Sarah Franklin,
"Transbiology: A Feminist Cultural Account of Being After IVF"
(page 2 of 8)
Another important tradition of feminist work on NRTs that avoided the
'renounce and defame' politics of a minority of FINRRAGE members was
modelled on the women's health movement. Three British feminists in
London—Gail Vines, Sue Himmelweit, and Linda Birke—produced a
guidebook for women seeking to use new techniques such as IVF in 1990
entitled 'Tomorrow's Child.'[11]
This practical approach drew
inspiration from Barbara Katz Rothman's pioneering work on amniocentesis
in the mid-1980s, which she ended with an Appendix offering 'Guidelines
for Personal Decisionmaking' to help women navigate the arduous choices
offered by prenatal screening and to cope with the condition she
identified as the 'tentative
pregnancy.'[12] The defining feature of
tentative pregnancy was its uncomfortable ambivalence:
paradoxically, having more information and more reproductive choice
could be oppressive and disempowering. This ambivalence was not used as
a basis to reject the technology, but rather to enable women to
negotiate its demands more effectively. Rothman's study drew direct
inspiration from Rosalind Petchesky's highly influential 1980 article
"Reproductive Freedom: Beyond a Woman's Right to Choose," in which she
famously claimed that:
The 'right to choose' means very little when women are
powerless ... women make their own reproductive choices, but they do not
make them just as they please; they do not make them under conditions
that they themselves create but under social conditions and constraints
which they, as mere individuals, are powerless to
change.[13]
Rather than the need to denounce IVF or amniocentesis, it is the
difficulty of navigating 'the right to choose' that has proven to be the
most consistent theme in feminist literature on NRT, as well as
abortion. Somewhat paradoxically, this has proven to be as much of a
challenge in the context of the 'new' reproductive choices—such as egg
donation, IVF, or PGD—as for the 'older' choices of abortion,
amniocentesis, or contraception. If there is any single take-home lesson
from this entire body of feminist scholarship, it is that the
relationship between technology and reproduction can never be separated
from wider questions of women's status and empowerment. In the
disappearing margin between limited choices and
having-no-choice-but-to-choose-one-of-them lies the signature
paradox of feminist debate over new reproductive technologies.
It has, of course, been argued that no one needs to choose IVF,
amniocentesis, egg donation, or PGD (Preimplantation Genetic Diagnosis)
at all (indeed this is exactly what the early feminist critics of NRT
were advocating). It has also been argued that feminists concerned with
reproductive choice might have more pressing issues to worry about than
infertility, IVF, or ultrasound—such as reducing maternal mortality,
and protecting access to contraception, as well as legal abortion.
Indeed the difficult reproductive choices for women who can even afford
IVF or PGD might seem most politically legible as a measure of widening
health inequalities. This view of IVF and its ilk as an elite gambit for
which, like cosmetic surgery, the rich who can pay should rightly serve
as the guinea pigs for a change, may well be one of the reasons IVF
remains a virtually unregulated industry in almost every country in the
world. I suggest, however, that part of a re-evaluation of IVF, and
feminist politics toward it, should include greater consideration of its
biopolitical implications for the general population. Especially now
that IVF makes up as much as 5% of the birth-rate in some countries, and
has become the gateway to new genetic technologies, such as PGD, and new
treatments, like regenerative medicine and tissue engineering based on
human embryonic stem cell derivation and cloning, its implications have
been greatly magnified. This rapid expansion of the IVF platform is
particularly significant given that many basic aspects of IVF remain
both problematic and controversial.
Let's begin with two salient facts about IVF. One is its extreme
popularity. Here is an experimental technique involving several radical
departures from conventional conception. The artificially matured and
surgically removed egg cell is washed, buffered, incubated and
fertilised in vitro. Successfully fertilised egg are passaged
through sequential media and stored in a sterile incubator for up to a
week. Surplus embryos may be frozen in liquid nitrogen, or
vitrified—for as much or sometimes more than a decade—before being thawed for
transfer, research purposes, or disposal. Screening preimplantation IVF
embryos for aneuploidy, or diagnosing them for genetic disease, involves
having an entire cell removed and biopsied, while ICSI (Intra
Cytoplasmic Sperm Injection) involves the injection of sperm directly
into the egg through a microsurgical technique that bypasses the egg's
own mechanisms of natural selection. You could be forgiven for imagining
twenty years ago that these treatments were not likely to become as
popular or as commercially successful as they are today. Indeed, the
popularity of IVF treatment, as witnessed by the huge demand that is
responsible for its rapid transformation into a largely private global
biomedical service industry, is all the more remarkable given that the
core technique on which it is based does not work very well. Although
its success rates have risen dramatically in the past 30 years, they are
still well below 50% at the very best clinics, and less than half of
that in most others. Despite improvements, IVF continues to carry
considerable risk, including that of mortality as a result of ovarian
hyperstimulation. The risks of multiple births, which IVF increases by
over a 1000%, are routinely underestimated, despite the fact that even
twinning is associated with significantly increased level of neonatal
and maternal morbidity and pathology, and with triplets or more these
risks increase exponentially. Much culture media is proprietary (aka
made of secret ingredients), and it has become increasingly evident that
IVF treatment is associated with a slightly increased incidence of
developmental abnormality that may involve errors in genetic imprinting,
such as those that lead to large offspring disorder in cloned livestock.
These and other rare adverse effects of IVF have become more evident as
the population of IVF offspring has become large enough to detect
them.[14]
It is not so much that no one is worried about the fact that IVF is
in some senses the most dramatic form of experimental intervention into
human reproduction ever undertaken, nor that IVF is unusual in both its
technical chutzpah and now monumental scale. Many unsuccessful efforts
have been made to collect more basic data on IVF patients and their
offspring in order better to evaluate the clinical and biological
sequellae of this technique. The problem is that because IVF is largely
private and unregulated, such data is all but impossible to
collect.[15]
Patients are not unaware of the risks of IVF, and most empirical
studies confirm that patients worry about them. Interestingly, however,
the risks of IVF can be part of its appeal. To the extent that
part of the logic of choosing IVF is that even if you fail you can be
confident you've tried everything, a bit of hardship and even what might
otherwise be considered unacceptable risk, may become tolerable in
pursuit of a miracle baby.
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