The Invention of Infertility

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.

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4 responses to “The Invention of Infertility

  1. 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.

    In traditional societies there have always been rites marking the transition from childhood to adulthood, so I am not sure what you mean by childhood being a modern conception. I would rather say that it has become more diffuse in modern society. The distinction between the different phases of life has become less clear.

    Artifacts representing fertility worship are among the most ancient and universal in the archeological record. Not very surprising, since peoples survival depended on it (we now believe that the people next door will take care of it!).

    • I haven’t been clear enough in what I mean–sorry. I can try again, but I may not be very good at this.

      There have always been 12-year-olds. But now we think of 12-year-olds in a particular way. They are different from grown-ups. They cannot make serious decisions or do serious work yet. They need to be in school, learning things.

      Those ideas about what 12-year-olds should be doing are not universal across time and space. There were many times and places (and still are many places) where people that age migh have serious work to do. They might have quite a different role in the household from the common one you find now. They might work or live independantly. That’s the sort of thing I mean. Many ideas about what a person should/should not do at a particular age are cultural constructs as much as anything else.

      That bit is hardly original. There’s a book called Centuries of Childhood by Phillip Aries that I read a long time ago that lays this idea out.

      As you say, fertility has always been important. But it’s been understood in different ways. It might be seen as an act of God or a punishment from God, for example. It seems to me that it is only fairly recently that we have made it into a medical condition. Thinking of infertility as a medical condition–perhaps one that can be cured by proper treatment–has all sorts of ramifications for how people act.

      I don’t say this to say it is good or bad. It just struck me that our understanding of infertility as a (treatable) medical condition might well bes a relatively new thing. Certainly the experience of a person wrestling with infertility today is quite different from that a person would have faced 100 years ago. It’s just an observation.

  2. I don’t think there has been that much variation throughout human history, in what you expected a 12 year old child to do, though there have been extreme conditions, like the industrial revolution when things got out of balance. The religious rite of “Confirmation” which in some western societies marked the transition from childhood to adulthood is a remnant of the universal rites found in traditional cultures. Today it is only a religious rite, but 50 years ago in Europe, it had a very real social significance.

    Infertility may, as you say, often have been regarded as a punishment from good, but that didn’t mean that people didn’t treat it. They certainly did and it was perhaps the most important part of traditional medicine. Books could be written about it. We may laugh about their methods, until we do the statistics of our own infertility treatments. It is actually quite poor and honest doctors often advice couples to enjoy a holiday together instead. Our ancestors may have the last laugh.

    • While I suspect this is largely beside the point, I disagree about 12-year-olds. Now by law in this country a 12-year-old must be a student. That certainly wasn’t true for most of the last millenium. Twelve-year-olds worked to support their families or to support themselves. This was surely true in agrarian (pre-industrial) societies. But I’ll conceed both that I am not an expert and that this is beside the point.

      I didn’t mean to suggest that people didn’t try and overcome infertility. But as with many things these days, we’ve very much medicalized it. Obviously much is gained in this way, but also, as I think you suggest, something is lost.

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