Book Review

The Empty Cradle: Infertility in America from colonial times to the present

N Engl J Med 1996; 335:442August 8, 1996

Article

The Empty Cradle: Infertility in America from colonial times to the present
(Henry E. Sigerist Series in the History of Medicine.) By Margaret Marsh and Wanda Ronner. 326 pp., illustrated. Baltimore, Johns Hopkins University Press, 1996. $29.95. ISBN: 0-8018-5228-5

Marsh and Ronner look at 300 years of infertility in America from the vantage point of the late 20th century, with its advanced reproductive techniques. This very personal book evaluates the cultural, social, scientific, and medical aspects of infertility.

The diagnosis and treatment of infertility have evolved from myth to science, and the authors adequately relate each of the milestones along the way. The concept of fault is paramount, since the inability of the woman to conceive an heir is critical at all levels of society. It was not until after World War II that we forthrightly accepted the truth that the man could be the cause of a couple's infertility. In the 19th century it was believed that women who were educated and had careers brought infertility on themselves, but now we know that as a woman ages, her fertility decreases. Hence, in an ironic way, there is a link between myth and reality, fault and cause.

The anecdotes in The Empty Cradle will interest historians, physicians, indeed anyone curious about having children. A divorce petition filed in 1728 because of the husband's impotence is discussed. As far back as 1888, J. Marion Syms stated that “probably the gynecologist of today is consulted more often with regards to the sterile condition of women, than for any other disease.” This statement may be surprising since we think that the current burgeoning of concern about infertility is based on the new reproductive techniques and changes in society, such as the availability of fewer children for adoption. Yet reproductive failure has been important since biblical times.

Social issues are handled in depth and insightfully. President Theodore Roosevelt's criticism of the American middle class for “self-indulgence” for voluntarily remaining childless is but one example of how these provocative issues are presented. Current feminist positions regarding fertility are also addressed in a balanced and objective way.

This book, the result of an award by the American College of Obstetricians and Gynecologists to study a historical aspect of the discipline, is well executed. The writing flows, the editing is craftsman-like, and the personal aspects are interesting and add another dimension to the reality of infertility. My only criticism is that the biologic details of conception and treatment are handled in too much detail.

Alan H. DeCherney, M.D.
UCLA School of Medicine, Los Angeles, CA 90095