Transbiology: A Feminist Cultural Account of Being After IVF

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.’ ¹ 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.’ ² 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. ³

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. ⁴

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. ⁵ 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.

1. Linda Birke, Sue Himmelweit, and Gail Vines, Tomorrow’s Child: Reproductive Technologies in the 90s (London: Virago, 1990).[↑]
2. See Barbara Katz Rothman, The Tentative Pregnancy: How Amniocentesis Changes the Experience of Motherhood (New York: Norton, 1986).[↑]
3. Rosalind Petchesky, “Reproductive Freedom: Beyond ‘A Woman’s Right to Choose’,” Signs 5.4 (1980): 661-685.[↑]
4. For useful histories of the IVF technique, see: John D. Biggers, “In vitro Fertilization and Embryo Transfer in Historical Perspective,” in In-vitro Fertilization and Embryo Transfer Alan Trounson and Carl Wood, eds. (London: Churchill Livingstone, 1999): 3-15); Jack Challoner, The Baby Makers: The History of Artificial Conception (London: Macmillan, 1999); Adele Clarke, Disciplining Reproduction: American Life Sciences and ‘The Problems of Sex’ (Berkeley: University of California Press, 1998); R. G. Edwards, “The Bumpy Road to Human In Vitro Fertilization,” Nature Medicine 7.10 (2001): 1091-1094; R.G. Edwards and P. Steptoe, A Matter of Life: The Story of a Medical Breakthrough (London: Hutchinson, 1980); S. Fishel and E.M. Symonds, eds., In Vitro Fertilisation: Past, Present, Future (Oxford: IRL Press, 1986); Ruth Henig, Pandora’s Baby: How the First Test Tube Babies Sparked the Reproductive Revolution (Boston: Houghton Mifflin, 2004); Naomi Pfeffer, The Stork and the Syringe: A Political History of Reproductive Medicine (Cambridge: Polity, 1993).[↑]
5. As the authors of one of the largest meta-reviews of the literature on IVF and birth defects, published in 2005, note: “Since it appears there is an increased risk of birth defects in infants born following ART treatment and we cannot yet identify the cause, it is now very important to collect detailed and accurate information about all treatments that couples have undergone and their underlying causes of infertility; and to be able to identify children born following ART procedures so they can be followed.” Michelle Hansen, Carol Bower, Elizabeth Milne, Nicholas de Klerk and Jennifer J.Kurinczuk, “Assisted Reproductive Technologies and the Risk of Birth Defects—A Systematic Review,” Human Reproduction 20.2 (2005): 328-338.[↑]