It’s natural for people who are struggling to conceive to think of themselves as broken in some way. ‘Sex makes babies’ is among the first lessons that we learn about the subject. When that doesn’t happen it is practically inevitable that one would conclude that something, somewhere, is wrong.
Of course, that judgment often has some truth to it. The diagnostic process can often identify obstacles to conception that, if fixed, would make conceiving more plausible. So couples get surgeries and take hormones and do all the work of ensuring they are optimizing their chances at a child.
But even then, conception is not a given: it is not foreordained or inevitable. It is not offered to us as a right to be claimed on the basis of the self-scrutiny and management a couple pursues. The most that a couple can do is improve their odds of conceiving: they can do nothing to guarantee it. And sometimes, even when such odds are improved, conception still does not happen.
All that makes me think that theorizing infertility along the lines of a disability or disease is a mistake—even though we are prone to do it. The involuntarily childless person discloses something deep and fundamental about our reproductive capacities, namely, that they are exceptionally vulnerable and highly continent: so much luck and so many inefficiencies are involved in forming human life that one might reasonably doubt the intelligence of the designer. But those features also bind a couple together: to attempt conception requires, after all, the frequent and successive uniting of a couple in love. Childlessness is not a pathology in need of a remedy, but rather a disclosure of the deepest truth about human life: that it comes from God.
In vitro fertilization offers couples who experience unexplained infertility to conceive—but it does so through circumventing the employment and use of the reproductive organs (and, indeed, the act of the persons whose organs they are). It is common to think about such a circumvention along medical lines: we replace failing kidneys with dialysis machines, and similarly we can use in vitro to help couples conceive.
Yet dialysis machines or other such interventions are inherently therapeutic in nature. We don’t give people prostheses or catheters or any other interventions except on the prior condition that their lives are somehow disabled or diminished and the intervention can ameliorate their suffering.
To employ in vitro fertilization on the same grounds inherently pathologizes infertility: it both presupposes and reinforces the idea that there is something wrong with the couple who has not conceived, that they are in some mysterious way diminished. In that sense, in vitro fertilization magnifies the stigma on childlessness: when it is employed within a community, it reshapes everyone’s perceptions of the childless in ways that they are otherwise unable to escape.
All this was, I thought, a novel thought to me. But it turns out that I’d merely forgotten Oliver O’Donovan’s analysis of contingency in Begotten or Made, which I have almost surely been parroting the past few years without ascribing due credit.
“Pregnancy is not a condition of health,” he writes, “it is an event which depends on contingencies.” A doctor might suspect a pathology in a childless couple—but “to suspect a pathology is not to prove one.” Indeed, even naming childlessness ‘infertility’ seems to participate in the attempt to expunge any traces of sheer contingency or luck from the process of forming human life.
Of course, many childless couples will be no more content to accept their lot of witnessing to contingency than they would be content to accept being pathologized: they want a child, not an explanation or rationalization for why they don’t have one yet. But in so wanting they come to terms with the fundamental core of human existence, the sheer givenness of our life behind which we simply cannot go and for which we must simply be grateful: in coming face-to-face with the radically contingent origins of life we discover something true about our own lives, namely, that we live and move and have our being only as the gift of God alone. That is the cross of childless couples; but it is also their joy.