Welcome to IVF This, episode 136, IVF and when is enough enough? 

Hello, hello, my beautiful friends. I hope you are all doing so, so well today. I am trying to survive the, what we would call fall in Texas. I mean, temperatures are still like 85, 90 degrees, but it is raining here. So we have hope for cooler temperatures.

soon. That is certainly my hope as I'm wearing a sweatshirt today, just mostly out of ambition, mostly out of hope and blind faith that I will one day not have to sweat while wearing a sweatshirt. But anyway, today's topic is a question that I get pretty regularly, especially from individuals who have been on this journey for a while, whether you're strictly staying in infertility or you're pursuing fertility treatments.

and neither has yielded what you're hoping for. You've not gotten pregnant, you've not stayed pregnant, you've not gotten that baby in your arms yet. And so I wanted to address this question, number one, because I don't think that we think about it in the framework that I'm gonna offer you today, But more importantly, that you have something productive to do with that question. And I'm gonna explain why, right? So coming to that question, when is enough is enough, is rarely an easy or painless short past, right? Most of the time it includes a great deal of heartache and a lot of anticipatory grief. And if you're unfamiliar with that term, go back three or four episodes to talk about

the whole concept of anticipatory grief and what it looks like, what it can look like, if you're unfamiliar. So the reason that it comes up so much is because we tend to think that there will be an option or a path that is either less painful or will be devoid of pain. Like we will get to feel a sense of relief if we choose to either stop treatment or continue with treatment or whatever that might look like, right? So I'm gonna talk about a couple of different things that I will call my framework.

for understanding or deciding when it's time to walk away from treatment or when you're just kind of on the fence and you're not sure what to do, right? Cut out that last right. I don't know why I keep saying right. One of the things that I want to make sure is adamantly clear, explicitly clear from the get-go is that this is going to go back to you and maybe your partner went to know, no,

One of the things that I want to make sure is very clear is from the get-go, this is about you. This is about what you think you can handle. This is about what you think you need and a little bit of your partner, right? They can also know when enough is enough, but I say maybe because you are the person, the person with the uterus, the person with the ovaries is the person who's gonna be taking on a lot of the physical and emotional toll.

. So I'm gonna talk about a few different things because one of the things that I go back to time and time again is that it is you and sometimes your partner is the person that's gonna know when enough is enough. And I say maybe sometimes your partner because there is so much that is physically demanded by the person with the ovaries and the uterus that the physical toll cannot be felt by someone else. It can be seen, parts of it can be seen.

by someone else, but you're the only one who's going to be physically feeling and mentally and emotionally experiencing this journey very uniquely, right? Your partner, if you have a partner, is gonna have their own experience, but physically the demands are placed upon you, and emotionally you're gonna be carrying the vast majority of that burden by nature of you being the one with the ovaries and the uterus, right? It's no shade, no harm, no foul to your partner. They just...

They're just not at a vantage point to experience everything that you're gonna experience, right? So we wanna stay focused on what you need or what you think you need, not what you think other people want from you, not what you feel like your partner wants or needs from you, not toxic positivity culture, that bull crap that's tried to convince you that just keep hope or all you need is one, and all of that very damaging messaging. It comes down to what you need, what you want.

and what you're willing or not willing to do, okay? So let's start out with the framework of sorts, right? It's a four-part framework for when is enough and is enough. So let's start out with the four-part framework for when is enough enough, right? Just helping you make that decision. Because I think for a lot of us, that question is kind of ethereal, right? We're asking an unanswerable question, which makes it.

so damn hard to answer because it's so vague, right? When is enough enough? And I don't think we get any traction on answering that question for ourselves or helping ourselves make that decision because it's so vague, right? When we ask ourselves vague questions, it usually does one of two things. It yields vague answers or the prospect becomes so overwhelming that we just shut down, right? And so the idea behind this episode is to give you that framework.

Emily (06:23.638)

to give you four main areas to consider. And I'm gonna offer a few questions along with those specific areas that I want you to consider. Now, let it be known, right here, right now, there are no right or wrong answers. You know that's not how I work. It's not a question of right or wrong. These are just opportunities for you to think about ways that IVF impacts your life and the life of your partner, your influence it has on you and work and your life, all of those things, right? There's no judgment.

What works for you might not work for me, right? And vice versa. And most importantly, and as always, this is cafeteria style. You take what works for you and you leave what doesn't. And it's not gonna hurt my feelings, I promise. I just want you to be able to arm yourself with the thing that's gonna help you the most, all right? So the four part framework has to do with the emotional, mental, that's together, emotional and mental toll of the experience.

the physical toll, the financial toll, and the logistical toll, okay? So when we break down the question of is enough into these four areas, we get the opportunity to think a little bit more critically. We get the opportunity to get more productive with our questions, with our introspection, our insights, things like that. It's just, it doesn't have to be just an emotional choice, although there's nothing wrong with that. There's nothing wrong with it being an emotional choice. But you get more

meet to chew on when you're kind of in this, when is enough enough? Right. And it's not just, you know, one thing that I have heard before is if you're thinking about is enough enough, you probably already know the answer. And I don't think that's true. And I think that actually places undue burden and maybe even resistance to the person who's asking that question. Right. When is enough enough? Well, if, if you're asking the question, you probably already know the answer. No.

You might not, you could, you could, and it's just an easier pill to swallow than actually deciding, but it's very often you don't know the answer and you're really searching for some side of clarity, some side of, some sort of, you're really searching for some sort of clarity or some sort of insight, and that's what I'm hoping that this podcast episode can provide you. All right, so let's start with mental and emotional, right? How do you feel like you have handled this process or this journey so far?

Are there ways that you could have quote unquote, quote unquote, handle it better? I don't believe that there is a gradation for handling it better, so that's why I put it in quotes, right? Are you willing to continue to expose yourself to potential pain? That would be choosing to continue treatment or choosing to continue trying to conceive. Are you willing to accept that pain would be inevitable whether you decide to continue with treatment or discontinue treatment?

Right, like I hate to burst y'all's bubble, but there's not a path without pain. Right, if you continue moving through treatment or going towards treatment, there's gonna be pain. There's physical pain, there's mental and emotional pain, there is a lot of uncertainty, there's everything that you're gonna experience. And, not a but, but an and, if you decide to end treatment, that is a grieving process in and of itself, okay?

For people who are walking away from treatment, I have a dear friend, her name is Lana Manachowski. She has a podcast called So Now What? Where she talks about rebuilding your life after fertility treatments have failed, right? Had her on this podcast before about a year ago, I think. And I absolutely adore her. So I encourage you to check it out. Like if you're writing the fence on this, check out what she talks about. Because I think one of the things that is so.

challenging for us to conceive is what our life is gonna look like should we not have the family that we envisioned and that's mostly what she talks about right so Lana Manekowski uh what was our podcast name oh so now what so check that out if you're on the fence on that okay but if you're willing to continue treatment how are you going to support yourself better right and i don't mean figure out a way how to not feel bad

during this process, that's not a realistic expectation, okay? But what supports can you draw on to help yourself through the process? Like an IVF peer partner, no, like an IVF peer partner, a support group, therapy, coaching, rallying your friends or creating a point person within your friend group to really be that conduit for venting or self-expression or anything like that, right?

making decisions ahead of time. Who are you gonna tell? What are you gonna tell? And when are you gonna tell, right? If you have a partner, what do you need from them if you were to do another cycle or start a cycle? If you're not willing to continue treatment, it's the same set of questions. How are you going to support yourself? How are you going to take care of yourself? Those are ways that we can address that first part of the framework, which is the mental and emotional toll that IVF and this journey takes on us.

Emily (11:52.162)

All right, and then we go to physical. What has been the physical toll that this journey has taken on my body? Are you willing to endure more? Is it detrimental to your mental health with the physical symptoms, the side effects, right? Weight gain, migraines, insomnia, all of that stuff. Are you willing to have repeated medical procedures or surgeries if necessary? Or are those physically affecting you in such a negative way, right?

is the Venn diagram between physical and emotional labor overlapping? And if so, by how much and to what intensity? Are you tired of feeling hyper-focused on your body and symptoms? If so, is there a way for you to manage that hyper-focus without stopping treatment? And there may not be. There could be ways. There may not be, just depending on who you are. And either one of those is okay.

Are you willing to continue treatments? If you are willing to continue treatments, are you willing to take breaks if necessary to take care of yourself physically or emotionally or whatever, whatever area you need, right? And if there's not, that's totally fine, right? How are you going to take care of yourself through that grind?

Financial. We all know that financial like we... financial. We all know that IVF is obnoxiously ridiculously disgustingly expensive right? Some of us have insurance coverage which is wonderful and some pay out of pocket for everything like me and my husband did. So there are a few financial questions that you would want to ask yourself. Namely what would be the financial questions that you would need to address? Are you willing to pay for around out of pocket?

or another round out of pocket? Are 401Ks or CDs or other options available? My husband and I took out a personal loan for our very first round of IVF. Is that an option, right? If you don't have a strong credit score, do you have a co-signer for a loan? Would you be willing to take on, like change jobs or take on a second job in order to help

maybe secures fertility benefits. Would you be willing to?

Okay, fertility benefits. That might be an option, but it also might not be an option.

I wrote my notes in way too small of a font and it's really fucking me up here.

I know that there's a Facebook group called, I think it's called Paying for IVF, where it talks about a lot of companies that have remote positions or part-time positions with benefits that cover fertility. Some of them talk about how benefits will start on day one, and so they just, they start, they get enrolled in benefits and then they quit and then they just pay the COBRA premium. Like there are a lot of different options. What are you willing to?

pursue, what are you willing to take on, what are you not willing to pursue, and what are you not willing to take on? Again, there's no right or wrong answer. It's just whatever's gonna work for you and your family.

And I have had this come up where people think like it's a horrible thing to make this type of decision based in finances, but I gotta tell you babes, it's hard out there. Like I know we're not supposed to use the R word recession, but it's there, it's alive. And there are a lot of financial struggles, just day to day going to the grocery store is obnoxiously expensive. So I don't want you to think.

poorly of yourself if this is a large part of your decision matrix. It's a large part of your life and that it's okay. It doesn't mean anything about your desire to be a parent or your ability to be a parent or anything like that. If that is like 85, 90% of the decision, it's like the portion of the decision. Right? Let me say that again. So it's not bad.

if 90% of the decision is based in financial expectations or financial requirements or financial means, there's nothing wrong with that because ultimately you do have to survive in this world. So I have had people make comments about like, I know I shouldn't make this decision financially. Yes you should. It should be a consideration. How much of a consideration is entirely dependent upon you and your life and your means.

but it doesn't mean it shouldn't be there, right? All right, and then finally, logistically, are you able to get to a clinic within a reasonable distance or timeframe, or is the closest one to you like five or six hours away and that's just not feasible, right? Are you with a clinic that you don't really like or trust, but it's again, the only clinic in the area? Are there travel...

arrangements that you could make to go to a clinic that maybe offers a more reduced price or a better financial flexibility pricing, things like that. I have many clients who've gone up to CNY, which is a fertility clinics in New York and Pennsylvania, Colorado, stuff like that, because they have very reasonably priced fertility options, IVF payment plans, stuff like that.

Can you carve out a way to make that happen? And if not, that's okay, but at least you can answer that question for yourself. Is your protocol conducive to your life, right? Do you work a job where it's hard to get off for those doctor's appointments? Is there a way that you could work with your HR department to make sure that you have safety in your job to make sure that you can get to those appointments? Do you, again, need to change jobs because of that flexibility?

Are there conversations that you can have with your supervisor to ensure that you would have that flexibility, right? And most of you, and I think that this is really important with any time of framework that you're working on, number one is these questions are not going to be comprehensive. Like I can't possibly think of all of the questions that are going to be applicable to every person. So if you're thinking like listening to this podcast and you're like, well, what about that is a perfect question for you, right?

That's a question for you to dig into and investigate and see what could come up based on what you need in your life and what you see as either a need or a non-negotiable, a negotiable, whatever that looks like, right? And number two, when we ask the question, like when is enough enough, it seems like a simple question, but I guarantee you, all of you are already considering these four aspects of this framework.

You're already doing it. You're already making cost benefit analysis, looking at opportunity costs, whether or not you're, one, giving yourself credit for doing that, or two, have the words or verbiage or can articulate that that's what you're doing. But you're already doing it, right? The framework just offers you a really clear and concise way to kind of look at that, all right? So.

I want you to number one, give yourself credit for the fact that you're already making these considerations, making these thoughts, these questions are already coming up for you. And I want you to give yourself grace. There's not gonna be a bad choice. There are horrible outcomes to be sure, but that doesn't mean that the choice that you make or don't make is good, bad, right or wrong. Okay? Again.

There's not a bad choice. What we're talking about wanting to avoid are horrible outcomes. And you don't have a whole lot of control over that. You have some, but you don't have much. It's like a 90-10 split between what you have control over and what you don't. And so I want you to think about like, what is the best choice? Not the right choice, not the wrong choice, but what is the best choice that supports you and the life that you have?

the life that you want by yourself or with your partner or with your family, whatever that looks like, right? You are the only person that can answer that question. And anyone who tells you, oh, that should be like, it's a no brainer. You just keep going and going and going until you get what you want. That doesn't always work. And if you've been around this journey and I've talked to so many women who have done that and it really is, it's not sustainable.

So what can be a sustainable way for you to either take care of yourself while you're going through treatment or take care of yourself after treatments or after discontinuing treatments or whatever that looks like, right? It's all coming back to how can you take care of yourself no matter what the decision you make. Because I guarantee you the decision you make is gonna be the best decision. It doesn't mean it's gonna be an easy decision.

And it doesn't mean that the consequences of that decision are gonna be easy to navigate or without grief or without anger or without any fallout emotions. I would expect those. Like accept that that's gonna be a part of it. And when you do, when you can accept that pain is gonna be, at any point, if you can accept that pain is going to be available to you.

throughout any point of this journey, I actually believe that frees you up to truly make the best decision you can for yourself and your family, right? If pain's an inevitable part, no matter what you decide, if you're gonna continue treatment or if you're not gonna continue treatment, then it's not like a burden is lifted, but it is more freedom, right? If you're gonna hurt either way, hurt in the way that's gonna serve you the best. And that's what I'm here to.

provide you guys and that's what, that's the gift of that thoughtfulness, that mindfulness when you're making that decision. That's the gift I want you to give yourself. The freedom to know that there's no bad decision and the freedom to know that you're the one who ultimately gets to decide no matter what. So that is what I have for you today, my friends. I hope you have a beautiful week and I'll talk to you soon. Bye bye.