Embracing Desperation in Fertility

New research shows that “negative” emotions, like desperation and anger, often deepen a patient's involvement in decision-making and cause them to deliberate carefully, rather than consigning them to paralyzed indecision or blind commitment to unrealistic goals.
In-vitro fertilization (Wikimedia)

On September 27, a diverse group—doctors, authors, filmmakers, trauma therapists, and members of the public—will convene in New York City to watch the infertility documentary The Cycle: Living a Taboo. They will also participate in a forum to “challenge conventional wisdom and foster a new, more open dialogue about infertility.” This project is meant to give voice to important but often marginalized perspectives, including patients who are not only unsuccessful but traumatized by the fertility treatment experience.

It’s good to redirect our attention from the depression and anxiety that we often associate with those seeking fertility treatments to a more complicated emotional cocktail that includes desperation, anger, and helplessness. But while we collectively share and show compassion for our diverse reproductive experiences, we must clarify exactly what we mean when we discuss these emotions and how they bear upon patients’ competencies. Before we encourage infertility patients to spring out of the stirrups to avoid an emotionally bumpy ride, it's good to question why so many stay on the path to fertility treatments nonetheless.

I have spent the past two years researching emotion’s impact on fertility treatment decision-making and informed consent, conducting lengthy interviews and survey research with approximately 400 in-vitro fertilization patients and 90 reproductive medicine professionals. My research has revealed that, by themselves, generalized labels such as “desperate,” “angry,” and “vulnerable” are often misleading; they can actually do a disservice to and disparage the patients.  

Some infertile women do experience feelings of desperation, but common-sense understandings of what it means to be desperate range from unsophisticated to flagrantly wrong.  Yet these labels not only are present in popular stereotypes of infertile women and couples, but for decades they have often been applied (without empirical evidence) by well-intentioned individuals seeking to draw attention to patients’ vulnerabilities—including experts in medicine, law, and business, religious leaders, and former patients. In reality, the lived experience of these emotions is highly complex and nuanced, and many purportedly “toxic” emotions actually play positive roles and are critical to successful coping processes. My research shows that some “negative” emotions, including desperation and anger, often deepen patients’ involvement in decision-making and cause them to deliberate carefully, rather than consigning them to paralyzed indecision or blind commitment to unrealistic goals.

First, let's assume that (as some have asserted) fertility patients are at their wits’ end, desperate and vulnerable. A desperate person presumably feels that she lacks other options and is making last-ditch efforts to accomplish an ardently desired goal. Yet, such an individual does not necessarily pursue her goals in a hell-bent fashion, throwing caution to the wind. Although 72 percent of my patient participants described themselves as desperate, they described their own sense of desperation very differently.

Admittedly, most patients observed that fertility treatments could be all-consuming, making them feel empty, incomplete, and hopeless. But they also defined their desperation as a motivating determination, one that not only spurred them to seek treatment but also to research, to select the best physician partner, to question, and to discuss. Desperate patients defined themselves as ambitious, not deluded—a key distinction that rehabilitates patients’ agency and self-determination.

Anger is another commonly misunderstood emotion. Fertility patients may be angry due to a lack of control, an absence of support or validation, or the need to suddenly cope with a tide of of information, decisions, and appointments. They may be infuriated with God, their spouses, health insurance, physicians, insensitive friends, and blithely pregnant women. They may also be annoyed or outraged at the older celebrities who suddenly conceive through mysterious means, or by inaccurate portrayals of infertility in media and popular culture, which often paint treatment as a quick and relatively uncomplicated fix  that can devolve into a hilarious plot line and where fictional couples enjoy seemingly limitless resources for treatment and adoption. While “infertiles” are grateful that Hollywood has enthusiastically embraced infertility as dramatic fodder, that willingness has also spawned Baby Mama, Brooke’s saga of infertility and adoption on One Tree Hill, and Robin’s sudden discovery that she can conceive (and light-speed emotional recovery) on How I Met Your Mother. In contrast, the show Giuliana and Bill on the Style Network portrays fertility treatment more realistically, showing how patients may be angry at how the plot of treatment actually plays out—countless admonitions to “just relax,” creative fertility financing, and the surreal process whereby patients choose the fate of hypothetical embryos in the event of their untimely death or divorce.  

Presented by

Jody Lyneé Madeira

Jody Lyneé Madeira is an associate professor at the Indiana University Maurer School of Law. She is the author of Killing McVeigh: The Death Penalty and the Myth of Closure and a forthcoming book about the impact of emotion on patient decision making.

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