By Eswar
On Rohini S.Rajagopal’s memoir of infertility – ‘What’s a lemon squeezer doing in my Vagina?’.
In an article about stillbirth, Emily Oster, an American economist, made the following observation: ‘Like miscarriage or birth trauma or countless other parts of pregnancy and parenting, [stillbirth] is not a topic that’s easy to discuss. The result of that lack of ease is a lack of discussion. But the lack of discussion can leave people feeling unprepared and alone in loss. It also makes it more difficult to think about interventions that might change outcomes’. This observation is valid for yet another aspect of pregnancy and parenting – infertility.
A few years ago, someone asked in Quora about things you should know before getting married. I responded by saying people looking to start a family should consider checking whether they are able to have children. The intention is not to make the entire relationship about having children but to avoid disappointment and suffering in the future. We see parents everywhere around us, but we do not give enough thought to the physical conditions required to become a parent. We presume everyone can become a parent. When reality turns out to be different, couples can often be at a loss.
Rohini S. Rajagopal is happily married to Ranjit. A few years into the marriage, their life changes when they plan to start a family. Delay in getting pregnant leads them to the world of infertility treatment. The shock, the pain, the suffering and the bundle of joy they eventually welcome is narrated courageously in the book – What’s a lemon squeezer doing in my Vagina?
Like the title of the book, the experience is candidly laid out, sometimes humorously. Still, there is always an element of shock to the reader, and the underlying pain does not go unnoticed. The pain of not bearing a child and the resulting social stigma is generally known. The unknown is what it means for a couple, especially the woman, to go through the fertility process in a clinical setup. Even when someone very close to us goes through the process, the conversation rarely goes beyond cursory inquiries. An unsaid but accepted awkwardness prevents everyone from discussing the topic further. What really happens inside those scary, cold rooms of the fertility centres?
Medicine, as a field of science, is continuously evolving. Still, the terms of diagnosis, prognosis, procedures and treatment for some conditions are nascent. For example, consider cancer treatment. After many years of research, some types of Cancer are still incurable. Certain types of Cancer require the removal of body parts resulting in trauma and disfigurement of patients. In this regard, Cancer treatment is still in a developing stage. When reading this book, infertility treatment also comes across as if it is in its early stages.
The Wikipedia description of In Vitro Fertilisation(IVF), a type of infertility treatment, makes it look simple. ‘The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova (egg or eggs) from her ovaries and letting sperm fertilise them in a culture medium in a laboratory. After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is transferred by catheter into the uterus, with the intention of establishing a successful pregnancy.’ The actual process, though, could not be more complicated.
The treatment requires medication, blood tests, scans and invasive procedures, and every step is often repeated multiple times. In the book, this is compared to ‘watching a food show on TV and then trying to recreate the dish at home. There is a lot of trial and error’. There is uncertainty in the outcome. Some procedures are shocking even to read. One of the stages involves a Speculum, a metallic tool about the size of a lemon squeezer. In Intrauterine Insemination, a type of infertility treatment, the speculum is inserted into the vagina to expand the opening, and the sperm is injected using a catheter. For Rohini, the pain is not just physical. ‘The ninety seconds it must have taken to fix the speculum and inject the semen were excruciating and not just because of the physical hostility of the act. Not just because it felt raw or sore or I was bleeding. But because it was a breach of my already fragile self. It tore through the membranes of my defences, leaving me exposed and helpless.’
Some other medical treatments and procedures are even more daunting physically and mentally than the cycles for treating infertility. The difference here is in the reasons for getting treated. In other conditions, people endure treatments since the disease is often life-threatening or severely impacts everyday life. These patients are often left with no choice. In the case of infertility, couples do have an option to not take up the treatment because of its nature and success rate. When there is a choice, what drives them to undergo treatment? Is it a personal decision arising from a natural desire to bear a child? Or is it a decision triggered by social pressure?
Even though I say couples, often, it is women who go through the treatment. Rohini says that one reason for this is to do with human biology. ‘In IVF terms, an egg is a far more prized commodity than a sperm. Getting one good quality sperm cell is relatively easy – you have millions to pick from – while the stock of the eggs is a hastily diminishing resource’. For this reason, Rohini believes fertility treatment is centred on the woman and her eggs. Even when the egg is fertilised in a lab, the remaining steps – implantation, pregnancy, and labour – happen inside the female body. Even for male infertility, women undergo the process once the sperm is extracted. Though neither of them had any issues, it was Rohini who went through the process. ‘Infertility is not an equal-opportunity employer’, Rohini observes wryly. Since the treatment was centred on Rohini, she had more visits to the clinic. She was often on her own when it came to knowing the treatment procedures and making decisions. This may seem less of an issue in the beginning. But day in and day out, when only one person takes the brunt, it gradually affects their relationship. Fortunately, the couple endured these troubles without giving up on the treatment or sacrificing the relationship.
Finally, one treatment cycle succeeds, and the pregnancy is well into the trimester. When sharing the news with relatives, one conversation shocks Rohini.
‘Was it IVF?’
‘No’, The reply comes spontaneously.
‘Not IVF? You didn’t seek any treatment?’
‘No nothing.’
‘It happened naturally?’, the relative persisted.
‘Yes’, Rohini mumbled, wishing the interrogation would end.
‘Okay, then. Congratulations!’
What shocked Rohini was not the directness of the questions but her instinctive denial. Her replies made her wonder why she had to lie as if she had done something wrong or a dishonourable deed. She discovers that the shame she felt towards her body made her lie. That is when Rohini realised what she really felt about it – ‘Infertility was a dirty secret. I only wished to get past infertility and pretend it never happened’. That realisation is the seed for the book. From being unable to talk about infertility and treatment in a private conversation, Rohini grows into a person who can discuss this publicly. The transformation is visible in her writings when she discusses the condition and treatment openly and comfortably without feeling shame or self-pity.
The book is not a guide for infertility treatment. It is a personal memoir. We get to know the procedure through the person going through it. The style makes the reader relate to the experience rather than becoming a know-how guide to treatment. The story interweaves the author’s upbringing, her family, the environment she grew up in, and the decisions taken in other areas of life. Through them, we not only get to know the person but also are able to understand the choices the person makes when dealing with infertility.
There are some aspects of life that we can never experience ourselves. Even if we can, we wish we never encounter them. Still, some people go through them by choice or lack of one. The only way to know at least a little about those experiences is through those who have encountered them. Why should one need to be aware of these experiences? In the context of infertility, there are two reasons. First, to question ourselves if we are glorifying parenthood to the point where there is an unnatural expectation for everyone to become a parent. Second, to comfortably discuss infertility without awkwardness like other human conditions. Ability to discuss openly about infertility could help prevent people from suffering on their own and help with their decisions and treatment choices. Through this memoir Rohini S. Rajagopal has laid a foundation for this discussion.
The story ends well for Rohini and Ranjit. But as I finish reading this book, it is hard not to think about those couples who are going through this silently and others who may never see the light at the end.
Baradwaj Rangan 
brangan
November 5, 2022
Thanks for this, Eswar — both for bringing this book to our attention, and for writing so empathetically about it. You should really write more.
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Raghu Narayanan
November 5, 2022
Eswar: A well written piece, kudos! And hat’s off to Rohini S Rajagopal for having the fortitude and courage in writing this book and for the deep insights about the emotional aspects which you have brought out well.
What a world we have created for ourselves!!!
One of the major purposes of life on this planet for any species, is procreation which results in extension of that species. For humans, somewhere down the line probably when we had settled into civilizations, had reasonably secured our survival and established a family based society, this purpose probably came down to procreation for the purpose of extension of the family or lineage. And in a patriarchal society, the inability to procreate was unsurprisingly cast as a problem with the woman. Though it was always equally probable that the man in question was impotent.
In today’s world, for medical and biological reasons, it might still be the woman who is subject to physical and emotional hardships associated with the process. However, we as a society, have not come very far in clearing the cloud of psychological trauma that is inflicted on the woman in such circumstances. There is still no collective consciousness, thought or action which is being taken. What transcended from the level of a species to a family and onto the individual, must see a reversal process where the individual is supported by the family and the family by the society. However, we still see many, many cases where the individual is blamed and left to fend with the trauma all by herself.
Indeed, what an intolerant world we have created for ourselves!!!
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Anand Raghavan
November 5, 2022
Very good article Eswar. Sensitively written. Over the last few years, fertility clinics are seen everywhere. To me, those looked like cashing on distressed couples’ desperation. OTOH, it also shows how societal pressure brings these couples to those clinics. One wishes the choice be entirely the couples’ , in fact more so of the woman.
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Yajiv
November 5, 2022
@Anand Raghavan: You hit the nail on the head. Couples choosing to remain childfree is still not considered acceptable by our broader society. More often than not, I’ve noticed it’s the woman who gets blamed for such things. You see reactions ranging from “aiyo paavam” to far more condescending comments.
Thanks Eswar for sharing this with us. The book seems very well-written.
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Madan
November 5, 2022
Eswar, I echo what BR said, pl write more often. I loved this piece though I had to speed read not because of impatience but because it hits too close to home. This may sound ridiculous but my wife’s relationship with her parents has broken down to all but a point of no return over the issue of child-bearing. Myself and my parents have provided her as much support as we can and insisted we would never pressurise her to undertake any procedure like IVF unless she herself wants to and says she is ready. But a completely different story with her parents. Of course, it’s not just that and hardly as if they were doting over her with incredible affection prior to these arguments but this simply pushed matters over the edge.
Of course I would like for us to have children but I cannot fathom what would be achieved in destroying a marital relationship over that one thing as if our companionship for each other, which is much stronger now than at the time of marriage, doesn’t matter. With great difficulty have I protected her and our marriage from her parents! Yes, completely weird and wild but it happens! The patriarchy is so strong that it may even blind the girl’s parents.
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Satya
November 5, 2022
“With great difficulty have I protected her and our marriage from her parents! Yes, completely weird and wild but it happens!”
I am very sorry if I come across as insensitive, but it is hard to resist the thought of Tamil cinema making a small, light hearted film on this conflict (can’t see my Telugu cinema pulling off something like this). Let me know if they have made one recently. On the other hand, I wish you guys the best for whatever path you lead yourselves into.
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Madan
November 5, 2022
“I am very sorry if I come across as insensitive, but it is hard to resist the thought of Tamil cinema making a small, light hearted film on this conflict” – Oh, to quote someone else’s words, “I could write a book”. 😛 Maybe I will, someday. It’s delightful material for a novel. Don’t worry, I have the emotional distance to see the funny side of it and half the time we both chortle at their antics anyway (yes, I did use the word antics).
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Yajiv
November 6, 2022
@Satya: Good one. I actually wanted to comment “Someone please hide this book from Ayushmann Khurrana” but was worried it would come off as insensitive so didn’t 🙂
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Eswar
November 6, 2022
Thanks, everyone, for taking the time to read.
BR, and Madan, thanks for your encouragement. Appreciate it.
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Eswar
November 6, 2022
Madan, you are spot on about the relationship. In a way, this relates to Raghu’s comment. Our view is sometimes so narrow that we miss the bigger picture. Marriage is far more than child-bearing. I am glad you are dealing with this calmly and open about it. Respect. All the best to both of you.
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Anu Warrier
November 6, 2022
Eswar, thank you for bringing this book to my notice. Two of my nieces (-in-law) underwent the procedure, both of them multiple times. For one of them, the pain and trauma (physical, mental, emotional) and the uncertainty of success after all of it took a deep toll – now, they have a child, but the marital relationship is at a standstill. The other has had one child through IVF and the second, I assume, through normal means. But the intrusive questions both had to face for not conceiving years after marriage, the ‘concerntrolling’ they went through, the unending ‘advice’ on how to conceive – in their place, I might have punched someone.
Your review of it is so empathetic, thank you for that.
@Madan, a huge thank you from the sisterhood for your support for your wife. It means a lot for the woman to have that validation.
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Madan
November 6, 2022
Eswar: Thanks! I wish it was true that I have dealt through all it calmly; there have been many hair-and-voice raising moments. But it does seem touchwood as if we have finally crossed the bridge by staying resolute and understanding our priorities. With her parents it eventually became like too bad you want to die on that hill but that’s your choice.
Anu Warrier: The ‘funny’ thing is I think what I have done is the most normal and obvious thing to do – to respect an adult’s decision as to what to do with her body. I do understand – from her own parents’ reaction, most tragically – that this somehow is not normal and the norm is to coerce the woman into complicated procedures she may or may not be completely on board with. But I wouldn’t have it any other way than the way I have chosen.
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Prat
November 7, 2022
The novel Madhorubaagan (One part woman) is a very effective story depicting the world vs a married couple without kids, though it is not strictly contemporary.
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RK
November 7, 2022
It’s not just about society pressure. For many people, though definitely not for all, children do complete an aspect of their self.
For two years, from the stillbirth of our first daughter to the conception of the second, infertility was a real threat that dangled over our heads. The whole process from conception to delivery, though entirely natural, was psychological hell. Even if the doctor assures you everything is normal, you fear what happened before will happen now.
My own experience of the stillbirth of my first daughter is very much part of my being even though I am now the father of two daughters. The only way I was able to deal with that event then was seeing what my wife went through. It has linked us together like no other event, though we never talk about it. It’s always there, colouring my entire worldview.
Curious that I would first talk about this in a film discussion board after 10 years.
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Rahini David
November 7, 2022
“For many people, though definitely not for all, children do complete an aspect of their self.”
This is an aspect that is almost never mentioned. I had a relatively short problem with fertility. We wondered if something may be wrong, a fallopian tube wasn’t all that it should be and I had to have a few scans and the whole business was resolved in under 3 months as the other tube was fine.
But I had a ‘friend’ who had to mansplain to me that it is completely a-ok to not have a child and if I loved my husband we are ‘complete’ and I should ask the ‘keladu-kattais’ of my family to lay off and ME wanting a baby was seen as “Oh how brainwashed you are, you dear dear child”.
Lay off people who decide differently from you do, whichever side you maybe in.
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Anu Warrier
November 7, 2022
RK, I (unfortunately) know what you mean. Our baby died 25 minutes after it was born. Now, so many, many years later, I still hold him dear, and still grieve (once in a while) for what may have been. It’s not entirely rational, that grief, but since has grief been controlled by reason?
I didn’t feel I needed a child to ‘complete’ me, but yes, it felt like a part of me died that day.
@Rahini, that ‘friend’ was an idiot. You want to have children? I hope you do and without any travails. You don’t want to have any? Great. Please don’t. You are good either way? Then you have no reason to worry at all. But for heavens’ sake, don’t judge others who don’t choose as you do! That is what freedom of choice means.
The only caveat I have here is that ‘No means no’ here as well. So if one part of a couple want to have a baby and the other doesn’t, the ‘no’ vote triumphs every time. The other part of the couple, of course, has two choices – either make peace with that decision or get the hell out of that relationship and find someone who makes the same choice as him/her. Which is why, in my opinion, it is so important before you get into a marriage/deeper relationship that you have this talk. And if a ‘Maybe’ at one point becomes a hard ‘No’ for someone, it is incumbent to revisit the discussion and have another difficult conversation. No fair doing the switch and bait.
@Madan, that’s how I think as well. Your body, your choice. And that goes for both men and women. But you know – to your cost – how ‘abnormal’ that is in a society which feels it can judge anyone/everyone for the choices they make!
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Kay
November 8, 2022
Empathetically written, Eswar. Thank you for this article. I had read excerpts of this book when I was pregnant and I thanked god I didn’t have to go through that process. Conceiving a baby and going through the pregnancy and delivery in itself is a very invasive process. The endless scans and blood tests are nerve wracking. To have to go through this pre pregnancy is heavily taxing on the women.
But still what baffled me in my personal experience was two examples – both relatives. One of the tried IVF multiple times over a period of 20 years repeatedly before having a successful delivery. The other akka also went through 3 rounds of IVF which resulted in delivery of 2 stillborn children and one child that passed soon after (they had married within family and there were genetic issues) before having a healthy baby. She again went through 2 rounds of IVF to have her second child. And I can’t believe it’s entirely because of societal pressure in both the cases. Why would someone willingly put themselves through this to have a biological child? I honestly don’t know if I’m being judgemental here.
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Kaushik Bhattacharya
December 12, 2022
Thanks for such a sensitive and well written piece Eswar. My wife went through multiple IVF cycles (almost a decade ago now) and I still remember how painful and relentless the actual process of the treatment itself was but even more how depressing and deflating it was for us (and significantly more so for her) after the first couple of cycles were unsuccessfully. She was determined to make it work though and we got third time lucky.
Given we live outside India, it’s common enough here and societally no one has any discomfort talking about it which meant that we never saw any reason to not talk about it with friends and relatives in India either but I can see why things might be much harder in a society like India.
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Cathy
December 29, 2022
@RK & @Anu – I am so sorry for your losses. I went through an intense battle with infertility through multiple years and while I was lucky to be blessed with a little one at the end of that arduous journey, not a week goes by when I don’t mourn my angel babies. I am very grateful and happy for what I have today but it doesn’t take away the sorrow and pain of the lost ones. How we grieve is intensely personal and needs no reason or rationale.
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