When your partner doesn't want to continue treatment: what lies behind “I can't do this any more”

“I can’t do this any more. I can’t face another round.”

He says it in the kitchen, while clearing up, almost in passing — as if hoping the sentence would weigh less if he said it between two plates. She stops, tea towel in hand. In three weeks they have an appointment at the clinic. The medication boxes are still in the fridge, the calendar on the door is still full of notes. And suddenly it is no longer clear whether there are still two of them on this path.

This moment is more common in assisted reproduction than it seems. It is rarely loud. More often it begins with silence, with a tired “we’ll see”, with days when one partner simply stops talking about the next step. But once it has been said, it opens a question nobody rehearsed in advance: what do you do when one of you wants to carry on and the other does not?

In this post I won’t tell you who is right — because in that form, there is no answer. I will try to show what often lies beneath both sentences, why the conversation gets stuck so quickly, and what a couple can do so that the decision doesn’t become a wound that stays open long after treatment has ended, one way or another.

When one path splits into two

At the start, a couple usually decides on treatment together. At least that is how it feels. You both want a child, you both go to appointments, you both wait for results. But even here two different paths are already beginning. One person carries the physical part — hormone treatment, procedures, the mood changes the medication brings. The other watches from close by and often doesn’t know what to do with their own helplessness. Each of you lives through hope and disappointment at your own pace.

When infertility goes on for a long time, these two paths can begin to drift apart. Not because you have stopped loving each other, but because each of you bears uncertainty differently. I have written about what infertility does to a relationship in general in Infertility as a test for a couple: what happens to the relationship. Here I want to stay with one single point: when the drifting apart reaches the question of whether to continue at all.

Why this happens more often than we think

Deciding on fertility treatment has never been a given. In 2007, Jacky Boivin and colleagues gathered data from studies around the world and estimated that only around 56 per cent of couples facing infertility seek medical help. So even the first step is a decision many people don’t take. The same is true of every step after it.

In a 2012 systematic review, Sara Gameiro and colleagues looked at why people stop treatment before it runs out. The most common reasons weren’t only postponement, money or medical advice, but also the psychological and physical burden of treatment, along with relationship difficulties or personal distress. In other words: people often don’t stop because they no longer want a child, but because the road to one has become unbearable.

Research by Brennan Peterson and colleagues shows something else couples need to hear: partners often experience infertility with different intensity and cope with it in different ways. When that difference is large, the relationship is under more strain; when partners see each other as similarly affected, things are easier. A difference over who wants to continue is often just the most visible form of a difference that has been growing between them for some time.

What often lies behind “I can’t do this any more”

The words “I don’t want to continue” often sound to the other person like “I don’t want a child” or even “I don’t want you”. They rarely mean that. When I read the research and listen to people’s stories, underneath them I most often find one of these:

• Exhaustion. Physical, emotional, financial. The feeling that life has been lived from cycle to cycle for years and that everything else is on hold.
• Fear for your partner. Watching someone you love go through procedures and disappointments again and again can be unbearable. “I can’t do this any more” sometimes means “I can’t keep watching you suffer”.
• Fear of another loss. After a lost pregnancy or several failed attempts, there can be a sense that the relationship won’t survive another blow.
• Helplessness. Especially the partner who doesn’t physically carry the treatment can feel superfluous, without influence, like a spectator. Deciding to stop is sometimes the only thing still in their hands.
• Quiet grieving. One partner may already have begun, inwardly, to grieve for the child who won’t come, while the other has not.

None of these is selfishness. But they are hard to say out loud — which is why what often remains is a short, clipped sentence that lands on the other person as rejection.

What often lies behind “I can’t stop”

On the other side is someone for whom the thought of ending treatment feels like the end of something much bigger. Beneath the wish to try once more, I often find:

• The sense that the possibility is still open. As long as there is another attempt, there is hope. Closing the door means starting to grieve — and that is often something a person can’t yet imagine.
• Fear of later regret. “What if it worked next time?” That question can be stronger than any tiredness.
• What has been invested. Years, the body, money, sacrifices. When a great deal has been invested, it is hard to stop without feeling it was all for nothing.
• Identity. For some people, parenthood is part of how they have seen themselves since childhood. Ending treatment also means saying goodbye to a part of yourself.
• Loneliness. When a partner says “enough”, it can feel as if you will now grieve alone — or carry yet another decision alone.

When the two lists are placed side by side, something surprising appears: partners are often not as opposed as it seems. Both are afraid of something. Both are losing something. What sets them apart is mainly which fear is stronger.

A conversation that goes round in circles

When partners find themselves on opposite sides, the conversation often gets stuck in the same way. The dialogue below (composite, not a real person) will be familiar to many from their own kitchen:

“Just once more. The last time. I promise.”
“You said that last year too.”
“So you don’t care.”
“I don’t care? I’m the one who watches you cry in the bathroom. I can’t do it any more.”
“Then stop watching.”

In this short exchange each defends their position, but neither says what they are afraid of. She hears that he doesn’t care. He hears that his pain doesn’t count. Both leave more alone than they came. This kind of cycle is similar to the one I describe in From blame to needs: as long as partners speak in positions, they don’t hear each other; when they begin to talk about what they need and what they fear, the conversation shifts.

When the conversation happens matters too. The worst time to decide whether to continue is often the day after a negative test or a loss. That is when pain speaks, not reflection. Decisions made in that moment can later feel foreign — to both of you.

It isn’t about who is right

In situations like these, partners often look for allies: a friend who says “you mustn’t give up”, a mother who says “you’re torturing yourselves”, a doctor they hope will decide for them. When the question turns into a contest over who is right, one of you wins and the other loses. But in a couple, that kind of victory almost always means the relationship loses too.

In relational family therapy, the approach I am training in, we also look at what each partner brings into such a moment from their own history. Christian Gostečnik describes how, in a couple’s hardest moments, very old feelings are often awakened — for example the feeling that “my wishes never counted”, or the feeling that “I always have to be the one who makes sure nobody breaks”. When one partner says “no”, the other may hear in it a much older “no” they heard as a child. And the one who says “no” may once again find themselves in the role of the person who has to pull the brake, because nobody else will.

Putting this into words doesn’t make the decision easier. But it makes it more shared. Partners stop defending positions and begin to look together at a question that is hard for both of them. It can help to treat ambivalence — the simultaneous “yes” and “no” inside each of you — as a normal part of deciding. There is more in the knowledge base under ambivalence.

Exercise: two lists, one table

This exercise isn’t meant to help you decide in one evening. It is meant to help you hear each other. Do it when you are not in the middle of a new cycle or just after bad news.

1. Each on your own, on paper. Each of you writes two sentences: “If we continue, I’m afraid that …” and “If we stop, I’m afraid that …”. Both sentences, even the one that feels foreign. Take ten minutes.
2. Exchange without replying. One of you reads your sentences. The other doesn’t answer, correct or comfort — only repeats in their own words what they heard: “If I understand you, you’re afraid that …”. Then swap.
3. Look for common ground. Together, underline which fears are alike. It often turns out that you are both afraid of loss — of your partner, of yourself, of the relationship or of the future.
4. One question, not a decision. Each of you writes down one thing you would need in order to talk about the decision more calmly — more information from the doctor, a break, help from a third person, some time without talking about a child.
5. Agree on a time. Agree when you will talk about it again. Not tomorrow and not “some day”, but on a specific date. Until then, you don’t argue about the decision.

If you want to take the exercise further, the questions in the knowledge base under questions before a big decision can help.

What if you can’t agree

Sometimes, after long conversations, partners still disagree. It is only honest to say: there is no formula that resolves this without loss. But a couple can consider in-between options that aren’t just “yes” or “no”:

• A break with an agreed end. A set period without treatment, after which you talk again. For many couples it is the first time in a long while that they can breathe.
• A joint conversation with the doctor. Questions about options, risks and chances belong with your gynaecologist or the clinic where you are being treated. When you both hear the same thing, the conversation at home often changes.
• A clear limit, agreed together. Some couples agree on the last step they will try — and write it down before it is right in front of them.

I have written about what the decision to stop itself means, and how grieving follows it, in When is enough enough? Deciding to end fertility treatment.

One more thing matters: even if things end up the way one of you wanted, the other may be left feeling that they lost. The resentment that builds around such a decision can linger for years. Not because the decision was wrong, but because the sadness around it was given no room. You can read more about how resentment forms in the knowledge base under resentment.

Where this view falls short

Everything I have written assumes a couple in which both want the relationship to last, and where the disagreement is painful but honest. That isn’t always the case.

When “no” means something else. Sometimes resistance to treatment is really resistance to the relationship or to a shared future, which a partner doesn’t dare say. Then talking about treatment will lead nowhere, because you aren’t talking about the real thing. The important question is a different one — and I write about it in When your partner grows in another direction.

When there is pressure or control. If decisions in a couple are made through threats, intimidation or withholding money, that is no longer disagreement but abuse. Help is available on the SOS helpline for women and children victims of violence, 080 11 55 in Slovenia; in an emergency call 113 or 112 in Slovenia.

When depression is behind the decision. Long-term infertility can trigger depression in one or both partners. Then “I can’t do this any more” may refer to everything, not just treatment. If you notice that your partner (or you) is losing interest in things that used to matter, sleeping badly, withdrawing from people or thinking about not being here, it makes sense to see your GP or a psychiatrist. If you are having suicidal thoughts, the Mental Distress Line is available on 01 520 99 00 in Slovenia (7 pm to 7 am), and the Samaritan helpline on 116 123 in Slovenia (24 hours a day).

When medical facts decide. Sometimes it isn’t the couple who decides whether to continue, but health, age or test results. That is a different loss — not a loss through disagreement, but the loss of choice itself. Questions about what makes medical sense belong with the doctor treating you.

When one of you never really wanted a child. Sometimes it only becomes clear during treatment that one partner agreed to a path that wasn’t theirs. It is a painful discovery, but an honest one. The conversation that follows is no longer about treatment, but about what you want from your life together.

How couples therapy can help

Therapy won’t make the decision for you. Nor should it. What it can do is create a space in which both of you are heard — including the one who usually falls silent at home. In couples therapy it often turns out that the biggest obstacle to the decision isn’t the decision itself, but the fear that the other person will be left alone with the pain.

In sessions we work on how you hear each other, how you tell each other what you are afraid of, and how you can make a decision — whichever it is — in a way that lets you stay together afterwards. If you disagree about whether therapy even makes sense, it helps to know that one of you can start; more on this in When only one of you wants therapy.

Sessions take place in person in Ljubljana, and I also work with English-speaking clients. As a marriage and family therapist in training under supervision, I regularly discuss my work with an experienced therapist. If a loss has already become part of your story, you may also find Grieving as a couple: why you grieve differently helpful.

What to remember

• When one of you wants to continue treatment and the other doesn’t, you are often closer than it seems: you are both afraid of loss, each simply fears a different loss more.
• “I can’t do this any more” rarely means “I don’t want a child” — more often exhaustion, fear for your partner or quiet grief.
• Research shows people often stop treatment because of its psychological burden, not because they no longer want a child.
• Don’t make the decision the day after bad news; agree on a time to talk and give yourselves in-between steps.
• If abuse, depression or doubts about the relationship lie beneath the disagreement, that is a different question — and it needs a different kind of help.