Title: In Fertility: The Story of a Miracle and the Big Business Behind It
Author: Kathryn Blaze Baum
Genre: Non-fiction
Publisher: Viking
Pages: 320
By trade, investigative journalist Kathryn Blaze Baum is a pursuer of clarity and resolution and light, the teller of other people’s tales. But in her book, she is, for once, the subject of her own story. This is how In Fertility begins, with Baum, determined and confident, describing her decision to conceive a second child.
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The conception is long-planned, timed around Baum and her husband’s demanding work schedules and an exact two-year age gap between her children. She gets pregnant on beat. But then something goes wrong – violently wrong – and the story diverts.
The author, a Globe journalist, finds herself in a medical nightmare in which mysteries compound, resolutions unravel and she’s anything but a protagonist. The narrative splits into alternating sections – half investigation, half infertility memoir – that sometimes overlap or blend, evoking the shifting chaos of a fractured life.
Both modes of narrative circle the theme of control, in different ways. “At some point, usually pretty early on, you’re at the mercy of your body and you’re pushing up against the limits of what modern science can do for you,” Baum writes early in the book. “My body wasn’t my own. It was taken over, overwhelmed.”
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The memoir sections of In Fertility also record the taking over of the author’s mind. She ruminates more than she narrates, fixated on the countless unknowns of her condition. She litigates every possible mistake and wrong turn and exhausts herself with self-punishment. There’s an insightful account of the self-absorption that often comes with early grief, the turning of everything around a person into a crystal ball of personal messages and predictions.
That Baum is aware she’s not quite herself only disorients her further, especially as her diagnoses pile up and her treatment becomes increasingly complex. She and her husband navigate a baffling bureaucracy to contract a surrogate. There are inexplicable issues with her embryos. She almost dies from the medication used to stimulate her ovaries. Each of these developments has its own blast crater, requiring a whole new battery of tests and specialists and procedures – drugs to counter previous drugs, surgeries to fix previous surgeries – such that it would be more difficult to stop than keep going.
In the book’s expository sections, Baum zooms out to investigate the entity to which she has ceded so much of her time, body, will and sanity: the fertility industry. Complete with an index of specific medical and industry terms, it provides as close to a definitive account of Canada’s assisted reproduction policy and practice as possible, given the byzantine nature of the laws, economics and politics around it. Baum draws upon dozens of interviews – from the CEO of a multinational private IVF network to a historian of fertility legislation to a nanny who had to abandon her plans for parenthood because she could afford only one cycle of IVF, at a cost between $12,000 and $20,000.
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Their stories illustrate the consequences of Canada’s failure to effectively nationalize new reproductive technologies as they rapidly developed in the eighties and nineties. Largely left up to private capital, what could have been a normal sector of health care is now a labyrinthine system of pay-for-play clinics, poorly regulated and under-researched treatments and a profit-driven incentive structure that leaves patients vulnerable to everything from misinformation to practitioner abuse to old-fashioned snake oil (some of which Baum tries herself).
The research explains the flaws in the current system without tipping into the sensationalism or conspiracy that is common in media coverage and (inaccurately!) suggested on my advance copy’s back cover. Baum makes a case for fertility industry reform while remaining cautious of changes that would restrict access to care or further stigmatize the populations that use it (LGBTQ prospective parents are the fastest-growing patient demographic for IVF).
As a primer on a life-altering condition that is also honest and vivid about its emotional toll, In Fertility would have been invaluable to me during my own tour of infertility hell, not least because Baum’s story and mine are very similar (we share a supposedly rare Asherman’s diagnosis, a reproductive endocrinologist, a reproductive counsellor and a surrogacy lawyer).
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But 12 years out, In Fertility feels cloistered to me in the same way my own 2019 book does when I re-read it now. As Baum acknowledges, any story that is set in one of Canada’s only 35 IVF clinics will be limited, reflecting the experiences of citizens who can access them – affluent urban professionals, disproportionately white.
Still, narratives that overfocus on issues with clinics and treatment risk presenting infertility care as a problem in itself, rather than as a symptom of a larger global shift to the far right that entrenches existing disparities around access to reproductive care in ways that extend far beyond babymaking. Interviews with more reproductive justice scholars could support this context, which is crucial as attacks on reproductive medicine advance in step with abortion bans, trans care bans and diminished support for pregnancy, birth and early parenthood.
Now, I see infertility less as a unique burden or insult than one point on a continuum of reproductive suffering that is as vast as it is underacknowledged. Among all these other people, the randomness of nature feels easier to accept.
But healing can be just as random, and at In Fertility’s conclusion Baum’s has only begun. I won’t spoil it, but there’s a twist that is as unpredictable and medically baffling as everything that’s happened before, only this time the reporter doesn’t try to explain it. Against her will, she has become comfortable with irresolution. Early in the story she quotes a Yiddish saying: “Man plans, God laughs.”