Fertility Holidays (New York University Press, 2016) by Amy Speier follows Americans traveling out of the country seeking low-cost in vitro fertilization. The Czech Republic has emerged as a central hub of fertility tourism and offers an empathic health care system with a plentitude of egg donors at a fraction of the price. The following excerpt is from chapter 1, “Couples Confront Infertility.”
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The American Society for Reproductive Medicine estimates that infertility affects 6.1 million North American women; roughly one in eight couples of reproductive age experiences this inability to “make babies.” In narrating their infertility journeys, couples I met mentioned a point in their lives when their friends began having children, which can be understood as a social cue for the “normal” or right time to start a family. In the summer of 2011, I met Janice and Craig, who were in their early forties. Their tans from living in the Sunshine State gleamed under the streetlight when I first met them, sitting outside of the pension in Zlín across from Lauren and John. The two blonds, Janice and Craig, were both nurses and had met at work. They had been married for ten years, and they usually spent their summers in her home country, Canada, something I gleaned from Janice’s subtle accent. They were planning on building their own house on a piece of land they had already purchased in central Florida. Craig remembers, “[At] about thirty- five, maybe seven years ago, we had a large group of friends, all about the same age, you know, midthirties. We’re all teachers and nurses, and we all hung out. Then everybody started deciding to have children, and we just kept trying.” It took two years of trying, with one year of “timed” intercourse, before they realized something was wrong.
Since the advent of the birth control pill, North Americans have held onto the notion that they can prevent conception when they do not want it, but also can easily initiate it when they do. Unfortunately, contraception and conception are not the same things. Over breakfast I met a very chatty couple from Los Angeles, Maureen and Daniel. I had seen many of Maureen’s postings on a website for women thinking about traveling to the Czech Republic, so I had anticipated their arrival, always eager to meet more people. Daniel described how they met at a community college in San Diego, where they realized they shared many of the same interests in film and editing. They carried a newly purchased iPad with them everywhere, pulling up Czech phrases, maps, and pictures of their travels. I could tell they were technologically savvy. They had been together for fifteen years and married for six. Daniel commented dryly that once they started trying to have children, on the heels of many of their friends, “A strange perception from a guy is that you spend most of your life hoping you don’t get pregnant. I’m sure women are the same way, but the guys really worry about it. It’s a big worry. Then all of a sudden, it’s like, God, it’s so much harder than you’re taught in school.” When conception does not happen immediately, North American couples often grow impatient and frustrated, assuming it should happen easily, the “natural” way.
The Universal Declaration of Human Rights, Article 16, claims, “Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.” The discourse of “rights” is prevalent when people speak of infertility, which is understood as hindering one’s right to have a child or start a family. Rothman links this discourse of rights to capitalism: “Women, like men, lay claim to their own bodies and to their own children and call on the basic values of capitalism to support those claims.” She mentions our notions of the body as something that is “viewed not as a resource for the community or the society, but as private property, a personal resource.” The discourse on one’s right to have a family becomes a talking point for those who suffer infertility.
Infertility interrupts normative ideas of one’s life stages. However, the point at which North Americans begin to think about having children has shifted over the past few decades, reflecting cultural trends of women in higher education and the workforce and in divorce rates. “The timing of parenthood has changed,” and the delay of childbearing has complex effects. In North America, there is a general trend of women seeking higher education and careers before getting married, and North Americans, on average, have children at twenty- four to twenty- six years of age. The decline in marriage rates, along with high divorce rates combined with remarriage, can be credited with a drop in heterosexual reproduction. After putting off marriage and childbearing, or marrying a second or third time, people are often shocked when they find that being older can hinder their ability to conceive. It “wreaks havoc on life plans.” In addition to age- related infertility, there are other causes of infertility: roughly 30 percent of cases are male factor infertility, where men may have a low sperm count or low sperm motility. Another 30 percent of cases are female factor, where a woman’s tubes may be blocked or scarred from endometriosis or prior pelvic infection. In the other 40 percent of cases, infertility remains unexplained. However, the ways in which North Americans confront this knowledge reflect cultural notions about health.
Despite the fact that infertility can be either female or male factor, it has been well documented that dealing with infertility is a largely gendered phenomenon. According to Park, “Women appear to be more stigmatized for their childlessness than do their male counterparts.” Women are the ones who must assume the “work” of pursuing medical treatment through reproductive technologies, and they “bear the burden of medical intervention.” Given the stigma of infertility, many keep their problem a secret or pursue treatment secretly. Furthermore, Rose identifies the individual moral responsibility for one’s health and one’s family’s health as the social obligation of women.
Women I interviewed, in wondering why they are unable to conceive, often say defensively or perplexedly that they are healthy. They see themselves as following the medical model of how to get pregnant: they must first get healthy. They have been upstanding citizens who practice yoga, eat well, and take care of themselves, reinscribing the ideology that health is an individual responsibility. However, this ideology then leads to women feeling cheated by their bodies when they do not conceive easily. I met Claudia and Ben, a couple from Seattle, over my first breakfast at the pension in the summer of 2011. They were very calm and relaxed, having already spent more than a week in the Czech Republic. I was catching up with them on their second-t o- last morning in Zlín. They are both very tall, fit, and health-conscious, maintaining a vegetarian diet — which I could tell when they left the delicious bacon untouched. When I interviewed the two of them later that afternoon in their third- floor apartment, Claudia exuded an air of calm, having just meditated and written in her journal. She repeatedly stated that she is a healthy person, which made it difficult for her to understand her infertility: “I have no idea, because I’m a very healthy person. I never thought I’d have a problem having a child, and it’s been unexplained. I’ve had every test, every whatever. I have a perfectly normal cycle. I always have, but this is all unexplained.”
In addition to this confusion about their infertility, some women wondered aloud why friends whom they considered unhealthy still were able to conceive. I met Valerie at the clinic during my second week in the summer of 2010. She pushed her long, dark hair behind her ears as she leaned in and spoke loudly over the quiet clinic sounds. She carried a stack of papers that included her medical history, as her husband, Dan, shrank into a corner holding tightly onto a tour book of Vienna. The two were from San Diego and had met when Valerie was in her late thirties. During our interview the next day outside of the pension, she remembered that they were both surprised when she accidentally became pregnant early in their relationship. They decided to get married, only to suffer successive miscarriages. In her anger and frustration, she lamented: “I had one girlfriend who’s forty- two years old, overweight, eats like crap, and she got pregnant and had a baby, damn it. Why can’t I? I’m healthier than her. You know?” There is a moral dimension that tinges the way many women speak of a person’s health, as if only the woman who assumes responsibility for a healthy diet and sensible weight deserves to get pregnant. The women in my sample recounted how, when they attempted to get pregnant, they had eliminated alcohol and caffeine from their diet or done other things to attain a healthy status. Many women not only feel morally compelled to assume self- care but also feel “morally obliged to avail [themselves] of new biotechnological resources.” Thus, when confronted with infertility, they often turn to reproductive technologies.
The owner of one of the IVF broker companies, Petra, is a slim, stunning Czech woman with ash- blonde hair carelessly pulled into a ponytail, defining her high cheekbones as her blue eyes twinkle. I had contacted Petra over the phone and arranged to meet her in the early summer of 2010. She invited me to have an “American” breakfast in her sprawling suburban Atlanta home the first time I met her. Over crispy bacon and fried eggs, she told me about her personal experience as a woman who suffers infertility. She told me how she and her husband, though they married after dating for only four months, had waited until they were financially stable before trying to have children. Like most others, she thought she would get pregnant immediately. Petra remembers trying to conceive: “At some point I was so stressed, so obsessed, I mean, we were timing the intercourse to the minute. I was constantly talking about it. I was envious of those that told me they were pregnant. I mean, the whole shebam [sic]. I mean, it’s just a part of infertility.”
Petra speaks quickly, bluntly, and to the point. She is petite, and a powerhouse of energy. Petra claimed that some women, like her, are simply “stress control freaks” who can’t get pregnant because of their personalities. High levels of stress indicate the intense level of emotional investment women experience during this process. Petra complained, “Nobody told me that you might prevent it [conception] from actually happening just because you’re so stressed out.” The management of one’s stress can be considered an element of this individual control over one’s health. Thus, women not only are responsible for their physical health but also must monitor their mental health. A myth that circulates throughout conversations about getting pregnant (one that hinges on a woman’s ability or inability to contain her stress) is the idea that if you “relax,” you will get pregnant. Stories abound of couples who proceed with adoption, only to then find themselves pregnant.
In addition to the stress of infertility, women may suffer from depression. Craig, the nurse from Florida, described the emotional journey of infertility: “I will say one thing. Having been in the infertility thing and having so many years of disappointments, when you first start every month, it’s a disappointment, and then every procedure’s a disappointment. You prepare yourself, like right now, transfer is tomorrow and you’re all having fun, but you have these depressing moments. It’s like 50 percent, [I’m] prepared for the worst. I think too, I think my wife’s very positive.” This need for positive thinking amid stress, fear, and depression becomes another moral axiom and ties into the ideology of hope, particularly for women.
Reprinted with permission from Fertility Holidays by Amy Speier, and published by The University of New York Press, 2016.