Episode #168: PCOS and Fertility Treatment Dropout: What Comes Next?

Hi, and welcome back to the PCOS Repair Podcast. Today, we’re doing a research review on one of the areas that is very prominent in the treatment of PCOS, and that’s fertility. This research article, titled Dropout of Infertility Treatments and Related Factors Among Infertile Couples, looks at where and why dropping out of a treatment regimen is occurring. What they’ve defined as “dropping out” is anyone who stops fertility treatments without achieving a healthy pregnancy.

Why are so many couples—specifically women, as this article focuses on—choosing to stop fertility treatments before they get pregnant, even when they still have the option to continue? If you’ve ever felt exhausted by the roller coaster of fertility treatments or are concerned about the impact on your emotional health from undergoing fertility treatment—or even just trying at home—this episode is for you. You don’t necessarily have to be going to a fertility clinic. Maybe you’re just experiencing that roller coaster at home as you try to recover your cycle or get pregnant naturally. This episode looks at why, sometimes, it feels easier to just stop trying.

You are not alone. Stopping treatments or stopping the effort to get pregnant isn’t weak. There’s actual research—that’s what today’s episode is about—that shows why people make that decision. I don’t like the word “dropout,” although that’s what the article uses. I prefer to say “choosing to stop,” and that’s what we’ll dive into today. We’ll walk through some fascinating studies that combine both numbers and personal stories so we can better understand what’s really going on under the surface. My hope in sharing this article is to shed light on an area that touches everyone dealing with fertility issues—whether you’re working with a medical team or taking a more natural approach. You’re still on that month-to-month roller coaster, asking, “Is it working? Is it not? When do I give up? When do I stop? When does the emotional toll outweigh the hope of pregnancy?”

Infertility is extremely stressful. Emotionally, physically, and relationally—it’s just hard. It can put a strain on your relationship with your partner, and it can also affect relationships with family and friends. Now, imagine adding invasive procedures, high costs, financial stress, and constant disappointment—repeating that cycle over and over without a guarantee. If we knew the process would work—if there were a guarantee—it would be a different mental game. You could tell yourself, “I just have to get through this.” But when there’s no guarantee, we carry so much doubt and fear in every decision. “Am I spending money needlessly? Am I…?” You fill in the blank.

For women with PCOS, who may already be dealing with irregular ovulation, metabolic challenges, and hormone imbalances, fertility treatments often feel like the only hope. But what happens when that hope turns into burnout? In the medical system, online, and on social media, most of what we hear—usually because it’s more uplifting and marketable—are the success stories. We see the baby announcements and miracle outcomes. But what’s not talked about enough are the stories of people who choose to step away. The women who say, “I just can’t do this anymore,” even when the clinic says, “You can keep going. There’s no reason to stop.”

This study brings those stories to light. It was conducted in Iran and looked at people who stopped fertility treatments. They used a multi-stage mixed method design, meaning they combined a thorough review of existing research, a large cohort of patient data, and in-depth interviews with women who had gone through failed fertility treatments. First, they systematically reviewed global studies—so even though the research team was based in Iran, they looked globally for patterns in treatment dropout. They followed over 400 infertile couples who had undergone at least one round of IVF or similar Assisted Reproductive Technology (ART). These couples were observed for at least six months, regardless of whether they continued or discontinued treatment. Finally, they conducted in-depth interviews to hear directly from the women about why they chose to stop.

What makes this research especially compelling is that it includes both comprehensive data and emotional insight. The biggest and most consistent reason people stopped seeking fertility treatment was psychological burden—not necessarily finances or failed procedures. The stress from repeated failure, depression, anxiety, hopelessness, strain on relationships—all of it compounded. While financial strain did play a huge role, especially in places where ART isn’t covered by insurance, physical reasons like fatigue, hormone side effects, and needing to take a health break also came up. But what struck me most in the interviews was how invisible these struggles felt. Many women felt dismissed by their care team. Their emotions, doubts, and trauma weren’t acknowledged. They were told to keep trying, and once things got going, it felt like a runaway train. They didn’t feel like they had any choice left.

This may be due to poor communication, misunderstanding their diagnosis, confusion around success rates and options, pressure from family or cultural expectations, or even social stigma. Interestingly, the study found that discontinuing treatment wasn’t always about giving up. Some women felt empowered by reclaiming agency in their lives. They chose to pause—not permanently stop—for their mental health.

The fact that psychological burden was the number one reason for stopping is incredibly important. It’s the feeling of a lack of agency. Things were happening to them, and they didn’t feel heard. I want to pause here and say: sometimes, we need to look within. People around us—especially fertility care teams—are there to do their job. That job is to manage your medical care, not your mental health. If you feel dismissed or emotionally unsupported, please seek help outside your fertility care team. Get support for your fertility care mental health. That part is so important and often overlooked. Honestly, it should probably be required that anyone undergoing fertility treatments also sees a therapist, a life coach, or someone who can help with the emotional toll.

When I’ve worked with women trying to get pregnant, I don’t typically stay involved during active fertility treatments, although I’ve supported patients through lifestyle adjustments alongside treatment. Whether you’re trying naturally or through medical intervention, the mental toll is intense. You rehash, you overthink, you ruminate. Every minute drags by while you wait to take that pregnancy test, and you dread it at the same time. It’s a roller coaster—and we know it’s not helpful to our stress levels, but how do we manage that?

The truth is, your medical care team isn’t there to help with that part. It’s not built into the system. Their job is to check your vitals and handle the procedures. But you do need support from someone who isn’t emotionally invested—someone who can help you sort through your feelings and make clear decisions.

Stopping is okay. Taking a break is okay. But it’s unfortunate that we often only stop because we’ve reached burnout. This is a sign that the emotional component of fertility care needs more attention. If you’re listening to this podcast, you probably have PCOS or someone close to you does. You likely know that fertility treatments start sooner, last longer, and require more cycles for women with PCOS. That alone can leave you feeling discouraged before you even begin.

PCOS is one of the leading causes of anovulatory infertility—meaning you’re not ovulating. That puts you in a vulnerable position with IVF and IUI. Any ovulation induction may feel like your only option. These treatments have to be perfectly timed. Some clinics don’t monitor as closely as others, assuming that mid-cycle is the same for everyone. But with PCOS, timing can be completely unpredictable. It’s not methodical. So it’s vital that your provider is listening to you and taking your specific situation into account.

That speaks directly to the agency piece. The more informed you are, the more you can advocate for yourself. That’s what I hope this podcast provides—tools to help you be an informed and empowered patient.

One point from the study really stuck with me: just because something is medically available doesn’t mean it’s emotionally sustainable. You don’t have to push through. You don’t have to sacrifice your mental and physical health just to prove you can. If you do want to keep going, make sure you’re taking care of yourself—mentally and physically. Take time off work, get rest, go for walks, spend time in nature—whatever helps you cope.

So what can we take away from this study? Know your limits. They matter. If you’re feeling burnt out, it’s okay to pause. It doesn’t matter what your care team says. If it doesn’t feel right, you don’t need to continue just to stay on theirschedule. And there’s no real evidence that taking a few months off causes harm or reduces your chances. Every situation is unique.

Be honest with your care team. Ask questions. If they say, “You need to do this next step,” ask, “What would be the downside of waiting?” Sometimes, it’s insurance-related or something logistical—but knowing why can help you feel more in control. Ideally, you find a care team where you rarely feel the need to push back. But even then, speak up when something doesn’t feel right.

Build your support system. That might include coaching, therapy, or a support group. Be cautious with support groups, though—they’re great for some, but someone else’s experience (positive or negative) can heavily affect your own emotional state. Be mindful of what’s helpful for you.

Stay open. Stay curious. This isn’t about gritting your teeth and pushing through. The lifestyle and root cause side of PCOS is so important. That’s why I started with lifestyle before diving into fertility treatments. When you’re grounded in your own health—when you know how your body responds to food, movement, sleep—you have a much stronger foundation. That helps you succeed, make clearer decisions, and know when you need a break.

Maybe you’re someone who wants to keep trying for years. Maybe you’re someone who wants to try for three months, then reevaluate. Either way is valid. But give some thought to how you’ll approach that—what you’ll do, how you’ll support yourself. That way, you won’t get stuck in regret or burnout later on.

We can’t control everything. But we can stay in the driver’s seat of our outlook, our next step, and how we care for ourselves. So let your journey be your journey. There’s no shame in needing a break. There’s power in knowing your boundaries, in choosing when to start, stop, or pause—and what you need in that moment.

And as always, tap into your root cause healing, because that’s where your body feels its best. Whether you’re going through hormonal shifts or navigating fertility treatments, the way you support your body matters.

If you found this episode helpful, don’t forget to hit that subscribe button so you don’t miss an episode. Until next time—bye for now.