Is Dr. Stein more procreative than ibn Saud?

You’ve heard of David Koch, right? You know, that billionaire who funded Wisconsin Governor Scott Walker’s holy war against workers.

You may also have heard of his philanthropic passions, which include natural history, opera and infertility research.

Yup. You read correctly.

I just came across a 2009 Koch interview with the Archeological Institute of America.  In what is an otherwise remarkably coherent conversation, Koch responds to the interviewer’s comment about the increasing focus on physical science (at the expense of genetic science) as follows:

My wife and I are a major supporter of a fertility clinic in New York and it’s incredible what they’ve done to create normal adults from infertile people. They have an understanding of how eggs develop, that’s why they’ve been so successful.

The head guy over at New York Presbyterian Hospital is responsible for about 15,000 normal healthy babies. I used to think ibn Saud was a hell of a guy. He was the founder of modern Saudi Arabia and he had 700 children. But I told the guy at NYPH, you’re up to 15,000 and counting. You’ve got ibn Saud beat by a mile.

Yikes.

Raise your hand if you want an international dialogue about infertility

I was psyched to read Amalia Rosenblum’s argument against the glorification of biological parenting in Ha’aretz yesterday. One of her several provocative points is that we’re too disconnected from the natural world to be attuned to our biological clocks, if those much-ballyhooed things exist at all.

She asks, “How is it possible that, in every cultural context, most people aspire to have the exact number of children that will raise their social status without deviating from what is considered the bounds of good taste?”

She’s right, of course, that fertility rates are dictated by historically and socially specific conditions. In many parts of the world–like Gaza, to take an example from Ha’aretz’s region — the average woman will bear six or seven babies in her lifetime. It’s about needing kids to work, to take care of you in your old age and the reality of high child mortality. Ending Israel’s economic blockade of the strip would probably impact fertility rates more than making IUDs freely available.

By the same token, privileged westerners tend to have fewer kids. We usually wait longer to conceive. When we run into obstacles, we spent the gross domestic product of Kerala state on high-tech treatment and build a blogging career around our experiences. (Who, me?)

Seriously, though: Infertility impacts people everywhere. It must — even in places like Gaza where fertility rates are breathtakingly high. Maybe the causes of infertility are different. Maybe residents of fishing villages who eat a lot of mercury-laced seafood, for example, have different types of fertility problems than Manhattan women who delay childbearing because of their careers.

How do rural Cambodians deal with barrenness? What happens to Himba boys in northern Namibia who are born without testicles? Maybe they have something to teach about how to deal when you just can’t biologically produce “the exact number of children that will improve your social status,”  to use Amalia Rosenblum’s words. Or not. But I would like to know either way.

When I Googled “infertility blogs Cambodia” I got a bunch of adoption sites targeted at Westerners. Argh.

The year 2011 saw some exciting developments in the online infertility community — Redbook‘s “The Truth about Trying” campaign is just one. I hope that in 2012 we can make this conversation more international and inclusive.

Finally! A smart article about stress and infertility.

Has an ignorant friend, coworker or mother has ever offered you this seemingly innocuous fertility advice: “relax”?

Now, instead of wasting calories with a spoken response, you can pass on this article.

One of the author’s many good points is that stress is a too-convenient explanation for a mostly inexplicable–and therefore scary–problem:

Infertility, like autism, remains one of modern medicine’s greatest mysteries. Fertility doctors know why a 45-year-old woman can’t get pregnant, but they don’t know what’s wrong with up to one-third of their patients who are struggling to conceive—causing them to diagnose them with “unexplained fertility.” As a society, we wonder if we’re suffering from lurking environmental toxins or secret sexually transmitted diseases. But stress is an easy explanation.

People always try to find reasons why you’re suffering and they’re not. This isn’t necessarily because they’re bad. Randomness is scary, and most of them simply want to believe that they have earned their health or good fortune. For better or worse, that’s rarely the case.

File under “too absurd to be true”

On Tuesday Mississipians will vote on whether to amend their state constitution to define the term “person” to include zygotes — the single cell that is formed when an egg is fertilized.

Initiative 26 is particularly scary, as the Ms. blog points out, because it opens the doors to criminalize women who’ve had miscarriages. That’s right, not only abortions — but miscarriages, too.

If it passes, I’m sure the consequences will be borne most heavily by the women who already lack access to basic reproductive services–like women on Medicaid who lack abortion access because of the Hyde Amendment,  or women in prison.

On another note, I would like to know what the drafters of this initiative think the consequences could be for political representation and governance. Would they like to count frozen embryos in the census? Will they let us count them as dependent children in food stamp applications or to claim tax credits?

Maybe before they get to those questions, they should ask themselves why Mississippi’s child poverty rate is 33 percent — the highest of all 50 states.

Do your embryos need a check up?

This is impressive.

anniversaries

A couple of days ago was the one year anniversary of my “one year anniversary” post. I am sad that this post seems to represent the apex of my blogging career. I wish my infertility anniversaries continued to provide literary material. Now they are just tiresome.

Other than #occupywallstreet, the most exciting thing in my life these days is bed bugs. I found one on my shirt one week ago. It was a cinematic moment.  I had rolled over to turn off my reading lamp. There it was, perched on my shoulder in the weak yellow glow. I’d never seen a live bed bug before, but I knew. Things were about to change.

It was probably a good thing that I had a very early miscarriage only days before that, because the amount of toxic chemicals I proceeded to spray in my apartment would’ve killed anything weighing less than 75 lbs.

I bought mattress and box spring protectors. I threw out pillows, old clothes and the frame backpack that came with me on the travels that characterized the decade of my 20s. I had spent hours sewing souvenir patches on that ratty thing: a Bolivian cocoa leaf, a Berlin crest, the stone structures of Machu Picchu.  I put it in a garbage bag and left it among my neighbors’ detritus in the alley.

The exterminator’s name was Raul. The landlord sent him. We had to leave the keys with the superintendent because he would only come when we were at work.  He ripped the sheets off the bed and upended the futon mattresses. He left his card on our little hallway table.

When I called, he said he had seen nothing: no eggs, no fecal stains on the mattress. But within days, I had found more: tiny, struggling creatures, desiccated and dying. Only one was turgid with blood. I taped them to the back of an envelope and put them in a yogurt container marked “bed bugs.”

Raul came again. This time he said the bed bugs that I’d saved were gnats. It was a relief, in a way. But I think I am still ready for war.

bed rest

It drives me crazy that my clinic instructs 48 hours of bed rest following embryo transfers.

I’ve scoured the Internet for a medical journal article that lends credence to this practice. As far as I can tell, there are none. I did find an abstract of a Czech study suggesting the opposite:  that IVF patients subjected to 24 hour hospital bed rest tended towards worse outcomes than those who were not.

If anything, post-transfer bed rest seems grounded in Victorian myths of female bodies.  One of these myths is that that the vagina is a hole that things fall out of if you’re not lying down.

When your uterus wants to get rid of something – endometrial tissue, dead embryos, live fetuses – it usually has to work hard to do so.  How can we be so compelled by a myth that experience proves false?

It’s nice to take days off from work. It’s nice to nap all day. It’s nice to be catered to. But I find it uncomfortable to rely on pseudoscience –least of all pseudoscience that deploys sexist anachronisms – as an excuse.

what i really want

A few months without fertility treatments had an effect beyond guilt-free coffee drinking. I stopped noticing every pregnant person on the street.  I started thinking about other life possibilities, like hiking the Anapurna circuit, which costs roughly the same as an IVF cycle but involves yaks.

For me, and I imagine many infertile people, the goal of pregnancy can subsume the goal of parenting.  Getting pregnant – and then getting to the next stage once you are pregnant – becomes the sole objective.  This is most true at crucial moments:  the day before an embryo transfer, for example, or when waiting for the results of a pregnancy test.  At those points the fate of the universe seems to hinge on my fertility status.

It took me a few treatment-free months to reflect on this.  I started to question if I wanted to be a parent as much as I wanted to get pregnant.  Is it the difficulty of achieving pregnancy that makes me want it so badly? If parenting were the real goal, wouldn’t I be more excited about other options?

I’m tempted to say that fertility treatment has tricked me into wanting something more than I really do.   We already live in a society that teaches that childbearing – at least in the gender normative, biological style – is a marker of adult success.  Ironically, regimes of hormones and follicle monitoring seem to have made me more emotionally vulnerable to this myth, even as my political critique has sharpened.

But then I wonder.  What’s the difference between thinking you want something and really wanting it? Desires come and go, but that doesn’t mean they’re less genuine in the moment you’re experiencing them.

Last week I saw Dr. Stein for the first time in months.  He was his usual self—harried and tired-looking, rushing from patient to patient in the morning monitoring flurry.

We’re now preparing for a frozen embryo transfer.  As always, I am expecting failure.  But this time I promise myself that I will spend more time Googling Nepalese mountain treks than early pregnancy symptoms.

Comments from Solidarity Summer School

Below are notes from a talk I gave at the Solidarity summer school on July 27th. It was part of a workshop called Socialist Feminism: Theory and Practice.

Feminist activists working from an intersectional perspective — that is, feminists working simultaneously on issues of racism, gender oppression, ablism and other forms of domination — have shown the limitations of individual rights as a tool for advancing human liberation.

For example, women prisoners’ organizations have shown that abortion access doesn’t secure reproductive justice if women prisoners who choose to bear their children are still shackled during childbirth. Poor people’s organizations have shown that access to birth control means less if people don’t have the resources to care for the children they choose to bear.

To be clear, access to birth control and abortion are major social movement victories. Radicals and revolutionaries should support campaigns to defend and expand them.

But we should also think long-term. What kind of organizing will lead us towards a world in which people’s needs — not only the physical ones, but intellectual and emotional ones, too — are fulfilled? What sort of politics will help us imagine a world free of domination?

An intersectional feminist perspective can help us begin to answer these questions.

I want to give three examples of ways to apply this perspective. This is not intended to be an intellectual exercise as much as a practice of drawing connections between different sites of struggle, whether those struggles are potential or real. I don’t think we can even begin to answer the two gargantuan questions above without doing that.

The examples come from two personal experiences:

– When I was 19 my hearing went from bad to worse. I got a cochlear implant.

– More recently, as a result of fertility problems, I chose to enter into the world of assisted reproductive technology.

1) Most of us think of assisted reproductive technology (ART) as something that’s available only to rich and privileged people.  There is a lot of truth to that. In the United States, you need thousands of spare dollars, great health insurance, or a willingness to go into credit card debt to get in-vitro fertilization treatment.

For that reason, it’s easy to ignore ART when we think about reproductive justice. But we shouldn’t. That’s because like any other form of medical technology or reproductive treatment ART can be used to solidify or challenge existing power relations. Consider how governments and pharmaceutical companies have used Norplant and forced sterilization to subordinate certain communities. In-vitro fertilization can be used advance right-wing political agendas, too.

For example, Israel grants citizens unusually free access to IVF – all citizens get unlimited treatments until they get two babies or hit age 45. Jews living in the occupied Palestinian territories (but NOT Palestinians in those same territories) qualify for this.

On the other hand, abortion is much more limited. Women seeking low-cost or free abortions have to appear before a termination committee and show they’ve met certain criteria (economic hardship is not on this list).

Why is Israel so generous with some reproductive services but not others? The main answer: This system was developed as part of a nationalist project in which Jewish women’s childbearing is deployed as a weapon, mostly against Palestinians.

To bring the issue home: Consider the coverage in the mainstream media of the US 2010 Census. There was a lot of hand wringing about the population of the US becoming less white, about the “majority” becoming the “minority.”

The Israeli state’s has similar anxiety about the high Palestinian birthrate, but magnified by a thousand.

We don’t have much time to discuss this in depth. Suffice it to say that a strong reproductive justice movement in that region would have to have a sharp analysis of the occupation of Palestine.

Another question we might discuss in this workshop is how do reproductive justice issues come up in the immigrants rights movement in the US?

2) As I mentioned earlier, cochlear implants are surgically implanted devices that allow people with certain types of deafness to perceive sound.

Before the days of cochlear implants, and before mainstreaming became politically popular, hearing parents in the US would send their deaf children to deaf institutions.

These schools were often hostile to Deaf people. Hearing administrators usually viewed sign language as barbaric and understood themselves to be on a civilizing mission. In some ways, the institutions resembled those that sought to Europeanize Native American kids.

But still, those schools had benefits for Deaf people: they forced them into the same space and gave them the opportunity to build relationships with each other. Those institutions helped form the basis of Deaf communities that saw themselves more as a national minority than as a group of disabled people. That is why people who identify with these communities describe themselves as “Deaf” instead of “deaf.”

Cochlear implants and the rise of mainstreaming changed that.  These two things offered hearing parents the promise – which often goes unfulfilled — that deaf babies can grow into hearing kids, or at least approximations of them.
Why did I get a cochlear implant? I am not deaf with a capital D. I was born hearing and in most ways identify with the hearing world. This remained true even as my hearing deteriorated throughout my adolescense and even as I made some contacts with the Deaf community and learned some ASL.  I never fit perfectly into either the Deaf of hearing worlds. My cochlear implant has helped me survive in the world that I’m in.

Some discussion questions: how could we have excellent healthcare without imposing standards of physical normativity? Would cochlear implants exist in a socialist feminist world?

3) Feminists have long debated whether technology is a tool of oppression or liberation. One great example of technology as a tool of liberation is contained in Marge Piercy’s novel Woman on the Edge of Time.  One memorable aspect of this novel is her portrayal of “post revolutionary” human reproduction, where creation of children has been delinked from the human body. Instead, babies are made in test tubes and people of all genders can apply to “mother” in threesomes. One consequence of this is that gender binaries completely dissipate. Another is that there is no breast feeding and no unique mother-child bond, at least not in the way we think of it today.

Some questions we might discuss are: What are examples of reproductive technologies being used for liberatory purposes and for oppressive purposes? Can one technology be both in different contexts? Some ideas: surgeries used to assign conventional genitalia to sexually indeterminate infants, surgery/technology used to transform bodies to be in line with the person’s gender (sex reassignment surgey), sterilazation, etc.

more on cyborgs

In a previous post, I wrote about how, when I was 19, Donna Haraway’s Cyborg Manifesto changed my life.

By that time, my ability to hear had been declining steadily for over a decade. Then, in the spring of my sophomore year of college, the hearing in my left ear took a final plunge. My right ear was little better.

With the exception of a sign language class and a couple of hard of hearing friends, I operated entirely in the hearing world. I survived with lip reading and, more often than I would like to admit, bullshitting. Both of these skills had improved in proportion to my physical decline. I was excellent at both.

But with one ear completely shot, even my most finely honed survival skills felt inadequate. I decided to get a cochlear implant.

This device consists of surgically implanted electrodes that send sound directly to the auditory nerve, bypassing the non-functioning cochlea hairs. The external component resembles a conventional hearing aid and communicates with the internal part via a magnet, which is implanted between the scalp and the skull.

I had hearing aids since age ten, but a cochlear implant was something new entirely. For one, it required surgery. The surgery involved the implantation of machines – magnets, electrodes and the like – in my head.

Until that point my body, as inadequate as it was, was, I thought, natural. Now I was going to have a prosthesis attached to my head. I would be metal and wires.

Haraway’s work is informed a lot by the theoreticians and activists who are sometimes known as US third world feminists.  One of this movement’s largest contributions is explaining the world through the perspectives of intersecting oppressions and identities – that is, through the perspectives of people who operate in two or more worlds at once. Gloria Andalzua, whose poetry I quoted in a previous post, is one example.

Haraway explains that just as gender is historically and culturally specific, so too are our understandings of the human body and human species.

Her path out of these neat categories – some examples of neat categories are man/woman, black/white, citizen/non citizen, human/machine — is through the cyborg: a creature that is part human and part machine, part fiction and part real. Seeing that I was about to become part machine, I embraced this wholeheartedly.

Now, a decade and a half later, I’ve want to see what this set of politics has to teach us about fertility medicine.

Much of the time I’m conscious of how reproductive endocrinology has functioned as a boutique specialty accessible to those that have cash or decent insurance. For obvious reasons, it’s important for all of this to question this. One way is by supporting campaigns for better health insurance policies and domestic partner benefits.

And for similar reasons, I think it’s important for infertility patients – especially those of us who consider ourselves feminists – to be extra critical of discourses that draw thick lines between natural and assisted reproduction, and between “test tube” babies and natural babies.