I remember the hospital robe they had me wear—one of those short-sleeved, soft cotton robes with the snaps all the way up the front—and I remember the way the skin on my arms goosebumped up, the hairs at attention. I remember lying back on the exam table, much like the one my OB/GYN had, except I was in the radiology unit of a hospital. I scooted my butt down to the end of the table, my feet in stirrups. It was dark. They slid in the speculum, widening it, like they were jacking up a car to change a tire. They injected the contrast dye into my uterus, waited for it to spill into the fallopian tubes, rush into my abdominal cavity.
After that, all I remember is the pain, which they said would feel like menstrual cramps, but which were so much worse. They moved me onto my side, and then onto the other side, and I clenched my whole body, tightened my jaw. It was only five minutes, but it felt like forever.
The HSG—short for hysterosalpingogram—was conducted in order to determine whether my fallopian tubes were blocked. It's a test commonly performed on women who are having trouble getting pregnant, just one in a series of tests meant to pinpoint the source of the problem. It’s an outpatient procedure, and you can have the results within minutes. When I was told my tubes looked fine, I didn't know how to feel. Though it was just one more confirmation that my body was functioning as it should, it also meant I was no closer to the answer I was looking for. As I limped down the hallway toward the exit, my husband Michael at my side, I asked myself again: Why can't I get pregnant? What's wrong with me?
Several months earlier, seated in front of the doctor at the fertility clinic for our very first appointment, I had felt much more hopeful. No, it wasn't hope. It was relief. For nearly two years, I had been spending money on fertility-friendly lube that promised to mimic fertile cervical mucus, allowing my husband’s sperm to swim freely. I had been tracking my ovulation on my smartphone. I had been increasing the frequency with which I had sex with Michael, despite persistent pelvic pain. I had even gone off of my antidepressants cold turkey, wanting my body to be free of those chemicals should I find myself pregnant. This means I’d been without my primary mood stabilizers for almost two years. Listening to a doctor lay out a plan of attack—tests, treatments, monitoring, procedures—felt promising. For the first time in a long time, it seemed that the burden of making this thing happen—this thing we both wanted so intensely—was no longer on my shoulders.
But then there was the bloodwork I had to get done, blood the lab technicians struggled to collect because I had always had "difficult" veins. There was the fertility medication I had to be injected with every day. There were the early mornings—every other morning—when I had to drive to the clinic, get more blood drawn, receive an ultrasound so that the doctors could monitor my ovaries. While the mental load of babymaking had been partially taken from me, the physical load was still all mine. Michael didn't even have his semen analyzed until after I had undergone the painful HSG procedure. The doctors hadn’t considered it a priority, and were more concerned with ruling out my own deficiencies in order to set a course forward.
We already know that women bear most of the burden of preventing pregnancy. They must give time and mental space to finding a gynecologist they trust, and then they must choose, pay for, and implement a contraceptive plan, filling themselves with additional hormones their bodies may react to in a number of adverse ways. If they "fail" to do this successfully, they must then make a choice, or even several choices: Get an abortion or bring this pregnancy to term. Put a child up for adoption or become a parent. None of these options are easy, physically or emotionally.
But we don't always think about the fact that the burden also lies with women who are actively trying to become parents. Oftentimes, though male infertility contributes to more than half of all cases of global childlessness, infertility issues are assumed to be women's issues. As a result, women are made to jump through exhausting, painful hoops, sometimes all on their own, in the hopes of starting a family even if the problem does not lie with them. And in many cultures, there's the pursuit of becoming that perfect wife—the one who can provide her husband with offspring—and women are left to puzzle out all of the ways in which they might be broken.
There are a number of reasons for this. For one, as often seems to be the case when it comes to gender bias within the medical field, there's a decided lack of research devoted to male infertility. In fact, a literature review published in 2006 showed that out of 157 articles on gender and reproduction, only one was focused on men. The way we educate men about (in)fertility is also different. Another study published just last year showed that, in federally funded US clinics that provide family planning services, 81 percent provided education around preconception care for women, while only 38 percent provided the same education for men.
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But the factor that infuriates me the most is the stigma attached to male infertility: The anxiety men feel around semen analysis, the ways in which male infertility is often conflated with impotence, the sense men get that a diagnosis of male infertility is somehow a reflection on their masculinity. In fact, this negative stigma is so strong that, sometimes, the woman in the relationship takes the blame for the couple's infertility even if her body is in excellent condition.
And okay, I sympathize. But when assisted reproductive technologies are, on the whole, applied more invasively to women's bodies, only adding to the mindset that women bear the responsibility for reproductive problems, I can't help but feel angry and resentful as well.
When all was said and done, I went through two rounds of intra-uterine insemination (IUI) over the course of several months before we took a closer look at my husband. And only after switching to a new urologist did we learn that his white blood cell count was high. This is when I learned that, despite Michael’s insistence that he had quit years earlier, he had secretly been smoking, a habit that can adversely affect sperm production and development.
I was furious, as his transgression had led to months of unnecessary testing and treatments and monitoring and procedures on my part. All of this could easily have been prevented. But while months before, the doctor at the fertility clinic had laid out all of the things I wasn't allowed to do during the treatment process, Michael had never been told about the lifestyle factors that could affect his fertility. In taking our medical history, the doctor had never asked him about the habits that could have possibly contributed to the past year and a half of infertility.
I'd like to think that, one day, the infertility testing and treatment process will be more egalitarian, with preconception education being extended to male partners, and with men being encouraged to get their semen analysis done right off the bat. And with testing kits being developed so that men can test their sperm viability in the privacy of their own homes, perhaps we're getting closer.
But we're not close enough yet. And until that responsibility gap gets narrower, women will continue to bear an unfair amount of the burden.
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