Despite the first IVF child now being over forty years old, public and patient understanding surrounding causes and treatments for subfertility remains poor. Furthermore, with one in seven couples seeking assisted conception the risk of unnecessary upset and/or offence due to poor communication is high. Misleading language used for routine and research diagnostic testing itself further obscures the meaning of actual diagnoses through terms like ‘normal’ rather than ‘typical’ and problematic phrases such as ‘hostile uterus’, ‘killer cells’ or ‘your body has rejected the hormones’.
Much of the language used to frame subfertility uses figurative language such as metaphor, metonymy and euphemism and other forms of vague and indirect expression. These can be understood in different ways and lead different individuals in one conversation to form different understandings of the problem that may diverge from the facts. Metaphor in particular has the ability to highlight some aspects of a situation whilst downplaying others. For example the phrase ‘killer cells’, used in conjunction with a research explanation of failed embryo implantation, implies agency and may evoke connotations of aggressive and deliberate action on the part of the uterus. Given that the images evoked by metaphors are often vivid and memorable, they are likely to endure in the face of evidence to the contrary.
There are culturally driven attitudes and understandings of the role of the different sexes in relation to conception, fertility, pregnancy and healthy live born children, which will often be expressed through figurative language. These attitudes can impact on the ways in which we perceive men’s and women’s roles in the process of reproduction. Male identity around fertility often becomes confused with ideas of manhood and masculinity. This is particularly prevalent around sperm analysis results and conception. Conversely, once conception has been achieved information about pregnancy and the language that is used to convey it tends to abdicate any further role for the male. Female related concepts often relate to ‘insufficiency’ of the ovary and ‘failure’ of fertilisation, implantation or nurture the developing embryo – implying certain roles in motherhood. For both sexes, the potential for language-related misunderstandings, and even conflict, is further exacerbated when a miscarriage occurs. The language of blame also permeates discussions of pregnancy loss, with women feeling that they have ‘failed’ or that their bodies have ‘let them down’.
To address this multi-faceted problem in fertility and language, there need to be more conversations between linguists and clinicians. Collaborations of this type are necessary for understanding patient-focused language, so that this knowledge can be used to inform evidence based recommendations for improvement.