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Hey,
This is the second of the Saturday Letters that free subscribers receive most Saturdays. It’s a note to you, whether you’re wondering what fertility over 40 is about, you’re considering treatment, you’re in the thick of it, or coming out the other side.
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Here’s what happened in my first IVF cycle, at a clinic in Spain.
I was told to test my embryos using PGT-A (a genetic test). The package was chosen for me. There wasn’t any conversation about whether I wanted to. Or explanation of what it meant, what it would cost, or what the legal implications were in Spain.
It was only after the cycle that I learned it’s illegal there to transfer an aneuploid embryo. So when all three embryos came back aneuploid, it felt the decision had already been made for me.
The same doctor then advised I should use a donor egg as casually as if commenting on the weather. It wasn’t a conversation. It was a redirect, offered in the same breath as the bad news.
I was devastated by the IVF outcome. But harder still was the realisation that I’d been processed as a customer, not cared for as a human. All the way along, decisions had been made for me while I nodded along.
This happens to a lot of us.
It hits hardest when you’re a solo woman over 40, alone in the consult with no backup. You might be used to managing complexity everywhere else - especially if your job involves considerable responsibility. But in the world of assisted fertility, it's easy to become an obedient bystander, without realising until it's too late, in one of the most important decisions of your life.
This isn’t about becoming a medical expert, or thinking you know better than the doctor. It’s about giving yourself space and agency from the outset, as both the customer and the patient. It’s your money, and your body, and your decisions.
“Trust your doctor” sounds sensible until you’re three cycles in, wondering why you trusted them on something they never explained.
I've heard it time and again from women. “I assumed the doctor would tell me.”
Online research tells you about success rates. It doesn’t tell you what’s actually optional, what the clinic’s incentives look like, or that language like “your stats are above average” might be a sales tactic to get you into treatment (and spending). It’s more enticing to invest in a doctor being optimistic, than one giving you the harder reality check.
And nobody tells you you’re allowed to ask. You're allowed to take an active role in your treatment. You're allowed to demand answers before you commit thousands of pounds and months of your life.
The rules are different in assisted conception, and nobody explains them to you.
You can’t control the biology. You can’t control the outcome. That’s the grief, and it’s real.
But you can control whether you walk in blind. Knowing what to ask, what’s actually optional, whose interests the clinic serves, is what protects you from the second trauma of feeling exploited or misled, on top of the grief.
Infertility-related trauma is more common than previously recognised, and it’s often compounded by feeling unheard or blindsided. Preparation doesn’t change whether the cycle works. It changes whether you walk away knowing you did everything you could to protect yourself, and whether you knew how to identify the best doctor for you.
This isn’t about the doctor being a miracle worker. It’s about being able to trust they’re doing everything they can, because you can see the decisions being made with you, not for you.
Before the cycle starts, ask these and get the answers in writing. “Let’s be optimistic” is not a treatment plan.
One. Ask whether procedures like PGT-A are optional. What are the pros and cons? What’s the legal framework in [insert country]? What does it cost, and what happens if you decline?
Two. Ask for outcomes with your own eggs versus donor eggs, for your specific age and diagnosis, before the cycle starts rather than after it fails. Ask when and why donor eggs would be suggested, and have that conversation upfront, not as a redirect after bad news. As a woman over 40, donor eggs inevitably become a part of the conversation. Preempt it before it’s dropped on you.
Three. Ask what happens if this cycle fails. Ask whether that answer changes if retrieval is cancelled, if no embryos fertilise, or if transfer is postponed.
One more, optional but revealing: ask what the clinic’s most commonly recommended add-ons are, why they recommend them, and who benefits financially.
By my third cycle, I finally understood what had been missing. I went into consultations knowing what to ask, what to prioritise, and what to steer clear of.
And I stopped assuming the doctor would offer the information I didn’t know to request.
The difference wasn’t entirely the clinic. It was that I wasn’t a bystander anymore. I was in the driving seat. I selected my third IVF clinic as a well informed 43-year old woman. I felt certain about investing the rest of my finances with them.
And when I found myself able to try naturally with a known donor, that clinic was supportive of the opportunity.
You can’t guarantee an outcome. But you can guarantee you walked in with your eyes open.
And if the cycle doesn’t work, at least it won’t be because you didn’t know what to ask.
Sarah
P.S. Every other Tuesday, The Tuesday Briefing gives you deeper stories on one element of treatment or the industry: the questions to ask and the one thing you need to know before you commit. Plus a monthly live Q&A with hand-picked experts who specialise in treating women over 40.
One private consultation costs around £250 and gives you one doctor’s time. A year of the Tuesday Briefing costs the same, and gives you twelve expert Q&As plus the frameworks to walk into that consultation ready.
P.S.S. The outcome of my time with that clinic was quite the plot twist. I paid the deposit; and then conceived a healthy baby via natural conception aged almost 44, with the known donor. (Here’s a timeline of everything I did in the months leading up to pregnancy.)
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