If you’re reading Fertility Road magazine, and this article specifically, there’s a good chance that you already have some experience with IVF treatment. Even if you’re not yet in treatment, the idea of personal boundaries will likely be familiar to you. Just as fences between properties can provide protection, security and privacy, personal boundaries protect your personal or mental space.
They involve the physical and emotional limits of appropriate behaviours between people and help define where one person ends and the other begins.
That’s the dictionary definition stuff over, so let’s get right down to what it means for people in, or seeking, fertility treatment. As an aside, in doing some research for this article, I was shocked by how little I could find addressing this important issue. I’ve included a useful link to one interesting piece offered by a clinic in the US.
Why it’s important to set personal boundaries for IVF treatment
Given the emotional, physical and financial implications of IVF treatment, it can be an especially challenging time for people on their fertility journey, and the need for boundaries can become acute. Such boundaries are by their nature personal or individualised because things affect different people in different ways. With my coaching clients, seeking or going through treatment, I am always struck by how much they need to learn about IVF and how overwhelming this can be. Faced with the huge amount of, often conflicting, information they receive, it’s clear that they don’t always have the opportunity to ask specific questions or identify and set their own boundaries before actually starting treatment – the main focus of this article. Boundaries needn’t be set in stone but it’s a good idea to start your treatment journey with some.
This article will discuss different types of boundaries and why they might be important for you. I’ll also share some proven strategies for establishing and maintaining boundaries during treatment. There are many different boundaries to consider, and they often overlap so they shouldn’t necessarily be seen in isolation.
This is about understanding your emotional limits and developing strategies for coping with potential disappointments or stress. The combination of stressors including (but certainly not limited to) infertility, treatment itself, time away from work, possible relationship conflicts, money issues and not least the effect of medications on your body and mental health need to be recognised. These stressors can take a toll on your emotional state. Once you accept this, you can take steps to counteract these challenging emotions. It may be a good idea to set up regular appointments with a mental health professional or counsellor to ensure you are not internalizing too much stress from the process and have a safe space to express your feelings.
Deciding the type and extent of treatments you’re comfortable with, the medications you are willing to take, limiting the number of cycles you’re willing to undergo, or setting rules about when to take breaks between cycles for rest and recovery are all examples of physical boundaries relating to IVF treatment. You may feel like you are constantly being bombarded with the ‘ticking clock’ of infertility and wanting to try again after a failed cycle is only natural. However, it’s worth understanding that it will probably take more than one IVF cycle to achieve a live birth and the number of cycles needed only increases with the woman’s age. Ask your clinic about how many cycles they estimate you might need to have a child. Otherwise, you might run the risk of burn-out and financial hardship.
Ethical boundaries and your values
Now that IVF treatment has become quite mainstream, it’s easy to forget that people of different faiths may have different ethical or specific religious boundaries. For example, some people limit the number of eggs fertilized to reduce or eliminate the chance that extra embryos will be discarded without having the chance to make a child. You don’t have to subscribe to a particular faith to have a strong feeling about what’s right or wrong for you. Indeed, many clinics today will try to accommodate your specific needs if they’re not breaking any local laws or regulations. Obviously, the earlier you communicate this to the clinic the better. One of my coaching clients, Blanche, is seeking egg donation. Her first choice for treatment would be Spain. ‘It’s incredibly attractive to me as it’s less costly, with more choice and excellent success rates’ she told me. However, Spanish clinics don’t allow the patient to select the egg donor and all donors are anonymous. ‘Unfortunately, Spain is not an option for me as I feel very strongly that the child should have the opportunity to have contact with his or her donor. It’s very frustrating the discrepancies between countries offering treatments. They all seem to have different ethical systems.’
You may wish to decide on a specific budget for your IVF treatment and you can communicate this to your healthcare provider to make decisions about the most cost-effective course of action. At the very least you should understand the potential costs involved, setting limits on what you’re willing to spend. IVF treatment can be very expensive and typically only a minority of patients receive state funding depending on the country. It may also be worth seeking financial advice prior to starting treatment – after all this is one of the most important ‘investments’ you will make in your life. This is why transparent pricing is very important and why unexpected costs are one of the most common complaints made by patients. For this reason, the UK’s fertility regulator (HFEA) requires clinics to provide all patients with a costed treatment plan (best estimate) before starting treatment.
Decide with whom and when you want to share information about your IVF journey, which can help avoid unsolicited advice or intrusive questions even from well-meaning friends and family. Blanche shared with me two examples of unsolicited advice she received recently regarding her decision to continue with treatment to try for a second child. ‘You mustn’t do this’ one family member said and another friend offered the following: ‘your child is wonderful, you won’t have another child so wonderful’. It’s also common for members of the LGBTQ+ community to receive a disproportionate amount of unsolicited advice or questions because of their particular need to access treatment.
Attending events: It’s okay to decline an invitation to a baby shower, party, or any event that you worry will be too hard. You are not being antisocial or inconsiderate, you are taking care of yourself by setting a boundary.
Understand that IVF can be a time-consuming process. Set boundaries on how much time per week you dedicate to IVF-related activities, including appointments, research, and discussions, to avoid having the process take over your life.
Establish boundaries at work, like whether or not you disclose your treatment to your colleagues or manager. Request time off or a flexible schedule as needed for treatments and rest. This is a hot topic in many countries right now with many organisations (such as Peppy and Carrot) emerging to support fertility rights and promote employee benefits in the workplace.
Healthcare Provider Relationship
Make it clear to your healthcare provider that you want to understand all your options, risks, and benefits before any procedure. This includes the right to second opinions and sufficient time to make decisions. Some IVF clinics and doctors can be quick to get you into what I call the ‘IVF funnel’ (you know – the type that’s hard to climb out of once you are in it). In most cases, this is done with good intentions, but it can come across as not respecting your boundaries. The solution to the ‘problem’ of you not getting pregnant may be obvious to them (after all they do this process multiple times every day) but you may still be ‘processing’ your options.
Identify the people whose opinions you value in your decision-making process. Limit the influence of others who may not understand or respect your choices. Everyone has an opinion, and they are entitled to it. However, you may get more benefit hearing from people with some detachment from the process and no specific emotional connection such as an independent fertility counsellor or a fertility coach. In any case, you are better off finding the decision that’s right for you with support rather than being offered a ‘ready-made’ decision.
Social Media Boundaries
If you use social media, decide early what you’re comfortable with sharing online and stick to it; whether that’s nothing at all, every single step of your journey, or somewhere in between. Undoubtedly social media has been beneficial in bringing people together to share experiences and learn from each other. The negative aspects are well documented, but its clear that responses to whatever you post are not under your control. Given that the entire IVF process is often seen as a lack of control you might want to limit the opportunity to lose yet more control.
Coping Mechanism Boundaries
Figure out what activities help you relieve stress and how often you need them. Whether it’s a weekend getaway, a yoga class, or reading a book, make time for these activities and treat them as non-negotiable.
Yes, I know – that’s a lot of different boundaries to think about! Now that we’ve covered most of the important boundaries, let’s take a moment to think about how to establish which boundaries might be important for you.
To establish your boundaries, you have a couple of options. First, you could address every category above and put in place a personal boundary for each. Second, you could work through the list prioritizing which, if any, is important to you right now.
Some people find it helpful to do a self-assessment:
For each category, rate yourself on scale of 1 to 10:
- with 1 being your absolute worst feeling
- and 10 being your absolute best.
For those categories scoring low (say under 5) you might put a boundary in place. Having decided which boundaries are most important for you, you can now decide what strategies to use to maintain those boundaries while you seek, undertake or come out the other side of treatment.
You may be interested in reading: How To Cope With IVF Failures And What Happens To Your Body?
Communication is key
Be clear and transparent about your boundaries with the people involved in your process, including doctors, family, and friends. This will help them understand your needs and respect those boundaries. IVF treatment and the desire for a child are highly charged and this is true for patients and the people supporting them. For this reason, its important to be crystal clear about what you are feeling to avoid others ‘filling in the blanks’. Especially if they are bringing their own experiences (both good and bad) to the table.
Don’t hesitate to ‘speak up’ expressing discomfort or dissatisfaction if your boundaries are crossed. Be assertive in communicating your needs to your healthcare providers, family, friends, or coworkers. I’ve spoken with many patients who find it difficult to say no to a doctor’s request or recommendation.
While it may be made with the best intentions – it may cross a personal boundary. That needs to be communicated to the doctor or clinical team as early as possible. This often happens with a particular add-on treatment or non-routine medication. In my experience, many patients are not happy to go on a particular medication because of unclear benefits, additional costs and potential side effects which they felt were not explained clearly.
Controlling your narrative
You get to decide on a need-to-know basis who should be involved or updated on your IVF journey. It’s completely acceptable to not disclose information to everyone who asks.
In terms of decision making, everyone has an opinion, and these can often be very different even for an apparently straightforward question (like whether you can ‘afford’ to continue treatment). You may wish to limit the number of opinions you are exposed to and thus the number of people you share information with. It is not about secrecy – it is about managing the information flow which can easily become overwhelming if unchecked.
A support network can provide a sounding board for your concerns. This could be a mental health professional, counsellor, coach, support group, or trusted loved ones. They can help you establish, articulate, and maintain your boundaries.
Don’t be afraid to ask for help. This is true in all aspects of life, but it’s particularly important for IVF when the stakes are so high. Everyone is different and is likely having a different experience – even if that difference is only slight. With this in mind, other people’s opinions should always be considered in context. However, listening to how others with similar experience have established, reviewed and maintained their personal boundaries may be very helpful.
Many clinics offer free independent fertility counsellors as part of the treatment service and there are many online communities and patient support groups where you can find support. Please bear in mind the need to consider your boundaries (including sharing information, social media use and so on even in these supportive environments).
If you have a partner, whatever their degree of participation, involve them in discussions about your boundaries. Their support can be key to maintaining your boundaries and, ultimately, your wellbeing. Great communication, especially with your partner, is important during the IVF journey for many reasons. It is particularly true for boundaries. Your need to understand each other’s boundaries – being in it together doesn’t necessarily mean that you experience things the same way.
Sadly, misalignment of values, goals and boundaries can create conflict and lead to dissatisfaction or even break-up.
Engage in self-care practices regularly, such as mindfulness, exercise, or hobbies. These practices can help you manage stress and remind you of your own needs and boundaries.
An opportunity to reflect while doing other activities may really help crystallise what is really important to you and where your boundaries now lie. The more you take care of yourself and each other, the more resilient you will be for any challenges that lie ahead.
Understand the IVF process, its potential implications, and alternatives. The more you know, the better you can establish informed boundaries and advocate for yourself.
Sadly, IVF is not entirely standardised, so it is worth the effort educating yourself to understand the processes and principles.
This should empower you to make informed decisions and establish boundaries which are right for you.
Respecting and re-assessing your boundaries
Once you have set boundaries, it’s important to respect them yourself. It’s easy to let them slip in times of stress or pressure. Remember, these boundaries are there to protect your physical, emotional, and financial well-being.
Boundaries can change but respect them while they are in place.
Regularly check in with yourself and reassess your boundaries. Are they still serving you well, or do they need adjustment? It’s ok to change your mind but it’s worth setting a date with yourself to ask yourself if the boundaries you set up are still relevant. Perhaps, something has changed in your circumstances which has allowed this change of boundaries? It’s important to be flexible and adjust your boundaries when necessary and communicate these changes to those involved.
An example of a significant change of circumstances leading to a boundary change occurs when women opt for egg donation after previously ruling it out while they attempt IVF using their own eggs.
Financial boundaries frequently change also. Several months ago, Blanche told me that she had decided not to pursue further treatment for many reasons, including cost. However, after another failed cycle, she told me ‘I keep coming up with financial boundaries and then moving them because the drive to have another child is so strong. It’s such an emotional situation that sometimes you don’t think straight.
But I’m conscious that I’m very privileged to be able to afford treatment by making other sacrifices.’ Boundaries are there to help, protect and serve you. If they stop doing that, you are free to stop or change them.
IVF treatment and personal boundaries – FAQ
Why is it important to consider personal boundaries prior to IVF treatment?
Fertility treatment in general and IVF treatment is often physically, emotionally and financially challenging. By establishing boundaries, you can regain some control over your situation and protect yourself. Your boundaries may be different to others and that’s okay as we are all different and process things differently. Many boundaries overlap and you don’t have to have a boundary for everything – only the things that matter to you.
How can couples best approach agreeing their shared/common boundaries?
Clear and frequent communication is key. It’s not about being in perfect agreement on what constitutes each of your boundaries, its more important to understand and respect each other’s boundaries. Your experience of treatment will be different however engaged with the process your partner is. Regular check-ins with each other and external support (such as fertility counsellors or coaches) can help to reset any boundaries as needed.
What is the best way to ensure my personal boundaries are communicated with my clinic?
It can be tricky getting your message over to your clinic as you may have fears about seeming ungrateful, picky or being a ‘difficult’ patient. It’s always good to have an advocate at the clinic; someone with whom you have a good connection and will support you and your needs. This is often a fertility nurse or a counsellor but could be anyone involved in your care.
Communication between staff can be challenging or even poor especially in busy clinics so feel free to check-in with your ‘advocate’ to make sure that your needs have been acknowledged and understood by the team providing your treatment. Communicating your needs and boundaries to the clinic in writing is always a good idea.
Is it ok to change my personal boundaries?
Of course. Your boundaries are personal to you and are neither permanent nor irreversible. Circumstances change, people’s views change and this means that what you decided some time ago may no longer be the right decision for you now. It’s probably not helpful to move your boundaries frequently as then they probably won’t feel like boundaries at all and will have little influence on your mood, behaviours and decision-making. Set a date in your diary (in one, three or six months – whatever works for you) to revisit your boundaries and then reassess if they are still working for you. If not, change them! They are your boundaries.