I immediately recognized Paul Giamatti’s expression. He opens his mouth slightly, blinks twice slowly, looks down, and lets out a quiet sigh of bemused resignation. Then the camera pulls back and there he is, in a windowless white room, in a white recliner, with his white legs bare and his pants around his ankles. Next to him, on a white end table, sit a stack of magazines, a bottle of hand sanitizer, and a plastic cup. The wall-mounted television in front of him is playing hardcore pornography.
After presumably producing a semen specimen, he accidentally knocks the batteries out of the remote as he tries to turn off the blaring video. Foiled by the damn clicker, he stands up to manually shut off the TV. While attempting to do that, the crinkly protective paper covering his chair sticks to his ass.
The short scene, which unfolds within the first five minutes of writer-director Tamara Jenkins’s Private Life, is one of many in the Netflix movie, released Friday, that sharply portrays the surreality of undergoing fertility treatment. It’s ironic: Richard, Giamatti’s character, is stuck in a profoundly sterile space, making something necessary to fertilize his wife’s eggs.
To Jenkins, imagining the act of supplying a clinic with porn is hilarious. “Somebody bought that and put it there!” she told me. “There’s drawers full of magazines. It’s like, ‘Oh yeah, it’s for medical purposes.’ It’s very weird.”
I had similar thoughts this summer as I walked into a downtown D.C. office located not far from George Washington University, where my wife and I met and first started not getting pregnant. After I filled out a form—on which I had to note how long I’d abstained from ejaculation—a nurse handed me a sealed cup and directed me to a bathroom. On one wall hung a sexy portrait of Marilyn Monroe that I think was supposed to put me in the mood. There was no flat-screen to be found, only a plastic rack filled with issues of Penthouse. So, like my 13-year-old self, that’s what I used. I never expected that nostalgia would be part of the experience, but I was happy to be supporting an ailing print publication.
When I was done, I brought my sample around the corner to the lab for analysis. Then I walked out into the August heat and released a few pent-up giggles. I didn’t have crinkly paper stuck to my ass, but what had just transpired left me feeling like there was nothing I could do but laugh.
For millennia, the world has been trying to make sense of infertility. Ancient Greeks reckoned with the struggle to reproduce. The Bible finds meaning in it. By the middle of the 20th century, Edward Albee’s “Who’s Afraid of Virginia Woolf?” introduced America to a couple whose marriage-disturbing inability to conceive leads them to create an imaginary son. More recently, Raising Arizona (1987) and Baby Mama (2008) centered on protagonists grappling with their own infertility. Hell, the tear-jerking opening montage of Up (2009) features a husband and a wife learning that they can’t have children. And on the recently premiered season of This Is Us, Kate is gearing up for fertility treatment.
These days, there’s also no shortage of easily digestible educational material on the sensitive subject, including journalism both short (e.g. Motherlode of The New York Times), and longform (may I suggest this GQ article on the global drop in sperm counts), and documentaries (Netflix’s One More Shot is an excellent look at one couple’s quest to have a baby).
But even 40 years after the advent of in vitro fertilization, most depictions of modern fertility treatment don’t actually show what going through it is like. As a result, the emotional and physical effects of the process are left unseen. Jenkins wanted to tell a deeper kind of story, one that buries itself under your skin like a subcutaneous hormone injection. Private Life isn’t about infertility. It’s about how infertility affects a single relationship.
“It’s not an issue movie,” said Kathryn Hahn, who costars as writer Rachel, the wife of Richard, a New York City theater director–pickle merchant. “It’s about this marriage. And then the issue comes second.”
With the same brutally funny specificity that lights up her first two films, Slums of Beverly Hills (1998) and The Savages (2007), Jenkins plunges into the lives of two people consumed by their desire to have a child. Hahn loved the script so much that right after reading it she began worrying about losing out on the role. “My heart was in my throat,” she said. “I was laughing and also wanting to burst into hysterical tears, which is my favorite pocket to be in as a viewer and a performer.”
The 56-year-old Jenkins has said that she and her husband, who have an 8-year-old daughter, went on a version of Rachel and Richard’s journey. Everyone’s experience is different, but if there’s an aspect of the pursuit of fertility treatment that at least approaches universality, it’s this: “It hijacks your fucking life,” Jenkins said.
In her film, that omnipresence quickly becomes clear. The opening 20 minutes dive headfirst into an IVF cycle, beginning with Richard forcefully jamming a trigger shot into Rachel’s butt cheek. Then there’s the retrieval, during which a doctor extracts her eggs and prepares them to be fertilized. But we learn that Richard’s semen contains no sperm. That’s when the acronyms start flying. Richard needs testicular sperm extraction (TESE). Next, via intracytoplasmic sperm injection (ICSI), his sperm is inserted into eggs to form embryos. Later, on the day of the transfer, embryos are placed inside Rachel’s uterus.
The intricate, terminology-loaded early section of the movie is realistically bewildering. Jenkins said that it “puts you in the seat of the characters, and they’re as clueless about it as the audience is.”
My wife and I identified with this for a variety of reasons, not the least of which being that she shares a Biblically symbolic first name with Hahn’s character. Like millions of Americans across all races and socioeconomic backgrounds, Rachel and I have had trouble conceiving. Approximately 12 percent of women struggle to get pregnant or carry a pregnancy to term. And despite the perception that infertility is a single-sex issue, it’s attributed to male and female factors at about the same rate.
In Private Life, Jenkins made sure that Rachel and Richard were on equal footing. “They’re in it together, in that they both have faulty parts,” she said. “They’re on equal turf. I was interested in that. That it wasn’t just ‘your old eggs.’”
Unlike the 40-something couple in the movie, Rachel and I were 30 and 31, respectively, in 2014, when we started trying to have a child. Theoretically, our chances were good. But after more than a year without any positive results, we were frustrated. At home, the two of us recited the cliché about “spending your whole life trying to avoid getting pregnant” over and over. We also were more than a little envious. Photos of our college friends’ kids were popping up on social media. In the summer of 2015, my younger brother and sister-and-law’s daughter was born. Later that year, Rachel and I prepared for the possibility of fertility treatment.
My first semen analysis—I was permitted to collect a sample at home before shuttling it like a pizza delivery man to the clinic in an hour or less—came back normal. After Rachel got some blood tests done, her gynecologist prescribed her Clomid, an inexpensive medication used to stimulate ovulation. For a short stretch every month, she took several pills a day. During that time we were instructed to have lots of sex. Following an intercourse schedule was even more unromantic than it sounds. Adding to the fun: Our newly adopted yellow lab liked to be in the same room with us at all times.
At any rate, the medicine didn’t seem to help. Aside from a call from the doctor saying that Rachel’s monitored hormone levels indicated that she might be pregnant—she wasn’t—we didn’t get many hopeful signs. After a handful of Clomid cycles, cognitive dissonance set in. Is all of this crushing disappointment worth it? Do we really want a kid?
Two days after the 2016 presidential election, my brother phoned to gently let me know that his wife was pregnant again. We both openly wondered what it would be like to bring another child into this fucked-up world. I was reminded of that conversation while watching Private Life.
Before the egg retrieval, Rachel mentions a friend who called having a baby “an immoral act.” “Overpopulation, climate change, the rise of neo-fascism ...” she says, before Richard asks whether she’s taken her Valium.
As a topic of conversation, infertility is bizarre. It’s not like chatting about work or sports or the latest bingeable streaming show. The weight of the subject makes small talk about it nearly impossible.
When a friend offers Rachel a glass of wine during a party scene, she turns it down, sheepishly saying that she’s “cycling.” The woman, understandably not thinking anything of it, follows up by saying that her sister also goes to SoulCycle.
“I’m almost testing it out for myself,” Hahn said. “What does it feel like to say, ‘I’m cycling’? What does it feel like to say ‘IVF’ out loud? What kind of reaction do I want from her? What’s gonna feel good? Nothing.”
It’s a dilemma that my wife and I face. Though people’s responses to finding out about our infertility are always well-meaning, there’s no satisfying way to chat about the subject.
Sometimes friends suggest relaxation. “The research supports that stress does not cause infertility,” said Julie Bindeman, a D.C. area psychologist who specializes in reproductive challenges. “But the research overwhelmingly supports that infertility causes stress.”
A common refrain that we hear is, “I know people who have gone through it.” Another is, “Someone in my moms group did IVF.” That kind of encouragement should soothe us. Instead it just reminds us of how far we have to go.
After mistaking fertility treatment for spin class, Rachel’s pal apologizes and then papers over the gaffe by suggesting that she talk to her cousin, who “got pregnant twice, in her 40s, with just one ovary.”
Eye-roll-inducing comments like that are just one reason talking about infertility causes anxiety. Another is the often prohibitive cost of treatment. It’s grotesquely expensive. Over the course of Private Life, Richard borrows tens of thousands of dollars from his brother, Charlie, who’s played with goofy charm by John Carroll Lynch. Charlie’s wife, Cynthia, a role that Molly Shannon inhabits with the perfect amount of comedic incredulity, disapproves, calling her in-laws “fertility junkies.”
When you’re dealing with infertility, it’s hard not to feel like you’re at the mercy of a malevolent force. But Rachel and I are lucky. We live in Maryland, one of 15 states that require insurers to cover at least a portion of infertility care. Thankfully, the private school where Rachel works as a prekindergarten teacher offers a plan that pays for the majority of our treatment. To us, that’s more than essential. It’s miraculous.
We were referred to a large suburban D.C. fertility center in 2017, about three years after first trying to conceive. The cheerful doctor we met with there ordered lab work. The results were mixed. Rachel, tests showed, had a diminished ovarian reserve. In her case, this meant that the quantity of her eggs was lower than normal for a woman her age. Still, the doctor assured us that we had options. He recommended a procedure that of course has a name lengthy enough to necessitate an acronym: intrauterine insemination (IUI). This entailed directly placing my sperm in Rachel’s uterus in an attempt to fertilize an egg. (Confused? It’s the turkey-baster method.) Rachel took hormones orally. In December, a few days prior to the IUI and then the night before it, she injected hormones into her belly. She felt most comfortable doing this step without my help; I was more anxious about the shots than she was.
The actual IUI took only a few minutes. When the doctor left the exam room, Rachel and I jokingly fist-bumped. It felt like we’d achieved something. We even succeeded in relaxing over the holidays. And then in January, she went in for a pregnancy test. It was negative. Rachel said that she felt defeated. This shouldn’t have been surprising. We’d been told that the procedure had about a 12 percent chance of resulting in pregnancy. Rachel and I mourned over sushi, which she’d planned to give up if she got pregnant. We repeated this ritual twice after two more failed IUIs.
When fertility treatment doesn’t work, Jenkins said, “a lot of people just recede.” After an IVF attempt results in a negative pregnancy test, an exhausted Rachel and Richard retreat to their bedroom. “They’re hiding in their own apartment,” the director said.
Around dusk, two kids knock on the front door. The couple shuffles out into the hall but can’t bring themselves to answer. It’s Halloween, and Rachel and Richard are unprepared for trick-or-treaters. “They don’t have any goddamn candy,” Hahn said. “It always kills me. There’s something so depressing about that.” But, she added, “They’re still together.”
By that point, they’d begun to explore adoption. Their doctor has also mentioned the possibility of using a donor egg. Here Jenkins’s talent for capturing fraught familial relationships shines. Rachel and Richard pick the latter option, and, instead of seeking out a stranger, they ask their 20-something niece Sadie—Charlie’s daughter from a relationship prior to his marriage to Cynthia—if she would consider donating them her eggs. She says yes, setting the movie on a new course. But Sadie wasn’t easy to find.
Jenkins said that the actor slated to play the character dropped out. This caused the director to panic. “I thought, ‘Oh my God, they’re gonna pull the plug because we’re missing an actor who’s well-known,’” Jenkins said. Then she and casting director Jeanne McCarthy auditioned almost 100 young women.
“I said to Jeanne, ‘My God, we’re in New York, isn’t there some theater actor under a rock somewhere doing some small thing in a basement theater?’” Jenkins said. “And then a couple of days later she emails me: ‘I found somebody under a rock.’” At the time, Kayli Carter had appeared in a production of Mark Rylance’s play Nice Fish and had a role in the yet-to-premiere Netflix Western series Godless. “I thought she was fantastic,” Jenkins said.
Sadie is the perfect foil for Rachel and Richard, who in their minds lack her vitality. “The movie’s about middle age,” Jenkins said, “and kind of banging up against the ceiling of what you think is the kind of life you’re supposed to have.”
By this summer, my wife and I also felt like we were hitting the ceiling. Tired of the impersonal, baby-factory feel of the first fertility center, we moved to a smaller practice. Predictably, our new doctor explained that it was probably time to start IVF. You see, after three IUIs, the odds of success, which are already relatively low, dip dramatically. Out of curiosity, I asked the doctor why IUI is even performed when the chances of it working aren’t great. Her answer was simple: It’s significantly cheaper than IVF, which has a far higher rate of success than IUI, but can cost upward of $20,000 out-of-pocket per cycle. Some insurance companies require patients to have several IUIs before IVF is authorized.
Feeling fortunate that Rachel’s insurance is supposed to cover three IVF tries, we moved ahead. Many other plans quickly got pushed aside. We skipped a friend’s wedding in case it coincided with the egg retrieval. I also told my best friend that we couldn’t join him and our buddies on a trip to New Hampshire. Making Rachel inject herself away from home seemed like a horrible idea. “If you travel you look like you’re in a meth lab or something,” Jenkins said. “What are you doing with all these drugs in your bags?”
So Rachel had blood work done. I did my Penthouse-assisted semen analysis. Soon, a dry-ice-insulated box of medication and syringes arrived on our doorstep like a dystopian stork. Before long, our house felt like the backdrop of Icarus. When the cycle started, Rachel mixed clear vials of hormones and gave herself two shots per day. As the retrieval approached, it became three shots per day.
While this technically was a collaborative process, Rachel obviously was the one doing the heavier lifting. The hormones made her feel bloated and nauseous. She was advised to avoid exercise, which over the last year had become a crucial stress reliever. We spent evenings Googling things like, “Is it OK to have one beer while doing IVF?”
And every few days, Rachel went to the clinic for monitoring. Having blood drawn had made her squeamish to the point of fainting in the past, but after doing it so many times over the last year, she’s grown used to it. In fact, she even has a favorite phlebotomist. And by now, her iPhone’s predictive text feature routinely suggests the words “blood work” and “ultrasound.”
It was official: Fertility treatment had hijacked our lives.
Near the end of Private Life, Richard makes a bitter observation. “I’m not your husband,” he says. “I’m just some guy that injects hormones into your ass every night.” He and his wife’s quest to have a child has completely overwhelmed their marriage. For Richard and Rachel, the process feels exhaustingly interminable.
In August, after a week of giving herself two and then three shots per day, my wife went in for a monitoring appointment. The hormones, the nurse said, had caused her ovarian follicles to grow too big too early. That afternoon, the doctor canceled the IVF cycle. Rachel responded stoically. The ramifications of what had happened didn’t hit her until the next day.
“I’m not good,” she said tearfully. That night, we went out for sushi.
Over the last several years, Rachel and I have searched for ways to process our infertility. I find that laughing about the science-fiction-esque treatment tends to take the edge off. Thank God my best friend doesn’t mind my often masturbation-joke-laden text rants. Rachel, on the other hand, craves information. She devours infertility-focused blogs, message boards, and Instagram accounts.
Occasionally we both have mini existential crises. Every so often Rachel will ask me why we can’t have kids. I never have an answer. I’ve become fatalistic. When my best friend tells me that our infertility is unfair, I push back. It’s not fair or unfair. It just … is.
“In a weird way it becomes not even about the baby,” Jenkins said. “You transcend that, and it’s just this kind of Kafkaesque track you’re on.”
My wife and I watched Private Life together. When the credits rolled, Rachel turned to me and said that what the movie nailed was the never-ending wait of fertility treatment. You’re dying for your name to be called, but you know that it may never happen.
Rachel and I are in the middle of another IVF cycle. We’re also considering adoption. I have no clue what will happen next, but I’m glad not to be going through this alone. After all, the only certainty that we have is each other.