I'm a big fan of the sitcom Parks & Recreation. I'm going to give away a couple of big plot points from this season, so consider yourself warned if you don't want to know. The protagonist, Leslie (Amy Poehler), is married to Ben. They make a sweet couple. Anyway, Leslie is 39 years old and a few weeks ago she found out she's pregnant. They weren't really trying, but they're very excited. Whatever, I was fine with that. I always feel like it might be nice to see a semi-realistic portrayal of infertility on a TV show, but I realize not every show has to address every issue. And yeah, yeah - Sex & the City covered it, and How I Met Your Mother glossed over it, and Friends took a stab at it too. But two of those shows addressed the issue over 10 years ago, and the other one (HIMYM) spent one episode on it.
So, Leslie and Ben go for an ultrasound and discover much to their shock that Leslie is pregnant with triplets. Sigh. Okay, show, I get it. This is funny! Ha ha! Except I just basically got enraged. Yes, triplets do happen naturally. But the vast majority of triplets happen thanks to assisted reproductive technology (ART). In fact, 77% of triplets or higher order multiples are due to ART (New England Journal of Medicine). On the show, the characters freak out about the amount of money having three kids at once is going to cost, but not once does anyone mention that Leslie is only 5'2" and carrying triplets comes with a lot of risks - for both her and the babies. No one mentions that 91% of triplets are born preterm, no one mentions the health issues those kids will probably face at birth, no one mentions that there is a decent likelihood that she won't have three live children at the end of this pregnancy.
I realize it's a sitcom and no one wants to talk about the scary stuff. So why am I all bent out of shape about this? Why does it bother me? Because Parks & Rec's portrayal is just another squandered opportunity to have a conversation about the risks we take to have children, and how in this country, I feel like our risks are heightened because we don't provide coverage or support for infertility. And I think part of that is just based on general ignorance. What do we know, as a society, about ART? We know crazy Octomom and we know John and Kate Plus 8. [Seriously guys, I realized how little most people know about ART when explaining to my dad and sister, two well-educated people, the difference between IUI and IVF]. And a few sitcoms. Terrible, and not representative.
When I was in college, I got to see the late great Ann Richards give a speech about women in politics. She made what was, for me, the best argument you can make as to why we should all want more women (and for that matter, more people of color and other minorities) at the political table. She told a story about how, in Texas, for a long time women could not open a bank account or get a credit card without having their husband or father co-sign. The law didn't get repealed until a woman was elected and pointed out the existence of this old, stupid law to her male colleagues. The point is that we all bring different experiences to the table and the only way we can learn is if we have a diverse table. I feel the same way about infertility - most people are going to know bupkis about infertility and how it gets resolved. The only way they are going to know about it is we keep telling them about it.
So here's what I think non-infertiles should know about the risks we take:
- Many of us risk all our savings (this is true for people pursuing ART and adoption, because no, neither of those things are free or cheap) for a shot at having a child. And this is one of those things that drive me crazy about "just adopt" - okay, sure, I'll swing by the orphanage or a Walmart and pick up a kid on my way home. Adoption is not free, even if you decide to go through the state foster care system. If you decide to do private adoption, it's very expensive. In many cases, more expensive than paying out-of-pocket for ART.
- We have to endure a lot of tests to try to get to the bottom of our infertility. Some of those tests are painful. And they all seem to take forever. Some states require that insurance pay for those tests, but most states do not. So if you've been trying for over a year to have a baby and it hasn't worked and your general practitioner or gynecologist suggests you get some tests done? There's a good chance you'll have to pay for that.
- Once we get to the point where we're in treatment, we are usually taking scary meds that give us shitty side effects. The ultimate physical toll of those meds is still not entirely known.
- The majority of twins are born to fertiles, and are not a result of ART. That being said, the reason a lot of women will decide to put in 2 embryos (or 3 in some cases) is because this shit is expensive and the success rate, even for younger women, is kind of low. Like, a third of women under the age of 34 will have success on the first try. LOW. So if you've just sunk your savings into this, you want to make sure you have the best odds of it working and that might mean more than one embryo being transferred. Don't get me wrong, I think twins are awesome. But we all tend to think about how hard twins will be after they are born without thinking about how hard it is to actually carry and deliver healthy twins. Never mind triplets (you won't frequently hear crazy stories like Octomom because that shit is a total anomaly with a quack doctor who put in so many embryos that he lost his license to practice medicine - it makes me crazy that this is what so many people think all of ART is.).
I realize that we're probably never going to be like most of Europe where a lot of ART is covered. But it bothers me. It bothers me that we support women once they get pregnant (and woohoo - my Obamacare mandated insurance-covered breast pump arrived yesterday!), but we don't support them when they can't get pregnant. And we don't support them when they can get pregnant, but they suffer from recurrent pregnancy loss. Those women are scary and make us sad and we wish they'd all just go away or just be okay with the fact that they can't have kids. Or just adopt! Just adopt already! Adoption is a great way to resolve infertility, true, but anyone who has known someone who has adopted would know you can never put the word "just" in front of adoption.
You want to know what would be an even better way to resolve infertility? For all of us to have choices. We get to make a lot of choices when we're sick. But when we're infertile, our choices are limited, not because there aren't a lot of options for us out there. We're limited because it will depend on our financial situation, what state we live in, the job we work in. It won't just be based on our diagnosis and our own deeply held beliefs about if and how we want to grow our family. It will be based on the risks we are willing and able to take.