issue 217 - March 1991
The great miracle
Babies are being sold in kit form – an egg here,
a sperm there, a uterus somewhere else. Celia Kitzinger takes
a close look at biotechnology’s answer to infertility.
The world’s first ‘test-tube’ baby, Louise Brown, was born in July 1978 in England. Since then reproductive technologies have been big news in the West. Newspaper and television interviews with radiant mothers nursing new-born babies portray doctors and scientists as glamorous heroes selflessly promoting ‘miracle cures’ for infertility. Reproductive technologies, it is claimed, ease the heartache for childless women, offering them a last chance to hold a baby of their own in their arms.
Between 10 and 15 per cent of heterosexual couples are involuntarily infertile, and for many this causes intense grief. The longing for a child can take over a woman’s life. There are enormous cultural pressures on women to bear children, and tremendous stigma attached to infertility.
The method used to conceive Louise Brown, in vitro fertilization (IVF), is done by bringing together ovum and sperm in a petri-dish on a laboratory bench. Usually the ovum and sperm are taken from the would-be parents, but either or both can come from other people, so that a woman can bear a child with no genetic relationship to her or her husband. Once a viable embryo has been achieved, it can either be deep-frozen and stored for later implantation (or use in experiments), or it can be transferred straight into the mothers’ body.
The procedure presents serious health hazards for women. The hormones given to encourage superovulation – the production of more than one ripe egg per month bring the risk of burst ovaries, ovarian cysts and other adverse reactions ranging from migraine, dizziness, vision problems, weight gain and depression, to breast and ovarian cancer. The surgery is performed under general anaesthetic and involves three incisions into a woman’s abdomen after distending her belly with carbon dioxide. Women on these programmes are rarely informed of the risks they are taking: if they complain about pain or side-effects, they are often told that this demonstrates a lack of commitment to having a baby.
Nor are women told how low the success rate is. Half the IVF clinics in the US have never sent a patient home with a baby. Overall, only one in every ten women leaves IVF treatment with a baby – and evidence suggests that many of these could have conceived without IVF. For 90 per cent of women, IVF treatment means doctors’ appointments, hospital visits, tests, repeated invasive examinations, surgery, tremendous anxiety, depression, disruption of work, strain on personal relationships, disappointment, hope, despair – all without a baby at the end of it. These stories are missing from the media hype.
Instead women are given misleading statistics, in which every pregnancy – even those lasting only days – is included as a ‘success’, or the number of babies born is divided by the number of women in the programme, so if one out of ten women becomes pregnant with sextuplets, it is reported as a 60 per cent success rate.1 The media implies that reproductive technology is an exciting ‘scientific breakthrough’ and modern miracle when the results suggest it is a failed technology.
Women who have been in IVF programmes – even those who did end up with a baby – describe feeling ‘like guinea pigs’, ‘just a statistic’, or ‘a disappointment to the doctors’. When they embark on such programmes, many already feel inadequate and guilty because of their infertility. The treatment they receive reinforces their negative self-image. One woman explains how she felt when her fertilized eggs failed to implant:
‘I had terrible feelings of guilt that my body was this damaged vessel incapable of letting life continue. It was difficult for me to think that I would be carrying around fertilized eggs that would die one more time. I didn’t think I could stand any more dead babies.2’
Scientists on IVF programmes often describe the women they treat as ‘non-achievers’ and ‘failures’ with ‘defective’ bodies which can only be fixed with technology. Many are punitive, and blame women’s infertility on supposed infections contracted from sexual promiscuity, or on earlier abortions, or they chastise patients for pursuing careers and postponing childbearing until it is too late.
Women who reveal distress about their treatment are classified as emotionally unstable and unworthy of becoming mothers. ‘I didn’t dare ask too many questions because I thought it might affect my position in the queue,’ says one woman. Another explains: ‘I would have liked to have gone back and talked to my gynaecologists after it didn’t work, but as (an IVF scientist) said: “You’re history; we are on to the next one; we haven’t time for you now”’.3 A third woman was dismissed with the explanation that it was ‘psychologically beneficial to experience failure’.
A high proportion of pregnancies resulting from infertility treatments are multiple pregnancies – with associated risks to both mother and babies. In 1987 an English woman gave birth to six live babies, all of which died. Another delivered quins: one died shortly after birth, one had neonatal convulsions, one is blind and has inflammations of the intestines, one had a shunt inserted for hydrocephalus, and the fifth has chronic lung disease.1 Some women, horrified by prospects like these, have aborted multiple pregnancies, but then live with appalling guilt added to grief at their infertility.
Even healthy multiple births are an enormous strain. One woman with two-year old quads cautions others contemplating the same course: ‘Unless you have lots of money and lots of help, there is just not enough of you to go round’.
So why is reproductive technology portrayed as a success? In part reproductive scientists are using women’s bodies to advance their own careers. Medicine has always needed an experimental human population on which to develop its techniques: black slaves, white working-class women, prostitutes and Third World peoples have all been used. The treatment of women for infertility provides a voluntary, eager, experimental population from whom data on various other frontiers such as biochemistry, genetic transfer, tissue construction and so on can be gathered.
‘I want to be out there in the very front,’ says one doctor, adding ‘the grant money in my area dried up; so I became interested in infertility’. Another doctor, excited to be working at the frontiers of science, compared reproductive researchers to the creators of the atom bomb.4
But more importantly reproductive technologies are governed by market-place values: social pressures on women to produce babies are being exploited by big business. Sperm, stored in ‘banks’, is now a saleable commodity. Sperm donor Ken ‘is making as much money for five minutes in the bathroom as he does for almost a whole day in his job as a law clerk.’ Surplus eggs removed from women’s bodies are used for a range of scientific experiments or, in the US, sold to other women unable to produce their own ova. Eggs of women over 40 are described as ‘unsalable stock’. An embryo is, in medical phraseology, ‘the product of conception’. Some embryo flushing and transfer procedures have been patented and franchises formed, and profit-making clinics spring up wherever a ready market exists. In effect, babies are being sold in kit form – an egg here, a sperm there, a rented uterus somewhere else.
Much of this marketing is presented as scientific progress when it is nothing of the sort. Take surrogacy. The only ‘technology’ used in most cases is the low-tech or no-tech procedure of artificial insemination which has probably been around for centuries.5 What is new is the industry constructed around it.
Surrogate motherhood is a commercial transaction in which a man buys the services of a woman to bear him a child and perpetuate his genes. It does not usually involve a contract between two women, and in the US a contract between the sperm donor and the mother has more legal standing than a contract between the man’s wife and the mother.6 At least one North American programme accepts single men who want babies of their own, but usually the man who buys the service has an infertile wife. Often she has children by a previous marriage but her new husband wants his own biologically related off-spring. The surrogate mother is no more than a human incubator.
As babies become products, mothers become producers, pregnant women the unskilled workers on a reproductive assembly line… Mothers, rather like South African diamond miners, are the cheap, expendable, not-too-trustworthy labour necessary to produce the precious product writes Barbara Katz Rothman, feminist sociologist.4
The control of women’s reproductive ability has long been a cornerstone of patriarchal power. For centuries women’s wombs have been policed through clitoridectomy and infibulation, denunciations of female sexuality, punishments for infidelity, repressive laws against abortion and compulsory sterilization. Today we are seeing an extension of this control over women’s bodies, through the development of reproductive technologies.
These technologies routinely sort women into fit versus unfit reproducers – medically controlled artificial insemination is available almost exclusively to white, able-bodied, heterosexual women, preferably married. Sperm and ova are screened to ensure that both are of the best possible quality, to assure a ‘perfect’ product, and in future, according to a one-time President of the American Association for the Advancement of Science, women ‘will not have the right to burden society with a malformed or a mentally incompetent child’. Perhaps we will all be directed to sperm banks like the one in California stocked only with the sperm of Nobel prize-winners and men of achievement – although only one in every fifty women who apply for insemination is considered good enough.
While scientists scramble to develop prestigious technology to ‘solve’ infertility, concern about medically-induced or environmental causes of infertility is almost absent. The medical profession has often caused the infertility it attempts to correct – IUDs double the risk of becoming infertile and oral contraceptives aggravate the growth of fibrous tissues in the ovaries, also leading to infertility. Female and male infertility is also caused by pesticides, weapons-testing, crop dusting, chemicals used in industry and tobacco marketing. Spurred on by visions of higher profits, these industries, like the reproductive industry, continue virtually unchecked.
Reproductive technologies may offer a beacon hope to infertile couples: they may even help a lucky few realize their dream. But while attempting this, many women endure humiliating, painful, even life-threatening side effects. Most have to accept a childlessness made harder to bear by the shattering of unrealistic expectations – raised to generate profits for big business. Others are forced by poverty to sell their services as human incubators to male baby-buyers. Women need to know the limitations and risks involved in reproductive technologies. And they need legal safeguards so that the rights of the poor and vulnerable are not sacrificed to maintain the illusion of choice for a few, rich, white western heterosexual couples.
Celia Kitzinger teaches psychology at the University of Surrey, UK.
1 Quoted in Judith Laskar and Susan Borg, In Search of Parenthood (Pandora, 1987).
2 Quoted in Jocelynne Scutt, The Baby Machine, (Merlin Press, 1990).
3 In introduction to Lasker and Borg by Sheila Kitzinger, 1987
4 Recreating Motherhood: Ideology and Technology in a Patriarchal Society, Barbara Katz Rothman (Norton and Co., 1990).
5 The first recorded case of successful artificial insemination was in 1884 – done during a medical examination of the woman without telling either her or her husband.
6 Infertility: Women Speak Out About Their Experiences of Reproductive Medicine, Renate D Klein, (Pandora, 1989).