After performing more than 600 IVF cycles a year for nearly two decades, I’ve noticed something that has little to do with embryology and everything to do with expectations. The couples who cope best with this process aren’t necessarily the ones with the best prognosis. They’re the ones who walked in with a realistic picture of what they were about to go through.
I wish more of my colleagues talked about this openly, because I think we do patients a disservice when we let success rate percentages do all the talking.
The number isn’t the whole story
When a couple sits across from me for the first time, the question is almost always some version of: “What are our chances?” It’s a fair question, and I always answer it honestly, using their specific age, hormone levels, and diagnosis rather than a generic statistic. But I’ve learned that the number itself matters less than what they do with it.
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A 40 percent success rate sounds discouraging to some people and perfectly reasonable to others. The difference isn’t the number. It’s whether they’ve been told, clearly and early, that one IVF cycle is often not the whole story. In my practice, I see far more couples succeed across two or three cycles than on their first attempt. When patients understand this from day one, something shifts. A negative result becomes a data point instead of a verdict.
Grief has no clinical pathway, but it deserves one
I treat a lot of recurrent implantation failure and recurrent pregnancy loss. Clinically, these cases are about finding answers, adjusting protocols, looking for immunological or anatomical factors we might have missed. But every failed cycle is also a loss, and I don’t think medicine handles that part well.
There’s no discharge instruction for grief. No follow-up appointment dedicated purely to “how are you feeling about what just happened.” We move quickly to “what’s next,” because that’s what we’re trained to do, and often what patients ask for. But I’ve started building in a pause before that conversation. Just a few minutes to acknowledge what didn’t happen before we talk about what we’ll try next. It’s a small thing. Patients tell me it matters more than I expected.
Men get left out of this conversation too often
A meaningful share of the cases I see involve male factor infertility, and I’ve noticed a pattern that doesn’t get discussed enough: The male partner is frequently treated as a secondary character in his own fertility journey. Appointments are scheduled around the woman’s cycle. Questions are directed at her. He’s present, but somehow peripheral.
This matters clinically, not just emotionally. Male infertility is a real, treatable factor in a significant portion of cases I see, and when we don’t engage fully with both partners, we sometimes miss things. It also matters for the relationship. I’ve had more than one patient tell me, after a difficult cycle, that she felt like she was carrying the medical burden and the emotional burden alone, even with a present and caring partner, simply because the system around her made him invisible. I try to correct for this actively now. It’s a small adjustment in how I run appointments, but I think it changes outcomes that have nothing to do with embryo grading.
What I tell every couple before we start
I’ve started saying the same thing to nearly every new patient before their first cycle, regardless of age or diagnosis: This may take more than one attempt, your bodies may respond differently than the textbook predicts, and the emotional weight of this process is real and worth planning for, not just the financial and physical weight.
It’s not a discouraging conversation. If anything, patients tell me it’s a relief. Most of them have already sensed that this might be harder than the glossy brochure language suggests. Naming it directly seems to give them permission to feel what they’re feeling, rather than wondering if their difficulty coping is somehow unusual.
After 600 cycles a year for as long as I’ve been doing this, I’m convinced that what we say to patients before treatment starts matters almost as much as what we do once it does. The medicine has advanced enormously in my career. I’d like to think how we talk to people about it can advance too.
Mohamad Mazen Dayeh is a reproductive endocrinology and infertility specialist.
