On humanity, miracles, and becoming addicted to dicey games
As good people with good intentions, by now we have our plate full with an amazing whole lot of extremely complicated modernity. It gets in our way for us to worry about several times a day, it seems to be constantly getting worse, and just to receive that kind of information hurts beyond belief. For instance, there are things like torture, human slavery, misery, migrants, carnages, mass-murders, mass-rapes, forced conversions, global warming, species extinction, world-wide corruption. However, of all these issues deemed unfit for conversation at the dinner table, nothing seems to bear an utter unfitness than the plight of those who wished to have children but couldn’t, or those who are still trying but so far had no signs of success. Just don’t say “infertility” if you’re referring to people. Everybody will make sure they get as far away from you as they can.
There is nothing new about this sort of rejection. For many thousands of years, ever since civilizations started keeping records of their mythology, a woman who can’t have the child she was expected to have – and it’s always the woman’s fault – has consistently been linked to something evil and worthy of expulsion from her society, if not altogether of ceremonial murder. Religion perpetuated the same trend. Zoroastrian’ organization of life according to Ahora-Mazda is beautifully ethereal, but still, although infertility shows up only once, it shows up in the side of darkness. And then it shows up as heavily loaded with God’s signs of wondrous power of punishment or reward in the Bible* as in the Koran. History is loitered with real cases of infertile queens expelled from their kingdoms or gone mad to the point of mass-murdering their subjects. Literature follows close in the same trend. Start reading Arabian Nights, and pretty soon you’ll run into a story where the first wife is infertile and acquires all kinds of malignant powers over the second wife and her son. Read anything you want, all the way down to Lady Chatterley’s Lover: the moment infertility comes into play, and all hell falls loose from there. Times have changed, last century’s wars projected women into public life, this century’s social networks changed our relationships and our attention spans for good, but still – here’s one unpleasant topic that never changes. Very few subjects seem as unpalatable to human taste as infertility – and, since in consequence no-one wants to talk about it, there is not even a minimally consensual explanation for this world-wide abhorrence, tentative though as that explanation might have been. Authors publishing on “infertility” and meaning to be heard or read have been getting less and less frontal, and by now, when you carefully pick your terms, it has become almost mandatory to use the more politically correct and less negative “involuntary childlessness” instead.
Of course, nothing forbids you to publish a book or to give a public talk on “infertility”, clearly spelled at the title. It’s just that your book won’t sell, and you’ll be giving your talk to a room full of empty chairs.
This lack of research and readership, followed by the absence of conversation and debate, leads to a strange kind of ignorance surplus right at the age of information excess. To a major extent, it is this discrepancy that allows all the doctors and researchers with no scruples, all those who are in this for the money and nothing else, to put gullible people desperate to reproduce through the kind of misery everybody pretty much ignores. It’s definitely easier to talk about climate change, the situation in Yemen, armies unleashed against migrants, or the sex trade.
A part of this indifference lays in nothing but our recent tendency to believe that we can expect all kinds of miracles from science, and certainly from Medicine. It is not that those who believed in miracles yesterday or will believe in miracles tomorrow are stupid. I believed in miracles four times in a row and came out empty-ended, but I can read, write, add and subtract. The real problem is just the way we are constantly bombarded by advertisement, and targeted with sharp precision for whatever it is that we’re missing and hurts us profoundly. Advertisement agencies charge their clients with the inflated prices they do because everybody knows it works. Somehow, sooner or later, we all end up falling prey to the power of one ad or another, and yet we are all intelligent adults and we all know publicity is not for real. Believing that technological miracles will always work, certainly for ourselves if not for other people, is as ludicrous as believing in advertisement, yet by the time we resort to ART we’re so desperate for “the miracle of life ” we would believe anything – we generally enter our first IVF clinic by the time we want advertisement to be for real and thus became prey for any kind of spectacular not technique this or that other clinic now have to offer. Back in my personal struggle with IVF, by the end of the 90s when I was already 38 and completed devastated by endometriosis, my doctor told me the odds of getting pregnant with his method were one in six. I immediately clapped my hands and told him back, “It’s already won, then. All I have to do is repeat the treatment six times!”
Yet I was a Developmental Biologist with a Ph.D. in mammalian fertilization and a post-doc in mammalian cloning. It was my duty to know better. I just didn’t want to, because I was on my way to finally have a baby and until then if I wanted something all I had to do was to work real hard at it. Sure enough I worked real hard, but never had even a likely case of early pregnancy. Then, for the first time in my life, I fell prey to a major depression and tried to kill myself twice.
The only reason I’m telling my own story is because it happens to lots of women. A possible connection between all the hormones we’re soaked in during the treatments (and they all have to pass their messages through the brain, because it’s how the sexual cycle works) and suicidal behavior or even just depression has never been studied, confirming something ugly we’ve all come to know in one way or another.
How come everybody around us who never had menstrual or pregnancy problems doesn’t even seem to notice? Because this is still a man-shaped word, I guess, so persistent that even those women who were lucky enough to have smooth cycles and fine pregnancies don’t see what we’re going through.
Still, or problem should be quite visible, since it is so awfully simple.
Let’s start by excluding all the labs that invested a lot of expensive research in perfecting the estrogen treatments that make you seem younger and feel stronger after menopause, since they sell pretty much as cosmetics for those precise reasons – yes your bones need Calcium but who cares, what women are after are all those not-aging beauty results, such as the promised shining skin or the strong, beautiful hair. Outrageously enough, at first nobody tells you that most brands will make you put on a lot of weight real fast, such as the eighteen kilos I got in four months, much as I tried to fight them back hitting the gym and trying seemingly fabulous massages; and then, when you discover it’s not exactly menopause that’s doing this damage to your body but rather the estrogen you’re taking, your doctor can change the treatment but won’t pay any attention to the hardest part that follows: it’s all up to you to go on a serious, tightly-controlled diet, if you have the means to afford it. Back then I was still childless, and certainly not a grandmother. I could go into one of those severe yet well-balanced diets accompanied once a week by the nutritionist prescribing my new way to eat and selling me three different sorts of pills, a bottle of diuretic syrup, and four nutrition bars a week for my moments of more desperate hunger, all of them products I very much doubted were really necessary for the daily routine of eating what it took, but that I kept on buying without ever voicing my doubts on their usefulness because it was crystal-clear to me that all that stuff was the price I had to pay for the nutritionist to give serious attention to me and keep on giving me good advice. With this sort of following dieting becomes quite easy after the two first weeks, and I ended up seizing the occasion to lose twenty kilos instead of eighteen. And, quite obviously, that felt so wonderful I could almost fly.
Now I have two boys in their half-20s always in need of help, four grandchildren and one more on her way, which my son wants to call Clara as homage to Mom. It’s been quite a great ride.
To finally have my own family was the most precious blessing ever bestowed upon me, but those two forced me to forget all the money I once could spend on myself. I had to start working less in order to raise our kids with all the love I wanted to give them. We had to buy a bigger house for all of us to fit happily in there, that house had to be paid back to the bank, and I was the one in charge of those payments due to a special arrangement I made with my husband right before the day of their adoption. I used to have the smallest Peugeot of the whole assembly line, and suddenly had no choice but to buy the biggest van they had to offer if we meant to go places together on weekends and vacations. Kids grow real fast, which, by the way, also means we have to constantly buy them new clothes, not to mention their infamous shoe-sizes, in need of a change twice a year. Then, with our kids, come also our kids’ friends, body-board equipment, one dog for each that they absolutely love but quickly proceed to never take care of since Mom gets up at 7 and up is perfectly able to walk them so she can obviously do everything else dogs need, next comes the very kind and fun young vet charging a bundle for each vaccine.
And I didn’t count yet, still within my promise to my husband to pay all of their needs by myself, the outrageous price of their ever-changing textbooks, of the private school we sent them to in order to be sure that they were closely watched all the time, of the tutor they absolutely needed to get their homework done since I got home way too late for that, of the only psychologist in town able to take away their fears of being abandoned our finding me dead in the morning when my husband was away, and so on. Any couple with kids knows how they change their lives, and even more so those couples, like us, who adopt kids who were really brutalized by their biological family.
My academic productivity went down quite noticeably, and the great Professor I had always been so proud of being, the person who sits on top of her desk to watch her students’ eyes shine with enthusiasm and incredibility, started to draw sudden blanks halfway through a sentence and have to ask the young people who were used to absolutely trust her, “What was it that I was talking about?” The situation became serious to the point of being called to the College’s Administration, where they said they perfectly understood my situation and couldn’t be more sympathetic, but I was the Director of the Biology programs and couldn’t be so absent-minded unless my salary would be reduced in proportion to the work I was now delegating on my younger colleagues, so that I could be less engaged without any hallway badmouthing. Within a short while after accepting their deal I had no choice but to take crescent number of extra jobs to pay for all this luxury we had never had before. These jobs were Biology editorials for newspapers, Biology radio shows, popular science translations, storytelling at nearby schools, and a number of other tasks that allowed me to work at home more and run away less, spending more time with the kids – but yes, badly hurting my chances of keeping on climbing the Academic ladder, together with taking away a considerable part of my retirement.
I felt incredibly blessed during those first years as a Mom, but I also got incredibly scarred – for life. My children still made me happy just from their own happiness jumping out of bed in the morning, their tenderness kissing me goodnight, and all the hilarious comments and questions they never tired to make in between. But, after two years of just about no sleep at all, followed by a sad divorce where we still really loved each other but my husband just couldn’t deal with all their noise and agitation, I became to this day a regular visit to my psychiatrist’s office, something I had never thought I would one day need to do – and pay for, pay the extra load of those really expensive monthly visits, plus some really expensive pills, much as this guy is a great companion, makes me laugh just about all the time, and is even able to stop me after something I just said and go like, “Oh, but you really heard what you just told me? Goodness, that whole story, and the words you used to tell it to me, it was all so 21th-century romantic! Can’t you use it in your next novel?”
Those kids grew in no time, they still need our financial help as so many young adults do today, and much as I love my grandchildren I’m constantly reminded by their parents they require a lot of our investment, too. Due to all my gynecological problems I entered menopause at 44, back when our money was truly ours and we weren’t rich but we had no financial problems. I am now 59, an age where many women without these sorts of problems enter menopause in turn. Had it happened to me now, and had my doctor given me one of those fast-fattening estrogens, I could never afford the cost of the diet and of all the exercise I did back then. And, as with any other woman, that would make me feel real bad.
Other than these treacherous beauty products, the quality of women’s reproductive cycles have been so little studied, and most of the illnesses leading to infertility receive so little attention that – come on, this is ridiculous. There has to be a very strong reason for our civilization to have put a man on the moon in the 60s, and still not even have bothered to come up with some new sort of painkiller that won’t destroy our stomachs or turn us into morphine addicts. Please don’t tell me this is not a male-shaped world. At least not yet.
Going back to when we enter the infertility clinic for that first time. I had the duty of knowing that a cycle is not a lottery, and just because they tell me “1 out of 6” it doesn’t necessarily mean I’ll meet that average. Those techniques, any technique invented so far, do not work way more often than they work. Still, once you enter your doctors’ office, all you care for is believing in miracles. Infertile couples flocked to the first clinics offering IVFs in the late 70s, as their doctor puts it, “literally expecting miracles. “The techniques were still so incipient, that “whenever it worked, we thanked God.” One single success story would lead tens of couples to the doctors’ doors. That’s how fragile their long path madethem before they finally got there.
Hence the need to put an end to this error.
Yes, of course, there are miracles. There are more and more babies born out of ARTs as time passes. But they are miracles. Among many other things, this means those success stories are rare.
And it doesn’t look like anything is about to change about this miraculous rarity.
Technology might become better and better as time passes, as it certainly will; it still doesn’t mean that it will ever allow us to beat Nature at its own game. After all, having been after it for thousands of years, we still didn’t find a way to live forever. We are right now celebrating the thirtieth anniversary of IVF, and sure – it colonized the world, it branched out into more than forty ways of having a child without intercourse, and the supporting Materials & Methods are ever more efficient and better looking. But in any event, it’s still a lottery. Or rather a Casino Royale, considering the luxury of most gambling places and what you’re required to pay just so that they let you sit at the roulette table.
ART babies are miracles because no-one knows how and why they managed to be born.
Much as they know about ovaries and hyaluronic acid, doctors still cannot really explain why one ovary responds to stimulation and the next one doesn’t, or why one embryo implants in the uterus and the embryo next to it doesn’t. Between 1978 and 1998 the success rates went up from 10% to 16%, but they have been stuck in there ever since. Almost all clinics lie when they report on their performances, to the point where by February 2018, Japanese feminists, representing what might be the only country on earth fully honest on its statistics, were most surprised to find that their average success rate of around 1 baby for each 6 cycles was not a failure of Japanese ART but rather the most common rate of the entire planet. Cooking the numbers is not forbidden in private business.
Expecting “better technology” to solve any infertility problem with a “miracle” is an archetypical human error, but as with anything miraculous springing from the old glorious fight of Man against Nature we need to keep reminding ourselves it just won’t happen all that easily. It is the same kind of error that led sages and laity alike to expect “miracle cures”, that would eradicate just about all illnesses creeping humanity, coming from all those upcoming “better antibiotics” that seemed to be just around the corner after Fleming discovered Penicillin. Or, likewise, it belongs with the same narrative of miracle cures promising everybody during Nixon’s Presidency that, with a generous public investment and a noble research effort, there was absolutely no reason why “better science”, taken altogether, would not “soon” be providing a “cure for cancer”, considered altogether too.
Conversation, debate and information on the amazing world of the New Reproduction Age are also necessary – and urgent – if we want by any means to get the word out on the weird genetic neurosis that is right now leading couples all over the world to try their luck at multiple joined combinations of several ART to have a “biologic child”. The first time you look at it, it feels as though no-one is thinking anymore, and that people in the clinics doing this plainly lost their minds or openly lost their scruples. Or both.
You can make a child by combining an egg taken from an egg donor with sperm purchased from a sperm bank, and then a surrogate mother gestates the embryo: somehow, people paying for the combo consider this to be their “biological” child. And this is not a sci-fi case-scenario in poor taste. It happens way too much for comfort and too close for silence. A whole host of extra techniques can be added here, including screening for “superior” genes prior to Embryo Transfer. Of course, yes, this is the Age of Capitalism, so we should bow to the inevitability of the rule stipulating that whomever pays owns. Still, if you’re going to go as far as considering that a child is your biological child just because you ordered and you payed it – than the child might be financially yours, but other than that, hey — it’s just the economy, stupid. That child might be your material possession, but finances will never make a human being your own biological legacy.
Still, just the fact that people now equate dollars with genes and seem to be perfectly at ease with this strange new model is hair-raising enough in itself. Couples seem to be more and more into these expensive, meaningless, and highly tentative solutions than into traditional child-bearing systems “that help so many people in need” such as adoption. This might initially seem real strange, especially considering that, in both cases, the child often does not carry any of the parents’ genes at all. Except that in adoption there is a child involved from the beginning of the story. In those twisted ART attempts at parenthood, on the other hand, there might never come to be any child at all. But not even this heavy-duty detail will turn those who want children and can put a coin into the game away from spending as many hours as they can possibly endure at the slot-machines.
America is a perfect example of this recent switch in methods, since only 1% of all couples interviewed most recently say they would consider adoption an acceptable solution for parenthood. Listening to people making their case, it’s clear tables are now turned on who saves whom. It used to be that couples saved children by adopting them. Now it’s more like couples need children for their own salvation. Therefore, no couple in their right mind, and on the straight path for their own rescue, wants a kid who’s going to come in with a bad past and lots of bad genes, ruining their love, their marriage, their lives, their whole family, their street, their school, maybe the whole world. Even adoption agencies are problematic, take problematic decisions if a biological parent shows up claiming the child back, and these problematic situations change from country to country and from state to state, know what you expect in order to prepare your defenses against potential aggressions of those sorts.
As a matter of fact, adoption agencies might be the worst part of this whole conundrum, and the real reason why couples with the means to play expensive games prefer to roll the dice in what they end up considering a safer way to win the night. It is generally perceived that adoption agencies tend to treat prospective parents as some sort of potential criminal, and this unfriendly attitude is curiously but maddeningly found throughout the entire first world . No one needs a permit to have a baby; but to adopt a baby, you and your partner may be investigated for years. Even after you got your kids, states still enforce waiting periods of one duration or another, but never less than one year, before they let you become a full-right parent “to see how things go”, and during that period they have all kinds of ways of checking upon you. They pretty much can do what they want, often be quite an impressive source of vexation, seem to have a strange pleasure in denying you the peace you need so badly – and they can certainly drive you crazy in the process.
Before this scenario, people either go adopt their kids at some faraway poor country (although there were plenty of orphans right next to their door), or they plainly give up on adoption altogether. This second case becomes more and more the rule as more and more clinics seduce infertile people into trying their services, regardless of how “biological” the resulting child is going to be – if there is a resulting child, the infamous rule that doesn’t apply at all when it comes to gambling around at the huge, colorful ART Casino Royale.
Why me? Infertility hits you with an added violent punch: you constantly think you’re the only one suffering from it, or failing all your ART attempts. And the more you suffer the more you keep your silence. If you suffer from a health limitation that makes your life miserable, but you hear no-one else talking about it, it doesn’t take you long to assume you’re the only person accursed with an illness as horrible as yours. Or, at best – OK, yes, you know other women have it, too. But since they live in that part of the world where you live and none of you receives solace or solidarity from socials powers or simply from society, then, for an infertile woman, you were obviously born in the worst possible part of the planet. You will never be understood, accepted, or at least minimally helped by your National Health Service, because to look the other way when confronted with women like yourself has always been the typical reaction of your countrymen. You will never be helped. You will never be heard. You will never be loved . I lost track of how many times I heard “because that’s how men are in my country”, or “because my country’s society has all these limitations”, referring to cases that are the same everywhere, including in my own country, Portugal – and these conversations might as well be taking place in New Zealand, Portugal’s absolute antipodes. In Africa you’ll get “and he doesn’t even marry me because he’s afraid of what his Mother would say, you know how African man are!” – although such Mothers are the same everywhere, and so are their wimpish macho boys. In the US it might be “I never dare talking to him about our problem because it comes from him and this is a very old-fashioned society, where men can’t stand to be identified as the infertile part of the couple” – as though there were one single place in the planet where men accept easily, when not altogether deny, that their couple’s infertility is caused by something more or less dysfunctional in their sperm, or in their ejaculates. An Indian woman on an IVF program complains about the impossible amount of times her in-laws call her husband to find out whether there’s finally a child on his way, assuming no husband’s family in Europe would have such a crude behavior. She’s devastated. I would be, too, if I thought no-one but me had to endure any of these aggravations – and by now I’ve spent quite an impressive number of years telling an equally impressive number of western women invasive in-laws of this sort abound, and often their children lack any courage to silence them at all. Once, reading through literature, I ran into the case of a young Muslim women from London, already with a three-year old little IVF girl in tow but returning to the scene since she’s required to have a boy, who sincerely believed she wouldn’t have to endure any of that if her in-laws were not Muslims. It moved me to tears. When we don’t know any better, the grass is also so much greener.
This is a kaleidoscope where nobody talks, and therefore everybody feels lonely.
Not all that long ago, I couldn’t help breaking in laughter when a younger Japanese girlfriend started explaining to me that Japanese men are extremely conservative, and therefore she can’t get herself a boyfriend because she’s a single mother. I had suffered exactly from the same problem in Portugal. It’s not men and social conservatism that are different in different places. It’s our silence that is always there to punish us unnecessarily. Patterns are always the same, everywhere. Only women don’t know, and thus suffer even more than they otherwise would have to.
Twenty long years
One last topic needs to have more light shed on it, this time around debating what it really means to be at the mercy of an agent as invisible and as lethal for our well-being as carbon monoxide. Are we going to bring to the table the potential for damage some of us know so well is there? Or are we going to remain silent to simplify our own lives and thus willingly let the lives of men and women who trust biomedical salvation lose their quality of life and slowly slide into a permanent state of intoxication? We should start to explore what happens when it comes to developing addiction to the high of IVF cycles and then falling prey to depression, especially if there is a cycle repeating month in and month out.
IVF cycles are one of the most addictive experiences on earth for a woman longing to have a child: all’s going well at first, you’re almost there by the time of superovulation, after the first two weeks you’re indeed pregnant, it’s impossible not to day-dream, not to rejoice, and certainly not want to feel all this again for a second time around if the first one fails. Although it’s a time-bomb, at least this one’s easy. However, and although no-one writes about this, IVF cycles are also physically addictive. And that’s where things can become much more complicated. A good number of women, in different parts of the world, talk about something like “feeling high on pregnancy”. I remember that feeling distinctively myself, and yes, it’s a real high, and a really great one. Like you spend the day on rollerblades and have ten times more energy you ever remember having at age eighteen. How could it not be, on second thought, with the monumental doses of progesterone we’re soaked in? It’s only normal we would want more. Yes, but then the cycle fails, and the high is brutally brought to a crash.
Since it fails more often than it works, IVF is a potent bipolar treatment more often than not.
Eventually, you’ve crashed from the highs often enough to be struck by a serious depression.
Why would it be rare to become suicidal?
Do I know this from studies? No, I know this from women talking to me. Doctors and researchers might study culture media, transfer media, egg harvest, whatever. But for more than twenty years it has always seemed to me that with such rich materials, such abundance of data, and such easy ways of getting a hold of patients, nobody cared to study anything having to do with their feelings through each cycle and after a bunch of them.
Meanwhile, for the women who’ve already been to the Moon in anticipation and next thing they knew they were trying to kill themselves in desperation, time passes and life find its balance once more. And now the high you got from those tons of over-progesteroned mock-pregnancy calls you at night the way a siren would, the memory of having been almost there is blissful, clinics keep putting out ads for so many new techniques allegedly so much different from the previous ones, the whole thing is so appealing that a couple might…
… a couple might enter therapy twenty years after they tried their first IVF, and this is from the literature, not from hearsay
These were twenty years of a really difficult life, with lots of strict rules, extremely harsh on the body, terribly corrosive on both party’s libidos, all the ways mined with those ups and downs from almost-there to depression that seem made in hell on purpose to ruin marital life. The same marital life, the only one you’re gonna have, you could have chosen to spend in many other ways of finding joint gratification and sense of fulfillment. This is taken from literature, not from hearsay.
Now, shouldn’t someone, at some point, have told all those couples, in one way or another, “STOP!, beware of miracles!”?
But where are those people? How come they don’t even exist? Is everybody this afraid of pharmaceutical companies, that so far can rule the show in total freedom for as long as nobody wants to hear about infertility? Is everybody oblivious because those with the problem don’t talk, and those without it don’t care? Is everybody too enamored with the miracles of science to even remember The House Always Wins and thus keep on playing at Casino Royale until there’s nothing left?
Or all of the above?*In both the Old and New Testaments.
*In both the Old and New Testaments.
ART – Assisted Reproduction Techniques.
“the miracle of life” – This term has been increasingly used by the industry of making babies, in clear cold-blooded manipulation of those suffering from involuntary childlessness.
IVF – in vitro Fertilization
“that help so many people in need” – Another world-wide cliché.
It is generally perceived that adoption agencies
tend to treat prospective parents as some sort of potential criminal, and this
unfriendly attitude is curiously but maddeningly found throughout the entire
 Again, just because I heard the same stories everywhere. In the first world, this has to be the most silenced subject of them all.
Clara Pinto-Correia is a Portuguese-born novelist, journalist and educator. The daughter of a physician, she was born in Lisbon and earned a doctorate in cellular biology from the University of Porto. She was an adjunct professor in Veterinary and Animal Sciences at the University of Massachusetts Amherst. She wrote a weekly column for the Portuguese newspaper Diário de Notícias. In 1984, she published her first novel Watercress (Agrião), followed by Goodbye Princess (Adeus, Princesa) in 1985. Adeus, Princesa was made into a movie in 1992.