IVF and Gamete Donation Transformations: Gender Reproduction and Contemporary Society Week 18

Structure of Lecture What are IUI/DI; IVF; ICSI? Success Rates Funding IVF in England Feminist and non-feminist responses to IVF IVF as context-specific Accounting for treatment failure Gamete Donation in Statistics (UK) Gamete Donation and the Law (UK) Gendering Donation Altruism vs. Commerce Stem Cell Research

What is IUI / DI? Intra-uterine Insemination (also known Catheter for IUI Intra-uterine Insemination (also known as AI: Artificial Insemination) A laboratory or an ‘at home’ procedure Dates back to early 1900s Was main way of overcoming low male fertility/male infertility Can use prospective father’s sperm but generally relies on donor sperm, known as Donor Insemination (DI) Used by single women and same-sex couples Uses a woman’s own egg Washed sperm is introduced into woman’s uterus via a catheter May be used in conjunction with charts/tests/drugs to optimize timing Maximum of one treatment per woman’s menstrual cycle Woman’s fallopian tubes must be open and healthy Declined in use following ICSI Unstimulated DI recommended by NICE for couples who can’t have penetrative sex; STIs mean sperm needs washing; same-sex couples

Some Statistics on DI (HFEA 2010 & 2011) 2087 women patients in 2011 4091 cycles of DI 513 live births in 2010 (6.6% multiples) Success rates 2010: Overall live birth rate 12.8% stimulated Overall live birth rate 11.3% unstimulated Women under 35: 20.7% stimulated, 14.6% unstimulated Women 35-37: 17.1% stimulated, 11.4% unstimulated Women 38-39: 11.9% stimulated, 9.4% unstimulated Women 40+: 5.3% stimulated, 4.7% unstimulated Established 1991

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 Can use prospective parents’ gametes or donor

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 53% of IVF cycles in UK involve ICSI

Some Statistics on IVF (HFEA 2010 and 2011) 48,147 patients in 2011 (up 5.7% from 2009) 61,726 cycles of IVF (inc. ICSI) 17,041 live births, 13,778 of them with woman’s own ‘fresh’ eggs (4,590 multiples) Success rates (with ‘fresh’ eggs) 2010: Overall live birth rate 25.6% (up 0.4%) 32.2% for women aged under 35 27.7% for women aged between 35–37 20.8% for women aged between 38–39 13.6% for women aged between 40–42 5.0% for women aged between 43–44 1.9% for women aged 45 and over

Changing Success Rates Success rates have increased overall 1992 – 2005 Success rates fluctuate to around age 35, then decline

Source: HFEA Website

Stages of Treatment, ‘Fresh’ IVF 2009 HFEA Data

Type and Source of Gametes, 2010 IVF using woman’s fresh eggs is commonest treatment 3% of treatments use donor eggs 6% of treatments use donor sperm 18% of treatments use frozen embryos, most with woman’s own eggs Proportion of treatment cycles started, egg type and source, HFEA 2010

Funding IVF: England NICE 2004: Recommends up to 3 cycles on NHS if woman aged 23-39 and couple have not conceived after 3 years or have an established cause of infertility NICE 2011: Changes period of trying to 2 years and recommends up to 1 cycle on NHS if woman is aged 40-42, has not had IVF and does not have low ovarian reserve 2009: 3 cycles bring cumulative success rate to 45-53% Postcode Lottery 2005: 22% of PCTs funding1 cycle, 58% taking steps to achieve that 2007: 36% of PCTs funding 1 full cycle 27% funding 2 cycles 5% funding 3 3 PCTs not funding any 2014: 49% of CCGs funding 1 full cycle 24% funding 2 cycles 24% funding 3 cycles 3 CCGs not funding any 2011: 24/135 PCT responders funding cycles for single women Sources: NICE; 2008 Interim Report on NHS Infertility Provision; 2014 report into the status of NHS fertility services in England PCTs = Primary Care Trusts CCGs – Care Commissioning Groups

Rationing: Additional Eligibility Criteria CCGs across England have additional and varying eligibility criteria for access to funding. These can include: - limits on a patient’s BMI (Body Mass Index - a measurement of obesity) - excluding smokers - excluding those who already have children - exclusion after a certain number of fertility treatment cycles, however funded - exclusion based on length of relationship

Resisting IVF Activity: On what grounds is IVF opposed, and by whom?

‘Pro-Life’ responses ‘Pro-life’: embryos are ‘alive’ Cases of embryo ‘adoption’ Constructs embryo as human US – ‘snowflake babies’ from 1997; 366 as of Jan 2014 Former US President George W. Bush with a ‘snowflake baby’

Media Responses: Disruption of normative reproductive categories Intergenerational gamete donation disrupts ‘normal’ grand- parent, parent, child relations Fragmentation of parenthood (social, genetic, gestational) .

Media Responses: Disruption of normative reproductive categories Two fathers, no (social) mother Temporal disruptions (e.g. twins born years, even decades, apart)

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 Side effects of drugs: hot flushes, depression, headaches Increased risk of ovarian cysts Risk of Ovarian Hyperstimulation Syndrome Risks of multiple births Emotional stress and blame

Critiques of FINRRAGE Too generalising about women as victims, men as appropriating women’s bodies Assumption of natural reproduction outside of culture Cannot account for women’s involvement (outside of complicity / false consciousness) The technology itself is not the problem, if women can reclaim it 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’

But FINNRAGE critique: Centralised women’s bodies in the debate - Talk of treating the ‘couple’ but technology borne by woman’s body Provided international perspective - Technologies operate differently in different countries Highlighted race / class discrimination re access - ‘Ideal’ couple is heterosexual, white, MC Showed links between industries - fertility medicine; stem cell research

IVF is 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….

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, even if male factor infertility Technology succeeds, but women fail

‘Poor performer’ 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) Sources: Throsby (2004; 2006)

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

Coping with IVF 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)

IVF 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)

Gamete donation and the law (UK) Before 2005 donors were automatically anonymous Since 2005, donor-conceived children have the right to information about genetic parents at 18 Since 2009, donors have the right to information about donation – if successful, number of children born, sex and year of birth Donors have no legal obligation to their donor-conceived children Regulated sperm donors can claim £35 per clinic visit plus additional expenses (travel, accommodation, childcare costs) Egg donors can claim £750 per cycle plus additional expenses (travel, accommodation, childcare costs) Nice recommends that sperm donors are aged 18-41, egg donors 18-35

Eggs, sperm and embryos Eggs are scarcer than sperm A woman has a finite quantity of eggs (unlike sperm) Sperm are more easily available / accessible than eggs Different cultural status; gendered (see Emily Martin) Embryos: the ‘start of life’ / potential children stronger sense of connection (especially to existing children)

Opposition to Egg Donation Hands Off Our Ovaries (Pro-life/anti-abortion) http://www.handsoffourovaries.com/ No2eggsploitation (Pro-choice) http://no2eggsploitation.wordpress.com/

Gendering donation Sperm donation ‘Getting paid for what you’re already doing’ (Almeling, 2007) Disconnection Egg donation: Altruism Women need to be mothers (and other women should help them to achieve that). ‘Despite being told for years I may need fertility treatment, we were lucky to conceive within weeks…Donating my eggs seemed the best way of paying back our good fortune.’ ‘I had a friend who went through several unsuccessful fertility treatments…I thought, I’m suitable for this. I can help change someone’s life.’ Source: National Gamete Donation Trust, 2011

Alternatives to Altruism ‘Nadia told me that she had decided to sell her eggs out of necessity; it was just for the money, and not out of altruism or wanting to “donate”. She said that she had plans to renovate her house, lay the foundation for a floor, because her floor was made of earth. She did not care about the risks because she felt that, ‘in anything you do there is a risk’. […] ‘What may be of importance are the ethics of who is positioned as more appropriate to sell a bit of their body. The fact that the women in my study themselves feel “dignity” in gaining stuff for their homes and in becoming westernized women who “choose” what to do with their bodies puts one in a quandary. It would be a kind of feminist imperialism to tell them they are wrong to desire these neoliberal ideals.’ Source: Nahman, 2008

Constructions of the good egg donor (US) Tall (5 feet 8 inches+) Not overweight Conventionally attractive Doing it for the ‘right’ reasons Intelligent OvaCorp donor manager: ‘You will find that a donor’s selling tool is her brains and her beauty […] bottom line, everyone wants either someone that’s either very attractive, someone very healthy, and someone very bright’ OvaCorp donor manager: ‘She has a really good background. See…definitely, it’s not for the money. She makes 65 grand a year. Great height and weight. Obviously, Hispanic […] She’s Caucasian enough, she’s white enough to pass, but she has a nice good hue to her if you have a Hispanic couple’ Source: Almeling, 2007

Trading Gametes for Treatment In 2009, 738 women donated eggs as part of an egg sharing cycle Women donating eggs had 37.6% live birth rate per cycle 714 women received eggs as part of an egg sharing arrangement Women receiving eggs had 31.9% live birth rate per cycle

Stem cell research Stem cells: (as yet unrealised) potential in regenerative medicine Human embryonic stem cells best source Research uses donated embryos Donation to science preferred to donation to infertile couples Research also needs eggs, in finite supply and rarely donated to science Newcastle scheme gives cheap IVF in return for eggs - coercive? - reduces chances of IVF success

Conclusions 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 Egg and sperm donation appear to be parallel but reflect ‘different regimes of body commodification for men and women’ (Almeling 2007: 319) Eggs and embryos are valued and conceptualised very differently The act of donation (and the justification available to donors) is profoundly gendered The demand for eggs (for fertility treatment and for research) reinforces the responsibilities places on women to be mothers, to be altruistic, and to be responsible for health care