ART stands for
"assisted reproductive technologies." I discovered this when my husband and
I confronted the hard fact of our secondary infertility. Perhaps it is because
I am an art historian that the invention of another referent for "art," already
so charged with meaning, captured my attention. The new usage, albeit peculiar
to the medical profession, seems as much an extension as a jarring displacement
of the word's conventional semantic range. Whether originally intended to do
so or not, ART puns on notions of creativity and skill, ingenuity and artifice
through which we humans act upon and transform the "found" order of things in
the everyday world. The acronym cleverly plays on the tension between the colloquially
opposed categories "art" and "science." Closely related terms in Latin for describing
knowledge, ars and scientia have come to represent antithetical
branches of learning or fields of endeavor. Self-consciously or unconsciously,
ART positions the practice of medicine somewhere in-between, unmasking the pretensions
of ars medicae, the healing arts, to science or, vice versa, masking
the aspirations of scientific control to art. The age-old debate over the artist's
proper task could just as well be applied to the physician: improve on or compete
with nature, respect or challenge it?; find harmony with nature or bend "her"
to "man's" will?
Artists and the coterie of specialists who govern
art's institutions, like physicians and ethicists, exploit and advance reproductive
technologies on which they seek, at the same time, to impose limits. Old master
and impressionist paintings are copied in the medium of ceramic tile for a Japanese
art collection; motifs from Edo screens and Ming Dynasty scrolls unfurl on fancy
scarves in museum boutiques; details of altarpieces surface on Christmas cards,
miniatures from illuminated manuscripts in date-books. The digital imaging processes
of the Cyberspace Age turn all objects virtually into a genre of clip-art. As
numerous commentators have observed countless times, reproduction begs questions
of authenticity, place-value and ultimately ownership. Images, excerpted like
genetic material from more complex entities, give life to the consumer products
by which we measure the success of our seasons. Extracted, interjected, transferred,
reconfigured as so many different identities...exactly what in "art" belongs
Armand and I had easily conceived our son Ira,
born in August 1990, but our concerted attempts to conceive again proved unsuccessful.
By early 1994 we had embarked on a course of medical treatment that included
cycle after cycle of intra-uterine insemination (IUI) and then of in-vitro fertilization
(IVF). After years in which art had constituted my object, my body became an
object of ART. I "worked on" medieval churches and their paintings. Now I was
worked on - probed, analyzed, interpreted. Once, I did achieve pregnancy, only
to suffer a miscarriage at ten weeks. My response to this blow was to persist
with yet another annual round of expensive, high-tech interventions, each of
which failed. The more I tried, the greater my exasperation and sense of defeat.
I knew, as I turned forty-one, that my prospects for becoming pregnant were
dwindling (in direct proportion to our savings). Slowly, and with great reluctance,
I began to give my body permission to claim victory. ART, in my case at least,
could not prevail against the power of nature. Yet under no circumstances did
my evolving acceptance of the inability to conceive mean acquiescence: on the
subject of another baby for our family, biology was not going to have the last
What makes my story worth telling is not some
uncanny insight I have gleaned from a painful journey. Its tropes of willful,
almost obsessive, determination and profound despair are all too familiar to
women who have suffered infertility. Rather, I undertake this risky literary
venture on account of the form in which my self-reflection takes shape. Fragments
of recollected experience crystallize in terms of images that I have encountered
in my research as an historian of medieval art. Images from the distant past
are so deeply burrowed into the recesses of my consciousness that, fantastically
transfigured, they sometimes invade my dreams. There, in sleep, I marvel, the
amazed spectator of wondrous new artworks from a world long since vanished.
While historians today examine how being embedded in a particular cultural moment
may color their own (or their predecessors') interpretation of the past, I find
myself performing the inverse operation. Thus study of the Middle Ages, spilling
over into the disparate arenas of my life, becomes a prism through which I revisit
my infertility. The writing of history weaves the life and times of others into
art. Turning my practice as a historian to my own life, I offer the following
bricolage of iconography, anecdote and critique.
Cult of the Clinics
From the window
of her cell, Saint Radegund expels a demon from the possessed woman Leubile,
miniature painted c. 1100, Poitiers, Bibliotheque municipale, MS. 250 (Life
of Saint Radegund), fol. 35r.
Radegund cures Bella, from the same manuscript, fol. 34r.
first encounter with ART occurred in June 1993 on a trip to Norfolk, Virginia
where I had an early morning appointment to examine twelfth-century sculpture
in the collection of the Chrysler Museum. I spent the night at a pleasant Bed
and Breakfast near the museum. The next day, I met two women conversing over
coffee and blueberry muffins. With the same blase nonchalance one might remark
on the local weather, they were comparing their husbands' sperm counts. They
had traveled here from Istanbul in order to undergo IVF at a well-known clinic
also within walking distance from the B & B. Their husbands, having completed
that part of the protocol for which their presence was necessary, had just returned
home (they had important jobs). Another cup of decaf, more vital statistics:
how many follicles their ovaries had produced, how many eggs retrieved, how
many fertilized, how many times the embryos had divided so far, their grades.
Both women were anxiously awaiting embryo transfers: how many would be put back
in the womb, how many frozen for later use? The proprietor-hostess replenished
the tray of muffins...she knew the routines. What planet had I landed on? But
it was not so much the unfamiliar talk or its incongruous setting that disturbed
me as the eery feeling of its personal relevance.
At once unsettled and intrigued, I began to ask
questions. Armand and I were having unexpected difficulty conceiving a second
child. Testing indicated a "male factor," I confided. Armand's urologist suggested
that the problem could easily be corrected by a minor surgical procedure. We
would then have to wait about three months to see whether motility and count
would improve. Don't bank on it, my breakfast company warned; the same procedure
had been performed on their husbands but turned out to have little or no impact
on sperm quality. So I listened intently as each woman described her couple's
medical history, their infertility work-up, their daily regimen of injections,
ultrasounds and blood-levels, the number of attempts at IVF in Norfolk and elsewhere.
The price-tag? Approximately $10,000 per trial - not including fertility drugs
(add some $2,000) or lab "extras" like the micro-manipulation required to inject
a single sperm directly into an egg (intra-cytoplasmic sperm injection, or ICSI,
another $3,000). I began to feel slightly nauseous and left for the museum,
my head spinning. Although I had come to Norfolk to look at miscellaneous stone
carvings scavenged from the distant past, I now stared aghast at my future.
Several months later, under pressure of my thirty-ninth
birthday and disheartened by the predictable failure of the surgery, Armand
and I decided to advance a notch in the hierarchy of resort. Well-meaning urologists
and gynecologists were competent in their own respective spheres but I needed
advice of a higher order; most of all, I wanted results. We then did what people
seeking relief from physical ills have done since time out of mind. Leaving
behind the village soothsayer and empiric, we heeded the irresistible call of
the pilgrimage roads and made our way towards the shrines that reported the
greatest numbers of miracles.
Where would we find the mightiest wonder-workers?
Fortunately, shrine clergy carefully tracked the successes of their resident
luminaries. Saints not performing to standard, not maintaining respectable quotas
of cures and punitive strikes, would eventually lose their luster. They could
be humiliated, their bones dumped unceremoniously onto the sanctuary pavement.
Should they still refuse to come to their senses, they might even be abandoned
by their custodians. Saints had to keep up, or face obsolescence. Inventio,
the ritual finding of new relics, kept old patrons in line, motivating them
to tackle each scourge and every bout of pestilence. Competition has historically
proved a powerful incentive. If saints put out for their sanctuaries, surely
ART doctors would do the same for theirs. I had faith in the system. Armand
and I completed the requisite battery of diagnostic tests at the end of 1993
and began treatment in early 1994 at a clinic in the Washington D.C. area where
we lived. The slight variation in pregnancy rates elsewhere did not seem to
justify the considerably greater expense of travel and disruption to our daily
life. In the end, pragmatic constraints make most pilgrimage (like politics)
a local affair.
Since male factor infertility in our case had
an unknown etiology and since Armand had in fact fathered our son four years
before, we decided to try a few IUI cycles on the off-chance that perhaps sperm
quality had not really changed all that much in the intervening period. While
pursuing this low-tech procedure, I would boost my fertility with the cheap,
easy-to-take pill, Clomid. Perhaps we might "get away" with this less aggressive,
more economical approach. A few thousand dollars later, however, we graduated
in June 1994 to IVF with ICSI. The fears stirred in Norfolk the previous June
had come to pass.
At the time of my experience with ART, IVF had
a success rate of around twenty percent under the very best circumstances. Couples
in which the female was well under thirty-five and had good ovarian function
and the male, punchy sperm might have a decent shot at a baby through IVF or
one its variants. The more eggs harvested and fertilized, the more embryos developed,
the greater the chance of achieving a pregnancy (eventually). The particulars
of our secondary infertility, however, made for a grim prognosis. Two obstacles
combined to present an intractable case: the fact that I was approaching forty
handicapped the treatment of male infertility. Women in my age group could expect
to produce fewer eggs under ovarian stimulation, not all of optimum quality.
Then, in order to maximize fertilization, the retrieved eggs would be subjected
to the technique of ICSI. Probably not all the eggs would be fertilized and,
of those fertilized, not all would necessarily progress further into multi-cell
embryos. But the real blind-spot in the IVF process followed embryo transfer.
What fostered or impeded implantation was anyone's guess.
Taking into account these variables, IVF increased
our chances of achieving pregnancy from zero to around sixteen percent. The
chance, however, of actually having a live birth decreased to around thirteen
percent, since miscarriage (as in natural conception in my age group) remained
a possibility. According to my rough calculations, Armand and I had at least
as much chance of a successful outcome as did the infirm who congregated around
the tombs of medieval saints. If anything, holy bodies reposing in their reliquaries
had a better clinical record. ART indeed improved the hand that nature had dealt
to some couples, but the desired result, a baby, was still a distant prospect.
Yet we desperately hoped for a miracle. Every other couple I met on the fertility
circuit prayed that they, too, might rank amongst the chosen on the right side
of the statistical curve. There were no unbelievers.
The negative pregnancy test, accompanied by the
very negative balance on our bank statement, jolted me back to the late twentieth
century. "Now what?," I asked the medical director of the clinic, fighting back
Unsurprisingly, he recommended a second attempt;
we should look at the first cycle as a trial run.
"But it's so expensive, basically we'd be gambling
away another $15,000."
"You know," he replied, "children are an enormous
financial responsibility; maybe you can't afford a second one."
Taken aback by the doctor's caustic remark, I
pretended not to register its weird logic. Instead, I pursued a rather different
line of inquiry. "Since the main impediment in our case is sperm quality, what
if we tried IUI cycles using donor sperm?" Indeed, the clinic's specialist in
male infertility had from the start proposed both this method and adoption as
alternatives to IVF. "Wouldn't I have a better shot at becoming pregnant than
by repeating IVF?" I persisted.
"Yes," he brushed me off. Little did I know then
that to refuse the newly invented remedy for male infertility was tantamount
Wheel of Urines
Wheel of Urines,
miniature painted c. 1420, London, Wellcome Institute Library, MS. 49 (Wellcome
Apocalypse), fol. 42r.
birthday came and went, forty years too quickly spent. Forty is a magic number.
The Judeo-Christian tradition appoints it the ultimate figure of liminality,
a term anthropologists use to describe the transitional phase in rites of passage.
Before attaining a new status within the community, an initiate undergoes a
dynamic process of change during which he or she is set socially apart and often
remains physically confined to a discrete sphere of existence. This interim
stage of separation, which follows exclusion or withdrawal from society and
precedes re-integration on different terms, may be fraught with uncertainty,
even danger. The interval between conception and birth, forty weeks, yields
the archetypal measure of suspended transformation; the developing fetus embodies
the ambiguous state of abeyance between non-being and full identity.
God caused it to rain upon the earth forty days
and nights, cleansing "his" creation of every breathing thing outside Noah's
ark. Over time the flood waters subsided and finally, "...on the first day of
the tenth month, the mountain peaks appeared. At the end of forty days Noah
opened the porthole he had made in the ark...(Gen. 8:5-6)." [After nine months,
the womb opened and a new world came forth, head first.] The Hebrews wandered
for forty years in the desert until a generation that had never known slavery
crossed into the promised land, a people reborn. Jesus fasted in the wilderness
for forty days before assuming his ministry. The Levitical injunctions (12:1-5)
designate the period of a woman's postpartum purification as forty or eighty
days depending on whether the infant is male or female.
Along the continuum of a woman's reproductive
life, forty is the age that ART specialists have designated as the benchmark
in the inexorable decline of natural fertility. A single point thus stands for
the transitional years in which the mature female body, no longer in its prime
but not yet depleted, marks time before finally reaching menopause. Why forty
rather than thirty-eight or thirty-nine? An arbitrary cut-off based on science,
or on the convenience of a figure now so culturally diffuse that its ancient
symbolic charge goes unnoticed?
Magic has its uses. When my biological clock sounded
its alarm, a way opened in the marital union for recourse to donor sperm. Unorthodox
though it was, Armand and I decided to proceed by technologically reversing
course. We returned to Clomid and artificial insemination but now enlisted the
assistance of a few surrogate cells picked out from a list of numbers. It was
a difficult and emotionally wrenching choice for us both. The sense that we
were somehow going against the professional grain only made it more stressful.
During one procedure, a nurse held up the vial of sperm, read the number on
the label and asked,"Is this the man we want?" I responded that I did not regard
the bodily fluid in the tube as a man. Odd, I thought. Although the practitioner
was accustomed to dissociating genetic material from the women who donate eggs
or provide surrogate wombs, she glibly conflated sperm with the male person
who was its source. Yet her words spoke nonetheless pointedly to my residual
feelings of guilt. Had insemination with donor sperm demoted me to a less-than-faithful
wife? I felt ashamed.
Five cycles brought us to mid-January 1995. Meanwhile,
on January 1, our medical insurance policy changed. We had switched health plans
so as to take maximum advantage of a new Maryland law. The state that underwrote
Armand's employee benefits now mandated full insurance coverage of three IVF
attempts per couple per lifetime. If the IUI cycles proved unsuccessful, we
would have the option of trying IVF at a different clinic, one which our managed
care provider authorized. True, our insurance would not cover injectable fertility
drugs or the then still "experimental" technique of ICSI. But at out-of-pocket
costs of "only" $5,000 per trial, as opposed to $15,000, IVF seemed like a bargain.
Soon after the last IUI, we went for our first
consultation at the pre-approved clinic, associated with a major hospital in
downtown D.C. Since the hospital pharmacy had a limited stock of the fertility
drug Pergonal, in high demand and short supply everywhere, we purchased a few
boxes in the event we decided to "cycle." (In conversational ART-speak, "cycle"
is a verb as well as a noun, just as ICSI is both a verb and an adjective, as
in "to ICSI" the eggs, or "ICSIed" eggs). Two weeks later, however, I found
myself going to the clinic not for IVF but, with no menstrual period in sight,
for a pregnancy test. It turned out positive. At last! Relieved and thrilled,
I returned the unopened boxes of Pergonal.
The weekly count-down to which I had so long looked
forward had begun. Forty, thirty-nine, thirty-eight... thirty-four...ultrasound
at the clinic...thirty-two, first OB appointment, thirty, twenty-nine... And
then, late one Saturday afternoon, blood everywhere, dreams awash in an unmerciful
gush of bright red waste. When the emergency room staff confirmed the miscarriage,
Armand wept. The absence of his genes in the fetus I carried had in no way diminished
his profound sense of loss. Numb with grief, I continued to count the weeks.
How many would it take for my body to heal so that I could resume my place on
the fertility treadmill?
June 1995. Two years after my initial contact
with ART at Norfolk and we were still at ground zero. I had proved I could become
pregnant with IUI and donor sperm. Should we return to this method or go forward
with IVF? The physician on whom we now relied persuaded me (skeptical though
I was) that my age warranted the most aggressive approach possible. I had, after
all, crossed the threshold into the over-forty category. In any case, I had
taken Clomid many more times than he believed was advisable (a risk of cancer
increased with sustained use). As long as I would have to take injectable fertility
drugs like Pergonal or Metrodin, why not do an IVF cycle for which we had the
insurance coverage? To ICSI or not to ICSI? That was my question. He adamantly
and persuasively argued that our best chances for fertilization lay in using
the ICSI technique with Armand's sperm, rather than in combining my eggs with
donor sperm in a "natural" IVF cycle.
The start date of an ART cycle is closely correlated
with the onset of the menstrual period. My short-lived pregnancy had ended with
an unwanted flow of blood. Now the regular monthly event I dreaded most was
the signal I eagerly awaited. I kept watch for the red flag that meant I could
now try again. Maybe this time we would get lucky. The fertility circuit converts
endings into new beginnings, a source of comfort and, at least for me, a compelling
force for repetition.
At the appropriate point in the cycle, Armand
began twice daily to give me intramuscular injections in the hip. There was
evening and there was morning, the first day of many in which a powerful fertility
drug surged in my veins. The pharmaceutical contained reproductive hormones
that control the ovaries (organs also called gonads) so as to stimulate the
growth of the follicles, or cellular pockets, in which the eggs develop. These
hormones were extracted and purified from the urine of post-menopausal women,
who happen to secrete high amounts of natural gonadotropins. During the era
of my involvement in IVF, the necessary hormones were not yet manufactured synthetically
through recombinant DNA technology. Urine was the only source for the industrial
production of human menopausal gonadotropin (hMG) preparations like Pergonal
or Metrodin. Clearly the historical preoccupation with urine, the medieval physician's
main diagnostic tool, had paid off.
ART, it thus turns out, is a recycling program.
Hormones recovered from the excreta of older women enhance the fecundity of
younger women. When a girl becomes nubile she bleeds from her vulva, and when
menstruation ceases the by-products of her former capacity for reproduction
are expelled through the same orifice. From blood to urine, and with injections
of hMG, back to blood. As medieval people had known all along, female effluvia
are life-giving substances. Women supply the blood, the very matter, from which
they first concoct the fetus in their oven-wombs and then the breast milk, twice-cooked,
for nursing the baby after birth. Even the superfluous blood released in menstruation
can play an important role in procreation. Beatrice de Planissoles, a noblewoman
who lived during the late thirteenth- and early fourteenth century in the southern
French village of Montaillou, took special precautions to ensure the viability
of her daughter's marriage. She kept cloth that had been soaked with the girl's
first menstrual blood, a precious elixir, so that one day she might remove some
to mix into the drink of her son-in-law, thereby guaranteeing his marital fidelity.
I doubt Beatrice would be surprised to learn that ingredients distilled from
her own urine might prove useful in the generation of her grandchildren.
Especially interesting to me, however, is the
purported role of nuns in the manufacture of Pergonal, the oldest hMG preparation
on the market. In the late 1950s and early 1960s, the Instituto Farmacologico
Serono in Rome (a subsidiary of the Swiss pharmaceutical firm Ares-Serono) obtained
eighty thousand liters of urine from post-menopausal nuns and other women in
rural Italian communities for the extraction of reproductive hormones. Why the
selection of cloistered women as "naturally" the most suitable or expedient
source of urine? And what lies behind their donation to Serono: a love of science,
an exchange of gifts? The nuns' contribution to the production of a highly purified
fertility drug, however ironic, makes perfect sense to a historian of medieval
culture. The more radically that holy women of the thirteenth and fourteenth
centuries sealed off their bodily cavities, the more miraculous their bodily
exudings. The sweat and saliva of starving virgins cured infirmities, and their
divinely induced lactation provided sustenance. Surely it seems only a matter
of time before a pharmaceutical company tapped into convents for urine from
female bodies practiced in renunciation and transformed by charity. Who else
but older women vowed to chastity could possibly eliminate waste that might
heal the infertility of younger women? The Serono program merely extended a
deeply ingrained tradition of spirituality, not to mention ancient principles
of sympathetic magic, in a new direction. Did technology reactivate a cultural
memory, long dormant perhaps, but never totally eradicated?
A barber surgeon
bleeds a woman, woodcut in I-Eeronymus Brunschwig, Liber pestilentialis de venenis
epidimie. Das Buch der Vergifit der Pestilentz, printed by Johann (Reinhard)
Gruninger, Strasbourg, 1500, fol. XXVv.
giving over my body to ART I became a member of an order, the demanding protocols
of IVF a rule that set me apart from the work-a-day world of ordinary folk.
I opened my Book of Hours at 5:30 a.m. with the meticulous ritual of injection.
First Armand and I had to mix the precise amount Pergonal or Metrodin powder
with sterile solution. I snapped open the glass ampules containing each substance.
Armand did the needlework, drawing up the solution into a syringe, infusing
it into a vial of powder, again drawing up the now dissolved medicine, infusing
the liquid into several more amps of powder. Armand replaced the thick mixing
needle with a long, thin and equally terrifying one. While he removed residual
air bubbles by flicking the side of the syringe, I pointed to a spot just slightly
to the back of my hip. Armand aimed and lunged. I gritted my teeth against the
pain that began my day.
By 6:00 a.m. I was out the door, headed towards
the metro and the clinic for monitoring. At 6:45 the waiting room was already
crowded with women. Each of us wondered in silence about the follicles proliferating
in our ovaries. No chatty coffee klotch and no blueberry muffins here. The ultrasound
technician brought the shadowy image of my ovaries onto the screen and I waited
with baited breath as she counted and measured the bulbous black blobs, each
of which potentially concealed an egg. The more follicles, the more eggs, the
better our chances... Then on to the lab technician for "blood work" so that
hormone levels could be ascertained. Another line to attend. Which technician
would draw my blood today? Some were so adept that I hardly felt the needle,
others so heavy-handed that thirty seconds seemed an eternity. Back on the metro.
When I finally sat down to my work around 9:00, I was exhausted. Between 3:00
and 5:00 p.m. I waited for the nurse to phone with instructions based on the
physician's review of the data. 6:00 p.m., vespers: Armand and I repeated the
injection ritual, thus concluding the office of IVF for the day. So we continued
until, in the fullness of time, the follicles abounded and grew fat and my blood
was saturated with the stuff of their ripening.
Finally the evening came for Armand to inject
me with a different pharmaceutical preparation. It contained human chorionic
gonadotropin (hCG), the hormone secreted by the placenta during pregnancy. Bringing
the eggs inside the follicles to maturity, the hCG would trigger ovulation twelve
hours later. The scheduling of the injection therefore had to be precisely coordinated
with the next phase of the IVF cycle, egg retrieval. Using an ultrasound-guided
needle, the physician had to aspirate the eggs just before the follicles naturally
ruptured, or the eggs would be released and "lost," the cycle ruined. Time was
of the essence.
Now "our" clinic was associated with a hospital,
and egg retrievals were performed - of all places - in the maternity ward. The
elevator doors opened to a view of the nursery full of beautiful newborns. Was
this supposed to be inspiring? No, convenience and efficiency dictated the set
up: women in labor and women in the IVF program could to some extent share the
same medical equipment and staff. The juxtaposition of the "coulds" and the
"could nots," however, always struck me as more than a little cruel. True, successful
ART patients might find themselves returning here in nine months but the vast
majority of us would never make it to the delivery room. Indeed, by the time
I got to this point in my second IVF cycle, after having miscarried some eight
weeks earlier, I could not even bear the sight of pregnant women. The longing,
the frustration, and oh yes the envy were just too overwhelming. I had to avert
my eyes from bellies and babies; had to shut the openings through which I felt
most vulnerable and, like female saints of yore, close myself in to gain some
semblance of control over my life.
Armand and I were led into one of the birthing
rooms where the anesthesiologist administered an epidural. Five years before
I had an epidural during labor with our son. Now I belonged to the other group,
from whom nature withheld the fruit of the womb. I was wheeled into a room down
the hall. My doctor and his assistants were ready for the routine procedure,
the technicians in place in the adjoining IVF laboratory ready to receive the
eggs. Then the unthinkable happened. A woman in labor with twins was rushed
into the adjacent delivery room; the obstetrical staff needed the one and
only ultrasound machine on the floor. We would just have to wait. The eggs
in which I invested my shattered hopes for another chance at pregnancy might
be lost. My doctor, clearly irritated by the predicament in which we found ourselves,
was as helpless as I was motionless.
"You do understand, don't you, that in there it's
a matter of live babies," he reasoned. "These, well, are just eggs."
"Doctor," I managed to reply, "this is a big hospital.
Isn't there somewhere another ultrasound machine we could use."
"No. Not one of the right sort."
"I hate to bring this up, but" [given the hefty
fees patients and some insurance companies shell out for IVF - a thought I kept
to myself] "don't you think you might buy another machine... I mean, couldn't
there be two ultrasound machines..."
"Well maybe now. This never happened before."
I listened, intent upon the sounds coming through
the door that connected the IVF procedure and delivery rooms. Voices were coaching,
she was pushing and screaming and pushing and screaming. At last, applause accompanied
a baby's cries. The ultrasound machine, no longer needed since the second baby
was on its way, was freed for our use. Twenty minutes to the twelfth hour. The
team worked fast. The follicles were intact; the eggs were still there! The
harvest went forward. Meanwhile, in the next room, the second baby was born
to another round of applause. Drifting into the nether regions of my darkest
despair, I knew in a flash the utter futility of all my extraordinary efforts
"Why those tears?" one of the nurses asked me.
"You just got six eggs."
The specialist in ICSI went to work on my eggs
and Armand's sperm. In twenty-four hours we would hear from the IVF coordinator
about fertilization and thereafter about embryo transfer. Two days after the
retrieval, Armand and I returned to the maternity ward for phase three of the
cycle. A nurse, freshening up one of the birthing rooms just vacated, carried
out congratulatory balloons and flowers. Not for us; we had three embryos. At
least this time I would not have to compete for an ultrasound machine, as the
transfer required none. We were all in a lighter mood. As the embryos were pipelined
into my uterus the doctor joked about his recollections of the art history course
he had taken from the legendary professor Horste W. Janson, whom I knew only
through the famously lucrative textbook he had authored. I had to refrain from
laughing in the hope that the embryos would settle into the plush uterine lining
prepared to receive them. Finishing touches on a work of performance ART, the
collective enterprise of anonymous master craftsmen in the lab and of countless
invisible women whose secretions made possible my own. A postmodern story familiar
to every medievalist.
Two weeks later, I went back to the lab for a
blood test that would determine whether or not implantation had occurred. Positive
for pregnancy or negative? The six excruciating hours I waited by the phone
for the results capped an excruciating fourteen days of wondering if the embryos
were still there, of imagining cell division, of hoping... Finally the phone
rang. "I'm very sorry," the IVF coordinator apologized, "it's negative. Stop
taking the progesterone and you'll get your period within a couple of days.
The doctor will call you and you can come in for a post-cycle consult." Why
hadn't those embryos implanted? Maybe this or that movement in the recovery
room had disturbed them; maybe I shifted my position too much in the first twenty-four
hours; maybe I doubted too much. Maybe if I had a more positive attitude...
I momentarily buried my sorrow in order to pick up Ira from his pre-kindergarten
class. Tearing out the school door into the June sun, he rescued me from the
crowd of all those moms pregnant two and three times over. I would not be one
From blood to urine and back to blood. Thousands
of dollars' worth down the sewer, I thought, as I flushed the toilet. Women's
monthly bleeding is a calendrical system, an involuntary periodic flow that
keeps time in accordance with the moon. No wonder, then, that the voluntary
letting of blood to restore humoral equilibrium was aligned with heavenly bodies
whose movement divided day from night and one month from another. Zodiac Man
may claim to represent a universal medical standard for the practice of phlebotomy.
In fact, however, his is but a mirror image of the power that Nature vested
in the rhythms of female bleeding. How to appropriate the power of woman's fertility
is a matter for Culture to answer. Gazing into the sky, I could only rail against
my fate. I was locked in a cosmic struggle. And I was losing.
Why did the IVF cycle fail? The postmortem conference
with our doctor provided no information. What else was there to do but repeat
the procedure; we had coverage for two more attempts. We looked at the calendar
trying to predict when my next period would begin so as to get a sense of when
we might cycle again. We would then make our summer plans. During my two years
in ART I had grown accustomed to scheduling my professional activities and family
vacations around my menstrual periods, count-down for all fertility therapy.
My body may have held me captive to its reproductive tides, but I was a willing
and docile hostage. At our clinic, two physicians performed IVF on an alternating
basis: each cycled his patients every other month. In July our doctor would
not be available. We made the calculations accordingly.
The success or failure of our late August/ September
cycle was determined, as it turned out, on the first day of Rosh HaShannah,
the Jewish New Year. What a coincidence. On the birthday of (Adam's) Creation,
we in synagogues everywhere recall three barren women of the Bible: Sarah, Rachel
and especially Hannah (1 Samuel 1-2:11), whose prayer sets forth the holiday's
central themes. God remembered them and they conceived. Infertility overcome
is the founding story of the Days of Awe, which open the harvest season at the
head of the agricultural year. Divine judgment looms over the process of reaping
what one has sowed, an annual reckoning that takes as its sign the mastery of
women's bleeding. We attended a service for young children with our son. The
rabbi initiated a collective celebration of congregants' various accomplishments.
"Families that had a new baby in the past year, come up to the bima (pulpit),"
she called out. Peninnah's piercing words. From the depths of bitterness and
resentment, I poured out my grieving soul. What would be the results of the
blood test I had taken early that morning? In the late afternoon, the IVF coordinator
phoned, "I'm sorry, Marcia, it's negative." My bleeding was not to end.
Some days later, I turned forty-two. "But," said
the mother of Ira's kindergarten friend as we walked home from the local elementary
school, "you look really young; I thought you were in your early thirties."
"Tell that to my ovaries," I cracked. We had insurance coverage for one last
cycle, which we completed to no avail in November/ December. By the end of 1995,
we had been bled dry. Emotionally and physically drained, I had reduced my life
to follicles projected on a screen.
Kindness of Strangers
Library - further reproduction prohibited
An infant, swaddled
and abandoned at a city gate, historiated initial, c. 1360-75, London, British
Library, MS. Royal 6E VII (Omne bonum Encyclopedia), fol. 104.
the five months in which Armand and I organized our lives around our last two
attempts at IVF, we also began seriously to explore adoption as a way to build
our family. I began to ask myself what it was I really wanted, to become pregnant
at all cost or to have a live baby? I began to decouple the two goals,
for it slowly dawned on me that if I endlessly pursued the first, the second
might well go unrealized. To let go of trying to conceive would be tough;1
not to cradle
another baby of my own would be unbearable. Our resources were finite and we
were not getting any younger. I might ultimately have to choose between chasing
a desire to give birth a second time and looking beyond to the fulfilment that,
I knew for me, lay in a lifelong bond between parent and child.
The "dead time" between cycles, built into the
alternating schedule of the physicians in the IVF program at the clinic, allowed
me to prepare the ground for adoption. Individually and as a couple, Armand
and I examined our feelings. Would adoption be right for us? We took a series
of seminars sponsored by FACE (Families Adopting Children Everywhere). I researched
and gathered information. We networked through our many friends, neighbors,
colleagues and relatives who had adopted their children. We did not shirk from
asking ourselves and others hard questions. Investigation of the pragmatic aspects
of adoption and personal reflection on the issues that adoption would raise
in the specific context of our family blended together in an integral learning
We attended "open houses" offered on a regular
basis by many adoption agencies in the Washington Metropolitan area. I compared
the business of ART, a purely capitalistic venture, to the adoption industry,
subject to more government regulation but market-driven nonetheless. Strangely
(or perhaps not), the medical and legal solutions available to infertile couples
seemed keyed into a common index of value, as if professionals in both fields
shared pricing guidelines and mutually adjusted their fees. How else could IVF
and adoption, involving radically dissimilar operations and expertise, so consistently
parallel one another in their cost to the consumer? Clearly the commensurability
of the two services depended, in the final analysis, on the product that we
dreamed they would deliver.
If fertility clinics tended to sell themselves
by pitching statistics in too free-wheeling a manner, agency presentations could
also be problematic. Often, as the highlight of such evenings, newly adoptive
couples displayed their babies and toddlers. Innocently intended to encourage
prospective couples ("yes, there is a baby at the end of the tunnel"), the practice
seemed unnecessarily exploitative. What were we desperate folk supposed to feel?
To what position did the showroom scenario reduce us? Were we shopping? Was
this supposed to assure us that yes, our children too would be healthy and free
of defects? Why did "special needs" cases, if they came up at all, get swept
under the rug, a trivial concern, a rare occurrence?
We could not escape the opportunism to which the
"free-enterprise" treatment of infertility in the United States is prone. Yet,
by the same token, I had to admit that I favored the flexibility which came
with it. We in America could take advantage of more options than allowed, say,
to our European counterparts, who face nearly insurmountable obstacles should
they wish to adopt. ART may indeed be more cheaply available in Europe, historically
obsessed with bloodlines. But should ART fail, tortuous bureaucracies make domestic
adoption practically impossible, where it is not altogether illegal, and immigration
laws, xenophobic in the extreme, severely restrict international adoption.
Armand and I decided on an international adoption,
preferably from China. Collecting the requisite original documents for notarization,
certification and authentication at the county, state and national levels proved
laborious. We needed official papers in French and English from three countries
(Belgium, where Armand was born and raised; Canada, where I happened to be born;
the U.S. where we lived), two states (New York, Maryland), one colony (the District
of Columbia), and God knows how many counties (Westchester, Montgomery, Anne
Arundel, Prince George's etc.). We built a comfortable working relationship
with a small agency in D.C. that respected our wish for as young an infant as
possible and agreed to advocate in China on behalf of our interests. I had originally
considered a larger, better-known agency based in another state, but had been
put off by the director who regarded adoption as an exercise in charity. Confusing
the strict, administrative process in Beijing with God's Will, he expected prospective
couples to accept selflessly and without question whatever awaited them.
He was not alone. Far too many adoption providers,
I discovered, tacitly assume that infertile couples (not unlike lepers in the
twelfth and thirteenth centuries) must be prepared to heed a divine calling
for which their misfortune sets them apart. I did not have a vocation for perpetual
penance, however. Adoption surely ought not be construed as a week-end excursion
to the mall; does that mean infertile couples should be targeted as a venue
for would-be do-gooders? Adoption entails choices - whether or not, for example,
to assume the responsibility of parenting a child with special needs - that
do not arise in giving birth, which presents a fait accompli. Such decisions
belonged to Armand and me, not God. As a patient in the fertility clinic, I
followed protocols to the letter. As a client of an adoption agency, I wanted
to call the shots. Taking an assertive stance felt wonderful.
Best of all, by turning my mind away from my ovaries,
I gave my heart a chance to open and grow. Something was stirring. Had a seed
been planted there? I felt an excitement, enthusiasm, and optimism I never did
during IVF. To accept and trust these feelings was another matter however. My
full and unwavering commitment to adoption evolved only gradually, in fits and
starts, over the course of many months. While completing the legwork for an
international adoption, we concurrently proceeded with the remaining IVF cycles
for which we had insurance coverage. My strategy, unconventional it is true
(and to some adoption agencies unacceptable), was to play one path against the
other in the belief that I could use the tension between the two to my advantage.
Thus I went forward with IVF no longer dreading that, for all the years of hoping
and yearning, I would come out with nothing; my life did not depend on a positive
pregnancy test. By the same token, I contemplated adoption without losing sight
of the authenticity of my own feelings and the integrity of my own needs; I
refused to let the religious or humanitarian agenda of others dictate my course
On the dreary December afternoon that we learned
the negative outcome of our last attempt at IVF, Armand and I (longstanding
afficionados of Chinese cinema) went to see the recently released film of Zhang
Yimou. I had nearly finished processing all the requisite documents and had
received our INS clearance. We resolved to take care of the outstanding details
by the end of the year. A couple of days later I spoke by telephone with an
old friend. I filled her in on the failure of the last cycle.
"We're moving ahead with our plans to adopt a
baby girl from China. I hope we'll have an assignment sometime in the spring
"You can't be serious about going through with
this! Why can't you accept things the way they are? You have a son, he's five
and a half. Time moves on and you're going backwards. It would be different
if you got pregnant..." Her reaction took me by surprise.
"If ART had worked, and I had become pregnant,
you would be happy for me. So I'm not sure I understand...why is it okay for
me to have a baby naturally (of course, my sense of "natural" in matters of
procreation had long ago exploded) but not through adoption, which would be
to "go backwards?" What would be different if I got pregnant? Well I am not
going to get pregnant; for whatever reason, I just can't conceive. Can't I resist
the finality of biology? Did my only recourse lay in ART?"
My friend's incomprehensible position and lack
of support awakened my fighting spirit. I kept replaying the conversation in
my mind until I suddenly became aware of resounding questions that, strange
as it may seem, I had never consciously articulated, let alone attempted to
ponder. Why in fact had I been so invested in becoming pregnant? What was at
stake for me? What does pregnancy mean in our culture? Why is biological motherhood
valued above all? The critical act of framing my personal issues in relation
to unexamined social prescriptions marked a pivotal moment in my embrace of
adoption. I shall forever remain grateful to my friend for bringing me to the
place from which I could finally let go and move on.
A lecture engagement in January 1996 took me to
London and Paris. As I revisited familiar urban vistas, cafes, and boutiques
(irresistible as always), I imagined the pleasure I would derive from future
jaunts around town with my son and daughter. The sailboats at Luxembourg
Gardens, hot chocolate at Angelina's, the bird market, ice cream at Berthillon.
I tried to picture her as a teenager and as a young adult. Would she enjoy peering
into windows at Lolita Lempika's or casing the shops around the Place Victoire
as much as I do? The short months of pregnancy and newborn care seemed a tiny
fragment of the life I wanted to be part of.
Within days of returning home, however, my resolve
weakened inexplicably. My menstrual period threw me into a crisis of conviction.
I had not exhausted all of ART. Maybe if I did a Pergonal or Metrodin IUI cycle
with donor sperm, I could get pregnant. I called the clinic. Could I cycle?
Yes. I would need to come in early the next morning for a baseline ultrasound
of my ovaries, order the donor sperm and get the doctor's prescription for the
fertility drugs. Escape from controlling habits of mind was not as easy as I
had believed. As Michel Foucault had rightly observed, the body is the prisoner
of the soul. As soon as I put down the phone, I felt terrible. Traitor. I was
abandoning the baby whose quickening in my heart I had just recently begun to
feel more and more strongly. Should I really do this cycle? I vacillated. No,
I couldn't go through with it. But wait, the dossier had just gone off to Beijing;
it would take at least three months for the Chinese administration to act on
it. I could still play one path against the other. I woke the following morning,
put myself on automatic pilot and went to the clinic. Later that afternoon,
the nurse phoned to inform me that specimens from the donor I ordered were not
available. "Did we want to select another from the list?" Thank God, a sign!
"No," I answered, "It's too complicated, let's forget it." What relief I felt
as I hung up the phone. Peace at last?
Four weeks went by. At night I lay in bed imagining
the circumstances of my future daughter's birth and subsequent abandonment.
I knew that I would never have more than a general idea of the reasons leading
to her separation from her biological family and integration into ours. Family
planning policies in China and the culturally entrenched need for a male heir
created a devastating mix; was she a second- or third-born daughter? Or perhaps
the birth mother was unwed and had no means of supporting herself and a child?
How soon after the infant's birth would she be abandoned? How would it be done?
When would she be found? Would the birth parents leave a token or a note? How
long would it be before authorities in Beijing assigned us a child and grant
permission to complete the adoption in China?
Far more distressing questions haunted my sleep
and woke me before dawn. Would the birth mother make the decision and carry
it out herself, or would she be unduly pressured? Would her husband or mother-in-law
take the child from her by force? What if, on the contrary, she coldly turned
her back and walked away? (Let's not kid ourselves, this does happen and not
only in China.) I tried to enter the birth mother's state of mind. How could
I possibly fathom her feelings of grief and guilt? Would she suffer abiding
pain and bitterness? Would time bring healing and acceptance? Would she ever
know for certain whether her baby survived? Would she ever wonder about me?
World's apart, we would forever be unknowingly joined, by cruel and arbitrary
imperatives, in the life of a child whom she had conceived and I would raise.
ART, through its fertility drugs, had connected me to the bodies of anonymous
women across time, adoption, through its double bond of love and loss, across
Then my period appeared, and I was again besieged
by the same gnawing doubts as four weeks before. Should I cycle? But what if
I actually did get pregnant? I wouldn't be able to go to China! And if I miscarried
again? I would lose everything. Despite the fact that I was on the verge of
not wanting anymore to become pregnant, I did make the early morning trip to
the clinic for the requisite baseline ultrasound. I got as far as the waiting
room and left. My heart was not there.... it belonged to a little girl who,
though I did not know it at the time, had in truth been born that very day.
I never returned to the clinic. I had enough of ART.
The planets had shifted their alignment in my
favor and a new, brighter star rose on the horizon. Spring had come to Washington.
As I walked back and forth between our home and the Friendship Heights Metro
station, I passed a large house on Western Avenue that had recently been sold
and spruced up. Plaques reading "Mother Theresa's Infant Home" and "Missionaries
of Charity" were posted on either side of the front door. Had a foundling hospital
been opened here? Curious, I decided to bring over the maternity clothes I had
been saving all these years but would now no longer be needing. A young Indian
nun, clad in the white cotton sari of the order, greeted me at the door and
invited me into the foyer as I explained my purpose.
"Could you, I mean your organization, use some
maternity clothes; they are in excellent condition?"
"Oh yes, we have someone here now," she replied.
I asked her about their mission in Chevy Chase D.C.
"This house is for pregnant girls, women, who
can't stay with their families, which are hostile to them, and so have nowhere
to go. We support them through the pregnancy."
"Do some choose to put their babies up for adoption?"
"All the babies are adopted through Catholic Charities,"
and she proceeded to enumerate the sectarian requirements for adoptive couples.
"But what happens if someone decides during the
course of pregnancy that she wants to keep her baby..."
"Well, then she has to leave."
"Pardon me?" Maybe I hadn't heard correctly...
"All the women who stay here have to put their
babies up for adoption."
Dumbfounded, I handed her the bag of clothes and
bid goodby. Quite a peculiar profession of charity, I thought; something seemed,
well, not quite kosher (or, as the French say, "pas très catholique").
Adoption through Catholic Charities is as expensive as through any other non-profit
venue; adoptive couples pay the birth mother's medical expenses, costs associated
with her pregnancy (like maternity clothes and counseling), agency social workers
for their home study, and all the legal fees involved. The overhead for the
one or two residents of the Chevy Chase "shelter" was for all intents and purposes
absorbed by adoptive couples. The women needing the most support were, presumably,
those who wanted to parent in the face of disapproving, angry families. I wondered
where they were supposed to go: return home? (The nun neglected to tell me,
I have since learned, that the Missionaries of Charity operate another house
in the District for women who do indeed choose to keep their babies. The two
groups of expectant mothers are therefore segregated, a policy that, it seems
reasonable to speculate, prevents the decisions of some from impinging on the
resolve of others.)
Where exactly did charity come into the picture?
In the ritual gesture I had just performed, of course. Did I do any differently
than the abbot of Cluny who once a year washed the feet of twelve paupers in
humble imitation of Christ serving the apostles? The religious orders distributed
food and clothing to the poor at funerals and anniversaries on behalf of deceased
benefactors; it was their job to convert the material wealth of rich donors
into heavenly treasure for the same. Money-laundering, medieval style. My modern
feminist re-staging of St. Martin, or St. Giles, or St. Francis clothing the
beggar - the archetypal demonstration of mercy in medieval hagiography
- had come right off the painted walls of the churches I studied. Ah, so that's
how images work.
Giles clothing a beggar, wall painting c. 1200, in the crypt of the Collegiate
Church of Saint-Aignan-sur-Cher.
Whether my maternity clothes provided needed assistance
to anyone is doubtful. The act of giving them away, however, had important symbolic
value. It represented a definitive break with my procreative body and put closure
on the reproductive phase of my life. (Similarly, in the saint's life, the gift
of a garment signifies more than an ascetic renunciation of worldly goods and
carnal pleasures; it epitomizes the shedding of high social rank and all fleshly
ties to kin, including the responsibility for dynastic propagation.) By the
end of June 1996, I had lost track of my menstrual cycle: I had forgotten the
date of my last period, and was surprised when it came. For the first time in
over three years, I was free.
I owe the section heading to John Boswell, The Kindness of Strangers.
The Abandonment of Children in Western Europe from Late Antiquity to the Renaissance
(New York, 1988).
Fig. 8. Lineage of Adam and Eve, miniature painted
by Stephanus Garsia Placidus, third-quarter of the eleventh century, Paris, Bibliotheque
Nationale, MS. lat 8878 (Beatus of St. Sever), fol. 5v.
the sultry Monday morning of September 2nd, Armand and I look out
from our hotel window at the futuristic city-scape of Shanghai. We would soon
meet our daughter for the first time. According to official records, she was
found in a suburb far to the north of the city on March 6th ; a birth
date of March 3rd is presumed. Orphanage staff had named her Wang
(the patronym assigned to all their 1996 foundlings) Li Bei; her characters
literally mean "energy treasure." Since receiving our assignment some two weeks
before, I have been spinning a mental tapestry of prized and priceless qualities.
Sketchy outlines of a spirited temperament emerge in the foreground: dynamism,
vibrant power, vitality in vast abundance. I stare at a black and white image
of her in a photocopy of a fax transmission made from a photocopy of an undated
photograph. I try to glean the proverbial thousand words. A lifetime of deciphering
images has not equipped me to see through a glass this darkly. I think of Ira,
barely six, now with my parents in New York. He had understood. When I first
brought home the documents from the agency and showed Ira the picture of his
new sister, he kissed it. Still, I have no clue.
Everything has led up to this day, but when the
interpreter from the Shanghai Adoption Administration accompanies us to the
Children's Welfare Institute on Pu Yu Road I feel unprepared. Into the garden
courtyard, through the double doors of the building, up the stairs and down
the hall to a small living room where Armand and I, petrified with anxiety,
wait in silence. The director of the orphanage brings our six-month old baby
and places her in my arms. The moment for which I had ached is now. Language
ceases. My body takes over; it alone knows what to do. I am in the midst of
a purely physical event, like giving birth or being born. Gradually my mind
registers the sounds of applause and picture-taking. Armand holds the baby.
The director wants to know what we will call her. "Gabrielle Libei," I stammer.
"Gabrielle Libei Rose," Armand adds, "after my mother." Both our children now
bore Americanized forms of the Yiddish names of Armand's parents, survivors
of Auschwitz and Ravensbruck, who had passed away only shortly before Ira's
birth. The handing down of names from the dead to the living signaled the continuity
of the generations. As the director assumed custody of the baby for the last
time, we brought our visit to a close. The next morning we would begin finalizing
On the way back to our hotel, the interpreter
laid out the week's schedule. Was it 4:00 or 5:00 p.m. already? Armand and I
strolled along the Bund by the Huangpu River. Kites and balloons danced overhead,
loaded barges crept along. Behind us stood nineteenth-century buildings that
had belonged to the foreign concessions during the period of Western colonial
domination. Ahead in the distance, the Pudong TV and Radio Tower soared into
the sky to reclaim the city. Neither one of us could speak about our experience
at the orphanage. We were too stunned.
Less than twenty-four hours later we were playing
with the baby in the privacy of our hotel room. Gabrielle laughed a full belly
laugh that rolled over her plump little body and flooded mine. In that instant
of recognition, I became hers forever. Something in the ring of her laughter,
her sparkling eyes and the grasp of her tiny hand curled round my finger told
me that I had found all I had been searching for. She was my very own. Moment
by moment, day by day, physical intimacy sealed our deepening attachment. I
got to know my baby not in a hospital maternity ward but while exploring the
bustle of Shanghai and the gardens of Suzhou. Everywhere people responded to
her loveliness and congratulated us. I was especially moved by how much the
staff of the Shanghai Adoption Administration and Children's Welfare Institute
cared for her. They showered her with beautiful gifts - mementos of the city
(including a miniature crystal replica of the TV Tower), a childhood memory
album, a cup emblazoned with her baby picture. When finally we flew home, it
was Rosh HaShannah. Gabrielle lay sleeping against my chest, and sometimes suckled
the tip of my nose. I tasted the sweetness of the New Year. Such great good
fortune I had not imagined could be mine.
I watch my children grow, delighting in the person
each is. I thrill to both. To say more would be to trivialize the somatic intensity
of my passion for them. That passion springs not from conception and birthing,
nor from sharing a gene pool, but from the maternal relationship to which I
assent and which I renew every waking and sleeping minute until it is time for
my name to be passed on. The years I spent consumed with and by reproductive
technologies seem now strangely unreal. How could I have been so driven? To
what purpose? Yet, I wonder... Perhaps the experience of ART helped me to see
beyond nature. Needles, probes and monitors demystified procreation, revealing
it for the mechanics that it is. The real story lies in how humans translate
the single mode of generation common to the species, a biological phenomenon,
into the culturally diverse structures that make family a social artifact.
Zodiac Man, miniature from the Wellcome Apocalypse, fol. 4 1 r.