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Lesbian Infertility a Feminist Issue  by Elizabeth Ruth
Lesbian Infertility a Feminist Issue

Illustration: Jaime Drew

I know something of missed opportunities, stunted and miswoven cells, futures undone. I know relentless, raging optimisms, babies not yet wished into being.

Yes, I know all too well these trying, trying times that so many face, because, for almost five years, my partner and I have watched younger women with buoyant, hopeful energy push double strollers through fertility clinic doors and flip the pages of glossy magazines while we wait for blood draws and ultrasounds, and a successful pregnancy.

We’ve celebrated friends and family as they gave birth to their second children, while we experienced miscarriages and continued trying for our first. They are everywhere, the fresh, naive faces. They don’t look haggard, weary, defeated. How I’ve hated them for their blind privilege, and especially for their optimism. Not being able to bear a child will break your heart, but hopes raised and dashed, month after month, will bleed all joy from living.

Flesh of my flesh, Blood of my blood, who will I be without you? Who would I have been if you’d stayed?

More than a decade ago, at the University of Toronto, I concentrated my graduate studies in the areas of women’s reproductive and mental health, researched the history of various cutting-edge drug treatments and pored over recommendations made by the Royal Commission on New Reproductive And Genetic Technologies. I wrote papers on the ethics of anonymous sperm and egg donation and argued, from a feminist point of view, for regulation. I investigated potential long-term side effects of pills like Clomid, both on women who took them and on the offspring produced. I learned that very little research had been done in the area. There are still no long-term studies—which is why doctors are able to tell me, with great assurance, that there’s no link between the fertility drugs so many of us now swallow and inject, and the cancers all women fear.

So, when I decided, on my 35th birthday, to have a child, I wasn’t naive about the history of the Western medical model responding to women’s health. I knew other drugs deemed safe had later been proven dangerous and taken off the market. I believed our bodies, especially our hormonal bodies, are routinely perceived and treated as defective, or in need of control and management, and that childbirth itself has become a state of emergency in North America, with C-sections and early interventions fast becoming the norm. I also expected that, because I was old, reproductively speaking, and because my partner was a woman, I’d find myself in a doctor’s office.

At the very least, I had a sperm access issue. What I couldn’t envision then, and swore I’d never do, was to give over control of my body. Of course, that’s exactly what I ended up doing. I conceived without drugs on our first attempt, using frozen sperm from an anonymous donor. I was optimistic, with no visible stress in my life. I knew it wouldn’t be long before I was pregnant. The procedure was a simple, non-invasive insemination (sperm deposited in the vagina, at the opening of the cervix) and not, as it would be for years subsequently, the highly touted, invasive and more expensive intrauterine insemination (IUI). I was certain I was pregnant within hours, though people told me it wasn’t possible to know so soon. Two weeks later, the pregnancy was confirmed with a blood test.

Unfortunately, I miscarried at eight weeks. Despite reassurances to the contrary, I wondered whether my hypothyroidism was a factor. My thyroid, previously regulated with a prescription medication, had spiralled out of control the instant I became pregnant. I searched for answers online, in bookstores, and at the library as to why this might’ve been and how to prevent it happening again. Though I can never know for certain what caused that miscarriage, the doctor doubted it was my thyroid. (Another fertility doctor was adamant that it probably had been the cause.) What exactly is the relationship between hypothyroidism and miscarriage? I still don’t know. I was told to grieve and move on, because miscarriage is common, and an easy first conception is a sign of fertility. I tried for another year without success.

That first doctor had many lesbian patients, yet her receptionist routinely asked for my husband’s health card number. The doctor, a walking infomercial who answered our questions before we had a chance to finish asking them, never spent more than 10 minutes with us. She told us she wouldn’t speak with my partner, as I was the patient, so that’s how it was for almost a year—both of us at morning ultrasounds and blood draws (10 days per month), both at scheduled information appointments, and both at two monthly inseminations—but only one of us invisible. I only understood this to be discriminatory after a straight couple I knew began seeing the same doctor and, though they were also using anonymous donor sperm, the male partner in that couple was actively involved in conversations and decision-making. That first doctor was a gynecologist and reproductive specialist, but not an endocrinologist, which is the reason I finally left.

I was willing to put up with discrimination because I wasn’t sure the situation would be different at another clinic, and finding a new doctor meant being on a waiting list for months. My second fertility doctor, reportedly one of the best in city, was extensively renovating his multimillion-dollar Toronto clinic while we dug ourselves deeper into debt, stepped through plaster dust and suffered summers in the attic waiting room without air conditioning. My thousand dollars a month for two inseminations wouldn’t buy the leather chair I sat on while I waited.

This specialist recommended fertility drugs to us on my first visit because of my age, he said, and because I was a lesbian, not because any tests showed me to be infertile. “Fertility drugs will save time,” he told us. He looked me up and down. “My guess is you’ll respond best to injectables.” His plan was the usual—to have me inject gonadotropins and carpet-bomb my uterus with multiple eggs each cycle, thereby increasing the likelihood of conception with our frozen sperm.

I wondered whether his reputation and his stats (and, perhaps, research funding) were dependent upon high success rates. Would I lower those success rates if I took too long to conceive? If I took a natural amount of time to conceive? So I said no to fertility drugs. For two more long years I said no. Definitions of infertility have shifted dramatically in the past decade, arguably since drugs have been more accessible. Whereas once a woman would be referred to a specialist after two years of unsuccessfully trying with her male partner, now many doctors refer after one year, and increasingly after only six months of consecutive attempts. Why? Have women’s bodies changed? Or, perhaps our eggs are a new cash crop?

Refusing drugs was not easy. I secretly wondered if I shouldn’t give in, if I wasn’t denying myself because of ideological principles, and overinflating the potential unknown risks. It was harder to say no when most of my friends, many of them lesbian, had said yes without similar reservations. My partner was becoming anxious about our mounting debt. It was also a monthly struggle with the doctor, who, at each insemination, while he sat with his face between my legs and deposited sperm into my uterus, would remind me of how low my chances of conceiving were without drugs. He’d remind me of how relatively ineffective frozen sperm was, compared with fresh, despite the fact that we had no access to fresh—he said he would not treat us with a known donor. Once, he told me that my becoming pregnant a second time would be the equivalent of winning the lottery.
 
We tried to find a doctor who would allow us to do IUIs with a known donor’s sperm, but we were plainly told, by three, that they weren’t legally permitted to have a known donor’s sperm washed and inseminated in me. Was it, as one specialist claimed, because if I contracted an STI the clinic would be liable? Or, as another claimed, because they worried our known donor might be gay, and gay men are not allowed to donate sperm? The third specialist told me bluntly that it was because I was a lesbian and he wasn’t comfortable. We pointed out that heterosexual patients could also contract STIs and that I should have an equal right to the donor of my choice. Those conversations left my partner and I frustrated, confused and angry, but apparently powerless, since doctors’ hands were tied because of legislation.
 
For anyone to be willing to wash and inseminate me with this better, fresher sperm of a known donor, they’d have to be convinced I was in a sexual relationship with that donor. In other words, I’d have to lie.
I’ve known of lesbian couples who’ve done this, at great cost to their personal relationships, their anxiety levels and their senses of self. Interestingly, The Assisted Human Reproduction Act and Health Canada are clear that no distinction is to be made between semen from a known donor (including men who are not a patient’s sexual partner) and semen from anonymous donors.
 
Further, according to Dr. Leah Steele and Dr. H Strotmann, in their May 2006 article for Canadian Family Physician, doctors shouldn’t use fresh semen in their offices, and “any physician planning therapeutic donor insemination is legally obliged to use semen that’s been cryo preserved for six months.”
 
What we initially thought was denial of service to us because of paternalistic legal barriers was, in fact, something more subtle and insidious. Our doctors weren’t willing to bend the rules for us, but they’d routinely do so for their heterosexual clients, and hide their bias behind a misleading veil of legality. Meanwhile, we continued to purchase frozen sperm each month, at a cost of $500 per sample, plus $150 to the specialist and a $50 delivery charge to the cryobank.
 
Watching friends conceive through the same clinics and with the same doctors was difficult, but knowing that some had an edge on us because they were straight was infuriating. We learned that by not doing IVF (in vitro fertilization) we were moving through a second-rate treatment model. Had I wanted to, IVF was not something we could have afforded. The costs are staggering, ranging from between $6,000 to $10,000 per cycle. But the odds are better. With IVF, a woman receives gonadotropin injections to stimulate her follicles to produce multiple eggs, which are then surgically retrieved from her body, fertilized in a laboratory and re-implanted in that same woman—or in another woman. Our friends used their relatives’ cashed-in RRSPs to do IVF with frozen sperm and, afterwards, told us the attention they received as IVF patients was better than when just doing intrauterine inseminations; they’d felt like a priority. We never felt like anyone’s priority. In fact, we felt like a nuisance. Those friends conceived on their second IVF attempt, after years of doing exactly what we were still stuck doing.
 
One of the many mornings when I was at the clinic to cycle monitor (psycho monitor I call it), I met a patient who was also a GP. We broke the unwritten code of silence in the waiting room and exchanged details about our treatments. By this point, I’d grown desperate and had, against my own judgment, agreed to three cycles of fertility drugs. My partner’s insurance plan offered partial coverage for a limited number of attempts. The GP-patient told me that in her private practice, because of anecdotal research, she advises women not to take gonadotropin injections or Clomid, even for the recommended period of less than six months, but that she had been taking Clomid for eight months and was terrified of what she was doing to her body. Most of all, she was fearful of what she was willing to do. Like me, she’d entered the process with a bottom line that was continually shifting, so she no longer trusted herself to be able to stop.
 
Would she end up with ovarian cancer in 10 years? Would it all be worth it if she conceived? Clomiphene, a.k.a. Clomid and Serophene, is a relatively inexpensive drug (about $60 per month) taken from day four or five of your cycle through to near ovulation. It’s meant to promote regular ovulation. Injectable gonadotropins are synthetic or
(originally) distilled from menopausal women’s urine, and they push your body to mature multiple eggs. They cost us, on average, $1,700 per month. Both classes of drugs have common side effects compromising the likelihood of conception: thinning of cervical fluids in the case of Clomid and ovarian hyper-stimulation syndrome in the case of injectables.
 
Why are there no long-term studies? Who benefits from not tracking such information? Would being fully informed stop women from taking fertility drugs? Probably not. But it would guide our decision-making, as more of us might decide against drug treatments altogether, or disentangle from them earlier.
 
Knowing the actual risks to long-term health would, at the very least, make our consent to treatment legitimate.What does yes really mean in a system where saying no feels impossible? There are known short-term side effects of the drugs (read the packaging). On injectables, I experienced headaches, skin rashes, racing heart, chest pain, numbness in my toes, anxiety and ovaries hyperstimulated to many times their natural size, making it dangerous for me to do physical activity (like riding my bicycle), lest they rupture. Each week, after a pregnancy test would come back negative and my hormones would drop from artificially high to normal again, acute depression would set in. I skipped months of cycles after each round, waiting for my ovaries to return to normal size.
 
On Clomid, I had a steady migraine, weight gain and anxiety. All of this is routine. And the treatments are unsuccessful just as often as they are successful. Even with technology, the doctor is, at best, guessing what dose of drug might produce the desired number of follicles in a given woman. Women who take fertility drugs feel like we’re making decisions largely in the dark, leaping at fate, hoping to land softly, babe in arms. We feel uniquely unsuccessful when the drugs don’t bring the desired result, and overexposed as we share personal information with myriad professionals who use terms like “poor egg quality,” “incompetent uterus” and the present-day scarlet letters, “advanced maternal age.” We make martyrs of ourselves, but no one notices because the very cultural definition of motherhood is tangled up in martyrdom.
 
After all, fertility has always been a life-and-death matter—women have been dying for their children for centuries, or been expected to do so. In some parts of the world, women still die in childbirth or because of related complications. But in wealthy nations, like ours, where “choice” can be purchased on VISA or paid for in cash, the notion of dying to be mom isn’t something doctors or patients are willing to acknowledge.
 
We can’t, because admitting that we are, in effect, guinea pigs in a field with less than scientific diagnostics and treatments, and maybe putting our lives in danger, might mean stopping. Doctors can’t admit to undocumented risks without calling their purpose into question.
 
After another year and thousands of dollars more debt, I walked away from the second doctor, too. I came to see that the stress and treatment were anathema to my well-being. It became clear one day, as my partner and I waited almost half an hour for the doctor to perform the intrauterine insemination. Our sperm was thawed and we began to panic—after 20 minutes of being exposed to air, frozen sperm begins to die. My partner found the doctor and asked him to please hurry. He waved her off. Again, five minutes later, my partner went to fetch him. This time he came with the nurse, but was obviously angry. He ignored my greeting and briskly told me to lie down. I was already undressed, my feet in the stirrups. As he threaded the catheter through my cervix, an unpleasant, if not painful experience, he raised his voice and reprimanded us: “You people think you know best. If I tell you the sperm is fine, it’s fine. This’ll never work if you don’t trust me. You ask too many questions. Next month I’ll prepare cue cards and hold them up so I don’t have to keep repeating myself!”
 
I should’ve kicked him in the face, but of course I was desperate to get the sperm into me as quickly as possible.
When it was done, I stared at the beige ceiling I’d stared at for so long and knew I couldn’t harm myself in this way any longer. Perhaps it was my lack of belief in the drugs and biomedical model, but I would never succeed at a clinic.
 
Leaving was scary, too, for it meant being willing to risk the unknown, believing more in my intuition about my body being healthy than in “expert” advice. Possibly, it meant never becoming pregnant. I sought out an experienced traditional Chinese doctor who performed acupuncture on me several times a month and reminded me at each hour-and-a-half-long visit that there was nothing fundamentally wrong with me, that I was still young enough, healthy enough and deserving enough to become somebody’s mother. Each time I left her office, I felt more at home in my own skin, like myself again. More than three years of paying doctors to tell me I was defective, show me statistics on rates of pregnancy for my age group and push drugs as the only hope for success produced no pregnancy.
Three months within a traditional Chinese model, and I was pregnant for the second time.
 
North American boomers who saw the advantages of the pill were weaned on the nebulous concept of freedom of reproductive choice, and that limited perspective has filtered down to us, their children. You’d think that having greater reproductive options (assuming you can pay) would be easy. But, of course, it’s not. Having choice means bearing the burden of responsibility for our yeses and our nos and that’s a heavy burden to carry when the outcome is so profound. In fact, it requires superhuman strength to say no to drugs, or exploratory surgery, or even daily ultrasounds, without feeling you’re potentially closing off your option of having children, without doubting yourself and being judged as treatment resistant.
 
So what if there are side effects? Our second doctor told me that if I wanted to be a mother badly enough, I’d take a second mortgage on our home and increase my odds by doing IVF. I was a new homeowner who barely scraped into the market. (We ultimately sold the house.) What about women who don’t own homes or can’t even pay their rent?
What about people who can’t imagine doing what we did: maxing out credit cards and overdraft? What about the more logical option of having both my partner and I try, thereby doubling our monthly egg pool and odds, without drugs?
 
I met a young lesbian couple on Pride Day one year, pushing a double stroller. They’d tried to conceive without technology, when, perhaps out of frustration, or because of the financial stress of paying for anonymous sperm, they’d agreed to gonadotropin injections. “Whatever happens to you,” one mother told me, “don’t do it.” Their twins had been born premature and one baby needed several emergency surgeries because part of his intestine was sitting outside his body. He’d have lingering health problems as an adult. The couple was drained, emotionally and financially, and had spent their first year as new parents separate, each caring for one baby, both worried for their gravely ill newborn.
 
“But it worked out,” I said. “I mean those are the chances all parents take, right?”
 
“Maybe,” said the other mother. “We love the boys….” She spoke with the honesty of a stranger and the raw wisdom that only comes from surviving a trauma. “But we wouldn’t do it again if we knew.”
 
I smiled politely, envying them their children, despite their arduous journey. I dismissed it as an unusual case, exceptional, and made their situation rare. But stress on prospective parents’ relationships, massive debt, pregnancy and delivery complications, high rates of multiple births, lack of social support for same-sex parents trying to have a family, lack of support in general for all people within the fertility machine—these are the norm.
 
A free-choice analysis of the present-day fertility model is short-sighted and stops at easy, non-threatening questions about over-medication and equal access. It doesn’t extend to an institutional critique of the industry, which would look at how profit-driven motives might be guiding or defining (in)fertility. There have been other feminist critiques of the new reproductive and genetic technologies before now, but what’s new today is that lesbians and single women of all sexual orientations—those who need access to safe sperm, women who are not by any objective measure infertile—are using these technologies in great numbers. As a result, more women in Canada are being referred to fertility clinics and undergoing drug treatments when they’ve failed to conceive fast enough. We ought to be challenging how the fertility machine participates in—or prevents—the creation of non-traditional families, and we must demand an honest examination of the relationship between pharmaceuticals and fertility doctors. We might even want to talk about the social construction of infertility itself.
 
What frightens me most isn’t the actual drug treatments, though they may indeed prove dangerous, but the culture of uncritical thinking and denial in which we willingly submit to them. Yet, women are not passive, ignorant, dupes. We’re simply pressed to keep trying under our doctor’s hand by our own deep directions. Sometimes we forget that our bodies, that we, are there at all. After a time, we see with blinkers, registering only desires, pushed on by those who want us to be happy, or by a medically driven society that believes in taking drugs the way other people, in less secular times, believed in God. We’re just plain frightened at the prospect of never being anyone’s mother.
Above all, we become disembodied through the process of being poked and prodded, and treated under the assumption that we’re defective. We stop believing in our bodies, and eventually stop listening to them and begin following the minority of women for whom the drugs work, holding them up as beacons of hope. We search out those in clinics and on television with whom we might identify, and all the while we’re tempted, painfully tempted, by that candy dangling before us—a baby, a healthy baby, our baby.
 
It is possible to have too many choices. I know the denial, minimization and myopia that are required when on a mission to conceive. My partner and I know the repeated disappointment, anguish over what life might look like if pregnancy never happens, and how these fears cause you to begin to welcome the drugs despite risks, to welcome anything that brings a baby, so hey—even twins begin to sound great. After all, two babies are better than none. We patients grow into this mindset because we must contort, intellectually and emotionally, to fit a model of treatment that’s inflexible, pathologically negative and refuses to see us in holistic terms. Should we hear only the stories of those who succeed? Are they not perhaps the most biased, the least likely to question their treatments? Don’t they just need to get on with the business of parenting?
 
I don’t wish to demonize individual women who opt for fertility drugs, or argue against the existence of actual infertility, but I want to remind us all that, in our brave new world, the interpretation of infertility and the need for fertility treatments is always political. We must think critically. Are the drugs dangerous? Are there alternatives, such as acupuncture, that could be explored first? Are queers in a uniquely vulnerable position within the system, and if so, how is that being played out?
 
But most significantly, is the model for treatment itself generating or exacerbating the very problem it purports to rectify? Can infertility or subfertility be an iatrogenic disorder? In other words, can childlessness result from the inherent stress and negativity of Western infertility treatments? I conceived the first time when I’d not yet become embroiled in the medicalization of my own fertility, when I was making the decisions, had no debt or stress, and before I came to believe my body was too old and defective to bear a child. I conceived the second time only when I disentangled from the medical model, took back control of my body and the process, and was therefore able to trust both. Finding an encouraging, supportive, traditional Chinese doctor who engaged with my questions and fears made a difference. She didn’t dismiss me as irrational or uneducated, because the model she works from teaches that there is a connection between the mind and body, and that the body is something to be respected, not only corrected. Instead of statistics and percentages, she offered stories of success.
 
She also told me openly that I might never become, or stay, pregnant. Despite all that’s happened, I still find myself alone by the blue-note light of the Alberta moon listening to k.d. lang sing “Helpless” while I write this and miscarry, for a second time. My thyroid, once more shocked into overdrive by pregnancy, failed to respond to aggressive treatment. Again, doctors tell me it probably had nothing to do with the miscarriage, but this time I don’t believe them. I think of the incredible debt I’ve accumulated paying for something I once swallowed for free, the books I might’ve written all these years, the trips my partner and I might’ve taken had every penny not been going towards buying sperm and paying for inseminations. I think of other undiscovered dreams, secondary for so long, that never had a chance to materialize. And I think it’s time to stop.
 
Yes, there comes a final, terrible point of clarity for any woman trying in vain to have a child, where the choice that matters most becomes the choice between the life before us now and the life we so desperately imagine creating.
Again, I wonder what sins I’ve committed to draw such bad luck my way? I see my future laid out before me, and that future may be too quiet, free of obligation.
 
Perhaps there’ll be no new love. I’m alone tonight but I’m only one of many childless mothers watching cradles rock empty, seemingly banished for no reason from the club that is motherhood.
 
This is all I know: Reproductive technology offers queers options we couldn’t have dreamed decades ago, but we’re not the intended or desired recipients. And, there is no meant to be. Babies are random gifts from gods, as well as measured reproductive science, bestowed upon the undeserving just as often (though it seems to me now, more often) as the deserving. Trying to become pregnant for a long time is like swimming in molasses, a dark curse that grows more powerful with each negative pregnancy test, each appointment, invasive procedure or injection. So while a tiny beam of light fades from me tonight, a clawing, crystalline sense of frustration also fades. The struggling and trying and hoping and waiting feel as though it’s finally coming to an end. Even the world beyond my keyboard seems to be slipping away. In some senses it’s a relief.
 
Yet, tomorrow I’ll pick up the phone and call my partner, who’s at home in Toronto, naive and still hopeful, and I’ll read her this story I don’t want to tell. My story. Our story. And I’ll ask: If red is the colour of love, what colour is loss?  
 
A year this article was written, the writer and her partner and I became parents. Ignoring the advice of three fertility doctors, her partner conceived without using fertility drugs.