Review

Against despair

INFERTILITY SERVICES: A DESPERATE CASE
Greater London Association Of Community Health Councils, London
Naomi Pfeffer and Alison Quick.

In recent years, the experience of infertility has been made publicly visible almost exclusively through the moral dilemmas posed by the new reproductive technologies. The debates around the technologies — currently focused on the embryology and currently focused on the embryology and human fertilisation bill — have given rise to a mass of conflicting ideas and strange alliances.

A strand of radical feminist thinking sees procedures like in vitro fertilisation (IVF) and embryo transfer (ET) as one stage on a slippery slope in the enslavement of womankind by male egg snatchers. They speak out against the technologies alongside those who see them as a threat to the ‘natural’ nuclear family and women’s place within it.

On the other side, medical and pharmaceutical interests argue that the procedures give women longed-for and healthy children. Other argue that there is a place for the technologies, but that they should be provided in a way which is far more responsive to those who use them.

A version of the infertile person is necessary to these debates. The otherwise divergent ideas of many of the pro- and anti-technologists converge towards images of desperation. Men, and particularly women, are seen as being prepared to go to any lengths to have a child. For the pro-lobby, technology comes to the rescue, delivers the goods and enables the woman to fulfil her true destiny. For the anti-lobby, the childless ones are driven by desperation to fly in the face of nature and compromise us all morally.

But how does all this square with the ways infertile people experience their infertility and the services? Infertility Services - a desperate case by Naomi Pfeffer (co-author of The Experience of infertility) and Alison Quick is a modest publication from GLACHC which mounts a challenge to prevailing views.

They suggest that infertile people — whose voices are usually absent from the debates — are ill served by the current preoccupation with the high-tech end of the spectrum. The vast majority of those who do seek medical treatment for infertility do not use high-tech services at all, but encounter a substratum of badly managed and uncoordinated routine tests and treatments.

Infertility services lack overall planning and developments all too often reflect the interests of particular consultants. This can mean that the introduction of IVF and ET diverts attention and resources from the less glamorous services, causing further deterioration.

What is most striking about this report, however, is the refreshing assumption that although infertile men and women have their infertility in common, there are as many differences between them as there are amongst people in general — differences of class, culture, sexuality, options and resources. Infertility has different meaning for different people, and they seek different solutions. Some people might not seek medical solutions at all, and certainly not everyone is prepared to accept all the treatments that are technically possible. Images of desperation serve to further stigmatise those experiencing infertility, and detract from considering how services might meet their real needs.

Above all it is a salutary reminder that with the even more haphazard planning arrangements likely for ‘non-core’ services such as infertility, the implementation of the NHS Act will have a far greater impact on services for the mass of infertile people than any legislation on embryo research.