When 'The Miracle of Life' Doesn't Happen

In The Art of Waiting, Belle Boggs explores the meaning of infertility in a culture that venerates parenthood above all else.

Belle Boggs's book 'The Art of Waiting'
Graywolf Press / Trace Ramsey / Zak Bickel / The Atlantic

“We are warned and promised that pregnancy will one day happen,” Belle Boggs writes in her new book, The Art of Waiting. People are expected to be responsible, to use contraception, to keep pregnancy from sneaking up on them until the day they are ready to join the ranks of the parents. Then the body’s miraculous capacity for life will just kick in and from the womb’s fertile soil will sprout a baby.

But it doesn’t always work that way. One in eight couples have trouble conceiving. Boggs and her husband were one such couple. In her book she tells the story of her infertility, of treatments and support groups, of giving up and then trying again, of the jealousy sparked when she saw other mothers, of nightly shots and picking out embryos for the in-vitro fertilization that eventually allowed her to have a daughter.

But she also explores the many limitations of the classic conception story, and the people it leaves out—couples, both heterosexual and LGBT, who conceive with assisted reproduction, or using surrogates, or who choose to adopt. People who, despite their best efforts, are never able to conceive at all. Victims of eugenics programs who were sterilized against their will. She manages to acknowledge the real loss of people who want children and can’t have them, without casting their lives as less-than.

And she grapples with the fact that trying for a child is always an uncertain prospect. In a “never-give-up” culture, how do you decide when it’s time to let go?

Keep trying. Be content. How do you reconcile those two messages?” Boggs writes. “How do you do both at once? I turned those questions over for a long time: not quite content, not actively trying, while all around me, other people tried harder.” Her trying paid off. But her years of waiting gave her the empathy to see that infertility is more than just absence.

I spoke with Boggs about cultural narratives of fertility, and the struggle of people whose stories don’t fit them. A lightly edited and condensed transcript of our conversation is below.

Julie Beck: Scientists can’t seem to agree on whether humans have an innate built-in desire to have children. A lot of them think we just have a drive to have sex, and the kids will obviously come from that. But there is such a focus on children in human culture. Do you think that there is something innate about wanting children?

Belle Boggs: I think that’s an unanswered question but I think it’s an interesting question. During my experience of years of child longing and waiting to build my family, I found that there were often questions in the comments if I published something—not that anybody should read the comments on anything—like “Why doesn’t this person just get over it?” “She should just get a dog.” “She should just adopt.”

When I started writing this book, I was interested in what science was saying about infertility and longing. There’s a Finnish researcher named Anna Rotkirch who did this amazing interesting qualitative study of what they call in Scandinavian countries “baby fever,” basically really wanting a baby. It was inspired in part by her own experience of baby fever. She and her husband had decided they would have two children, and they did, but she found herself really wanting another child. Even though this worked in some ways against her career goals.

She put out an open call for experiences of baby fever, and she got many submissions, almost all of them from women. She found you could trace some patterns. One factor she noticed was proximity to babies—being around other families who have infants or young babies ignited this desire. Falling in love was another factor in the experience of baby fever for these women. And a lot of people complained about it—they said “This is not a convenient time for me.” She found it was not just people who grew up thinking and planning to have children who came down with this baby fever. It was kind of coming out of nowhere for people.

Beck: You write about how animals will do anything to reproduce, they’ll put themselves at risk in all kinds of ways. And how we’re unique in that we spend a lot of energy trying not to reproduce. But this baby fever, and fertility treatments like IVF seem to be more in line with our animal sides—you make a huge financial sacrifice, and you also have to endure a lot, bodily. Does that tilt it toward humans being driven to reproduce at cost to themselves?

Boggs: I think everyone who has a child is making a sacrifice.  If you’re an expectant mother carrying a child, that’s a burden on your body. If you’re planning to educate, feed, and clothe this child, that’s a sacrifice. If you’re an adoptive parent, that’s a sacrifice. In a lot of ways we shouldn’t have to sacrifice so much. Since having my daughter I’ve thought a lot about the supports that aren’t there for us as working parents in this country. The cost of medical care, for one, but also the lack of guaranteed maternity leave, the scarcity of quality, affordable childcare.  The experience of fertility treatment is this other kind of sacrifice. There’s certainly no guarantee that any fertility treatment will be successful. So it’s stressful on that level and it’s also enormously expensive. Most people don’t go into IVF treatment knowing how much they’ll wind up spending, because they don’t know how many cycles it will take. My husband and I purchased what’s commonly called a cost-share agreement, which I’m glad we did because it allowed us to plan a course of IVF with our doctors that was as safe as possible. We elected to have single-embryo transfer, which was the safest choice for us. I don’t know if we would have felt as free to make that choice if we were paying in individual cycles.

Beck: Can you explain what a cost-share agreement is?

Boggs: It took my husband and me a while to save the money that we needed for the IVF treatment. Our insurance did not cover it. We considered the possibility of paying per cycle, which at our clinic at the time was estimated at $11,000 per cycle. That would not include medications which can run between $2,000 and $5,000. We knew because we have so many friends who’d been through IVF that it was very possible we would need more than one cycle in order to be successful. We knew it was also possible we might not be successful at all. For the cost-share agreement, we were assessed for our health and age, my ovarian reserve, all those factors. For $20,200, not including the cost of medication, our clinic would give us six tries, three tries with fresh embryo transfer, and three frozen embryo transfers. We would get a percentage of our money back—70 percent—if the IVF didn’t work. Then we could use that money to find another doctor or pursue something else. It was expensive, and I’m glad it was available to us but I think it’s obviously not accessible to a lot of people. It would make everything so much more fair and accessible if insurance covered infertility as the medical condition that it is.

Beck: Our culture has, as you put it, “a belief system that puts children at life’s center.” You know, the children are our future and all that. And so it’s assumed that everyone’s future will and should include children. You also wrote that, when you taught young kids, all your students basically imagined themselves having kids one day. What do you think it does to people’s mindsets that we imagine our own children while we are still children?

Boggs: I teach at a university now, but in my teaching career I have taught ages from kindergarten on up. I’ve seen it in first-grade classrooms, I’ve seen it in fifth grade when you start doing sex ed, into high school. What I noticed with my students was that many imagined that the families they would eventually have would look somewhat like their own families did. They planned to have their first children around the same time their parents had, and many planned to have around the same number of kids. I identified with it. I thought the same thing when I was younger. I thought, “I’ll have my kids by the time I’m 30, I’ll have two, and I’ll have a boy and a girl.” That’s so specific! And of course you can’t control that. I’m pretty satisfied having my one child who was born in my later 30s. I’m not disappointed that my family looks different from what I imagined.  For people who can’t have children at all, I think this narrow definition of family can lead to this profound disappointment and great isolation.

One of the things I’ve found really exciting is observing my LGBT students. A gay male student I taught in high school, he had a really positive concept of what his family would be like. He imagined getting married and adopting a child with his future husband. This was before we had marriage equality in North Carolina. So seeing the expanding definitions of family as our culture has gotten more inclusive was exciting.

Beck: I wanted to talk about the way people talk about women’s bodies and really put them on a pedestal for being, I don’t want to say “baby-cookers,” but… You mention how in sex ed classes, teachers will say things like “Your body is a miracle!” And sometimes I hear people using this as an argument for like, why you need to respect women, or why women are more awesome than men. They say things like “Our bodies LITERALLY CREATE LIFE, what do yours do?”

Boggs: I think we still have this fertility narrative that emphasizes the miraculous and deemphasizes choice. We’re uncomfortable talking about the female body, particularly connected to reproduction, in an unidealized way. At a school I taught at, we had a really wonderful public-health nurse come in to do the “This is how your body works” talk. She told the kids “Your bodies are miracles, because they can create life.” And we separated the girls and the boys for this talk.

Beck: Do you know if the boys were told the same thing? Because you know, they have a role to play in creating life also.

Boggs: I wasn’t in there with the boys. I sort of hope they were also told the same thing—I hope there was some equality of inaccuracy there. I could see the pressure building on my students and also the attraction to the idea that your body is a miracle. My personal suspicion is we’ve come up with this narrative for schoolchildren—that the way the female reproductive system works is a miracle—to help them deal with the fact that menstruation certainly is inconvenient and painful. I had one student who was so upset, because she had totally misunderstood the menstruation part of the talk, and she thought that once she got her period, she would have to deal with it every day for the rest of her life.

Beck: Oh no! Oh honey, you can just get an IUD.

Boggs: Yeah, it was so sad. But we cleared it up, her mother and I.

Beck: It seems to me like there are two different common narratives that both end up promoting this idea of pregnancy as something that just happens at the drop of a hat. One is the “Your body is a miracle” thing, but then there’s also this message of “If you fuck up once, you’re gonna get pregnant,” and so you’re supposed to ward it off. This is true of movies and TV too, I feel like there are so many stories where a girl has sex one time and boom she’s pregnant. For example—have you seen Gilmore Girls?

Boggs: I love that show!

Beck: Me too! Okay, so you know Lane? She has sex literally one time and then she immediately has twins. It’s insane.

Boggs: That’s a really good point. A miracle is something you’re not supposed to have control over. Some outside force is acting on you. It’s not something you participate in. This resistance to active participation is something I really take issue with. I’ve noticed some of the same things, like examples of teen moms are often really idealized. If you think about a movie like Juno, Juno is funny and witty, she’s the hero, and she’s adorably pregnant. The woman who eventually adopts the child, until she gets the child, she’s brittle and unhappy and older and all these other stereotypes.

Beck: I think Juno had sex like one time as well.

Boggs: You look at narratives of teen moms who get pregnant after very little sexual experience and then they have the baby and it’s really idealized. There’s some sense that it’s going to turn out okay. I like for teen moms to have that message, but it’s really hard. Our country does not support mothers very well.

Beck: We’ve talked a bit about these warring narratives of control and fate around having children. There is some control-oriented language—people talk about family planning, for example. But also then a child is a “gift” or a “miracle,” the sort of things that have to be given. People will talk about what God’s plan for them is. You wrote a lot about whether you were “meant” to have children or “meant” to adopt—did you feel like the fate narrative resonated more strongly for you when you were trying to have a child?

Boggs: The fate narrative, for me, became appealing when we gave up on fertility treatment for a time, because it was a way to say this is not what is meant, this is not our path. That can be reassuring to people for all kinds of experiences. And I thought for a while, “Okay, well this is telling me that maybe adoption is our path because I love older children.” I love babies and their heads smell really good, but I also really like hanging out with older kids who can talk and do stuff, who can go outside and play and read books. When I thought about parenting, I was always imagining myself at that later point.

So I spent a lot of time researching adoption agencies in North Carolina, looking at what if we adopted internationally, what if we adopted through the foster-care system. I've read blogs of adopted families, and the beautiful lives that they had, but also, as we began looking into adoption, it quickly was revealed to me that that’s a very complicated difficult long path as well, that also involves a lot of waiting. It’s not exactly that I was impatient. I just realized this isn’t an easy answer.

Beck: So when people are like "just adopt," it's like "Oh, just do this other extremely complicated thing."

Boggs: It’s extremely complicated. It involves pain and loss for someone, often for everyone involved. That's not to say that it's not a beautiful way to build your family for so many people. But it's certainly not an easy answer. So I thought a lot about how this idea of fatedness was not relevant to my experience. It was something I was trying to impose on my experience to help myself come to terms with what was happening in my life. I also wouldn’t say I was fated to eventually wait a long time to conceive my daughter through IVF. I don’t really believe that either. I’m very happy with my family life. I think it was a lucky life but I don’t think it was a fated life. If I said that, then why am I fated to be able to save $20,000 to spend on this and somebody else with other financial pressures or a less supportive family system isn’t? Or someone who lives in a rural place where there aren't even any clinics nearby? They’re not any less fated than I was, I just happen to be privileged and I recognize it.

Beck: There's a part in the book where you were talking about the proverbial woman who's going through IVF and you wrote, “I think the real trouble is with her unfulfilled desire—her grasping, her wanting, her circumventing … Resistance to the things that are, particularly resistance that fails, is undignified." I feel like there's totally something there where it's seen as undignified to want things, it's undignified to suffer openly. We like our people to suffer in silence, to just accept what life hands them. And there’s a sort of Christian philosophy there, that you should accept God’s plan for you with faith and grace. And that gets co-opted in a secular way, too, like oh, a child just isn’t in the cards for you, or it wasn’t “meant to be.” I just think that's very interesting.

Boggs: I think it’s interesting too. There’s a phrase that I found in my research, it was used by Marni Rosner, she's a therapist who specializes in reproductive trauma and longing, and she did this study of women who lived without children, but not by choice. She did a study of their experiences. Anyway the phrase that came out of that that seemed so powerful to me is this phrase “disenfranchised grief.” She didn’t coin it, I think it was coined by Kenneth Doka, a writer about grief. Disenfranchised grief is grief for a loss that cannot be openly acknowledged, publicly mourned, or socially supported. And fertility fits into that category really well because it isn't something that we are comfortable talking about. Because it is an experience of loss if you're trying for something and it's not happening. For me at least, I became very aware of each month as a new experience of loss. Not that I was having miscarriages, but that I was deeply disappointed. That is something that’s really painful but also very hard to talk about. People just don’t know what to do with it if you do talk about it. People want to make you feel better, so they might offer advice that doesn’t help, they might offer platitudes, of course some people are great and they just listen. But it’s something that many people are pretty uncomfortable with.

I think it can be very limiting to expect people to just accept what’s handed to them. That’s not to say people can’t do that and find fulfillment that way too, because they can and plenty of people do. But if you look to the Bible, and the story of Sarah, how old was she when she finally had her kid? Really old. It portrays just this dignified waiting, just wait and wait and wait and then maybe God will give you a baby.

Beck: I don't like the way the word “dignity” is often used to mean “concealing your suffering.”

Boggs: Yeah, that’s a really great insight. I wish that I’d said that. I agree with you. I don't like that either.

Beck: I feel like this idea came up a lot in the book. I wrote down a couple of lines: “There are no clear norms for grieving the loss of a dream,” and “The person I had hoped to become was torn away, leaving only the person I had always been.”

So you have this whole question of do you keep trying or do you keep waiting or do you just accept what's given to you? And I guess life kind of answered that question for you—you eventually were able to have a daughter, which is great. But I’m really interested in the part before you know the answer, before you’re sure. I think that applies to all kinds of goals that you can sort of control but sort of can’t—having a child, falling in love, or professional success goals that are dependent on other people, like getting a book published. Something that's not totally within your control. How do you deal with the fear that you may never have the future you imagine for yourself?

Boggs: I think one way of dealing with that is for me by making wider circles of friends and acquaintances and getting to know other people who also had to accommodate a really different life than they once imagined for themselves. A few years ago I worked on a long reported piece for The New New South about North Carolina's eugenics survivors. For people who don't know, many states around the country, starting around the 1920s, actively pursued routine sterilization of the poorest and most vulnerable citizens, often children. I started that piece before I started my IVF treatment and I completed it while I was pregnant. I got to know a few people in my state who had been actively engaged with advocating for compensation of eugenics victims and survivors in North Carolina. One in particular was this man Willis Lynch who lived about an hour and a half from me. We’re really different. He was almost 80 years old when I met him, he lives way out in the country and had always lived in pretty much the same area, and is a man, and what happened to him is in no way like me. I just had an unlucky biological problem. Nobody did this to me. Mr. Lynch had a crime committed against him by the state when he was 14 years old. He was sterilized. He grew up in this big family, lots of siblings, and the thing that was most valuable to him, the ability to have kids and raise a family, was taken away from him and he had to live the rest of his life and experience the rest of his relationships in life knowing that.

What happened to him was also really connected to shame—the state sterilized him because they said he was unfit to have children. He knew, and I know, and everybody knows now that they in fact sterilized him because his mother was on public assistance and he was poor. There's nothing unfit about him. Even though there was all this shame connected to what had happened to him, and sadness and sorrow too, he spoke out at public hearings, he spoke out to the press, he talked about what had happened to him and how difficult it had made his life. He was a really powerful advocate. So I think the experience of talking to people like that, who have had much harder roads than I was ever contemplating and yet they found other ways to be creative, to make an impact, to be generative, to find meaning and purpose for their lives—that, to me, was so inspiring and such a good lesson. That’s not to say that I need people so they can teach me a lesson but if we're lucky our friends do teach us and our friends do help us put things in perspective.

Beck: You wrote about talking to people at your support group and their stories and how they'd either find success or they wouldn't. And you said, "The narrative failed because it was about only one thing—becoming pregnant. I needed my story to be more flexible." So how do we make that story more flexible for everyone?

Boggs: That’s a good question. I think that’s the ongoing goal isn’t it? For everyone to see possibilities for their lives that are less limiting and less programmed by narratives that don’t necessarily fit. My support group was really helpful, but it was most helpful in the times when we were able to talk really openly about everything that we were feeling, and not just when we were talking about the body and the rituals of treatment. It kind of comes back to the smart thing you said about this idea of dignity being about not expressing suffering.

In my work and my teaching I try to be open. I often teach classes in personal essay or some form of creative nonfiction writing. I heard one time the poet Alan Shapiro say something that really stuck with me which is writing is a way of being happy even if what you’re writing about is how unhappy you are. And I like and agree with that perspective. Not everyone's a writer, but I think most people feel better when they can express themselves, when they can find someone to talk to or when they can be open, as you say, about their suffering.