A Triptych of Losses – Reproduction Scholars Reflect on Fertility Fest
Fertility Fest is the world’s first arts festival dedicated to fertility, infertility, the science of making babies and modern families. Here, Susie Kilshaw, Zeynep Gurtin and Katharine Dow, three scholars of reproduction, provide their reflections on various events that took place at The Barbican, between 23-12 May 2019, as part of the festival, exploring themes of miscarriage, “unsuccessful” fertility treatment, and children that were never born.
The ‘M’ Word: Miscarriage
Susie Kilshaw (Anthropology, UCL)
I found myself watching a portrayal of miscarriage taking place on stage as part of Theatre Company, Open Sky’s Cold. The “transposed fairytale” tells the story of a couple who find themselves in a snowbound wood after a diagnosis of miscarriage; the writers’ response to their experience of pregnancy loss. The scene was presented in the session on miscarriage, which also included psychotherapist Julia Bueno’s reading from her book The Brink of Being and visual artist Foz Foster talking about his body of work Labour of Love. Witnessing a miscarriage, even if only a portrayal seems shocking: the intimacy of such an event in a public setting. And yet this is exactly what such endeavours aim to do “More common than you might think, less talked about than it should be. A whole evening dedicated to bringing miscarriage out of the shadows” was the tagline for the event. Such activities, support groups and charities, most notably the Miscarriage Association, have helped to break the silence and bring miscarriage into the light, primarily in order to stop women feeling isolated following miscarriage.
After the performances, the artists were joined on stage by Ruth Bender Atik, National Director of The Miscarriage Association, and David Ogutu, Medical Director of Herts & Essex Fertility Clinic to take part in a discussion chaired by Kate Brian, Women’s Voices Lead at the Royal College of Obstetricians and Gynaecologists. Throughout the evening a number of themes emerged repeatedly, including the silence, ambiguity and uncertainty surrounding miscarriage and the way miscarriage reverberates, impacting one’s future and one’s loved ones. The artists all reflected on the impact of miscarriage on the wider family including grandparents and would-be siblings with particular attention drawn to the impact on partners. There has been an absence of men’s voices in miscarriage discourse and Foz lamented that it is as though it doesn’t impact male partners. Men are portrayed as in the background, stoically supporting devastated and grieving women; yet Foz points out that in his experience it was his wife that was more pragmatic and provided strength following their three losses.
Miscarriage is often protracted, bloody, painful, similar to labour, public (thank you, BBC’s Fleabag for the scene in which Claire miscarries in the toilet of a fancy restaurant only to return to the table for a glass of wine), but it can also be relatively painless and straightforward. The extraordinary mundaneness of miscarriage, the everyday struggle of daily life is at the heart of Foz’s work. The secrecy, hiddenness of miscarriage and the alienation of medical language were central themes of the evening, but in my work I have also witnessed profound changes in the approach to miscarriage. Miscarriage is increasingly being framed as a significant loss with medical professionals striving for sensitivity in care for women who miscarry including sensitive disposal of remains. Societal shifts are leading to miscarriage being discussed more publicly and women are finding ways of breaking the silence.
My current Wellcome Trust funded research focuses on the remains and residues of miscarriage and takes a broad approach to the materials involved, so I was particularly interested in the different ways the artists remembered and memorialised their losses. As he showed images of his work, a 75ft scroll painting depicting the “children” enjoying everyday activities such as playing in the park, I was struck by Foz’s choice of words. He experienced the loss of children, later explaining that he imagines them as having personalities from conception, which is why he found the language of medical practice so alienating. Having shied away from the topic because of the political nature of the questions involved, I feel we need to transform the way we discuss embryos and foetuses and produce ways to acknowledge them as subjects without ceding women’s reproductive options and agency. When I miscarried what happened to my baby was never discussed. However, if I miscarried today I would be offered options for the “sensitive disposal” of the remains including cremation, burial or taking the foetus home in a suitable container to perhaps bury in my garden. Improved miscarriage care has involved care of the remains with this practice extending to all foetuses. If I had a termination, I would also be asked how I would want the pregnancy remains to be disposed of.
I am mindful that we need to remember the diversity of women’s experiences and ensure sensitivity to the full range of reactions. Miscarriage is not a distressing experience for all, as Ruth Bender-Atik reminded the audience. And whilst it important to talk, educate and support it is also necessary that in bringing miscarriage out of the shadows that we don’t end up casting other shadows - on reactions that do not fit with the dominant narrative of grief and memorialisation. For some women, miscarriage (or some miscarriages) are something to be responded to with pragmatism. Similarly, we need to make space for a diversity of reactions to all forms of reproductive loss whether it be sadness or depression after the termination of an unwanted pregnancy or relief after a miscarriage. Events like this one are a powerful way to open up the discussion, provide opportunities to express a variety of reactions and allow us to debate how we reconcile grief for the loss of a “child” or “baby” and the agency of women over their body and reproduction.
When ARTs don’t work
Zeynep Gurtin (Institute for Women’s Health, UCL)
When we talk of IVF and assisted reproductive technologies (ARTs), the images that come to mind are often of babies and families on the one hand, and of scientific progress on the other. We imagine that where nature has failed, technology will triumph: that modern medicine will reliably deliver miracle babies to those who persevere in the pursuit of parenthood. Yet for many men and women, this is not their experience of fertility treatment. For every cycle of “success”, there are several more of “failure”. But these stories of loss often remain unheard, muted in the margins, silenced by our collective desire for happy endings and our collective aversion to pain.
This is why, perhaps, it felt so important for Fertility Fest to offer space to artists giving voice to their experiences of reproduction gone astray as part of the Big Fat Festival Day on May 3rd. In the morning, Faye Glen and Camilla Lyon presented their bodies of work born out of the brutality of going through unsuccessful IVF; in the afternoon, film-maker Irina Vodar premiered Anything You Lose, an autobiographical feature documentary spanning her seven-year journey through assisted reproduction. The two sessions highlighted different perspectives: while Glen and Lyon spoke about life after IVF, art after ARTs, Vodar offered us an opportunity to journey with her across the world, as she underwent fertility treatments, uterine operations and surrogacy in India.
Vodar’s film is, at times, hard to watch as Irina and her partner Eddie struggle with the medical procedures, ethical conundrums, financial demands, and the stresses placed on their relationship by multiple cycles of unsuccessful treatment. But it is also suffused with love, tenderness, and good humour, sometimes in the most challenging of circumstances.
There is one particularly touching, poignant scene in which Irina and Eddie are about to learn whether their latest treatment cycle has worked. They climb up the stairs to the second floor of the clinic, stop outside the door before going to meet a nurse who has the results of Irina’s pregnancy test. They look at each other, take a deep breath. “I don’t know what is going to happen. I’m thinking most likely nothing is going to happen,” Irina says. “No, no! The world is going to happen!” Eddie responds, barely able to contain his excitement, “- and it’s right on the other side of that door!” Irina looks at him, with absolute warmth, willing his words into being, “The world is going to happen on the other side of this door?” she repeats, “Oh darling!”
As an audience member, you hold your breath with them, and for a brief moment experience the impossible bind of fertility treatment: keeping hope alive while simultaneously preparing for disappointment. “Everyone knows IVF doesn’t always work,” Irina’s voice narrates at some point, “everyone feels they will be different.”
In their unique ways, both Glen and Lyon also explore the fissures between desire and rationale, and speak of their art as a way to make something tangible and visible out of the invisible, internal, emotional experience of going through IVF. Glen’s sculptural pieces, expressing the fragility of the body and her attempts to conceive, seemed to me to evoke both medical instruments (like intrauterine devices) and indeterminate body parts (like scarred fallopian tubes), bent out of shape and painfully twisted. She described her process of leaving polymer clay pieces in the oven for too long (originally by accident) to create the scorched appearance that makes her works so evocative, so disquieting. Art, Glen observed, was a means to push boundaries and to create something even in the face of destruction.
Lyon’s watercolour pieces, combining floral imagery and abstract geometric shapes, were inspired in part by her residency at Murray Edwards College Cambridge, coinciding with her fertility treatment. Her delicate pieces incorporate the quiet resilience of flowers – “the way they just keep going” - and explore the interplay of nature and artifice that exists both when growing plants in a formal garden and when creating life in a laboratory. Circularity is another prominent theme, especially in the larger pieces that Lyon created after her treatment ended. Huge circles loom in the centre of woman-sized pieces, ready to swallow one in, much the way IVF becomes all-consuming. Lyon spoke of her art as a means of working with hope and grief - “a grief like no other, grieving for something imagined” - helpful both while going through IVF and in trying to make sense of it in retrospect.
When ARTs don’t work - and they often don’t – the experience can be one of profound loss. The loss not just of time and money, but also of relationships that couldn’t bear the strain, the hope for parenthood, the very life that one had imagined living. But even amidst this feast of losses, not everything is forfeited: lives can be happy and fulfilled and generative, even in the absence of much-wanted babies.
That may sound trite, even unimaginable perhaps, to someone currently in the middle of treatment, in the painful liminality of not knowing whether their story ends in “success” or “failure”. But Lyon and Glen both advocate for thinking about IVF outside of such binaries: Lyon emphasizes how important she felt it was to create amidst, despite, after the “uncertain attempt at creation” that is fertility treatment. Glen adds, “ARTs don’t always work, but art does.” As the lines by Rumi, the 13th Century Persian mystic, which inspired the title of Vodar’s film assuages, “Don’t grieve. Anything you lose comes round in another form.” Creating, whether it is fine art, sculpture, or film – or, as one lady from the audience shared with us, hand-knitted blankets for other women who’ve lost their unborn babies – can be a way to transform our losses, to make something from the very thing that unmakes us.
Katharine Dow (ReproSoc, University of Cambridge)
Some kinds of loss are hard to name. This observation is made by the lead character of Avalanche, Julia Leigh’s stage adaptation of her book of the same name. It comes right at the beginning of the play, rounding off a tragicomic anecdote about visiting a psychic. While all the others there were seeking to connect with dead relatives, lovers, friends, her grief is for the child she never had. She refers to this never quite there, yet quite real, child as her ‘childling’, the creative choice of word reflecting the poetic flourishes that make this account of infertility stand out not just for its honesty or poignancy, but also its artistic power.
This is not the only haunting in this play. The excellent solo performance by Maxine Peake – herself a survivor of ‘failed’ IVF – is peppered with the appearance of first a girl, and then a boy, who walk in and out of the set, occasionally playing with a dolls house. These silent childling apparitions add a piquant visual reminder of what is missing. The maturity of Leigh’s vision is reflected in the fact that she is visited, not by babies, as with so much of the media surrounding assisted reproduction, but by school-age children.
This is a story of loss, of a sort of unaccountable loss that has no established cultural tropes – that is, as Leigh puts it, hard to name. As the encounter with the psychic elucidates, the loss of a child who has never been conceived, or never implanted in the womb, is not really a death or a bereavement if we define death as reserved for those who have lived, yet the losses of infertility are not so different in their tenor. As she describes injecting herself with hormones every night, repeated egg collections, different attempts at IVF with fresh and frozen eggs and embryos, we feel the snowflakes of her desire for a child falling silently and compacting around her, isolating her, making her feel ill and ‘unsexy’, straining her relationships with those closest to her. Her marriage is long gone, she feels alone, she is riven with longing. Meanwhile her career, which had just begun to flourish as she started trying to conceive with her now ex-husband, is straining to take flight – opportunities land around her and she doesn’t know whether to take them or dig in for one more round of IVF.
It is always worth remembering that, while some of the losses of infertility and ‘failed’ IVF are singular to that experience, many are, ironically, shared with those who do become mothers. But these losses – of career opportunities and pay rises, or relationship strains and breakdowns – are perhaps all the more tragic for the fact that they do not come alongside the intense joys that motherhood can bring. Many of these losses reflect the huge social significance that motherhood is given, and of how difficult it is to disentangle a woman’s identity and status from her relationship to parenthood, whether or not she has, or wants, children. The main character mentions briefly at the beginning that, before marrying her ex-husband Paul, she wasn’t bothered about becoming a parent. This earlier iteration of herself who could be relaxed about not being a mother has melted away; perhaps this is the greatest loss of all.
Despite the accumulation of these small tragedies and the torment of being frozen in an apparently doomed cycle of failure, she does emerge from the avalanche, with a vital message: that there is love, as well as life, after infertility. Speaking about her niece, with whom she has formed a close bond, she says, ‘I commit to love widely, intensely and tenderly’. This is a quietly revolutionary aftermath to IVF. This is not a woman who has been diminished by her experience, but who is honest about the grief that remains and who has a healthy cynicism about the fertility industry, whilst also looking forward to a future that is nonetheless full of love.
This incredibly moving and powerful play reminds us of an important fact: love is not a finite resource. There is no need to restrict its subjects. Widely, intensely and tenderly is really all we need.