Infertility: Maintaining privacy, avoiding secrecy

When Michelle Obama's memoir, Becoming, was released in October 2018, several reviewers noted that her book reveals that the Obamas struggled with infertility. When I was lucky enough to receive a copy as a gift, I learned that Michelle and Barack didn't simply have a 'touch of infertility': they went through IVF in order to have both Malia and Sasha.

Why, some reviewers seemed to wonder, was the public learning this significant piece of the Obamas' history now? And, to be bipartisan about it, we learned in Laura Bush's 2010 memoir, Spoken From the Heart, that she and her husband had endured a long struggle with infertility and were planning to adopt when they found they were expecting twins Jenna and Barbara.

My response is this: The Obamas and the Bushes, so different in so many ways, share the perspective of countless other infertile couples and individuals: infertility is not a secret, but it is private.

One might also say that the Obamas and Bushes acknowledge their infertility because it is in the past. For both couples, it brought them two cherished daughters. I have seen that when people are in the trenches of infertility, questions about what to say, when, and how swirl around in their heads.

Secrets, truth, and privacy

Most people recognize the danger of secrets. Secrets lead to feelings of shame. They distance family and friends and promote misunderstandings. Couples determined to tell no one about their infertility may find others assume they don't want children, are selfish, or are clueless in thinking they can wait as long as they want. Hence, most people coping with infertility decide to tell others something — the challenge for them is avoiding the pitfalls of too much information.

When counseling infertility patients, I often suggest that they tell a simple truth. Not the whole truth. Not nothing but the truth. Less is more when it comes to talking about infertility.

Couples can think through what they want others to know. In most instances, it is simply that they want children, are having trouble making that happen, and are receiving good medical care. They want others to respect their privacy and to simply stay tuned, knowing that when there is good news to be shared, they will joyfully share it. Specifics of diagnosis, types, and timing of treatments are usually too much information.

Maintaining privacy while avoiding secrecy also arises when individuals and couples are exploring or pursuing other paths to parenthood, such as adoption, egg or sperm donation, or surrogacy. Again, I advise people to share only what others really need to know. Adoption is never a secret these days. But how much do others really need to know while people are waiting for a match with a birth mother or counting down the hours until she signs surrender papers? Often, it adds to the stress of the situation.

Is there an obligation to tell?

Similarly, when people choose egg or sperm donation, do they have an obligation to tell all to others? Years ago, I thought that those who did not acknowledge donor conception were being secretive. Then I realized that fertile heterosexual couples do not tell others how they conceived. Why should it be different for those who participate in third-party reproduction?

On NPR one day, I heard a wonderful interview with an author who had a baby at 50. The interviewer said, "I understand that you had a baby at an older age."

"Yes, we are so fortunate that there are all sorts of ways to become pregnant these days," the author responded. She spoke a simple truth and felt no need, it seemed, to tell the whole truth and nothing but the truth.

Privacy and dignity

The word that I have come to pair with privacy is dignity. Perhaps it is my response to living in a time of oversharing. I believe a certain dignity comes with maintaining privacy, especially when it comes to one's family. Years ago I realized this when a couple I was counseling adopted their son. I was overjoyed for them and filled with questions. They answered some of my questions: where he was born, how long they had to remain out of state. They chose not to answer questions regarding his birth family.

"We feel that's our son's story to tell or not tell," they said. "Until he is old enough to make these decisions for himself, we want to respect his privacy."

Infertility so often feels like an out of control experience. By actively making decisions about privacy and secrecy, it's possible for people to take back some of their lost control and gain pride in their ability to tend to and preserve their unfolding family story.