IT IS SPRING when Belle Boggs first realizes she may never have a child, and nature suddenly appears rife with signs of fertility. Cicadas unburrow from their 13-year sleeps; eagles nest in a tree near her farm house; the North Carolina Zoo announces that their female gorilla, Jamani, is pregnant. “What is all this juice and all this joy?” Gerard Manley Hopkins muses in his aptly titled poem, “Spring,” and Boggs may well have wondered the same thing. The “vibrating, whooshing, endless hum” of the male cicadas’ mating song is so loud that, “a man calls 911 to complain because he thinks it’s someone operating machinery.” When the din finally subsides — by the end of May, “the adults are dead, eaten by other animals, worn out from their reproductive frenzy” — it is a relief.

In The Art of Waiting: On Fertility, Medicine, and Motherhood, Boggs explores the “natural” basis of a reproductive drive, meditating on fertility and motherhood in species ranging from feral cats to marmosets, baboons, and mice. Yet her ultimate goal is to unsettle assumptions about the natural versus the artificial, the healthy versus the broken. That resorting to medical intervention to conceive is an act of transgression against nature or God’s will is a fallacy Boggs spent years wrestling with herself, and that her collection of essays patiently refutes. In the mess of functions and dysfunctions that is the human body, fertility is often seen as an add-on, Boggs argues — nice to have but not essential equipment for life. Unlike other kinds of bodily brokenness that we agree should be fixed through medical means — mental illness with medicine, clogged arteries with surgery, even crooked teeth with braces — intervening to fix infertility is viewed as an act of hubris, a step down the slippery slope to the assembly-line reproduction of a Brave New World. Boggs is, eventually, successful in conceiving a baby through IVF. Yet when her mother-in-law sees her pregnant for the first time, she blurts out, “Did you do it the natural way, or did you pay eighty-thousand dollars?”

To overreach or interfere in her fertility marks a woman as “unnatural, greedy, grasping”; one must instead, like the barren but serene Biblical Sarah, “accept […] God’s will with patience and faith.” Yet no one raises the same scruples about technological fiddling when it makes other body parts run more smoothly. Referencing her father’s recent six-figure triple bypass surgery (covered by insurance), Boggs notes tartly, “I’m pretty sure that no one has ever asked him, Did you stay alive the natural way, or did you spend a million dollars?” If healthcare is a right, she suggests, then it should cover reproductive health as well; reproductive health that is not just the absence of disease, but the “ability to make choices — when or if (and how) you’ll have a child.”

Boggs moves beyond her own ambivalently titled “broken female parts” to consider how reproductive technology has been a powerful practical tool in the push for LGBT rights. Gabe Faibish, a gay writer friend Boggs interviewed for the book, felt for most of his life that, “being gay meant certain kinds of family structures were closed to him. He would not get married; would not have a house with a dog and a yard with children.” Boggs charts how medical breakthroughs in reproductive technology, combined with landmark legal decisions over the past decade that legalized gay marriage and extended adoption rights to same-sex couples, have revolutionized both the way we have babies, and our understanding of who has a right to have them.

LGBT individuals, previously written out of the domesticity and parenthood narrative, now have this possibility open to them. What legal scholar (and lesbian assisted reproductive technology parent) Martha Ertman calls “Plan-B” families — new, inventive ways of bypassing biology in order to make families when the reproductive narrative hits a snag — are increasingly common. Boggs, like the other ART parents she interviewed for the book, feels empowered by the act of taking family-making into her own hands, “foil[ing] the limited human body” and challenging what counts as “natural” when it comes to building families.

Boggs’s meditations on the politics of reproduction and ART are eloquent and impeccably researched. Ultimately, however, her prose is most luminous when she is limning the subterranean psychic toll that infertility takes on its sufferers. If, in matters of reproduction, the opposition between nature and artifice turns out to be a false dichotomy, so, too, does the opposition between the real and the imaginary. The childless might not have real children, but they have imaginary ones. We discount this psychic investment at our peril.

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Writers have always sensed a certain affinity between biological and artistic spawn. (“Thou ill-form’d offspring of my feeble brain,” Anne Bradstreet writes, lovingly if self-deprecatingly, in “An Author to her Book”). Boggs quotes from the diaries of Virginia Woolf, who frequently measured the creatures sprung from her brain against those who failed to spring from her loins. Her biological sterility reinforced and compounded her moments of artistic sterility: “and all the devils came out — heavy black ones — to be 29 & unmarried — to be a failure — childless — insane too, no writer…” Her novels, in the end, became her cherished offspring, not just compensating for but far surpassing the joys of biological motherhood. When Woolf completed The Waves at the age of 48, she marked it with this one, luminous, triumphant sentence in her journal: “Children are nothing to this.”

Works of the imagination can compensate for the biological children we never had, as Woolf demonstrates, but they can also memorialize (and therefore, in a manner, substitute for) children we have lost. Literary critic Peter Sacks argues that the art of the elegy functions as a kind of grief work; he quotes Ben Jonson’s poem “On My First Son,” where the dead child is apostrophized as his father’s “best work of poetry.” By giving his son a new body in words on the page, Jonson replaces the absent loved one with the consoling presence of art.

But I think Boggs’s deeper point is that our biological spawn are, in some measure, also creatures of our brains — richly imagined entities, bodies overlaid with a tapestry of wishes and myth — and that to separate the two (one or the other, one for the other) is a mistake. Our imaginary children — those we never have — become wedded to us, flesh of our flesh, no less than real-life children do. Freud understood this psychic truth. Our parents, in addition to being the palpable, visible beings who raise us, are also our internalized superegos: imaginary constructs, “ego-ideals” enshrined in the self, that are no less powerful for being imaginary. In Boggs’s essays, there glimmers a suggestion that Freud’s proposition might work forward as well as backward: “Perhaps,” she muses, “imagining ourselves as parents is not only the expression of a biological drive but essential to understanding who we might become.”

Our imagined successors occupy a special spot in our hearts and brains, a nest we feather with every bright-colored thing or hope we come across. The infertile, as they come to terms with their inability to create new life, mourn the loss of this imagined child in ways that are not dissimilar from ordinary grief upon the death of a loved one. Freud’s 1917 essay “Mourning and Melancholia” tells us as much: “Mourning,” as he defines it, is “the reaction to the loss of a loved person, or to the loss of some abstraction which has taken the place of one, such as one’s country, liberty, an ideal, and so on.” Losing a cherished idea — the idea of a child — is, at least so far as the economy of the ego’s mourning process is concerned, no different from losing a cherished loved one.

And yet this loss goes unrecognized by the larger culture. Dr. Marni Rosner, a psychotherapist and author of a study on infertility as trauma, writes: “[The loss] is not concrete,” because “there are no clear norms for mourning the loss of a dream.” The grief counselor Kenneth Doka calls it “disenfranchised grief” — loss that is not credited by the surrounding culture as loss. Boggs detects the presence of such disenfranchised grief keenly in one man she interviewed for her project: Willis Lynch who, in 1948 at the age of 14, became a victim of North Carolina’s forced sterilization program. “Things might have been different if he had had children of his own,” Boggs suggests. “He told me he still wondered if a daughter would have come to hear him sing, if a son would have been someone he could have been proud of.” These imaginary relationships haunt those involuntarily deprived of offspring, like phantom limbs one cannot see or touch but that persist, just the same, in their stubborn thereness.

Boggs has her own phantom limb moment when, after two years of intensive treatment for infertility, she decides to stop. “I don’t feel like myself,” she complains one day to her husband. Or more accurately, she qualifies, “I felt split in two. The person I had hoped to become was torn away, leaving only the person I had always been.” In letting go of the idea of a child, Boggs has to relinquish a piece of herself, an ego-ideal constructed around a projected event that, finally, she recognizes will never arrive.

The waiting of Boggs’s title is key to her sense that, for those who are “TTC” (“Trying to Conceive”), time takes on funny shapes — a rhythm unrecognizable to non-initiates. The infertile keep time differently from you and me. “We lived in a constant state of waiting: for the next cycle, the next appointment, the next support-group meeting,” she notes of her day-to-day schedule. In websites and chat rooms, TTCs create customized digital “tickers,” rectangular banners running across the bottom of their screens to mark relevant milestones in their lives: menstrual cycles (fertile days “might be marked with hearts or a sprinkling of baby dust”); “angel baby” memorial icons for babies lost to miscarriage or stillbirth (“It’s been x months & y days since we said goodbye”). These are ways of measuring the unfurling of a life that only those engaged on the difficult quest for conception can understand. Boggs acknowledges the comfort she took in this community where the jumble of slang and acronyms (IUI — Interuterine Insemination; BFP — Big Fat Positive on a pregnancy test; “snowbabies” — frozen embryos) didn’t need to be spelled out for the fertile.

At the same time, Boggs’s “baby fever” never prevents her from being sensitive to those women who choose to opt out of the motherhood narrative. These holdouts are continually prompted by the surrounding culture to believe that they are less-than-women, denatured, Boggs observes. As an English teacher, she is able to rattle off a list of unsavory childless women dotting the Western literary landscape, from the desexed Lady Macbeth to the boozy Martha of Edward Albee’s Who’s Afraid of Virginia Woolf? (“unfaithful, lewd, alcoholic”).

Sadie Dingfelder’s Washington Post editorial, “Let Me Introduce You to My Imaginary Children,” is a hilarious account (and forms a lovely counter-piece to Boggs’s essay, “Imaginary Children”) of how one woman deals with her failure to comply with the compulsory fertility narrative. Dingfelder invents children to salve the panic and pity she sees clouding the faces of well-meaning strangers when they discover she is 36 and childless. Once, after assuring a concerned taxi driver that she had just dropped an imaginary daughter off at college (“‘We’re so proud of her. She’s all grown up,’ I added, tearing up a little”), she was met with this curveball: “What, no sons?” “He was right,” she decided, impressed by the man’s perspicacity. She needed to expand her imaginary family in order to better fit the narrative expectations of her sex.

“All families start as stories,” Boggs observes, “no matter how true or untrue they eventually become.” In The Art of Waiting, she illuminates the myriad ways in which the stories we tell ourselves about children — whether real or imagined, desired or declined — materially shape our sense of who we are. In the process, she makes a passionate and humane case for everyone’s right to choose and direct their own reproductive story.

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Ellen Wayland-Smith teaches in the Writing Program at the University of Southern California, and received her PhD in Comparative Literature from Princeton University. Oneida is her first book.