Fertility Across Cultures

I recently said goodbye to a girl I supervised at work. She left to get married and will then relocate to be with her future husband. We'll call her Jane. Jane started out as an intern and continued working part time after graduating this past summer. I didn't spend any time with her outside of work (or lunch), but I liked her and she was a good worker.

Jane is Indian but was born in the U.S. and lived here for part of her childhood. Her family returned to India when she was 12-ish and lived there until Jane was ready to go to college. The family then moved back to the U.S. so she and her siblings could attend college here.

Shortly after I met Jane she mentioned that her father was pushing for her to get married and that once she was finished with college she wouldn't have an excuse anymore to refuse. The thing is, she was to have an arranged marriage and she was quickly becoming "too old" at 25 to find a quality husband. Her father is obviously very traditional in keeping with this custom, as obviously not all Indian-Americans or even Indians continue to have arranged marriages. Jane was accepting of this and in some ways more than happy to go along with it. Once I learned that she was open to talking about it I probably asked her a million questions because I was so interested to learn more about it and how it all worked.

I could go on and on about the process of finding a husband and arranging the marriage but that is not the point of this story, fascinating as those details are. But once Jane's father had found a "match" that they were interested in (there are websites for this whole process - somewhat similar to mat.ch.com and others) they invited him to their home to visit. Thankfully, Jane would be able to refuse any potential husband if she didn't feel right about it. Although I'm not sure how useful that is when only meeting someone once. But I digress... He came with his sister and her family and the meeting went well and everything seemed to be on the right track.

Unfortunately, Jane was admitted to the hospital the next day for what I later found out was heavy menstrual bleeding that had been going on for more than a month. She was diagnosed with PCOS and was told that was the cause of her issues. She had also been experiencing dizzy spells, likely related.

All told she was out of work for a week. When she came back she looked terrible and I was very worried about her but she insisted that she was fine and could work. The following week she came to my office all smiles and looking so much better. She told me that her suitor had agreed to marry her. Apparently, he and his family had been having second thoughts once they learned about her new diagnosis of PCOS. They were concerned that she might not be able to have children, and therefore carry on her husband's family as he is the only living son. Ultimately, they chose to proceed but it had been the cause of a lot of worry and stress for her. She had already had a previous arrangement fall through because the man backed out (for reasons he didn't specify) and I think she was reluctant to start the search over. She also felt she would have to reveal her potential fertility issues to each new person.

This incident really hit home for me and made me think. Just what issues come up when dealing with fertility in cultures other than my own? I feel very lucky to have not had to worry too much about it. I would not be embarrassed to reveal my issues to most anyone. If they thought less of me because of it I would consider that their loss. I don't bring it up with most people because I figure they don't want to hear about my ovaries and my husbands sperm. If asked, however, I would discuss just about any aspect.

There also was a time when I did reveal my PCOS to my now-husband, then-boyfriend, and I told him that I may never have children of my own. He didn't care and said that we would find another way to build our family if it came to that. Truthfully, I didn't expect his reaction to be any different than what it ultimately was. I would expect that if a man married me it would be for more than my ability to carry on his genes. I guess it was different for Jane's future husband. For one thing, it was different because there weren't really emotions involved in it. They certainly are not yet "in love". But were there also other things at work such as cultural expectations for family or even gender?

I've been thinking a lot about this lately and wondering what extra pressures are put on women or men with fertility challenges in other countries and cultures. Is there more shame connected to what they feel compared to me? Or less in some cases? Even though I am not ashamed of my issues, that doesn't mean that I have not struggled with feeling inadequate or guilty at times. And of course I realize that even women who live in the same country as I don't have exactly the same experiences. Culture obviously isn't the only thing that shapes the way we and others react to our infertility. But what if I lived in a place where I was expected to bear children? Or I couldn't talk about my fertility issues or even have the opportunity to be properly diagnosed? Not all people in my country are as open-minded as I am about infertility and obviously many of us have faced unfortunate situations at the hands of ignorant fertiles, but in the U.S. we arguably have more understanding and less social stigma than in many other places.

I don't judge Jane and her family for the way they enter into marriage; that is their tradition and view and I don't begrudge them that given that she is an adult and willing participant. But I certainly feel fortunate that these issues didn't play a role in the evaluation of my suitability as a wife.