Published on January 8th, 2019 | by Allegra Hirschman1
Am I Infertile or Just Queer?
For me, trying to conceive was a clusterfuck of hope, disappointment, preoccupation, self-care, and self-doubt with a side of amateur science and a small dose of witchcraft. As I started the journey of trying to get pregnant through my medical provider, it became clear that the processes I would be using were not designed with my specific circumstances in mind. I am a ciswoman married to a ciswoman and we were trying to conceive our second child; my wife gave birth to #1. Once I was up to bat, and various homophobic laws had changed (don’t get me started), we could fully utilize our insurance, which covers “infertility.” I am endlessly grateful for this coverage and understand the need for this diagnosis from a bureaucratic, medical, and political standpoint. The last thing we need is for the Trump administration to start coming after the already tenuous health benefits of queer and single women, so I understand why this ill-fitting blanket must be thrown over anyone trying to conceive in a way that can not be summed up by a grade-school hand gesture. At the same time, starting off as “infertile” has an impact on the kind of care I received. This process turned out to be confusing and disheartening in particular ways that are unique to individuals who begin outside of a perceived cis/hetero partnership.
Failing Before We Began
The questions I was asked and the tone of the encounters assumed that I had already “failed” at something. From the beginning the phrasing was confounding. Questions like “So you are able to ovulate on your own?” and “What medication are you on?” made me feel like I was missing something. All of my labs had come back normal and some even good “for my advanced maternal age” (34 at the time), but I had no idea what was “normal” and what was cause for alarm. Our plan was to use the clinic to help monitor the timing of my cycles and administer IUI’s (intrauterine inseminations) with donor sperm. I was trying my best to enter this process with a positive outlook and the belief that, despite not having a sperm producing partner, I would still get pregnant.
Technically, my charted diagnosis was male infertility. Of course it was. Wasn’t this the only obvious, logical explanation for a female partnership? To their credit, my healthcare providers were embarrassed by this line item as well. Still, having the lack of a cismale partner be a diagnosis is a bit disturbing.
On our second go, the Nurse Practitioner doing our inseminations remarked how amazing it was that we had “such a great attitude.” While I believe she was being earnestly supportive, this watered my seeds of doubt. Why shouldn’t we be in a good mood? This was just how we were trying. We were giddy and excited to start this process. We had not been trying “on our own” with no success for six months or a year to qualify for this treatment. We were just queer, but maybe that really was a problem?
It felt like it was only a matter of time before my defects were to be discovered. I was asked at every visit what kind of ovulation-stimulating medication I had taken. I was not on any. I had no medical reason to think I needed this. And yet every question made me wonder if my chances were much worse than I thought.
Coming Out Fatigue
Despite the fact that I live in San Francisco and saw plenty of other queers in the infertility department waiting room (yes–I see you), on almost every visit I have had to come out again, to at least one member of the medical staff. I don’t mean that I was asked a neutral question about being partnered, I mean that someone said something that assumed my heterosexuality and I had to correct them. One day when I waited at the crowded medical assistants station to get my next instructions, I was told: “Do not have sex for the next 48 hours.” When I looked confused they clarified, “Your partner should not ejaculate, since it reduces count.” This time, another staff member stepped in: “She’s using a donor.” And all eyes shifted away from me.
No matter how many times I come out, and as a bisexual femme this is a near constant activity, I mentally rolodex all of the ways the reaction might go. Straight women often shift their physicality, either taking more distance when they get the chance, or adjusting their posture and demeanor in a way one does when they have been socialized to situate themselves properly as an object of desire. Coming out to people who are charged with my medical care adds a whole other layer of anxiety. What if I am relying on someone to literally assist me in growing my family, who does not believe my family should exist? At my darkest moments I worry that they could actively sabotage the process, but more often I fear that, through some unconscious bias, they will just try a little less hard for us.
This paranoia, coupled with the desire and pressure to be a model sexual minority, means I find myself trying to make sure that after someone assumes my heterosexuality, they do not feel in any way awkward for their easily avoidable mistake. If they do apologize for the mistake, I am already tripping over myself to tell them not to worry. After all, worrying is my job.
At my first visit, after leafing through one of the hundred copies of Fit Pregnancy magazine in the waiting room, I was told to undress and handed a plastic cup for a pregnancy test. “I wouldn’t be going through all this trouble if I was pregnant.”
The medical assistant was in no mood for debate. “It’s just to make sure.”
“I am married to a woman, so me being pregnant is pretty impossible, or at least, uh, haha, hard to explain.” She nodded, without cracking a smile, and kept her hand extended with the cup which I took and urinated in dutifully.
With all of the coordinating it takes to deliver either sperm or a sperm-producing human at just the right moment, I was livid when they would casually say that I could also “try on my own” on the surrounding fertile days. “My wife and I keep trying but…” This was also an ill-received joke. I desperately want a rainbow flag on my chart so we could all stop talking, especially me. If I was lying there in stirrups and the person holding my hand was a man, I assume they wouldn’t ask, “Well, who do we have here?” I am not saying that assuming partnerhood is a good habit, I guess I am just saying “READ MY CHART.”
The Stress of Conceiving While Queer
Queers seeking appropriate medical care have to fight like hell to balance the desire to be both visible and safe. We have to do a complicated tap dance to receive benefits from programs not designed with us in mind without calling attention to ourselves in ways that could disqualify us.
We are taught early on to apologize for being outside of society’s designated boxes, as if we are the ones who are responsible for the poor treatment we receive. The fact that, in many states, same-sex couples seeking reproductive services have to undergo psychological evaluations in order to even start trying is offensive and invasive before an increasingly invasive process begins. Trying to conceive is already a highly stressful, time-consuming, and often prohibitively expensive undertaking for those of us fortunate enough to even consider a medical route. This stress is compounded by being told to relax and that stress is counter-productive to breeding.
When we do open up about the process, we are often told inspirational stories of straight couples with fertility issues who finally “stopped trying” and then got their magical stork package. The flock of storks serving our community need legal paperwork, timed routes, and maybe an eye of newt blessed by Ellen. I am still working it out. And as much as I wanted to empathize, and do understand that many couples of all arrangements deal with this, the last thing I needed was to know is that Greg and Peggy just banged it out every night on vacay and came back with a BFP (Big Fat Positive on a pregnancy test, for those of you not in the know).
Anyone who knows the process of trying to conceive (or as we veterans call it, TTC) outside of the bedroom knows that the amount of visits to the clinic can make you feel like having a speculum in you is the new normal. It got to a point where I didn’t even have to scoot for my vaginal ultrasounds. Yes, that’s right, like an infertile cowgirl I was able to hop into the stirrups with my ass almost hanging off the table just as they intended–that is how second-nature this all has become. Considering that this process can, even under relatively good circumstances, take some time, having medical visits free from heterosexist assumptions would certainly make the time spent in paper gowns pass a bit faster.
What Would it Look Like to Be Taken into Account?
It is challenging to even picture what standards of care for single and queer women would look like–standards that actually center our needs instead of treat us as a variation of the “normal couple.” However, I believe they are not just possible but crucial both for the success of this process and for our mental health as we undertake it. This includes small changes. My clinic recently changed its name to replace “infertility” with “fertility.” Language does matter, and what rendered someone infertile in the past does not necessarily mean infertility today.
Approach matters even more. We are told that the ideal way for this process to happen is through an act of intimacy between two heterosexual partners. Even in lesbian and queer circles we call this “natural insemination.” When this is not the method, many of us enter into a partnership with our medical providers that, whether we like it or not, also feels intimate. In this partnership, I want my wife to feel addressed and included even if she is not contributing genetic material. I want to talk about timelines, expectations and odds of conception that are based on large-scale peer-reviewed research about non-heterosexual conception rates. I want this research to exist. If a standard protocol is necessary, I want the design and implementation to take me into account. At the very least, I want that rainbow flag on the first page of my chart.