Sparing Fragile Egos
In 2008, after two years of failing to make a child organically, we learned the doom Kathy had already been feeling for more than a year was justified: I was diagnosed with male-factor infertility. Our only real chance to move forward would be in vitro fertilization. We couldn’t afford it; we couldn’t afford not to do it. One way we tried to work through that diagnosis, our anger, and our options was to start a secret infertility blog, “Less Than a Million.” This post and what comments from 2008 that are attached to it come from that blog.—gb
From The Empty Cradle:
By all accounts, both popular and medical, it was not usually couples, but wives, who sought medical help when pregnancy failed to occur. They entered the doctor’s office asking, as did “Evelyn Salisbury,” Maxine Davis’s infertile everywoman, “What is wrong with me?” Women, however, did more than simply internalize responsibility for the couple’s infertility. Many a wife, apparently abetted by the family doctor, protected her husband from any suspicion that he might be responsible for the couple’s plight. According to New York gynecologist Asta Wittner, a couple’s regular physician would rarely inform a man that he was infertile, no matter how low his sperm count, out of “fears that an inferiority complex might develop in his patient if told he is at fault.” Wives, Wittner complained, would rather undergo extensive treatment themselves than risk asking their husbands to come in for an examination. Nearly every infertility expert, whether male or female, confirmed the reluctance of most men to believe themselves responsible. Or, as writer Maxine Davis put it tartly, “The husband … doesn’t think for an instant that the fault might lie with him.” (Marsh & Warner 154)
Fertility specialists’ delicacy with men’s sexuality, a theme of Marsh and Warner’s book, while necessarily improved, continues to be a problem. I think it is a great clinical mistake. Indeed, I am certain that clinicians’ historical squeamishness is one reason so few effective treatments actually exist for infertile men: decade upon decade of light treading means that fewer diagnoses have been made, fewer treatments tried. That is not to say that doctors’ theories regarding women’s fertility have always been brilliant: too many women in the nineteenth century had their cervixes amputated to make that claim. But it is to say that andrology has many more unanswered questions than gynecology, and there must be a reason for it. So: I call delicacy! That said, what are doctors to do when now, as in the 1930s (the passage cited above describes Depression-era fertility problems), women are still the driving force behind treatment itself?
That drive was evident in my own house even after we discovered that my sperm count was the likely cause of our infertility. K insisted for a week that she return to the clinic to continue tests—she wanted an HSG because she wanted to make sure that everything was fine on her end. I understood her desire in one sense as a wish to do something, to be proactive in our treatment given the fact that our options had instantly diminished to IVF with ICSI. However, I think her desire also stemmed from her awareness that there are more treatments available for women, that if some problem with her reproductive system could be found, then that problem could be fixed. Not so mine.
That men themselves appear to be still squeamish about their sexuality doesn’t help either, especially given the fact that testing semen allows doctors to rule out—or, in my case, to rule in—a primary factor of a couple’s infertility pretty definitively. The contrast between our own doctors’ beside manners is telling: in K’s initial visit, they pried her open and pressed her flesh without so much as a nod at me or an acknowledgment that my presence might be embarrassing. In mine, the urologist pulled the curtain and shut her out without so much as a question that I might want her there. The doctors’ manners telegraph their patients’ delicacies as much or more than they reveal their own. It is true that women may be more inclusive, willing to share their experiences with their partners in ways that men hesitate; at the same time, because they are more involved in the problem of infertility, I suspect that women are also more willing to undergo hardship to solve it than men, and doctors are therefore more eager to accommodate that willingness. It is a situation that has really significant consequences. After all, it costs much, much less to test men’s semen at the outset than to put women through ultrasounds and HSGs. Why that wasn’t the very first thing we did, even when, after trying to conceive for six months, we suspected something might be wrong, I do not know; nor do I know why, on our initial visit to the clinic, an ultrasound of K came first. I suspect, however, that it was because it is historically normative to test and treat women aggressively.
Much good could come of reversing that norm. However, if men refuse to be forthcoming (and I’ve read enough infertility blogs to know that, while there are many male partners out there who are sympathetic and helpful, there are many others who participate in infertility diagnosis and treatment with reticence), what really can doctors do, either to further research or to develop workable, cost-effective infertility treatments?
Update: On further reading and reflection, I think this post oversimplifies the history and consequently gets a few things wrong. For example, this post makes me seem more certain about why there are fewer treatments for male infertility than I actually am. It may indeed be the case that men’s reproductive systems are less malleable and, therefore, less treatable than women’s. I once had a friend who argued at length that women are more evolutionarily worthy. It is also the (admittedly irrelevant) case that the females some species of frogs can undergo parthenogenesis and reproduce if there are no male frogs around. So, anyhoo: I’ll look into it more.
