"I'm sorry, but your pregnancy test is negative".
You would think after working in reproductive endocrinology (infertility treatment) for 13 years that I would be comfortable saying these words, but I assure that I never am.
Someone asked me once, "What is the hardest call that you have to make?" My initial response was the dread I feel calling any of our patients who has had an IVF (In vitro fertilitization) cycle that has not been successful. I have gotten to know the couple pretty well and I know they put a huge amount of time and effort into this cycle. Recently, though, I have changed my mind.
I have asked my patients about what is the hardest news for them to receive. After informally polling about 20 people, I was surprised at the consensus: it was a negative pregnancy test after their first fertility treatment cycle. Why, I wondered, would this be the most, difficult? I know the statistics, that people have approximately a 15% plus chance per IUI cycle or 30-50% plus chance using IVF. Why, then, would there be such an emphasis on the first IUI or IVF cycle knowing that even if the test is negative, there is an excellent chance with subsequent cycles?
Because, according to the patients I spoke with, it is not a matter of probabilities or statistics. Instead it is the culmination of what already feels like a long journey. By the time they have come in to Reproductive Medicine Associates of Connecticut (RMACT) for a new patient visit, most couples have already been trying for some time. Maybe they were hoping they would get pregnant on their own, or that they really didn't need help or maybe their spouse was reluctant to get help. Maybe they were at another doctor's office and didn't have good luck, or a good experience there. The new patient visit in of itself may seem like an accomplishment because both partners agreed to and came in for an evaluation. There, they either gets diagnosed with a problem and/or are started on a treatment cycle. It is a huge relief that there is finally a plan in place. I can only imagine, then, the magnitude of the disappointment hearing that the cycle didn't work, given the emotional investment that was made even before the cycle began.
What I have learned from this is that our nurses and our patients have to be equal partners in creating a positive experience from a negative result. We, as your providers, are beginning to realize the emphasis placed on the first cycle and are committed to being more sensitive to your feelings. Even though we know, practically speaking, that the odds are that a future cycle is going to work, hopefully sooner rather than later, we will not dismiss the first failed cycle as a minor disappointment. On an fertility journey, there is no such a thing as a minor disappointment.
For our part, we want you to know that having to tell you that you are not pregnant is never easy or commonplace. If we ever relay results quickly or seem flippant, rest assured that it is out of our discomfort and sadness that your cycle didn't work. Please forgive us for a seemingly inappropriate response to your pain. Also, please know that what keeps us going and gets us through relaying bad news is the knowledge that we are hopeful that good news is yet to come.
Monica Moore is a nurse practitioner and one of the nurse managers at Reproductive Medicine Associates of Connecitcut (RMACT). Prior to joining RMACT , Monica was the donor nurse coordinator at the Atlanta Center for Reproductive Medicine. Monica's first job in reproductive endocrinology was at Cornell Center for Reproductive Medicine and Infertility over 10 years ago.
Monica's research interests include: improving the efficiency of donor oocyte programs, advancing education for nurse managers, and developing patient teaching techniques. Monica enjoys any opportunity for teaching nurses or other staff members. Monica has published abstracts, online articles and a book chapter. She chaired the ASRM Nursing course in 2007 and was a recipient of the IVP Care's Professional Patient Education Grant in 2004. She is one of the founding members of the Advanced Nursing Network, a committee of the nursing practice group (NPG), whose purpose is to establish a national network of nurses in managerial or midlevel positions.
Monica received her undergraduate and graduate degrees from the University of Pennsylvania, where she was a member of Sigma Theta Tau, the nursing honor society.