All Reproduction Is Assisted
August 14, 2018
With Responses From
Feminism needs better reproductive strategies.
According to the New York papers, the first artificial womb was discovered—not invented—on the night of February 24, 1894, in a “queer little shop” on East Twenty-Sixth Street. The shop’s owner, a reclusive scientist named William Robinson, was roused from sleep by the personal physician of E. Clarence Haight, a Madison Avenue millionaire whose wife had died in childbirth and whose daughter had been born weighing less than two pounds. Desperate to save the baby, the physician begged Robinson to give him something to keep her warm. Robinson hurried to the back of his shop and emerged with what he called his “artificial womb”: a black steamer trunk with a sliding window cut into the lid, a cruder version of the infant incubators soon to debut at the Great Industrial Exposition of Berlin in 1896. “The Little Tot Has Been Nearly Three Weeks in the Artificial Womb, and the Prospects Are That It Will Live to Begin Life in the Normal Way About Three Weeks More,” reported the Daily News on March 16.
The artificial womb lent itself first to speculative fiction, then to scientific research, and finally to feminist theory.
Like many advances in reproductive technology, the artificial womb lent itself first to speculative fiction, then to scientific research, and finally to feminist theory. In the early decades of the twentieth century, the artificial womb appeared in hundreds of pulpy newspaper stories and dystopian novels, including Brave New World (1932), in which ectogenesis—the development of embryos outside the uterus—enables the mass production of human beings. In 1952 the New York State Medical Society started designing an artificial womb that doctors imagined as a “goldfish bowl filled with chemical fluids,” connected to a life-support machine, that would “do the work of” a human mother. They did not succeed, but in 1962, doctors at the Royal Caroline Hospital in Sweden announced that they had, unveiling their artificial womb that “brought back to life babies born dead” and, more horrifying still, “babies legally aborted from their mothers.” This was the same year that expectant mother Sherri Finkbine learned that the child she was carrying would likely be born with severe deformities; after a highly publicized request for an abortion was denied by her home state of Arizona, she flew to Sweden—to the same hospital where the artificial womb was being housed—to terminate her pregnancy. In the face of growing outrage over restrictive abortion laws, the artificial womb’s promise of creating life without any woman’s consent began to look increasingly dystopian. By the mid-1960s, research into artificial wombs sputtered and then died for a time.
It was not until 1970 that radical feminist Shulamith Firestone imagined a future in which technologies of artificial insemination, test-tube fertilization, artificial placentas, and parthenogenesis (“virgin birth,” she calls it in her manifesto The Dialectic of Sex) would liberate women from reproductive work. In the right hands, Firestone insisted, artificial wombs and other reproductive technologies could dismantle hetero-patriarchal sex roles. They could make the grinding work of pregnancy—nausea and exhaustion, labor and delivery, postnatal recovery and postpartum depression, nursing and around-the-clock childcare—just one option among many for how to create and care for children. The problem, as Firestone saw it, was that research on reproductive technologies was performed only incidentally in the interests of women. The development of the artificial womb, for instance, had to be justified as a lifesaving device for premature babies and not as a laborsaving device for women who simply did not want to do the work of gestation. “Until the decision not to have children or to have them by artificial means is as legitimate as traditional childbearing, women are as good as forced into their female roles,” she warned.
Firestone’s enthusiasm for new reproductive technologies was met with incredulity, scorn, and outrage among many of her fellow radical feminists. Some criticized her techno-utopian naïveté; others doubled down on the “natural” as the feminist antithesis to technological dehumanization. In The Dialectic of Sex, Firestone dismisses the natural as part of a “reactionary hippie-Rousseauean Return-to-Nature,” a dangerous ideology that transfigures discomfort and risk into an essential female experience, one women can harness as a source of personal empowerment and political emancipation. Firestone mocks the mystifying maneuvers of the natural in a brief, funny, and (to my mind) fairly accurate thought experiment on what it feels like to push a baby out of your vagina.
Like shitting a pumpkin, a friend of mine told me when I inquired about the Great-Experience-You’re-Missing. What’s-wrong-with-shitting-shitting-can-be-fun says the School of Great Experience. It hurts, she says. What’s-wrong-with-a-little-pain-as-long-as-it-doesn’t-kill-you? answers the School. It is boring, she says. Pain-can-be-interesting-as-an-experience says the School. Isn’t that a rather high price to pay for interesting experience? she says. But-look-you-get-a-reward, says the School: a-baby-all-your-own-to-fuck-up-as-you-please. Well that’s something, she says. But how do I know it will be male like you?
It is hardly surprising that the School of Great Experience turns out to be male, and the imperative to reproduce joyfully a persistent strain of internalized misogyny masquerading as liberation. The idea that women were made to shoulder the burdens of physical and social reproduction without complaint or recompense—that they were made to feel pain happily, creatively, and disproportionately—fails as the starting point for an emancipatory politics.
Nonetheless the discourse of the natural has continued to grow, invading mainstream debates about reproduction with an exclusionary and consumerist logic that has only intensified since Firestone published The Dialectic of Sex. “Natural childbirth,” “natural breastfeeding,” “natural parenting,” “nature-based schooling”—these practices preoccupy women who have the dumb luck of procreating in the Global North and the privilege of pretending they are procreating “in Eden,” as one manufacturer of “all-natural” prenatal supplements promises on the side of its plastic pill bottle. There are hundreds of thousands of videos online in which attractive, mostly white women stand in well-appointed apartments and promote “superfoods” for boosting fertility, $500 hypnosis tutorials, and expensive tubs for guaranteeing a “beautiful water birth.” Some offer videos of the ecstatic DIY births of their own children. (No video is more than 25 minutes long.) One blogger soothes her anxious viewers by reciting the transcendent vision of a shared “female biology” in Adrienne Rich’s Of Woman Born (1976): “the diffuse, intense sensuality radiating from the clitoris, breasts, uterus, vagina; the lunar cycles of menstruation; the gestation and fruition of life which can take place in the female body.”
The ‘natural’ makes sexual reproduction look like an autonomous, unassisted act that gives certain women privileged knowledge of maternity, kinship, and care.
It is easy to poke fun at the natural in its most obvious, dated, and ironic manifestations; this is the natural as a lifestyle choice rather than a political problem. It is harder to see how its pre-technological imagination, even in its more innocuous or understated forms—promoting apps that help women plot their most fertile days, attributing maternal bonding to hormones, insisting that “breast is best,” ignoring the existence of non-heterosexual reproduction—occludes the many individuals who carry or care for children. They include lesbians, trans people, and gender non-conforming people, as well as single women, women who cannot conceive or carry, women who have had miscarriages, adoptive parents, mothers of premature babies, and surrogates. As Donna Haraway points out in “A Cyborg Manifesto” (1984), the idiom of the natural makes sexual reproduction look like the only option rather than one kind of reproductive strategy, underwritten by the apparent truism that sex and sex roles are “organic aspects of natural objects.” At the same time, it also makes sexual reproduction look like an autonomous, unassisted act that gives certain women privileged (and often tormented) knowledge of how maternity, kinship, and care work.
Yet feminism has not done a good enough job articulating what alternate strategies of reprodction may be. In part this is a problem of thought, in part a problem of genre. From Firestone to Haraway to Laboria Cuboniks (an anti-naturalist, gender-abolitionist collective of “daughters of Haraway”), the manifestos issued by feminists often call for universal access to reproductive technologies, biotechnical interventions, hormones, and “endocrinological knowhow” (including about gender hacking). What necessarily gets lost in these manifestos’ universalizing are the differences in how particular technologies calibrate particular peoples’ experiences of reproduction and care; how they bring to light vast structural inequalities of time, money, kinship, healthcare, legal protections, and bodily integrity; and how, when these inequalities become palpable enough, the desire to reproduce naturally can undercut a progressive politics of reproduction.
To appreciate all this—and to figure out what to do about it—we need narrative.
• • •
S is thirty-four years old and has recently separated from her partner. She lives in San Francisco and works at a biotech named one of the “100 Best Places to Work for Women” by Forbes. S’s company offers its employees many perks to help maintain a “good work-life balance”—employee sports teams, carwash and bicycle repair facilities, on-site haircuts and spa treatments—but the perk I am interested in is the $20,000 lifetime medical cap for elective oocyte cryopreservation, better known as “egg freezing.”
There is an unforgiving choreography to freezing your eggs. You measure time not by the winding down of an imaginary biological clock, but by the nightly recurrence of needles, the daily rhythm of blood screenings, and the counting of follicles.
When Facebook, Apple, and Yahoo all announced in 2015 that they would start offering an “expanded suite of family benefits,” it was egg freezing—not on-site childcare or adoption assistance—that captured the public’s attention as “tech’s hottest new perk.” It was also egg freezing that attracted criticism for its classist and anti-feminist politics, its shoddy scientific underpinnings, and its antagonism to a natural timeline of motherhood. “Freezing your eggs might seem like a cool way to defer motherhood,” wrote Suzanne McGee in the Guardian. “When you’re ready, just thaw ’em out, fertilize ’em, implant ’em and bingo—you’re a mom!” McGee’s contempt was directed not at the companies but at the women who would opt to freeze their eggs—women whose choices, she implied, could only be explained by their folksy ignorance of just how superior natural conception is. As was the case with many debates over reproduction, what started out as a critique of capitalism quickly became a critique of women’s choices.
S, who was involved with designing and instituting the company’s egg freezing policy, dismisses McGee’s argument as “ridiculous” and thinks critics such as McGee are ignorant of what is involved in egg freezing at a corporate and individual level. Until very recently, S tells me, California state law mandated that the company’s private insurance provider cover infertility treatments regardless of gender or sexual orientation. Many insurers, however, continued to make coverage contingent on a medical infertility diagnosis: a doctor had to confirm that a couple had not achieved “clinically or biochemically recognizable pregnancy after 12 months of intercourse.” S’s company had a large and active LGBT association that had repeatedly pointed out to management that it was impossible for gay, lesbian, and trans employees to procure a diagnosis of infertility. They wanted the company to step in where the state could not, rectifying the discrimination that affected them directly. It is not clear how long or how hard the association pushed, but in 2015 Google and LinkedIn announced that they would cover two rounds of elective egg freezing for all employees and S’s company followed suit to stay competitive.
Her frozen eggs are a happy product of Silicon Valley’s marriage of capitalist competition and social justice; she sees no reason to apologize for this, and she grows defensive when I ask. She tells me she has a half-dozen friends who have frozen their eggs and have paid for it out of pocket, cashing out savings accounts, borrowing money from family and friends, or taking on thousands of dollars of credit card debt to cover it. “Cover what?” I ask, and I am embarrassed to realize that I have very little idea of what the treatment entails.
S’s explanation is swift and precise. Exactly one month before the treatment starts, she tells me, you go to the UCSF Center for Reproductive Health—a well-oiled machine, S explains, where patients are dispatched quickly and brusquely and you rarely see the same doctor twice. The doctor checks your uterus, uterine cavity, and ovaries with a transvaginal ultrasound. She judges where you are in your menstrual cycle by the size of your follicles, the round fluid-filled sacs that house the eggs the treatment will target. If you are on birth control, now is when you stop taking your pills; if you have an IUD, you make an appointment to have it removed. If all you are doing is having your eggs frozen, you attend the first half of a class on self-injections; the second half is for women who are ready to have the embryos fertilized and implanted immediately after retrieval, women who are ready to become mothers. At the class, you learn how to properly wash, dry, and glove your hands; how to disinfect bottles of hormones with evocative names such as Gonal-F, Menopur, and Lupron; how to prepare the needles you will plunge into your stomach every night at exactly the same time, aiming for the soft flesh between your abdominal muscles; how to prepare yourself for the bruises, the weight gain, the mood swings, the exhaustion, the risk of ovarian swelling and pain (a condition known as ovarian hyperstimulation syndrome or OHSS), and—although S does not say it, I can hear the nervousness on the steely edge of her voice—the possibility that the procedure will fail.
Once you begin the injections, she continues, you return to the clinic every other day for an ultrasound and a blood draw. Most of the women are there with partners—it is still unusual to see a woman there by herself—and S, like her friends and colleagues, is sensitive to the idea that she is not having a “normal baby” the “normal” or “natural way.” They fear that bringing a child into the world with the help of sophisticated technology places her in a compromised class of mothers. I am struck by how many of the women I speak to accidentally refer to ART as “artificial reproductive technology” rather than “assisted reproductive technology,” the crude nature/culture dichotomy announcing itself with a slip of the tongue.
To reproduce is always to begin to mark time according to a series of technologically mediated discoveries about your body: four weeks before a woman’s hCG levels are high enough to bind to the man-made antibodies in the pigment on a pregnancy test; twenty weeks before a sonogram can check for anatomical irregularities and determine the sex of your child; twenty-eight weeks to viability, though only then with the help of breathing tubes, catheters, incubators. But time changes when the technologies involved in reproduction change. There is an unforgiving choreography to freezing your eggs, S tells me. You begin to measure the days and the months not by the winding down of an imaginary biological clock, but by the nightly recurrence of needles prepared and disposed; the daily rhythm of blood drawn and screened, follicles measured and counted. Every afternoon between the hours of 1:00 and 2:00, you stare at your phone, hoping the clinic’s number does not flash, hoping an automated voice does not inform you that there is a problem with your hormone levels and your eggs—or your body—are in jeopardy. Every night you inject yourself at 9:00 sharp and fall asleep an hour later.
You begin to count the passing days by what you are not allowed to do during them. You cannot smoke. You are encouraged not to drink. You cannot exercise for fear of ovarian torsion, a twisting of the ovary that cuts off its blood flow, inducing severe pain and vomiting. You cannot under any circumstances have sex. The risk of fertilization is far too great and, ironically, nothing could be less desirable or more dangerous than getting pregnant. S’s physician tells her that, if she is lucky, there are upward of twenty-five eggs growing in her ovaries, and he pauses to let the horror of accidental fertilization sink in. The compression of reproductive time in the present is accompanied by a corresponding expansion of reproductive scale: from one unknown offspring to twenty-five forking paths into parenthood, from one unknown future to a multiplicity of futurities.
S has greater control over her reproductive future than ever before, yet she seems even more shackled to the specter of the natural now that the choice is hers to make.
Toward the end of S’s treatment, the rhythm of testing and scanning picks up; the measurement of time becomes more incremental and more precise. Now she goes to the clinic every day for an ultrasound. The doctors track her follicles closely to predict the day they can retrieve the maximum number of eggs. Optimization is key: if they perform the retrieval too early, they will not get as many mature eggs as they would like; if they wait too long, some of the eggs will get too big and self-destruct. They set a day and, exactly seventy-two hours before, S injects herself with a “trigger shot,” a hormonal agent that induces “final follicular maturation.” Then she waits. There is nothing left for her to do but arrive at the clinic, submit to anesthesia, and sleep while the doctor passes a needle through the top of her vagina, into her ovaries, and aspirates the eggs from her body.
S undergoes the treatment twice. Her doctor retrieves twenty-five eggs in total, fifteen of which are viable. Fifteen months’ worth of genetic material produced and harvested in only three months is a pretty decent yield, her doctor assures her, and anyway, she has reached her medical cap on elective treatments after two rounds. She calls these fifteen eggs her “insurance policy,” a strategy for hedging against an unknowable future. They allow her to mute the questions she no longer wants to think about: Will I have a long-term partner? Will I have a hard time getting and staying pregnant? Will I deliver a healthy baby?
A lot of people ask her why she doesn’t just have the baby. Before there was a timeline, they insist. Now there is none. “The eggs should be liberating,” she sighs, but it is clear both to her and to me that her internalized sense of what is normal and what is not—what kind of family arrangement she desires—is achingly out of sync with the emancipatory promise of technology. She has greater control over her reproductive future than ever before, yet she seems even more shackled to the specter of the natural now that the choice is hers to make.
• • •
B, a forty-year-old writer and university lecturer, waits for the next installment of her book advance so she can pay off the debts she has incurred for her in vitro fertilization (IVF) treatments. Unlike S, whose egg freezing was fully covered by her employer, B’s IVF was financed through small loans from friends and colleagues. The same women who lent her money also picked her up from the doctor’s office after her retrievals. They covered her classes when the pain from the hormonal therapy became debilitating, when lying flat was the only position that made sense. When she miscarried after her first and only intrauterine insemination (IUI), they were the only women she told, until one day she found the private knowledge of her pain too onerous. She wrote a post on Facebook about what she had endured: hormones that were poorly calibrated, a humiliating insemination, a miscarriage. “For the possibility of romantic love, I won’t even take one evening off from TV,” she concluded. “For the possibility of this other kind of love, I will apparently do everything.”
People keep assuring B that she is in control of the process. But there are constraints—biological, material, emotional, financial—guiding and shaping her choices.
There is a peculiar invisibility to undergoing IVF as a single person. The stories we read and the pictures we see on clinic websites are almost always of couples: two handsome people—a man and a woman, two men, two women—beam as they open their arms to a happy, impossibly healthy-looking child, preparing to enclose her in the safe harbor of a clearly defined family. We look at couples without children and wonder: Do they want them? Are they having trouble? But it does not occur to people when they speak to a single woman that she too might be trying to have a child—or that she might have lost one.
When B miscarried, she was in the middle of a job interview. She knew what was happening to her, but she had no idea how to express it. She spoke and smiled through the pain as women so often do; she got the job. Yet the intensity of her loss was at odds with the invisibility of her desire to have a child. Even when we talk, she seems unsure how much grief she is entitled to voice. “It was physically and emotionally horrible in a way that feels disproportionate,” she tells me. “But my doctor kept telling me that it was a nearly universal experience for people with my kind of reproductive system.”
B comes from a family that she describes as “hyperfertile”: she is one of six children and in her family, it is far more likely that someone will get pregnant by accident than struggle to conceive. When she went in for her first evaluation, her follicle count was unusually high for her age. The doctors who saw her kept smiling and complimenting her ovaries. “Look at those follicles!” one exclaimed. “Look at them just doing their thing!”
She was proud to hear that having children might be something she was made to do well. She had always known she wanted to care for others, but she had never felt a strong biological imperative to give birth or have a child who was genetically related to her. She considered adopting at first. She went to a ten-week training for potential foster parents, but she soon learned that the important part of becoming a foster parent was guarding yourself against attachment. In the state where B lives, parents whose children are placed in foster care have a year to demonstrate that they are fit to care for their children. As the foster parent, you are instructed to root for the parents. The training teaches you how to create barriers to love, how to preemptively detach and grieve the loss of a child who, you are told repeatedly, was never yours to begin with. B did not want her inaugural experience of parenting to be a year-long rehearsal for losing and letting go.
Unlike S, B’s insemination took place at a teaching hospital with medical students crowded around her, watching and taking notes and whispering. B has a retroverted uterus—the top of it tips backward rather than forward—and this confused the young male resident who was responsible for performing the IUI. After two unsuccessful attempts at placing the sperm inside B, he grew flustered. “What the hell is going on here?” he kept muttering in B’s direction, until the supervising ob-gyn, a woman, intervened and inseminated B on the first try. B got pregnant and, though she lost the pregnancy, though the world seemed to shrink from her obliterated, exhausted body and she from it, her doctor was eager to try again. “We could totally just keep doing IUI, and it will probably work out,” she prompted B, who could not bear the idea of it. If she was going to get pregnant again, she wanted it to happen outside her body first where the viability of embryo could be determined in advance of implantation; she wanted gradual attrition—the calculated paring down of her eggs and embryos after tests and screens—not sudden and singular loss.
She opted for IVF and, after only a week of injections, looked in the mirror to find an altered version of herself staring back: a woman who had gained fourteen pounds, who looked like she was already halfway through a pregnancy. After two weeks, her heart raced when she climbed the stairs to her apartment. She could feel her ovaries growing suddenly alert to gravity, tugging at her and weighing down her steps. She imagined the pain as a prize for how well her doctor said her body was responding to the hormone treatments, reassuring her that all the side effects were “normal,” even if normal felt unsafe.
‘For the possibility of romantic love, I won’t even take one evening off from TV,’ B concluded after her intrauterine insemination ended in miscarriage. ‘For the possibility of this other kind of love, I will apparently do everything.’
The next ultrasound showed that she was on the verge of ovarian hyperstimulation syndrome. There was an alarming amount of fluid splashing around inside her ovaries and now her heart beat so fast when she walked that she worried she might have a heart attack. Her doctor prescribed her a different trigger shot, one that she warned would substantially reduce B’s overall egg haul. It struck her as an especially cruel irony: her acute responsiveness to the treatment meant that viable eggs would have to be sacrificed to keep her healthy when all along she had known that something was wrong, that the hormones had pushed her body into alien territory.
A different male resident performed the retrieval and, even through the haze of fentanyl, it hurt. He did not seem bothered, but the doctor supervising him watched B’s face closely and, after a moment, asked if she wanted to hold hands. The women’s fingers stayed intertwined the entire time the resident retrieved B’s eggs—twenty-two in all. Later B would learn that only eleven fertilized into embryos; only six made it through the preimplantation genetic screening; and only three turned out to be free of any chromosomal abnormalities. There was a roughly 50 percent chance that one of the three embryos would implant successfully. When the doctor called with the results of the genetic screen, she asked B if she wanted to know the sexes of her embryos. “I have two girls and a boy,” B told me, her voice swelling with pride.
When we spoke, B was still trying to decide when to do her implantation. She was just about to switch jobs, and her new employer would not offer her paid maternity leave until she had been in her position for at least a year. As a single parent, she needed paid leave; she could not risk delivering a baby even one day before the twelve-month mark. She could see the years piling on, pushing her past forty to forty-one, forty-two, forty-three—and even further if she wanted to have more than one child.
I ask her what she will do. She sighs and says, “I just have to move forward, whatever that will mean.” People keep assuring her that she is in control of the process. But there are constraints—biological, material, emotional, financial—guiding and shaping her choices, and these have attuned her to a new type of “physical impossibility,” an added layer of responsibility she must bear in navigating a world of unknowns. “It feels so wrong,” she tells me. “But I guess that’s what normal feels like.”
• • •
N, a graduate student, and K, a photographer, always assumed they would both get pregnant, perhaps even at the same time, and have more than one child. It seemed both fair and efficient to divide the labor. Yet N, who has had chronic medical issues since she was a teenager, was told by her doctor that carrying a pregnancy would be far too dangerous for her. The fertility specialist they visited in 2010 found her frustration amusing. “Why don’t you just use her?” he joked with N, pointing at K. “There are two uteruses in this relationship. I don’t see what the problem is.”
In 2011 K had a sudden and severe uterine hemorrhage and was hospitalized for seven days. K’s doctors presented her and N with the option of an emergency hysterectomy—the safest option, they insisted, even if it meant that neither of them could ever become pregnant, making surrogacy or adoption their only options for having a family. They sought the advice of a high-risk obstetrician who insisted that the couple should not reproduce biologically. “You’re too overweight,” she told K, adding that because K is prone to depression and anxiety, she could pass her “mental illness” on to their children. The women were crushed, then furious, then motivated to act without their doctors’ blessings.
N and K tried IUI five times. Five times, the resident who performed the insemination assumed that N and K were friends or sisters and ignored N as he inseminated K.
For some time, K and N had serious misgivings about the political valences of their decision. As a scholar of queer theory and disability studies, N had read a half-dozen feminist books on lesbian conception from the 1980s and ’90s, many of which refused to acknowledge the medical or technological dimension of fertility except to critique it. “We don’t have fertility problems, we just need sperm,” N jokes. She was tortured by the argument for some time, wondering if she and K should avoid the hospital’s sperm bank and ask a friend to donate informally. But the legal complications of a known donor were terrifying: paternity claims, visitation rights, a child dragged in and out of family court. They decided to use the sperm bank.
As a lesbian who had never had any sexual contact with a man, K found the idea of sperm insertion uncanny—a little bit funny, even. She discovered that she had expected some flicker of romance or magic to accompany the lead up to conception. But everything in the clinic conspired against it: the sterility of the exam room, the metallic cool of the speculum, the resident who barely knew where her cervix was when he examined her during her painful preliminary visit.
N sat on a chair next to her and listened as the resident explained the process to K.
“In three days, we’re going to do the insemination,” he said. “So we’re going to need a sample from your partner.”
The women exchanged confused looks. What sample could he possibly need? Blood? Urine? The resident persisted, explaining that they would collect the sample and store it until the insemination. Before the women could ask him to explain, he left the room. It was only after they had left the clinic that they realized he had assumed N was K’s friend, there in place of her husband, whom he must have believed was at work or too embarrassed to come.
N and K tried IUI five times. Five times, the resident who performed the insemination assumed that N and K were friends or sisters and ignored N as he inseminated K. Five times, a single pink line appeared on the pregnancy test: “not pregnant.” N wondered if the persistent negatives were a sign that they were not meant to have a child; K, who had grown up religious, thought that perhaps God was telling them that they did not deserve one. Neither of the women was used to beating back the internalized homophobia that had suddenly taken root in their minds, transforming the decision to have children into a referendum on their life together.
Nor were they used to the unsolicited advice they would receive from people who barely knew them or their story. “Why don’t you just adopt?” suggested more than one acquaintance—as if adoption were easier or faster or less emotionally fraught than trying to have a child through IVF. “People do not run up to pregnant women and ask, ‘Why didn’t you just adopt?’” N mimics, strained with impatience and injustice. “We cannot have a biological child that is both of ours,” she tells me.
‘Why don’t you just adopt?’ suggested more than one acquaintance—as if adoption were easier or faster or less emotionally fraught than trying to have a child through IVF.
After the IUIs failed, they proceeded to IVF, borrowing money from N’s family to pay for K’s therapies and procedures. (N’s brother and sister-in-law, who were undergoing IVF at the same time, were fully covered by their insurance.) K was taken off her antidepressants and put on Lupron, which suppresses menstruation. N felt guilty that it was K, and not her, who had to endure the anxiety and sleeplessness caused by the medication changes. To reassure themselves that everything they were experiencing was normal, K and N joined several online groups for women who were TTC: “Trying to Conceive.” There was an Instagram community of over a million people that they found through hashtags such as #ttc, #ttccommunity, and #ttcsisters. The photos were posted by mostly straight, mostly white women, and they included inspirational quotes (“Stay patient and trust your journey”), jokes (“Aunt Flo: the most hated bitch in TTC”), prominent baby bumps, and successful #ivfbabies and #iuibabies in their mothers’ arms. K also joined a smaller queer TTC Facebook group of 1,200 members, almost exclusively lesbians who liked to joke about the male doctors who mistook their partners for friends or sisters. There was a group specific to K’s fertility clinic, which she joined but tried to participate in as little as possible. Most of the women in it were in the “shit-out-of-luck phase,” she told me. Many had maxed out their egg retrievals—the medical cap is four—and were running out of embryos to implant. K found the community claustrophobic, a place where women spun their wheels, madly projecting their grief onto strangers.
When I spoke to N and K, they were ten days away from their fifth IVF transfer. After two miscarriages, they had decided to have their remaining embryos genetically tested. Of the twenty-eight eggs that the doctors had extracted from K in her last retrieval, only five had fertilized, and only one was viable. They found out the sex of the embryo and it was, for N, a “total mindfuck.” “Knowing the gender of this embryo in a freezer has made it seem more real to me, to us,” she says, and I suspect her conflation of sex and gender is deliberative. All her schooling had trained her to understand that having a gender is not what makes people real, but now, somehow, it did.
• • •
Some days after I speak with N, she sends me a New York Times op-ed from April of this year titled “Adventures in Transgender Fertility,” by Joanne Spataro. The article details how Spataro’s fiancée, a trans woman named Lara, has been gradually decreasing her estrogen dosage so that she and Spataro can have a child “the way fertile cisgender people do: They simply couple up, and boom—a child is born.” Spataro’s writing evinces palpable discomfort around biological matters: she describes only the most superficial effects of estrogen withdrawal (weight gain, hair growth); she never uses the words “sperm” or “sex.” “If things worked out, I could have a biological child with the woman I love, as long as I had eggs and she had the other half of the ingredients,” Spataro writes. “And she did—sort of. But it hasn’t been straightforward.”
The indirectness of Spataro’s style surprised me at first, especially given the article’s broader aims of urging people in the trans community to speak more freely about fertility and to educate trans teenagers about preserving their fertility before transitioning. These social imperatives seem at odds with Spataro’s aching desire to create and inhabit a biological family. It is a desire she suppresses in her terminology—no sex, no sperm—but which she embraces in her imaginative descriptions of the child she and Lara might one day have. “The thought of not being able to have my own biological child could make me tear up in front of my happily childless friends,” she writes. Of Lara, she observes: “She’d admit that all she wanted was to have a child together, a mixture of us two in human form, like two kinds of sand blended in a clear glass. A symbol of love who could walk around, crack jokes, do somersaults and go to college.”
The fantasy of having a child becomes warped when its fulfillment is precluded not by individual bad luck, but by vast structural inequalities among women.
The vitriol of the online responses to Spataro’s piece made me better understand why suppressing the sexual-biological dimension in her article might have been a strategic choice, betrayed by the New York Times in its promotional tweets that described Spataro and her partner as struggling to have a child the “old-fashioned way.” “The sexual permutations have become overwhelming,” complained Gary. “We’re talking about a man and a woman having a baby, yes?” asked Charlie. “Trying to portray this as a lesbian experience is ridiculous and offensive,” declared Iris, who, like Gary and Charlie, seemed upset and confused by the apparent normalness of it all: the egg and the sperm; the plain old sex; the singular and symbolic nature of the child born from (what they all presumed was) heterosexual coupling. Commentators from within the LGBT community were frustrated that Spataro and her partner’s non-normative sex and gender roles did not align with an anti-normative practice of reproduction. That struck me as a terribly unfair burden to ask any person or couple to carry. Why did reproduction have to reify gender identity instead of making it gender-neutral? And why did reproducing as a lesbian and trans woman mean that Spataro and her partner had to model reproduction’s most inconvenient configurations and its most subversive politics?
Perhaps the best account of the ambivalent relationship of reproductive desires to reproductive politics is micha cárdenas’s bioart project Pregnancy (2009). Pregnancy pairs a poem describing cárdenas’s experiences of cryogenic tissue banking with videos of her sperm wriggling under a microscope. To start producing sperm, cárdenas stopped taking her estrogen and T blockers; to examine her sperm, she purchased a kid’s microscope kit for fifty dollars. “I felt like a trans woman scientist dating all these materials,” she laughs when I ask about her DIY setup. “I was at a trans literature conference, and someone told me about a small Facebook group for trans women who were banking their sperm. I made the videos to post to the group and one of the members was a biologist who was really encouraging.”
The Facebook group was, for cárdenas, just one node in a long history of trans women taking care of each other when no one else would. “They told me I would be sterile, / the doctors and brochures, / that I couldn’t do this, / what I’m doing,” cárdenas writes. “But they don’t know / and they lied to me.” The viciousness of the lie was compounded by the truth of the fatal violence that disproportionately affects trans women of color. This violence is itself a reproductive issue, one that often remains invisible to those who can take their safety for granted, whose reproductive timelines are organized around the slow inevitability of aging and not the possibility of sudden death. But cárdenas knows she may not live long enough to have children. “I could be dead anytime,” she says. “There is a real sense of urgency.”
cárdenas started writing Pregnancy when she went off her estrogen. Like S’s, B’s, and N and K’s stories, Pregnancy deals in multiplicity and uncertainty, a record of extreme affects and imperfect politics. On the one hand, there is an expansiveness of life that cuts against the fear of death: “I see the sperm under the microscope, / each one swimming, with its own intention, / each one its own possible life, . . . / and I wonder / how many people are inside of me?”
At moments such as these, Pregnancy can seem Whitmanesque in its aesthetic and political aspirations. The individual act of reproduction emerges as a resounding, uncompromised act of political resistance, a way of making a world that was not made for you. “We will fight back these genocidal projects, by making life, family, love and joy, / by making babies with our queer trans bodies,” cárdenas writes. This is praxis in its most resplendent form: millions of sperm squirming, turning, chasing each other’s tails under the microscope’s attentive lens.
But just as soon as the poem begins to speak in the hortatory language of the manifesto, it retreats from its own optimistic prophecy, exhausted by the energy it takes to make and remake one’s body, let alone remake entire structures of oppression and injustice. The speaker’s voice turns flat, depressive, elegiacal. She starts to question the ethics of treating children as revolutionary projects. Instead of willing an alliance between reproductive desire and reproductive politics, cárdenas merely notes the unevenness of reproduction, how the right to have a child is not a right that is equally distributed:
but we decided . . . to go the biological route,because adoption seems almost impossible,for two sick brown queer and trans women,with histories of mental illness and poverty in both our families,you know, just the usual for QTPOC.The legal rights you have to your baby,are more tenuous if you don’t have a biological input,and I don’t want another trauma at an international border,and the cost of IUI, ICSI and IVF are in the tens of thousands,oh the privilege ofcis-hetero reproduction!
What Pregnancy makes clear is that people’s bodies are unruly sites for politics. They do not cling to universal or identitarian positions with the clarity or the righteousness that many desire. Nor should they. This is, in itself, a kind of anti-naturalist politics, a recognition that between the body and the political lies a vastly mediated world where belief and behavior do not always overlap. In this indeterminate space, people who appear similar in crude or categorical ways can have incommensurable experiences; and people who seem, on the face of it, very different from one another can have converging experiences of the physical and emotional impossibility of doing life’s work under political conditions that are not meant for women—or families, however they are constructed—to thrive.
• • •
“Why does anyone want to have children?” a friend of mine asked me after reading an early draft of this essay. It was a simple question but it startled me. I had not asked it to any of the women I had spoken to; it struck me as more intimate than asking them to describe their hormone injections and transvaginal ultrasounds. At the same time, it was a question that the injections and the ultrasounds made especially urgent: why would you put yourself through this?
Yet all reproduction, even reproduction that appears ‘natural,’ is assisted. Some forms of assistance are simply rendered invisible because they are taken for granted.
It is not a question that has a rational answer. Like sexual desire, reproductive desire seems fundamentally irrational. The idea of a child is a fantasy, and like all fantasies, what it means varies from person to person. For me, a child could represent a path to immortality; for you, a chance at rectifying the sins of your father. Yet what is undeniable is that the fantasy becomes warped when its fulfillment is precluded not by individual bad luck, but by vast structural inequalities among women. The “unnaturalness” of your endeavor becomes a proxy for your subjecthood, a referendum on your political, economic, or social position in an unequal and unjust world.
Yet all reproduction, even reproduction that appears “natural,” is assisted. Some forms of assistance are simply rendered invisible because they are taken for granted by people for whom reproduction is not an obviously political issue. If you do not have to pay money to conceive, it may not occur to you that conception can be prohibitively costly. If you do not have to transform your body to gestate, it may not occur to you that gestation is hard and risky work. If a physician has never hurt you or mocked you or ignored you or lied to you, it may not occur to you that being deemed healthy enough to have children is an ideology rather than an ontology. If you do not have to worry about the legal status of your relationship to your child, it may not occur to you that she can be taken away. If you do not fear for your safety, it may not occur to you that you need to stay alive to create life.
Where the stories above intersect is not primarily in the physical or psychological details of women’s encounters with reproductive technologies, but in how these technologies make visible our still-limited fantasies about reproductive politics. As Dorothy Roberts has argued, the mainstream movement for reproductive rights—the fantasy of perfectly unconstrained choice—has often crowded out the crusade by women of color for reproductive justice: not just a woman’s right not to have a child, but her right to have children and raise them with “dignity in safe, healthy, and supportive environments.” For Roberts, those rights are rarely acknowledged in debates over reproductive policy, which tends to focus on abortion at the exclusion of broader changes such as a non-discriminatory system of universal healthcare, paid parental leave, and protections for LGBT people and people with disabilities.
But acknowledging the positive right to reproduce may change more than just the distribution of public resources. It could make assisted reproduction the preferred strategy by which we fight, until the natural no longer looms so large, no longer nestles comfortably into our language. It could begin to close the gap between women of different classes, races, and sexes, until stories such as the ones I have relayed here are no longer marked by anger, frustration, or loneliness but by solidarity. It could allow the political to catch up to the technological, our behavior to catch up to our beliefs, so that reproduction is no longer impossibly comprised—a haunted fantasy—for so many women.
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