Sunday, June 29, 2014

Infertility on Film and Television-Part 2: Rules, Housewives and Friends

The most common infertility topic I see on television is surrogacy, which is strange because in real life it is not as common as IVF, IUIs, use of donor sperm or eggs (topics that are rarely brought up) or even simply medication. One reason surrogacy is more uncommon in reality might be that of all the options, surrogacy is the most expensive (partly because it is a legal process). For some reason on television shows any time a couple is struggling with infertility they immediately look into surrogacy or adoption (which might be why we infertiles get so many people asking “Why don’t you just adopt?”)

In all of the surrogacy movies on Lifetime they make it all look so simple: the doctor takes an embryo and puts it in the surrogate, then she takes a pregnancy test and it’s positive (usually on the first try). The surrogate never needs any injections or hormone supplements leading up to the embryo transfer and the parents are always so happy and calm. These programs never show how much the parents go through before deciding to use a surrogate-things like the tests, ovulation tracking, IUIs or IVF attempts, nor do they mention all the hormone injections and doctor’s appointments the couple and surrogate would go through before having an embryo to put into their surrogate in the first place-like the egg retrieval process. These movies also neglect to address the financial investment and emotional implications that I am sure come with using a surrogate. 

Three television series that I have enjoyed over the years and that have addressed infertility and surrogacy are Rules of Engagement, Desperate Housewives and Friends. I do not think any of these shows were very realistic in their portrayal of surrogacy or the emotions that I am sure come with that decision. Again, none of them show the parents really struggling emotionally with their infertility ("Friends" does a little), nor do they imply that the surrogates did more than have some embryos injected into their tummies and then take pregnancy tests.

Rules of Engagement


In Rules of Engagement (2007-2013) the desire of Jeff and Audrey (played by Patrick Warburton and Megyn Price) to be parents never seems very great (they talk about it in some episodes and don't even mention it in others). They make fun of the semen analysis, with jokes about masturbation and porn. The results show that Jeff has slow moving sperm and the doctor gives him a list of instructions, which he fails to follow (how much does he really want this?) somehow magically leading to the development of "super sperm" at his next test. They save the episode with him admitting near the end that he has been frustrated that they can't get pregnant because he feels like it is his fault, but a scene that could have been emotional is immediately turned comical.

Two seasons later they try IVF (for ONE episode). In one comical scene Jeff stabs himself with the needle when trying to give Audrey an estrogen injection (unrealistic, but fitting for this show). The one realistic part is Audrey complaining about the side effects of the hormones, which is why Jeff is scared when he pokes himself. Later, Audrey declines alcohol, suffers hot flashes (which are more common when estrogen levels drop not increase), and feels forgetful throughout the episode and they even meet a woman who is pregnant as a result of IVF. Overall they seem to dance around the issue of infertility and although I appreciate that the effort (having infertility as a part of the story line raises awareness), I don't think they ever take it seriously enough. 

In the first scene of the next episode they are discussing surrogates. They jump from infertility treatments in one episode to a surrogate in the next, never addressing the emotional implications of a failed IVF treatment (or multiple treatments: Audrey says they decided if the last IVF cycle did not work they had planned to find a surrogate). The surrogate herself is not a main character and there are several episodes where she and the baby are not even mentioned by parents Jeff and Audrey. The series ends with the surrogate giving birth (after over two seasons of being pregnant) and Audrey discovering that she is now, miraculously, pregnant. I hated the end and thought they should have just left it with the surrogate giving birth instead of throwing in a pregnancy on top of it.

Desperate Housewives


Desperate Housewives (2004-2012) is one of my favorite shows, but as far as infertility goes they really dropped the ball. Spoiled Gabrielle (played by Eva Longoria) never wanted to be a mother, but she ends up pregnant when her husband Carlos (played by Ricardo Chavira) tampers with her birth control pills. Just as Gaby is getting used to the idea of being a mother, she falls down the stairs and suffers a miscarriage. After the miscarriage there is one scene where she finally accepts the loss and deals with her grief. That scene was fairly honest emotionally, but up to that point she went around acting like she didn’t care and it was no big deal (which I am sure was angering for anyone who has ever suffered a miscarriage).

A few months later, when Gabrielle and Carlos decide they want to try to get pregnant again, they discover that Gaby cannot become pregnant because of complications from her miscarriage. I think it is odd that they never found anything wrong right after the miscarriage (probably because the writers did not know where they were going to take the story yet) and also don’t like that they never explain exactly what the problem is. All they say is that she had a miscarriage and now she can’t get pregnant again. It is all so vague, as infertility often is on television.

Next they decide to adopt but the process proves to be difficult because of their pasts (she slept with her teenage gardener and he spent time in prison for child labor in a factory his company owned). They end up going through a somewhat shady private adoption agency. Gaby is picky about the birth mothers’ looks and keeps turning down options, until they meet a pretty exotic dancer. They essentially pay her off, buying her any gift she desires. Just after she has the baby, they find out that the father is not the guy she told them he was so Gaby and Carlos kidnap the baby from the hospital. With the security in hospitals I don’t know how this would even be possible!

Somehow they are granted temporary custody (after kidnapping? really?) until the teen birth father can be found (he on vacation for spring break). The most realistic emotional scene in the whole thing is when the birth mom changes her mind and shows up with cops to take her baby back. Gaby is completely DEVASTATED (even thought her maid was doing most of the work caring for the baby) and left sobbing in front of her house after having to be physically restrained when social services takes the baby. That scene made me cry! 

Then it gets unrealistic AGAIN when they decide to get a surrogate. Gaby seems so calm telling her friends that they won’t adopt again and that surrogacy is the only option saying she has some eggs on ice. She says it like it’s nothing. I have been through egg retrieval and the routine of the shots and the side effects of the hormones are not something that I can imagine a diva like Gaby would get through without some complaints. The show's writers should have addressed that better. It was almost insulting that they brushed over it like that with no discussion (or research on the topic).

Gaby and Carlos convince their Chinese live-in maid to be their surrogate (who agrees to have their baby in hopes of avoiding deportation-again, really??) and just like that she is pregnant. After months of Gabrielle catering to their surrogate’s every need, Carlos becomes overly attracted to the woman carrying his child and starts having an affair with her.

Even though they are getting divorced by the time their surrogate goes into labor, they both show up at the hospital for the birth of their child. Then the baby is born and it is black…they are both Hispanic. This is when it gets really ridiculous: the clinic mixed up their embryo (oops) with another couple’s (their embryo didn’t take). As they leave the hospital they seem tired and defeated but not devastated the way I think a real life couple would be after so much.

Of course, they bounce back and several years later she miraculously gets pregnant not once, but twice! <insert eye roll> I know TV needs drama, but how much does one couple really have to go through?! I have a hard time believing any real life couple has had so much bad luck in every avenue of attempting to become parents (miscarriage, infertility, failed adoption, mixed up embryos). I’m not saying a mix-up has NEVER happened, but I really doubt with all of the precautions nowadays that any reputable clinic would just mix up embryos. It all happens so fast and is all so unrealistic. I feel like they almost made a mockery of the entire situation.

Friends 


In the fourth season of Friends (1994-2004) Phoebe's brother marries an older woman, and they quickly learn they can't have kids. They ask Phoebe (played by Lisa Kudrow) to be their surrogate. The show does find a way to explain some detail: like the uterus is ready for the embryos when the endometrial layer is thick. The same day Phoebe goes in for an ultrasound the doctor transfers 5 embryos and tells her that she has a 25% chance that one will take. The characters also discuss the costs (which I liked because most shows don't do it): Phoebe’s sister-in-law tells her this is their only shot because it cost $16,000 and they cannot afford to try again. These details might have been true when the show aired 16 years ago, but Phoebe having a moment alone with a petri dish containing the embryos, is completely unrealistic (and unsterile).

Phoebe comes home from the doctor and immediately takes a pregnancy test, saying that even though the doctor says it usually takes a couple days, her body has always worked faster than western medicine. No surprise, it’s negative. The next day (I assume she only laid upside down in a chair wearing the same clothes overnight) she takes another test and it is positive. She WAS pregnant with triplets, but even with multiples her hormone level would not have been elevated enough to get a positive after only one day-the embryos usually take a day or two to even implant and then it is typically at least a little over a week before a woman’s hCG levels are elevated enough for a home pregnancy test to detect.

In the ninth season I think the show’s writers redeemed themselves with the story of Chandler and Monica (played by Matthew Perry and Courtney Cox Arquette). Chandler and Monica’s story revolves around their desire and attempts to become parents for the last season two seasons. After trying to get pregnant for about a year, they see a doctor. Chandler is nervous about the semen analysis and makes jokes like he always does, but overall he seems okay about it. I like that they did not make too big of a deal about it because it seems like that is often given more attention than the women’s tests even though the women have more tests (and more invasive ones).

One part about the testing that I liked was that Monica said she had TESTS (plural) at one point, because women really do have to undergo more testing than men, and she says a minute later that she has an “invasive vaginal exam” to get to. I like the latter comment because it is the first (and only) time where I have ever heard a woman in any TV show or movie even mention what might be involved in the tests. She doesn’t go into detail, but she at least reveals that she will be undergoing more than a blood test. Women do so much more than just have blood drawn-there are so many exams and procedures to check different things related to infertility and they are all uncomfortable and at least a little invasive.

The show displays some serious situations sprinkled with comedy, but never at the wrong times. Moments that need serious emotion are given time for that emotion to show. For example, Chandler gets the call with the results of their fertility tests and then has to tell Monica the bad news: his sperm have low motility and she has a “hostile uterus,” which means they pretty much have no chance of conceiving on their own. They don’t make jokes; they just hug and agree that they are going to figure out what to do. In contrast, at the doctor’s office they say some funny one-liners about the causes of their infertility issues and Chandler makes jokes when the doctor discloses their options. Fans still feel for them, but comedy is what the show is about and is very much a part of Chandler’s character.

Their options are surrogacy (again, this less common approach is brought up) or insemination with donor sperm. Surrogacy could be an option, since it’s Monica’s uterus that is the problem, not her eggs. They never say what the problem is exactly though (endometriosis? polyps? fibroids?) and leave the audience to assume whatever it is cannot be treated. One problem with the storyline here is that the doctor suggests insemination (which is a broad term that could encompass IUI) with donor sperm, but if her uterus is “an inhospitable environment” I don’t see how donor sperm would succeed any better than Chandler’s lazy sperm. The other big question I have is why did the doctor not suggest IUI specifically or IVF, both of which are options in cases of low motility? If Monica can get pregnant with donor sperm there is no reason she would not be able to get pregnant using Chandler’s sperm and one of these procedures. But, this is TV and it is not always realistic.

The first option Chandler and Monica decide to go with is that of a sperm donor. They sort through profiles and end up inviting Chandler’s colleague (played by John Stamos) over for dinner where they scare him away with all their questions about his genetics and family medical history. By the end of the night Chandler thinks the sperm donor is a better specimen than he is and Monica has decided that she doesn’t want to use a donor. She says that if she can’t get pregnant with Chandler’s baby she doesn’t want to get pregnant with anyone else’s. I like this scene because when it is all said and done Chandler confesses that he feels the same way, but was being supportive of a donor because he thought that was what Monica wanted (the things we do for love). I understand how Monica feels. I think if we couldn’t have a child that was genetically both of ours that I would rather adopt.

Adoption is what they end up doing. The scenes with the birth mother are a little goofy and I am sure no prospective parents are ever surprised by twins in the delivery room with the way things are handled today, but it made for a fun surprise on the show and led to some comical solutions from Chandler. I think even with the extra comedy thrown in, once the characters decided to adopt the show still managed to display some real emotions (especially when Chandler and Monica are holding their new babies, smiling and hardly looking away) and brought attention to the idea of adoption and infertility. 

I would not watch this show expecting to get a completely realistic and honest story about infertility, but as far as comedies go, it does well. I know that it is fiction and it is a comedy, so they are going to make light of all types of serious situations. Even though they take a comic approach, it is impressive that a sitcom would even tackle such a serious subject especially when it was not something that was openly discussed at the time. This show is more truthful and detailed about the process of infertility testing and exploring options than most shows out there.

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