A Somewhat Different Insurance Issue

I’ve written in the past (before the long hiatus–can I start saying “BH”?) about issues around ART and insurance.   There are a lot of tough questions around this.   ART is expensive.   It is health care.   Is it/should it be covered by insurance?   Does the need for ART have to arise from medical infertility rather than social infertility?

(These are tricky questions/categories.   A lesbian couple where at least one woman has fully functioning reproductive systems is sometimes said to be socially rather than medically infertile. But how is this different from a woman  with a fully functioning reproductive system who is partnered with a man who cannot produce sperm?  She is also socially infertile, I think?)

Anyway, I’m not going to review all that here.    I am sure these issues will arise again and I will discuss them as needed.  You can always dig around in the older entries, too.  (This reminds me–I have not been using tags, but I think I will start to do so again.)

So to today’s thoughts, spurred by this article from the morning paper.  (There’s a slightly more detailed version here, but I can only access page one of two.)    Erin and Marianne Krupa are a married lesbian couple who live in Montclair, NJ.  (This happens to be my hometown.)   They want to have a child.   But Erin Krupa, who they decided would carry the first child, has stage 3 endometriosis.   That means she is infertile.  And here I do mean medically infertile.  She has a medical condition that prevents her from conceiving/carrying a pregnancy by ordinary means.   It has nothing to do with the health or sex/gender of her spouse.  

Fertility/Infertility for Couples and Change Over Time

There are several lively conversations currently going on in the comments.  I’m not at all sure I can sustain all of them.  But having spent some time revisiting the post on social infertility I wanted to consolidate some of the thoughts I’ve had and move them here.  (After a while I find it very difficult to read through the comments.  It just gets to be too many indents, etc.)

This particular thread of conversation started with some musings of mine about “social infertility.”   This is a term that has gained currency only fairly recently.   I would guess (though I do not know) that forty years ago it was unknown.    And I can see why the emergence of the term would be linked to the development of assisted reproductive technology as an industry/commercial enterprise.

There’s more to be said about that, no doubt, but there’s a different line I want to follow for the moment.    I want to think about infertility in couples as opposed to in individuals.  

Back To Social Infertility

A couple posts back I put up something on “social infertility”–a phrase I had run across that struck me as interesting.   Then just as the discussion there got going, the Florida Supreme Court issued an important opinion and I got sidetracked.   Now I want to return to the social infertility discussion, but tie in something that made more apparent by the Florida case.

One thing was particularly striking to me in the discussion around social infertility.   I began with the assumption that “social infertility” was rather a disparaging term.   Those who were merely “socially” infertile could be distinguished from those who were “medically” (or perhaps “really”) infertile.    Since they weren’t “really” infertile they might be entitled to lesser concern–perhaps not covered by insurance or maybe even not able to access fertility services.

But my assumption was, if not wrong, at least debatable.  

Do We Need To Talk About “Social Infertility?”

There’s a phrase I’ve seen a few times recently that has gotten me thinking–it’s “social infertility.”   I think it is worth spending a little time understanding what the term adds.

I think there are at least two separate questions to address–but they are so intertwined I don’t know if I can really separate them.  And one of them–the first–seems to me to be sort of messy on its own.

The first question is what “social infertility” means.  This seems to require thinking about what “infertility” means when used without the modifier.   The second question is why a distinct term like “social infertility” might be useful.  All in all this seems like a surprisingly knotty problem.  

Infertility, ART and the Nature of Consumer Society

There was an interesting op-ed in the NYT yesterday.   It’s about the commercialization of infertility treatment, but I think it makes points that can be understood more broadly.  And, somewhat like the adoption story I blogged about yesterday, it makes me think about the importance of trying to put a bigger frame around the problem.

The authors–Miram Zoll and Pamela Tsigdinos–are women who pursued/endured “increasingly invasive and often experimental interventions, many of whose long-term health risks are still largely unknown.”  The treatments were unsuccessful and eventually Zoll and Tsigndinos decided to stop.  This is a decision the women are (now) happy with:

Ending our treatments was one of the bravest decisions we ever made,

Infertility, Adoption and Stigma

I’ve been thinking quite a bit about stigma recently, for a while variety of reasons.  You can see some of this on the blog.    It’s always interesting how once you start thinking about something you begin to see it as relevant in lots of different places.  Anyway, once again I found  an interesting post on Beyond Blood, the new blog by Abbie Goldberg I mentioned recently and it brings me back to this topic.

Goldberg’s post is about increasing public openess around infertility.   The taking off point is the number of celebrities who have gone public about their struggles with infertility.  The idea here is that the increasingly publicness of infertility makes it less shameful to be infertile.   I think you could say that this diminishes the stigma associated with infertility.   (It’s hard not to see the parallels to coming out as lesbian or gay in this process of publicly acknowledging infertility issues, but that’s another story.)  

Science and Reporting: What Do We Really Know About Fatherhood’s Effect on Men?

Today’s media features another story on the effects of fatherhood on men that is tied back to the earlier report about fatherhood and low testosterone levels.   But both stories also make me think about the role of science and science reporting in what we know (or think we know) about parenting.  That’s something of a perennial theme here.   I want to take the time to talk about the science (and the reporting) in a little detail.

This new story is about the relationship between fatherhood and life expectancy, and if you poke around the web, you will frequently find it reported this way:  “Fatherhood Helps You Live Longer.”  I’m sure that attracts readers.

Now that seems a particularly bad headline because if you actually read the reports of the study, it isn’t what it says at all.  

Varieties of Infertility And Access to ART

Thinking about ART and third-party gametes and all leads me to think about infertility.   It’s actually surprising to me to look back on this blog and realize how infrequent entries on infertility have been.     It’s curious, because generally speaking the people who use ART, including third-party gametes, are facing some sort of fertility issue.   

Of course, “some sort of fertility issue” can cover a lot of ground.   There are heterosexual couples where a specific fertility issue can be identified for one member of the couple.   There are heterosexual couples who have engaged in unprotected intercourse for a specified period of time (a year?) without conceiving even though no specific problem can be identified. 

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?  

Once more, news from Georgia

I’ve been following some legislation in Georgia recently.  It’s gone through a number of revisions.   You can read about them in the earlier posts. Interestingly, you can trace the origins of this legislation back to the furor over the octuplets.  The unease about the octuplets seems to have provided a vehicle for groups more generally concerned about ART.

The new version of the bill, one passed by the Georgia state senate, is described here.    Provision limiting sale of sperm and eggs are gone, as are restrictions on the number of embryos that can be implanted transferred and who can utilized ART.   The bill now provides that embryos can only be created for the treatment of human infertility.  The question of what qualifies as “infertility”–an important question when you consider people who wish to parent singly as well as same-sex couples, is left rather fuzzy.

Apparently there is also a separate bill, passed out of the Georgia House of Representatives, that promotes embryo adoption.  This is the first I’ve heard of this second bill, but you can find some discussion of embryo adoption here.