By the time many couples reach a fertility clinic, they have already been trying for two or three years in private. What is less visible is what happens next － not the treatments that continue, but the patients who quietly disappear.
In clinical practice, there is a phase rarely spoken about: the point at which couples stop seeking care altogether explains Dr Amrita Nanda, Fertility Specialist at Birla Fertility & IVF, Bhubaneswar. No closure, no second opinion, simply absence. Appointments go unbooked. Calls are not returned. Treatment pauses indefinitely. This is the silent drop-out phase of infertility.
Where patients are lost
Data suggests this is not uncommon. International registries indicate that nearly 30–50% of couples discontinue fertility treatment after the first or second cycle, even when prognosis remains reasonable. A large European cohort study published in Human Reproduction reported that almost half of patients who stopped did so not because of medical futility, but emotional stress, financial pressure, or treatment fatigue. In other words, biology was not the barrier. The burden was.
Infertility care demands repeated visits, invasive procedures, unpredictable timelines and sustained expense. Each negative cycle is not simply a failed attempt; it is a psychological setback. Over time, the exhaustion accumulates quietly.
The emotional mathematics
Patients often calculate more than success rates. They calculate resilience. After months of injections, scans and two-week waits, many begin to wonder whether continuing is worth the toll on work, relationships and mental well-being. Studies from the Journal of Psychosomatic Obstetrics & Gynaecology have shown that anxiety and depressive symptoms in fertility patients can be comparable to those seen in chronic illness. When distress rises and support feels insufficient, withdrawal becomes a form of self-protection.
What must change
This phase deserves as much attention as any laboratory parameter. Better counselling, realistic expectation-setting, transparent cost planning and flexible treatment pathways can reduce attrition. Patients do not simply need protocols; they need continuity and reassurance that pauses do not equal failure. Because many who stop still have a fair chance of conception with appropriate care.
Fertility treatment does not always have a happy ending with biology. Sometimes, it is abruptly ended by fatigue. Recognising the silent drop-out phase may be the first step towards ensuring fewer patients walk away before they truly have to.
