The Memory of Treatment

For a long time, I thought that fertility treatment decisions were mostly about probabilities and statistics. I'm no longer sure that's true.

More and more often, I meet women who are not only worried that a transfer may fail. They are worried about what comes after that. About having to go back to ovarian stimulation. Back to injections. Back to putting life on hold. Back to becoming a patient again.

Recently, one of my patients, a 39-year-old woman, decided to continue ovarian stimulation after two IVF cycles had resulted in four blastocysts, only one of which was euploid. As we talked, I realized that she wasn't just trying to maximise her chances of pregnancy. She was trying to minimise the chance of ever having to return to fertility treatment.

During consultations, we spend a lot of time talking about numbers: ovarian reserve, euploid embryos, implantation rates, live births. They matter. They should be part of every discussion. But today's patient reminded me that they are rarely the whole story. Patients don't experience treatment as a series of statistics. They experience it as a series of memories.

Patients rarely remember the numbers. They remember the first injection, the phone call from the embryology lab, the day of embryo transfer, a negative beta hCG, crying alone in the car afterwards.

She made me realise that, in medicine, decisions are not shaped by evidence alone. They are also shaped by lived experience. Sometimes, that experience can become heavier than the evidence itself.

For me, once a patient myself, the hardest part of fertility treatment was the uncertainty of not knowing whether I would ever become a mom. Now I understand that, for some patients, the hardest part is the thought of having to start again.