Tuesday, January 8, 2008

Book Review: The Infertility Companion

I've been so excited about reviewing this book but have made it a policy to refrain from reviewing or recommending a book until I have completed it so I've had to wait. I finished it last night.

The Infertility Companion: Hope and Help for Couples Facing Infertility (Christian Medical Association) is a book that is part almanac, part dictionary, part personal testimony and part Bible teaching and study. It's written by an Infertility Doctor and an Infertility Patient.

I'll start with my critiques because they're pretty minor. My biggest complaint about the book is that for some reason I've not quite put my finger on, DH and I both found it visually hard to read. I can't decide if the text is smaller, the leading is smaller, the characters are closer together, the lines are longer or if it's because the pages are gray and not white, but I found it hard to read more than 20 pages in one sitting before my eyes were too tired. I've never experienced that with a book before and I'm quite confident it wasn't the content that made it hard to read so I'm quite befuddled. At times I was frustrated because I wanted to continue reading but couldn't comfortably do so. So, I know I've been talking about this book for weeks-don't be dismayed by how long it took me to complete it. It's not much longer or more difficult than any of the others--it's just typeset in an odd fashion.

My other critique is that the book is littered with one paragraph personal anecdotes from various people that I found distracting on almost every occasion. I struggle to see their purpose and at times, was frustrated by the incongruence that occurred when the anecdotes interrupted the primary authors' train of thought, with little explanation as to why they were offered in the first place. The primary text is stronger when one skips the interruptions (though for thoroughness' sake, I did read them all).

However, those two, minor things encompass the totality of my complaints about this book.

What I love about this book is how straightforward it is. This is not to be confused with authors who are insensitive. This book just lacks the emotional aspect of a lot of the other books, which my DH especially appreciated. He felt much more comfortable reading this book than reading some of the others I speak highly of, including ones I've recommended here. The book reads largely like a textbook on infertility, if such a thing could exist given the diverse nature of individual experiences. However, it is very conversational and approachable in tone-not at all dry and difficult to read like the mention of a "text book" would suggest.

The authors write with one voice and do an excellent job at it, which I think lends itself to the "neutrality" of this book. It's not a book by women for women, or men for men. It's a book for a general audience, which I think is rare in this particular genre of texts.

The book spends some time on the interpersonal aspects of infertility, including the patients' relationships with themselves, with each other, with God, with their friends and family, with Christendom and with the general public. It also address such things as parenting after infertility, secondary infertility, childlessness by choice, and responding to well meaning advice.

Perhaps one of the most instrumental things I've read in any book on the subject was in the authors' chapter on myths of infertility. In response to the myth "If you adopt, the pain will go away," the authors cited another author who identified six key losses that are rooted in infertility:

1. Loss of control
2. Loss of individual genetic continuity
3. Loss of a jointly conceived child
4. Loss of the pregnancy and birth experiences
5. Loss of emotional gratification surrounding pregnancy and birth
6. Loss of an opportunity to nurture and parent a new generation

pg 29

How freeing it was for me to read that it is perfectly normal to mourn the loss of pregnancy--a need that will never be met through born-child adoption! I've already shared this with a few other people because it was so instrumental to me to identify the various types and sources of grief and loss. I wish I could put it on a flyer and distribute it to the world and maybe then people would cease looking for trite things to say or ways to help their infertile friends "get over" this loss!

The rest of the book, however, is what I found most useful. It's an explanation and bioethical exploration of the tests and procedures common in the treatment of infertility. It covers everything ranging from sample collection to examinations to medications to surgical procedures. The authors are quick to confess their own limits and biases, but even with the procedures with which they don't agree, they highlight the benefits along with the risks. I appreciated this neutrality. They are also careful and responsible to state that their opinions on anything that falls outside the bounds of clear scriptural teaching and/or does not jeopardize innocent life is their own opinion and not gospel truth. On the other hand, where something does violate clear scripture or the sanctity of life, they are firm in stating its inappropriateness for the committed Christian (examples would be fornicating to produce fluid samples or children, selective reduction abortion, etc). In some cases (IVF for example), they are very helpful in helping the reader understand the limits they should place in order to keep the procedure one that honors God and human life. Where Catholics and Protestants might differ, they offer information and resources for both worldviews.

I appreciated how respectful the authors are of opinions that differ from theirs when it comes to matters of interpretation. There is no condemnation-only simple, undecorated statement of their opinion and where applicable, medical and scientific facts. They do not pressure the reader to come to the same conclusions and as I mentioned, are generous in even offering the benefits of procedures that they would not choose for themselves.

They offer a very useful grid for evaluating the ethics of reproductive technology. They have borrowed the framework from a secular textbook and offer it as being both useful and consistent with a biblical worldview.

The four principles are:

Beneficence-to do good. Thus, we ask, "Does it do good?"

Nonmaleficece-to do no harm. We ask, "Does it avoid doing harm?"

Autonomy-the patient has the right to make decisions about care rendered to him or her. We ask, "Does it respect self-determination, the patient's right to decide for him- or herself?"

Justice-fair, equitable, and appropriate distribution of social benefits and burdens. Our own definition of justice goes beyond this definition to ask whether something seeks what is right or due the patient in a given instance. So we ask, "Does it give what is right, due and equitable?"

pg 171
So long as the reader retains honesty careful grounding in scripture when answering the questions posed in this construct, I found this to be a very useful and practical framework.

The book also has quite a few extra curricular resources. The end of each chapter has discussion questions for the reader. I suppose with some moderation, they could be good prompts for a group discussion as well. The appendices of the book include a scripture-based workbook of questions and exercises for each chapter, an infertility medical workup worksheet, the Christian Medical Association Statement on Reproductive Technology, an IF glossary with common vernacular explanations, a list of resources and complete citations for all of the studies, interviews and writings cited in the book.

The book is very well cited. Each time the authors mentioned a clinical study, a public statement by a group or committee, a medical fact, and even in some cases a hermeneutic explanation, there was a corresponding citation. This set me at ease that the things that I was reading were true, or at least easily verifiable. It also gave me a place to go if anything piqued my interest to the point of wanting to seek out further information. I appreciated this responsible treatment of a lot of things that are offered as "fact" in a world full of questions and controversy.

I will confess that I did not complete the workbook or discussion questions yet, and am not sure if I plan to. However, I did read through them and found them relevant and thought provoking.

The book is like an encyclopedia insofar as there may be portions (even large ones) that are not relevant to you if you are not considering a certain procedure or class of procedures. I did read the entire book so as to have a firm understanding of it, but I admit to times when I had trouble staying interested in subjects that are not a part of our journey. I will say that the book can easily be read in sections or chapters. If you skip a section that is not relevant to your journey, I do not think it will make the rest of the book unreadable and I think you would still benefit. Each chapter can stand on its own and be contextually accurate and understandable. However, the book also feels unified enough to be read through as a traditional chapter book.

There is a ton of clinical information in this book, which distinguishes it from other books in this genre. For that reason, it's a lot more difficult to retain all of the information in the book than it is with other books that are more narrow in subject. For that reason I think this book is most useful when consulted many times, especially the subjects of particular relevance to the reader. I know I shall have to read through the details of some of the Reproductive Technologies several times before I feel I have a firm grasp on them but again, that selective reading is very possible in a book structured this way.

This book is an excellent resource for infertility patients. I'm not sure it's useful for pastors, friends and family or doctors, but I suspect it was never intended to be. This is not your typical infertility Bible or personal enrichment study, so I would not add it to my library in lieu of books that are more personally challenging, but it is an excellent academic reference resource, which is especially useful in a world where the sheer volume of facts and anecdotes can be overwhelming.