bookish review

Review: Inconceivable, Alex Johnston

Inconceivable: My Life-Altering, Eye-Opening Journey from Infertility to Motherhood by Alex Johnston
eARC received from NetGalley and Sutherland House for review
152 pages, Nonfiction, Memoir, Infertility

“Alex has a truly unbelievable story: this is a wild journey to motherhood, filled with hard-won insights into how society can help families struggling with infertility.”
— Gillian Deacon, host of CBC’s Here and Now

Fifteen years ago, when Alex first started trying—and struggling—to get pregnant, she received outdated medical information and erroneous advice. Unfortunately, this incorrect information is still widely offered to women today, and barriers to accessing treatment haven’t changed. Alex shares what she learned on her own path to parenthood, including navigating infertility and IVF treatments, surviving the loss of her first child, having two daughters through surrogacy in Canada and the United States, and finally, after many years of trying, giving birth to a baby boy the old-fashioned way. All the while, Alex fought for a government policy change to better support people trying to build their families.

Inconceivable is an emotional roller-coaster ride with a purpose and a goal: to inform women about the realities of their fertility through sharing a painful and private experience with infertility. Through telling her own story and recounting those of other women, Alex explores the complexity of this issue while contextualizing these intimate experiences with rigorous research and investigation. She wants to “pay it forward” for other women and create a platform to drive the conversations around infertility that we need to have as a culture.

Content warnings: Full-term stillbirth, infertility’s effect on mental health, medical details re: fertility treatments

Inconceivable is Alex Johnston’s account of her journey through infertility, IVF, and surrogacy. Johnston openly shares the realities of every step of the process – medical procedures, information and misinformation, societal prejudices and pressures, and the emotional toll of all of these factors – and brings the reader along in the telling with a conversational and warm tone. In telling her story, Johnston advocates for awareness, better access to up-to-date evidence-based fertility education, and accessible and affordable assisted reproductive health benefits.

This is a timely release – it hit shelves last Tuesday, May 4th – as April 18th-24th was National Infertility Awareness Week in Canada. Infertility is a complex and difficult subject, but if you’re aware of the statistics, it’s a shame that an experience this common is shrouded in misconception and uncomfortable silence. Approximately 1 in 4 have experienced a miscarriage, stillbirth, or loss of an infant. Many suffer consecutive losses before seeking medical assistance. 1 in 8 couples have experienced infertility (defined as not conceiving after a year of actively trying to conceive). Social media has given rise to more and more people sharing their stories, both in search of community and to educate others, but there’s still an educational barrier and a general unwillingness to engage the subject.

Personally I didn’t know much about reproductive health – beyond the standard contraception and STI info given in sex ed – until pregnant with our daughter, at 26 years old, from an amazing and informative OB-GYN. Access to evidence-based information is more important than ever as the average age for starting a family continues to rise – well into the late 20s and early 30s – given that infertility rates increase dramatically with age, while the success rates of assisted reproductive technologies inversely decline. Many only learn these statistics when faced with an infertility diagnosis.

One thing I appreciate about this memoir is the author’s honesty regarding her privilege and the hundreds of thousands of dollars invested into growing her family. There is an astronomical – and in many cases insurmountable – financial barrier for assisted reproductive technology; this memoir talks about the high costs of IVF and surrogacy, but also mentions how many other options, like adoption, are prohibitively expensive and complicated. Ontario provincial health benefits currently cover one round of IVF in a patient’s lifetime – but if you’ve ever looked into the average success rates per IVF round, multiple rounds are required on average for successful conception, with success rates dramatically decreasing with age. This barrier disproportionately shuts out anyone who requires medical assistance to grow their family – in this memoir’s case a heterosexual couple, but Johnston also frames this issue in relation to same-sex couples and anyone planning a pregnancy without a partner.

Johnston’s experience in government is also a unique asset: daughter of a former Governor General, with current and prior experience working in political and non-profit advocacy roles, she has a broad perspective that includes both personal experience and the realities of pushing for policy changes, even on widely popular issues with champions in politics. The takeaway is that it took a demographic shift in elected representatives, and the efforts of numerous passionate campaigners, many years to make small changes. The details are specific to Ontario but the story at the heart of the book is one that many people face – with different degrees of social and financial support.

I would have appreciated more attention to supporting facts – statistics, particulars of legislation changes including names and dates – but that’s personal preference, as my usual go-tos for nonfiction lean more toward investigative journalism and academia than memoir. Johnston includes a short list of citations at the end of the book, including enough general supporting info to back up her points, contextualize her personal story, and give a jumping-off point for anyone who wants to learn more.

Inconceivable is a quick and easy read in terms of length and author’s voice; its subject matter is difficult but shared with honesty and a solid understanding of the author’s personal story in its broader societal context. Johnston’s memoir is a valuable contribution to the conversation around fertility and assisted reproductive technology in Ontario, published by Toronto-based nonfiction firm Sutherland House Books, with content addressing current fertility options and existing legislation in Ontario.

Books in the background of the header photo: Everywhere Babies by Susan Meyers and Marla Frazee (top) and Welcome Baby by Barbara Reid (bottom).

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