Journey to the Other Side
I am sure many people are curious as to what drove us to write this book. Aside from a strong academic interest in the lives of women, there is also a deep personal motivation for us to undertake this task. In truth, we come from two very different places; one of us is childless by choice, while the other has battled with infertility since her early 30 having undergone several in vitro fertilisation (IVF) treatments and two miscarriages. Usually these two sides do not find much common ground, often regarding each other from across the âfertility trenchesâ with suspicious eyes. Yet, in reality, these two positions as childless women, in a society that venerates motherhood, share more commonalities than could have been expected.
From comparing our own stories, we learned that fertility and motherhood are neither a certainty nor a natural desire but, instead, a deeply personal struggle. We both found that the experience of not having children deeply affects the ways we see ourselves and how others see us. We realised that often our childlessness comes as a bit of a shock to those who wrongly assume that well-educated women in their 40s and 50s would surely have had the good âsenseâ to reproduce . We have also come to realise that the stereotype of womanâs destiny equals motherhood is still a strong narrative of western society and that the normative force of this narrative has, to some extent, coloured much of our personal adult female lives. We have often doubted our decisions and second guessed ourselves; we have struggled with the labels placed on childless women and have at times been deeply shocked by what others feel is their right to comment about what is believed to be a very personal condition.
In my case, there were two main occurrences which triggered the desire to write this book. The first was a good friend, who sought to comfort me after my first devastating miscarriage by stating that I should not be worried as, after all, âsmart women tend to have less children in the first placeâ; the second was a well-meaning older student of mine who, in no uncertain terms, told me that I should consider having kids now âas you know dear you donât have forever to make these decisionsâ.
Understandably both these assertions rocked me to the core. Suddenly I began to see myself as others saw me, as somehow unnatural, defective and perhaps a little selfish. This coupled with my own sense of disappointment and the inevitable insecurity, which unsuccessful IVF treatment and miscarriages seem to produce, got me thinking about how infertility affects women at a personal levelâhow this disease profoundly changes our biographies and sense of self at the deepest of levels. I began paying closer attention to the experiences being described by my infertile âsistersâ on our online support group, and soon a pattern began to emerge. Infertility is a life altering experience, one that changes us so deeply, that even the safe arrival of children can never hope to erase. Furthermore, I became deeply conscious that many of those dealing with infertility found little comfort or understanding in âthe real worldâ and instead found solace with others also struggling in online support groups, forging deep friendships that have spanned both the real and virtual worlds.
The stories which we relate in this book attest to this. By following the journals and posts written by the women over a period of six years, we relate the struggles faced in coming to terms with infertility. We describe the pain and frustration these women have felt at being unable to achieve what is commonly viewed as a womanâs right. Yet these women are not victims, but instead show a capacity to overcome adversity, which is utterly spectacular. To this end, we also discuss the strategies they employ to survive in what they often consider to be the hostile fertile world.
Infertility and Its Impact on Sufferers
Infertility can be defined as âa disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourseâ (Zegers-Hochschild et al. 2009). This rather sterile, and fuss free medical definition for what may for many be a life altering experience, fails to describe the complex nature of the situation, or the experiences of those who live through it. While the impact of infertility is severe for a couple, it can be argued that for women, the burden of infertility is doubly hard to carry (Thompson 2002). Western constructions of femininity are closely tied to mothering, and women in most if not all cultures around the globe are defined through their reproductive capacity. In fact, most cultures assume that all women will want to have children , a desire which is believed to be biological in its origin (Inhorn and van Balen 2002).
Not surprisingly, most young women grow up with the expectation that one day they will find a suitable life partner and will become mothers; infertility is seldom if ever discussed as a possibility. Not surprisingly, the belief that motherhood is certain has resulted in sexually active women taking all manner of precautions not to fall pregnant. In fact, fertility is seen as so natural that even medical practitioners will not begin testing until a woman has tried to conceive for at least six to eight months (longer if she is under the magical age of 35) even when there may be reason for a coupleâs concern. As a result, the experience of being infertile in a society that venerates fertility is not an easy one. Women who want children but are unable to conceive or carry a pregnancy to term often feel confused, lost, purposeless and alone.
As can be seen, infertility is far from resembling its clinical description, but instead constitutes, what Giddens (1979) termed, a critical situation; a major kind of disruptive experience which can severely affect a coupleâs, and in particular a womanâs, biography. It constitutes a shift, which permeates every aspect of her life. For many women, their childlessness is seen as a personal failure, a failure of their body to engage in what they feel should be a natural process. As such, a number of stories recount the feelings of anger, sadness and frustration at their bodiesâ inability to conceive. Furthermore, infertility is also an intensively private matter that often spills out on to the public arena. Countless times, the women who shared their stories with us recounted in their posts and journals how society had little sympathy for those struggling with treatment. A number of women discussed how employers were largely unsympathetic to their needs, and the sense of âexpert entitlementâ felt by well-meaning individuals leading to the offering of (un) âhelpfulâ advice on how to get pregnant. Finally, the struggle with infertility was made even harder by media stories which, while promoting motherhood as natural, paint the use of Assisted Reproductive Technology (ART) in a negative light. In fact, the demonising of ART has been so pervasive that in some countries the availability of treatment has been affected by these stories. For example, the news stories on Hollywood actress Nicole Kidmanâs use of IVF and a surrogate in 2011 changed Australian laws on surrogacy , almost completely destroying the ability of couples to make use of surrogates for pregnancy.
The intense feelings raised by the struggle with infertility, coupled with the strong public opinion prompted by the use of ART, has led many infertility sufferers to remain silent about their struggle. Yet the lack of input in this debate by those who are most vested in it, has contributed to a lack of recognition of infertility as a disease which places severe financial, physical and emotional burdens on suffers due to a lack of adequate support and response in government policy and medical care (Throsby 2004).
The Cost of Reproductive Technology
Infertility is a booming business. It is suggested that around 70 million couples are afflicted by infertility around the world with the numbers expected to increase by 5â10% annually (Brezina and Zhao 2012) making this a billion-dollar market. Infertility is most often addressed through ART, a group of procedures âthat involve the in vitro (outside the body) handling of human oocytes (eggs) and sperm or embryos for the purpose of establishing a pregnancyâ (Macaldowie et al. 2013). There are a number of ARTs currently in the market. It could be argued that the main forms of ARTs take the form of1:
In vitro fertilisation (IVF): A procedure whereby an egg (or more than one egg) is retrieved from the body of a woman and combined with sperm outside the body to achieve fertilisation. If fertilisation is successful and the fertilised egg continues to develop to form an embryo, the embryo is subsequently transferred back into the uterus/fallopian tube of a woman with the aim of achieving a pregnancy. If many embryos develop, some of the surplus embryos may be frozen and used later.
Intracytoplasmic Sperm Injection (ICSI): An IVF technique where to achieve fertilisation a single sperm is injected directly into an egg.
Frozen Embryo Transfer (FET): Where an embryo that has been frozen (cryopreserved) is thawed and then transferred to the uterus/fallopian tube of a woman with the aim of achieving a pregnancy.
Gamete Intra-Fallopian Transfer (GIFT): A procedure where an egg (or more than one egg) retrieved from the body of a woman and sperm obtained from a male are both inserted back into the fallopian tube of a woman, with the aim to achieve fertilisation (and then pregnancy) within the body of the woman.
Assisted hatching: An IVF micromanipulation in which a small opening is made in the zona pellucida of an embryo to help the blastocyst emerge prior to implantation.
Intrauterine insemination (IUI): Entails the insertion of a catheter into the womanâs uterus to deliver prepared sperm around the time of ovulation. However, according to a number of fertility treatment clinics, the success rate tends to be lower than other forms of ART.
Each patientâs treatment may require the use...