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How much is too much ? How can you stop yourself from reaching a breaking point ? How do you know when you've tried enough and it's time to move on ?

This was the plaintive question posed to me by a patient who had had failed four IVF cycles and had come to me for a second opinion. Should I do a fifth cycle doctor ? Shouldn't I just forget about it ? Haven't I done enough already ? Haven't I put myself through enough ?

Haven't I taken enough shots ? Changes enough doctors ? gone to enough clinics ? This is really getting too stressful - and I'm not sure whether it's even worth trying again. Is it worth putting myself through all this stress and pain just to have a baby ? Is there any hope of IVF working if four cycles have failed ? What can you do differently ?

No easy answers 

These are common questions IVF patients ask; and the reality is we don't have any answers to them. Just because four cycles have failed, does that also mean the fifth cycle will fail? The chances of the fifth cycle working do not increase because of the four earlier failures - but neither do they decrease! It's effectively a new lottery ticket - and the patient has to go through the decision-making process all over again . It's a hard process and I don't think that I have the answers .

The patient's personality 

A lot really depends on the personality of the patient! Typically, when we were kids, we were taught the importance of tenacity and persistence. We all know the story of King Bruce and the spider - and how we should keep on trying and trying again, until you finally succeed!

Logic and more 

That logic is fine when you're studying for an exam or preparing for an interview - but does the same logic apply when you're doing something like IVF ? Unfortunately biological systems don't often follow logic, and it's important that everyone needs to draw their own "laxman rekha", their personal limit, so that they don't cross it before going to pieces or breaking down . Each person's laxman rekha varies and depends upon many factors - emotional resilience; personality; finances; temperament; social support mechanisms; and how stable the marriage is .

Peace of Mind 

Are you a maximiser ? or a minimiser ? Do you believe in technology ? Or would you rather leave things upto Nature ? Do you believe that you can determine your own fate ? Or do you feel that everything is predestined and you have little control over what will happen ? The question you need to ask yourself is simple - what will give me peace of mind ?

You need to go through a lot of soul-searching before you make a decision, knowing full well that there is no easy answer and no single right decision which applies to everyone - but that whatever decision you come to and find for yourself will be the right decision for you.

The right decision 

One word of advise - be selfish and make the decision which is right for you. If you are happy with your own decision, you will keep everyone else happy. If you are unhappy, you will keep everyone else unhappy as well ! Take the path of least regret, so when you look back on your life, you do not kick yourself for missed opportunities. Remember that we rarely regret the things we do - but we often regret the things we don't !

Authored by : Dr Aniruddha Malpani, MD and reviewed by Dr Anjali Malpani.

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