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

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

3. 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

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

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

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

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 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

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

9. Source: HFEA Website

10. Stages of Treatment, ‘Fresh’ IVF
2009 HFEA Data

11. 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

12. Funding IVF: England
NICE 2004: Recommends up to 3 cycles on NHS if woman aged 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

13. 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

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

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’

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

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

18. 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

19. 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’

20. 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

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….

22. 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

23. ‘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)

24. 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

25. 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 )

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 4th IVF cycle, Testimony on HFEA web-site)

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

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)

29. Opposition to Egg Donation
Hands Off Our Ovaries (Pro-life/anti-abortion)
No2eggsploitation (Pro-choice)

30. 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

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

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 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

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

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

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
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