What Have We Lost? Infertility, Miscarriage, and Disenfranchised Grief

Introduction and Creative Process

I started drawing this comic while my wife and I were in midst of struggling with unexplained infertility. My research, drawing, and writing were iterative and generative. I developed the structure and ideas for this story through a process of reflection, research, and drawing. For example, the genesis of the entire project began through my practice of self-portraiture. During Covid, I started drawing daily self portraits. As I drew, questions about my self emerged; staring into my mirror, or looking at an old photograph, I would put lines on paper and my face would emerge from the blank page. As we struggled to have a child, I was reproducing myself on paper. This process was meditative, but it also provided space for new understandings to develop and coalesce into a graphic narrative.¹ I primarily used pencil, ink, and ink washes to create the portraits, and the comic has taken on a similar style, moving between controlled and well-rendered crosshatched images created with ink and a dip pen, and looser, more chaotic images created using brushes and medical syringes filled with an ink wash. These diverging styles visually demonstrate the chaos and uncertainty of infertility, as well as the physical and mental degradation of our journey.

For over ten years we tried unsuccessfully to have a child. As a patient, I found the process to be overwhelming and relentless. We were reminded of our failing bodies every month with each negative pregnancy test and our only response seemed to be another cycle, another protocol, another medical intervention. As Kimball (2019) points out, the grief from infertility is different, ‘it’s less about the loss of a potential child than it is about the endless possibility that there may yet be an actual child. The next procedure might work, the fallopian tube could always clear, the next fetus might not miscarry’ (para. 29). In a sense, the comic became a way for me to understand and process what my wife and I were going through, the disenfranchised grief we were feeling (Brigance & Brigance, 2023), and to come to terms with what we were losing.

In both popular media and in academic literature, discussions of trauma and grief in relation to infertility and miscarriage have recently gained traction (Boggs, 2016; Jaffe, 2024; Kimball, 2019). At a psychological level, researchers have noted that the psychological effects of infertility are similar to cancer, HIV/AIDS, and heart disease (Dooley et al., 2014). In terms of grief, the stress of coming to terms with infertility has been compared to divorce or the death of a loved one (Dooley et al., 2014; Jaffe, 2024). In her work on reproductive trauma, Jaffe (2024) explains how people construct ‘reproductive stories’ based on their beliefs and values. She notes that people experiencing infertility and pregnancy loss face an existential crisis as their reproductive stories fall apart. They don’t just lose a pregnancy or the possibility of having a child, but as their stories fall apart, their core beliefs, their worldviews, and their ability to imagine a future all disintegrate.

Arguably, the experiences of reproductive trauma discussed above are not accounted for within dominant approaches to fertility medicine. The structure of assisted reproductive technologies (ARTs) cultivates what Berlant (2011) called cruel optimism. That is, the object of desire (i.e. having a child) that we were attached to, and thought would bring us fulfillment, was also responsible for sustaining our cycles of suffering. Similarly, numerous scholars (See Becker, 2000; Domar et al., 2022; Greil & McQuillan, 2010; Jensen, 2016; Thompson, 2005) have pointed out how the medicalization of childlessness has resulted in an industry that is focused on “achieving a pregnancy in the fastest and most direct manner possible, regardless of the cost or invasiveness’ (Becker, 2000, p. 16). Additionally, within this system success is only viewed as the birth of a baby, even though the majority of people that engage with ART are not successful. Contrary to this, some have argued that fertility clinics should have a duty of care that aims to ‘alleviate the suffering caused by an unfulfilled child wish’ (Gameiro et al., 2024, p. 1591; see also Mertens & Mertes, 2023).

Through the comic, I am not offering solutions or recommendations, but I am making an attempt to illustrate the experience itself of the trauma and disenfranchised grief that often accompany infertility. As scholars in graphic medicine have pointed out, there is a lot of potential in these types of graphic pathographies to “cultivate an understanding of an empathy for patients’ experiences with illness” (Myers, 2015, p. 88).

Audience

As a topic, infertility has been taken up in literary fiction, dystopian science fiction, memoir, creative nonfiction, and more recently in graphic novels. Within graphic medicine, there have been a number of contributions, primarily in the form of graphic memoir, that address the topic of infertility, mostly written by women. As important and necessary as these memoirs are, there is a noticeable absence of stories from the perspective of men experiencing infertility and engaging with assisted reproductive technology.

It is important to acknowledge that women and those experiencing pregnancy disproportionately face the social, psychological, physical, and cultural burdens of infertility. It is primarily women’s bodies that are subjected to hormonal treatments and medical interventions that severely impact their physical and mental health. Additionally, in social and cultural spheres, women often face more scrutiny and stigma relating to their reproductive choices and capabilities (Boggs, 2016; Kimball, 2019). That said, the negation of men’s roles in infertility has important material effects. Because women have historically been blamed for infertility, most of the research relating to infertility has focused on women’s bodies. Within academic and medical communities, there is an increasing call for research and attention relating to men’s reproductive health and how men engage with reproductive technologies (Almeling, 2020). Further, because men are often made invisible when it comes to fertility diagnoses and treatments, there is also a resulting lack of support for men experiencing infertility.

This graphic narrative aims to address this gap and is one of the only comics about infertility from a man’s perspective. However, it is situated within a growing movement that recognizes the need to address men’s mental health, perspectives on masculinities, and, importantly, men’s understandings of and practices relating to reproductive health. Along these lines, in addition to this comic, readers should seek out recent memoirs, podcasts, documentaries, online support groups, and popular media articles that share the perspectives of men experiencing infertility.²

References

Almeling, R. (2020). Guynecology: The missing science of men’s reproductive health. University of California Press. https://doi.org/10.2307/j.ctv1503gt0

Becker, G. (2000). The elusive embryo: How women and men approach new reproductive technologies. University of California Press. https://doi.org/10.1525/9780520925243

Berlant, L. (2011). Cruel optimism. Duke University Press. https://doi.org/10.1515/9780822394716

Berger, J. (1976). Drawn to that moment. New Society, 37, 81-82.

Boggs, B. (2016). The art of waiting: on fertility, medicine, and motherhood. Graywolf Press.

Brigance, C. A., & Brigance, M. L. (2023). A qualitative study of a couple experiencing reproductive trauma: an attachment perspective through a duoethnography. Journal of Couple & relationship therapy, 22(2), 105-129. https://doi.org/10.1080/15332691.2022.2142716

Domar, A. D., Meyers, A. J., & Grill, E. A. (2022). How the medicalization of reproduction takes the fun out of the process. In K. Bergman & W.D. Petak (Eds.). Psychological and medical perspectives on fertility care and sexual health (pp. 189-204). Elsevier. https://doi.org/10.1016/B978-0-12-822288-1.00010-5

Dooley, M., Dineen, T., Sarma, K., & Nolan, A. (2014). The psychological impact of infertility and fertility treatment on the male partner. Human fertility, 17(3), 203-209. https://doi.org/10.3109/14647273.2014.942390

Gameiro, S., Leone, D., & Mertes, H. (2024). Fertility clinics have a duty of care towards patients who do not have children with treatment. Human Reproduction, 39(8), 1591-1598. https://doi.org/10.1093/humrep/deae128

Greil, A. L., & McQuillan, J. (2010). “Trying” times: Medicalization, intent, and ambiguity in the definition of infertility. Medical anthropology quarterly, 24(2), 137-156. https://doi.org/10.1111/j.1548-1387.2010.01094.x

Jaffe, J. (2024). Reproductive trauma: Psychotherapy with clients experiencing infertility and pregnancy loss. American Psychological Association. https://doi.org/10.1037/0000400-000

Jensen, R. E. (2016). Infertility: Tracing the history of a transformative term. Penn State Press. https://doi.org/10.1515/9780271078212

Kimball, A. (2019). The seed: infertility is a feminist issue. Coach House Books.

Mertens, M., & Mertes, H. (2024). Deconstructing self‐fulfilling outcome measures in infertility treatment. Bioethics, 38(7), 616-623. https://doi.org/10.1111/bioe.13226

Myers, K.R. (2015). Graphic Pathography in the classroom and the clinic: A case study. In Czerwiec, M., Williams, I., Squier, S. M., Green, M. J., Myers, K. R., & Smith, S. T. (2015). Graphic medicine manifesto. Penn State Press. https://doi.org/10.1515/9780271079264-005

Thompson, C. (2005). Making parents. The ontological choreography of reproductive technologies. MIT Press.