Sarah’s Laugh

How Infertile Women Deal

In Hebrew scriptures, barren women are fierce with grief. “Give me children or I shall die!” cries Rachel. Hannah calls herself “a woman in great trouble,” and when Eli the priest sees her praying in the temple in Shiloh she appears so disturbed he mistakes her for drunk. “I have been speaking from the depths of my grief and resentment,” she tells him. But how do infertile women grieve today? Every month that one fails to conceive is a loss. Every miscarriage is a tiny death.

After three failed artificial inseminations, I have some experience with that grief. I have replaced the phrase When I have a baby with If. And now my doctor has recommended an in vitro fertilization cycle. The prospect of hypodermic needles, hormonal drags, and operating rooms terrifies me. I know no one else who has gone through in vitro, and I am desperate to talk to people who have. Although I am not a joiner of support groups—I find them cloying and oppressive, and am easily embarrassed by the public sharing of one’s private life they demand—I decide to give one a try. Perhaps I’ll make a friend or two.

On a June evening long with light and perfumed with new blooms, I set off for my first meeting. I bicycle along the path that borders the Charles River, and for a moment I am one of the many who are happy to be out playing or walking or lolling about tonight. Then I turn onto one of the genteel, cobblestone side streets near Harvard Square and find the address; a newly built townhouse, complete with skylights and redwood deck. The woman who answers the door is tanned and fit. She waves me inside and up a flight of stairs to the living room, where several other women sit around a coffee table laden with grapes, cookies, and juice.

“Hi, I’m Karen.”



The social worker who will lead the group sits in a soft armchair. Her hair is pulled back in a ponytail; she wears orthopedic sandals. Now she bends forward to listen to the woman sitting beside her.

Small talk is awkward—this is the group’s first meeting and we are all strangers. Even so, everyone seems enormously grateful to be here among others who will understand the isolating experience that infertility often is. Four, five women arrive. We are ten women sitting close beside one another. I look around the circle to see who we are: early thirties to early forties, white, upper-middle-class, our faces marred by a stricken expression that no amount of make-up and nervous smiles can cover. We speak in voices too high-pitched, too low-pitched, or not at all. Yes, we are troubled.

As the meeting comes to order, our hostess’s twentysomething husband tramps in on his way to another part of the house and grins sheepishly at the living room full of women. This is not his meeting or gender, and tonight at least, trying to have a child is not his problem. Tennis racket in hand, covered in sweat, he is handsome in athletic shorts and T-shirt; an all-American guy, the type voted most likely to succeed.

We soon hear about this model husband: he has sperm antibodies, which means that his body attacks and destroys his own seed. Perhaps that explains his sheepish grin. Tonight, his wife will speak. Although it is his condition that is supposedly “causing” their infertility, so far she has not responded well to treatment. She has “failed” one in vitro cycle. “But I produced twenty-two egg follicles,” she says, putting her hand across her chest as if to steady its patter.

Twenty-two eggs, I know from reading, is a number well above the norm. During a non-medicalized menstrual cycle, a woman produces a single egg. Fertility drags, in an attempt to increase one’s odds at getting pregnant, typically stimulate a woman to produce six, ten, even fourteen eggs. But twenty-two! One’s system literally falls apart; severe vomiting and pelvic pain landed our speaker in the emergency room.

“The good news,” this thirty-year-old woman tells us, “is that with all those eggs, the doctors fertilized and put on ice enough embryos for several more cycles.”

She looks up at our listening faces, and then continues. “We went away Memorial Day weekend to a family reunion at my parents’ house in the country. And, well, while everyone was nice and everything, it was really hard. My sister was there with her two small kids and, well, I cried every night.” She wipes her cheek with her hand, brushing away new tears.

“I know what you mean,” says the woman beside her, a small woman with black hair. “In the condo association where we live, there’s a lot of social events. Pool parties, this time of year. And we don’t go anymore because it’s too upsetting—everyone else has kids. In the condo directory, we’re the only ones without kids listed under our name.”

Several heads around the circle nod sympathetically. I am not one of them. To me, it suddenly seems these women are crying less about being without child than about suddenly finding themselves the Other, different from everyone else they know. As a writer, as one who has lived on marginal income for many years, as one who married later in life, and, I might add, as a Jew, I have a fair experience with being an outsider. I’m accustomed to the unique view my Otherness allows. Again and again in this meeting, I hear these women—all of whom have good jobs, large houses, understanding husbands, and new cars—sob for part of their American dream denied.

And yet, isn’t this also a most human dream denied? Perhaps I—a freelance writer with a small house and an old car—am the defensive accuser in this group. Who am I to judge another’s pain? In the Bible, Rachel’s distress is augmented by intense jealousy for her sister and co-wife, Leah, who births four sons in rapid succession. Sarah, childless wife of Abraham, develops a hatred for her maid Hagar, with whom Abraham has a son, Ishmael. To those of us who are having difficulty conceiving, all pregnant women are Leahs and Hagars.

Somehow, it feels easier to empathize with the despair of unanswered prayers and wombs that will not open in Canaan than it does to empathize with feeling excluded at pool parties and vacation homes. In Genesis, having children is about peopling a nation rather than peopling a Volvo. Children are necessary to establish lineage, and most important, conception and birth are integral to one’s relationship with God. Those who are barren and troubled have a deep and aching dialogue with Yahweh. The children they finally conceive are signs that God hears and remembers; the births are profound events in the universe. Today, medical science diminishes the spiritual and cosmic dimensions of childbearing, and renders the “magic” of conception a matter of statistics and procedures. Even if biblical women did nothing but scream and wail at God for denying them children, I think we are all the poorer for having lost connection to that larger existence. At whom do we scream today? Spouse? Doctor? Our reproductive systems? These angers seem misguided.

“Okay,” says the dark-haired woman sitting across from me. She takes a deep breath and grips her wrist with her hand. “We’ve been married for six years. The first year, we were careless with birth control, but not really trying. The second year, we stopped using anything. Nothing happened. I started keeping track of my temperature. Nothing. I talked to my ob/gyn and she put me on Clomid. Still nothing. They did the whole infertility workup on me and my husband and didn’t find anything, so we kept trying. Finally, I don’t know how, but I got pregnant.” She shifts her weight in the chair. “I miscarried at eight weeks.”

“Since then,” she went on in a flat tone, “since then it’s been more Clomid, artificial insemination, and two more miscarriages. I just don’t know when it’s going to end.”

“Can I speak?” says a woman sitting on the leather couch. We are supposed to be going around the circle, each one telling her story to the rest of the group, and she is out of turn. “I have to speak.” But instead of speaking, she begins to cry: large, blubbering tears that turn her face red and blotchy. The rest of us wait, heads down, our gaze steady on the red Kilim rug.

“Today,” she finally says between sobs, “today is the anniversary of Jeremy’s death.” More crying—silent heaving. “You’re all invited to the unveiling over his tombstone this Sunday. I mean, we had a funeral and everything.” Although no one moves or responds, this seems to quell her for the time being.

“I’m 43,” she continues. “About two years ago, I met this man and we got married. We didn’t know if I was too old to have kids so we got started right away and I got pregnant.” This fact amazes her. “I got pregnant right off. We bought a house. We decorated one room as a nursery. Our friends threw us baby showers and I had an amnio so we knew we were having a boy and we picked out his name: Jeremy. His name is Jeremy.”

She breaks down again and the woman sitting beside her puts a hand on her shoulder. “He was stillborn.”

Inside me, I feel horror and disgust battling for attention. Horror for the stillborn tragedy, which in truth, makes me recoil for fear it could someday happen to me, and disgust for this woman’s flagrant display of her own troubles. Why am I unmoved by her grief? Perhaps I am too threatened, and need to distance myself.

But I saw how determined she was, even before the meeting began, to dominate the group. She interrupted people clear across the room; she spoke louder than anyone else; she took up half the couch. I disliked her immediately. And now I feel manipulated to feel empathy for her. I stare conspicuously at the rather large pimple on her nose. Clearly, she has won the group’s hard-luck prize. I look at my watch. All right, I think, she’s entitled to deep and extensive grief, mourning, outrage—but not here, not now. The meeting is to run for two hours and already this woman has taken up nearly half an hour. Even tragedy has its etiquette.

“Now,” Jeremy’s mother continues, “I’m going through my third and last IVF cycle.” (IVF is the acronym for in vitro fertilization.) The way this woman says it lets me know she does not have time or patience to spell out lengthy medical terms. “This is it,” she says. “Because of my age, I went straight to IVF. So far, my eggs haven’t been very good quality.”

My throat is tight, my stomach queasy. I came to this group to ease my own troubles. In a month or so, I will undergo a first in vitro fertilization cycle. I am 39 and doubtful about my own chances of becoming pregnant, fearful of shots and anxious about hormonal mood swings. Five years ago my husband was treated with radiation for prostate cancer. The radiation killed the cancer but rendered him sterile—we are trying to get pregnant with a nonrenewable supply of banked sperm. And though the cancer has been in remission, it remains a threat always hovering on the periphery of our lives.

But tonight, in comparison to this woman’s stillborn tragedy, my plight feels lesser, inconsequential.

Nor do I have room tonight in my small heart for the enormously difficult stories that follow. For as the circle picks up the order of our telling, I hear about ovaries that burst, tubes that broke, fast-growing fibroids. One woman, who drove down from New Hampshire, where insurance offers no coverage, sold her house to finance what has so far been only failed infertility treatments. Another woman hemorrhaged for a hundred days. Every imaginable mishap that the books say occurs to only a small percentage of women appeared to have happened to someone in the room. This is not a group to which I want to belong. Nor is it a particularly good match. I am at the beginning of my infertility career and many of these women are getting ready to retire.

I think again of Sarah. When she hears the prophecy that she will have a son within a year, she begins to laugh. Why shouldn’t she? She is 90 years old and the biblical writers note that her periods have long stopped. Almighty Yahweh is displeased at Sarah’s laugh, and accuses her of doubting his powers. But I am enormously glad for that laughter. It tells me that Sarah traveled so far in her grief that she no longer has any use for it. She has become a wise old crone who can laugh at herself. For it is modern, that laugh, full of female rebellion and existential doubt. Laughing at the preposterous, she exercises an outsider’s freedom. She laughs with joy—at the age of 91 she gives birth to Isaac.

Tonight, in this meeting, there is no humor that might support us. No one rises above her misfortunes, even for a moment, to joke about enslavement to our wombs or these intricate out-of-the-body odysseys to get egg and sperm to join. No one mentions adoption. As the session draws to an end, the social worker explains the rules about announcing a pregnancy. If it happens, we are supposed to call her before the weekly meeting, and she in turn will call the group members so as to give each person the chance to respond to the news in private. I understand about being sensitive to the feelings of others, and have myself felt envious or depressed hearing about so-and-so’s pregnancy status, but it strikes me as absurd and ironic that one of the more stressful things that can happen among a group of infertile women is for someone to become pregnant. In this room that’s thick with grief, I think of Sarah and decide to try a small laugh. The other women turn to me with faces long and lined; I hear my laughter ricochet raucous and ill-timed off the fresh painted walls.

Perhaps what unsettles me most profoundly about the infertility support group is that children—the object of so much heightened emotion—have been avoided as a painful topic. Instead, greater and greater misfortunes are embraced as the status quo. How does one grieve, I wonder, without losing touch with the joys that life still offers?

Outside this elegantly furnished living room waits a summer evening so temperate the air feels like a kindlier second skin. I want to be touched by that air. I want that air between my breasts, close to where the milk could be.

This article will appear in The Pregnancy Project: Encounters with Reproductive Therapy, forthcoming from Duquesne University Press’s Emerging Writers in Creative Non-Fiction series.