by Victor Grech, Clare Thake-Vassallo, Ivan Callus – Work should be attributed to the Pediatrics Department, Mater Dei Hospital, Tal-Qroqq, Malta and the Faculty of Arts, University of Malta 

Fertility has always been a vital and fundamental matter for the human race as evinced by the multitudes of fertility totems and rites that have been created by ancient cultures. Locally, for example, the Maltese Neolithic ‘fat lady’ statuettes are believed to be representations of Mother Earth, a symbol of fertility.1 Ancient biblical texts also testify to the importance that fertility has always had for humanity. Genesis recounts that God created male and female, blessed them and enjoined them to be fruitful and multiply. Further examples as to the importance of fertility in the Bible abound. For instance, after the destruction of Sodom and Gomorrah, Lot took up habitation in a cave with his two daughters, who were concerned by the lack of men other than their father. They therefore deliberately drugged Lot with wine and had sex with him, producing two sons in order to propagate the race. The Bible also recounts several scenarios wherein infertile women arranged for their husbands to have children by other women such as in the case of three of the four biblical matriarchs (Sarah, Abraham’s wife; Rebecca, Isaac’s wife; and Jacob’s wives, Leah and Rachel) who were infertile. The Old Testament is amply clear on this subject in that an infertile wife encouraged her husband to have sex and beget children from slaves and servants, and the children would legally belong to husband and infertile wife.2

 

Closer to present day, the infamous papal bull Malleus Maleficarum (1446) was used as an excuse to prosecute and generally hunt down and kill an estimated 50,000 ‘witches’, who were considered as vile as prostitutes, and this is germane to this dissertation as both were considered symbols of sterility.3

 

Interestingly, the first known documented recognition of the principle of physical insemination was documented in the Talmud (central text of mainstream Judaism), with the first successful artificial insemination occurring in 1742 using fish gametes. In 1780, the first canine and human inseminations occurred,4 with elaboration by the famous obstetrician Sims in 1866, who, ‘by a classification of all diseases of the uterus, […] found sterility to be incident to many of them’,5 and strove to create cures and treatments. However, opposition to these new techniques by Sims’ contemporaries was rife including ‘as a valid objection to gynecological examinations [was] the likelihood of inducing a lax moral sense in the patient’!6 And even more drastically, a review of Sims’s book concluded the utilisation of procedures such as vaginal examination and other techniques that might elucidate causes of infertility would be detrimental to the medical profession and

 

‘[a]t any rate, if such practices were to be considered the “business of the Physician”, there are a good many of us who would quit Physic for some other calling that would let us keep our sense of decency and self-respect. Better let ancient families become extinct than keep up the succession by such means.’7

 

This paper will now briefly inspect the intersection between infertility and popular culture with particular reference to Helena Michie and Naomi Cahn’s Confinements: Fertility and Infertility in Contemporary Culture (1997). This book was written by two female authors with personal experience in the fields of both infertility and pregnancy.8 Confinements attempts to provide an analytic framework for the understanding of the metanarrative of infertility, and its bias toward the more affluent Western middle-class couple, principally by analyzing Arlene Eisenberg et al What to Expect When You’re Expecting (1991) and other works which consist predominantly of self-help and self-empowerment narratives.9

 

Feminist attitudes to pregnancy and infertility are also discussed along with a very brief history of attitudes toward infertility, which until the 19th century was always thought to be the fault of the woman. To some extent this is still portrayed as a female choice for the following reasons: waiting too long to attempt to become pregnant, too stressed, too fat or too thin, using inappropriate contraception (e.g. the pill), sleeping  around with too many different partners and developing a sexually transmitted disease or having an abortion. Thus, infertility risks being portrayed dually as a female choice or a cultural responsibility, and as a female disease, while, on the other hand, such empowerment and availability of options may lead to guilt if matters do not take their hoped-for course. It is also ironic that ‘pro-choice’ invokes the view that a woman should have the choice of whether or not to terminate her pregnancy. This pro-abortion stance implies not only the guarantee of reproductive rights, but also access to sex education, to contraception and fertility treatments and to safe and legal abortion.10

 

Michie and Cahn contend that the idioms of popular pregnancy and infertility manuals romanticise the dream or illusion that expresses the middle-class evolution of heterosexuality, marriage, fertility, pregnancy and childbirth. These progressions are considered normative and create the context from which the rhetoric of infertility arises, along with the disparate circumstances and emotional crises that together constitute infertility treatment. The authors correctly state that ‘the rhetoric of choice diverts attention from the constraints within which an individual choice occurs onto the act of choice itself’,8 but the claim that the current infertility epidemic is caused by media attention to middle-class couples who find themselves in this quandary by waiting until both partners have established careers is rather dated, with clear evidence of falling fertility in all classes and races,11 not to mention the current possibilities of gamete banking whereby couples may bank ova and spermatozoa for later use.12

 

Undeniably, the intertwined and certainly incorrect conflation of the rhetoric of choice in treatment is evident even in the titles of these narratives, such as Kitzinger’s Your Baby, Your Way (1987).13 These manuals encourage women to learn about new reproductive technologies as fast as or even faster than doctors, a common enough situation to doctors in all specialities in these postmodern days of ubiquitous access to the Internet and to freely accessible medical servers, most notably the United States’ National Library of Medicine’s PubMed server archive.14

 

In turn, women with fertility problems may find themselves coerced, consciously or unconsciously, to opt for fertility treatments in a patriarchal society that values women mostly for their reproductive capacities.15 Michie and Cahn outline the invasive progression of reproductive therapies and of pregnancy itself, from basic ultrasounds through to laparoscopies and hystersalpingograms that look inside the female body, and in doing so, render the intimate public, a performatory aspect, exposing the body’s working to the healing medical gaze. Indeed, a very recent review of the long-term effect on fourteen Swedish women twenty years after their infertility treatment found that childlessness had a profound and lasting impact on their lives, resulting in high rates of marital breakdown and sexual dysfunction.16

 

The negative medical aspects are also debated, including the lack of complete candour by doctors who do not always give honest estimates of likely outcomes of treatments, and who do not counsel adequately with regard to possible deleterious side-effects. Regrettable medical tendencies to seek fame and profit in this form of treatment are underscored, along with exhortations to select doctors and facilities after careful deliberation.

 

Michie and Cahn also argue that women are policed through a series of interventions in both infertility treatment and possible subsequent pregnancy in the name of domesticity, supporting Paul Morrison’s notion of the ‘domestic carceral’,17 foreshadowed by Michel Foucault,18 almost a form of punishment for infertility, where we must almost ‘analyse rather the ‘concrete systems of punishment’, study them as social phenomena’.18 This aspect is even more relevant when infertility treatments are imbricated in explicit or implicit male dominance games, particularly when framed in feminist discourses and idioms, leading to unwitting antifeminist tropes.

 

The tendency for cultural scripts to underplay fostering and adoption, thus avoiding any of the above hazards, is also pointed out, along with the legal issues that arise out of infertility treatments, such as the problematisation of what constitutes a natural parent in the setting of egg and sperm donation, surrogate motherhood and same gender families, a notion prefigured in Piercy’s famous novel Woman on the Edge of Time (1976).19 The legal controls and punishments inflicted by the state in the setting of mothers who abuse alcohol or recreational drugs that may result in teratogenic effects on the unborn child are also elucidated, along with the impunity which males are afforded despite being partly or totally responsible for the environment that promotes such abuse, and often supplying these substances.20 Interestingly, little is made of male problems leading to infertility, although this still results in the female bearing the brunt of invasive and potentially hazardous treatments in order to bear her chosen partner’s children.

 

Impotence has also been the target of writers, and for example McLaren’s Impotence: A Cultural History (2007) guides readers through 2,500 years of impotence and attempted cures in various cultures, cures which are as varied as they are bizarre, including urinating through a church keyhole, whipping, flagellation, electric shocks to the testicles, and countless modern gadgets and drugs that may be bought over the Internet.21

 

Infertility in non-Western cultures has also been extensively addressed by Michie and Cahn, including the more extreme modulations of the impact of infertility in overtly patriarchal cultures on women, who seek help not only from Western medicine, but also from indigenous practitioners of traditional medicine, sometimes simultaneously, to their detriment.22 More specifically, for example, Bharadwaj argues that the rapid transfer and assimilation of infertility treatments to India is only part of the indigenization of Western technoscience and biomedicine in India, and contends that the success or failure of said techniques, when framed by the Hindu faith, becomes ‘a powerful critique of the incompleteness of the “Western” science of conception’.23

 

Conversely, Kahn discusses the ways in which orthodox Jews use traditional strategies and new media, such as the Internet, to cope with infertility in the presence of new reproductive technologies by establishing networks that provide support, information and education, along with unique frameworks that permit close collaborations between rabbis, doctors and other clinic personnel. These ensure that fertility treatments are conducted with strict attention to Jewish legal concerns, particularly with regard to incest, adultery, and traditional practices regarding bodily emissions, becoming ‘a set of tools and strategies that can be readily appropriated and harnessed to a particular set of individual and collective goals’.24

 

At this juncture, it must be pointed out that the Internet has become a key source of all sorts of medical information (including that regarding pregnancy and infertility) but must be viewed with extreme caution, as shown by Okamura, who reviewed 197 infertility-related websites using the Journal of the American Medical Association minimal core standards for responsible print. Only 2% of these websites met all four recommended standards, and the authors naively concluded that women’s health clinicians should assume the new responsibility of information monitor, an unlikely prospect when one considers the rate with which new websites mushroom all over the web.25

 

This paper will now briefly review some fictional works that deal with infertility, and it is intriguing to note from the outset that most narratives also deal with the aforementioned middle-class stereotype, implying a normative progression of heterosexual marriage, fertility, pregnancy and childbirth, unlike Science Fiction, which, as we shall see, perhaps due to its multicultural and intertextual nature, deals with infertility in much more diverse scenarios, such as infertility in aliens and in inhuman creations.

 

It appears that the first fictional narratives to foreground centrally the treatment of infertility are P. D. James’s, An Unsuitable Job for a Woman (1972)29 and Barbara Vine’s, A Dark Adapted Eye (1986),30 and both deal with an infertile woman and surrogate motherhood.

 

More specifically, Mary Higgins Clark’s, The Cradle Will Fall (1980)26 and I’ll Be Seeing You (1993),27 both deal with the idiom of misplacement, the covert and illicit transfer of ova from the body of one woman to another, with resultant confusion in the identity of the offspring. Both narratives involve parents who recognise other parents’ children as their own solely by visual resemblance, with the first story also involving a doctor who heads a fertility clinic and kills to keep secret the fact that he transferred aborted but still living embryos whose abortion he coerced, harking back yet again to the mad/criminal fraudster scientist. In more populist vein, Danielle Steel’s, Mixed Blessings (1992) narrates the events that overcome five infertile characters, one of which undergoes fertility treatment, miscarries, and in an even more normative ending becomes pregnant with twins,  without any medical intervention, despite being well past forty years of age.28

 

In conclusion, overall, current Western texts that deal with infertility, both factual and fictional, uphold a rhetoric that promotes the middle-class progression of heterosexual relations, marriage, fertility, pregnancy and childbirth, and fail to account for more liberal attitudes, such as same-sex couples – or even more extraordinary phenomena, since …

 

‘[n]ew reproductive technologies have split apart categories that were previously coterminous – birth mother, psychological mother, familial father, sperm donor, egg donor, and so forth – transforming the relations of kinship that used to play such a fundamental role in the rhetorics and practices of identity formation.’31

 

Moreover, many medical options, while seemingly science fictional (and several of these advances were actually prefigured by science fiction) are now considered routine in the field of advanced reproductive techniques, which has come a long way from the first test tube baby in 1978,32 to the extent that Chris Hables Gray opines:

 

‘In the future, many different sexes are likely to be produced, driven by desire (to create and live) and fear (of death and sterility) […]. Cyborgism could well be a bridge to different types of posthumans, some with male bodies, others clearly female, others yet who are hermaphrodites, and still more people who will be quite genderless. And there will be new sexes.’33

 

Conventional stances will undoubtedly stumble when confronted by circumstances that do not conform to formulaic and stereotypical viewpoints. Conversely, it behoves the scientists to exercise extreme caution in this modern age, where ongoing work in genetic engineering, biochemistry, eugenics and advance reproductive techniques have given us the opportunity to manipulate life at a fundamental level, ‘something previously exclusively reserved to nature and chance.’34

 

References

  1. Savona-Ventura History of Medical Practice and Pharmacy. In: Outlines of Maltese Medical History. Valletta: Midsea Books, 1997.
  2. Jeansonne Sharon. P. Women of Genesis. Minneapolis: Fortress Press; 1990.
  3. Kramer H, Sprenger J. Malleus Maleficarum. Cologne: University of Cologne; 1446.
  4. Dastur AE. Artificial Insemination-Historical Review. In Intrauterine Insemination. Allahbadia G, editor. New Delhi: Jaypee Medical Brothers Publishers, 2005.
  5. Sims JM. Clinical Notes on Uterine Surgery with Special Reference to the Management of the Sterile Condition. London: Robert Hardwicke; 1866.
  6. Heaton CE. The influence of J. Marion Sims on gynecology. Bull N Y Acad Med. 1956;32(9):685-8.
  7. The Cure of Barrenness. Medical Times and Gazette 1866;Feb:151.
  8. Michie H, Cahn NR. Confinements: Fertility and Infertility in Contemporary Culture. Piscataway: Rutgers University Press; 1997.
  9. Eisenberg Arlene et al. What to Expect When You’re Expecting. New York: Workman Publishing Company;1991.
  10. Tan ML. Fetal discourses and the politics of the womb. Reprod Health Matters. 2004;12(24 Suppl):157-66.
  11. Swan SH, Elkin EP, Fenster L. The question of declining sperm density revisited: an analysis of 101 studies published 1934-1996. Environ Health Perspect. 2000;108(10):961-6.
  12. Murray RD, Brennan BM, Rahim A, Shalet SM. Survivors of childhood cancer: long-term endocrine and metabolic problems dwarf the growth disturbance. Acta Paediatr Suppl. 1999;88(433):5-12.
  13. Kitzinger S. Your Baby, Your Way. New York: Pantheon; 1987.
  14. Public Library Of Science Medicine. Drowning or thirsting: the extremes of availability of medical information. J Pain Palliat Care Pharmacother. 2006;20(4):113-4.
  15. Corea G. The Mother Machine: Reproductive Technologies from Artificial Insemination to Artificial Wombs. New York: Harper and Row; 1985.
  16. Wirtberg I, Möller A, Hogström L, Tronstad SE, Lalos A. Life 20 years after unsuccessful infertility Hum Reprod. 2007;22(2):598-604.
  17. Morrison P. Enclosed in Openness: Northanger Abbey and the Domestic Carceral. Texas Studies in Literature and Language 1991;33:1-23.
  18. Foucault M. Discipline and Punishment: The Birth of the Prison. New York: Vintage Books; 1979.
  19. Piercy M. Woman on the Edge of Time. New York: Fawcett Crest; 1976.
  20. Chasnoff IJ, Landress HJ, Barrett ME. The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. N Engl J Med. 1990;322(17):1202-6.
  21. McLaren A. Impotence: A Cultural History. Chicago: Chicago University Press; 2007.
  22. Inhorn MC. Infertility and Patriarchy: The Cultural Politics of Gender and Family Life in Egypt. Baltimore: University of Pennsylvania Press; 1996.
  23. Bharadwaj A. Sacred conceptions: clinical theodicies, uncertain science, and technologies of procreation in India. Cult Med Psychiatry. 2006;30(4):451-65.
  24. Kahn SM. Making technology familiar: orthodox Jews and infertility support, advice, and inspiration. Cult Med Psychiatry. 2006;30(4):467-80.
  25. Okamura K, Bernstein J, Fidler AT. Assessing the quality of infertility resources on the World Wide Web: tools to guide clients through the maze of fact and fiction. J Midwifery Womens Health. 2002;47(4):264-8.
  26. Higgins CM. I’ll Be Seeing You. New York: Simon and Schuster; 1993.
  27. Higgins CM. The Cradle Will Fall. New York: Simon and Schuster, 1980.
  28. Steel D. Mixed Blessings. New York: Doubleday, 1992.
  29. James PD. An Unsuitable Job For A Woman. London: Faber, 1972.
  30. Vine Barbara. A Dark Adapted Eye. New York: Bantam, 1986.
  31. Novas C, Nikolas R. Genetic Risk and the Birth of the Somatic Individual. Economy and Society 2000;29:485-513.
  32. Steptoe PC , Edwards RG. Birth After the Reimplantation of a Human Embryo. Lancet 1978;2:366.
  33. Hables GC. Cyborg Citizen: Politics in the Posthuman Age New York and London: Routledge; 2001.
  34. Damyanov O. Technology and Its Dangerous Effects on Nature and Human Life as Perceived in Mary Shelley’s Frankenstein and William Gibson’s Neuromancer. Cercle Alexis de Tocqueville http://www.gouverner.net/go/articles/frankenstein_neuromancer.shtml#toc9 [accessed 30 June 2011].