Rohini S Rajagopal on fighting stigma, shame, and secrecy attached to infertility treatment

“Pregnancy was an exclusive club and I wanted to break in.” Rohini S. Rajagopal on her trajectory of infertility. More than being a narrative about the transformative potential of Assisted Reproductive Technology (ART), What’s a lemon squeezer doing in my vagina (2021) by Bangalore-based writer and editor Rohini S Rajagopal is a personal, and not always pleasant, journey about the technology’s flipside. Her memoir contains anecdotes that make the reader uncomfortable, phrases that most are unfamiliar with, and is essentially a dive into an uncharted territory for many married couples dealing with infertility. Rohini talked to Firstpost about her book, the backstory of her memoir, its content, intent and impact. Excerpts from the interview: How did you come up with the idea to write this book, and what was the compelling motive behind documenting your journey? The decision to share my story resulted from a promise I made to myself. I was in the initial weeks of my third pregnancy (after the first two ended abruptly in miscarriage) when I experienced an unexpected bout of bleeding. In a moment of abject desperation and frailty, I told myself that if this pregnancy goes forward, I will tell my story. The memoir gives us an insight into healthcare and the socio-economic factors surrounding infertility. As there is limited experiential literature on this subject specifically in the Indian context, can you tell us about your research process? Did you attempt to strike a balance in your subjective experience vis-à-vis research/data available? My original plan was to write this book as part-memoir and part-journalistic essays on the social, ethical, and legislative issues surrounding infertility. The personal narrative was meant to provide context and grounding in reality. Once I started writing, the personal narrative took up more space and eventually swallowed up all other intentions. It became the whole book instead of just a small part of it. So my research has been limited to representing my own account with absolute accuracy and honesty. Could you describe the kind of societal pressure you faced, and don’t you think Assisted Reproductive Technology (ART) reinforces the motherhood mandate and medicalises women’s reproductive health? As though, if you do not seek medical help, you haven’t done what it takes to be a mother. There were questions like - when is the good news? Are you taking treatment? Isn’t it time you focused on starting a family? At times, the question was not asked directly, but I felt that it was lurking in the shadows and would emerge if I let my guard down. In this context ART has proven to be a response to the motherhood mandate. Even before ART or even now in places where ART is inaccessible, there are rituals, offerings, home remedies, and alternative healing practices to ‘cure’ infertility. ART on the other hand offers the advantages of evidence-based medicine to address difficulties with conception. However, I think it’s important to understand and acknowledge the reality and complexity of ART - high cost, differential access and low success rates. In vitro fertilisation (IVF) is not a ‘sure-shot cure’ for infertility. The success rates are 30-40 per cent for a woman over thirty in a good clinic per cycle. It is lengthy, invasive and excessively draining–physically, emotionally and financially. We need more and more conversation on not just ART but other ways of becoming a parent such as adoption or other definitions of family and fulfillment, so that there is greater awareness and acceptance. Book review: ‘What’s a Lemon Squeezer Doing in My Vagina’ is a harrowing tale of infertility treatment in India In one of the chapters in What’s a lemon squeezer doing in my vagina, you also uncover the structural ‘inequality’ that a marriage is composed of and how infertility is not an equal opportunity employer. Could you please share the involvement of your husband in the treatment? Do you agree that the biological, personal, and social drama of infertility is played out in the woman’s body? Ovulation, fertilisation, pregnancy, labour, birth - everything happens inside the woman’s body so naturally the woman’s body is the site for all fertility interventions and the male partner does not have a lot to ‘do’ or ‘contribute’ during ART processes. My husband was always supportive but he could not really share the load in terms of injections, pills, surgical procedures or psychological stress. I could not afford to forget for a single waking hour that I was going through IVF – it was my everyday physical reality. But just like men’s role is now being re-examined in pregnancy and parenting, I think it is vital that men own a greater stake in ART. Along with being supportive they need to bring a sense of ownership and investment to the journey. There is a line in your memoir where you mention, “The last time we had felt like objects in a factory unit being sent from one assembly line to another”. How do you view the commercialisation, capitalisation and mechanisation of ART? ART Act 2021 came into force recently (with some criticism) to regulate IVF clinics and ART banks, prevent exploitation and offer redressal mechanisms. Until now, I think it has been a largely unregulated sector. The secrecy surrounding the topic, immense social pressure and how abstruse the technology can be for a lay person makes patients/surrogates/donors very vulnerable. Just yesterday I was reading this story in the News Minute about a twelve-year old girl in Tamil Nadu who was forced to donate oocytes multiple times by her mother and her partner. So strong legislation to supervise and monitor ART is critical. And the medical community must share information about success rates, percentage of miscarriages, risks of IVF, etcetera upfront so that people know what they are signing up for. We also need to exercise our right to information and transparency. Doctor-patient relationships can be unequal and we have to seek data and facts proactively. With a population density as high as that of India, do you think infertility still isn’t a pressing concern here, despite there being approximately 27.5 million couples suffering from infertility and if it isn’t, why? I have always felt that infertility does not get the attention that it deserves in public discourse despite the fact that one in ten couples in urban India trying to conceive are likely to face difficulties. After I wrote the book, I have had so many people in my life come forward to share their own encounters with infertility. And these are people I have known for a very long time but I had no inkling that we shared these common bonds. The stigma is so thick that it is challenging to cut through. I really hope more and more voices break the silence on this topic. You went through four IUI (Intrauterine Insemination), two IVF, two Frozen Embryo Transfer and two miscarriages, and though you could afford it your book mentions that it took a toll on you financially, do you think that women or rather couples from a disadvantaged background and not financially equipped would be able to access these treatments? It is a fact that ART is prohibitively expensive and it is not accessible to large sections of society. I fully acknowledge the class/caste privilege and my urban location that allowed me to benefit from the technology. I hope as more people seek fertility assistance, there is greater democratisation of access to the technology, with good quality, regulatory control and transparency. Soumya Kashyap is a research scholar and Priyanka Tripathi is an associate professor in the Department of Humanities and Social Sciences, Indian Institute of Technology Patna (India). They can be reached at soumyakashyap1994@gmail.com/ priyankatripathi@iitp.ac.in Read all the Latest News , Trending News ,  Cricket News , Bollywood News , India News and Entertainment News here. Follow us on Facebook, Twitter and Instagram.