IVF: Modern miracle or risky procedure?

1. IVF: Modern miracle or risky procedure?

2. Outline • What is IVF? • Feminist and non-feminist responses to IVF • IVF as context-specific • Accounting for treatment failure

3. What is IVF? • In-vitro Fertilisation • A laboratory procedure • A process of assisted conception • Eggs are removed from ovaries • Mixed with sperm in lab • 1 or 2 embryos re-implanted in womb

4. What is ICSI? • Intra-cytoplasmic Sperm Injection • Eggs removed and single sperm injected • Used when sperm count low or problems with shape/motility • First success in 1993 • Today 52% of IVF cycles in UK involve ICSI

5. Facts and figures (HFEA 2009 and 10) • 45,264 patients in 2010 (up 5.7% from 2009) • 57,652 cycles of treatment • 12,714 live births (2,441 multiples) • Success rates (with “fresh” eggs): • Overall live birth rate 25.2% (down 0.6%) • Women under 35: 33.7% • Women 35-37: 27.5% • Women 38-39: 19.7% • Women 40-42: 12.5% • Women 43-44: 5.1% • Women 45+: 1.5% HFEA = Human Fertility and Embryology Authority Established 1991

6. Source: HFEA Website

7. Source: HFEA Website

8. Funding IVF • NICE: PCTs should offer up to 3 cycles on NHS if woman is aged 23-39 and couple have not conceived after 3 years or have an established cause of infertility • 2005: 22% of PCTs providing 1 cycle, 58% taking steps to achieve that • 2007: 36% of PCTs providing 1 full cycle 27% providing 2 cycles 5% providing 3 3 PCTs not providing any Source: 2008 Interim Report on NHS Infertility Provision

9. Resisting IVF • On what grounds is IVF opposed, and by whom?

10. Non-feminist responses • “Pro-life”: embryos are “alive” • Cases of embryo “adoption” • US – “snowflake babies”

11. Disruption of normative reproductive categories • Intergenerational gamete donation • Fragmentation of parenthood (social, genetic and gestational) • Temporal disruptions (e.g. twins born years, even decades, apart)

15. Feminist responses: FINRRAGE • Feminist International Network for Resistance to Reproductive and Genetic Engineering • Reproductive technology as experimental and abusive of women • Taking women’s health care out of women’s hands and into men’s

16. Critiques of FINRRAGE • Too generalising about “women” and “men” • Assumption of natural womanhood outside of culture • Cannot account for women’s involvement (outside of complicity / false consciousness)

17. But…. • Centralises women’s bodies in the debate • International perspective • Race / class discrimination • Showed links between industries (e.g. farming / fertility medicine)

18. Women as users, not recipients / victims • Rayna Rapp: women as “moral pioneers” • Women actively use IVF, rather than simply being passive recipients / victims of it. • Policing of own bodies is experienced as empowering / resistant – “doing something about it”.

19. IVF as context specific • IVF in the context of population control • IVF as a technology of privilege • IVF as a technology of selection (e.g. sex) • IVF tourism (secrecy / finances) • IVF for a heterosexual couple; for a surrogacy; for a single woman….

20. IVF failure – blaming women? • Women do most of the “work” of IVF: • Information gathering • Organising appointments / tests (for both partners) • IVF focuses on women’s bodies • Different standards of “fertility” for men and women • Technology succeeds, but women fail

21. “Poor perfomer” • Liz: I thought, well… I was just sitting there thinking… gosh, they can’t… I feel labelled! You sort of… like a school report – could do better. • “crap eggs” (Stephanie) • “[I’m] rubbish at producing eggs” (Jenny) • “[I never] did that well with the eggs” (Jane)

22. Masculinity / virility / fertility • Men’s sexual performance is called into question • Inhorn wants to correct misnomer that IVF doesn’t impact on men Required to provide semen on demand May be invasive collection

23. Coping with failure ‘IVF only makes life more difficult… I would have had to accept it a long time ago if it weren’t for IVF. At twenty-eight I could have either gone for adoption or accepted my situation so I’d be five years down the line towards that and getting on with my life. Now you’re in a better position to do that when you’re twenty-eight than when you’re thirty-eight. If you’ve missed all your career boats and burned all your career bridges because you’ve spent the last ten years chasing fruitless treatment you’ve actually missed out a lot on life’. (Beth Carter in Franklin, 1997, pp. 177-8)

24. Success ‘To start with we felt a bit unsure and the idea of having to have IVF took getting used to. We were hit quite hard  emotionally. I thought it was going to work first time so it was a shock when it didn't… When you are trying for a baby it takes all the spontaneity out of sex so it is quite a strain. We would get quite excited when having the embryos replaced and then feel utterly despondent when it didn't work. But we worked through it giving each other support. In many ways it brought us closer together’. Caroline and Andrew, daughter Adelaide born following 4th IVF cycle, Testimony on HFEA web-site

25. Conclusion • IVF is a new reproductive technology that is in high demand • Failure is still the most likely outcome • It both affirms, and disrupts, normative reproductive categories • It has been the focus of considerable opposition from both feminists and non-feminists, but on very different grounds • It’s a social technology, context-specific