Assisted Reproductive Technology and sociology

Approximately 11% of women in the United States between the ages of fifteen and forty-four have difficulty conceiving a child due to the infertility of one or both of the partners. Many of these couples turn to assisted reproductive technology as a potential way to help them have a child. Reproductive technology is the use of medical techniques to enhance fertility and increase the probability of conceiving a child. Methods of reproductive technology include artificial insemination, gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), surrogacy, and zygote intrafallopian transfer (ZIFT). Although these technologies offer hope, they also are expensive, can cause psychological harm, and are often not successful. Feminists in particular are concerned about the social and psychological ramifications of assisted reproductive technology on women, and see their use as a way to reinforce traditional gender roles and expectations and for women to give up their power and control over their own bodies. More research is needed to better understand the psychosocial effects of assisted reproductive technologies on infertile couples in general and women in particular.

Keywords Artificial Insemination; Cloning; Ethics; Feminism; Gamete Intrafallopian Transfer (GIFT); Gender Role; Gender Stratification; Genetic Engineering; Intracytoplasmic Sperm Injection (ICSI); In Vitro Fertilization (IVF); Infertility; Reproductive Technology; Society; Surrogate Mother; Zygote Intrafallopian Transfer (ZIFT)

Family & Relationships > Assisted Reproductive Technology

Overview

Infertility is the inability to get pregnant after trying for one year. It has been estimated that approximately 11% of women in the United States have difficulty conceiving a child. According to the Centers for Disease Control and Prevention, in 2013, approximately 6 percent of married women between the ages of fifteen and forty-four in the United States are unable to get pregnant after a year of unprotected sex. Previously, this usually meant that the couple would continue to try by natural means to have a child or make the decision to adopt or remain childless. However, medical science has advanced to the point where a number of technologies are available that can help women conceive. These assisted reproductive technologies comprise the use of medical techniques to enhance fertility and increase the probability of conceiving a child. Methods of reproductive technology include artificial insemination, gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), surrogacy, and zygote intrafallopian transfer (ZIFT). The use of assisted reproductive technology becomes increasingly important as greater numbers of women postpone childbearing.

Artificial Insemination & In Vitro Fertilization

Two of the most widely known methods of assisted reproductive technology are artificial insemination and in vitro fertilization. Artificial insemination is a medical or surgical procedure in which a catheter is used to deposit sperm collected from a donor directly into the uterus of the woman trying to become pregnant. As with unassisted reproduction, artificial insemination often needs to be repeated before pregnancy occurs. In vitro fertilization, on the other hand, is a laboratory procedure in which an egg is removed from a woman's body, fertilized with donated sperm, and transferred to the woman's uterus to begin pregnancy. The externally fertilized egg does not need to be transplanted immediately, but may also be cryogenically frozen for future use. In vitro fertilization literally means fertilization that takes place "in glass" (i.e., a Petri dish) as opposed to in vivo fertilization that takes place in a live organism. In vitro fertilization is often combined with drug therapy to increase the probability of the woman conceiving. Zygote intrafallopian transfer is an in vitro fertilization technique in which the egg and sperm are combined in a laboratory and the fertilized eggs (i.e., zygotes) are implanted into the woman's fallopian tubes. Gamete intrafallopian transfer is an artificial reproductive technique in which eggs and sperm are directly injected into a woman's fallopian tubes. Gamete intrafallopian transfer is an alternative to in vitro fertilization. In vitro fertilization can also be used to create a baby that is gestated by a surrogate mother. This is a woman who fulfills the basic functions of a biological mother in gestating and bearing a child, but not the social role of mother in rearing the child after birth. In particular, a surrogate mother is a woman who gestates an artificially inseminated egg and gives birth to a baby for another.

In vitro fertilization In vitro fertilization increases the probability of multiple births. For example, between the years of 1980 and 1998, the rate of triples or larger multiples increased 420% (Schaefer, 2002). In 2011the twin birth rate was 8.1 percent; the rate for triplets or a higher-order multiple birth rate was 137 per 100,000. Although some couples readily embrace the idea of multiple births, not all do and not all are financially able to support and raise the potentially large multiples of children that can result from in vitro fertilization. Despite the old adage that two can live as cheaply as one, multiple babies require similar multiples for food, clothing, health care, education, and other needs. In addition, in vitro fertilization itself is a costly and time consuming process. In 2012, according to the American Society for Reproductive Medicine, it was estimated that the cost of in vitro fertilization is approximately $12,400 per procedure without any guarantee of success. This makes in vitro fertilization an option only for those who can afford the costs. Conflict theorists in particular note that women in lower economic strata are unable to afford these treatments although they are typically allowed access to low cost contraception.

Cloning & Genetic Engineering

Fertilizing an egg with a sperm is not the only type of reproductive technology, however. Advances in cloning technologies and genetic engineering may offer those wishing to have children other options in the near future. Cloning is the process of making a genetically identical copy (i.e., a clone). When applied to human beings for the purposes of creating a new human being, cloning is typically referred to as human cloning or human reproductive cloning. Human cloning is of great ethical concern to most observers. According to the American Medical Association, cloning may someday be a viable reproductive technology requiring minimal genetic input from another person (AMA, 1999). However, at this time the techniques used in human cloning could potentially endanger the developing fetus. Somatic cell nuclear transfer has not been refined nor yet proven to be safe in the long term. In addition, it is expected that there would be a high miscarriage rate from the transplantation of cloned fetuses. Further, the state of the art in cloning technology is such that the risk of developmental anomalies precludes the use of cloning as a reproductive technology at this time. However, even if all the technological difficulties are resolved, human cloning is thought to be potentially harmful to individuals from a psychosocial perspective. There are thirteen US states—Arkansas, California, Connecticut, Iowa, Indiana, Massachusetts, Maryland, Michigan, North Dakota, New Jersey, Rhode Island, South Dakota, and Virginia—that have bans on reproductive cloning.

Another technology that shows promise for use in assisted reproduction in the future is genetic engineering. This comprises a set of techniques by which the genetic contents of living cells are directly and intentionally altered. Genetic engineering can be used to modify existing genes or to introduce new material from another organism. Genetic engineering is used for a number of purposes, including attempts to modify defective human cells in an effort to treat certain genetic diseases. Many observers have serious ethical concerns about genetic engineering in general, and with the application of genetic engineering to humans in particular. For example, the use of genetic technology could potentially lead to the creation of "designer babies" which have been genetically manipulated to have higher IQs or various other desired physical or personality traits. This could lead to increasing disparity between the upper and lower classes, a situation of questionable ethics.

Further Insights

Infertility is considered by most observers to constitute a major life crisis. The question, however, is why this is so. Although in the recent past, many in the medical community believed infertility to be a psychological problem in most cases, today it is believed that infertility stems from physiological causes. As such, infertility has been medicalized, as has many routine situations experienced by women: dysmenorrheal (painful menstruation), premenstrual syndrome, pregnancy, and childbirth. Although on the one hand this means that pain may be controlled and the health and safety of both mother and child better ensured during gestation, labor, and delivery, on the other hand, many feminist theorists dislike this trend, believing that it views the natural processes of the female body as things needing medical intervention in the same way as do diseases and illnesses.

The medical community tends to define the problem of infertility in narrow terms, focusing almost exclusively on the clinical aspects of the problem including immediate causes (e.g., endometriosis, pelvic scarring, low sperm count) or those things that led to the immediate causes (e.g., postponement of childbearing until the thirties, sexually transmitted diseases). To infertile patients, however, the nature of the underlying physiological cause is irrelevant: the real problem is the inability to conceive and bear a child. It has been frequently noted that infertile couples often have an aura of desperation or obsession when it comes to having a child of their own. For the infertile patient, infertility often brings with it a feeling of helplessness and loss of control over one's own body. For many infertile couples, raising a child is in and of itself (e.g., through adoption) an insufficient solution to the problem: the central issue is having a child that is biologically one's own.

Feminists, however, take one of two different approaches to defining the role of assisted reproductive technology in a woman's life. Some feminists view assisted reproductive technologies as a way to reinforce traditional views that stress the importance of bearing children as part of a woman's role and depreciate the value of women who are not mothers. This traditional approach has been long used as a way to limit the opportunities of women in society (particularly at work), and is seen to be reinforced by the emphasis by the medical community on assisted reproductive technology for infertile couples. In addition, some feminists believe that the contemporary emphasis on assisted reproductive technology shifts the locus of control for conception from the woman and to the physician. These observers believe that this may harm women collectively even while it helps women individually. From this perspective, the problem of infertility lies not in the inability of a woman to bear a child but in the expectations of a society that view childbearing as necessary for a woman's fulfillment and shift in control and power from women to their physicians.

Surgical Intervention

As advances in medical technology have given physicians greater options for the treatment of infertility, the medical community has tended to respond to cases of infertility with technological solutions with an emphasis on surgical intervention. In this rush to apply technology, however, psychosocial factors are often ignored. To infertile couples, however, reproductive technology not only offers the hope of a solution to the problem of fertility, it also brings with it further tests, surgery, and expense, all without guarantee of success. This often leads to further stress on the couple. However, most people who turn to reproductive technology view it as a way of taking control over their lives rather than passively accepting their fate. However, reproductive technology treatments can drag out the situation almost indefinitely, and the couple needs to continually make decisions about whether or not to undergo further treatments. This can intensify the stress under which they must live. Many feminists are also concerned over the fact that assisted reproductive technology — like ultrasound, fetal monitoring, and other procedures related to the childbearing process — have become to be thought of as routine. Even when it is the male who is infertile, the woman must bear the burden of undergoing treatments. Further, in vitro fertilization is much more likely to result in an ectopic pregnancy than pregnancy reached without technological assistance. This situation can be life-threatening to the woman and further decrease her chances of conceiving in the future.

Viewpoints

Psychological Effects

To those women who want a child of their own, the fact of infertility can be psychologically devastating. Fertility specialists recognize the fact that there are significant psychological and social factors coexisting with the physiological aspects of infertility, and include professional counseling as part of the process. Frequently, it is the male in the relationship who is less willing to consider adoption as a viable option for the couple's fertility issue. However, it is the woman who is must bear the brunt of invasive medical procedures. Assisted reproductive technology treatments can affect may of the important aspects of a couple's life, including their intimate relationship, their relationships with friends and family, and even their relationships at work. For example, some infertile individuals find it difficult to be around couples who are pregnant or have small children. Similarly, parents or parents-in-law who question the couple about grandchildren or want to know all the details of the procedures and their progress can put strain on the individuals and their relationship. In fact, infertile individuals often feel isolated, resentful, or angry, a situation that results in them cutting themselves off from the very support network of friends and family that could help them through the trying time.

In addition, an infertile couple may put many other things on hold while waiting to conceive. For example, women (or men who will stay home with the hoped-for child) may turn down promotions, take less demanding jobs, or make other career decisions based on the possibility of a child in the future. Depending on the length of time that one sidetracks one's career, it may be difficult if not impossible to achieve one's career goals later. Similarly, one or both of the individuals may forgo pursuing higher education that might make them more marketable because they want to have sufficient time to spend with the hoped-for child. Couples may postpone other decisions as well, including whether or not to buy a house or move to another neighborhood because of the different needs for schools, home size, and other considerations that are important to a family with children that are not important to a childless couple. Feminists also note that women who undergo often unsuccessful procedures using reproductive technology experience not only the stress of the treatment but the psychological pain related to their inability to mean the social expectation of fulfilling perceived women’s roles. As a result, rather than helping these women, assisted reproductive technology actually may increase their suffering and give them unnecessary physical pain.

Other Social Implications

In some ways, infertility is a medical problem that may sometimes be solved through the application of new reproductive technologies such as in vitro fertilization. However, there are significant psychological and social aspects of infertility as well. Many individuals see reproduction as a biological imperative and believe it necessary to contribute their DNA to the gene pool. Yet in many ways, this attitude is the result of socialization. Feminist theorists in particular speak out against this view of infertility.

In addition, although physiological in nature, infertility has social antecedents as well. For example, the decision to put off conception and childbearing until the woman is in her 30s as well as social mores regarding premarital sex may increase the probability that a couple is unable to conceive a child without a technological assist. Further, even when a couple has decided that they wish to have nontraditional gender roles (for example, a stay-at-home father), other members of their social circle may have different opinions (e.g., friends with children, parents who want grandchildren) that — whether consciously or unconsciously — put pressure on the couple to have a child of their own. In addition, traditional gender roles and expectations often make women in particular feel like personal failures if they are unable to conceive and bear a child of their own.

Assisted reproductive technology is much more than a medical procedure. Although physicians and medical personnel may look at such technology from a purely clinical point of view, the issue of assisted reproduction is emotionally wrought for most couples who choose to undergo such procedures. The length and invasiveness of the procedures typically increase the stress in the couple's life, and may place strain on the marriage as well as cause them to question their own self-worth. Research into the psychological and sociological aspects of assisted reproductive technology is needed to better understand how infertility affects both the individual partners and their marriage.

Terms & Concepts

Artificial Insemination: A medical or surgical procedure in which a catheter is used to deposit sperm collected from a sperm donor directly into the uterus. Artificial insemination may need to be repeated before pregnancy occurs. (Also referred to as intrauterine insemination.)

Cloning: The process of making a genetically identical copy (i.e., a clone). When applied to human beings for the purposes of creating a new human being, cloning is typically referred to as human cloning or human reproductive cloning. Human cloning is of great ethical concern to most observers.

Ethics: In philosophy, ethics refers to the study of the content of moral judgments (i.e., the difference between right and wrong) and the nature of these judgments (i.e., whether the judgments are subjective or objective).

Feminism: An ideology that is opposed to gender stratification and male dominance. Feminist beliefs and concomitant actions are intended to help bring justice, fairness, and equity to all women and aid in the development of a society in which women and men are equal in all areas of life.

Gamete Intrafallopian Transfer (GIFT): An artificial reproductive technique in which eggs and sperm are directly injected into a woman's fallopian tubes. Gamete intrafallopian transfer is an alternative to in vitro fertilization.

Gender Role: Separate patterns of personality traits, mannerisms, interests, attitudes, and behaviors that are regarded as "male" and "female" by one's culture. Gender role is largely a product of the way in which one was socialized and may not be in conformance with one's gender identity.

Gender Stratification: The hierarchical organization of a society in such a way that members of one gender have more access to wealth, prestige, and power than do the members of the other gender.

Genetic Engineering: Techniques by which the genetic contents of living cells are directly and intentionally altered. Genetic engineering can be used to modify existing genes or to introduce new material from another organism. Genetic engineering is used for a number of purposes, including attempts to modify defective human cells in an effort to treat certain genetic diseases. Many observers have serious ethical concerns about genetic engineering in general, and the application of genetic engineering to humans in particular.

In Vitro Fertilization (IVF): A laboratory procedure in which an egg is removed from a woman's body, fertilized with donated sperm, and transferred to the woman's uterus to begin pregnancy. The externally fertilized egg does need to be transplanted immediately, but may also be cryogenically frozen for future use. In vitro fertilization literally means fertilization that takes place "in glass" (i.e., a Petri dish) as opposed to in vivo fertilization that takes place in a live organism.

Infertility: The physiological inability or diminished ability to conceive and produce offspring. Infertility is sometimes defined as the inability to conceive after a year of regular intercourse without contraception. The inability to produce offspring may be due to fertility in the male or female partner or in both partners.

Intracytoplasmic Sperm Injection (ICSI): A laboratory process used in cases of male infertility in which a sperm is directly injected into an egg to achieve fertilization.

Reproductive Technology: The use of medical techniques to enhance fertility and increase the probability of conceiving a child. Methods of reproductive technology include artificial insemination, gamete intrafallopian transfer (GIFT), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), surrogacy, and zygote intrafallopian transfer (ZIFT). (Also referred to as assisted reproductive technology.)

Society: A distinct group of people who live within the same territory, share a common culture and way of life, and are relatively independent from people outside the group. Society includes systems of social interactions that govern both culture and social organization.

Surrogate Mother: A woman who fulfills the basic functions of a biological mother in gestating and bearing a child, but not the social role of mother in rearing the child after birth. In particular, a surrogate mother is a woman who gestates an artificially inseminated egg and gives birth to a baby for another. (Surrogate mothers are also referred to as gestational carriers.)

Zygote Intrafallopian Transfer (ZIFT): An in vitro fertilization technique in which the egg and sperm and combined in a laboratory and the fertilized eggs (i.e., zygotes) are implanted into the woman's fallopian tubes.

Bibliography

American Medical Association. (1999). The Ethics of Cloning. Retrieved 8 October 2008 from: http://www.ama-assn.org/ama1/pub/upload/mm/369/report98.pdf.

Centers for Disease Control and Prevention (2008). Assisted Reproductive Technology. Retrieved October 8, 2008 from http://www.cdc.gov/ART/.

Kissil, K., & Davey, M. (2012). Health disparities in procreation: Unequal access to assisted reproductive technologies. Journal Of Feminist Family Therapy, 24, 197–212. Retrieved November 4, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=79291822

Neyer, G., & Bernardi, L. (2011). Feminist perspectives on motherhood and reproduction. Historical Social Research, 36, 162–176. Retrieved November 4, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=59158768

Schaefer, R. T. (2002). Sociology: A brief introduction (4th ed.). Boston: McGraw-Hill.

Silva, S., & Machado, H. (2011). The construction of meaning by experts and would-be parents in assisted reproductive technology. Sociology Of Health & Illness, 33, 853–868. Retrieved November 4, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=65246605

Strickler, J. (1992). The new reproductive technology: Problem or solution? Sociology of Health and Illness, 14 , 111-132. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=11007191&site=ehost-live.

Suggested Reading

Beckman, L. J. & Harvey, S. M. (2005). Current reproductive technologies: Increased access and choice? Journal of Social Issues, 61 , 1-20. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=16009083&site=ehost-live.

Bos, H. M. W., & van Rooij, F. B. (2007). The influence of social and cultural factors on infertility and new reproductive technologies. Journal of Psychosomatic Obstetrics and Gynecology, 28 , 65-68. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=25228057&site=ehost-live.

Byfield, J. (2001). How slippery the slope. Report/Newsmagazine (National Ed.), 28 , 54. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=5595085&site=ehost-live.

Donchin, A. (1989, Fall). The growing feminist debate over the new reproductive technologies. Hypatia, 4 , 137-149. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=8843477&site=ehost-live.

Hastings Center. (2003). International regulation of reproductive genetics. Hastings Center Report, 33 , S15-S17. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=10622659&site=ehost-live.

Morreale, M., Balon, R., Tancer, M., & Diamond, M. (2011). The impact of stress and psychosocial interventions on assisted reproductive technology outcome. Journal Of Sex & Marital Therapy, 37, 56–69. Retrieved November 4, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=57225772

Nelson, H. L. (1995). Dethroning choice: Analogy, personhood, and the new reproductive technologies. Journal of Law, Medicine and Ethics, 23 , 129-135. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=9509151942&site=ehost-live.

Simpson, B. (2013). Managing potential in assisted reproductive technologies. Current Anthropology, 54(Supp 7), S87–S96. Retrieved November 4, 2013 from EBSCO Online Database SocINDEX with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=90400100

Snowden, R. (1998). Psychosocial discontinuities introduced by the new reproductive technologies. Journal of Community and Applied Social Psychology, 8 , 249-259. Retrieved October 3, 2008 from EBSCO online database Academic Search Premier: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=11819979&site=ehost-live.