1. Infertility: His and Hers
1.1. infertility is a gender and marriage threatening condition which may be complicated by the option of new reproductive technologies
1.2. infertility is a condition that implicates two people, a wife and a husband, in a society where virtually all procreation occurs within the confines of marriage
1.3. some men refuse to acknowledge their own fertility where others will not seek treatment with their infertile wives
1.4. gender shapes the experience of infertility and its treatment for men and women differently
2. The man who replaced his wife
2.1. Shaira and Moustafa
2.1.1. Shaira is a 25 year old Christian woman
2.1.1.1. well educated
2.1.1.2. runs her husband's office supply company
2.1.1.3. has a degree in tourism from an American University in Cairo and speaks French and English fluently
2.1.2. Moustafa is a 43 year old muslim
2.1.2.1. from a powerful political family
2.1.2.2. has a legal practice
2.1.2.3. rents a villa to a foreign embassy
2.1.2.4. owns an office supply company
2.2. the couples infertility problem
2.2.1. Moustafa had been married before and divorced his wife because they were not able to have children. and his wife was a strong willed person
2.2.2. Moustafa is the cause of the couples infertility problems. he had been diagnosed with low sperm count and poor mobility
2.2.3. Moustafa's young wife underwent ICSI and became pregnant with twins
2.3. Male infertility
2.3.1. Moustafa laid the blame on his first wife solely because of her age; even though he was the cause of the infertility.
2.3.2. refuses to tell people how his children were conceived
3. Femininities, Masculinities, and Child Desire
3.1. Egypt is a paternity pronatalist country
3.1.1. a total fertility rate of 3.5
3.1.2. population of 70 million
3.1.3. Egypt is the largest country in the middle east and 15th largest in the world
3.2. pronatalist sentiments cross class boundries
3.3. desires for a gender balanced family of 1-3 children have taken hold in urban areas
3.4. women feel that their lives are incomplete without the experience of motherhood
3.4.1. most women in Egypt deem motherhood to be a natural part of their life
3.4.2. childless women have an identity crisis if they do not have a child
3.5. men in this region of the world deem paternity an important achievement and a major source of their masculine identity
3.5.1. some men refuse to face up to their infertility by avoiding diagnostic semen analysis
3.5.2. will bribe laboratory technicians for inflated reports
3.5.3. fail to show up at physicians offices once the diagnosis is made
3.6. women tend to shoulder the blame for childlessness wittingly and unwittingly
4. Conjugal Connectivity
4.1. remaining single is socially penalized for both men and women
4.2. marriages are typically arranged or at least semi-arranged through family intercession
4.3. marriages in Egypt are deemed inherently fragile and unstable until a birth of children is achieved
4.4. infertile marriages in Egypt are often quite successful and even more successful in many cases than fertile marriages with children
4.4.1. marriages evolve towards a "companionate ideal"
4.4.2. there are no children to come between the infertile partners who instead look to each other for love, affection, and support
4.4.3. Egyptian couples who are faced with infertility and the possibility of permanent childlessness is a re-avowal of marital commitment
5. Marriage and Divorce in the age of ICSI
5.1. technology has the potential to change people
5.1.1. effectively remasculinize emasculated men
5.1.2. the potential to defeminize women
5.2. some heartless men might decide to cast off their once-fertile wives of many years
5.3. therapeutic abortions are legal in Egypt
5.3.1. rarely practiced
5.3.2. prenatal testing is rarely carried out
5.4. female initiated divorce in the context of male infertility remains relatively rare
5.4.1. female initiation of a divorce remains stigmatized
5.4.2. divorce does not make since when a woman loves her spouse even if he is infertile
6. The woman with the secerets
6.1. Maisa
6.1.1. 39 years old
6.1.2. married to Ahmed for 17 years
6.1.3. suffers from blocked fallopian tubes
6.2. Ahmed
6.2.1. 46 years old
6.2.2. married to Maisa for 17 years
6.2.3. suffers from poor sperm count and motility as well as a prostate infection
6.3. Maisa's treatments
6.3.1. unnecessary and iatrogenic operation on her ovaries called a wedge-resection
6.3.2. cortisone injections in the uterus
6.4. Ahmed's treatments
6.4.1. varicocelectomies on both the right and left testes
6.5. IVF
6.5.1. became pregnant during the second trial but suffered a miscarrage
6.5.2. will not tell anyone if she becomes pregnant after her third trial
7. The "top secret" stigma
7.1. IVF in Egypt performs a kind of double stigmatization
7.1.1. the very treatment designed to overcome an already stigmatizing health condition leads to an additional layer of stigma
7.1.2. secrecy and suffering
7.2. feelings of infertility
7.2.1. infertile women describe themselves and are described by others as "missing" motherhood
7.2.2. infertile men often deem themselves to be "weak" and ineffective and may be deemed less masculine by others if their infertility becomes known
7.3. the stigmatized is experienced almost exclusively by women in Egypt. Although infertile men may feel diminished and emasculated they are rarely discriminated against by other Egyptians
7.3.1. infertile men are typically able to keep their infertility a secret
7.3.2. infertile men rarely feel under marital threat
7.3.3. men who are infertile are rarely reminded or taunted by others about their diminished manhood