Entering the world of assisted reproductive technology (ART) can seem fraught with endless choices. On your path, you might have decided what doctor to work with, whether to do IUI or IVF. If stimulation hasn’t been ideal, perhaps you had to choose between different protocols or even clinics; then there is the choice around embryo testing.
For some couples, there is an exceedingly hard choice about when to stop pursuing ART and whether to pursue other methods of family building.
Different answers exist for different people based upon their unique circumstances. Each decision is a valid one. As a reproductive psychologist, I have worked with individuals and couples through a rare, and yet, seemingly impossible choice of terminating a wanted pregnancy whose conception began as a result of in vitro fertilization (IVF).
Different answers exist for different people based upon their unique circumstances. Each decision is a valid one.
Terminating a Wanted Pregnancy
Pregnancy termination is a divisive topic and yet abortion is common as one in four women in the United States will have an abortion by the age of 45. It is seldom thought that women who are actively trying to become pregnant will end up terminating their pregnancy; however, 11.3% of abortions occur after the first trimester of pregnancy and around 1% of abortions occur after twenty weeks gestation. This narrow percentage of abortions shares a typical narrative: an individual or couple is excitedly expecting a baby and prenatal testing uncovers a fetal anomaly.
For those that have needed to use reproductive assistance to achieve a pregnancy, this is doubly devastating.
When There is No "Good" Choice
For any couple or individual in the situation of a pregnancy crisis, there seems to be no “good” choice. Decisions need to balance what a family is able to take on and include considerations that are emotional, financial, and religious in nature.
The anomaly in and of itself might impact decision making. For example, one that is rare can feel scarier than a more common anomaly is as there aren’t others that can serve as role models. Additionally, an anomaly that is perceived as lethal to either the person carrying the pregnancy or the fetus itself can be a clearer decision for many.
The Additional ART Burden
There is the additional burden of the cost and time going into the conception of the pregnancy in the first place, and the sense of defeat around building a family, that is unique to those utilizing assisted reproductive technologies. For many couples, “trying again” is not such an easy proposition.
For many couples, “trying again” is not such an easy proposition.
Financial resources can be finite, especially if you live in a state that doesn’t consider fertility to be an essential benefit within insurance. Having so many resources go into trying to build a family, and then receiving a poor prenatal diagnosis can make some couples feel like there isn’t really a choice for them: that this is an “all or nothing” pregnancy.
Other couples fear additional judgment around the false narrative of wanting a “perfect” or “designer” baby. This is far from the reality of the individuals and couples that I have worked with. Those that have terminated after IVF wanted their baby very badly, and making a choice to say goodbye was especially devastating.
The Impact of External Shame on Choice
Many people who terminate wanted pregnancies feel like they can’t share the entire story of their loss and will frame it as a miscarriage or use vague language like “we lost the pregnancy.” In addition to being concerned about others shaming them around their choice, they might express concern that external shaming will lead to feelings of regret.
Often, the biggest part of regret a couple has is to be in a situation where a choice is necessary. It can be useful to frame the decision making as working with the information at the time and making the best personal decision.
Often, the biggest part of regret a couple has is to be in a situation where a choice is necessary.
Medical Termination Can Be Rooted in Love
When a couple terminates a pregnancy for a medical reason (TFMR), they are creating a new contract: they are taking on the grief, the physical pain, the emotional pain, and the complicated feelings that accompany this choice. They do this not because parenting a special needs child would be inconvenient, or that this child wasn’t desired, but because of the love they had for their child.
They are aware that this loss will be a part of their history and their family’s story, regardless of whether or not they have the good fortune to be able to actively parent a child. They have a duty to protect themselves (and their child’s memory) from those that can’t fathom what this experience has meant and continues to mean. They take on the knowledge that they might not ever be able to have children or that the number of children they had imagined will not come to pass.
They have a duty to protect themselves (and their child’s memory) from those that can’t fathom what this experience has meant and continues to mean.
The Road of Healing
And still, they heal. The road of healing might look different for each person who finds themselves in these unique set of circumstances, where bad luck is compounded (first with the need for fertility intervention and second with a poor prenatal diagnosis or health concern). Support exists and there are other families that have walked a similar path. In time, you will heal.
If you find yourself in this position:
- You’re not alone and support is available
- This was a decision driven by love
- You will heal, and healing will be gradual
- You control how and to who you share your story with
It’s common to feel:
- Regret to have to make a choice
- Uncertainty about your choice
- Sadness about your loss
- Relief that your baby won’t suffer
- Grief, as you lost your baby
- Shame or guilt about making this choice
- All of the above and more (even at the same time!)
- Abortion Surveillance — United States, 2015. (2018).
- Critical Aspects of Decision-Making and Grieving After Diagnosis of Fetal Anomaly. (2015).
- United States: Abortion. (n.d.).