The brightening outlook for CHILDLESS COUPLES
People who’d like to have children but can’t are the subject of increasing study by medical investigators. Here’s a report on recent findings
OF THE THOUSANDS of Canadian couples who have no children after a year of marriage, many and probably most are childless by choice. But for another sizeable group, their failure to have children is a personal tragedy. Can anything be done to help these unhappy couples? Is the answer brighter than it used to be? Fortunately, the answer is a potential "yes.”
For today's childless couple, encouragement lies in the growing medical interest in their problem. Dr. John Rock, director of Boston's famous Reproduction Centre, who has devoted his life to research, recently referred to infertility as "a mystery and a challenge.” Seven years ago, a handful of physicians and veterinarians met in Toronto and organized the Canadian Society for the Study of Fertility. Its aims: "to promote investigative and educational work in the field of reproduction; to evaluate diagnostic methods and therapy; to promote research in reproduction.” Today the organization has 120 members, from coast to coast, and has awarded five $500 prizes for promising research papers by Canadian doctors.
Although the group is not directly affiliated with the older American Society for the Study of Sterility, which has pioneered in the field for sixteen years, its secretarytreasurer, Dr. George Arronet of Montreal, says, "We’re trying to do the same things and we have a close and happy relationship.”
What all this medical awareness means to the childless couple probably depends on which of the categories they fall into:
Cases in which either the husband or wife (or possibly both) has some physical deterrent to conception, such as a constitutional defect, injuries resulting from mumps, German measles, venereal disease, excessive radiation or heat, obstructions caused by inflammations and infections, tumors, endocrine imbalance, or blocked tubes.
Holding hope for these couples are things like modern surgery, including the use of plastics, better methods of freezing a husband’s concentrated sperm for the artificial insemination of his wife, and an ever-widening knowledge of the role played by adrenal hormones. (Testosterone is currently out of medical favor, many medical schools finding thyroid extract more promising.) The treatment of male infertility continues to be long and painstaking, complicated by the stubborn refusal of some husbands to submit to examination. Of those who do, it’s estimated that thirty percent become potential fathers. Hormone therapy is generally more effective with women; it establishes more frequent ovulation and thereby a greater chance of conception.
Cases in which neither partner shows any physical defect, but a pregnancy does not occur. These couples have always puzzled the medical profession, the public, and the men and women involved. Some psychiatrists speculate that psychological factors like tension, guilt, conflict, self-hate, subconscious resentments and immature attitudes play an unknown role in some of these cases.
They wonder why seemingly healthy couples find it so hard to reproduce and why some people, unproductive for years, suddenly begin to have children.
Can climate be involved? Can a woman actually will herself not to have a child? Can anxiety render a man impotent? And what’s the story behind the couple who adopt a baby and almost immediately have one of their own?
An American study on “the emotional content of infertility” has indicated that hidden, psychic factors may prevent conception. Eighty-three couples were interviewed several times by psychiatrists. The doctors discovered that many of them had negative feelings about parenthood, some fearing the pain of childbirth, others that they would have a defective child, and still others that they were not cut out to be good parents. A sidelight of the experiment was the discovery that eleven of the fifteen couples who feared having a defective child were themselves defective in some way, with blocked tubes, cysts on the ovaries, or low sperm counts. This may lend some weight to the theory — frequently advanced but seldom proved — that nature saves her gift of fertility for healthy parents.
Some childless couples — the voluntarily childless — admit openly that they don’t want children. Without the worry and expense of raising a family, they say, they are free to pursue a more worldly goal such as a career, political activity, travel, leisure, or a glittering social life.
Dr. George Arronet, who is director of Canada’s busiest infertility clinic in the Royal Victoria Hospital in Montreal, recalls a telephone call a few years ago from a man who wanted to know how his wife’s “stomach complaint” was improving under treatment. Informed that she had nothing wrong with her stomach but had registered in the infertility centre, he was dumfounded and furious. "A kid is the last thing I want!” he snarled, and flatly refused to pay the bill.
The centre now insists on having both partners present in a preliminary interview, when the doctor can explore their feelings and ideas. It has emerged that many of them aren’t keen about having children when it comes right down to it. Some are close to middle age, set in their ways, and fond of their peace and quiet. Others enjoy a comfortable life enlivened by pets, trips to New York, weekly bridge sessions and Sunday golf, and they admit they're loath to give up all this for the doubtful pleasure of parenthood.
Why, then, are they in a doctor’s office begging to be made pregnant?
"People are not always rational,” says Arronet, “particularly when it comes to having children.” He remembers one couple in a mixed marriage who were so anxious to have a son that they had apparently never thought past the moment of his birth. Faced with a casual question about the child’s religious future, they sprang into furious argument, were persuaded to go home and talk it over, and never came back. CONTINUED ON PAGE 56
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Many couples think they want a child, when it’s something else they're really after. An American doctor recently made a list of the answers his female patients gave to his question, “Why do you want a baby?” They included such reasons as: “Because my husband wants one,” "Because our marriage is breaking up,” “So we can inherit an aunt’s estate.” “To carry on our business”, and "My motherin-law keeps bugging me for grandchildren."
Many a lonely wife yearns for a child "to be my very own.” An official in a Canadian adoption agency recently interviewed a prospective client who turned up in tears on her way home from a funeral, and begged for a child “so I will have somebody to put flowers on my grave when I die.” A Toronto doctor in private practice recalls among her recent patients a pretty young woman who wanted a baby by the “other man" so her legal husband would agree to a divorce, a strong-minded female who wanted a child just to show she could do it, and a tired, middle-aged woman with a congenital heart condition, married to an elderly diabetic. Of this last case the doctor says, “No sane physician is going to move heaven and earth to make a sick woman pregnant.”
A defense against motherhood
Psychiatrists haven’t gone so far as to suggest that a fertile couple can practise effective birth control by simply wishing not to have a baby, but some do believe that negative attitudes and unresolved conflicts play a mysterious role in keeping the childless couple childless. Sterility, they explain, can be a defense of a disturbed personality against the experience of pregnancy and motherhood.
In the case of "one-child” sterility, where a woman is able to have a first child but no others, it has been suggested that mother and child have formed such a close and intimate association that everyone else, including her husband, is excluded. Similarly, the infertile husband is accused of resenting the intrusion of any third party into the loving circle of himself and his wife.
Gynecologists are generally skeptical of such speculation, but they agree that many childless couples are probably the victims of twentieth-century stress and strain. Dr. Arronet, for instance, suggests that if excessive work, inadequate sleep, too much alcohol and tobacco, too little contentment and constant tension can predispose people to mental illness, gastroenteritis, ulcers, and coronaries, it’s likely they can also affect man’s ability to reproduce. Arronet blames modern materialism for a lot of the trouble. He recalls a childless New Canadian woman, married for many years, who appeared in his office a couple of years ago and proudly rattled off a list of the furniture and electrical equipment that she and her husband had been able to buy. It soon became evident that they were under considerable strain trying to pay for all their possessions, yet they planned more expensive purchases for the future. Arronet says, "I told her to stop buying things, to go to church more often, and
to spend more time with her sick mother. Above all, I told her to relax. To make sure she did, I prescribed heavy sedation. Three months later she was pregnant.”
It’s possible that tension is the villain when a man and woman who have been childless for years adopt a child and shortly afterwards the wife becomes pregnant. Gynecologists have their doubts. (“Probably would have become pregnant anyway”), but everyone knows somebody who did just that, and it’s a fact that roughly ten percent of all the couples who put their names on the adoption list of the Children’s Aid Society of Metropolitan Toronto last year withdrew because of a pregnancy in the first few months of their preliminary sessions.
A few years ago. two U. S. gynecologists, Dr. C. I.ec Buxton of Yale University School of Medicine and Dr. Anna Southam, director of the infertility clinic at the Sloane Hospital for Women in New York, summed up their findings on a group of 1,568 infertile patients. In their book Human Infertility they observe: “The rather surprising finding that the greatest number of pregnancies occurred in the first month of investigation implies that factors other than treatment are important.”
They did not name the mysterious factors, but some psychiatrists suggest they include relief from tension, which (according to one line of thinking) can induce a tubal spasm during intercourse and thus prevent conception. Many gynecologists scoff at the notion: one recently advised husbands whose wives have tubal spasms during intercourse to relieve their tension with "a judicious amount of alcohol, preceded by a corsage of her favorite flowers and dinner in her favorite restaurant.”
At the Royal Victoria Hospital centre, the value of psychiatric therapy in cases of extreme disturbance is not underestimated, although director Arronet believes that a problem like tension or an unco ordinated sexual relationship is the business of the gynecologist. Many people find it painful and embarrassing to discuss details of their private life with
anyone, he points out, even their doctor. The centre operates six days a week and handles about seventy-five new couples a year. Like other clinics in hospitals across the country, it devotes a good deal of time to routine investigation and therapy.
Although some U. S. gynecologists estimate that one of every three infertile couples who undergo treatment can be helped, Arronet feels this figure is high. Of 140 patients treated at the Montreal centre in the past two years, 27 couples (or 19 percent) w'ere able to achieve a pregnancy. In three to five months the centre is usually able to list a couple as fertile, subfertile (requiring surgery or other special treatment) or sterile. “In the last case,” says Arronet, “we suggest adoption.”
About a third of the couples take his advice. The others apparently are resigned to being childless. Of these, many will become “aunts” and “uncles” of other people's children. Others will find a creative outlet in charitable work or civic enterprises. Still others, with no inclination to good works, will settle down fairly happily with their gardens, books, or hobbies. As they grow older and see their friends’ children marrying and moving off, their pain and frustration will lessen. Among all his patients, Arronet recalls only one case in which the discovery that the husband was sterile led the woman to inaugurate divorce proceedings. Most couples, he believes, have gone through so much together that their love and sympathy enables them to overcome the shock of a hopeless verdict. He has little sympathy for the practice of “letting a couple down easily” — which can leave them high and dry, never knowing what’s wrong and going for years from one doctor to another in an endless search for the magic formula that will give them a baby. “People deserve to know' the truth,” he says.
If anything makes gynecologists unhappy it’s the couple who postpone their family until they've bought a home, and a car, and all their furniture, and then turn up seeking help in their late thirties or early forties.
A Toronto doctor says, “At 35, a woman’s reproductive powers begin to wane. Even before this, there may have to be extensive therapy to either the husband or the wife before a pregnancy can be effected. Couples shouldn’t take it for granted that a baby will come along the minute they decide to have it. I strongly urge early diagnosis and treatment.”
Dr. Arronet is especially displeased with the physician who tells a couple
after one or two cursory examinations, “There's nothing wrong with you. Don't worry. Go home and wait.” He says angrily, “They go home and wait, and they come back when it may be too late. Every third couple tells us this story. We have 48 couples on our books right now who have been waiting for a baby for five years or more, and they all fail into this category.” In an effort to con vince doctors of the importance of early detection and treatment of infertility, the centre recently mailed educational pamphlets to all licensed Quebec doctors and all McGill graduates.
However, according to several medical men I talked to, it’s unlikely that much further headway will be made unless more money becomes available for research and improved facilities, including the services of full-time doctors and postgraduate students. A Toronto gynecologist told me, “We need somebody up here in Canada who’s prepared to dedicate his life to the study of infertility. Maybe in another ten years I can afford to retire from private practice and take on the job myself.”
Even with more money and more doctors, the problem of fully investigating human infertility appears formidable. About twenty years ago an American surgeon performed a hysterectomy on a patient when one of her ova was in the early stage of development. He was thus able to study a fertilized human egg. He made medical history but earned the displeasure of the Roman Catholic church. But generally, research has been largely confined to experiments with animals. Vivisection makes it possible to study such things as newly implanted eggs and the movement of sperm, which may, some day, cast light on the mysteries of human reproduction, it