taken lightly. For most couples, ending treatment can feel like giving up, throwing in the towel – certainly not options that were discussed at length in the original plan. It is a difficult and complex process, as there is always some probability of success in further attempts.

As you may recall, the newsstand is constantly reminding us of that possibility – “one more attempt and one more try will eventually lead us to bringing home our baby.”

Certainly we do not want to overlook the paucity of couples being grateful for someone else making the decision for them. Doctors and husbands usually take on these roles, and they are the ones who are most likely to put their foot down and push the “enough is enough” syndrome. For some, this can actually be a blessing in disguise. One woman in the support group confirmed this notion with, “I would welcome the decision to be taken out of my hands at this point.”
In order to truly reach a decision of ending treatment, couples need to be in a place where they are willing to examine their fertility journey both individually and collectively – one that includes revisiting the past, understanding the present, and coming to terms for what possibilities are left for the future.

As one couple said it so beautifully, “What was once a beautiful dream slowly became a project filled with demands, commitments, expectations, and at times, a compromised marriage. However the gifts we have received along the way continue to hold us close. For that we are grateful!

Bonnie Cochran, LCSW, is in private practice, specializing in grief and loss. She also is a founding member of 3HopefulHearts, a nonprofit organization that supports bereaved parents and families. Bonnie received both her bachelor’s and master’s degree in Social Work from Colorado State University. She is past chair of RESOLVE’s Professionally Lead Support Group Oversight Committee and currently facilitates a monthly RESOLVE infertility support group.