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

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Transformations: Gender Reproduction and Contemporary Society Week 18 IVF and Gamete Donation Slide 2 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 Slide 3 What is IUI / DI? 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 fathers sperm but generally relies on donor sperm, known as Donor Insemination (DI) Used by single women and same-sex couples Uses a womans own egg Washed sperm is introduced into womans uterus via a catheter May be used in conjunction with charts/tests/drugs to optimize timing Maximum of one treatment per womans menstrual cycle Womans fallopian tubes must be open and healthy Declined in use following ICSI Unstimulated DI recommended by NICE for couples who cant have penetrative sex; STIs mean sperm needs washing; same-sex couples Catheter for IUI Slide 4 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 Slide 5 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 Slide 6 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 Slide 7 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 womans 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 3537 20.8% for women aged between 3839 13.6% for women aged between 4042 5.0% for women aged between 4344 1.9% for women aged 45 and over Slide 8 Changing Success Rates Success rates have increased overall 1992 2005 Success rates fluctuate to around age 35, then decline Slide 9 Source: HFEA Website Slide 10 Stages of Treatment, Fresh IVF 2009 HFEA Data Slide 11 Proportion of treatment cycles started, egg type and source, HFEA 2010 Type and Source of Gametes, 2010 IVF using womans 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 womans own eggs Slide 12 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 Slide 13 Rationing: Additional Eligibility Criteria CCGs across England have additional and varying eligibility criteria for access to funding. These can include: - limits on a patients 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 Slide 14 Resisting IVF Activity: On what grounds is IVF opposed, and by whom? Slide 15 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 Slide 16 Media Responses: Disruption of normative reproductive categories Intergenerational gamete donation disrupts normal grand- parent, parent, child relations Fragmentation of parenthood (social, genetic, gestational) Slide 17 Two fathers, no (social) mother Temporal disruptions (e.g. twins born years, even decades, apart) Media Responses: Disruption of normative reproductive categories Slide 18 Feminist responses: FINRRAGE Feminist International Network for Resistance to Reproductive and Genetic Engineering Reproductive technology as experimental and abusive of women Taking womens health care out of womens hands and into mens 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 Slide 19 Critiques of FINRRAGE Too generalising about women as victims, men as appropriating womens bodies Assumption of natural reproduction outside of culture Cannot account for womens 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 Slide 20 But FINNRAGE critique: Centralised womens bodies in the debate - Talk of treating the couple but technology borne by womans 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 Slide 21 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. Slide 22 IVF failure blaming women? Women do most of the work of IVF: Information gathering Organising appointments / tests (for both partners) IVF focuses on womens bodies, even if male factor infertility Technology succeeds, but women fail Slide 23 Poor performer Liz: I thought, well I was just sitting there thinking gosh, they cant I feel labelled! You sort of like a school report could do better. crap eggs (Stephanie) [Im] rubbish at producing eggs (Jenny) [I never] did that well with the eggs(Jane) Sources: Throsby (2004; 2006) Slide 24 Masculinity / virility / fertility Mens sexual performance is called into question Inhorn wants to correct misnomer that IVF doesnt impact on men - Required to provide semen on demand - May be invasive collection Slide 25 Coping with IVF failure IVF only makes life more difficult I would have had to accept it a long time ago if it werent for IVF. At twenty-eight I could have either gone for adoption or accepted my situation so Id be five years down the line towards that and getting on with my life. Now youre in a better position to do that when youre twenty- eight than when youre thirty-eight. If youve missed all your career boats and burned all your career bridges because youve spent the last ten years chasing fruitless treatment youve actually missed out a lot on life. (Beth Carter in Franklin, 1997, pp. 177-8) Slide 26 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 4 th IVF cycle, Testimony on HFEA web-site) Slide 27 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 Slide 28 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) Slide 29 Opposition to Egg Donation Hands Off Our Ovaries (Pro-life/anti-abortion) http://www.handsoffourovaries.com/ No2eggsploitation (Pro-choice) http://no2eggsploitation.wordpress.com/ Slide 30 Gendering donation Sperm donation Getting paid for what youre 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 weeksDonating my eggs seemed the best way of paying back our good fortune. I had a friend who went through several unsuccessful fertility treatmentsI thought, Im suitable for this. I can help change someones life. Source: National Gamete Donation Trust, 2011 Slide 31 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 Slide 32 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 donors selling tool is her brains and her beauty [] bottom line, everyone wants either someone thats either very attractive, someone very healthy, and someone very bright OvaCorp donor manager: She has a really good background. Seedefinitely, its not for the money. She makes 65 grand a year. Great height and weight. Obviously, Hispanic [] Shes Caucasian enough, shes white enough to pass, but she has a nice good hue to her if you have a Hispanic couple Source: Almeling, 2007 Slide 33 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 Slide 34 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 Slide 35 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 Its 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