Death and the quest for new life seem unlikely companions. Last week’s headline read “Inquest told woman who died in car fire was ‘devastated’ over failed IVF.” The other side of the bonny baby glossy media success story is the suffering of fate.  Infertility pushes couples to extremes. It can become an obsession, a single minded internal desperation that overwhelms logic and balance.

Celebrity IVF pregnancies make it all seem so straightforward- we usually only hear the good news.  When the stars conceive by IVF it raises the hopes for many yet sharpens the pain of failure. It can be successful and that’s why it becomes such a focus for infertile couples. But, it may just be another transit on a voyage of deteriorating hopes and rising disappointment. Watching from the sidelines of general practice, you can feel the pain and distress at every stage.

The initial decision to try for a family is often now a positive lifestyle choice.  Effective contraception means that couples usually make a planned decision rather than stumble into parenthood. The first few months of “trying” carry a tinge of excitement and expectation but after a few months every period is a let down and tiny doubts begin to arise. Partners quietly worry about their own or their companion’s ability to have a family. Anxiety increases together with a feeling of personal responsibility, especially if one partner is already a parent. There may be an oblique comment or question slipped into a consultation with their GP but the decision to formally discuss infertility is always a major step at the end of a period of waiting, hoping, agonising and worry. Agreeing to investigation opens two vulnerable people to the possibility that it is them.  “Could it be my fault”- they always say – with an overbearing guilt. 

Months go by with the calendar focused on medication, mucus, and disappointment. Sex is goal oriented and timing is everything, Eventually, and it feels like the end of the line, IVF is presented as an option; a last hope destination at the end of a stressful and traumatic journey of guilt, recriminations, argument, and insecurity. Relationships may be hanging by a thread. Pregnancy is joyous but a couple that survives failed IVF can probably survive anything. There are casualties. Last week’s headline charts a lost life and single and unusual tragedy, but there are many broken hearts.

Domhnall MacAuley is primary care editor, BMJ