The Stigmatised “Barren Woman”: How Women and couples navigate invisible social rules on infertility

Wickramasekara’s sociological study on urbanites’ coping with infertility stigma found that, despite most men in his sample having fertility issues, blame and shame were mainly placed on women, due to patriarchal societal influences

Some women hide the fact that they seek IVF treatment from friends and family due to the societal treatment of them if it is found out they do so, hence terms like “barren women” are thrown at them, even if the issue lies with the man  

Richer couples might adopt, migrate, or freeze eggs, while Poorer couples often fake a pregnancy and return home later with a baby, pretending it’s biological

Tharani* (37) and her husband had finally opted for In Vitro Fertilisation (IVF) after experiencing multiple miscarriages. But there was still an issue: since her eggs were found to be of poor quality, causing the miscarriages, they would have to undergo the procedure using donor eggs. Another concern was that, as Tharani and her husband are considered to have pale skin tones, the egg donor would need to match their complexion. Why was this important? So that neither of their families would find out that the couple had turned to reproductive treatments to be “blessed with a child.” If the truth came out, she feared being labelled a “barren woman”.  

Although not widely discussed, in the quiet corners of coming-of-age parties, wedding functions, and mother’s blessing ceremonies, the “barren woman” is considered a bad omen. If she arrives first at such ceremonies, it is seen as inauspicious, and she is discouraged from offering blessings to the women being celebrated. In the familiar passages of her family homes, the “barren woman” is regarded as a curse and a disgrace, spoken of not just in words, but also through expressions.  

Stigma of infertility

“Fertility is a biological phenomenon, but within it lies a social construction centred on lineage. When faced with fertility barriers, people experience a dilemma about who will carry on the family line, which in turn creates a social demand,” explained Yohan Wickramasekara, Lecturer in Sociology and Theology at Aquinas College of Higher Studies. His research specifically focuses on infertility within the Sri Lankan context.  

He further noted that the social harms arising from infertility are often more severe than the biological ones. “Infertility leads to couples being excluded from society, resulting in alienation. As a result, the stress levels they experience are very high,” he added.  

In his study titled “Sociological Study on Sri Lankan Infertile Urban Men and Women Coping with Social Stigma”, Wickramasekara primarily focuses on male infertility. He found that although the majority of men in his sample had fertility issues, the blame and shame were disproportionately directed at the woman, something he attributes to the influence of a patriarchal society.  

Coping with infertility

How couples cope with being unable to conceive naturally varies depending on their economic status, Wickramasekara said.  

“Adoption is approached with uncertainty for several reasons, including the possibility that, as the child grows up, they may seek out their biological parents. Additionally, years later, the child’s biological parents might appear at the adoptive family’s doorstep,” he explained. “While those who can afford it may adopt and migrate, others who are unable to do so will temporarily relocate within the country and return pretending to have become biological parents.”  

Some couples who choose procedures such as Intrauterine Insemination (IUI) or IVF are highly secretive about undergoing such treatments. This doesn’t mean that couples should go around beating a drum and publicly announcing that they are resorting to assisted reproductive technologies. “They are secretive because being in a subfertility clinic reflects the couple’s inability to conceive through natural means, even though they wish to appear as though they’ve reached parenthood without assistance,” Wickramasekara said. “There’s a sense of hesitance and shame associated with assisted reproductive technologies because society dictates that the fulfilment of marriage vows rests on procreation. In my research, procreation is seen as achieved through natural sex, whereas reproduction is viewed as the commodification of procreation achieved through assisted reproductive technologies”.  

Stigma of IVF

The Daily Mirror also reached out to Dr. H. Ratnayake, a well-known Fertility Counsellor and Clinical Embryologist in Sri Lanka, to understand whether stigma still surrounds patients who seek IVF treatments. IVF is a form of fertility treatment in which eggs are fertilised by sperm in a laboratory, and the resulting embryo(s) are transferred to the woman’s uterus.  

“In my experience, while a few do hide the fact that they are resorting to IVF from their families, more often than not, people come with the knowledge and support of their families. Sometimes, it’s the couple’s parents who pay for the treatment. However, I have seen many women trying to hide it from their colleagues, perhaps because society treats a woman without a child who is seeking fertility treatments differently. They call them ‘barren women’ even if the issue lies with the male,” Dr. Ratnayake explained.  

Referring back to the case of Tharani, who was searching for an egg donor with a pale complexion, Dr. Ratnayake said that it is a reasonable request to ask for a donor who matches the complexion of either parent. “If the child is of a different complexion compared to the parents, society will talk, so their request is reasonable. In any case, we try to match for complexion when choosing donors because we cannot match for features. Anyway, 50% of the features will come from the father (if only an egg donor is used),” he emphasised.  

Meanwhile, Dr. M.N.M. Shafras, Clinical Director of the Jananam Indo Lanka Fertility Centre, acknowledged that many patients are reluctant to disclose their fertility treatments to family members. “Most of them think that if you can’t conceive naturally, it’s something to be ashamed of; but it’s natural to face such challenges. When couples try everything they can and still don’t conceive, family pressure sets in, especially when people keep asking, particularly mothers-in-law. Also, even though some people may be able to conceive naturally, the stress they’re under can itself cause fertility issues,” he explained.  

‘Insufficient awareness on how fertility works’

Dr. Shafras further highlighted that, in his view, the main reason many people in Sri Lanka experience fertility issues and turn to IVF is due to insufficient awareness about how fertility works. He emphasised that many women who come in seeking IVF treatment are unaware that fertility declines with age.  

“The ideal age for a woman to conceive naturally is between 25 and 35 years. After 30 years, egg numbers begin to decline. Around the age of 35 years, the decline becomes more rapid, and by the time they approach 40 years, the quality of eggs is lower. This increases the chances of miscarriage and the risk of chromosomal issues in the baby,” he explained.  

Even with IVF, success is still heavily dependent on age, Dr. Shafras stressed. “Recently, I saw a patient who was 41 years old. She had no idea that egg quality and quantity decline with age, and had postponed pregnancy for around six to seven years. When we did a scan, her ovarian reserve was very low, making natural conception unlikely. Even with IVF, the couple would have to use donor eggs, meaning the child wouldn’t be genetically hers,” he said.   

He added that fertility awareness should be part of school curricula, especially the fact that fertility declines with age.  

“People should also be educated on egg freezing. If a woman freezes her eggs when she’s around 25 years, she can still use them at 40 or 45 years, because the frozen egg retains the biological age it was at the time of freezing,” Dr. Shafras explained.  

He also pointed out that male fertility issues are real and often overlooked. “In some men, although there is seminal fluid, there are no sperm. While this may initially suggest they have no option but to use donor sperm, certain cases may be treatable through surgical sperm retrieval techniques such as TESA (Testicular Sperm Aspiration) or micro-TESE (Microsurgical Testicular Sperm Extraction), especially if sperm production is occurring inside the testes,” he said.  

Issues with using donor eggs or sperm

Dr. Shafras also addressed concerns related to using donor eggs or sperm. “IVF using donor eggs or sperm can be done even when women are at 45 years of age, but there are concerns. Many individuals might unknowingly use the same donors. This means that children born using the same donor could unknowingly share a biological parent, and there’s currently no proper tracking system to prevent this. That’s why it’s always better to use your own sperm or eggs whenever possible.”  

Another frequent concern among patients is the fear that their sperm or eggs may be mislabeled or mixed up in the lab. “This almost never happens. But understandably, the element of trust plays a huge role,” he noted.  

Screening for chromosomal issues

Preimplantation Genetic Testing (PGT) is a technique used to screen embryos created via IVF for chromosomal issues before they are transferred into the uterus. This procedure is performed only at the request of patients and is typically recommended for those over 37 years of age or those who have experienced frequent miscarriages.  

There are three types of PGT. PGT-A screens for the number of chromosomes, since an unequal division of sperm or egg cells can cause an embryo to have too few or too many chromosomes. This condition, known as aneuploidy, often leads to miscarriages and other issues in the child. PGT-M screens for known gene mutations carried by the parents, which can detect disorders such as thalassemia and cystic fibrosis. PGT-SR identifies embryos with balanced or unbalanced structural chromosome issues, helping to reduce the risk of miscarriage.  

These testing methods have been immensely helpful in preventing genetic issues in the baby and miscarriages, thus improving IVF success rates. However, concerns have been raised about issues surrounding certain factors, including the potential for sex determination during IVF.  

Selecting the gender of your IVF baby

In addition to screening for the number of chromosomes, PGT-A also reveals the gender of an embryo. Some allege that this information is misused to select only male heirs. In countries like India, gender selection through PGT is illegal due to its role in sex-selective abortions, which have led to high female feticide rates and an imbalanced sex ratio in the population.  

Does gender selection happen in Sri Lanka as well? Daily Mirror posed this question to Dr. Ratnayake. “Most people who have come to me requesting a particular gender have done so with the intention of family balancing. For instance, if they already have two or three boys, they may request a girl, or vice versa. It’s only for the sake of family balancing, which I consider a reasonable request. However, if someone is having their first child through IVF and requests a boy in particular, then that isn’t okay. This is common in India, where boys are preferred. If they find out the baby is a girl, they often resort to abortion.”  

Dr. Shafras shared a similar view: “Sex determination in Sri Lanka is mostly done for family balancing, and I don’t see anything wrong with that. In India, it’s banned due to the high rate of female feticide, but that’s not the case here. There’s still debate about whether it’s ethical or not. Also, only those who can afford IVF and PGT go for this. If someone claims that gender selection will affect population balance, that’s very unlikely.”  

He added that fertility tourism is already taking place, with patients from India coming to Sri Lanka for gender selection, which is banned in their own country. “If it gets banned here, they’ll simply go to places like Bangkok or Dubai to get it done. People who can afford it will always find a way,” he said.  

Wickramasekara also weighed in, offering a sociological perspective on gender determination in IVF: “Thus far, there is no ethical issue; but there is a definite issue with natural law. According to the law of nature, gender selection is not natural because it bypasses natural biological processes. If humanity overrides nature’s authority and administration, then nature becomes anthropocentric rather than nature-centric. Anthropocentrism may cause issues in the near future.”  

Discarding embryos

“In discarding embryos with various issues, we always take the consent of the parents. Some use these embryos for research, but again, only with consent. If the embryos are healthy but not the preferred gender, parents can choose to donate, freeze them for future use, or discard them. Discarding happens automatically when the embryo is removed from the required temperature of -196 degrees Celsius,” Dr. Ratnayake explained.  

However, there is ongoing debate about whether discarding unwanted embryos is ethically and morally justifiable. “Embryos are just a cluster of cells that cannot be seen with the naked eye. Some people believe life begins at fertilisation, others say it starts at the first heartbeat, which happens around the fifth week. A five-day-old embryo has no heartbeat and consists of only a few cells. Whether you view that as a baby or just cells depends on your perspective,” Dr. Shafras shared.  

The Daily Mirror also asked Dr. Shafras about claims that babies born through IVF face various health issues later in life. He responded, “The first IVF baby, Louise Brown, is now 47 years old and is doing well. While we cannot predict the long-term future for every child, so far there is no evidence that IVF causes health issues later in life.”   

Louise Brown, born on 25 July 1978, was the first baby born through IVF. She celebrated her 47th birthday last month. The day of her birth, 25 July, is now commemorated as World IVF Day.  

* Name changed to protect identity