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The Evaluation Cycle Didn't Work

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a blog by Traci Shahan, RN, WHNP-BC, Doctor of Nursing, Albrecht Women’s Care: A Center for Reproductive Endocrinology and Infertility, March 13, 2011

If you are like many of us, your evaluation cycle — or your first cycle of trying to get pregnant with medical help — did not “work,” which is to say that you are not pregnant.

This is sad and obviously not what you hoped for.

I want to talk about two very disparate issues related to this cycle not producing a pregnancy:

  • First, there are the emotional issues that can go along with not being pregnant, and,
  • Second, I want you to understand that although you may not be pregnant, you and your medical team have much more information than they did before the evaluation cycle. And we are going to put this information to work in subsequent cycles to help you conceive.

Emotional Factors

Okay, so you’re not pregnant — neither was I. I remember being very bummed right about this time, and of course there was plenty of advice from our well-meaning family and friends, who are usually just trying to help us. However, as most of us who have spent any time in the fertility trenches know, this advice is usually unhelpful — from the hackneyed phrase “just take a vacation” to “relax, then stand on your head for twenty minutes after sex,” to my all-time most dreaded, “God has a reason for this.”

I will not spend the rest of my 500-word blog allowance on why I took umbrage with these types of comments, especially the last type, but many of us had to take holidays from people who insist on chirping euphemisms long after we have hinted that we are weary of hearing them.

I will not in any way ever tell a fertility patient to relax, in light of the fact that many of us have felt that infertility is one of the nadirs of our lives. What, relax, when we feel like we are getting pummeled? Also, I never tell anyone, anytime, that God cooked up a little special something for them, which resulted in their suffering. (No, nothing that you have ever done or thought merits you the type of torture that infertility fosters! Yes, many other people in this world have thought, spoke, dreamed and acted just like you, and most of them conceived and carried without a glitch. Promise! Therefore the logic is flawed that a higher power is raining down justice on fertility patients.)

At the risk of wearing out my welcome with readers, here again, I recommend that you advocate for yourself and partner, and if need be, intentionally sequester yourselves away from anyone who is not supportive of you. One way that I did this was by not answering the phone, never opening certain e-mails, and staying away from baby showers. Certainly not everyone will feel the need to implement my strategies, but keep in mind that, by the end of several years’ treatment, pregnancy loss, surgeries, and failures, I was emotionally drained. Do as much or as little as you need, but always ask yourself, “What do I need today?” Writing sometimes will help clarify this, or talking with a supportive person.

The 'Education' Cycle

I sometimes tell patients that the evaluation cycle is best viewed as an “education” cycle, as it serves us all to understand more about your unique situation.

After the cycle, your medical team will have a deeper understanding of what your fertility issues are. There are times when nothing is terribly obvious during such a cycle, but no information can also be helpful.

Clomid challenge test normal? Great, check that off your concern list. Imaging of the uterus and tubes perfect? Awesome, you probably won’t need a gestational carrier. See, by eliminating many factors, other, perhaps, more subtle ones will come into focus, like a Polaroid photograph coming into slowly into focus from the murk.

Next week, I’ll talk about potential treatments or further testing that may be done after an evaluation cycle. Until then, know that you have many resources from which to draw strength and clarity: your loved ones, online communities, lots of great print books, your medical team, and superb sites like FertilityAuthority.

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