For many women, infertility treatment ends in the happiest way: the birth of a child. But for others, treatment ends when a doctor tells them that further treatment has little chance of success or when they can no longer tolerate the financial, emotional and/or physical stresses of high-tech fertility treatment. No matter what the reason for ending treatment, these women must come to terms with the difficult fact that they will never have a biological child.

What happens then? A woman's reaction to not having a biological child is as individual as each woman herself, according to Patricia Irwin Johnson, author of several books relating to infertility, including Taking Charge of Infertility. Johnston is a social worker with many years of professional and personal experience in this area. "I think it's important to understand that while the loss of the dream [of parenting a biological child] is certainly one of infertility's major losses, it certainly is not the major loss for everyone," says Johnson. "Some feel much more strongly about their loss of control. Others feel much more strongly about their loss of personal genetic continuity. Still others mourn the loss of the pregnancy experience -- either physically or emotionally, or both."

Katie, 26, of Ithaca, NY, had been trying to have a baby for 4 years and was in treatment for infertility. Her treatment experience included temperature charting, taking Clomid (a drug used to stimulate ovulation), intrauterine insemination (IUI), and a variety of different fertility medications give by injection. Katie underwent many tests and several surgical procedures. Her only pregnancy ended in a miscarriage.

When Lisa, 37, of New York City, learned that her infertility diagnosis would require her to utilize IUI or IVF in order to conceive, she knew that she would not pursue that treatment. Like Katie, she and her husband had made a decision only to go so far, and IUI and IVF were beyond the boundaries of their comfort zone. Lisa knew that her decision to end treatment would likely mean that she and her husband would not have biological children, but she has no regrets about it. "I never had a burning desire to have children," says Lisa. "I don't dislike them, but I just never felt that strongly on the issue."

Mimi, 35, of Memphis, Tenn., was 34 when she and her husband began their first IVF. She did not respond well to the medications and her doctor said that her body responded as though she were pre-menopausal. After several tries her doctor said that she had a very poor chance of conceiving a biological child. "The idea of not giving birth to a bio child is devastating," says Mimi.

Coming to terms with ending treatment means, for many people, "coming out" to family and friends that they will not be giving birth to a biological child. Patricia Irwin Johnston strongly encourages folks to drag themselves out of the closet as early as possible. "This doesn't mean sharing the details with the universe," says Johnson. "But being willing to acknowledge that one is getting treatment (generally) for a medical condition can help prevent the inappropriate feelings of shame that come to folks who hide in closets. I think it's essential that those who are out of the closet continue to maintain their right to privacy boundaries. Close family members and friends need education. Few people deserve or need the details. Mere acquaintances need no info at all!"

Katie says that she shared her decision to stop treatment with her mother. "She's still holding out hope that we aren't done trying," she says. "She really wants that grandchild! So I didn't share with anyone else."

Linda and her husband didn't hide their infertility. "We shared our infertility with immediate family almost immediately because I felt that it was better to get it out in the open than have people ask about when we are going to have kids. Most people were very supportive. My in-laws told us to keep trying, eventually we would have a baby. It took them a lot longer to come to terms with all of this than my parents."

"We have been very open with our families and friends about this, and everyone has been very sympathetic," says Mimi, though she added, "I still get a lot of comments saying, 'you still will get pregnant...you're only 35. '"

Lisa says that she has shared this decision with a very small number of people. "My best friend was very supportive," she says. "She heard all about the trials of infertility while we were experiencing that, and has been wholeheartedly behind us in this decision. I've not yet told my family or my husband's family." Lisa says that the topic has come up with long-time business acquaintances. "I've explained that we won't be having children. The reactions have ranged from intense support to disappointment."

For some women, the decision is the end to a cherished, lifelong dream, and comes after many years of painful, emotionally draining and expensive infertility treatment. Others aren't willing to endure the ordeal of infertility treatment. No matter what the reason for ending infertility treatment, most women make a decision about how they will deal with parenting. Some choose childfree living. Others seek alternatives: adoption, surrogate parenting, egg or sperm donors. According to Patricia Irwin Johnston, "Those whose greatest loss with infertility is the loss of the opportunity to parent are the ones who have the easiest time looking at options beyond treatment -- options which involve some kind of adoption: traditional adoption, surrogacy, donor gametes."

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