Jenni Quilter on IVF, nuclear family ideals, and motherhood as an "automatic-meaning machine"

Jenni Quilter didn’t grow up lusting after motherhood - she didn’t shape her life around an ironclad certainty she wanted kids. So when she was told she had a diminished ovarian reserve at the age of 35, she was disoriented to find herself “undone” by the news, and shocked at how quickly she plunged headfirst into reproductive technologies.

“I knew, consciously,” she writes in her book Hatching, “that my own baby desire was far slighter than that of other women I knew, but I had also unconsciously accepted that giving birth would act as a fulcrum, a kind of tipping point . . . Now I was exhausted by the prospect that I would have to craft this meaning on terms that would not be immediately or easily understood by people around me.”

So because Jenni found herself holding onto the idea of motherhood as an “automatic meaning-making machine,” she “didn’t blink” before pursuing IVF. “Rather than step back, I ran forward, further into the world of reproductive technologies, headfirst into an attempt to fall pregnant, not by sex, but by laparoscope and micropipette and catheter tube. If this sounds like a remarkable escalation of events, it was.”

Hatching is Jenni’s attempt to make sense of her “expedition,” and the result is a thoughtful, curious, fiercely intelligent book that asks us to consider women’s bodily autonomy, alternative kinship structure, and the power of seeing. Weeks after reading it, I’m still thinking about all the questions Jenni evokes, questions I had never thought to ask, and questions I’ll now, thanks to her book, never stop considering.

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Sara:  I was sort of horrified by how much I learned by reading this book; it really clarified just how little I actually knew about the history (and current state) of reproductive technologies and IVF. In the book, you write about how you plunged into IVF almost without thinking, and I wonder if you think that experience is unique to IVF, or if it’s a result of both how IVF works in the US and also just how much significance motherhood as an identity marker holds in many western cultures?

Jenni: I am the daughter of a scientist-educator and a doctor, and so the whole notion that medical technology is unnatural, and diametrically opposed to “naturally” falling pregnant didn’t seem that convincing to me. We are already heavily mediated by technology: think pacemakers, etc. I wasn’t as anxious as some of my friends have been about what my choice signified; it didn’t automatically read to me as a failure to choose to use it. That said, the speed is unsettling. When a couple decides to fall pregnant through sex, the choice to stop using contraception is often kept pretty private, and so there’s this quiet runway where they see what happens. But when you decide to undergo IVF, your daily routine radically shifts: you’re at a clinic most mornings, you’re viewing your body in radically new ways, you’re spending vast amounts of money. It’s structurally abrupt as an experience. It’s structurally abrupt to fall pregnant regardless of how you do it, but yeah, the pre-pregnancy experience is pretty different. 

I also think the common understanding that your fertility falls off a cliff in your mid-thirties was a strong driver in my decision. I had lived away from my family in Aotearoa New Zealand since I was 21–first in the UK, then in the US–and so the prospect of motherhood without common support structures like extended family or state subsidized child care meant that having a baby was always an economic decision for me. I could’ve thought about IVF when I was 25; there are people who anecdotally report freezing their eggs as graduation presents to themselves. But things were just too economically precarious for me through much of my twenties and early thirties. I kept on putting the question of motherhood off like any other big investment in time, money, or commitment. I also worried about having a child in a country so far away from home; how that would direct my future decisions. But all the while I was moving towards that fertility “cliff” (which I’m now not so sure of, by the way), and the pressure started building, building, and I was living in a society that strongly values the symbolic value of babies but not the reality of raising them. The ideal grew in power as I started to make more money, and I suddenly saw that I could fall pregnant and provide for another human being. 

Sara: One of the themes of the book is the interrogation of the nuclear family. You write: “IVF clinics unthinkingly, even compulsively, offer a heterosexual cisgender dream of a nuclear family.” And I don’t know if the average person thinking about IVF would necessarily think about it in those terms. I wonder if you could just talk about how you drew that particular conclusion.

Jenni: I wouldn't have thought about IVF in those terms either prior to experiencing it. I look around and I see friends who are queer who've had kids through IVF, single mother by choice who’ve used embryo donation. IVF seems like such a natural way to create alternative kinship structures. 

But the medical definition of a woman's infertility is the inability to fall pregnant after a year of unprotected intercourse. What happens if you're a queer woman? What happens if you’re  not having unprotected intercourse with a man for a year, but somehow you're still classified as infertile? How do you account for that difference between the medical definition and your own lived experience? I don't think people in the IVF community necessarily want to discriminate against alternative kinship structures. All the nurses I met were wonderful. The doctors were great. It's not as if there's this kind of concerted effort to go back to conservative family values. But when I visited IVF clinics, every doctor or nurse would, without fail, refer to my co-parent as my husband, to the point where I just gave up correcting people. When I went to have my eggs removed in my first surgery, there were eight women in the waiting room waiting with me, all dressed in surgical scrubs, all attended by their husbands. I'm not arguing that that's an accurate subset of the broader population, but it was striking to me in a large IVF clinic in New York City. Instinctively, there was this bias towards a heteronormative fantasy.

When you look at the history of IVF, there are traces of this from the get-go. The two men who produced the world’s first IVF baby, Robert Edwards and Patrick Steptoe, had to work for years with thousands of women without success, and in their book A Matter of Life they note–almost without noting what they’re saying–that they would ring the husband to inform the couple of the final pregnancy test result. In their decades of research, and then once they opened Bourn Hall, the world’s first IVF clinic, there is just no mention of queer or gay couples or single mothers by choice. They weren’t a visible population for a long time. I should note that Bourn Hall Clinic is now very mindful of this, and they feature other kinship structures on their website materials, but I don’t know how deliberately other clinics evaluate their materials and patient protocols.  

Sara: Do you think another part of some people's resistance to IVF might have something to do with the idea of asking permission? Like, being a sort of supplicant, and asking medical practitioners to please do to me what my body could not do for itself?

Jenni: Yes, for sure. It’s a power dynamic that people can find shameful, and historically, there are good reasons why that can have an awful lot to do with gender. But what’s extremely interesting is that you could gain more power if you start to understand why, if you’ve been having unprotected sex, you aren’t falling pregnant. The cause can become clear–i.e. endometriosis, or low sperm mobility. That can be freeing. But then, of course, you have to deal with that new information within the dynamic of your relationship. Some people don’t want to know. How will it feel to find out that one person is infertile and the other isn’t? Or how will it feel to not find a cause, which can happen too, and quite frequently? There is a significant percentage of cases of “unexplained infertility” where science has just reached–for now–the limits of understanding the interplay between hormones and eggs etc. The myriad paths to knowing or not knowing can all appear a very frightening prospect.  

Sara: Going back to Steptoe and other doctors who were instrumental in paving the way for modern reproductive technology, there’s very little mention of the actual women whose bodies were instrumental in the creation of IVF. There’s very little mention of their stories. Could you talk about how women’s bodies were used (sometimes without their consent) to get us to where we are now? There was that one awful quote that is standing out in my mind. Landrum Brewer Shettles said, in reference to obtaining human eggs for his medical experimentation and research: “Most of them I just poached.”

Jenni: Although there’s been a publishing boom in the last decade or so of women accounting for their reproductive frame of mind, it’s remarkably few voices when you look back even one hundred years ago, and just crickets if you go back earlier. I’m sure there was a rich oral tradition, but in terms of published writing that took those stories as seriously as the science these women contributed to, not a lot at all. For example, Karl Ernst von Baer was the first person to definitively identify an egg in a human woman in his book On the Genesis of the Ovum of Mammals and Of Man, but he only really included it in the illustrative plate–alongside the ovum of about 25 other animals–and didn’t describe the circumstances of discovery in his text. It was fine to write about dissecting dogs in detail, but he only briefly notes two dissections of women, and neither of these women contained the egg he found–that story remains untold. This is in stark contrast to the “discovery” of sperm under a microscope, which happened one hundred and fifty years earlier, and which was accompanied by intense debate, scrutiny, correspondence, verification, and peer review. From the 1940s through the 1970s, when people were racing to hone the techniques you needed to successfully conduct IVF, researchers like Shettles, who you just quoted, routinely took eggs and embryos from women without informing them; you’d go in for a hysterectomy say, and they’d discover you were pregnant or ovulating, not tell you, and take the embryo or egg. Because it was being done in the name of science, there wasn’t a whole lot of hesitation. 

These practices were also racialized. James Marion Sims is considered the father of modern gynecology in the United States, and in his book The Story of My Life, he describes how he developed a surgical technique to address vesico-vaginal fistula, which is an injury that can occur during childbirth. He did this by practicing on up to 30 enslaved women over eight years, and all they endured multiple operations, and all without anesthesia, though it was available to Sims at the time, and though he gave it to white patients. He used opium with the enslaved women instead, knowing it was highly addictive. Medically, there has always been a systemic indifference to Black pain and a willingness to experiment with Black women’s bodies in order develop systems of care that other women have profited from.  

I think when you're a woman and you're born in the late 20th century, you are encouraged to think that you're growing up in a time when women have never had more rights than we do now. More independence, more freedom. I grew up thinking my body was my own, and I still assume I have a lot of control over my body. But this is so hard won.   

Sara: So harrowing. I’m also thinking about Dr. Ombelet, who is trying to make IVF more accessible in sub-Saharan Africa. Can you talk more broadly about the differences in IVF across the globe, in terms of cost and accessibility?

Jenni: I think the biggest takeaway for me was the growing realization that the price does not have to be the price. In the US, we generally expect a course of IVF to cost around $10,000.00 to $12,000.00. Some of that will be covered by health insurance, some of it won't. Willem Ombelet is a South African doctor who settled in Belgium, and he’s developed a form of low-cost IVF. With others, he developed a IVF kit that looks a lot like a high school science project and costs about as much; I mean, it’s crazy IVF-in-a-shoebox audacity. He also rethought how much sperm you actually need, how much hormone is actually needed, how much movement between the sperm and the egg is needed within the test tube. If you’re doing this low-cost IVF in a place that has a strong medical infrastructure with good clinicians and good access to hospitals (like Belgium), the cost could be as little as 900 to 1000 euros, which would completely revolutionize IVF. He conducted clinical trials in Belgium, and the success rate was just as high (if not a hairsbreadth higher) than the usual protocols. It won’t work for everyone, but it could work for a significant number of people. He has been trying to implement this technology in Ghana, with mixed results, mostly because of the infrastructure on which this low-cost technique relies. But it is working, and could work globally. 

Imagine if women around the globe  had access to IVF for $1,000.00? Imagine how different things would be. 

Sara: I'm going to quote you again: “It was not so much about wanting a baby as expecting a life shaped by one. What would my life look like without that central bent around which everything else gained interpretive symmetry? No wonder I was bereft. Not realizing it, I considered motherhood as a kind of automatic meaning-making machine.” I found this passage so intensely relatable. Can you speak more to it? Because I do think especially in the US and other western cultures, people who are socialized as female are encouraged to view motherhood as a shortcut to self-actualization.

Jenni: I mean, the thing was, I hadn't thought that way for most of my life. I had genuinely grown up thinking that it was very possible I wasn’t going to have kids. Close friends of mine quietly expected to be pregnant by a certain time, but I just never did, which is why the realization that maybe I had been expecting motherhood without knowing I was expecting it hit me so hard.

Your life really does change when you have a kid. Your sense of time itself is transformed. And I talk about this in the book as a kind of time travel. You become subject to another human being’s needs in such an intense way, and it creates this crucible-like moment. 

There's an inherited wisdom to thinking that motherhood as a kind of automatic meaning making machine because it's just true–that intensity generates meaning, good or bad. And that's why it's so upsetting when you suddenly realize that you might want it and not be able to have it. I recognize the force of that now more than I think I even did at the time. Having children does act as a type of accelerant in transforming some very fundamental forms of living: eating, sleeping, what you do with your time.

I think you might feel a similar reorganization of meaning in your life if you decided to do something extraordinarily emotionally and physically taxing, like climb Mount Everest–a  massive task that required a huge amount of focus and energy. So it’s not like you can’t create similar types of meaning without children: it’s just that the meaning is given to you when you have a baby in ways that are irreversible. 

Sara: As we’re talking, you're sort of clarifying something for me, which is that an automatic meaning-making machine is not the same thing as like, Hallmark’s version of maternal meaning. Like the automatic meaning-making machine doesn’t mean you will have more self-knowledge or be more internally fulfilled necessarily. It’s just that the meaning is automatic, but it looks and feels differently for everyone.

Jenni: Yes. Childhood is an automatic meaning-making machine too, right? It meant something to us all regardless of whether our childhoods were shitty, great, or somewhere in between. It had meaning, whatever happened. I’m not sure why we automatically ascribe “meaning” to positive meaning when it comes to parenthood.  

Sara: Back to my notes. This was sobering! “In 1907, Anonymous, New York City, was heartbreakingly explicit as she pointed out in a letter to progressive weekly magazine, The Independent, the hypocrisy of the state in encouraging women to have children but refusing to offer competent medical care, paid maternity leave, or daycare options.”

Jenni: I know. When I read it, my heart sank too. I only have one child, and I think I would have had more if I was confident in accessing any of the things the woman mentioned in 1907.  But I feel really, really worried about my ability to provide for another kid, given my resources and given the world that we live in. And this letter is heartbreaking because the writer is so clear about the structural forces getting in the way of her having a child and the pressure to do it anyway. There’s a line at the end of the letter, where she basically says not having a child is her act of defiance, because she doesn't want to create a child that will end up being fed to the system. “You can refuse us any certainty of work, wages or provision for old age. We cannot help ourselves. But there is one thing you cannot do. You cannot use me to breed food for your factories.”

I didn’t set out to write a depressing book!

Sara: No, no, I feel like pointing out these things will galvanize people to keep pushing forward.

Jenni: I think the book is fundamentally optimistic. I wrote it to make sense of what was happening to me, and threw myself into the research as a counterbalance to the stories I was encountering at the clinic. I remember sitting at my first fertility doctor’s desk and looking at all these laminated charts detailing numbers and percentages and my chances, and thinking, I understand why that's really helpful for a pragmatic person, but not all people are pragmatic Type As. How do the non-Type A people work through this? How did the industry decide this was the best approach? In those moments, it was very hard to fully track how I was feeling because it was so much to absorb. The book was a way for me to think more deeply about the process, as well as what being a mother is without the expectations of motherhood and the consumerism of motherhood. Is it possible to have a vision of being a mother that isn't about fulfilling some feminine ideal, and that isn't about creating some kind of effortless domestic space that's been carefully calibrated to coexist alongside late stage capitalism? How do these things feed into one another? How does acquiring these things or wanting to acquire these things structure our own understanding of our kids and our selves?

Sara: Right. You write: “I was keenly aware that in the absence of a community I love that showed me how to be a mother, marketing might well creep into the gap.” I think a lot of people enter motherhood not being keenly aware that marketing might “creep into the gap,” so I’m wondering how you had the presence of mind to recognize that?  

Jenni: Well, I’m not immune! Part of the book is me trying to work out how to have a domestic space that centers ritual rather than consumerism–but at the same time, I love art, love aesthetics, love the power of images, and have spent a significant amount of my career writing about art. But I do think social media is a firehose that we think we’re sipping from.  

Sara: I started the conversation by saying I'm horrified by how little I knew, or how little I had deeply considered before, particularly about women’s agency and bodily autonomy. You write in the book that feminist anthropologists have been thinking and writing about this for 40ish years, but that deeper considerations of agency and the potential ramification of participating in reproductive technologies are infrequently considered by many folks actively engaged in IVF and infertility treatments. You mention that these questions and issues certainly won’t pop up in google or in your IVF doctor’s pamphlets. Do you think that’s by design?  

Jenni: No. I don't know. I vacillate between optimism and pessimism. I think it's quite possible to be unmoved by your own subjugation when you are trying to fall pregnant, and it doesn't really matter to you if you’re a guinea pig or a moral pioneer. You're just so intent on succeeding, and you’re willing to push other questions aside. In the book, I write about interviewing my own IVF doctor and not even bothering to ask him questions about feminist anthropology, because I assumed he would consider them beside the point. Because for him, it was just about giving a woman a baby. And of course, I could be wrong in assuming that, and I don't think he willfully minimizes this information, but I just think he doesn't value it in the way that I do. I’m curious: now that you’ve read about the implications for women’s bodily autonomy and women’s agency as it pertains to IVF, does it change your mind about IVF?

Sara: You know, I don't think it does. I mean, I can imagine myself plunging into IVF headlong just like you did and just like so many people do with the very simple desire to accomplish a goal of creating a family. Like, I want a baby so I’m going to X, Y, and Z if my doctor recommends I do X, Y, and Z. Because I want a baby. To lose yourself in any deeper sort of introspection of what it all might mean while going through it would be rather hellish, right?

Jenni: Yes. Exactly. Knowing this stuff won’t change peoples’ decision to participate in reproductive technologies. And to me, that’s so interesting. It doesn’t make it not important. But it’s exactly why systems don’t change.

Sara: If you were going to design a utopian IVF system, what would you do?

Jenni: IVF would cost $1,000.00 or it would be entirely covered by health insurance or a national health system. We can dream big, right? If IVF was virtually available to everyone in this country, that would radically shift how IVF is used. Right now, it's only basically for those who can afford it orr those who have good health insurance. If it’s an economic privilege, conservatism naturally arises. 

Sara: You write in your book about being given embryo photos after implantation. What do you think of that policy?

Jenni: It’s very related to abortion rights, because if we’re taught to cherish these photos of embryos and put them up on our mantle, it makes us think about conception and life differently. The anti-choice lobby is very aware of the fact that IVF can encourage us to rethink when life begins, which is why they're so interested in embryo adoption. But on the other hand, I really wanted to have that photo. It was enormously comforting to me that I had some kind of visual verification of what I had gone through, and visual verification of what had been put inside of me.

Having these images is in some ways deeply hopeful, and it's where I think I push back a bit against some parts of feminist anthropology, where there’s a tendency to assume that all image-making is objectification and automatically bad.  But we know there  is also power to be gained in image making. I don't think that that power only resides in the person who makes the image (i.e. the embryologist).  

Sara: Is there anything else you’d like to talk about?

Jenni: Many books like this follow an arc from being infertile to having a baby, and when I was experiencing infertility, I did not want to read them because I had to be careful, when I was dealing with grief, what stories to let in. I think there’s the same potential issue with this book, but I hope that because it’s a critical exploration of these new technologies, there’s a way in which this book can act as a kind of armor. Writing it helped me understand how my sense of agency seemed to rise and fall, and how I could regain it when I felt it slipping.