Fantasy of fertility forever

 

A SIGNIFICANT number of women in the Liberated Generation have chosen not to have children, and not necessarily because they can't. Career concerns often, take precedence, or the right partner never came along, or the maternal desire wasn't there - at least not until the 11th hour. By then it may be too late to prime the reproductive system or, more pointedly, too late to learn how to put someone else first. But, before these limits are accepted, there comes the furious scrambling between 40 and 50 to make up for earlier choices.

For every woman who accepts the consequences of her decision to forgo motherhood, there are many more women who are beguiled into believing today that the decision to have a baby or not can be put off indefinitely. Clare [a TV executive mentioned in an earlier chapter] spelled out the reason during a London dinner party of couples in their 40s: "The defining factor for a lot of women of my age was that we were the first generation that had access to the Pill. From almost the point at which you were sexually active, you were able to control reproduction. But the flip side is you think you can have a baby whenever you want one.

The new Scarlett O'Hara is the high achieving woman who tells herself, "Oh, fiddledeedee, I'll just think about getting pregnant tomorrow." If the marriage doesn't work out, or her career is too exciting and fast paced to even think about making time for a toddler, she can turn off the biological alarm clock and rely on technology to bail her out if and when the desire surfaces. Later she can choose among a sperm bank, a surrogate mother, and that sexy new technology called egg donor baby. Meantime, she'll make do with a dog.

"I find that women in this country really think of life stages in terms of childbirth, and what their position is vis a vis family," said one of my British interviewees. "Until they get out of the fertility years, it's the first quest. But now that it's technologically possible for women to put off having children, the way men have always been able to do, it's much easier to postpone the question perilously late - and then to become obsessed by it."

The myth of perpetual advancement, which so often leads men to believe that success in work is within their grasp if they just wait a little longer, has its counterpart for women of the Liberated Generation. They usually expect they can have reproductive success, whenever they choose. I call it the fantasy of fertility forever.

For every rare case of the 42 year old first time mother, there are many, many more women who wait until their late 30s or 40s, and do not conceive. Their passage into midlife is likely to be a rough one.

Most women assume they have until menopause to get pregnant. They don't. The cosmic joke today is: You spend the first half of your adult life trying not to get pregnant; then you spend the second half trying to get knocked up.

"The women most aware of their age in relationship to fertility tend to be those who shouldn't have to worry - the 30 to 35 year olds," observes Dr Edward Marut, medical director of a fertility centre outside Chicago. Ironically, it is the women who flirt with the dangerous edge of fertility who appear to be the most blase about age. "The 40 year old woman doesn't come in and say `I'm worried about age', because her whole mindset has been to put it off," observes Dr Marut. But in the back of her mind is a universal fear: Will I turn out to be infertile? Infertility is regarded by most women as the most depressing experience they can imagine. Even younger women don't want to wait to find out. To avoid that possibility, an amazing number of women are seeking "advanced infertility treatment".

Three friends of mine have tried to have in vitro babies. They all tell a similar story. When they married in their early 30s, they thought they had all the time in the world to start a family. They started trying to get pregnant naturally. When conception didn't occur, they began to worry. After one or two miscarriages it became an obsession. By the time they got to the fertility clinic, they would sacrifice anything - take out a second mortgage on the house, sell the car, stop taking vacations, all in order to plunk down $8,000 to $12,000 for repeated in vitro treatments, or $2,000 a try to get a donor egg from a younger woman.

They are given no guarantees and scant personal consultation. "We are giving women high doses of drugs like Pergonal (a hormone sometimes used to assist reproduction) to hyperstimulate their ovaries so we can get as many as 30 eggs in one cycle," describes one nurse technologist. High concentrations of estrogen surge through the body (reaching a peak of 2,000 to 3,000 picograms per millilitre), roughly 15 times the normal level of estrogen during natural monthly ovulation. Once multiple eggs mature to a certain size, another drug is administered to prepare the eggs for ovulation. Patients dare not show any hesitation by questioning what the drugs they are given could be doing to them, fearing they might be considered poor candidates.

One of my friends was a corporate lawyer who waited until 38 to try for her second child and eventually turned for help to a New York fertility clinic. Her experience speaks for many: "Every night my husband would stick me in the butt with a needle of Pergonal. Every morning I'd show up before work at the fertility clinic, take a number - like a meat market - and wait with over a hundred other sad, fixated, pre-40ish women - to have a sonogram and my blood drawn. At the precise moment in the month, I'd go and have multiple eggs `retrieved'. My husband would be in another room jacking off. Several days later I'd go in to have my eggs `transferred' back into me, after they had been fertilised with his sperm. My husband never had to touch me through the whole enterprise. Our whole sexual and emotional life - all the tenderness and passion - went right down the test tube. We tried twice, and stopped."

It was easier for this couple to "give up" since they already had one child. For the women who start reasonably early and try year after year, doggedly but to no avail, giving up can be one of the most wrenchingly painful events in life. It is easy to understand why some persist so long as there is any shred of hope. But the price in terms of personal development can be very high.

What are the psychic implications for those who enter the midlife passage with the illusion that technology will allow them to control their ovaries and reproduce themselves, but who fail? Experts report that such women frequently become severely depressed in midlife. In addition to mourning the multiple personal losses - of a baby, a dream, a new love shared with a husband - this is a primal threat to their sense of independent agency over their lives. After all, the typical Liberated Generation woman seeking help to reproduce in her 40s is someone who has been accustomed to exercising birth control for many years. She is probably autonomous in every other sphere. She is proud of the social engineering job she has done to establish her identity, marriage and career before deciding to conceive. She had a life plan.

NOW infertility rips away the illusion of absolute control. All of a sudden, her body is controlling her. Her professional and personal life become hostage to dehumanising medical procedures like "assisted hatching". Even her emotional life is no longer her own: the powerful hormones used in treatment will buoy up her mood during mid cycle, when she's also most hopeful of success, then leave her flat at the end of the month, when she's most likely to feel hopeless. Starting over again the next month becomes harder and harder. The woman begins to feel that her body is a factory being readied for experimental production.

She and her partner often put their lives on hold. They don't go back to college or sell the house or make the career change because they're always waiting. That means they cannot proceed with the normal course of adult development. They're stuck. Repeated failures can be devastating to the woman's sense of self worth and can lead to denial, or desperately futile treatment, such as has been described by Germaine Greer. Essayist Anne Taylor Fleming has written movingly of her own obsession with making up for lost time in her 40s, failing to conceive and feeling betrayed by the feminist message of her generation.

Almost invariably, these anxiety ridden women confess to doctors the same regret: "Why didn't I start trying to get pregnant earlier?" Yet, typical of their generation, they believe if they just work hard enough they can make anything happen.

More and more Boomer women over 40 are drawn to having a child as a way to delay the ageing process. Becoming pregnant in one's 40s is an outward sign to everyone around her that a woman is younger than her well guarded birth certificate says she is.

One of my London interviewees in her early 40s and still childless was defiant: "If it's all right for my granny, who ought to have been dead by now, to live ten years longer because she's had her hip replaced, then why can't I buck the life cycle just as justifiably by having a baby in my 40s?"

In southern California the environment perpetuates the illusion. Dr Richard Marrs spells out the rationale. "All my 43 year old women are saying, `Well, Susan Sarandon did it, why can't I do it?' It's competitive."

In certain enclaves of privilege, like Manhattan's Upper East Side, it used to be that well married women competed for who could remain the thinnest. These living holograms: were dubbed indelibly by Tom Wolfe the "social X rays". Now there is a new form of lone upmanship among women of a certain age: who has the youngest child? Much more chic then being slim is to be at a dinner party with an 18 inch clearance for the foetal mound. These Mummy Mommies, as Tom Wolfe might call them, can be heard at dinner parties revelling in nursery school talk and comparing brands of strollers with the hostess's daughter. It's a way of saying to one's peers: "I'm still young, and fertile, I don't know about you". Says one obstetrician who hears this sort of chatter socially: "It's women trying to show up older women, like having a larger diamond ring."

Older women often feel pressure to perform for younger husbands. (Almost invariably, you'll notice, older women who want to get pregnant are married to considerably younger men.) Getting pregnant is a tried and true way of locking up the deal in a non traditional marriage. But when these women cannot reproduce like their younger selves might have done, they worry, "What's wrong with me?" The one thing they always thought they could do was conceive a baby. No one can control ovaries. No amount of money can buy back the magic. Refusing to give up this false self sets up many such women for an unnecessary sense of failure and makes of the midlife passage a rocky voyage.

Millions of women today are using hormone replacement to bypass menopause. They don't feel any differently when they stop ovulating. And because of the effect of the hormones, they usually still have periods. It's an easy step from there to the fantasy that they will be fertile indefinitely. And now, technology fans that fantasy.

Since the first in vitro fertilisation 17 years ago, no genetic breakthrough has evoked more furor than the spectacle of post menopausal women giving birth in their 50s and 60s. The media feed us one sensational story after another. One day it's a 59 year old British woman, married to a 45 year old man, who produces healthy twins. Next, the world holds a birthwatch for a 63 year old Italian woman, heralded in the summer of 1994 as the oldest woman in the world to give birth. These are egg donor births. The eggs are recruited from younger women and fertilised in vitro, by the respective husbands of the postmenopausal mothers.

Millions of women today are using hormone replacement to bypass menopause. They don't feel any differently when they stop ovulating. And because of the effect of the hormones, they usually still have periods. It's an easy step from there to the fantasy that they will be fertile indefinitely. And now, technology fans that fantasy.

Since the first in vitro fertilisation 17 years ago, no genetic breakthrough has evoked more furor than the spectacle of post menopausal women giving birth in their 50s and 60s. The media feed us one sensational story after another. One day it's a 59 year old British woman, married to a 45 year old man, who produces healthy twins. Next, the world holds a birthwatch for a 63 year old Italian woman, heralded in the summer of 1994 as the oldest woman in the world to give birth. These are egg donor births. The eggs are recruited from younger women and fertilised in vitro, by the respective husbands of the postmenopausal mothers.

In fact, only 250 women in the United States attempted a postmenopausal pregnancy in 1994. It may seem an aberration. But the very phenomenon of postmenopausal motherhood has much wider ramifications. The danger is that it sends a message to younger women, who are already struggling just to get from A to B to C, that they can wait until they reach the pinnacle of their career before they can even think about having a baby. But it's rare to reach any sort of pinnacle before 40, whereupon even hardcore careerists are likely to blanch at facing the Barren Woman Syndrome.

The truth is, we all have to accept realities at each stage of life. It is very hard to give up the magic of fertility, but when we do, like any sacrifice - if it is consciously made - we have the opportunity of replacing whatever has been sacrificed with something better.