Empty Cradle 2
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
There are two persistent tensions that Marsh and Ronner explore in The Empty Cradle. The first is that between doctors’ abilities to treat infertility and patients’ desires to have their infertility treated. It would not be entirely wrong to say that doctors were forced by their patients to act beyond their capability or knowledge, and it would not be entirely correct to say that they were always altruistic. As Marsh and Ronner summarize it:
Women in infertile relationships are not merely passive victims of a medical establishment that preys on their desire for a child but are active agents in seeking out medical solutions. … By seeking treatment, women made an active choice to confront their childlessness. By challenging their doctors and making decisions about what treatments they would and would not accept, they demonstrated the limits of their willingness to put their fate in another’s hands. (252)
It is the unfortunate case that the treatments women would accept included treatments to compensate for their partners’ infertility. It is just as unfortunate, and frustrating too, that doctors were often willing to follow along in such cases. It is most frustrating to me in cases where the argument that a man’s ignorance was his bliss prevailed. It seems that doctors counseled against informing men that they were infertile on little more than presuppositions that men would become impotent if they knew. Now, at least, they suggest counseling.
At the same time, I can understand doctors’ frustrations. Historically, treatments for male-factor infertility were largely ineffective. Surgery to remove varicoceles, which affect 35–45 percent of all infertile men, are still relatively recent developments as treatments (indeed, as recently as 2006 statistical studies were being conducted to ensure that surgical treatment of varicoceles is effective). Other kinds of microsurgeries are even more recent. Hormone therapies frequently returned inconsistent results at best. I am no expert, but according to the research I have done, I think it is fair to say that the last 20 years have witnessed better improvements in treatment for male-factor infertility than any other 20-year time frame in history.
The other persistent tension that Marsh and Ronner describe is that between social and cultural assumptions about infertility and the possibilities that medicine promises. In general, the past 20 years have witnessed infertility treatments become increasingly aggressive (although not quite as aggressive as the cervical amputations some doctors swore by in the mid nineteenth century) and expensive even while the success rates of the various therapies available have not significantly improved. The aggressiveness invites criticism that women are being experimented and imposed upon, driven to false hopes in therapies that do not work (Marsh and Ronner 251). The expense has had significant consequences, too. Historically, infertility was a fairly egalitarian specialty. Early clinical pioneers in the field maintained public clinics, such as New York’s Woman’s Hospital, that treated low-income and (sometimes) minority patients. Doctors often funded those clinics with their private practices. However, the expense of ART has largely walled off infertility treatments to middle- and upper-class patients in spite of the fact that low-income couples experience infertility just as often as everyone else. It is on that thought, in fact, that Marsh and Ronner conclude their book. At the moment (that is, in 1996), it is unlikely that infertility treatments will become more widely available because
inequities in the availability of these new technologies arise, at least in part, from the way in which this culture defines the problem of infertility today. … The media, the public, and even many members of the medical profession misconceive or ignore the demographic analyses of the extent and causes of infertility in favor of an explanation that unduly emphasizes women of the upper middle classes who have postponed childbearing until their thirties. [i.e., There is more attention paid to women’s pursuits of careers as a “cause” for infertility than is warranted by demographics. This undue focus is a sexism that has persisted since at least the 1890s.] This gap between the demographic realities of infertility and the way it is defined culturally enables Americans simultaneously to castigate women for careerism and to provide those who are well insured or well-to-do an ever-expanding array of technological resources with which to combat this condition. (254)
I would be interested to know how that tension exists today. My impression is that it has not changed much, particularly in the face of the antifeminist backlash that seems to permeate our culture. But that is for another post, I think. For now, suffice it to say that The Empty Cradle enumerates and illustrates well the tensions between patients, their doctors, the treatments those doctors prescribed and between the changing social and personal conceptions of infertility.
A note on the text: The book, which was published by Johns Hopkins, needed an editor. It is rare to discover a misspelling or the precise misuse of a word (there is one instance, which I am having difficulty finding in the text now, in which Marsh and Ronner essentially substitute the concept of fatherhood for childlessness, a substitution that caused me no small amount of consternation until I realized the problem), but frequently—every third page or so, particularly in the early going—a paragraph will repeat the same thought, sometimes the exact phrase, as many as three times. It is the kind of error made in revision: you realize that a phrase or idea might work better at the top of the paragraph, so you copy it there, but then you forget to delete it from its original place. They are the errors that the editors at Johns Hopkins should have caught. (Speaking of hiring editors: Johns Hopkins? I am available, FYI.)
