IVF and assisted reproduction: A global history. Ferber, S, Marks, NJ., Mackie, V 2020. Singapore: Palgrave Macmillan. ISBN: 978-981-15-7895-3

IVF and Assisted Reproduction: A Global History by Sarah Farber, Nicola J. Marks and Vera Mackie (Palgrave, 2020) covers almost 100 years of the history of in-vitro fertilization (IVF) throughout the world. In little over 300 pages, the authors take us to different periods and places to see how IVF developed in different contexts. They focus on how IVF was thought of as a biological technology useful for reproductive matters, as a research tool, and even as a tissue-generating procedure. Throughout the book's seven chapters the authors touch upon a wide spectrum of aspects that make up this technology: from the technological to the commercial, from the emotional to the political and economic, and from the intimate to the public. They also point out when, how and why certain debates emerged and were settled and how these debates shaped IVF as a technology and as a business. Each of the seven chapters has a rich section of references and notes that are very much worth looking at in detail.

The first chapter, IVF and Assisted Reproduction: Global Visions, Local Stories, sets the tone and perspective of the book. It begins by stating that, not one, but two children were born in 1978 after separate successful IVF procedures. One of these was the well-known Louise Brown, born on the 25 July at the Oldham hospital in the UK as the result of the work done by Jean Purdy, Patrick Steptoe and Robert Edwards (the British team). The second was the less well known Kanupriya Agarwal, born on the 3 October in India as the result of the work done by Subhas Mukerji, Sunit Mukherjee and Saroj Kanti Bhattacharya (the Indian team). Beginning the book with these two births is indicative of the authors’ intention to offer a global history and not the anglo-centered story where the UK, Australia and the USA are at the center of the narrative. This chapter also sets out the politics of the book by offering a brief, yet concise, overview of the political discussions that have taken place within the milieu of reproductive studies. For example, in Words Unsaid, they discuss the ways of naming actors and relations and the politics behind these names; in Rights and Needs the reflection is around the difference between the right to form a family or to healthcare, and the need to have a child; and in The Power of Analogy, they discuss the different ways in which assisted reproduction has been framed.

In the second chapter, Towards the Two 1978 Births, the authors delve deeper into the stories of the two teams that achieved the first IVF birth: the British team and the Indian team. They also address the many actors and actions that were needed to make IVF technologically possible, imaginable and acceptable. They describe the disciplines involved, the materials, tools and techniques employed, the imaginaries created and invoked, the national paths, priorities and contexts, the political and ethical issues that had to be sorted, created, assembled and dealt with in order to assemble the British and Indian 1978 births, and to frame the UK one as ‘the first’ and the Indian one as ‘doubtful’. The end of this chapter is heartbreaking, it summarises what the chapter is about: 'These differences between Edwards and Mukerji and the contexts in which they were working partly explain why in the end Louise Brown’s birth was accepted contributing to Edward’s Nobel Prize, but Kanupriya Agarwal’s was not, contributing to Mukerji’s suicide.' (p.53)

This chapter looks at how IVF was made technologically possible. It comments on the different disciplines, laboratories, financing bodies, scientists, physicians, patients and philanthropists who participated in the research and development of this technology. Rather than focussing solely on the hegemonic narrative where Edwards and Steptoe are depicted as the principal, almost heroic, creators of this miraculous technology, they show that there were also many groups of scientists, located in many different places, with many sources of funding (or lack thereof), using different variations of the technique, who all contributed to the development of the industry. One of the take-home reflections in this chapter is that, while the first birth could equally have happened in India, Australia, France or the USA, where an achievement takes place matters, since not all places are viewed in the same light.

The chapter also explores how IVF was made imaginable. The authors highlight that, contrary to what one might think, IVF was not originally conceived as a technique exclusively for aiding in cases of female infertility due to tubal obstruction. Edwards’ main goal, according to RBMS co-editor, Martin Johnson, was to use IVF as a way to avoid the transmission of genetic diseases and it was not until he met Steptoe, who was concerned with infertility, that he took on the goal of using IVF as a way of dealing with infertility: “… in 1965, Edwards suggested 11 uses for IVF, only one of which directly related to infertility treatments.” (Johnson in Farber, Marks and Mackie, 2020:43). This part of the story reminds us that technologies encompass the visions and goals of a variety of actors and that these contribute to the shaping of the technology. This chapter also looks at how public perception was influenced by the way in which the media engaged with this biotechnology, presenting an array of narratives that span from the utopian to the dystopian. The different discourses and imaginaries that have surrounded the technology, since before it was technologically possible, have offered the 'vocabulary through which consumers read, hear and make sense of their own experience using the stories of others' (Farber, Marks and Mackie, 2020:9). Moreover, these imaginaries have also helped other actors and the world more generally, to imagine assisted reproduction and its possibilities1.

The third chapter, The Foundations of Global Assisted Reproduction, looks at the birth of a global assisted reproduction enterprise, the emerging sense of group and professional identity and the intersection of the practice of IVF with national population policies. It takes the reader to the first Bourn Hall2 Meeting, an invitation-only meeting that gathered 25 clinicians from the UK, USA, Australia, Austria, Switzerland, Sweden, Germany and France – note the absence of the Indian team. One of the aims of the gathering was to discuss ovarian stimulation, which was one of the aspects in which the teams made variations to the process. At that time, some teams would induce the maturation of more than one egg, then fertilize them and freeze them, while others would work with natural cycles, hence one single egg per attempt. The chapter then covers the story of the two leading medical associations – the European Society of Human Reproduction and Embryology (ESHRE) and the American Society of Reproductive Medicine (ASRM) – their meetings and journals (Fertility and Sterility and Human Reproduction, respectively). If the book is aiming at offering a global story, then this chapter has one shortcoming: the authors fail to mention the associations that exist outside the USA and Europe – for example, RedLara, the Latin American medical association established in 1992 which has also been important in the shaping of IVF in Central and South America. In this chapter, the authors also discuss the media responses to the growing industry of IVF and talk about the role played by pharmaceutical companies, financing bodies, professional associations and national population policies in the shaping of this enterprise.

In Regulation and Risk, the fourth chapter, the authors tell us about how rules and regulations have been created, negotiated and renegotiated to allow or prohibit certain practices and how these efforts have shaped not only IVF as a procedure, but the entire assisted reproduction enterprise. These negotiations have implied changing the definition of certain terms and the invention of new ones, for example: syngamy, pre-embryo and fertilized egg. The chapter focuses mainly on four regulatory objectives: who is allowed to use assisted reproduction, how to license practitioners, how to regulate gamete donation, and what can be done with embryos that will no longer be used by those who created them (i.e. can they be used for research, how long can they remain frozen, should they be donated). The authors also point out how certain topics have simply remained off the discussion table – for example, there is very little regulation addressing the emotional and financial risks patients face due to the misleading information about assisted reproduction success rates (Farber, Marks and Mackie, 2020:113).

While the vast majority of countries with IVF facilities (80%) have some sort of relevant legislation, regulation or both, these can be very different from one place to the next. In contrast to the previous chapter, this one offers a glimpse of what has happened outside the anglosphere. Although the chapter focuses mostly on the legislative and regulatory history of the UK (the Warnock report), Australia (Waller) and the USA, it also addresses how regulation has been carried out in other places such as in Egypt, China, Japan, and Italy. The chapter shows how some governments seek to come up with a minimalist and secular set of rules and regulations that are perceived as reasonable and logical, capable of dealing with issues of inheritance, adultery, parent liability, medical malpractice and birth legitimacy (Farber, Marks and Mackie, 2020:115). Others aim at creating a system for overviewing the safety and quality of the work of IVF providers (through regular reviews, monitoring and licensing), limiting third party participation (surrogacy and gamete donation), banning experimenting on or intervening in the embryo, and creating registries of births after gamete donation (Farber, Marks and Mackie, 2020:117). Given that each of these countries has different religious compositions, the chapter also points out the different ways in which reproduction and religion intersect.

This chapter also addresses the ongoing problem of producing too many multiple births and of how attention to success rates, and the unstandardized way of reporting these, are also shaping practice. Through the chapter they point out some of the efforts to change this. They mention how some places are trying to ensure a single-embryo-transfer practice and having insurance companies pay for multiple cycles by redefining what a cycle means. With regards to success rates, the chapter ends on a hopeful note, stating that ESHRE has recently started working towards a definition of success that will ensure that well-credentialed journals work with 'a recognised set of criteria for “success” in evaluating submissions on assisted reproduction-related subjects' (Farber, Marks and Mackie, 2020:139).

Regulation is the difficult task of presenting almost impossible questions to a panel of experts from different fields, who are frequently ontologically incommensurable, and then asking them to reach some sort of consensus or agreement. At this panel one commonly finds representatives of the religious realm focusing mostly on the embryo, the secular realm concerned with civil and political matters like parentage and identity, the medical realm interested in being left alone to work, the feminist activist realm defending women and their rights, and only in certain cases, the patient’s realm interested in having a healthy child. Often in these discussions the concerns of men and the wellbeing of children are under-addressed.

In Oocytes, Surrogacy and Cross-Border Reproduction, the fifth chapter, the authors offer the latest academic discussions, feminist debates, and legal frameworks regarding these issues. Put simply, the discussions navigate around the question of allowing the intervention of a third party, either by using donated eggs or surrogacy, and if these options should be offered and used with or without payment. In a context where blood and organs are not sold but freely, anonymously and voluntarily donated, how should oocytes circulate between bodies? As commodities or as gifts? Should surrogacy be paid for as any other work or is it a voluntary service? How should we deal with these issues if procedures like IVF commonly involve people from different geographical locations, in different economic and legal conditions, in unequal power relations, with different moral and religious ideas and restrictions, and with no international protection or regulation?

In contrast to what we see in the different promotional practices carried out by fertility clinics, such as the use of patients’ anecdotes with happy endings and pictures of smiling babies held by scrub-dressed doctors standing next to proud parents, when it comes to depicting surrogacy, it is the scandalous stories that frequently make the news and thus strongly shape the way surrogacy is narrated. Although the involvement of a third party in the reproduction process (by providing the oocyte or the womb) is a practice that has taken place for a long time, the current involvement of third parties has taken a strong commercial twist, now involving intermediaries, agencies, and citizenship laws. The chapter recounts iconic scandalous cases of cross-border surrogacy where the main concern is the abandoned babies and babies without citizenship. These cases serve as instances to reflect on how reproduction is not ‘only’ biological but, in fact, very much social.

The use of third party oocytes has come a long way: from being a donation practice (during the 1980s), to a sharing practice (during the 1990s), to a sellers’ and buyers’ market (during the first decades of the 2000s), to maybe a manufacturers’ market in the future with the creation of in-vitro gametes (discussed in the last chapter). These different practices have, obviously, different medical, social, emotional and legal implications. In the stage we are in – the market of gametes – profiling the donor has become the norm and anonymity still remains a question: should children, when adults, be able to access the details of those who provided the gametes for their conception? (Farber, Marks and Mackie, 2020:166).

The sixth chapter, Testing Boundaries, Finding Limits, explores several instances where boundaries and limits are being drawn and erased. As has been discussed in many articles and books (Franklin, 1997, Thompson, 2005, Birenbaum-Carmeli and Inhorn, 2009, Whittaker, 2015, Van de Wiel, 2020) assisted reproduction decoupled reproduction from sex and fragmented the reproductive process in discrete moments that can now be manipulated (e.g. ovarian stimulation, gamete in-vitro maturation and manipulation, embryo transfer and implantation). This has allowed for new uses, new users and new controversies, which has changed notions of what can be done and what (we think) should be done. This chapter looks at all of these. It starts off by talking about the experience of facing infertility, particularly when the person is single or within a same sex relationship, and the implications this has in different countries; it then moves on to the emerging practice of freezing eggs for future use; then to the controversial use of IVF by older women; and then to the use of frozen gametes or embryos in cases in which one or both of the intended parents have died. The fourth point in this chapter is male infertility, which I find odd: why is the discussion of male infertility in a chapter discussing boundaries and limits? Male infertility has been the under-diagnosed (yet, equally prevalent) cause for which many women visit clinics year in and year out, it is not a new limit nor is it a tested boundary. Male infertility is, as the authors state, a stigmatized, growing condition that remains overlooked (see for example Inhorn, 2012, Almeling, 2011, Almeling, 2020). The following section talks about intracytoplasminc sperm injection (ICSI) and how it has become a standard practice in many places, and about the latest add-ons (such as fertility measurement, PGT-A, killer cells). Most of the topics addressed in this chapter point towards the commercialization of assisted reproduction, the expansion of the usability of the different assisted reproduction techniques, and the lack of scientific evidence to support their claimed advantages. The chapter closes with the difficult question: when to stop? This has been a recurrent ethnographic theme, worked on by many scholars in the field of reproductive studies.

In the final chapter, Thresholds of the Future: New Directions in Assisted Reproduction, the authors present the latest in the field, from a technological point of view: creating gametes in vitro and taking them to space to test their viability, embryo selection and design through gene editing with CRISPR, mitochondrial transplant, pre-implant diagnosis and preconception screening, new ways of developing embryos in artificial wombs (ectogenesis), sex-less reproduction, and low cost IVF (e.g. the Walking Egg Project). All of these technologies and services are thought of as ways of attracting more users, both within and beyond the framework established by the diagnosis of infertility.

This book can be of interest to a wide audience. It can be thought of as a handbook since it offers concrete information about the field of assisted reproduction across the globe, information useful to those who are new to the field of reproduction studies and also to those more established. It also works as a reference book, since it takes the reader on a quick journey through many different places, highlighting the main aspects of each stop but not necessarily delving into them in detail. Particularly interesting and worth not skipping is the book’s extensive and well commented set of references for each chapter. Here the reader will find an extensive list of scholarly literature, references to fiction and to international media coverage. In this sense, one can consider this book as a literature review focused on the history of IVF across countries and complemented with interviews and research carried out by the authors. It also works as a case study book. The historical perspective of the book spans from the early 1960s right through to the near future, signaling successes and failures as well as controversies and scandals, all of which are presented with a degree of detail useful for courses concerned with the ethical, philosophical and social science aspects of reproductive technologies. Finally, the book is innovative in that, although it focuses mostly on the anglo context, it does look at what has happened in Asia and Latin America, highlighting how these sites have also contributed to the making of a global history of assisted reproduction and a global reproductive ecology.