Thinking About the Inconceivable
For years I've been told that I think too much, so it's not surprising that when my husband and I first had trouble conceiving a child, I wondered if the problem was that I thought too much about it. A logic of illogic pervades this subject even in medical circles, where doctors are liable to say, sadly, "Oh, stop seeing me if you like. Then you'll probably get pregnant." The lessons of infertility--some based on true stories--run like Zen koans. How can a couple conceive a desired child? Give up; go on vacation/adopt; solve an unrelated problem; phone a doctor/storm out of a doctor's office in disgust. I came to believe that my part in conceiving--during seven years of on-again off-again treatments, four doctors, two operations, and more drugs than I like to think about--was to live life so that pregnancy would be the darnedest punchline. Perhaps this is why I read so little on the subject: I didn't want to think about it. I thought I already thought about it too much. I thought about it all the time.
And if this explanation seems a bit theoretical, it was. Until I picked up Sherman J. Silber's How To Get Pregnant in Brentano's last year, I had never seen a single infertility book for sale. True, there were medical libraries. There were rumors of books--one or two--to be ordered by mail. On the whole, though, if I didn't want to think about infertility, I could take a kind of comfort in the idea that I had company. No one else wanted to think about it, either. Yet somehow I took no comfort in it at all.
I remember bursting into tears when I discovered that an early feminist health guide failed even to mention my problem. I was on hormones then of course and cried at anything. The scarcity of the literature bothered me hardly more than the flatness of what was available in articles and pamphlets, a flatness which was if anything rivaled by spoken language, social as well as medical. From the euphemisms of the examining table ("This may pinch") to the platitudes of the dinner table ("Just adopt--then you'll get pregnant!''), the language of infertility suited the reality so poorly that a nervous person might suspect its purpose was not to make contact but to prevent it--rather like the social language of cancer. Like cancer, infertility is a terrific conversation stopper. Both problems embarrass people, who are thrown because the final outcome is unknowable, and aren't entirely sure your problem is medical at all, in which case it may be rude to pursue the subject. I don't have friends who know so little about sex that they think infertility is a sexual dysfunction, but I know people to whom the bearing of children is roughly equivalent to the meaning of life. For them, infertility is purely unthinkable.
The articles I read here and there were sensible enough. But their attempt to de-emotionalize a charged field, or to avoid misrepresenting the many with the oddities of individual cases eliminated texture and power, and I felt worse when I finished reading them, as if one more invisible shield had been erected between myself and a condition which I found as hard to conceive as a child.
I encountered Silber's book long after the worst was behind me. The crisis had broken. I had done what everyone kept telling me to: given up and stopped trying. And when that hadn't cured me, I'd realized it was okay to think again. Even so, reading How To Get Pregnant gave me an almost physical sense of relief, as if something had been lanced.
Silber's great feat is to describe vividly, thoroughly, and logically a normal fertilization and to place infertility at specific points on the same map. He's a seasoned specialist who perfected the technique for vasectomy reversal and for testicle transplants, but more to the point here, he possesses that rare talent for writing well--even grippingly--about a scientific subject. Part of his secret is details-anecdotes, exceptions, repetitions. But Silber doesn't stop there. While the awe infertility inspires in doctors sometimes leads straight to paralysis (not to mention shot-in-the-dark treatments prefaced with "We don't know why this works") Silber assumes and probes for an underlying logic. From the sperm's point of view that logic is survival. And the sperm's point of view--in the microscopic dimension--is what Silber takes. The ovum is fertilizable for as little as six to eight hours (estimates vary wildly). The chance that sex will occur during this time span is small. Sperm however, live up to 48 hours. The trick is for the longer lived sperm to cross the egg's path in an efficiently paced flow.
From the sperm's vantage, the female reproductive system looms with dangers. Except for that brief mid-menstrual-cycle moment when fertilization is possible, the whole female territory is prophylactic--to prevent, as they say, disease. That's my emphasis; Silber's is on the paradoxical advantages to reproduction of what, from the sperm's view, seem like a series of barriers. The acid vaginal environment (where 99.9 per cent of ejaculated sperm die before even entering the womb) and the mucus that covers the cervix, or entrance to the womb, screen out substandard sperm. "Crypts" on the cervical interior, and the narrow fallopian tubes where conception occurs (these tubes can cause infertility by stopping sperm permanently), are designed to delay the sperm flow to a trickle to improve the chances it will cross the egg's path at the right time. Even when the timing is right, the forces that draw sperm to egg seem less magnetic than the forces that got the sperm out in the vagina to start with. Many sperm go up the wrong tube, many never get across the womb, many wriggle on by the egg as if they didn't know it was alive. On the inside, the start of life seems less like Romeo and Juliet than a game of soccer.
Although Silber is less thorough on the female factor, he does make clear how the egg is transmitted from the ovary into the fallopian tube (the open ends of the tube have to sweep the egg in or the egg will fall into the pelvic cavity and disintegrate) and down the tube to its narrow end, where the egg lodges until fertilized, or not. Even at this point, the fertilized egg may fail to implant in the uterus.
Because Silber's detailed account helps bring an elusive, overwhelming problem down to a tangible level, he helped me sort out much of the superstitious garbage the infertile are subjected to. But his work gave me more than psychological reassurances. It is a real diagnostic aid. Using Silber's picture of normal fertilization, it's possible to theorize in a very specific way about just what points in the scheme--from the openness or traction of every female barrier to the vigor and quantity of the sperm--might contribute to a situation in which what happens to most sperm during normal fertilization happens to all of them. Fertility, like infertility, is often relative, and infertility, like fertility, is often a collaboration. A combination of relative inefficiencies may cause what appears to be total infertility, but changing a small factor in either partner can make all the difference. The more I studied Silber's scheme, the more I came to wonder whether or how this might apply to our case, in which doctors placed the onus of unexplained infertility on me.
In infertility medicine, the male factor is frequently virtually ignored while the woman submits to painful, draining, some times dangerous treatments--not to mention the psychological burden of the blame. One specialist kept me somewhat experimentally on a drug that left me dizzy and nauseated and made breathing so hard that I had to sleep propped up; this went on for seven months. He was also giving me endometrial biopsies (an excruciating if brief in-office procedure in which a piece of the cervix is scraped off with a sort of razor) despite my objections, and with a frequency even other doctors have remarked on. At the same time he advised my husband and me not to worry about precisely timing sex prior to postcoital tests--for fear of hampering I my husband's performance. He never reasoned that my illness, pain, and fear, and his callousness about them, might finally drive me to abandon his treatment and, for years, any treatment at all.
Silber explains something I hadn't known. The reason the female factor receives more emphasis than the male is not that the woman's contribution is greater, but that so little can be done to improve low male fertility that many doctors feel they have to make the woman superfertile to compensate. Without explicitly invoking feminism, Silber succeeds in redressing many of the implicitly sexist or even gynephobic tendencies of a field in which even the language is loaded, though of course that depends on who's using it. When my specialist--whom I'll call Dr. X--said my cervical mucus was "hostile," I couldn't help taking it personally.
Silber perceives the female body not as a hostess but a worker. Fertilization is a kind of dangerous mission (l kept thinking of Cockleshell Heroes, featuring Jose Ferrer and lots of rafts): "Ejaculation is a very tense moment for the sperm. . . . The invasion must take place promptly, and any sperm left behind will never be able to catch up . . . platoons . . . beachhead . . . " etc. And if this sounds vulgar, I welcome vulgarity in a subject that has far too much "viscosity," "pinches," and "many couples may find" for my taste. (l have my limits, though--namely one cartoon from Margaret Nofziger's remarkably uninformative The Fertility Question, in which the crucial moment is portrayed as a nose dive by a cockroach with gloves on into a foxy egg wearing mascara and lipstick. Read Nofziger's unusually specific comments on temperature chart variations standing up in a bookstore and save $4.95.)
As a metaphor, the dangerous mission seems a lot more appropriate than the hot date. To Silber, even "good" mucus is no swooning pushover but an organizer, breaking down just before ovulation into corridors, which guide the otherwise haphazard sperm into the uterus. He raves at length over "that remarkable liquid . . . the cervical mucus . . . in a technical sense it is not a liquid . . . it can actually be cut with a scissors . . . " Silber seems genuinely to relish the body's juicier features, describing the ovum as a "sticky, gooey mass," or marveling at "the complex, smelly chemistry of semen."
Silber's very appreciation of the body puts infertility in a friendly context--the infertile may be missing something, but it isn't bodies. And it certainly isn't sex. On the contrary, Silber takes pains to stress what a fine thing it is that human sex, unlike that of cats or pigs, is designed for more than reproduction. I don't necessarily buy his belief that our species owes its ascendancy to the capacity for nonreproductive intercourse and the stable family units it makes possible, but I like the drift. Human infertility could be considered a calculated risk in a feature of existence that evolution seems to favor as it does the capacity for walking, talking, and thinking: sex by choice, for pleasure and for love.
Silber's kindliness is also his limitation, however. The anecdotal support, drawn from his own practice, tends to depict mistreated couples saved by Sherman J. Silber. Few go uncured, none undiagnosed. The jacket copy promises "new hope" to the disappointed. But for the longterm infertile, like me, new hope can open up old wounds. Sometimes skepticism is kinder.
A few months after reading Silber--and the timing was no coincidence--I began to consider making one last try: AIH (artificial insemination with the husband's semen, which may sound redundant, but is a way past some of those female barriers, for instance that remarkable liquid). AIH is a relatively simple procedure, drugless and nonsurgical, but whenever I thought about it--particularly after I had begun to prepare by taking my morning temperature--I found myself in that peculiar state of paralysis that in all my infertility treatments has passed for hope. And probably because I knew it would be the last try, hope felt worse than ever. At about this time, an early copy of Robert H. Glass and Ronald J. Ericsson's Getting Pregnant in the 1980s came my way. I looked up AIH in the book, which is organized as a guide to tests and treatments, learned what the odds were for success (20 to 35 per cent), and discovered some of its risks (possible severe cramping in intrauterine insemination). I discussed the details with two doctors who reassured me a bit--partly because the one who would execute the inseminations was a woman whose judgment and hands, I had learned to trust. But what reassured me most was the experience of active participation and control. When the incident was over, I found I had been cured of an old superstition that taking my temperature would make me pregnant.
Planned as a "state-of-the-art summary of what medical knowledge . . . can and (just as important) . . . cannot do" by an infertility specialist and a research biologist who "deliberately present medical treatment not as dogma but as an educated guess," Getting Pregnant has a dry tone and nonanecdotal format that make it harder than Silber's book. But it offers a kind of acid bath I found extremely helpful in delineating the realistic parameters of hope. The most frequent object of skepticism here is the absence of control groups in infertility studies. "It has been shown," Glass and Ericsson observe in their chapter on the male factor, "that there is a 25 per cent pregnancy rate without treatment in males categorized as having poor sperm counts or poor sperm motilities. This figure is very similar to the success rates usually attributed to drug or hormone treatment." Success rates, the authors argue, must be compared with an untreated statistical sample to prove anything, particularly in a field where unexplained "spontaneous" cure is commoner than the other kind.
Silber too discusses the "spontaneous" cure and offers some intriguing statistics. He writes about a survey taken on a sample of 632 women artificially inseminated over 18 months. During each succeeding month, the women who had not become pregnant were inseminated again. Although the number of pregnancies dwindled after the third month, the per cent success rate remained nearly constant: of each monthly sample, whether 632 women in the first month or 23 in the eighteenth, some 20 per cent conceived.
But where Silber views such statistics as reason for new hope, Glass and Ericsson present theirs more matter-of-factly as a reference point for rational decision-making. On the test-tube baby question, Silber is impressed, marvels at future implications, and considers the ethical issues. Glass and Ericsson, in their detailed account of this delicate, arduous procedure, spell out the psychological as well as the physical stages of the procedure, not only for the ideal situation, but for the statistically commonest one--failure, which occurs in 75 per cent of all in vitro attempts. For a new infertility patient, Silber is the place to start, but to a patient at the second, or third or fourth opinion stage, Glass and Ericsson offer, besides statistical odds, a dose of skepticism that may be salutory in and of itself. Where Silber made it possible to believe that all this had really happened in my body, Glass and Ericsson made it impossible to believe that the subject was no fit place for a mind. And that if we didn't think about it very hard and very well, there was a reasonable chance no one would. Including more doctors than I like to think about.
A few years after I had stormed away from Dr. X, Dr. Y, a much friendlier man, discovered that my mucus was friendlier on the 13th rather than the 12th day of my menstrual cycle. Perhaps my problem had been the hostile doctor's timing. Dr. Y applied a theory, which Glass and Ericsson don't think much of--he blamed bacteria which many specialists do not consider a threat to fertility. Dr. Y's treatment was also unsuccessful, but the spirit of the undertaking--his consideration and his sound logic, and in particular his attention to the male factor--left us stronger and smarter, whereas after Dr. X my health and our marriage were badly shaken. Silber as well as Glass and Ericsson are all critical of colleagues for errors of logic or attitude or slips of hand that can be disastrous. Their information can help reduce the power infertility doctors wield. Still, doctor-patient relations form a category of their own.
A while after Dr Y's treatment had ended in disappointment, a friend gave me Nothing To Cry About by Barbara Berg (now out-of-print in the original Seaview edition, but forthcoming from Bantam). Berg's autobiographical novel begins with an account of miscarriage I found so painfully detailed that I put the book away until I began to research this piece. Then I discovered that it was not simply about three difficult pregnancies, two late-term miscarriages, one adoption, and one live birth. it was also about developing a successful doctor-patient relationship.
After a first obstetrician has bungled and possibly caused one miscarriage, Berg vows to have no repeats. First she researches her problem in a medical bookstore. Then she has friends check out names of obstetricians specializing in difficult pregnancies. She interviews the most promising, picks one and establishes an extraordinary relationship in which her doctor not only is crushed by her one miscarriage under his care, but welcomes and encourages her diagnostic collaboration. The doctors are only part of it, though. Her husband brings breakfast to her when she spends three months in the hospital. Her boss at Sarah Lawrence buses her students down. Her mother thinks up schemes to rent equipment so she can check her baby's heartbeat at any moment. Nurses find another patient with the same problem; they set up a buddy system.
Berg's book is very much about an accomplishment rather than a condition, and I found it inspiring rather than comforting. The happy ending might upset some infertile readers as the gruesome beginning did me. But the battle plan it offers is a valuable one, and I unhesitatingly recommend it to friends and family of the infertile who might learn from its model of an effective support system. Its model of aggressive patient behavior I've begun to put into practice myself.
At one point Berg describes becoming temporarily infertile between her second and third pregnancies. When her doctor suggests she keep morning temperature charts, Berg refuses, preferring (unlike me) another ovulation indicator, the endometrial biopsy. The morning temperature is a basic female fertility test: a sudden rise at mid cycle reflects increased progesterone following ovulation. This task can become so irritating, so symbolic that hurling the thermometer against a wall and shouting, "The hell with it!" has become a new Zen cure. The ready consent of Berg's doctor astonished me. Dr. Graham Barker, a British-based obstetrician and author of Your Search for Fertility makes a passing comment that would have surprised me less: "If she cannot be bothered to keep temperature charts, just how keen is she to conceive?"
Subtitled, A Sympathetic Guide . . . Your Search for Fertility includes many passing comments that while sometimes sympathetic are sometimes-well, subjective. "No discussion of fertility can leave aside the connections between marital stability and parenthood," Barker insists, but offers no evidence except his observation that "all practitioners have stories to tell of couples 'barren' for many years who suddenly find themselves proud parents." The first chapter opens with a sentence so bizarre that I can hardly believe there isn't a typo in it: "Any couple who either temporarily or permanently are unable to have children when they wish to face many problems--emotional, psychological, and [my italics] possibly medical."
I call it bizarre now, but when I first skimmed this book I felt as If I were being kicked in the stomach. Like many infertile, I have lost patience with amateur psychologizing, and amateur is what this stuff is. I don't argue that psychology has no bearing on infertility, but that the psychological factor should be treated no less scientifically than any other. Anxiety can affect the menses-regulating hypothalamus (the so-called "primitive" area of the brain). It might even cause the fallopian tubes to clamp shut. But the psychological factor in infertility is still largely a matter of speculation and (with specific exceptions) the effects may be as general as those of good health. "Psychogenic" infertility is often a misnomer for what should be called "unexplained." I'd care less if the whole notion of psychological causes for physical problems didn't so often mask moral judgments--the sort of thing Susan Sontag writes about in Illness As Metaphor. Such moral judgments can cause paralyzing guilt; in a doctor, they can result in bad medicine. The first gynecologist I ever saw certainly confused the medical realities of my body with her subjective moral standards. She simply told me not to have sex. Had she been more informative, I might have been more rational about my experiments with sex--particularly birth control--and might for all I know not be writing this today.
But since I am writing it, I read Barker's book through with care, and it was my gain. Barker's comments on a male problem known as "varicocele"--a varicose vein in the testicle-clarified, in passing, some Imitations of the standard sperm tests (though his success-rate figure for varicocele surgery is, by Glass and Ericsson, on the high side). And where Silber's ability to take the sperm's viewpoint made the mission of fertilization vivid, Barker seems to have some special sympathy for the fertility-regulating pituitary gland--a gullible fellow easily tricked by fibbing drugs which claim pregnancy (birth control pills) or estrogen shortage (Clomid, the standard fertility, drug). Similarly, another important fertility drug is produced by the pituitary's overreaction to menopause--it "screams" at the underproductive ovaries by sending huge quantities of follicle stimulating hormone (FSH), which can be trapped in the urine of fertile menopausal women and administered to the infertile as Pergonal. I'd heard the endocrine system compared to a language before, but I'd never recognized that hormones are capable of lies, exaggerations, and inappropriateness.
Barker's language is clear and chatty, if sometimes shrill or glib. He can be genuinely patient-oriented. He's the only author in the lot to go into the extremely relevant matter of health insurance. (Often, unless health complications are involved, as with the disease endometriosis, infertility procedures aren't covered; even when infertility is covered, patients should be alert to the pitfalls of the "preexisting problem" category.) Barker also takes some time on the subject of doctor-patient relations. He says, some what simplistically, "Infertility specialists on the whole tend to be fairly cheerful, and being friendly and good-natured, they like a happy ending to a story as much as the next person," but he does add that this means "often the couple will have to squeeze the truth out of the doctor," and pointedly advises, "If after initial consultation with a specialist you are getting 'bad vibrations' it is better to cut your losses and choose some one else." This is good advice, and taking it seriously I would not choose Barker for my own specialist. Neither his logic nor his patience would inspire me to put my future, and my pelvis, in his hands.
Safe behind the printed page, Barker helps fill out a skimpy literature, but his pronouncements might do more harm than good for a group with the infertile's special vulnerabilities. For if there is a psychological factor in infertility--and no doubt there is--much less can be said about the psychological causes of infertility than its effects. As a precaution, I would advise first reading the only book to outline both a psychology of infertility and a politics: Barbara Eck Menning's Infertility: A Guide for the Childless Couple.
Barbara Eck Menning is the founder of Resolve, a support organization for the infertile, which has regional branches and operates out of Belmont, Massachusetts. Menning's guide--which you'II probably have to order from Resolve--is divided into two parts. The first concerns the medical aspects of infertility, and it's clear enough, but also dry and somewhat out of date, because it was written six years ago. I include the book here because the second part, which is about the psychosocial aspects of infertility, still has no competition. (A forthcoming Virago book, The Experience of Infertility, by Naomi Pfeffer and Anne Woollett, may well provide it.) Dense, thorough, specific, direct, with flashes of contained rage which at first I took for brusqueness, these 76 pages hold so much insight per inch it may take time to absorb. It did with me.
I first heard of this book just after the years with Dr. X at the nadir of my infertility, when I learned of Resolve but amazed myself by never joining. Judging from my feelings when, calling their offices this fall, I Identified myself as an infertile woman, I realize that two years before I couldn't bear to make that identification. They were infertile; I wasn't fertile yet. But I had just stormed out of a doctor's office, I had writer's block, and my marriage was a minefield. Not only had I given up hope, I didn't care if I lived or died. In short, pregnancy was inevitable.
In a way, it's just as well I waited till I was on my feet again. Infertility is very bitter medicine. Menning uses a schematic format and extremely functional language, and she tends to break emotions down into outline form. Infertility is a life crisis, and "crisis is usually time limited and pushes toward resolution within six weeks or less. The outcome can be one of three possibilities . . . " "Resolution may be defined as working through a difficult feeling or emotion. There are three distinct steps in achieving resolution . . . " If resolution does not occur, there is a simple explanation--blocking There are four places at which blocking might occur. The "ideal process" of resolution is compared to Elisabeth Kubler-Ross's five stages of dying. Two years ago, I would have been enraged. My problem had evaded so many schemes I had no trust left for another one--even from another infertile woman."
At first glance, Infertility disappointed me this time around, too. I thought I already knew whatever Menning might have to say. From feminism I knew not to let infertility get to my sexual confidence, and from therapy I knew to keep in touch with my pain. I knew that the strange grief of infertility could be compared to bereavement, though I couldn't quite see myself having a funeral or even mourning a child who hadn't had the chance to die. I thought Menning, with her insistence that the infertile must go through prescribed steps to recovery, was forcing me to immerse in something I'd already recovered from. Grief didn't exactly seem to be the worst part anyway; it was that prolonged uncertainty. But a day or two later, crying my eves out over a TV movie son's wartime death, it occurred to me for the first time that perhaps I was grieving more than I'd thought. Over the next few days, I found lots of things occurring to me for the first time. So I put two and two together, took another look at the same chapters in Menning s book, and realized what a piece of work it is.
Infertility is in many ways grim, but its grimness is its strength. If Menning's writing can display the crudeness of someone who worked this all out from scratch, it also has the authority of one who has touched bottom on this issue, and the courage and astringency of one who profited from her position by taking a good hard look around. And what she saw there--besides a rare view of the underside of society's views on procreation--was a number of ordinary women and men who thought about the unthinkable simply because they had no other choice.
Menning is an infertility counselor and she shows it; she seems to know the psychology of this subject inside out. Infertility is a kind of bereavement, a kind of dying, and like these things it must be endured as well as understood. But infertility has its own twists. They have to do with the infancy of infertility science and the superstitions surrounding procreation. They have to do with "perpetual cycles of hope and despair" peculiar to infertility which keep pace with the menstrual rhythms. And they have to do with uncertainty. "It is this author's premise," says Menning, "that infertile couples do not search for pregnancy so much as they search for an answer."
Menning breaks up her text with substantial quotes from people who are or have been infertile, who represent a range of backgrounds and attitudes, and whose reactions demonstrate a range of depth and feeling--from the couple who adopt, to the woman who doesn't enjoy her yearned-for pregnancy, to the one who does, to the man who has affairs, to the one who finally has a vasectomy to get his mind off trying. What emerges from their collective voices is a picture of Menning as a woman with a mission. Nearly single-handedly she establishes not just the existence of those individual voices but the idea that they constitute a group--the infertile. And she fights for us, tooth and nail.
Here's Menning on psychogenic infertility in her chapter on the so-called "normal infertile" couple: "To imply that the couple are not conceiving because they have a secret subconscious wish to avoid pregnancy and parenting is sheer nonsense and has never been documented in a scientific study. That would be the ultimate birth control method! A person would only have to wish to keep from getting pregnant!" On pregnancy as proof of virility: "There is a great deal of machismo attached to keeping a woman constantly pregnant. . . . In actual fact, pregnancy has a negative effect on the frequency and quality of sexual relations." On the classic cure: "Adoption workers have been known to gloat over the fact that some couples become pregnant after adopting a child--because they relax! In fact the pregnancy rate following adoption is the same as for couples who do not adopt." (Barker confirms this, albeit reluctantly--he considers the statistical evidence more "glib" than the popular belief.) This is a subjective book. I often appreciated its spirit when I disagreed with its logic, and I wouldn't recommend it freely to the noninfertile. But even when anger colored Menning's objectivity, even when I didn't share it, it touched me, because I knew it was partly on my behalf.
Beginning her psychosocial section with a chapter on the mythic, religious, and social history of fertility, Menning writes, "Procreation took on an important value to those who viewed (and view) the pleasures of sex as sinful. . . . Motherhood purged sex." Then she quotes the Bible: "Adam was not deceived, but the woman was deceived and became a transgressor. Yet woman will be saved through bearing children" (Menning's italics). Her terse history shows the old ways with their pants down--from the prostitution of Greek priestesses, to the maligning of Eve, to Papa Freud's claim that women need babies because they want penises--and they all look pretty grubby.
Except for the rights of the infertile, Menning takes almost nothing for granted--certainly not the inevitability of cure, not even the inevitability of psychological recovery. She doesn't simply ask what makes people infertile, she asks what makes them want to be parents--not just what people mean when they speak of a "basic urge" but sometimes, less appealingly, eagerness to conform to societal pressures, or to be free from, or even compete with, their own parents. Thus, in effect, Menning not only maps out the often irrational emotional and social motivations for the infertile, she does the same for the fertile. She doesn't assume that fertility, hence parenthood, is synonymous with either normality or health, and so, in her attempt to reduce the stigma and mystery of infertility, she opens the subject up for all--for voluntary nonparents, and for parents too.
I found I could use Menning's psychological schemes as I did Silber's physical ones, diagnostically. For a long time I'd been aware of my darkest suspicion--my secret belief that to try to improve my life by applying reason, imagination, and will ran counter to the laws of nature, that if I was not to be made unhappy in the ordinary ways, something unusual could be arranged. But only after digesting Menning did I realize that this superstition came down to a fear that the cause of my infertility was feminism itself.
Menning is clearly informed by feminism--she resents the definition of women as breeders, and links the obsession with procreation to fear of sex. But the feminism of infertility is still rudimentary, and there are many connections left to make. Menning's potshots at mannish "militant feminists" and even "current confessional books by disenchanted mothers"--while responding to the less measured politics of the mid-'70s--seem beside the point. Exploding the myth of motherhood does at least as much for me as for Jane Lazarre; for years I clung to The Mother Knot like a spar, because Lazarre's ideas about motherhood came closer to my feelings about infertility than anyone else's. If it's possible to feel ambivalent about having a child, it's possible to feel ambivalent about not having one.
I don't think it's necessarily "masochistic" for an infertile woman to spend time with other women's children, or even to do abortion counseling. I don't feel, as some women seem to, that abortion's relation to infertility is ironic, because those of us who fight for abortion believe parenthood should be a matter of choice, not fate. Friends who are open-minded, irreverent, or original about pregnancy and child rearing help me sort out what has or hasn't happened to me far better than those who live an unexamined childlessness. And I feel that my case has something to give all of them, too.
In most matters relating to women as childbearers, there is a real child to consider. For me there isn't. Yet choice, reason, judgment have a bad rep in the folk wisdom of infertility, an imaginary problem caused, as we all know, by trying too hard. You get the idea that whether there's anything in it for the child or not, the issue of childbearing simply opens up stores of leftover ambivalence about not merely sex, but reason, judgment, and free will. Women's work, as Sheila Rowbotham has argued convincingly, carries on a tradition of unpaid domestic labor that both sexes shared before the end of feudalism changed the relation between the workplace and home. Can it be that women's bodies also become vessels for leftover values, in particular the fatalistic view of life? Eve didn't eat from the tree of lust but knowledge, right? I myself have a superstitious fear that if I ever really understand my mother, she'll die. And ridiculous as the notion is, dispelling it just hasn't seemed worth the risk.
For me the risks are different. I gamble on no one but myself. So it ought to be easier for me to look certain truths in the eyes--my growing doubts, for instance, about the idolatry of the mother, a mystification I cherished through years of feminism. Yet I've put off giving my infertility a good, hard think for years--till now, in fact. And I did come up with the darnedest punchline. I knew writing about infertility would help me come to terms with it, but I refused to write this until cured of my superstition that, by the Zen of infertility, writing about it would make me pregnant. Oddly enough, perhaps it will--though this joke has a different object. As a direct result of the reading--and thinking--that I did for this piece, I came up with a medical diagnosis that could conceivably be the answer.
Silber helped me picture what infertility really, physically means. Glass and Ericsson helped me think through some missing steps in the logic of our AIH. Berg helped me picture myself doing something about them. Barker put the finishing touches on my hypothesis. My husband helped me turn my thoughts into our action. The first step we took confirmed what I had hypothesized: a complication of the male factor, unaddressed for seven years. As I write this, the initial lab tests are in their final stages. As it happens, AIH alone might have compensated for the problem, but I now have a reasonable idea of the range and logic of auxiliary options--which could be decisive.
So once more I find myself at the mercy of uncertainty and hope. Still, it feels easier this time. I think very, very hard about the odds, and that keeps me from losing my head. The fact is, the odds are for failure. Not only are my chances of conceiving well under 50 per cent, but--another little statistic I've learned--miscarriages are terrifyingly common in pregnancies that follow infertility. The facts are frightening, but the knowledge is a comfort--and not simply because it can make failure hurt less. My basic outlook has changed. Since I thought the causes through, I'll be readier to accept the outcome with more confidence that, whatever it may be, it's mine. And if thinking is my way of mourning--and I think it is--then I'll be able, finally, to lay my infertility to rest.
Resolve. P.O. Box 474, Belmont, Massachusetts, 02178-0474, (617) 484-2424, is a national nonprofit charitable organization which offers counseling and referrals to people with problems of infertility.
Voice Literary Supplement, Mar. 1983