Today at work, someone compared IVF to having cosmetic surgery. Not to go into detail, but just to put things in context, we were having a discussion about the extent to which my employer should offer medical leave for an IVF cycle.
The person to whom I was speaking remarked that in some ways, IVF is more like cosmetic surgery than, say, a triple bypass. Because, they reasoned, it involves an active "choice" on my part in relation to a "non-essential procedure", whereas something like heart surgery is a "medical necessity".
This got me thinking about the concept of "choice" and "necessity" in relation to infertility treatment. I was distracted all afternoon, rolling this around in my head, until at one point I was so vexed that I resorted to drawing little diagrams and flowcharts.
What I came up with remains, to my mind, somewhat unsatisfactory, so I thought I would put it out en blogue for my wise friends to chew over. In the meantime, if you can stand it, I offer you some fumbling analysis of my thinking.
Let's start with this notion of "choice."
The problem is, when we refer to choice in connection with family building, it normally tends to be approached from the Fertile Perspective. In the Fertile's construct, the decision to have a family is invariably followed by a pregnancy and a birth. A couple chooses to reproduce, they take the necessary steps in the usual way of these things, and as a result, they are parents. They can also choose not to have kids, in which case, things remain as they are- just the two of them, until death do them part or until one of them runs off to Las Vegas with the pool guy/gal.
Of course, from an Infertile Perspective, things are quite different. The option of remaining childless is open to them, but the other route- so easy and available to others- is not. To get to where the fertile couple are, some definitive action is required- choices within a choice. To seek medical treatment or to adopt. Otherwise, by default, they are likely to be stuck within the status quo.
It's when you reach that point- the choice within a choice- that the Fertile Perspective simply does not work. In some ways, it's like comparing apples and oranges. The outcome may be exactly the same, but the means by which an infertile couple gets there make it something quite different, almost a hybrid of its own. And in the process, what might have ordinarily been a positive decision- to live child free- becomes not a choice at all, but rather, a worse case scenario, thrust upon them against their will.
To use another rather grim analogy- in ascending a perilous rocky mountain face, a climber's arm accidentally becomes trapped under a boulder, and he cannot free himself. He is miles from civilization, and no one hears his cries for help. Eventually, he realises that although he cannot reach his phone or his water bottle, he can grasp his pocket knife with his spare hand.
What does he do? Unless he cuts off his own arm, he will almost certainly die in that spot. Amputation or death, those are his options. He still has to make up his mind. But to me, the involuntary nature of his dilemma again makes it something quite different from a "choice" in the traditional sense of the word.
Admittedly, this is an extreme example, and I am not exactly suggesting that infertility creates such a black or white, life or death position. But it seems to me that it is somewhat the same as the Fertile/Infertile Perspective. The trapped climber facing an awful moment is suddenly having an entirely different experience from his best friend who uneventfully climbed this same rock yesterday. Both make certain choices along the way. But for one them, it ultimately becomes a decision about whether to cut off his own arm, rather than, say, where to stop for lunch. In the end, the divergence between their experiences is so great that the only thing they really have in common is that both of them decided to make the climb in the first place.
So, "choice" is somewhat problematic. What about necessity?
When I hear our decision to undergo IVF wrapped up in the same sentence as "cosmetic surgery", it makes me bristle. I guess because everything about that equation seems wrong to me. I can see where that mindset comes from- the old mantra that IVF is not considered medically "necessary". But then, a lot of ailments are not life-threatening and we don't automatically go around accusing people who seek a remedy of being selfish and self-serving.
Nor do we, as a rule, make arbitrary distinctions about those life-threatening illnesses, for example distinguishing between someone born with a congenital heart defect as opposed to someone who directly contributed to their state. For example, the guy next to me received a medical leave of absence to undergo that triple bypass. A medical necessity, they said, albeit in his case, a condition largely brought on by years of smoking, heavy drinking and excessive consumption of bacon sandwiches. But they don't talk about that. He had to have the treatment, because regardless of how he got into that state, it is now life-saving and essential.
Whereas IVF is not. It is "something you are choosing to do".
Which takes me back to the point I was trying to make above, albeit perhaps not very well. Somehow, labelling IVF treatment as a "choice" in this context seems to be an overly simplistic and inappropriate way of briskly packaging up a personal tragedy and thrusting it back on the person who has the misfortune to find themselves in this position in the first place. Justifying it with a dash of what is "necessary".
Slotting assisted reproduction in with cosmetic surgery, as if decisions about whether to live without breast enlargements or collagen lips are somehow just the same as a decision to live without children for the rest of your life.