Abstract
In The Pursuit of Parenthood: Reproductive Technology from Test-Tube Babies to Uterus Transplants, Margaret Marsh and Wanda Ronner deliver an in-depth look at the history of infertility treatments and technology. This book condenses decades of scientific research, experimentation, successes, and failures into a portrait of the doctors and patients who changed the face of parenthood. The book provides the milestones of the journey toward assisted reproduction. The book features each of the researchers and doctors whose work proved pivotal with detailed histories. It also provides the social landscape that shaped access to treatment and research. Intertwined are stories of women’s struggle to conceive.
Along with a preface, introduction, and appendix, the book is arranged into eight chapters. Within this structure, Marsh and Ronner provide a mix of personal stories of infertility struggles, historical details, statistics, quotes, and analysis. The introduction sets the stage for the book’s purpose and aim. The authors explain the current state of infertility research: The National Institutes of Health remain prohibited from funding grants for projects where an embryo would be destroyed. This means that research of that nature is privately funded. The authors explain that “the inability of the United States to develop a coherent national policy on these new reproductive technologies ultimately led to a research and clinical free-for-all” (p. 7). This lack of consensus means we have “by default agreed to let the market determine” which technologies get developed, who uses them, and how (p. 8). Most chapters open with the tale of one woman’s infertility story and then moves into a deep dive into the background of the fertility specialist featured.
In the first chapter, “Test Tube Babies Just around the Corner,” the authors detail the background and work of John Rock, a figure of stature in the history of infertility research. A key point of this chapter is how Rock’s empathy and respect for the women who participated in his research shaped his work. The authors include excerpts of letters written to Rock by women desperate to become mothers. Marsh and Ronner explain the specific sociohistorical circumstances that dictated social response to infertility research. In the climate of men returning from war anxious to start families, “few Americans doubted” that infertility treatments would be used to do anything except “promote the public good” (p. 24). However, the public’s opinion of infertility treatments waxed and waned with the times. This chapter tells the story of Miriam Merkin, a woman whose hopes for earning a PhD in biology took a backseat to financially supporting a husband in medical school and having two children of her own. Her contribution to Rock’s work remains substantial. So much so, Rock insisted she be listed as first author on their 1948 article, and he unsuccessfully lobbied Harvard to consider their research as her dissertation so she might be awarded her PhD.
Chapter 2, “From First Dream to First Baby,” centers its discussion on the work of Patrick Steptoe and Robert Edwards, which resulted in the first baby conceived using in vitro fertilization (IVF). At this time, public support of infertility technology declined. The prevailing attitude of the 1970s toward infertility treatments built on challenging the idea that women should want children. The authors explain that during this time period, women expressing upset at infertility woes were met with comments that the world was overpopulated or that pregnancy was an unpleasant experience. The popularity of the birth control pill, couples choosing childlessness, the constitutional right to an abortion, and a focus on women’s careers meant that many felt ambivalence about techniques such as IVF. Researchers in the field sometimes faced accusations that they “trampled on ‘the sanctity of life’” or that they were performing “immoral experiments on the unborn” (p. 46).
The third chapter, “IVF Comes to America,” unpacks the experience of Georgeanna and Howard Jones and their fateful intersection with a young Robert Edwards, which shifted the nature of their work. This shift met much resistance, with abortion opponents crying, “Why in a world full of unwanted babies would we want to make new ones in a laboratory?” (p. 60). A Virginia state legislator even introduced a bill intended to limit IVF research. Yet the need outpaced the opposition. As the Joneses awaited opening their new clinic, more than 2,500 infertile couples asked for their help. The authors point out that without the unqualified support of Mason Andrews and his considerable political clout, as well as the “freedom and institutional backing” of Eastern Virginia Medical School, their success would never have happened (p. 63). The success of the Joneses led other researchers around the country to undertake IVF, as well. The costs of IVF increased beyond the median income, yet patients continued to pay for the opportunity to undergo experimental procedures and take unproven medications. Patients were both patient and research subject.
The fourth chapter, “From Miracle Births to Medical Mainstream,” centers on the doctors and programs of the 1980s. The authors use Philadelphia as a template of trends. At this time, doctors pioneering IVF shared techniques and collaborated to solve problems via phone calls and conference meetings.
Chapter 5, “The Elusive Search for National Consensus,” examines the pronatalism of the 1980s. Magazines warned of the infertility epidemic while laying the blame at the feet of “liberalized sexual attitudes” (p. 102), which they posited led to pelvic inflammatory disease and delayed childbearing. Alongside this alarm, they warned high-achieving, educated women of a “man shortage” and claimed that waiting to lock down a husband might result in never getting married at all. While neither assertion proved true, these notions so thoroughly embedded themselves into the culture of the 1980s, interest in marriage and parenthood returned in a big way. The backlash against the feminism of the 1970s came swiftly and pervasively. The narrative that staying home and being supported by a man functioned as female empowerment proved salient. Men became “less likely than women to support” equality (p. 104). The chapter moves on to examine the attempts to legislate reproductive treatment and technologies. Without regulation, IVF became available nationwide by the end of the decade with state pressure for insurance companies to cover the costly procedures.
Chapter 6, “A Lot of Money Being Made,” opens by detailing the allegations against Ricardo Asch, who fled the United States to avoid arrest. Asch stood accused of stealing eggs from one patient to impregnate another, among other things. As Asch treated IVF as a business, he enjoyed a lavish lifestyle. After Asch fled from the United States, he practiced in Mexico City. The chapter delves into how an unregulated industry with explosive growth created opportunities for fraud and unethical behavior. The chapter ends with a discussion of attempts to regulate the industry.
Chapter 7, “Beyond Infertility,” explains how the use of donor eggs became mainstream. This chapter and the next discuss how assisted reproduction changed in the twenty-first century. The authors point out that when IVF originally came to the United States, faculty members served as the doctors performing the procedures. Their “excitement of discovery” and “satisfaction of helping a group of patients who had all but given up hope for a baby” as well as mastering new techniques and blazing a new frontier (p. 150) created an atmosphere of everyone being in it together. But by 2015, infertility treatments functioned as a nearly $4 billion enterprise. Today’s reproductive medicine operates in the private sector rather than the academic one. Surrogacy, donor eggs and donor sperm (or even the sale of those materials), freezing eggs, and genetic testing all comprise the current landscape of assisted fertility.
The final chapter, “Can the Wild West of Reproductive Medicine Be Tamed?,” opens with a discussion of the now infamous “Octomom.” The doctor who implanted her 12 embryos lost his license for negligence. But Octomom delivered eight babies all the same. Unemployed, she and her six other IVF-conceived children lived with her parents. Octomom tried to use her children to propel her into celebrity. While the story horrified many, other instances of doctor negligence exist. The authors detail the long history of warnings against multiple births, which are dangerous for both mothers and babies. This chapter also discusses surrogacy, compensated egg and sperm donors, and older mothers seeking assisted reproduction. Further, they discuss again the ways the costs of treatment make help inaccessible for many. The chapter ends with the authors encouraging regulation of the industry.
This book provides a thorough history of assisted reproduction. The text would be most appropriate for a graduate-level course on family or counseling. While accessible to undergraduates, many may find the text dry and too detailed to hold their interest. The book could be used in a Sociology of Families course, a Social Problems course, Social Inequalities, or a Gender course. Important to note: Page 6 features the incorrect term “transgendered couples.” Any instructor using the text should make a point to address this. The book could be used either in its entirety or as individual chapters.
This book could be paired with David Artavia’s (2020) “Is There New Hope for Trans Men Trying to Give Birth?,” Annah Fromberg’s (2020) “Ben Had No Idea His Father Was a Sperm Donor—40 Years Later He Met His Half-Sister,” and Melissa Cunningham’s (2020) “‘Completely Unfair’: More Pain for Would-Be Parents as Victorian IVF Reforms Delayed.” Students working in pairs or groups could explore this topic, analyze media examples, and then contribute to a larger class discussion of the ways reproductive technologies come to bear on our ideas of family as well as the ways regulation and social attitudes impact access. The book could also pair well with Maybe Baby (O’Rourke 2007), a documentary detailing the experience of a group of single women “past their reproductive prime” who “give up looking for Mr. Right and settle for Mr. Right’s DNA.” With its focus on assisted reproduction, The Pursuit of Parenthood is a useful resource for students to examine inequality, shifting social attitudes, and parenthood.