It was not that long ago that “test tube babies” only existed in science fiction. I remember my shock when, in 2007, one of my students at Wellesley College told me that she was an IVF (in vitro fertilization) baby. “The technology couldn’t be that old, could it?” I thought. In The Pursuit of Parenthood: Reproductive Technology from Test-Tube Babies to Uterus Transplants, historian Margaret Marsh and OBGYN Wanda Ronner demonstrate that IVF — in which an ovum or ova are removed via surgery from a woman’s ovaries, fertilized with sperm in a petri dish, and the resulting embryo or embryos are reimplanted in her uterus — has long since come of age, and deserves historical analysis. The sisterly duo present a lively, panoramic history of IVF and its associated reproductive technologies and social arrangements.
For anyone who has closely followed the news about IVF since the birth of the first “test-tube baby” Louise Brown in 1978, many of the stories in The Pursuit of Parenthood will be familiar. The book highlights much of the iconic news coverage of those whose pregnancies represented scientific advances or legal controversies. These stories from published newspaper and magazine reports, engaging in the re-telling, are deepened by interviews Marsh and Ronner conducted with many of the scientists and clinicians who were central to the development of IVF. With their combined expertise and access as historian and physician, Marsh and Ronner are able to add a valuable layer of practitioners’ perspectives to the publicly available sources.
Marsh and Ronner’s U.S.-centered history begins with Dr. John Rock’s efforts in the 1940s to help his patients at his infertility clinic at the Free Hospital for Women in Brookline, Massachusetts. The first part of the book, a narrative of the scientific and medical development of IVF, is one with many heroes and a few rogues. Rock (the focus of one of the authors’ previous excellent co-authored histories) and Miriam Menkin, Rock’s research technician, who actually achieved the first recorded human fertilization outside the body, make for engaging heroes to launch the narrative. Marsh and Ronner weave the stories of the researchers who developed IVF with the perspectives of women who wrote to Rock hoping his science might help them get pregnant, introducing the interplay between researcher-physicians and potential patients from the beginning of their story. It would take until 1978 for Louise Brown’s birth, though Marsh and Ronner intriguingly discuss some possible earlier undocumented successes. The possibility that some practitioners performed IVF out of the spotlight is a good reminder that innovation and documentation are not the same thing, and when a medical procedure as intimate and potentially controversial as IVF is at issue, innovations may significantly precede documentation.
While the first part of the book describes the development of the science and reactions to it in the popular media, the second part focuses on the development of a large-scale industry of assisted reproduction in the United States, and especially its evolution from a few university clinics to a large number of for-profit infertility centers by the 2010s. This discussion of the organization and financial structure of the industry is important. IVF broke new ground not just in how families came to be made, but in how Americans organized a form of health care that offered radical new treatments in for-profit, almost entirely unregulated settings. Marsh and Ronner describe how every attempt to regulate the new, highly-profitable industry was hamstrung by cultural divides over the moral and legal status of human embryos and the proper way to make families.
The third part of the book focuses on ethical conundrums that arose out of the new technologies, and legislative debates about embryo research and regulation of new reproductive technologies. Was it okay to sell sperm and eggs? If both of those were acceptable, was it also permissible for a clinic to create embryos from purchased gametes and offer them in a catalog? What would happen to superfluous embryos created during the IVF process? Could they be donated for research? Could embryos be created for research? Who had decision-making and custody rights over pregnancies and the resulting children in surrogate arrangements, in which a woman contracted to gestate a pregnancy for another would-be parent? These were not just theoretical concerns; Marsh and Ronner address these questions and more in the context of real-life scenarios from the 1980s forward.
Throughout the book, Marsh and Ronner ask where public opinion stood on the new reproductive practices. It seemed to sway back and forth, between optimism and queasiness. In the early days of IVF experimentation, post-war excitement about science and technology, and the generalized yearning for a renewal of private family life, lent a rosy filter to the possibility of IVF. This technological vision was challenged, though, largely by Catholic-led conservatives concerned over non-traditional modes of family building and the potential destruction of embryos, but also by some feminists who felt the technology was dehumanizing and forced women into childbearing no matter the toll it might take. Periodic headlines about “Test Tube Babies” evoked Frankenstein and Brave New World. The 1980s backlash against 1970s feminism mostly favored the development of IVF, as the conservative impulse proved to be more dominated by pro-natalism than by a longing for the purity of coitus-initiated pregnancy.
Marsh and Ronner describe Great Britain’s development of a government-orchestrated cultural consensus around the new technologies and the implementation of regulations to enforce the consensus. They lament that the cultural divide over abortion politics in the US seems to drive us further and further from the possibility of a uniform set of national standards and regulations. They acknowledge, though, that practitioners are wary of new regulation in the current political climate.
I, for one, am not eager for new national regulations of IVF at a time when conservatives in power are bent on deregulating industry and re-regulating women’s bodies and LGBTQ people’s lives. Most conservatives are not eager to push regulations at the moment, either; strict interpretation of conservative dogma concerning embryos would interfere with most assisted reproduction, and too many conservative voters feel morally justified using IVF to build their families. I see more likely possibilities in some of the quasi-regulatory phenomena that Marsh and Ronner describe as part of both earlier and recent attempts to bring some oversight to IVF.
Marsh and Ronner describe two mechanisms that have been successful in reining in at least some of the excesses of the IVF industry in the absence of comprehensive regulation like Great Britain’s: transparency and self-regulation. In 1992 Representative Tom Wyden crafted legislation to require clinics to publish their success rates, and it received bi-partisan support. As a result, prospective clients have the data to assess for themselves whether a clinic is likely to help them have a baby. Transparency should be extended throughout the workings of IVF clinics. Women who are deciding whether to freeze their eggs, donate eggs, or serve as surrogates should have clear and complete information about the risks and expected benefits of these procedures.
Transparency is also a potent prod for clinics to self-regulate. The public should know exactly what procedures are offered at clinics, so that community pressure can be brought to bear on clinics that most obviously breach ethical boundaries. And professional associations such as the American Society for Reproductive Medicine can publish guidelines for ethical practice and refuse to certify clinics that do not follow them. Over the past several years, this kind of self-regulation was effective in pressuring clinicians to stop transferring multiple embryos. This dramatically reduced the proportion of IVF pregnancies that resulted in twin and triplet births, which frequently compromise the health of mother and babies alike. Regulation via transparency and self-regulation may be piecemeal and inadequate, but we can at least do a bit better by making the most of them.
Marsh and Ronner bring their history of IVF right up to the present, and lay out the conundrums we will face in the near future. In contemplating the medical, social, and moral arrangements we will make as a society around IVF, it is crucial that we take into consideration the history they so ably teach us.