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The American Fertility Association’s Monthly Newsletter

Aug 29 , 2008

FEATURE WELL

Jennifer J Bute, PhD

Talking About Infertility: What Women Want to Discuss Can Change
By Jennifer J Bute, PhD

Various web sites, self-help books, and TV talk shows offer advice on how to talk about a fertility problem. Recommendations might include guidelines like these:

Discuss with your partner how much detail you want to share.
Pick an appropriate time and place to bring up the topic. Make sure you have the privacy and focus you desire.
Practice what you’re going to say ahead of time.
Let others know how they can support you—whether you want phone calls, questions, and so on.

Such recommendations are generally well-intentioned and are even somewhat consistent with my own research on how women talk about infertility. For instance, I mentioned in a previous piece that talking with loved ones about whether, and how, they should ask questions might help to prevent awkward or hurtful conversations.

However, such guidelines generally fail to recognize that what a woman wishes to discuss can change over time. In my dissertation study, I wanted to find out if women described changes in whether, and how, they discussed infertility as they progressed through their personal journeys. Women’s accounts of conversations indicated that talk about a fertility problem can, indeed, evolve over time.

The experience of infertility can serve as a change agent that prompts women to discuss new topics or to discuss particular topics in new ways. For example, a number of women indicated that they found themselves openly discussing sexual intercourse and bodily functions in ways they had not discussed such topics prior to experiencing infertility. One woman mentioned that she would never have started discussing her sex like with her mother if she hadn’t been undergoing treatment for infertility. But somehow the fact that her sex life now had a specific purpose, procreation, made discussing the topic okay.

Women’s recollections also indicated that talk can change over time as women cope with infertility. Some women tapered off talk as they dealt with the emotional roller coaster of failed treatments. One participant explained that she and her husband stopped telling people about their scheduled treatments because they grew weary of sharing bad news when treatments failed. For this couple and many others, what started out as a joyful announcement (e.g., “We have an IVF scheduled on Friday.”) became an increasingly painful topic of conversation. Similarly, some women stopped disclosing upcoming treatments to avoid the inevitable questions about whether treatment had been successful.

On the other hand, some women found themselves more willing to disclose their fertility problem as they resolved their infertility or developed new ways of talking about it. One woman became more comfortable discussing her fertility problem after receiving a medical diagnosis. She explained, “Once I had a diagnosis and I knew what we were doing. Once it doesn’t feel like your fault, I don’t really mind talking about it to whomever.” She elaborated on how her diagnosis provided her with the tools to discuss the fertility problem in ways she couldn’t before:

Part of it was that once I had the thing that was wrong, I had something to talk about. I had something to go from. It wasn’t just saying, “Well, you know, [husband] and I have been trying to have kids for eight months and we’re not,” or “[Husband] and I are trying to have kids, and I’m not even having periods regularly.” It’s, okay, it turns out I have this thing, and it makes it really hard for me to get pregnant, and here’s six or seven other things that I can say, “Well, okay, that’s what’s the root cause of them.” And it not only gave me some things to try to treat it, but it also gave me a way to say, “Here is what it is.”

Another participant found that questions about when she was going to have another child (she had one son who was conceived through IVF) bothered her less and less over time. She initially replied to such questions with a vague response such as, “I don’t think that’s going to happen” or by using her husband’s age as an excuse not to have more children. But these habits changed over time. She explained,

More and more, if people ask, I just tell them that we had a hard time conceiving and we’re not going to have another one. I’m not sure why I don’t feel the need to keep it hush-hush anymore, but I just really kind of don’t.

As counselors, columnists, and loved ones seek to support and advise women with fertility problems, it’s important to realize that what women feel like talking about can change over time, and even from day to day. Giving women space to negotiate talk is an important aspect of supporting them during these difficult times.

Jennifer Bute is an assistant professor in the School of Communication Studies at Ohio University. She researches issues related to health communication and is particularly interested in how people talk about health in their interpersonal relationships. She completed her PhD at University of Illinois at Urbana-Champaign in 2007, and her dissertation focused on how women talk or avoid talking about a fertility problem.

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Naomi R. Cahn

The Ticking Clock
Naomi R. Cahn

While the term “biological clock” refers, in scientific terms, to various physiological systems, including sleep rhythms, in the public mind – and for those of us coping with infertility -- it most commonly refers to a fertility clock, the appropriate time for women and men to have children. As we think everyone already knows, when women age, they have fewer eggs and the egg quality of the remaining eggs is lower, and they have a diminished response to fertility medications; they also have a higher rate of miscarriage. There are diagnostic blood tests to measure a woman’s “ovarian reserve,” a sign of her potential ability to conceive. Doctors have even developed a computer program designed to predict a woman’s remaining years of fertility.

But many people don’t know about declining fertility. Consider Cara Birrittieri’s 2005 book, What Every Woman Should Know about Fertility and Her Biological Clock. The book promises to help women in their planning for children, marriage, and a career. Although the author acknowledges that this goal is unrealistic, she hopes that she can help women plan to have children at a younger age, but warns: “The relentless clock will continue to tick, while countless numbers of you, due to life circumstances, will be unable to start a family in time.” She observes that most women don’t know enough about their own fertility, and suggests that the medical profession is somewhat complicit because of its reluctance to discuss private issues, such as planning for a family. Ironically, publicity about women’s aging ovaries may be deemed as anti-woman.

[cd discuss ASRM campaign here]

When women do obtain this information, they often express anger and betrayal that they did not know it sooner. Martha Stewart’s daughter explained in a 2007 interview with People magazine that she figured she’d be pregnant after a couple of months of trying, but has now “learned a few things” about women’s fertility. “Take all these movie stars we see on magazine covers who are having babies in their 40s. . . . a fertility doctor . . . [will] tell you bluntly, “It’s not her egg.’ But no one says that in these articles.” Instead, there is almost a cover-up of the use of reproductive technology, keeping secrets lest the twinned stigmas of age and infertility are revealed.

Being unaware of declining fertility is part of the narrative for many older women who use donor eggs or sperm, according to a study of 79 couples that was published in 2006. As part of their effort to understand how women viewed their “old eggs,” the authors of the study found that many women were upset that they had not learned all of the facts about their age-related decline in fertility, and often took it upon themselves to educate other women about the relationship between age and fertility. Their study identified two different ways in which women who had used donor eggs thought of themselves: they were either “eleventh-hour moms,” women who were shocked and felt cheated that their fertility was declining so quickly, or “miracle moms,” who were delighted at the ability of medical technology to allow them to give birth using someone else’s eggs, even though their own eggs were old. There is so much emphasis on women controlling their fertility by preventing conception that controlling fertility to enhance conception receives scant attention. As a legal reflection of these issues, most states have enacted laws affecting contraception, whether it be through restrictions on abortion, protecting adolescents by limiting access to birth control, or promoting abstinence education, but have enacted few regulations concerning infertility education, insurance, or marketing tactics.

Excerpted from Naomi R. Cahn, Test Tube Families: Why the Fertility Market Needs Legal Regulation (New York: New York University Press, forthcoming).
Copyright (c) 2009 New York University. Reprinted with permission.

Naomi Cahn is the John Theodore Fey Research Professor of Law at George Washington University Law School. She has written numerous law review articles on family law, adoption, and reproductive technology, and has co-authored several books. Her current projects include Test Tube Families: Why the Fertility Market Needs Legal Regulation (NYU Press, 2009), and several other articles on the intersection of adoption law and reproductive technology. Professor Cahn is a Senior Fellow at the Evan B. Donaldson Adoption Institute, and a member of the Yale Cultural Cognition Project, for which she and her co-investigators have received outside funding to conduct research on public attitudes towards gay and lesbian parenting.

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