Commerce, Industry, and Security: Biomedicalization Theory and the Use of Metaphor to Describe Practitioner–Patient Communication Within Fertility, Inc.

ABSTRACT

An infertility diagnosis is distressing. Supportive communication between practitioners and patients before, during, and after treatment is key to mitigating this distress. In the present study, interview questions prompted 22 cis-women who underwent fertility treatment(s) to reflect on practitioner–patient communication during treatment, and their metaphor use was analyzed in light of biomedicalization theory. Participants used metaphors to describe their health care experiences within the infertility-industrial complex known as Fertility, Inc. Findings suggest that metaphor use allowed patients both to participate in and to critique Fertility, Inc.—specifically, their individual communicative experiences with medical practitioners. Recommendations for communication between practitioners and patients and suggestions for future research are discussed.

KEYWORDS:

• biomedicalization theory
• metaphors
• infertility
• practitioner–patient communication
• women
• Fertility, Inc

Acknowledgments

We thank the editor and the two anonymous reviewers for their detailed feedback on several rounds of revisions, and Dr. Heather Carmack for her insights along the way. We are indebted to our participants for sharing their stories with us.

Funding

A University of North Carolina at Charlotte Faculty Research Grant and a grant from the Organization for Research on Women and Communication allowed us to complete the research for this article.

Notes

1. We use the term (in)fertility treatments throughout the article to reflect a lack of consensus among scholars, medical practitioners, and patients as to the correct terminology for treatment. For example, some physicians may refer to “fertility treatments” for an “infertile diagnosis,” whereas some patients never self-identify as “infertile” or are never given a formal diagnosis and thus refer to “fertility treatments.” For the purposes of our research, “(in)fertility treatment” captures the range of conceptualizations.

2. The heteronormative conception of cis-women and 12 months of unprotected sex (Chandra, Copen, & Stephen 2014). The authors stated: “Infertility is defined only for married or cohabiting women and indicates that they have been exposed to the risk of pregnancy with the same husband or partner for at least 12 consecutive months, but have not had a pregnancy” (Chandra, Copen, & Stephen, 2014, p. 19). As such, “infertility” as defined in their study would not address the conception issues faced by members of the LGBTQ community. However, the term impaired fecundity may be a more inclusive term. Chandra, Copen, and Stephen (2014) defined “impaired fecundity” as “comprised of the following three subgroups: nonsurgically sterile, subfecund, and long interval without conception” (p. 19). It is unclear if “subfecund” may be used to describe the particular situation of queer couples who simply need a gamete for conception but do not have a particular fertility diagnosis.

3. For more information, see http://www.resolve.org/?referrer=https://www.google.com/.

4. Johnson has an infertility diagnosis, Quinlan is fertile, and Myers does not have a child and is uncertain of fertility status (Johnson & Quinlan, 2016).

5. Perhaps this is where our findings deviate from Sontag's (1989) conclusions on metaphor. She argued that metaphor can stigmatize and disempower patients, in particular military metaphor, which she said “overmobilizes, overdescribes … [and] powerfully contributes to the excommunicating and stigmatizing of the ill” (p. 182). We agree—metaphors have the potential to disempower the ill, though Sontag (1989) studied metaphors generated by the medical field and the media, whereas our study examined metaphors describing practitioner–patient communication. Moreover, many patients do not perceive infertility as an illness (Sandelowski, 1993a), particularly a chronic, long-term, and potentially deadly illness such as HIV/AIDS, which is the focus of Sontag's (1989) work. Finally, we argue that biomedicalization theory allows for metaphor use that both constrains and empowers patients. Even as patients are forced to contend with the inequities of Fertility, Inc., individuals are empowered to make choices regarding specific treatments and providers—in short, to “shop around.”

6. For example, Laurel Fertility Care, which promises “concierge service.” For more information, see http://laurelfertility.com/concierge-service/.