Infertility

Throughout the last century, the inability of women to conceive children has been explained by discrepant views: that women are individually culpable for their own reproductive health problems, or that they require the intervention of medical experts to correct abnormalities. Using doctor-patient correspondence, oral histories, and contemporaneous popular and scientific news coverage, Robin Jensen parses the often thin rhetorical divide between moralization and medicalization, revealing how dominating explanations for infertility have emerged from seemingly competing narratives. Her longitudinal account illustrates the ways in which old arguments and appeals do not disappear in the light of new information, but instead reemerge at subsequent, often seemingly disconnected moments to combine and contend with new assertions.

Tracing the transformation of language surrounding infertility from “barrenness” to “(in)fertility,” this rhetorical analysis both explicates how language was and is used to establish the concept of infertility and shows the implications these rhetorical constructions continue to have for individuals and the societies in which they live.

“Robin Jensen’s thoughtful and engaging study interrogates a complicated matrix of cultural narratives, medical epistemologies, and gender normativities in order to scrutinize the evolution and constitution of infertility. Her investigation of infertility’s medicalization, shaped by metaphors that simultaneously percolate and lurk at particular historical moments, is compelling in its execution and impressive in its scope. Jensen’s sweeping archive and innovative thesis resist narrative simplicity, offering a valuable contribution to the field of rhetorical studies.”—Jeff Bennett, author of Banning Queer Blood: Rhetorics of Citizenship, Contagion, and Resistance

“In Infertility, Robin Jensen examines how discourses of infertility change over time, deftly revealing how these discourses do not follow a linear progression but instead shift, overlap, disappear, and re-emerge. Scholars of the rhetoric of science and medicine, medical and health humanities, and science and technology studies will marvel at her insightful, fine-tuned analysis, which beautifully illustrates how medicalized discourses continue to moralize, positioning infertile women as degenerate, noncompliant, or untimely despite ever greater technological and medical advances.”—Jordynn Jack, author of Autism and Gender: From Refrigerator Mothers to Computer Geeks

“Robin Jensen asks, What is human infertility? How do we understand that ‘involuntary childlessness’ known at different times, and within different ‘rhetorical ecologies,’ as ‘barrenness’ and ‘sterility’? She constructs her answer by weaving a rhetorical-historical account that is informed and engaging, layered and complex: no linear narrative here. The book is a shining example of what critical rhetoricians do, and how and why we do it.”—Judy Segal, author of Health and the Rhetoric of Medicine

Robin E. Jensen is Associate Professor of Communication at the University of Utah and the author of Dirty Words: The Rhetoric of Public Sex Education in the United States, 1870–1924 (2010).

Contents

List of Illustrations

Acknowledgements

Introduction

Chapter 1: From Barren to Sterile: The Evolution of a Mixed Metaphor

Chapter 2: Vital Forces Conserved: Narrating Energy Conservation and Human Reproduction at the Turn-of-the-Century

Chapter 3: Improving Upon Nature: The Rise of Reproductive Endocrinology and Chemical Theories of Fertility

Chapter 4: Psychogenic Infertility: The Unconscious Defense Against Motherhood

Chapter 5: Fertility in Clinical Time: The Integration of Scientific Specialties as Infertility Studies

Conclusion

Notes

References

Index

INTRODUCTION

The 2010 Nobel Prize in medicine was awarded to English physiologist Robert G. Edwards for his work developing in vitro fertilization (IVF) technologies with his colleague Patrick Steptoe. The award not only recognized Edwards’s career achievements but also highlighted the significance of IVF to both modern-day medicine and twenty-first-century society. Edwards won the award 32 years after the first baby conceived via IVF was born. Today, the baby (now woman and mother in her own right), Louise Brown, has become nothing short of an icon in an era in which conception, pregnancy, childbirth, and neonatal care are increasingly facilitated by elaborate medical technologies. As rhetorician Celeste M. Condit explains, IVF “serves as an excellent marker for the new phase of human reproduction in which we now live.” Since Edwards and Steptoe’s scientific contribution and Louise’s birth, approximately five million babies have been conceived through IVF, and over 140,000 IVF procedures are performed each year in the United States alone (about 20% of IVF procedures eventually result in a live birth). A far cry from the overview of conception in most biology textbooks, IVF requires that reproductive specialists manipulate a woman’s hormones to collect eggs from her body, then combine the collected eggs with sperm outside of her body, and finally transfer the resultant embryo(s) into her uterus post-conception. Ideally, the embryo then implants in the uterine lining and begins to develop into a fetus. In no small sense, then, IVF requires that potential parents position scientists, endocrinologists, and physicians as central players in the realization of their fertility.

The emergence of IVF, as well as similar, increasingly complex treatments such as intra-cytoplasmic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), ovum donation, gestational surrogacy, and mitochondrial replacement is situated in relationship to a number of previous scientific developments and discourses that have functioned in various iterations to medicalize infertility. Sociologist Peter Conrad defines medicalization as the process by which scientific and medical expertise becomes valued over experiential knowledge and is used to categorize aspects of social life in terms of disease or abnormality. For example, scholars have examined the ways in which childbirth was medicalized in the nineteenth century. They have isolated a variety of interconnected political, cultural, and rhetorical mechanisms that functioned to trade assumptions about birth as a normal part of the life cycle—best overseen by female relations and midwives in the home—with the contention that birth is an occasion for medical complications, best positioned under the purview of physicians working in closely monitored hospitals. This shift has been attributed, in large part, to the rhetoric of professional organizations such as the American Medical Association and members’ efforts to create a steady market for their expertise.

In this book, I demonstrate that what has been known in turn as “barrenness,” “sterility,” and, most recently, “infertility” or “involuntary childlessness” went through a corresponding transformation throughout the course of the twentieth century, though one that transpired in the midst of—and in response to—not one but multiple, diverse scientific narratives. I offer a detailed analysis of the complex processes by which infertility was (and is) medicalized and, in so doing, illustrate that medicalization is anything but a straightforward, deterministic process. Rather, medicalization emerges and unfolds according to dynamic rhetorical, material, and socio-cultural encounters, incorporating pockets of what rhetorician Jenny Edbauer describes as discursive “cooptations” or points of resistance, and often forming into interrelated but topologically divergent layers—what Conrad terms “degrees”—instead of one static, all-encompassing product. In the case at hand, I find that, although appeals aligning with that of medicalization can be traced back as far as the seventeenth century and garnered some following in the mid-nineteenth century, the medicalization process did not acquire significant traction until the 1930s when rhetoric circulating from and around the new field of reproductive endocrinology defined sterile bodies as chemically activated machines in need of technical intervention. Rhetoric about “psychogenic infertility” at mid-century created the infrastructure for an additional layer of medicalization as adherents of Freudian psychoanalysis incorporated women’s minds—as well as their chemical bodies—within the human (i.e., machine) in need of treatment. Most recently, the emergence of the integrated field of “infertility studies” in the 1960s and 1970s—and the concomitant shift toward comprehensive infertility research and treatment centers—articulated yet another layer of medicalization in that supporting discourse positioned the infertile mind-body, with all of its potential causes and abnormalities, under the on-going gaze of diverse, cooperating scientific experts employing an emergent transdisciplinary rhetoric. On its face, this theory of medicalization as layered may seem to suggest a transparent, uni-directional portrayal of that process; however, the narrative offered in this book works to demarcate the medicalization of infertility—and the medicalization process in general—in terms of a range of disparate, sometimes clashing, rhetorical interactions that, in and through time, coagulate into overlapping zones of reiterative meaning. Medicalization is revealed herein to be always in process and therefore never what Conrad has described as “total.”

On the whole, Infertility: A Rhetorical History is dedicated to answering one very basic question: what is human infertility? I approach this inquiry by exploring infertility not as a scientific or Platonic Truth writ large but as it has been constructed rhetorically via diverse arguments, appeals, and narratives over time and at particular historical moments. To this end, I offer something of what rhetorician Judy Z. Segal describes as a “kairology” of infertility via the “study of historical moments as rhetorical opportunities,” opportunities that are “subject to the vagaries,” disjunctures, and fissures of situations. More specifically, I consider how infertility has been defined in and across technical, mainstream, and lay communities; how these spheres of argumentation have shaped and transformed each other; and how different, emergent conceptualizations of infertility have had implications for individuals and the societies in which they live. My findings are drawn from analyses of unique primary sources originating in scientific laboratories, infertility clinics, doctor-patient correspondence, public lecture halls, and scientific and popular media coverage. They reveal that predominant explanations for infertility have surfaced in correspondence with seemingly competing scientific narratives related to social evolutionary theory, biochemistry, psychoanalysis, and reproductive medicine.

My findings also demonstrate that, throughout the last century in particular, popular explanations for women’s reproductive health have incorporated and fluctuated between those that highlight individual women’s agency in establishing fertility and those that frame medical intervention as determinant. This interpretation of events reveals that—while there have been times when medicalization has functioned to limit, to some extent, the amount of moralizing and blame associated with infertility—there are also many other historical instances that soundly refute the idea that medicalization necessarily suppresses the practice of linking “illness” to moral failings. Thus, the subsequent account illustrates how moralizing often persists despite medicalization and thereby situates subjects as both responsible for their health and yet inherently incapable of meeting that responsibility on their own. Correspondingly, the case studies presented here provide some evidence that, when mechanical and organic metaphors are mixed together to describe infertility, medicalization may be especially likely to take on a moralizing component.

What this account also offers, in a broader sense, is a study of rhetoric in, through, over, and according to time. Beyond attending to the role that kairotic appeals played in the installation of an emerging transdisciplinary rhetoric about infertility in the second half of the twentieth century, this book also considers the “percolation” of rhetoric about infertility over and through time, what philosopher Michel Serres describes as the unavoidable “repetition” or “echos” of what has long been conceptualized as chronologically past topoi. I cite Serres’s comparative theory of time not (only) because he employs stories of Aphrodite—the Greek goddess of love, fertility, and procreation—to reason through his philosophy but (also) because he depicts history as “folded, wadded up” or “twisted” rather than laid flat at fixed distances. He offers the following metaphor by way of theoretical explanation:

If you take a handkerchief and spread it out in order to iron it, you can see in it certain fixed distances and proximities. If you sketch a circle in one area, you can mark out nearby points and measure far-off distances. Then take the same handkerchief and crumple it, by putting it in your pocket. Two distant points suddenly are close, even superimposed. If, further, you tear it in certain places, two points that were close can become very distant.

Theorized in this “topological” sense, arguments, appeals, and narratives that are chronologically disconnected often reveal themselves to be interconnected in some sense in that they circulate not just horizontally but also “vertically” and “unexpectedly.” What this percolation model means for the study of rhetorical history (as well as, in this case, the emergence of a transdisciplinary rhetoric) is that the process of invention—what rhetorician Thomas M. Conley defines as “the modes of discovering arguments”—is always mixed with some degree of what Serres labels “redundancy” in that “we are archaic in three-fourths of our actions. Few people and even fewer thoughts are completely congruent with the date of their times.” For instance, although the idea that adoption spurs pregnancy in the involuntarily childless has, since the mid-twentieth century, been recognized as an antiquated myth, the so-called “miracle of adoption” has continued to emerge as an argumentative commonplace in both technical and mainstream media constructions of infertility even into the twenty-first century. In this case, traces or forms of past rhetorical constructions of infertility have percolated into contemporary rhetoric to help construct infertility today.

The rhetorical history delineated here, then, attends to this conjecture that old ideas and arguments do not disappear when their chronological time (as measured, for instance, by widespread scientific acceptance) has passed but, instead, percolate at subsequent, often seemingly disconnected moments to combine and contend with newer arguments, appeals, and narratives. This topological framework does not do away with context but, to the contrary, privileges the specific circumstances of any one moment while also highlighting the repetitive forms that appear across such circumstances. Serres insists that “history is not born of provinces, but of circumstances,” and philosopher Kevin Clayton explains of Serres’s framework:

we experience the same self-organization and the same emergent social forms as different social groups across both different geographical spaces and different chronological times have done, not because there exists some Platonic Form of which there are copies, but because energy and information flows taking the paths of least resistance have found these forms to be the most stable, given the conditions of the prevailing milieu.

From this perspective, the study of historical conceptualizations of infertility becomes less about explicating the ways in which rhetoric used to construct infertility and more about how those constructions of the chronological past, those forms, are “wadded up” in constructions of infertility in the recent past and present. Rhetorician Amy Koerber contends of health rhetoric generally and the discourses surrounding contemporary infant-feeding practices specifically that “as new rhetorical commonplaces” come into being, chronologically older commonplaces are never entirely “replaced” because they intractably “ling[er].” More specifically, in the words of rhetorician Jenell Johnson, rhetorical history from this standpoint “also relishes the synchronic view, pausing to dart sideways and slantways, in order to examine the interplay of particular texts and contexts in sometimes microscopic detail.” Following Koerber’s and Johnson’s complementary conceptualizations, this project works to convey a rhetorical history that repeatedly complicates the idea that the discursive past is made up of a diachronic succession of strategies, each superseding the other.

However, as Johnson’s “also” intimates, this topological—or what she calls motion-oriented—approach does not propose that the temporal flow of rhetoric across and among argumentative spheres is without impact or does not function coherently or cumulatively. Unlike Serres who suggests that history functions only in terms of percolation rather than in terms of flow or circulation—with the flow of chronological time offering only an abstract chain of reason for making sense of the incongruent “noise” that is time—the analysis that plays out here demonstrates that history is part and parcel of a broader rhetorical ecology that is as complex in its content as it is in its form, percolating and circulating, repeating and flowing in differing combinations in and through time. Even Serres seems to concede that it is only in attending to the flow of historical ideas in and across time that the existence of repetitive forms can be identified and the extensive diversity of rhetorical movement within an ecology can be delineated. Thus, while this inquiry speaks in an overarching sense to the ways in which historical constructions of infertility have percolated or jumped into the twenty-first century and other chronologically disjointed moments, the individual chapters themselves contextualize the “circumstances” of those percolations by tracing the rhetorical circulation of constructions of infertility within distinct, but still interrelated, chronological time periods. This approach to the study of rhetorical history conceptualizes rhetoric and corresponding constructions of time and relationality as always moving, interactive, and transformative, an orientation that is especially beneficial in contexts of emerging and established transdisciplinarity where individual fields of expertise necessarily and explicitly comingle.

Regardless of the specific historical mechanisms at play, though, understanding how and why individuals define infertility in particular ways at certain moments is important for a number of reasons, not least of which is that such definitions often correlate with beliefs, attitudes, and even behaviors. Long before the twentieth century, women’s lack of success in bearing children was attributed to immorality, sexual perversion, strenuous intellectual work, and/or so-called masculine professional aspirations. These attributions encouraged childless married women in particular to devote themselves to endless prayer, undergo painful sessions of bloodletting and surgery without anesthesia, forgo education and professional opportunities, and, whenever possible, avoid work outside the home.

In the twentieth and twenty-first centuries, rhetoric about infertility is more inextricably intertwined with talk about technology, medicine, and science than it has been in centuries past, but it plays no less a role in shaping individuals’ daily lives. In fact, it has been argued that, with increased scientific information about reproductive health, women who are deemed “infertile” face nothing less than a technological mandate to alter their behavior—sometimes endlessly—to achieve pregnancy and parenthood. This mandate is coupled with the “powerful cultural norm” of parenthood, as childbirth and motherhood is seen as “a vital component in the social definition of womanhood.” As a result, infertility clinics, products, and services have become a thriving international “baby business” into which billions of dollars are devoted each year. The Western, individualist belief that any goal is attainable with enough effort encourages those with fertility problems to continue devoting their capital to the baby business until they conceive and give birth to a healthy infant. Yet infertility treatments are frequently not covered by health insurance and thus can be limited to the extremely wealthy or those willing to devote all of their resources to conceiving a child. In addition, single individuals and those who identify as lesbian, gay, bisexual, transgender, and/or queer, regardless of financial resources, may find themselves denied access to treatments because some insurance and health practice policies require that applicants be heterosexual and married.

Beyond financial woes, women for whom conception and pregnancy prove elusive are at a higher risk for suffering from depression, as well as from sexually transmitted infections (because they are more likely to forgo safe sex practices). They also experience higher rates of divorce, which may be exacerbated by the social stigmatization targeted at childless couples. Reproductive health promotions such as the American Society for Reproductive Medicine’s ongoing “Protect Your Fertility!” campaign encourage even those women who are not actively trying to conceive and/or who have no evidence that their reproductive abilities are, or will be, unsound to alter their behaviors to protect themselves from fertility problems. These alterations might simply involve taking a daily multivitamin or obtaining a yearly gynecological examination. But they could also involve becoming pregnant before one is financially or professionally secure, or doing so without having the support of a long-term partner. They may involve seeking out expensive and/or medically inadvisable treatments when, given enough time, such treatments would prove unnecessary. Or they may involve an unwillingness to consider a future that does not feature clearly motherhood as a centripetal force.

All of these scenarios play out differently according to an individual’s race, class, religion, sexuality, age, and nation because rhetoric about infertility tends to foster “stratified reproduction” in which members of some demographic groups are encouraged to reproduce and others are not. In this respect, so-called hyper-fertility among individuals identified as minority and/or low-income is characterized as existing at the opposite end of the infertility-reproduction continuum and as posing a threat to society which is even greater than that posed by infertility among middle-to-upper-class, heterosexual Caucasian women. The rhetorical history delineated here builds off of anthropologist Khiara M. Bridges’s argument that pregnancy and its aftermath is “a racially salient event” in that it is animated by ideas about racial formation and inheritance. Indeed, technical and mainstream rhetoric about human reproduction has consistently constructed “infertility” as an “Anglo-Saxon” or “White,” middle-to-upper-class woman’s condition, despite the fact that minority and low-income women have long suffered the highest rates of involuntary childlessness. In many cases, the communication of myths about, for instance, minority women’s excess sexuality and reproductive ease have precluded the idea that such women could be infertile, just as appeals to “race suicide” in the early twentieth century and “the population explosion” in the 1970s have been employed to make concerns about low-income, minority women’s reproductive health appear moot.

Because infertility has—with very few exceptions—been constructed as a female condition, this analysis is closely tied to the study of gender, reproductive biology, and the social construction of womanhood. Although men and male bodies play a central role in the process of conception, the female body and its ability to conceive and carry a child to term has remained the primary focus of medical and societal discussions about barrenness, sterility, and infertility. Several important findings by reproductive endocrinologists emerging in the mid-twentieth century threatened to shift some of the focus on the infertile female body toward the male. I explore how these findings were discussed in scientific and mainstream media coverage, how they were translated into rhetoric about “infertile couples” rather than “infertile women,” and how the language of “infertile couples” was subsumed by appeals to Freudian psychosexual development in the female specifically. In this respect, the following analysis illustrates how “infertility” as a subject position has repeatedly been enlisted to resist more inclusive definitions, a process that has depended heavily upon scientific and pseudo-scientific warrants.

From a rhetorical and rhetoric-of-science perspective, this book is a study in invention and science as the frequent site of and contributor to such invention. Like rhetorician John Angus Campbell, I find that “diverse facts, images, and lines of argument” associated with specific scientific fields repeatedly function as topoi or jumping-off points for the construction of both disciplinary shifts and definitional changes as employed by broader publics. The chapters in this book demonstrate that prevalent definitions for involuntary childlessness have generally adhered closely to the arguments, appeals, and narratives associated with prominent philosophical and scientific fields of study. This is not to imply that science has dictated those definitions but, rather, that scientific and medical rhetoric has provided a number of warrants that science journalists, biomedical public relations writers, mainstream media reporters, and lay citizens have enlisted in various forms to make sense of infertility. The emergence of ideas in these cases has repeatedly defied a clearly top-down, or “deficit,” model of public understanding and suggests, instead, their development as coherent with the shifts, circulation, and percolation of a much more complex rhetorical ecology. Sometimes, for instance, scientific reports formally introducing an argument circulated almost simultaneously with corresponding mainstream media articles, articles that made use of the very language and appeals just introduced. At other points, scientific refutations have not been widely reported by mainstream media outlets and the general vocabulary of infertility has continued on, largely uninterrupted, as if a scientific refutation did not occur. In still other cases, patients have informed clinicians about their perceptions of infertility, those perceptions have then been communicated among experts and reported in scientific articles and, in this way, become encapsulated within experts’ prevailing theoretical understandings of infertility.

Further complicating the process of accounting for the flow and percolation of ideas about infertility from one sphere of argumentation to another has been the increased tendency among scientists and clinicians in the twentieth century to speak directly to and with lay publics. This practice functions within what rhetorician John Lyne describes as “a symbiotic third culture” that involves the establishment of “a scientific ethos while also engaging in the dialect of a literate ‘common sense,’” a task that generally requires the communication of different content—delivered in different ways—from that of traditional technical rhetoric. The public rhetoric of technical experts (i.e., third culture rhetoric) has been identified, recently, as under-theorized and in-need of scholarly attention, and it therefore functions as a focal point in the project at hand. All of this is to say, ultimately, that scientific conversations about social evolution, chemistry, psychoanalysis, and reproductive medicine encountered and transformed in conjunction with a number of other shifting variables to define infertility in specific, persuasive ways at any given moment.

To be sure, much scholarship has been dedicated to demonstrating that scientific practice is neither insulated nor entirely unique from other, less technical rhetorical activity. For instance, philosopher Donna Haraway argues that science is, first and foremost, a historically situated story-telling practice, a claim that has since been taken up widely by those studying the rhetoric of science. This delineation of science and its logics as narrative in orientation works against theories bent on highlighting the differences between, for instance, literal and figurative rhetoric, as well as those championing the supposed “transparency” of certain types of technical discourse and appeals. It is grounded in the “undifferentiated textuality thesis,” which, as rhetorician James Jasinski explains, contends that “all linguistic and discursive practices—scientific reports, poems, newspaper articles, political speeches, philosophical treatises, legal contracts, corporate ‘advertorials,’ radical manifestos, advice columns, and so on” are inherently rhetorical in that they offer “restrictive” representations of the social world. The present work emerges from this perspective that, no matter the stylistic means or purposes, all rhetoric constitutes the world by naming it in one way rather than another. In this sense, scientific and medical rhetoric functions as what sociologist Alex Preda terms “knowledge-producing social sites” that trade in symbolic force through more-or-less narrative structures.

These structures, however, are anything but static, and thus a growing body of scholarship has focused on tracing and thereby assessing the means through which science narratives in particular circulate, shift, transform, and are refuted. This book contributes to that conversation, finding that, although the overarching scientific narratives that emerged to help constitute infertility sometimes traded explicitly in competing arguments and ideologies, in some cases newer scientific narratives gained widespread traction not by competing with or explicitly refuting the status quo but by arguing that the newer narrative’s tenets were simply extensions of what previous narratives had proposed. For instance, theories of psychogenic infertility at mid-century generated support by demonstrating, repeatedly, how newer psychoanalytic narratives aligned with and built from the chemical theories of reproductive endocrinologists. In this situation, the newer narrative was actually grounded in very different assumptions about infertility’s causes and cures, but the strategy of narrative extension functioned to disarm potential critics by upholding the façade that nothing new had been introduced. In this regard, I find that the construction of infertility in and over time tends to be as much about how scientific narratives have competed with each other for widespread acceptance as about how they have built from, linked with, and distorted or transformed each other.

Of course, the ways in which scientific and medical narratives are constituted depends not just on the discursive negotiations of technical experts but also on the rhetorical efforts and imaginings of popular and lay publics. Public vocabularies, what Condit defines as “the acceptable words, myths, and characterizations used for warranting social behavior in a community,” are part of the “distributed ecological spread” that functions to shape and otherwise transform scientific and medical narratives. As Johnson explains, mainstream media representations of scientific and medical topics, no matter how technically inaccurate or “wrong,” offer resources for constituting and making sense of culturally relevant subjects. Rhetorician Elizabeth C. Britt demonstrates that the same can also be said of interpersonal or vernacular accounts of such subject matter. Assessing what infertility has been, is, and will be depends upon an analysis of the interplay among technical, mainstream, and lay iterations of infertility. The account at hand, therefore, attends to the mutually constitutive relationships among technical representations of science and medicine in history; popular-press media coverage; and what social psychologist Wolfgang Wagner terms “vernacular science knowledge” or the “widely distributed form of popular understanding of science.”

In order to identify and explicate these relationships, I draw largely from a critical rhetoric orientation, which involves the identification of fragments of discourse, such as sections of speeches, interviews, and newspaper articles, and then the use of those fragments to build arguments about how rhetoric constructs and shapes communities’ values, beliefs, and behaviors. Critical rhetoric rejects the notion that texts are stable entities that individuals encounter uniformly from beginning to end. Instead, this approach works from the assumption that discursive fragments interact with each other to create meaning. Thus, rather than analyzing a single speech, book, or self-contained manifesto, the critical rhetorician considers multiple speeches, books, and/or other artifacts as representative of, and providing clues about, the larger rhetorical ecology in which those fragments circulate. The goal for critical rhetoricians (and rhetorical scholars in general) is not to put forth objective, generalizable findings, for, as rhetorician Angela G. Ray explains, rhetoric is, by definition, “an art of the particular.” Rather, their aim and mine is to present a compilation of interrelated, pertinent discursive fragments and delineate emergent knowledge claims detailing how meaning seems to be created therein.

The knowledge claims in this book are designed to offer a rhetorical history of infertility that highlights the processes of addressing publics through discourse. The emphasis in this case, then, is less on how individual rhetors may have intended to use rhetoric to persuade audiences—although that issue plays a role as well—and more on the formation of arguments, appeals, and narratives within a rhetorical ecology that includes diverse and competing variables related not just to rhetoric but also to material, social, cultural, and legal spheres. Attending to this broader, fluctuating constitutive landscape illustrates how rhetoric evolves as it “mov[es] across” and percolates up from that topography, revealing itself not as a singular, static endeavor but as an ongoing transformative “public(s) creation.” To delineate rhetoric as a public creation requires the critic to identify and assess not just relevant discursive fragments themselves but also, and even more importantly, the relationships between and among those fragments. In this specific case, that approach plays out in terms of the identification of historical discussions of infertility in books, speeches, media accounts, professional papers, and letters, and then the analysis of those fragments in terms of their “encounters,” as Edbauer terms it, with each other. I explore, for instance, whether and how these sources explicitly cited each other, whether they used similar or contrasting arguments, and whether their narrative structures feature similar or contrasting appeals. This process is designed to highlight the co-construction of not only “infertility” but also “sex,” “gender,” “race,” and “health” more generally.

As one might expect, a number of key discursive fragments under analysis in this project are extensively visual in nature. Understanding the relationship between these fragments and those more textually based—while also recognizing, as rhetorician Cara A. Finnegan argues, that all rhetoric can and should be considered through the lens of visuality —requires attention to medicine’s robust visual history. Over the last few decades, scholars from a range of disciplines have made important interventions into the study of reproductive health, specifically, by focusing on the role of microscopic and fetal imaging. Anthropologist Janelle S. Taylor, for instance, explores how the fetal sonogram—or, more precisely, the fetal sonographer—personifies, fetishizes, and commodifies the fetus, often representing race, class, sex, and gender in ways that promote potentially harmful political agendas. Twentieth-century audiences were given—for the first time—the opportunity to see, via a range of what sociologists Bruno Latour and Steve Woolgar would term “inscription devices” such as x-ray machines, extraction apparatuses, and culdoscopes, depictions of reproductive organs and the processes of conception and gestation. However, as anthropologist Rayna Rapp points out, much of this imagery was (and is) all but impossible to decipher without the guidance of professionals. In this respect, many visual representations of (in)fertility came to have meaning primarily through the initial filter of experts. Thus, I analyze not only the infertility related images that circulated in scientific journals and popular press articles during the twentieth century, but also the manner in which audiences were instructed to interpret them and thereby “see” infertility. More specifically, I identify how experts narrated images of (in)fertility—both among themselves and with/for lay publics—and argue that those narrations played a central role in constructing infertility. Correspondingly, I consider how associated representations were framed for mainstream audiences by the popular press.

Under rhetorician David Zarefsky’s helpful schema of different “senses” of rhetorical history projects, this book would likely best be categorized as “the study of historical events from a rhetorical perspective” in that the focus is on delineating infertility in history through rhetoric. Where Zarefsky lays out this “sense” as one that explores how “messages are created and used by people to influence and relate to one another,” the project at hand is as interested in the messages themselves as in the encounters, interconnections, cooptations, and transformations that such messages undergo. The subsequent chapters therefore highlight these interests and come together to form an extended study of rhetoric, science, medicine, health, and argumentation as moving, relational, affective, and circulating yet, in many ways, folded up. The chronology featured in these chapters offers not a statement on the linearity of history but, rather, what Serres would label a chain of reason for articulating both the circulation of rhetoric in specific eras and the many points of discursive percolation and fissure that happen across time, the former of which is the major focus of the book’s conclusion in that it adopts Serres’s comparative methodology to analyze chronologically disconnected examples from the earlier chapters.

Chapter One explores the metaphorical predecessors of the term (in)fertility and thereby builds an infrastructure for the book’s subsequent analysis of these metaphors as they were repeated and employed in various ways at chronologically disconnected points throughout the twentieth century. Drawing primarily from three influential texts spanning the mid-seventeenth to the mid-nineteenth centuries, I analyze the shifts in focal metaphors (i.e., from barren to sterile), as well as associated clustering metaphors (i.e., fruit, machinery), to assess the facilitating role that these metaphors played in moralizing and/or medicalizing involuntary childlessness and thereby positioning individual women as more or less at-fault for their lack of children, particularly as specific metaphorical vehicles evolved and eventually came to mix together. I demonstrate that a nineteenth-century shift in reproductive metaphors to the realm of the inorganic was accompanied by a reduction in fear appeals and personal responsibility rhetoric. In the early twentieth century, as metaphors of sterility were mixed with metaphors of organic growth, involuntary childlessness was increasingly framed as both a product of female volition and as resultant of the female body’s mechanical failure.

Chapter Two analyzes the arguments upholding the major model of reproductive health at the turn into the twentieth century: energy conservation. Drawing from social evolutionary theory, individuals such as physician and Harvard professor Edward H. Clarke delineated a narrative of energy conservation and human reproduction that called for women to forgo traditional higher education and professional careers so as to protect what came to be known as their “vital forces” (i.e., their fertility). In contrast to narratives emerging from earlier epochs of gynecological study, I find that Clarke’s narrative drew from both organic and mechanistic metaphors to frame Anglo-Saxon women as responsible for their childlessness, either because they had renounced motherhood entirely to pursue their own (selfish) interests or because they failed to properly conserve their energy during their fragile adolescent years and thus never acquired the physical ability to reproduce. Furthermore, I extend historian Sue Zschoche’s work by exploring how and why public arguments about women’s reproductive health continued to offer up a reconstituted narrative of energy conservation well into the twentieth century.

In Chapter Three, I draw from early scientific, mainstream, and lay rhetoric discussing reproductive endocrinology, as well as from corresponding infertility-related press coverage, to explicate what I theorize as an initial layer of infertility’s medicalization. More specifically, I analyze the chemical vocabulary of human reproduction that came to fruition in the 1930s and 1940s. I find that, as appeals to vital energy and moral physiology were supplanted and/or joined with discussions of internal chemistry and medical intervention, fertility was re-envisioned as a derivative of chemical interactions, interactions that could be synthesized and had the potential to mirror and even improve upon nature. The chapter as a whole demonstrates how chemical rhetoric was appropriated to re-envision sex, gender, and reproductive health in light of appeals to biochemical variability, artificiality, and technical expertise, and it also generates evidence to support the argument that appeals to medicalization often do not align with the elimination of appeals to morality and moralizing.

Chapter Four focuses on the formation of what I posit as an additional, though intricately interrelated, layer of infertility’s medicalization via post-World War II appropriations of Freudian psychoanalysis in medical and mainstream media. I argue that advocates framed these appropriations as extending, rather than refuting, ongoing chemical theories of infertility. At this point, interest in “psychogenic infertility”—the idea that women who could not conceive were emotionally and/or mentally stunted—combined with propaganda campaigns that stigmatized childless women for their supposedly purposeful infertility. This analysis functions, first, to outline the alarmist rhetoric that fostered a virtual mandate for White, middle-to-upper-class women in particular to reproduce and engage in traditionally feminine activities; second, to highlight the rhetorical strategies used to build from and thereby complicate chemical narratives of reproductive health; and, third, to delineate what I term a hermeneutics of the reproductive female, which was featured in much mid-century clinical rhetoric and instructed practitioners to interpret infertile women’s minds and bodies for signs of psycho-sexual dysfunction.

Chapter Five explores the coming together, in the 1960s and 1970s, of multiple scientific disciplines under the rubric of a larger field of infertility studies and thus the emergence of a transdisciplinary rhetoric of infertility. I argue that this process contributed yet another layer of medicalizing discourse to the evolving characterization of involuntary childlessness. This chapter demonstrates that appeals to time—or, more specifically, appeals to clinical tracking, managing, and otherwise intervening in reproductive timing—served as the rhetorical common denominator for this transdisciplinary effort. I find that to be “fertile” in the second half of the twentieth century was to be functioning within scientific and clinical time, while to be “infertile” was to be out-of-time, often in more than one sense. I trace this definitional metaphor to the emergence of the biological clock trope in the 1980s and its continued employment in the twenty-first century, and I consider the implications of this discursive temporal regime for constructions of sex, gender, and women’s reproductive health in general.

Finally, the concluding chapter demonstrates that mainstream explanations for women’s reproductive health have involved the percolation, circulation, and blending of historically distinct arguments related to: (a) individual women’s agency in preventing infertility, and (b) the framing of medical intervention as determinant. This chapter situates contemporary rhetoric about infertility in relationship to this historical percolation in which women are blamed for their inability to bear children and/or objectified as bodies that require the intercession of technical experts to be restored to normalcy. Therein, I draw from and compares findings from proceeding chapters to reiterate a layered—though never “total” or complete —model of medicalization, and to further demarcate the relationship between the flow of temporally connected rhetoric and the percolation of chronologically disconnected arguments in the formation of what, in this specific case, became a transdisciplinary rhetoric.

In closing, Infertility: A Rhetorical History enquires into rhetorical constructions of infertility; the ways in which rhetoric flows and percolates in history; and the processes by which seemingly technical rhetoric from diverse fields relates to and interacts with other fields, argumentative spheres, and broader rhetorical ecologies. The latter inquiry is especially telling in this case as the study of infertility transformed, in the 1960s and 1970s, from a disciplinary specific endeavor to a transdisciplinary project. This breakdown in disciplinary boundaries required that scholars, clinicians, and “patients” alike develop rhetorical norms and patterns that worked across and beyond expertise. In this instance, those patterns played themselves out in terms of appeals to clinical timing. What becomes clear in examining the rhetorical history of infertility presented here is both the malleability of disciplinary interaction and the ways in which rhetoric is forever constituted anew out of the percolation, circulation, and transformation of what has come before.

Communication Studies

           Rhetorical Studies

Gender Studies

History

           Nineteenth-century

Rhetoric