The Marketization of Fertility Treatment

The Marketization of Fertility Treatment is the book’s account of how assisted reproduction makes the desire for a child legible as both a medical problem and a market opportunity. Clinics promise scientific help, emotional support, and a route toward a desired outcome, yet the process described around Alice Espanet and Ritxi is marked by uncertainty, repeated bodily interventions, competition, and escalating commitment. Its central tension is that the language of empowerment makes success sound attainable through sufficient effort while leaving patients to bear the meaning of failure.

From consultation to treatment

After seven unsuccessful months of trying to conceive, Alice Espanet and Ritxi sought help at a highly recommended clinic rather than waiting for the one-year interval they had heard was customary. Ritxi felt old and pressed by urgency; the account presents the couple’s decision in the context of his strong wish for fatherhood and his discomfort with losing. Their consultations also acquired a social ritual: when his obligations allowed, they took the day off afterward and went for a special meal, choosing Pobeña or the Puerto Viejo de Algorta in good weather and Bilbao in winter. Alice avoided alcohol and tried to eat cleanly, looking for a suitable dish for her pre-pregnancy condition.

The clinic’s pastel waiting room becomes the setting in which an intimate wish is converted into a sequence of procedures and technical terms. Blood tests and semen analyses sit alongside a karyotype, ultrasounds, hormone monitoring, and a hysterosalpingography. Alice’s first diagnosis is described as vague—low ovarian reserve—and the first treatment involves Gonal and Ovitrelle, followed by antral follicle counts and artificial insemination. The accumulating tests and specialist consultations lend the process a scientific order, but they do not make its outcome certain.

The waiting room also organizes patients into an imagined contest. The Narrator describes fellow patients in adjacent seats becoming contenders: who will arrive first, who will never arrive, and who will be left behind. The competition is not presented as a formal clinic rule; it is the emotional atmosphere produced when people seeking the same scarce outcome sit through the same uncertain process. Pastel decor and periodically updated magazines offer a calm surface, while the patients measure their progress against one another in silence.

Selling hope and managing failure

The clinic advertising, as the book describes it, presents assisted reproduction as a clean, scientific, effective service: a person wants a baby and, by entrusting the desire to the clinic, can obtain one. The advertised success rate is ninety percent, a figure the narrator treats as a sales claim rather than a guarantee. Against the promise that late capitalism can meet material and spiritual needs alike, reproduction appears as another desire made available for purchase. The persuasive language converts wants into rights and rights back into wants, suggesting that sufficient determination can make the hoped-for outcome real.

Failure exposes the pressure inside that promise. After the first attempt, Alice has spent two weeks avoiding abrupt movements, ham, and beer, yet her period arrives. The account renders that bleeding as the felt evidence of failure, not as a neutral step in a treatment schedule. A psychologist is offered for the following Monday, with the prospect of gathering up the pieces of shattered hope and beginning again with positive energy. The offer may provide support, but its language also turns distress into something to be processed so treatment can continue. The patient is expected to learn the vocabulary, withstand abdominal injections and bruises, and manage guilt even while confronting the unfairness of another person’s success.

The book sets this therapeutic encouragement beside the social advice patients may receive: not to obsess, to relax, to enjoy themselves, or to trust a story about someone who conceived unexpectedly. Such comments are meant as reassurance, but they can isolate people whose experience is already difficult to discuss. In the clinic’s logic, the next response to disappointment is renewed effort; outside it, silence can seem safer than explaining the process to people who minimize it.

The pressure is sharpened by the promise’s own mathematics. If the most advanced clinics can claim only a ninety-percent success rate, then one in ten people longing to gestate and give birth may not be able to do so. The narrator emphasizes that this possibility remains present even as patients are urged to be strong and keep fighting. The clinic’s financial language intrudes directly into this emotional landscape: after describing pain, guilt, and the need to begin again, the account turns to an offer of flexible financing. Hope, treatment, and payment occupy the same continuum, though the terms and cost of financing are not specified.

Escalation and the limits of the commercial promise

Alice and Ritxi underwent three insemination cycles, repeating injections, ultrasounds, and follicle counts each time. When pregnancy still had not occurred, the clinic recommended the next step: in vitro fertilization, described as longer, more expensive, more painful, and more desperate than insemination. They agreed. By then, the narrator says, they had passed the point of no return. That phrase captures the accumulating force of treatment: each unsuccessful cycle is followed not by a simple return to the starting place, but by a decision about whether to commit further time, money, and bodily effort.

The Narrator’s visit to the clinic as an investigator unsettles any easy assumption that Alice was simply a typical patient with a conventional wish for a child. After initially writing as if Alice shared the standard desire to hold a child of her own, The Narrator recognizes that this framing may be wrong. The receptionist remembers the couple’s long treatment, but says Alice is taboo there and cannot say whether she should be understood as an ordinary patient. She describes Alice as extreme, at times on top and at times in a hole, never in the middle. The clinic can preserve a memory of the treatment while leaving the patient’s desire unresolved.

The account then offers possibilities, not findings: perhaps Alice did not want children, perhaps she secretly tried to prevent pregnancy, perhaps she entered the first consultation to satisfy a man and found herself drawn into a tunnel she could not leave. It also imagines the opposite possibility—that the clinic’s procedures and expectations narrowed her choices. These are explicitly working hypotheses, not established facts about Alice’s actions or motives. Their importance lies in the question they open: a treatment pathway can make a desire look self-evident even when the person moving through it may be uncertain, resistant, or unable to exit.

What treatment cannot promise

The market’s promise ends at a different threshold from the work of parenting. In the narrator’s account of caring for Erik, a day includes changing nappies, running laundry, breastfeeding whenever the child cries, and searching for increasingly elaborate ways to entertain him. At nursery, Erik notices his mother as soon as she arrives, crawls toward her, and offers his arms; she experiences their reunion as a vivid form of love, while still doubting her ability to enjoy motherhood as she believes she should. The scene does not negate the value of fertility treatment, but it makes visible what a successful route to pregnancy cannot sell: the unremitting, particular labor of care and the feelings that coexist with it.

The book also describes motherhood as hours of boredom and repetitive labor, often socially undervalued despite a culture that praises self-giving. The narrator’s hope that close contact with life might become visible in her writing sits beside the practical demands that leave little room to write. Read alongside the clinic’s emotional, inspirational sales language, this contrast marks a boundary: treatment may organize the pursuit of conception and offer a next step after failure, but it cannot guarantee uncomplicated desire, maternal fulfillment, or a life in which care and creative identity fit neatly together. The Marketization of Fertility Treatment therefore concerns not only the purchase of medical procedures, but also the way a complex human longing is framed as an achievable outcome—and how much uncertainty remains with the people who pursue it.