The world of fertility
WHEN BRITISH scientist Robert Edwards, the creator of in vitro fertilization, won the Nobel Prize last week, the world marveled over how routine his procedure has become. IVF, once feared and reviled, is responsible for some 4 million births worldwide, a stunning expansion of families and joy. In Massachusetts, the first state to mandate health insurance coverage for fertility treatments, IVF and its offshoots have led to the conception of more than 60,000 babies.
And yet, as anyone who has gone through fertility treatments knows, the process — more than 30 years after the first IVF birth — is still shrouded in a culture of silence. In the brief time I spent in packed fertility-clinic waiting rooms a few years ago, I discovered some clear, unspoken rules: Don’t make eye contact. Don’t smile. Keep your nose in your magazine. It seemed counterproductive, even absurd: a roomful of well-informed, pragmatic people, taking charge of their lives in a positive way, feverishly pretending they weren’t there.
But Dr. Jill Colman isn’t surprised.
“It’s that classic club that you don’t want to be a member of,’’ said the clinical psychologist, who specializes in infertility and other women’s health issues. Years ago, when she ran support groups for the infertility association RESOLVE of New England, Colman had trouble assembling enough women who wanted to talk. In part, that was due to superstition. Women in the midst of treatment didn’t want to jinx the process.
But partly, Colman says, the trouble was shame. Fertility problems touched on those classic measures of self-worth: sexuality, virility, vitality. And, as academics have noted, the stigma of infertility dates back to biblical times, when “barrenness’’ was cited as the will of God.
These days, our culture encourages women to fault themselves for a string of different reasons, equally unfair — for concentrating on their careers, taking “too long’’ to meet the right partner, waiting until they’ve reached a measure of economic stability before they start their families. The notion that infertility is self-inflicted is used as an argument against mandated coverage. Yet no one asks if pregnant women should subsidize physical therapy for skiing injuries, or heart surgery for people who eat too much fat.
And while women’s biological clocks are one clear factor, infertility can be caused by physical problems that strike at any age. Problems in men account for 40 percent of infertility cases. And men, Colman notes, are even less likely to talk about their struggles. (In 20 percent of infertility cases, the cause can’t be identified.)
Colman wonders what the world would be like if pregnant celebrities — the actresses who use IVF and deliver twins in their mid-30s, or turn up pregnant at 47 — would be more forthright about medical intervention. What if those glowing magazine spreads were used to demystify the process, to talk about doctors’ visits and subcutaneous injections, instead of just strollers and baby weight?
But then along comes Jennifer Lopez, who spoke out against IVF in an issue of Elle this year. “I just felt like you don’t mess with things like that,’’ she said, whooshing us right back to 1978, when Robert Edwards’ first success, the birth of Louise Joy Brown, was shrouded in dread about playing God.
Women today, it seems, will have to erase the stigma on their own. RESOLVE of New England has tried to tackle the problem of waiting-room silence, executive director Rebecca Lubens says. Volunteers sometimes set up tables and hand out doughnuts, offering support and advice.
And Colman says that in her hometown of Arlington — which boasts one of the state’s highest concentration of first-time mothers over 40 — knowing glances across the playground often evolve into open conversation.
There is strength in numbers, and Colman suggests there might also be strength in time. Just as adoption once went from being a source of shame to a widely-acknowledged, accepted way that families are made, today’s generation of fertility-clinic kids might come of age knowing their own creation stories.
Perhaps in school, when they learn how babies are made, they’ll also learn about embryo transfers and intrauterine injections and intracytoplasmic sperm injection, words that evoke science, marvel, and great happiness. Here’s hoping they learn about Robert Edwards, too.
Joanna Weiss can be reached at firstname.lastname@example.org.