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BMJ. 2007 June 23; 334(7607): 1323.
PMCID: PMC1895690
Review of the Week

Seeds of discontent

Reviewed by Abi Berger, associate editor, BMJ, and general practitioner, London

Making Babies the Hard Way—Living with Infertility and Treatment. Caroline Gallup. Jessica Kingsley Publishers, £12.99, pp 240. ISBN 978 1 84310 463 6. Rating: ****.

A chronicle of a couple's epic attempt to have children questions whether modern reproductive technology is more trouble than it's worth, finds Abi Berger

Caroline Gallup went through almost four years of unsuccessful infertility treatment before finally stopping. It's clear from her book that reaching the decision to stop was a long and painful process and that her persistent hope of becoming a mother has never quite died.

Gallup tells the story of her initial desire to become a mother and the desperate gnawing that grows inside her as achieving her dream seems to slip away. It's a story that makes essential reading for couples hell bent on producing a family and for doctors trying to support them. It's also a useful eye opener for those who are not sure whether they are ready for the robust demands that infertility treatment can make on couples.

The book combines the story of a journey with a lay person's digest of the biological aspects of infertility technology. It would have been hard to do the first without providing the second, although there's a lot of repetition—just in case the reader has forgotten what's involved. Or perhaps, the sense of this simply reflects the repetitiveness of undergoing seemingly endless cycles of the same thing until someone says enough is enough. Reaching that point is undoubtedly a unique decision for everyone undergoing such treatment, and should be regarded as such.

What's interesting in this couple's story is that Gallup's husband Bruce has been diagnosed with azoospermia, and therefore for him it's apparently an open and shut case. He discovers that he cannot conceive children naturally through any intervention whatsoever. His hope truly dies. But Caroline can still hold out for a genetic child of her own if she is willing to accept a donation of another man's sperm. And while this remains a possibility, the door never quite closes. While the goal—pregnancy—is the same for both partners, if feels very different, and they become virtually estranged from each other. The book's message is an important one that is often underplayed or even ignored by the medical profession: undergo infertility treatment without thinking through the emotional implications at your peril, or at least recognise that the emotional whirlwind may be far removed from the dream you were pursuing. Fortunately, this couple survived, but it's not always the case.

Apart from addressing the arguably modern cultural assumption that having children is a right, this book provokes other more difficult questions. Is the conception of a non-genetic baby going so against nature's intention that for women to conceive using donor sperm can feel like infidelity? And can couples who embark on such a journey ever truly come through it intact? Is modern technology causing more trouble than it's worth?

Doubtless Gallup would conclude that the availability of the technology and her own personal resources allowed her hope to survive longer than would otherwise have been the case. Without them she may have felt more bereft at the point of the diagnosis, but I suspect she would have come through with more resolution and reached closure more quickly and more succinctly. On the other hand, had she not been in this position she may have always wondered with regret about what might have been. It is one thing to simply and rationally close the door right from the beginning, but quite another to close the door after working through the process emotionally. Undertaking the treatment at least helps to ensure that no stone is left unturned, or at least considered.

The only thing really missing in this story is the robust voice of Caroline's husband, Bruce. He is “heard” only sporadically throughout the narrative. There are numerous references to the two of them undertaking different processes to get through the ordeal, but I would have loved to have read about their journeys in equal measure.

The book's message is an important one that is often underplayed or even ignored by the medical profession: undergo infertility treatment without thinking through the emotional implications at your peril


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