Life with infertility: a family diagnosis, in which there is no guilty
Al is 32 years old, and the last eight years she and her husband have been trying to have a child. During this time, both spouses managed to undergo a lot of examinations - while doctors always identified the "female factor" problems: El's husband's performance was normal. "Since childhood, I have been naughty with hormones, I was registered with the pediatric gynecologist, and from an early age I took various drugs to regulate the menstrual cycle. Therefore, when I failed to get pregnant on the move, I was not very surprised," she says. .
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He, who has never personally encountered the diagnosis of "infertility", he seems like a sentence. In practice, the first statement of the diagnosis rather means that the doctor and patients need to pay more attention to the problem: it is made when during regular sex without contraception pregnancy does not occur within a year, if the partners
younger than 35 years, or within six months, if partners are older than this age. No additional examinations are necessary at this stage - the conclusion is made on the basis of this single feature.
The cause of infertility may be related to the health of both women and men - but even WHO notes that it is the condition of a woman that is most often used when determining infertility: this can mean the impossibility of becoming pregnant, the inability to endure pregnancy, and the inability to give birth to a living child . In medicine, it is customary to distinguish two types of infertility: primary (in women who have never been able to become pregnant) and secondary (inability of a woman to give birth to a child after she had another pregnancy or she was able to inform and give birth to a child once). It’s difficult to talk about an average portrait, for example, the age of women facing a diagnosis: the gynecologist Oksana Bogdashevskaya notes that women between 33-35 years old are more often observed in her clinic for infertility, but it doesn’t mean anything - there are both 25 and 45 year old patients.
The diagnosis of second-degree infertility (that is, secondary infertility), for example, faced a 26-year-old Natalie. She lives with a civil husband for about five years, and during that time she did not succeed in becoming pregnant; while in the past she already had a miscarriage. “At that time I was 22 years old, and I felt inferior,” she says. “After a while, they told her husband to make a spermogram. Then it turned out that her husband doesn’t have live spermatozoa. Inside, a little was relieved, and there was hope that it was not only in me. My husband didn’t believe and secretly went to pass the analysis again. The result was the same. My mother-in-law began hinting that it was my fault that we had no children. She didn’t want to accept that her son had problems. "
The birth of the child is still imputed to the woman as her primary responsibility, and the impossibility of giving birth is often perceived as a sentence.
Doctors say that the couple have a chance to have a child, but a small one. Natalie's husband is not against adoption, but she is not ready for such a step - and does not exclude that they will part if the question of the child arises even more acutely. "Apparently, it is difficult for men to understand how important it is for a woman to take out her child, to go through all the important moments in the development of a baby. One of my friends, after it turned out that her husband was infertile, filed for divorce. He says:" I don’t love him so much to refuse from being able to have your own child. "And these words are firmly in my head."
The world is gradually becoming more couples, faced with infertility, but scientists believe that in general, its level in the world over the past 25 years has not changed - the increase in the number of infertile couples is associated with population growth. In 2010, in the world among all women aged 20–44 years, primary infertility was observed in 1.9% of women, and secondary (here it was meant cases when a woman gave birth to at least one child, but is not able to give birth to the second) - in 10, 5% of women. The habit of implying first of all the "female" factor, speaking of infertility, both at the official and at the household level, leads to the fact that it is considered primarily a "female" problem. It is not surprising that women, who for some reason do not manage to have children, face enormous pressure - from society as a whole, and from relatives.
So it was, for example, with Natalie: “I remember when I came to work, the company had three girls with the problem of infertility. After a while, one colleague left the decree, and a couple of months after she got pregnant the second one. And then the first real hysterical on this ground: I closed in the toilet and sobbed for half an hour until they found me there. So I hopelessly felt. I do not envy them, I am happy for them. But so sad that they will experience such happiness, but I don’t. "
In part, the emergence of this point of view can be explained by statistics, which seem to feed the accusatory logic of "probably a problem in it": according to research, about 37% of cases of infertility in couples living in Europe and the USA are due to problems
with the health of the female partner, 35% with the health problems of both partners, and only 8% with the problems of the man; in 5% of cases, the cause of infertility can not be accurately identified. The gynecologist Oksana Bogdashevskaya emphasizes that finding one cause is not enough - infertility is most often caused by a combination of several factors. But much more strongly this situation is due to patriarchal attitudes in a society where the birth of the child is still imputed to the woman as her primary responsibility, and the impossibility of having a child is often perceived as a sentence.
Psychologist Anna Silnitskaya, who leads support groups in conjunction with psychologist and narrative practitioner Elena Baskina, says that in their work they are wary of the term "infertility": "It is used in medical discourse, where a fairly objective approach is used in relation to a woman for medicine: a woman is an object in which something is “broken,” it is necessary to “fix”. " According to Anna, in the very word "infertility" there are many meanings associated with the traditional role of women in society, with ideas about which woman can be considered "real" - and this approach severely injures those who are faced with the problem. Elena suggests instead using the phrase "reproductive difficulties" to denote what women face in the most useful way for them: "Difficulties are something you can cope with, take some action, work around them, find a solution, make an alternative reproductive choice. "
Three years ago, Silnitskaya and Baskin conceived the project “You are not alone”, aimed at supporting women who have difficulty conceiving or having a child: the first support group meeting was held in February 2014, now the experts renew them two or three times a year. A variety of women attend: there are those who come after a long treatment and a variety of medical procedures, there are those who have lost children at different stages of pregnancy or have lost as a result of medical procedures of the organs. There are those among the participants who think about whether they want children and how they can become a mother - for example, if they are not married or in a stable relationship. When asked whether there is such a thing that a woman who came to the group comes to the conclusion that she does not need to have a child, Anna replies that it happened several times - but there are many cases when women still gave birth to children (themselves or because assistive technologies) or thought about adoption.
Despite the fact that infertility is a common problem, it remains a painful and taboo topic that is not customary to talk about publicly: it is discussed more likely in a medical rather than a psychological or social way. Men who, like Mark Zuckerberg, for example, openly talk about the difficulties with pregnancy as a couple and that this experience was very painful for them, there is not much in the public space. In Russia, the common myth that a family without children is doomed and will surely fall apart is superimposed on it - a man allegedly needs children (especially a boy who can become his heir and successor), and if a partner cannot give them to him, will find another. “Historically, to trace the roots of this myth is not difficult. But it does not work in modern reality, the world has changed,” said psychotherapist Anastasia Rubtsova. She notes that in modern society many people do not need children - and the family, as a rule, is not created at all for the sake of the birth of offspring. In reality, a child cannot save a broken relationship, a happy marriage is not necessarily the one in which the children were born, and difficulties in conceiving do not always mean that the partners will part after failing to cope with the crisis, although this is a common situation.
Psychotherapist Yekaterina Sigitova says that not every couple who cannot make children has psychological problems, but some still have them. "Potentially, the possibility of having a child can be adversely affected by stress in one or both partners, unresolved strong conflicts and accumulated aggression, unconscious" anti-motivation "in one or both, lack of trust and insecurity in each other, fear of serious changes in life and much more," - she considers. At the same time, the specialist notes that there are no clearly defined psychological causes and factors contributing to infertility by science - the relationship between the psyche and the body is very complex and difficult to study, so you should not make hasty conclusions.
Al says that before her and her husband's eyes there was always an “anti-example” of friends — a married couple in which the male partner said from the very beginning of the relationship that he wanted children, and when it turned out that the couple had little chance of having a child health problems of his wife, left his spouse with the words: "I do not need a barren wife, I need a healthy woman with children." Al often recalled this incident - in the eight years that she and her husband were trying to have a child, her condition changed from an unshakable belief in success to a feeling of complete hopelessness, but their trials with her spouse only rallied: "Sobbing hysterically and literally rolling on the floor, I shouted that it was time for him to leave me and that he was wasting time with me. My husband always abruptly cut me off and suggested the same thought: we will go this way together, we will definitely succeed. " The woman admits that during the years of unsuccessful attempts, the thought released her that the meaning of life is to become pregnant - although the couple are still trying to have a child, already with the help of assistive technologies: they have two unsuccessful IVF attempts, and a third turn.
It is important to learn to talk about what happens when the struggle ends in failure. It takes no less courage to abandon attempts to have a child
In vitro fertilization, or IVF, is an assisted reproductive technology and one of the most common measures to overcome infertility when it is difficult for a couple to conceive a child on their own. According to a study in Denmark, three out of four women give birth to a child within five years after starting treatment for infertility - both thanks to him, and spontaneously and independently of him. Danish information allows us to make fairly accurate conclusions: this is one of the few countries where all actions related to assisted reproductive technologies, and all cases of childbirth are recorded.
What statistics do not give a presentation about is situations when technologies fail or when an attempt fails. Not everyone is ready to take advantage of the IVF procedure, primarily because of its cost. It is perceived as a mechanism of success, working without failures, and we rarely hear about situations when it does not work. For example, the 48-year-old Svetlana faced failure in IVF. The woman has secondary infertility: the first time she became pregnant at the age of 27, but the pregnancy turned out to be ectopic. Svetlana says that all nine years of marriage with her first husband tried to have a child and was actively observed by the doctors, but she did not succeed in getting pregnant. Later, the doctors removed one fallopian tube to Svetlana and said that the couple have a chance to have a child using IVF - but then the procedure was not so common and the spouses did not decide on it. At 41, with her second husband, Svetlana still tried IVF, but the attempt was unsuccessful: “I spent the family money on drugs, to work as a doctor - and all for nothing. But I don’t regret it. After 40 years there is very little chance of success - where something 20-25%. After 30 years - 50%, if you try in the third ten - the probability is very high. "
According to the European Society for Human Reproduction and Embryology, out of a million and a half cycles carried out using assisted reproductive technologies, on average only 350,000 end up having a child - which means many couples have to resort to IVF
several times - until the result is positive or until they decide to stop trying. In a culture where the appearance of a child is perceived as an obligatory stage in family life, and couples who consciously decide not to have children, are still perceived as an exception to the rule, it is important to learn how to talk not only about how much effort a couple makes to get a long-awaited pregnancy , but also about what happens when the struggle ends in failure - and that in order to abandon attempts to have a child, no less courage is required.
In October, it became known that WHO is going to expand the concept of infertility: those who do not have sexual relations or a partner with whom they can have a child will also be considered barren. It is assumed that both single people and same-sex couples will be able to qualify for funding the IVF procedure on a par with heterosexual couples, and infertility will no longer be considered solely a medical problem. Perhaps, thanks to these measures, society will finally cease to see in infertility only the “breakdown of the system”, a problem marked by the “male” or “female” factor - and it will also see the difficult family history that lies behind every diagnosis.
