Pamela | Surviving the Trauma of IVF

Distraught by her infertility diagnosis, Pamela pursued the IVF pathway. A decade of costly and painful failed fertility treatments left Pamela traumatized. Determined to expose the exploitative and dangerously pronatalist practices of the highly unregulated multi-billion dollar fertility industry and to bring together other IVF survivors, she founded the “silent sorority” community and the ReproTechTruths website. Today, she and her husband lead deeply fulfilled lives pursuing their many passions.

• TRANSCRIPT

  Pamela (00:00):

  It is a traumatic experience to find out that your body cannot do something. And I think the real criminal aspect of this $30 billion fertility industry is that these services are sold when people are at their most emotionally vulnerable. These decisions are not easy ones for a lot of people. However, it's painted as a binary. You can't have children, we can fix you. And that notion of being cured puts the patient in the position of having to decide when enough is enough.

  Nandita Bajaj (00:45):

  That was today's guest, Pamela. Hi everyone, and thank you for joining me. My name is Nandita Bajaj and I'm the host of Beyond Pronatalism, Finding Fulfillment With or Without Kids, an interview series in which through intimate conversations with women and men from diverse backgrounds, I explore how they are courageously and creatively navigating pronatalism - the often unspoken pressures to have children, whether from family, friends, or the culture at large. In each episode, I dive into personal stories with people who are forging unconventional pathways to fulfillment, including redefining what family means to them, whether that means being childfree or childless, having biological kids, adopting or fostering children or animals, or creating close-knit communities of friends and loved ones. Hi Pamela, it is so terrific having you on the show. Thank you so much for joining me today.

  Pamela (01:42):

  It's great to be here and there's so many things we can discuss. I really look forward to our conversation.

  Nandita Bajaj (01:48):

  Likewise. And Pamela, you've held a number of different roles in your long career, but in the context of this podcast, you're perhaps best known for your work as a truth teller about the painful realities of unexplained infertility and the trauma caused by pronatalism and the for-profit assisted reproductive technology industry. And I am really looking forward to this conversation with you. So to begin, perhaps you could start by sharing a brief introduction about yourself.

  Pamela (02:24):

  It's an interesting time to be alive and after experiencing a coming of age when the women's movement was really taking hold, I found that I had the opportunity to both participate in a lot of the new opportunities that came toward women. But at the same time, I also realized there were a lot of hidden messages about what expectations there are for women and what makes a woman complete. So in my own experience, I'm 62 this June, I've had the opportunity to really both participate and also be an observer to the changes that are happening around us. And I spend a fair amount of my time discussing these topics, not so much because I think it's going to help 60-year-old women, but I do think that will have significant implications for younger women and younger men who are really looking at some of these topics for the first time.

  Nandita Bajaj (03:23):

  Yes, I agree with you. I wonder if you could start by sharing a bit about your upbringing, where you grew up. What was the landscape like in terms of the pronatalism and the gendered expectations around what you would do in life?

  Pamela (03:42):

  So I was born in Detroit, Michigan, and Detroit and the Detroit suburbs are fairly conventional in the way that organized young people's lives. It was the kind of prototypical being a part of a nuclear family. And what I discovered as I got older is that the expectations for young people were evolving. However, at the same time I was raised in a very Catholic household. And accordingly, there's a very strong set of messages around the importance of procreation and having a family and being complete and being a good Catholic. And as a child, you're pretty much just taking it in. You don't have necessarily the critical thinking skills to say, huh, I wonder if they're really thinking about all the implications of what it means to put people into a family situation before they may be ready for it. And as I got a little bit older, I realized economically it was very expensive to have a family, and I also had ambitions to develop my own career.

  (04:53):

  And so it became very early on a tug of war between the expectations that were put on me to get married young and have children and my own interests in broadening my horizons a bit. And I wanted to be good at both. I wanted to be able to be a good participant as a family member, a caregiver, but I also knew that in order to do that I needed to be full and complete and I had strong interests in developing other talents as well. So that was the kind of jumbled up world in which I grew up. And I came of age in the eighties and nineties and really realized that it was next to impossible to do both well. And I started to really question where the real needs were and what would fulfill me personally.

  Nandita Bajaj (05:44):

  And what turning points were happening around that coming of age time where you started to realize that it was difficult to manifest both those realities?

  Pamela (05:55):

  Well, on the one hand, the idea of being able to have a household to keep yourself fed and clothed, you needed two incomes if you were going to consider raising children. I worked in the auto industry, a very male-dominated industry at the time, still fairly much so today, and the industry had no interest in having progressive policies like family leave. That didn't exist. So if you were going to have a child, the expectation was you were either going to leave the workforce or it was going to be very expensive and you'd have to make very significant compromises and potentially at the disadvantage of a child you might be bringing into the world. And I've really felt strongly that I could not bring a child into the world unless I could provide a stable good environment. So that pressure to create that environment and at the same time understand biologically what was coming my way, how to reconcile all that, it was like living in a pressure cooker.

  Nandita Bajaj (06:58):

  For sure. And at that point, you knew that you were definitely wanting to have children and you were trying to figure out how you would manage the two worlds. And then I know you've shared that you did start to try and have children in your late twenties. Can you share the process of finally deciding to go down that road knowing, well, the concessions that were involved with creating a family and still having a career?

  Pamela (07:35):

  Yeah, it was difficult first and foremost to really confront the fact that just because you decide you're interested in doing something biologically, that your biology is going to cooperate. So that was a real gut punch to realize that we may not be able to do it on our own without some clinical intervention. So the very difficult early days were just learning about what are the steps and what different kinds of interventions might be required. In my case, both my husband and I both had biological inhibitors, so it complicated the matter a little more. And the unexplained infertility category is growing. There are a lot of environmental influences that can inhibit reproduction. So apart from all that, it was learning, drinking from a fire hose about all the different things that can go wrong and why pregnancies don't occur. But at the same time, I realized that as we got further into the medical discussions, that there was a real push on the part of the clinics to get us to sign up for a really large expensive treatment regimen without necessarily having demonstrated with evidence that the treatments would be appropriate for our particular condition.

  (08:51):

  So I think the real light bulb went on at one point that we've gone through quite a few tests and diagnostics, we've spent a lot of money and we're no further along in terms of understanding why we're not being successful. At the same time, when you walk into a clinic, you are surrounded by images of babies. There is this almost really other worldly kind of creepy sensation that if you stick with this clinic long enough that they will magically create some new life. But it's almost like inhabiting a world in sci-fi. So trying to understand where you fit amid this created environment that does not reflect the reality of what's going on with your body even makes you feel like more of a failure. So it's a very strange phenomenon to be in the middle of.

  Nandita Bajaj (09:44):

  You just said it makes you feel like more of a failure. Let's get into the emotional experience of that time when you first both realized that biologically reproducing children is not a possibility naturally and before you began going into these treatments.

  Pamela (10:06):

  It is a traumatic experience to find out that your body cannot do something. It's really important for the bigger public to understand that these are not simple issues, that these are very personal, they're spiritual, they're really complex, and these decisions are not easy ones for a lot of people. However, it's painted as a one dimensional, it's painted as a binary. You can't have children, we can fix you. And that notion of being fixed or cured somehow then puts the patient in the position of having to decide when enough is enough. And that in and of itself becomes both an intellectual and an emotionally charged decision. Now later on the third dimension, which is the cultural component, when you are going through that experience, there is this expectation that if you're a young married couple that you're having discussions about starting a family and you get often asked questions about when you're going to get started and why don't you have kids?

  (11:16):

  Or if they're meeting you for the first time, the expectation is you have them. How many do you have? So you're going through all this medical intervention behind the scenes, which most people keep quiet, but you're having to answer with a happy face to everyone around you like nothing's going on. So culturally, the pronatal pressure in the midst of trying to reconcile that perhaps you will never have children raises the ante. And so it was for us personally, a remarkably difficult time, both in terms of our own personal identity, in terms of our relationships, and in terms of what the world around us, the people we worked with, the people who came into our lives socially in the neighborhood or out meeting friends at holiday parties. Those kinds of expectations feel very crushing.

  Nandita Bajaj (12:12):

  Clearly, and I appreciate so much the layers of complexity that you've shared and there's the inward pain and then there's the outward awkwardness when you are experiencing something that you don't necessarily want to share with the world.

  Pamela (12:28):

  Well, and I would add that that is one of the reasons why the title of the book that I wrote about our experience is Silent Sorority. If there's a universal, and this extends literally across the globe, I've talked to women in just about every continent who have themselves been of different religious upbringings who have been part of different cultural expectations. It doesn't matter if you're in a western or an eastern country, if you're northern latitude, southern latitude, every person who goes through this diagnosis understands that they are in this gray zone of not necessarily fulfilling an expectation that the society puts on them or that they themselves had grown up believing that was going to be their inevitability. And so if I can, I would just say that this particular experience is a universal one for those who have had to walk through the doors of a doctor's office and found out that something didn't quite work right.

  (13:34):

  And I think the real criminal aspect of this is that a lot of these services are sold when people are at their most emotionally vulnerable, and it's being now amplified further by social policy that is very much pronatal. And so if you are not in a position to be able to explain this to people because your own world is sort of falling apart around you, then the people who control the narratives are the people who are the pronatalists and not the people who are saying, hold on. If I am unsuccessful and my life is as a childless man or woman, how will that affect childless men and women in a much larger way? And I think that for me personally, I did not feel like I could remain silent. I felt that I never would've wanted to wish that experience on anybody, and that if we did not start discussing these issues in a more multidimensional way, that there would just be generation upon generation that gets ignored, marginalized, and ultimately very much preyed upon.

  Nandita Bajaj (14:51):

  Well said. And what you just said about when the diagnosis is first received by women and men of infertility, the experience is often that of shame, sadness, failure, et cetera. And in the absence of all of these technologies, I would like to understand to what degree people then have the opportunity to explore the different life paths versus being left with the feeling of unending indefinite failure?

  Pamela (15:24):

  Yeah, it's interesting. I did a bunch of research not long ago. I went into the New York Times archives and started searching for life pre-IVF. And what was it that the expectation was for individuals who were unable to have children? And what I discovered was that there was a social compact, an understanding that if people did not have children, meaning you would show up at a neighborhood gathering or you'd be on a holiday of some kind, if people did not discuss their own children, you never asked them, do you have children? Because there was an understanding pre-IVF that not everybody could for reasons nobody understood. If you look over the millennia of human existence, 10% of the population at any given time in civilization has not been able to have children. And if you look even in biblical recordings, you hear about people who could not have children.

  (16:31):

  So this is not a new phenomenon. And what I really, truly understood in my own experience is that as the information started coming in about the fact that we might not be able to be successfully pregnant and conceive and deliver a child, we took steps along the way to imagine our lives without children in the midst of actually pursuing treatment. And so as we started to look at the options around us in terms of how our lives might unfold, what I discovered was that we had even within ourselves accepted that children would not be a part of our day-to-day reality. Yet people kept pressuring us indirectly and directly about when we were going to become parents. And I think that part of it was the unexpected continued pressure, even though we had already made the decision that we could very comfortably feel fulfilled as individuals and as a couple without children, that people were projecting deficiencies on us because we didn't parent.

  (17:51):

  And that is when the pronatalist concepts really took on a different dimension because while it was difficult personally to accept that that was a life change that would not come our way and we had to reconcile it personally, it didn't end there. It did not end there. We are bombarded. If you drive down a highway, there are billboards telling you that they can make your dreams come true and deliver you the family you always wanted. Wherever we go these days, people now ask us whether we're grandparents. And so it's a very strange feeling to have literally experienced a life trauma, resolved that trauma, but that society wasn't going to let it go. So we're re-traumatized every time we walk into a new social situation.

  Nandita Bajaj (18:48):

  Yeah, I totally understand that. And I like how you are contrasting the pre-IVF days to the post-IVF. I wonder to what degree the very fact that the treatments are available, people somehow feel that it's their right to ask you.

  Pamela (19:03):

  It's a very nefarious kind of thing because I mean, I try to just flip things on its head. And so it would be the equivalent of walking into a room full of people and interrogating them about why did they have children and why did you have so many? It's just those are very personal conversations and it really strikes me that there is a commercial aspect to this. I'll tell you an anecdote which really stuck with me years ago. I was just completing treatment, had made up our minds we were done, we were not going to pursue them any further. And I was on a plane and there was a young woman sitting on the aisle seat. And across the way, somebody asked because she had a huge medical textbook in front of her, and the person said, oh, you must be in med school. And the young person said, yeah, I am.

  (19:53):

  And she said, are you going after a particular branch of medicine? And the young woman said, things are just so expensive and med school is so crazy that I think if I'm going to really make a return out of my investment here and be able to make a really good living as a doctor, I'm looking at either plastic surgery or fertility medicine. And my first thought was, you should not be in the medical establishment if your entire reason for pursuing medicine is to make money. But that is quite honestly, if you look at the industry at large, the clinics are owned by mega investors and there are actually in Australia for-profit. They trade their shares on the Australian Stock Exchange, IVF clinics. So this is very much an industry that has operated with impunity and has never really fully demonstrated that it is evidence-based medicine that's being sold to individuals.

  Nandita Bajaj (20:53):

  And you've written so much about that and so much of that interrogation for you came from your own personal experience of the interventions not being successful the way they had been promised. I wonder if you could speak to the realization that you had and after how many treatments did you and your partner decide that enough was enough?

  Pamela (21:16):

  We pursued trying to create a family for almost a decade. And when it became very evident that we had spent tens of thousands of dollars, I think at last count it was closer to $60,000 and it was all out of pocket because the way it's set up when you agree to work with a clinic, you pay upfront, there is no guarantee. Now some clinics are coming up with gimmicks, but let me just make it clear, they would not offer those gimmicks if there was not a profit motive. And ultimately when we stepped away, we realized that we could not only spend our time in ways that were much more personally fulfilling, but that the trade-off of being in a situation where you were putting everything you had and then some into an outcome that was not going to happen was in our case, almost the definition of insanity.

  (22:16):

  And so for our own mental health as well as our emotional and financial health, we decided that we were going to extract ourselves from the industries that had brought us to continue to come back for more. And I've heard other women and men who have been in the IVF world who were patients say that they felt like they were addicts, that there was just enough hope with each new treatment, and they're coming up with more all the time, that if they just tried this particular diagnostic and this particular therapy, that there may be an opportunity for a different outcome. And it's that very narrow possibility that keeps people inside. And as I've described many times over, there is no exit ramp. You have to decide yourself that it is more destructive to keep pursuing it than it is in any way going to bring something worthwhile into your world. And so reconciling the emotional, the physical, and also the cultural, you understand when you are taking yourself out of that experience that you will face prejudice for the rest of your life. So you are electing to put yourself in a situation where people are going to judge you.

  Nandita Bajaj (23:46):

  Right. And the fact that there's no exit ramp, that's obviously a very for-profit business strategy, isn't it?

  Pamela (23:54):

  There's a reason why there are programs and regulations for certain products and services that are considered destructive. There are ads when you buy a cigarette that it is an addictive substance. There are actual opportunities for external regulation to ensure that consumers are not being taken advantage of. Those consumer protections do not exist in this industry.

  Nandita Bajaj (24:23):

  And can you speak to whatever degree you feel comfortable, the emotional, psychological and physical repercussions that you went through for almost a decade undergoing these fertility treatments before you decided to stop?

  Pamela (24:37):

  Yeah, I mean, I suddenly realized the best way to describe it is that you're in this echo chamber and at some point you realize that there might be another way. And so exploring other alternatives and other pathways became sort of my relief valve, if you will. So I remember talking to women who I knew had made the decision not to have children. They were older than I was, and I knew that I needed a role model of some kind. And so asking them what their life was like looking ahead for me. And at the time I was approaching 40 and I was talking to women in their fifties, how has your life evolved? And tell me what brings meaning and a real sense of personal fulfillment. And what I discovered was this huge other dimension of being a fully formed adult that had not been in my day-to-day while I was coming of age and that certainly is not well-represented in the media. And so it really struck me that my reality and the people that I was meeting that were not parents was a very different perception than what culture was kind of indoctrinating - motherhood, fatherhood, parenthood, good. People without children suspect. People without children, not necessarily what you would describe as good role models. And I think part of me just got really fiercely angry about the fact that I had to now justify to other people that my entire reason for being still had meaning. And I threw myself into advocacy roles. So a lot of the work that I did early on with Silent Sorority and with Reprotech Truths, which captured stories of people who had been injured and emotionally compromised by a for-profit fertility industry, became a real driving force in my life. I also have two nieces and two nephews, and the idea that they would have to go through what we went through just was unthinkable to me.

  (27:09):

  And I wanted them to have role models that said, your life can be very fulfilling without parenthood. And lastly, what I realized was there are other implications about having lots of children, and part of that is a resource demand. And so as the planet becomes more burdened, it does make more sense to me to have people consciously consider, if you are going to bring new life into the world, are you prepared for what the impacts will be? So I work very much with a set of environmental groups who are working very hard to bring issues around environmental damage and what humans are doing to bring that about. And I feel that my role here on this planet at this point in time is to be a truth teller to help bring information to the next generation. And that to me is very fulfilling.

  Nandita Bajaj (28:09):

  I think that is just such an inspirational message and inspirational story of how something so painful can be turned around into something quite meaningful and out of your own volition. And so you mentioned a few things, that you've written this book, Silent Sorority, and you've talked about the Reprotech Truths. If you can share a bit more about the work that you've done there and what kind of feedback you've received from people who I'm sure have felt liberated from finding a resource like that.

  Pamela (28:44):

  It has been probably one of the most surprising aspects of this whole experience. I remember back in the early two thousands going online and being a part of a new community and they were community boards and then they became blogs and a number of different ways for groups to interact that went far and above today's traditional social media. And in fact, I have to say that just as an aside, I find social media like Facebook and Instagram and others really diminishing the conversation rather than enlarging it. The beauty at the time that I started blogging was people actually wrote really remarkably complex and really insightful long pieces about where they were relative to their own expectation and their social and cultural challenges. And so as women started coming forward mostly under pseudonym, it became very clear that there was a pattern of expectation outside of the United States where I live and that we could learn from each other in terms of how they had moved forward in their own respective societies.

  (30:03):

  There was a point in time when there was a real movement inside of Canada, there was a movement inside of South Africa, a huge movement inside of the UK, and I could go on. I think the most really startling and to me heartwarming responses was from a woman in Slovenia who learned English to participate in the discussions that other women had because the English language was the predominant one. And I had a chance to meet her in person about eight years after we had become blog pen pals. And to meet these people in person, which I've had the good fortune to do in a number of countries, has been so rewarding. And in fact, I was in New Zealand last month and I met a woman that I'd been writing to for 15 years for the first time, and we felt like we knew each other. And she said, it's because we've met each other from the inside out. And that really struck me. And so I do think that there is capacity for these stories to come into a more broader audience, but there has to be an appetite for it. I have a number of very supportive friends who went on to have children, and they want their children to know about my story because they recognize their children may not be able to have children.

  Nandita Bajaj (31:25):

  Oh, I love those stories. They are so powerful. I feel our policies, our rhetoric, our feminist advocacy is regressing in some ways because the pronatalist messaging and the reactionary rise in it, it's even stronger when we see things like egg freezing and IVF being touted as some kind of a feminist solution when we're taking leading edge technology and applying it to a very patriarchal context, a context that has been kept alive to keep women tied to their reproductive capacities. So in fact, the ideology of tism, not so much the act of procreation, which can be a feminist thing or not, it's the ideology of pronatalism that is preventing a lot of young people from actually recognizing that there are multiple pathways. And egg freezing right now seems to be like the coolest thing to do, this futuristic thing that you can decide if you want to or if you don't want to later, but at least you can have an insurance policy because most of you will want to, right, without giving people an opportunity to actually explore deeply the questions.

  Pamela (32:46):

  This may sound a bit extreme, but it is a weird form of enslavement because if you think about it, if you're a young person and you have eggs frozen, you then have an obligation somewhere down the line to use those eggs, which requires a full blown IVF protocol. And at the same time, there are women in their fifties and even their sixties now who are being sold eggs from younger women so that they can fulfill a long held fantasy of having a child. And it was something I just never considered because I didn't want to potentially harm another woman who had to go through an egg harvest to give me an egg that may or may not fully fertilize and go on to a full-blown pregnancy. So what I mean by enslavement is you have all of these procedures that are being sold with this expectation that they are somehow then going to be acted on.

  (33:52):

  And so young women are being actively recruited, and you can look at it online, if you look in a campus newspaper and look up donor eggs or egg donation clinics, they call it donation, but they're paying the women for those eggs. And there are stories of individuals who've gone through multiple rounds of egg harvesting, and younger women tend to produce more eggs during IVF than older women do. So some women have up to 15 or 20 eggs extracted at a time which damages their own fallopian tubes and potentially renders them infertile down the line when they might themselves want to have a family. So these procedures that are being actively marketed are really damaging for young women and also very usurious and predatory for older women because they're being sold, again, a promise. But the complexity of a full-blown pregnancy is not something that can easily be guaranteed.

  (35:02):

  And I just find the whole topic of this push toward creating more life, this pronatalist agenda is damaging to young women because it is sending messages that you are somehow incomplete unless you are part of this reproductive world and ultimately generate a child. It takes away any kind of personal spiritual sensation of your own personal decision-making, and you've got this pressure from outside. And frankly, policies, there are now discussions around tax deductions for the number of children. There are new ways to reward people who have children in ways that discriminate against people who don't have children. So it's a remarkably complicated topic, and sometimes we're not even aware of how completely all-encompassing these messages are until we've had a chance to step back and ask who benefits from this.

  Nandita Bajaj (36:09):

  And speaking of who benefits from this, I know you've got some great statistics in your research about the explosion of the fertility industry. Could you share a few of those stats on the multi-billion dollar industry that it has become?

  Pamela (36:26):

  It really started in the early 1980s, and at the time all fertility clinics existed as an offshoot of a research hospital. And it wasn't until the nineties that clinics were allowed to be standalone. And there were efforts early on in the late eighties, early nineties to take a look at whether or not there were adequate regulation and consumer protections in place. And as a result of the scrutiny from the regulatory bodies and the people who make laws in Congress here in the US, the industry around the clinics decided that their best alternative to keep regulation out was to self-regulate. So they created a professional society that allowed clinics to participate voluntarily and that they would report out statistics about their outcomes, but they set the parameters. So if there was a pregnancy but there was not a delivery, they would present their data as a success.

  (37:40):

  So they cherry-pick their customers, they would take younger people who had a higher propensity for being able to handle an IVF round. And then ultimately this self-policing allowed for the explosion in the number of clinics. So the industry went from being in the hundreds of millions to today, at last count, it was over $30 billion. And this is a global industry that's continuing to add new product lines. So they will offer any number of services in order to keep people in the treatment regimen, if you will. And so it's just from the point of view of overall growth, there is no limit. And as I said, there is not even an age limit. So people are visiting clinics from a very young age to donate eggs all the way up to their fifties if they want to pursue donor eggs. That's a huge growth market. And because of the pressure and the external validation that mothers, fathers and parents get, there is this drive for a number of people who may not have necessarily thought about whether they wanted children who are participating in pursuit of a family because there are other social advantages to having children.

  Nandita Bajaj (39:06):

  I like that you used the word enslavement, because it is taking a life and completely commodifying it. Not only the woman's body, which has been commodified for millennia, but now the embryos and the eggs, all the parts of the woman are now being separated and dismembered in a way and just given their own identities. And then the staggering number of fertility clinics that you've said have exploded and how it's become this multi-billion dollar industry. That's something we never ever hear about in daily news.

  Pamela (39:43):

  We don't, and this is a very, very rare point of view, but there was a really compelling opinion piece that was carried in The Guardian, and it was the point of view of an individual who was conceived with IVF and the individual said that they themselves have always felt like a commodity, that when they realized how much money that their parents spent on creating them, that the pressure on that individual to feel like they had to be worth it. And this very unusual understanding about those who are conceived using these technologies, some of whom don't know who their biological mother or father is. This is now becoming a human rights discussion. It is not something we hear about in the United States, but in the UK and in Western Europe. They're now having discussions with individuals who are conceived via IVF, who feel that their human rights were not necessarily first and foremost, and that they themselves feel damaged as a result of the way they were conceived.

  (41:00):

  And this is again, the first time we're hearing about this because if you think that IVF really took off in the mid to late nineties and then accelerated into the early two thousands, those individuals who were created using donor eggs, donor sperm, donor embryos sometimes and others who were conceived with parents via IVF, they're just coming of age. They're 21, 22, 25, 30, and some of this is just dawning on them. And there are very few longitudinal studies that have been done. What little I can share with you is that there have been scientific studies on the culture, the medium that is used when an egg and sperm are created and an embryo results, and the metabolic changes that occur as a result of the embryo culturing are just now starting to have early indications that some of the individuals created via IVF have metabolic issues that are just now being recorded in primary care discussions. They're either pre-diabetic or they have other congenital issues that are traced back to the IVF labs. Now, the clinics don't want anyone to hear about it because nobody wants to know that they are actively potentially creating a child with some kind of health issue, but these longitudinal studies don't exist because nobody has ever asked the clinics to perform them.

  Nandita Bajaj (42:38):

  I had never heard of that perspective. It brings up so many other connections for me, connections like surrogacy where other women's bodies are used to produce children for other people or like you've talked about, egg donation, et cetera, and we never really think about the child in the case of these kinds of transactions. And Pamela, this is one of the most underrepresented discussions happening, I find even within discussions about feminism and reproductive justice. The fertility industry is still touted as providing the right to conceive to those who cannot conceive, but in a blind kind of a way without the critical analysis that you've done about the motivations, the for-profit nature of this industry. I just feel like that conversation is so deeply missing in some of the international agencies doing work in sexual and reproductive health and rights. And I am hoping just because our platform is working at the intersection of environment and reproductive rights, that conversation like ours would reach those bodies. So before I wrap things up today, Pamela, I know you spoke briefly about arriving at a point in your life where you have found fulfillment. I would love for you to share a bit more about what that looks like today.

  Pamela (44:09):

  Life is very busy. In fact, this morning I was on a community call. We are facing some new legislation in the state of Nevada where I live in the Sierra Nevada mountains. And particularly, there are a lot of challenges right now relative to demand on resources here in Lake Tahoe and whether or not the actual environment can sustain it. So there are a number of legislative discussions being had at the state level. We've been working also nationally to try to bring more attention to what's happening in areas that have been over- visited that are actually facing a lot of environmental and really significant damage. So I would say that that brings me a sense of real remarkable intellectual engagement because these issues do transcend from how to be a better visitor when you go to other places, to how to be a caretaker in your own community.

  (45:09):

  So that is certainly taking up a lot of my mindshare at the moment. But at the same time, there is a very full sense of activity, both personally, both intellectually. And then as I said earlier today, there's still a very active group of women who got to know each other through our own experiences and having to come to a new understanding of who we are and how we exist in this society that doesn't always see us. So the women that exist both here, online, and in real life, we spend a lot of time together as well.

  Nandita Bajaj (45:43):

  That sounds very beautiful and a very meaningful way to spend your time. Thank you so much for the incredible work that you've been doing for decades and taking all of the personal trauma and the emotional upheaval that you went through and transforming it into something so liberatory for so many people and giving them permission to form their own identities that are not set by society. And thank you so much for giving me so much of your time today and sharing your journey with me today. This was a really important and beautiful conversation.

  Pamela (46:22):

  Thank you. If I can leave you with just one last metaphor, I've always been struck by mosaics and how beautiful they are in their own way, and what I realized was mosaics are made up of a bunch of broken pieces, and I've often found that in trying to reconcile all of the various challenges every one of us face in any given day in our lives and putting them together in a new way, you can create new beauty. And that's something that I always feel very strongly about. We are flawed, and yet at the same time, we have opportunities and talents that even we ourselves can sometimes be surprised by.

  Nandita Bajaj (47:03):

  That's a remarkable statement. Thank you so much.

  Pamela (47:06):

  Thank you so much.

  Nandita Bajaj (47:08):

  That's all for today's episode. Thank you so much for listening. Check out the show notes to see how you can get in touch with me. Whether you'd like to share feedback about the show or a particular episode, or whether you'd like to join me on the show to share your own story, I'd love to hear from you. Thank you so much again for joining me today as we collectively discover and celebrate the many different pathways to fulfillment beyond pronatalism. Beyond Pronatalism is brought to you by Population Balance, the only nonprofit organization advancing ecological and reproductive justice by confronting pronatalism. This podcast is produced and hosted by me, Nandita Bajaj, with the support of my production team, Josh Wild and Alan Ware.

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