The Guardian (UK) has a science podcast I’m quite fond of. I was listening to it this morning and the topic for discussion was last weeks Nobel Prize for Physiology or Medicine. (I wrote about the award, that went to Dr. Robert G. Edwards, the surviving developer of IVF, last week.) The person being interviewed, who had worked with Dr. Edwards as a graduate student in the 1960s or early 1970s, observed that when Dr. Edwards started his work, infertility didn’t really exist. (I may be misquoting him here, but this is what got me thinking.)
Before people get all agitated here, let me expand on this. Sadly there have always been people who wanted to have children and could not. That’s as old as human history. (I’m thinking of Sarah and Abraham in Genesis, for example.) But how was that inability to have children understood?
My recollection is that women were said to be barren. This might not have been understood as a medical condition–it might instead be a moral one. Certainly it was a terrible failing on the part of a wife. (Was there any male analog to being barren? I’m not sure there was.) I suppose since little was understood about human fertility, little was understood about why some women did not seem able to have children. Nor was there much understanding of what could reliably be done to improve matters.
I don’t mean to suggest that this wasn’t important to people. (If nothing else, consider the number of novels in which it is an important plot point.) What I mean to say is that it wasn’t understood the same way we understand infertility today–as a medical condition that may well be susceptible of treatment.
Over time more was understood about human fertility, but it seems that as recently as the 1960s we really didn’t know that much. Some couples had a great deal of trouble conceiving, we didn’t know exactly why that was, and we didn’t know when to tell people it was hopeless. (Indeed, to some degree this is still true–many instances of infertility are unexplained.)
As I understand it, today infertility is defined by the amount of time you have tried to conceive a child without success. It’s a description of a symptom. The cause of infertility may be any of a number of things or something we don’t understand at all.
I understood the implication of the speaker on the podcast to be that in the 1960s infertility didn’t exist (or at least wasn’t widely recognized ) as a condition that might be treatable. The inability to have children might well be a tragedy for a couple, but it was the way it was and couples were mostly counselled to consider adoption.
This has changed dramatically. Not only is infertility widely understood to be a medical condition, for better or for worse there is a very substantial sector of the medical market devoted to treating infertility. A great deal of assisted reproductive technology (ART) is just this–a method of treating infertility.
The definition of infertility as a medical condition leads to questions about insurance coverage. This is a controversial topic for ever so many reasons. A single woman cannot become pregnant on her own. Is she infertile? Is her need for third-party sperm any different from the need a woman who is married might have if her husband is unable to produce sperm? Should insurance cover one and not the other?
I suppose what struck me about this is that you can make the same observation about many other things we think of as real and ever-present. I still recall studying the invention of childhood in college (which is quite a while back.) Of course there have always been human beings in the 1 to 18 year-old-range. But the construction of this period in a person’s life as “childhood” with all that this entails in a modern one. In the same way, our understanding of fertility is a distinctly modern one.