text: Alexandra Savina, Alexandra Sivtsova
Illustrations: Katya Dorokhina
Al is 32 years old, and for the past eight years she and her husband have been trying to have a baby. During this time, both spouses managed to undergo many examinations - while the doctors always identified the "female factor" of the problem: the indicators of El's husband were normal. “Since childhood, my hormones were naughty, I was registered with a pediatric gynecologist and from an early age took various drugs to regulate the menstrual cycle. Therefore, when I did not succeed in getting pregnant on the move, I was not very surprised,”she says.
Those who have never personally come across the diagnosis of "infertility", it seems like a sentence. In practice, the first diagnosis rather means that the doctor and patients need to pay more attention to the problem: it is made when, with regular sex without contraception, pregnancy does not occur within a year, if the partners
under 35 years of age, or within six months if partners are older than that age. No additional examinations are required at this stage - the conclusion is made on the basis of this one feature.
The cause of infertility can be associated with the health status of both women and men - but even the WHO notes that most often when determining infertility they mean the woman's condition: this can mean the inability to get pregnant, and the inability to endure pregnancy, and the inability to give birth to a living child … In medicine, it is customary to distinguish two types of infertility: primary (in women who have never been able to become pregnant) and secondary (inability of a woman to give birth to a child after she had another pregnancy or she was already able to deliver and give birth to a child once). It is difficult to talk about an average portrait, for example, about the age of women facing a diagnosis: gynecologist Oksana Bogdashevskaya notes that women aged 33-35 are more often observed in her clinic for infertility, but this does not mean anything - there are both 25-year-old and 45-year-old patients.
For example, 26-year-old Natalie was diagnosed with second-degree infertility (that is, secondary infertility). She has been living with a common-law husband for about five years, and during this time she never managed to get pregnant; while in the past she already had a miscarriage. “I was 22 at the time, and I felt inferior,” she says. - After a while, they told my husband to do a spermogram. Then it turned out that the husband did not have live sperm. Inside, I felt a little relieved, and there was a hope that it was not just me. My husband did not believe it and secretly from me went to take the test again. The result was the same. The mother-in-law then began to hint that it was my fault that we had no children. She didn’t want to perceive that her son had problems”.
The birth of a child is still imputed to a woman as her main responsibility, and the inability to give birth is often perceived
as a sentence
Doctors say that the couple has a chance to have a child, but not much. Natalie's husband is not against adoption, but she is not ready for such a step - and does not exclude that they will part if the issue of the child becomes even more acute. “Apparently, it is difficult for men to understand how important it is for a woman to bear her child, to go through all the important moments in the development of the baby. One of my acquaintances, after it turned out that her husband was infertile, filed for divorce. Says: "I do not love him enough to refuse the opportunity to have a child of my own." And these words stuck firmly in my head."
The number of couples facing infertility is gradually increasing in the world, but scientists believe that, in general, its level in the world has practically not changed over the past 25 years - an increase in the number of infertile couples is associated with an increase in population.In 2010, among all women aged 20–44 years, primary infertility was observed in 1.9% of women, and secondary (here it meant cases when a woman gave birth to at least one child, but was not able to give birth to a second) - in 10, 5% of women. The habit of primarily referring to the “female” factor when speaking of infertility, both at the official and at the household level, leads to the fact that it is considered primarily a “female” problem. It is not surprising that women who, for some reason, cannot have children, face enormous pressure - both from society as a whole and from those close to them.
This was, for example, with Natalie: “I remember when I came to work, there were three girls in the company with a problem of infertility. After a while, one colleague went on maternity leave, and a couple of months after her, a second one became pregnant. And then the first real hysterics happened to me on this basis: I locked myself in the toilet and sobbed for half an hour until they found me there. I felt so hopeless. I do not envy them, I am happy for them. But it is so offensive that they will experience such happiness, and I will not."
In part, the emergence of this point of view can be explained by statistics, which seem to feed the accusatory logic of "probably the problem is in her": according to research, about 37% of cases of infertility in couples living in Europe and the United States are explained by problems
with the health of a woman partner, 35% - with health problems in both partners, and only 8% - with problems in a man; in 5% of cases, the cause of infertility cannot be accurately identified. Oksana Bogdashevskaya, a gynecologist, emphasizes that finding one reason is not enough - infertility is most often due to a combination of several factors. But this situation is much stronger due to patriarchal attitudes in society, where the birth of a child is still imputed to a woman as her main duty, and the inability to give birth to a child is often perceived as a sentence.
Psychologist Anna Silnitskaya, who leads support groups together with psychologist and narrative practitioner Elena Baskina, says that in their work they are wary of the term 'infertility': for medicine: a woman is an object in which something is “broken”, you need to “fix it”. " According to Anna, the very word "infertility" contains many meanings associated with the traditional role of women in society, with ideas about what kind of woman can be considered "real" - and this approach traumatizes those who are faced with the problem. Elena suggests instead using the phrase “reproductive difficulties” to denote what women face in the most useful way for them: “Difficulties are something that you can cope with, take some action, get around them, find a solution, make an alternative reproductive choice."
Three years ago, Silnitskaya and Baskina conceived the project "You are not alone" aimed at supporting women who have difficulties in conceiving or having a child: the first meeting of the support group took place in February 2014, now experts renew them two or three times a year. A wide variety of women visit: there are those who come after a long treatment and many medical procedures, there are those who have lost children at different stages of pregnancy or have lost their organs as a result of medical procedures. There are also those among the participants who think about whether they want children and how they can become a mother - for example, if they are not married or in a stable relationship. When asked whether it happens that a woman who has come to a group comes to the conclusion that she does not need to have a child, Anna replies that this happened several times - but there are also many cases when women nevertheless gave birth to children (by themselves or thanks to assistive technology) or are considering adoption.
Despite the fact that infertility is a common problem, it remains a painful and taboo topic that is not usually talked about publicly: it is discussed in a medical rather than a psychological or social way. Men who, like Mark Zuckerberg, openly talk about the difficulties with pregnancy in a couple and that this experience was very painful for them, are still few in the public space. In Russia, this is also superimposed on the widespread myth that a family without children is doomed and will surely fall apart - a man supposedly needs children (especially a boy who can become his heir and successor), and if a partner cannot give birth to them, he must will find another. “Historically, it is not difficult to trace the roots of this myth. But it does not work in modern reality, the world has changed,”says psychotherapist Anastasia Rubtsova. She notes that in modern society, many people do not need children - and a family, as a rule, is not created at all for the sake of having offspring. In reality, a child cannot save a broken relationship, a happy marriage is not necessarily the one in which the children were born, and difficulties with conception do not always mean that partners will part without coping with the crisis - although this is a common situation.
A child cannot save a broken relationship, a happy marriage is not necessarily the one in which children were born, and difficulties with conception do not always mean that partners will part
Psychotherapist Ekaterina Sigitova says that not every couple who cannot have children faces psychological problems, but some still have them. “Potentially, the possibility of having a child can be negatively influenced by stress in one or both partners, unresolved strong conflicts and accumulated aggression, unconscious“anti-motivation”in one or both, lack of trust and lack of confidence in each other, fear of serious changes in life and much more,” - she thinks. At the same time, the specialist notes that there are no clearly defined by science psychological causes and factors contributing to infertility - the relationship between the psyche and the body is very complex and difficult to study, so one should not make hasty conclusions.
El says that before the eyes of her and her husband there was always an “anti-example” of friends - a married couple in which the male partner from the very beginning of the relationship said that he wanted children, and when it turned out that the couple had little chance of having a child because of health problems of his wife, left his wife with the words: "I do not need a sterile wife, I need a healthy woman with children." El often recalled this incident - during the eight years that she and her husband were trying to have a child, her state changed from unshakable belief in success to a feeling of complete hopelessness, but her trials with her husband only rallied: “Sobbing in hysterics and literally rolling on the floor, I shouted that it was time for him to leave me and that he was wasting time with me. My husband always cut me off abruptly and instilled the same idea: we will walk this path together, we will definitely succeed”. The woman admits that over the years of unsuccessful attempts, she was let go of the thought that the meaning of life is to get pregnant - although the couple is still trying to have a child, already with the help of assistive technologies: they have two unsuccessful IVF attempts on their account, and the third is next.
It is important to learn to talk about what happens when a fight ends in failure. It takes no less courage to give up trying to have a baby
In vitro fertilization, or IVF, is an assisted reproductive technology and one of the most common measures to overcome infertility when it is difficult for a couple to conceive a child on their own. According to a study from Denmark, three out of four women give birth within five years of starting fertility treatment - both because of it, and spontaneously and independently of it.Danish information allows us to draw fairly accurate conclusions: it is one of the few countries where all activities related to assisted reproductive technologies and all cases of childbirth are recorded.
What the statistics do not provide are the situations when technologies fail or when an attempt fails. Not everyone is ready to use the IVF procedure, primarily because of its cost. It is perceived as a success mechanism that works smoothly, and we rarely hear about situations where it does not work. For example, 48-year-old Svetlana faced failure in IVF. The woman has secondary infertility: the first time she became pregnant at the age of 27, but the pregnancy turned out to be ectopic. Svetlana says that for all nine years of living together with her first husband, she tried to have a child and was actively observed by doctors, but she did not succeed in getting pregnant. Later, doctors removed one fallopian tube for Svetlana and said that the couple had a chance to have a baby using IVF - but then the procedure was not so common, and the couple did not dare to do it. At the age of 41, with her second husband, Svetlana still tried IVF, but the attempt was unsuccessful: “I spent my family funds on medicines, on the work of a doctor - and everything was in vain. But I have no regrets. After 40 years, there is very little chance of success - somewhere around 20-25%. After 30 years - 50%, if you try in the third ten - the probability is very high."
According to the European Society for Human Reproduction and Embryology, out of one and a half million cycles carried out with the help of assisted reproductive technologies, on average, only 350 thousand end in the birth of a child - which means that many couples have to resort to IVF.
several times - until the result is positive or until they decide to stop trying. In a culture where having a baby is perceived as an obligatory stage in the life of a family, and couples who deliberately decide not to have children are still perceived as an exception to the rule, it is important to learn to talk about more than just how much effort a couple puts in to get a long-awaited pregnancy. but also about what happens when a struggle ends in failure - and that it takes just as much courage to give up trying to have a child.
In October, it became known that the WHO is going to expand the concept of infertility: those who do not have a sexual relationship or a partner with whom to have a child will also be considered infertile. It is assumed that in this way single people and same-sex couples will be able to apply for funding the IVF procedure on an equal basis with heterosexual couples, and infertility will no longer be considered an exclusively medical problem. Perhaps, thanks to these measures, society will finally stop seeing infertility as an exclusively “system breakdown”, a problem labeled “male” or “female”, and will also see a difficult family history that is hidden behind each diagnosis.