In this commentary on Almond’s (this issue) paper, in which he asks us to consider ways in which his personality/history/psychodynamics played a significant role in his younger women patients becoming pregnant, the author questions Almond’s premise that we can know what “real-life effects” we have on our patients, when so much that occurs in psychoanalysis happens in mutually unconscious and procedural realms. In addition, the author critiques Almond’s archaic and reductive conceptions of gender and sexuality, which feel particularly problematic as they interpenetrate with his fantasies of his impact and pivotal role in their pregnancies.