The Loneliness of Infertility

The summer after our third miscarriage, Jeremy convinced me to go to a fancy party for his work. He thought that dressing up and eating a nice meal in a ballroom with other dressed-up people might distract me. I sat in my cocktail dress—too tight on my post-IVF bloat—and held my husband’s hand under the table. Occasionally, a waiter would pass by with canapés and I’d grab one with my free hand. The table was buzzing with wine-leavened conversation, with introductions and interruptions and compliments, especially for the women, who wore a lot of modest necklines and black and navy—the assured unchicness of women who do not need to impress. They generated an air of capability and confidence, of success.

I desperately, desperately did not want to talk to any of them. Over the previous four years, socializing had become my biggest problem, second only to infertility. If you had asked me about my social life, I would have said, “It does not exist,” though, in fact, all I did was talk to other people—in support groups on Facebook and the forum sections of infertility websites. I’d wake up in the morning and log on and read and write all day with hundreds of infertile women, sharing details of our miscarriages, our IVF results, our searches for surrogates, and replying to one another’s queries and stories in turn. But as soon as I logged off, I’d forget all about these women. Not to say I found these groups useless: though I wasn’t happy about my condition, I was certainly grateful to have a place I could discuss it. But the circumstances of these conversations left them feeling ghostly and unreal, in a way that talking with other women, even about other shitty and gendered topics, never had.

Still, the outside world—I thought of anything non-infertility-related as “outside” and still do—was way worse. Somewhere along the four-year way, my outside friends had retreated. I’d see them every once in a while, but they felt remote, far off in their own galaxies of pregnancy, baby raising, or simply not being infertile. I backed off too. Not infrequently, I’d think of one of these women and feel a sudden hurt, but I preferred this pain to the sharp vertigo I experienced whenever they said something to remind me of my new difference, my distance. Social life presented an agonizing conundrum: my infertility was the only thing in my life, and no one, apart from other infertile women, ever wanted to talk about it.

At Jeremy’s work party, I was trying to silently project a sense of my private agony, but eventually, the woman seated beside me tapped me on the hand and asked me my name. “Do you have any kids?”

“No,” I said.

“Do you plan on having them?” she asked. Her expression was quizzical, slightly amused.

“We can’t,” I said. “We’ve had three miscarriages.”

Despite being clinical, correct, the word miscarriage, like the word infertility, suggests the particular unruliness of the female body. And even given our culture’s nominal feminism (I would be shocked if any woman at that party would have rejected being labelled a feminist), there is a perpetual undercurrent of disgust about female genitals and organs. They are, in the words of French surrealist Michel Leiris, “unclean or as a wound . . . but dangerous in itself, like everything bloody, mucous, infected.”

Saying miscarriage out loud was like putting my uterus on the table, bleeding and scarred and radiating misuse. Tears and death and not a small amount of sex. I felt vulgar dropping this bit of feminine gore into the lighthearted civility of the room.

I understood the irony: I had no more exposed my uterus by talking about my lack of children than any other woman who mentions “having kids” does. All children, living or dead, come from bloody uteruses and vaginas—things polite people don’t discuss—but the logic of misogyny, which carves out a space of relative respect for some mothers (especially the wealthy, white, and married), means we usually agree to forget this. The beauty of the child erases its origins in the female body and sexuality. But when these parts go wrong and there is no child, nothing is redeemed. It’s just the spectre of the female body and sexuality: blood, mucous, infection. Death.

A few moments passed. The woman’s mouth opened and closed over the empty air. The waiter came by again, and I plucked a canapé from a round tray. Open, closed, open, closed, like she was gulping air. “Oh,” she finally said before rushing off to the washroom or something. I didn’t see her again. I still don’t know who she was or why she responded the way she did. Her chair remained empty all night, and whenever I looked at it, I wanted to laugh. It was funny, really: a literal instantiation of my isolation.

From her first recorded mentions, the infertile female was a monster. The Babylonian Atrahasis epic, from the eighteenth century BCE, describes a conflict between the gods and the overpopulated world of men, during which the gods flooded the Earth. Eventually repenting for this destruction, the deities restored humankind to the Earth, with a built-in safeguard against overpopulation: “Let there be a third group of people. [Let there be] fertile women and barren women. Let there be the Pagittu-demon among the people and let her snatch the child from the lap of the mother.” The demon, writes the University of Pennsylvania Museum’s Erle Lichty, was the lion-headed demoness Lamashtu, barren and envious, who caused infertility, miscarriage, and infant death.

The Hebrew Testament of Solomon describes the demon Obizuth—her name in Middle Eastern mythology, Abyzou, is derived from the word for abyss—as a fusion of woman and beast: “her glance was altogether bright and greeny, and her hair was tossed wildly like a dragon’s; and the whole of her limbs were invisible.” Abyzou was barren, and she confessed that her envy of women who could bear children motivated her murderous hauntings: “[B]y night I sleep not, but go my rounds all over the world, and visit women in childbirth . . . . [I]f I am lucky, I strangle the child.”

The art of this period depicts these demons as serpentine, the unruly, unnatural appearance of such female forms symbolizing their rebuke to traditional femininity.

Beginning in the Renaissance, many Europeans became absorbed in representations of witches, who were frequently accused of kidnapping children and causing miscarriages and stillbirths. The witch hunts in Europe and North America were a touchstone for late twentieth-century feminist historians, who rightfully noted how the accused often defied the conventional female gender roles of the era: many exhibited the unwomanly characteristics of anger or promiscuity, for instance. But fewer have emphasized how prominently female barrenness figured in the witch trials, how infertile and childless women were considered both particularly vulnerable to infestation by Satanic spirits and prone to acts of witchcraft themselves.

A seeming bright spot: the Old Testament had, on its surface, a good deal of sympathy for infertile women. (The invocation “Sing, O barren woman!” compares the plight of the chosen people of Israel to the sorrow of an infertile wife.) But in these tales, women are described as passive instruments of their reproductive fate: “self-controlled, pure, working at home, kind, and submissive to their own husbands.” Thus emerged the only acceptable image of the infertile woman: the pining religious supplicant, barren but virtuous.

As with the portrayal of women as a whole, the infertile feminine was split into two opposing archetypes: Abyzou, and the pious Hannah, who after many years of infertility and prayer would go on to mother the prophet Samuel. Angry and vengeful versus passive, silent, and hopeful—public images of female infertility are one or the other to this day.

Feminism—and, in particular, the movement for reproductive rights—has long been either dismissive of or outright hostile to the plight of infertile women. The roots of the reproductive rights movement are not actually in choice—at least, not in the universal, expansive way in which modern feminists talk about choice. Rather, some early advocates of birth control and abortion in the West were concerned with limiting maternity, especially for poor, disabled, and racialized populations (particularly Black and Indigenous women).

In the early and middle twentieth century, feminists fought for and celebrated new technologies in birth control—first, barrier methods like cervical caps and condoms, and then the first generation of contraceptive pills. However, this early feminist project was inextricable from the larger cultural anxiety about the precariousness of race and class in an era marked by mass immigration, incipient civil rights for Black Americans, and the rise of unions.

Margaret Sanger—best known for starting the American Birth Control League, the precursor to Planned Parenthood—founded birth-control clinics and published pamphlets on sexual education during an era when even the idea that women might want to have sex for reasons other than reproduction was blasphemous. But her ultimate enthusiasm for contraception was inseparable from a larger conversation about how modern nations might better society through population control. “If we are to develop in America a new race with a racial soul,” she wrote in 1920, “we must not encourage reproduction beyond our capacity to assimilate our numbers so as to make the coming generation into such physically fit, mentally capable, socially alert individuals as are the ideal of a democracy.”

Sanger’s statements would later be regarded as foundational in laws, often motivated by eugenics, enacted in the US in thirty-three states, which forcibly sterilized at least 65,000 citizens, a large proportion of whom were Black, from the 1900s to until as recently as the 1970s. In Canada, similar laws saw the compulsory sterilization of thousands of women—the majority Indigenous—up until the 1970s; Indigenous women report that coerced sterilizations continue to this day.

Mainstream attention—not just among feminists but across our culture—continues to focus on upper-class white women’s infertility even now, usually in the context of scientific advances in fertility medicine. This makes it easier than ever for the public to view infertility not as a general women’s health issue but a type of malaise of the privileged. It also plays directly into racist and classist beliefs that poor women and non-white women are “hyperfertile”—unthinking reproducers who are closer to fertile nature than white women and should be encouraged to have fewer, rather than more, children. (Black women actually experience higher rates of infertility than white women.)

But as a matter of policy it is primarily white middle- to upper-class women who can access health care services to address their infertility. Across North America, free or low-cost women’s health clinics—themselves all too few and far between—will provide birth control, early pregnancy care, and abortion-referral services but rarely treatment for infertility. (In Canada, only Ontario and Quebec cover some IVF treatments, for instance.)

This exclusion from our public narratives about and public policies for infertility is self-reinforcing: because most academic studies on infertility draw data from fertility clinics, which are frequented by the patients who can afford to access them, white, upper-middle class women are overrepresented in the academic discussion of infertility as well as the one in popular culture. This is not just a question of the collective imagination: it also limits much-needed investigations into conditions that are specific to marginalized demographics. For example, the treatment of fertility-impairing fibroids, which Black women experience at significantly high rates, and are still underresearched compared with conditions that are more commonly diagnosed in white women, such as endometriosis.

In March 2018, a Liberal MP, Anthony Housefather, introduced a bill that would decriminalize paying for donor eggs, sperm, and surrogacy in Canada, bringing us into line with US states where third-party reproduction is legally commercialized. The decision was met with support from infertility advocates and the LGBTQ community—and scathing op-eds by some feminist academics and journalists who were concerned that lifting the payment ban would commodify women’s body parts and lead to their exploitation.

Since then, I have read dozens of accounts of surrogacy as womb renting, as animal husbandry, as slavery (whatever issues I have with these writers, I can’t deny them their flair with metaphor), all of which take for granted the noncapacity of the surrogate to freely consent. A documentary about surrogacy as baby buying permanently screens on Amazon Prime Video, while a non-peer-reviewed study about the harms of donor-sperm conception on children was covered approvingly on Slate and NPR. And the sentiments survive in a diluted, everyday form, like the self-described feminist in a parenting group I joined who proclaimed that it was gestation that made one a mother.

When I read this work, I feel disoriented. If anyone were an expert on female infertility, surely it would be me—at thirty-nine, I’d spent five years trying, and failing, to have a child. I’d racked up almost every diagnosis in the book, seen half a dozen specialists, and had five surgeries. I recognize nothing of this experience in the feminist debates around reproductive technology. It’s the tone of them: the bloodless, objective, anthropological approach to the question of me and what to do about the problem that is me. It says something—though I’m not sure what—that I never felt the insult of being objectified as a woman more keenly than when I was infertile and reading feminist analyses of infertility: in framing infertile women as problematic consumers of technology that they despise, many contemporary feminists ignore the actual experience, the meat and pain, of infertility. They ignore the grief.

Her emotional and existential experience erased, the infertile woman first enters the public imagination not as a woman, not even as a patient, but as a consumer of biotechnology. A specific kind of consumer: the consumer as spectacle. With her grief reduced to a vague “desire” for a baby, and the efforts of making this baby rendered as so extraordinary, so risky and costly and scientifically improbable, it’s difficult to see her as anything other than a curiosity of capitalism, akin to people who undergo cosmetic surgery.

“You really wanted a baby,” people who have had no trouble conceiving sometimes say to me, thinking themselves supportive, affirming. And while I’ve tried many times to pinpoint why this offends me, there’s an element I always have trouble explaining. It’s not that it’s trivializing; it’s not that they have underestimated my grief. Rather, it’s that they don’t get the particular nature of this grief, how it’s less about the loss of a potential child than it is about the endless possibility that there may yet be an actual child. The next procedure might work, the fallopian tube could always clear, the next fetus might not miscarry. As per the saying: miracles happen.

In my digital infertility groups, a meme is often posted beneath stories of the poorest prognoses: an image of a dandelion or a rainbow, below which is written, in cursive font: Always Hope. “I fucking hate hope,” a friend who struggled with infertility before having her daughter told me recently. “Hope is how you tell women to shut up. Hope is weaponized.”

It’s not that motherhood is out of reach, it’s that it’s just out of reach. It’s not that motherhood didn’t happen, it’s that it almost did and, in fact, still could. The difference between the grief of infertility and other reasons for mourning is in that promise of “just,” in “almost,” in “still could.” This does not make it more or less livable than other forms of grief, but it goes a long way toward explaining why it is expressed in ways that seem so desperate and even alien to the casual onlooker, why a woman might put herself under the knife ten, twelve, twenty times to get pregnant, why she might spend hundreds of thousands of dollars in the effort. The end to her grief is just so near.

Jeremy and I met the woman who would give birth to our son in January: bleak weather, waning hope. For almost five years, we had been on what insiders call a “surrogacy journey.” Our first and then our second surrogates miscarried our three remaining embryos in turn before deciding not to continue. Around the same time, I had an ectopic pregnancy that required surgery. My infertility felt less like the absence of something than like a malignancy spreading from one part of my body to the next, from me to these other women who had tried to help.

In my panic, I had emailed a number of family members and friends, asking if they knew anyone who could help. It was a desperate email and one I’d sent many times to no avail. But then, as I was fear googling surrogacy expenses, a message popped up from an address I didn’t recognize. It was from a woman named Mindy who worked in college admin with my cousin and had posted about her desire to be a surrogate on Facebook. She’d been thinking about it since she and her husband had had their first child the previous year. “Having Charlotte was one of the most important things I’ve done,” she wrote. “I really want to help someone who can’t . . . experience that for themselves.”

When Jeremy and I met Mindy and her husband, Eric, we felt not only a rush of relief at how kind and trustworthy they seemed but also a shock of familiarity at their dynamics: their dark-humoured banter, their love of animals, the fact that they’d named their daughter Charlotte Elizabeth—the name Jeremy and I had for years on our list of names for girls. As the four of us sat in their living room and agreed to go forward, Charlotte popped up and down over the edge of her playpen, peering at me, like a tiny firecracker with pigtails shooting straight up from her head.

By the fall, Jeremy and I had nine frozen embryos—we also found Anna, our egg donor, online—but, eager as we were, the gravity of the situation hadn’t fully impressed itself on me. Jeremy, Mindy, Eric, and I slogged through the routine of clearing medical, legal, and psychological screening and then the wrenching process of thawing the best embryo and, after Mindy had undergone a trying regime of injections and monitoring, transferring it to her uterus. It worked on the first try. But as the pregnancy went on, each blood test promising, each series of heartbeats measured and deemed perfect in frequency and strength, I had to accept something multiple losses had made seem impossible: we were having a baby. In gaps in my days, I found myself saying this to myself silently, over and over, like a mantra: we’re having a baby. But there wasn’t excitement, just relief that he was still alive, that this one wasn’t dead yet. And as long as he was alive, I would not have to keep trying for him. Waiting for my baby felt less like anticipation than a break from prolonged effort and pain.

Mindy narrated what I couldn’t feel: he kicked a lot, mostly at night, and he moved around when he heard music or when she’d play Jeremy’s and my voices for him using headphones she’d stick on her belly. Every visit, the baby was more and more present, pushing Mindy’s belly out the front of her parka, making it difficult for her to sit or run. But despite these signs of life, he was still mostly a theory, an idea. The baby that hadn’t died yet.

Since he’s still alive, maybe I can start buying things, I rationalized when he was still a few months away. I bought onesies with prints of ponies and hamburgers and a big soft toy bunny, because years ago, in a dream, I’d seen a little curly-haired boy holding one. I put the things in the Room, the room that every infertile couple has, the one that is supposed to be for a baby, then fills with sad junk, until (if) luck changes. I moved around some of the junk and spread out the new cute things. But it still didn’t look like stuff for a real baby in a room for a person that would actually exist. It felt provisional—stuff for a baby that hadn’t died yet.

A familiar pattern of anxiety for an infertile parent-to-be, but luckily the baby himself would have none of it. He came five weeks early, quick as a flash flood, before Mindy’s epidural had a chance to work and while Jeremy was in line at a Walmart, hurriedly buying a car seat.

I had spent years lamenting how invisible I felt in my infertility, how little understood, but in truth, no one would ever be more indifferent to my neuroses than my newly born son. No one cares less about your trauma than a baby does. But how quickly he eclipsed it, and us, and everything else. He changed so much in those first few minutes: at first, just a head between Mindy’s thighs, then a wiggling eel, yellowish, laid down on her belly. Then, wiped down, a squalling red silhouette with a rubbery cord I cut myself and the doctor clamped with a plastic clip. Then a series of measurements—six pounds! Twenty inches!—that the doctor shouted into the room from the tiny basin in which the newborn was prodded and measured. The room collectively sighed: despite being born premature, he was healthy and robust. Then, finally, a tiny little baby in a diaper a nurse laid between my bare chest and my hospital gown.

Apparently I was crying so hard I could barely stand; I don’t remember that. What I remember is the screaming red child, the way the exact pitch of his voice had an immediate and indescribable meaning to me, the way he plugged into my chest in a very exact and deliberate way and instantly fell asleep.

Eventually, Mindy turned her head and we caught each other’s eye. Oh, I thought. This is what she wanted me to have. This is what she was talking about. The fact of this—that there was so great a feeling I had not known and that another woman had been willing to give it to me—overwhelmed me as much as Charlie’s existence.

A common objection to surrogacy (as well as to labouring with the help of epidurals) is that it separates motherhood from the bodily work of pregnancy and childbirth. I already knew this was bullshit. The medical experience of my infertility—all the miscarriages, surgeries, tests, and IVF, as well as the physical burden of the attendant grief—was as much a part of the process of conceiving Charlie as Anna’s egg retrieval or Mindy’s pregnancy. I was less prepared for how bodily early motherhood was, how the combination of fatigue and a newborn baby would produce an effect that was hormonal, almost postpartum. My stomach cramped; I was sweating buckets.

Most surprisingly, my breasts were sore. Curious, I let Charlie latch and suckle and immediately felt milk pull down to my nipple. The nurse told me that, having been pregnant multiple times, I already had the plumbing to produce breast milk, and now my body was responding to the proximity of a baby. Jeremy, too, got folded into this biome, a three-person constant exchange of touch and skin and hormone-steeped sweat; soon, we all smelled the same, like slightly sour breast milk. I did not need to go through labour to learn, as all new mothers do, that the term labour is an insulting misnomer that implies it begins with your first contraction and ends after birth.

Some people say the condition of modern womanhood is one of navigating contradictions and clashes: between the personal and the political, the said and the done, the body and the heart. For me, every time I saw Mindy, or Charlie, or even Jeremy, and every time I texted with Anna, I was aware of two stories: the one in which I had to have other women help make my baby (how sad!) and the one in which I got to have a baby with other women (pretty cool!).

A few weeks after Charlie was born, I found myself going back to my old IVF and surrogacy message boards, wondering what these communities of women could have been like in a different world. If earlier feminists had seen us as sisters rather than patriarchal dupes or oppressors of other women. If infertility lobby groups had embraced an idea of infertility as an issue of medical, emotional, and spiritual health rather than a type of consumer identity. I imagined a feminist movement parallel to the one for abortion access, in which women would call for more research into the causes of infertility, the potential efficacies and risks of various treatments.

We could call for expanded access to proven reproductive health care for all Canadians—not just the rich ones, not just those in cities who are partnered and straight—by demanding it be brought under the auspices of a properly regulated health care system. We could align ourselves with, rather than against, surrogates and egg donors in lobbying for a system in which policies around third-party reproduction are shaped by them, for their own safety and interests, which opens up the possibility of them organizing as workers. We could support infertile women who do not conceive in either finding other forms of family or healing into satisfying lives lived without children. Truly patient-centric clinics could bloom under our watch.

Perhaps most importantly, infertile feminists could embrace our status as different kinds of women—as the kinds of women who eat people in folk tales—to challenge the idea that motherhood is unthinking, automatic, and instinctual, instead of a thing that is both worked at and worked for.