There is a particular phrase that comes up again and again in my work with people going through fertility treatment: “I feel like I failed.”

Sometimes it’s accompanied by, “I should have researched more/tried the UV light for my eggs/done acupuncture.” The list of imaginary crimes is endless and is often related to hindsight bias.

When I hear this, I hear the heaviness of the struggle, and the multitude of ways a person engages in self-blame. And I ask them, “When you say you’ve failed, what was the test?”

It stops people in their tracks for a second because, technically, there was no test. It’s not a test to have a baby or a competition. And yet infertility or a failed transfer can feel remarkably like being handed an exam paper.

There were medical treatments and biology, probabilities and variables. Chromosomes and hormones, age, chance, and countless processes and complexities beyond anyone’s conscious control.

The Invisible Exam

We’ve spent decades learning that certain behaviors lead to certain outcomes: If you work harder, you’ll progress. Follow the instructions and you are likely to get the desired outcome.

These beliefs are useful because they give us a sense of agency in the world. Then infertility arrives and all those rules are broken. “Null and void” was the term I once heard.

You can take the medications on time. Attend every appointment. Change your diet, stop drinking, exercise, meditate, take supplements, research, choose an excellent clinic, and understand your treatment protocol—and still, you may not get pregnant.

For people who have built their lives around competence, this can be psychologically disorienting, like the rug has been pulled out from under their feet. And since that feeling is overwhelming, our minds often reach for the best explanation they know: I must have done something wrong.

The sense of failure can be deeply personal: This is my fault. I’m disappointing my husband. Perhaps we won’t have the family we want because of me.

When the Body Becomes the Report Card

When I first meet with a person, I often get a list of numbers: Follicles. Estradiol levels. AMH. Eggs matured. Eggs retireved. Fertilization rates and number of blastocysts. Embryo grades and Beta hCG levels. The numbers can quickly stop feeling like medical information and start feeling like scores: 12 follicles can feel better than five; three blastocysts can feel better than one; a euploid embryo can feel like an A; a cycle with no transferable embryos can feel like an F.

This type of scoring system can be painful, as the outcome becomes a judgment about the body rather than information about the suitability of the protocol or the process: My ovaries didn’t perform. My eggs aren’t good enough. My body can’t do what other women’s bodies can do.

This is not a performance, and yet once the outcome starts to feel like a grade—good or bad—it tends to create enormous performance anxiety around the next retrieval: I need to do better next time.

“But She Got Pregnant”

Comparison makes the imaginary examination even more painful. Someone your age gave up trying and became pregnant naturally. Someone at your clinic retrieved 10 eggs. Someone online had a lower AMH and ended up with two euploid embryos. Your cousin got pregnant on her first IVF cycle. These stories become legend, blending fact and imagination into truth. The mind interprets them as evidence of it all being possible. Others can do it, so why can’t I?

But reproductive biology doesn’t work like a standardized exam. Two people can do the same things and have completely different outcomes. Intellectually, we understand this., but emotionally, another person’s success can easily become evidence of our own inadequacy. That is why “I’m happy for her” and “Her pregnancy makes me feel terrible about myself” can coexist perfectly well.

When Your Identity Makes It Harder

Sometimes infertility collides with an identity we have spent decades constructing. We all carry a reproductive narrative: a picture of how we imagined becoming a parent, what our child might be like, and how we would be connected to them. Fertility treatment asks us to revise that story over and over, often before we have had time to grieve the version we hoped for. And infertility can challenge not only the reproductive story we imagined, but also familiar ways we have come to understand ourselves:

• The person who believes effort leads to success encounters something effort cannot guarantee.
• The perfectionist encounters imperfection.
• The planner encounters something that feels like chaos and randomness.
• The person who has always trusted their body experiences it as unreliable.

Simply knowing saying, “IVF failure isn’t your fault,” while true, often isn’t enough. The deeper work is identifying what you believe the outcome says about you as a person.

Trash the Test

Fertility treatment has outcomes, but an outcome is not the same thing as a failure. An outcome is information. A retrieval yielding one egg is information, an embryo that doesn’t implant is an outcome. A cycle that is canceled is an event. Even a pregnancy loss, painful as it is, is not evidence that you failed. None of these things is a character assessment.

You participated in a process whose outcome you could somewhat influence but never fully control. So perhaps the next time you hear yourself say, “I failed,” stop at the word and ask yourself, Did I show up for something extraordinarily difficult? Did I make the best decisions I could with the information I had at the time? Did I keep going when I was scared?

That’s a very different measure of success.