On the spectrum of self-actualized lives, Tanya Selvaratnam, a Sri Lankan-American performer, writer, producer (primarily of advocacy films like Catherine Gund’s What’s On Your Plate? and Chiara Clemente's Our City Dreams), and executive at the Rubell Family Collection, ranks fairly high. Selvaratnam, 42, has now poured her considerable energy into a book detailing her experience with infertility, called The Big Lie: Motherhood, Feminism, and the Reality of the Biological Clock (out January 7).
It's a bold title. It may bother you. It may even seem disingenuous: After all, only 10 to 20 percent of women over 35 will be unable to get pregnant after six months of trying to conceive. (I know there are a lot of statistics on this issue floating around, but this is the one the medical community uses).
But Selvaratnam’s intention is to provoke. What happened to her while trying to conceive around 40 was horrific. After three miscarriages, she turned to a fertility clinic for IVF, but basic testing during the treatment admissions process revealed life-threatening cancerous cysts. They were removed successfully, but her marriage did not survive her medical issues, and she has not pursued motherhood on her own. The experience motivated her to look more closely at the way modern women think about planning for a family, the emotional and financial cost of reproductive medicine, and the complicated mess of shame and guilt around infertility.
The Big Lie is a very strong title, and can be hard for people to hear.
But it is a big lie that we can do things on our own timetable. It constantly amazes me how, even with all of the information out there about the connection between age and fertility, we still hold on to this fantasy or myth that science can make things possible. My generation is really the guinea-pig generation when it comes to this, because we were the first to benefit from second-wave feminism, and also from the advances in reproductive science at the same time. It’s not necessarily that one or the other intended to deceive women — a whole set of cultural and social norms just worked in tandem with each other to create this environment where anything feels possible. But you can only manipulate biology so much.
What do you think it is that makes so many women quiet about going to fertility clinics and doctors?
I think there are many layers to why it’s still in the dark and hidden. Our culture is about I share, therefore I am, but what exactly are we sharing? We put forward the face that we want people to see, and talking about our failures, or our mistakes, is something that’s very hard for people to do, even when so much of our life is lived in public now. There’s social pressures making us feel we need to succeed — I mean, it’s very American — but we don’t want to talk about our abortions, and our miscarriages, and our failed IVF treatments, even though sharing those stories might help other people not have those same sad experiences.
I’ve often thought that age-related infertility issues are a third rail of feminism. It’s obviously a high-class problem, which is why it’s hard to get riled up about the high cost of IVF or the injustice of not getting to have a child because you put a career first.
There’s still this top-down, imposed attitude that having a child should be a pursuit of those who can afford to have a child. So having a child becomes a luxury. Only rich, infertile women can have kids, because of the way our insurance structure works in this country. Only fifteen states in America have some kind of mandated fertility treatment insurance. It’s a tragedy, because you’re saying, basically, where you live and how much money you make determines whether or not you can have a child. It’s an unfair and very cruel system. Scandinavia in particular has created a more benevolent society in this regard. This is not just about women’s desires and needs — it’s about a better framework for everyone to exist in.
Even though IVF can’t fix every fertility problem, it is the most successful treatment we have to help older women get pregnant. Do you think American health insurance should cover IVF?
Absolutely. Look at Israel. They have one of the highest utilization rates of IVF, and also one of the highest success rates, because they have pioneered how to make IVF free and accessible to all people. The proof is in the pudding. The economic segregation of who can pursue fertility treatments is just wrong. Every doctor and infertility consultant that I spoke to about this issue agrees — the insurance system and the political system has to change. We have to start considering infertility as a disease and, in that sense, developing funding and infrastructures that deal with it as a disease, because seeing it as a luxury, like dermatology or plastic surgery, something that’s elective, is totally bogus.
What else would be helpful to change the system as it stands today?
We have to teach people that preventing pregnancies and disease is not the answer for sex education — we have to incorporate women’s biology’s and women’s fertility span into that education so that as we grow up, we think proactively about what might happen to our bodies as we get older. We’re unleashed on the world at 18 in college, and are expected to figure it out on our own. I had an abortion in my early twenties because I was using the pull-out method — so stupid, how could somebody who went to Harvard be so stupid? — but I was never taught how our fertility span works, or the day that we ovulated, or the days we can get pregnant. These choices, when it comes to partnership and family and parenthood, in particular, are basic life aspirations that we shouldn’t have to wing it about.
A lot of people want to say that egg freezing, which has gotten so much better recently, is the answer. Women in their twenties will freeze eggs, like they pierce their ears in their teens.
But egg freezing needs to be democratized as well. It’s such an elemental consideration: Egg freezing should be more accessible; why isn’t it? How can we change that? These are questions that we need to start asking so that the conversations aren’t just happening amongst elite, white women — which is kind of what’s been happening for the last few years. However, I don’t think we can just trumpet egg freezing as the answer to delaying motherhood. There’s a holistic, comprehensive approach that goes along with egg freezing to make women more aware of what their options are. It’s an option, but that doesn’t mean it’s going to work out for you if you do it.
Right, because the success rates from freezing eggs are still not that high — you could be 40, go for your eggs, and the eggs just don’t work. One thing I feel strongly about is that women should have their FSH, and maybe AMH levels too — the markers of low ovarian reserve — tested as part of a routine gynecological exam after, say, 33 years of age.
Absolutely, 100 percent. Women shouldn’t have to seek the information for themselves. It should be automatic. Empowering people with knowledge will help them make better choices, so why aren’t we doing it? Why are we so scared to have the conversation? Think about it in the content of so many public health issues, whether it is smoking or eating disorders — why aren’t we preparing people for the impact that their decisions have on their bodies and why aren’t we allowing people to live healthier, happier lives in the name of just letting people doing what they want to do?
How do you look back on your fertility struggles now?
For me, thinking spirituality, and perhaps trying to see the silver lining, I really had to deal with these things growing inside me that were potentially life-threatening and cancerous. I didn’t get to make a new life, but I saved my own, and maybe that was the story that I needed to tell. If I hadn't been trying to so hard to get pregnant and hadn’t failed with my pregnancies, I might not have discovered those tumors that in a couple of years would have been to late to be treated. So as horrible a situation as mine was, it was also a miracle. The irony is that now that the these tumors are gone, I feel in my gut that I would probably be able to have a successful pregnancy. But now I’m in a position where I don’t have a partner to have a child with. And I’m also healing from all those physic and psychological wounds that I had to deal with over the last few years.
Still, I have to say that I’m basically very happy now. The book was therapy. I wrote myself out of the belly of the whale. Instead of focusing just on whether I was going to be a mother or not, I followed my experience, where it was taking me.