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Ageing and Reproductive Decline in Assisted Reproductive Technologies in India: Mapping the ‘Management’ of Eggs and Wombs

Abstract

In this paper, I discuss the ethical underpinnings to the anthropological analysis of age and reproductive decline in the ‘management’ of infertility, by suggesting that assisted reproductive technologies (ART) ‘use’ age and reproductive decline to further endanger women’s bodies by subjecting it to disaggregation into parts that do not belong to them anymore. Here, the category of age becomes a malleable concept to manipulate women seeking fertility management. In ethnographic findings from two Indian ART clinics, amongst women aged between 20 and 35 years visiting an IVF/ART clinic in Hyderabad city in South India, and women above 50 years of age visiting an IVF/ART clinic in Hisar in North India—reproductive bodies are similarly disaggregated. In case of younger women, the treatment is fixated on rescuing eggs that may be in ‘decline’, and in case of older women, the aim is to engineer a viable pregnancy. Thus, the constant focus on eggs and wombs in infertility treatment creates a body that is not only not whole but also completely without agency. Age becomes a category that has rhetorical value to ‘push’ or persuade women into particular forms of fertility management through infertility medicine. I undertake a problematization of the egg and the uterus through the identification of the recurring motif of the menstrual cycle within IVF treatment to suggest that bodily holism is not part of ART discourse that unethically thrives on promoting technological intrusions to promote its use and normalization.

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Data and materials of the research can be obtained upon reasonable request via the corresponding author.

Notes

  1. I use ‘egg’ instead of ovum/oocyte, as many of my respondents have identified it as the ‘egg’ in their interviews.

  2. The difference between the egg ‘provider’ and egg ‘donor’ is a new form of distinction that was brought into effect to identify those women who provide their eggs in exchange of compensation; and those who donate them such as relatives and friends (without any exchange of compensation). Though in Elizabeth Roberts’ (2012) ethnography of IVF in Ecuador female relatives may ‘gift’ eggs to their childless relatives in exchange for financial support.

  3. The decline in egg quality can be seen via an ultrasound scan and are measured quantitatively through the ovarian reserve test.

  4. Even though recent studies suggest that a changing lifestyle wherein the environment, sedentary living and unhealthy eating is impacting men and women’s reproductive bodies—the idea of an egg reserve itself comes under scrutiny. Despite 2 years of unprotected sexual intercourse, and an age at which a woman is still deemed fertile, depleting ovarian reserves become indicators of failing fertility.

  5. In Egypt, according to Marcia Inhorn (1994, 257), ‘The most common ovarian cause of anovulation is the polycystic ovary syndrome (PCO), a condition of self-perpetuating, chronic anovulation. PCO, in fact, represents a complex ovulatory dysfunction involving the hypothalamus, pituitary, ovaries, adrenal glands, and peripheral adipose (fatty) tissues, all contributing to an endocrine imbalance usually associated with infrequent ovulation, hirsutism (excessive, male pattern hair growth), the growth of multiple “follicles” (cysts) on the ovaries, and infertility’

  6. The pregnancy is also an important part of the script in Hyderabad, amongst the visibly ‘younger’ women visiting the clinic for fertility treatment. However, many of the narratives of birthing here were also stories of miscarriages and abortions, and for the desire to carry their foetus.

  7. Sama’s report suggests that a majority of IVF pregnancies result in caesarean sections. This is validated by research findings from my fieldwork as well. Especially in the case of older women, Dr Anuj insisted on a caesarean.

  8. Inhorn (1994) mentions that Egyptian women would translate complex medical diagnosis in their own language to make meaning out of an otherwise alien treatment protocol.

  9. In the ethnographic fieldwork, there was very little mention of prenatal testing of babies for Down’s or other genetic disorders that may be passed through the elderly parents. Often such tests would cost more money, and the risk of losing the precious pregnancy through the amniocentesis meant that many couples would prefer to forego such testing. However, one man in his mid-fifties whose wife gave birth to their son at 45 via IVF, mentioned that their doctor in an adjoining state, insisted on conducting an amniocentesis, saying: ‘I cannot give you a child who has any disability’.

References

  • Andrews, Lori B. 1995. Beyond Doctrinal Boundaries: A Legal Framework for Surrogate Motherhood. Virginia Law Review 81 (8): 2343.

  • Bharadwaj, Aditya. 2003. Why adoption is not an option in India: the visibility of infertility, the secrecy of donor insemination, and other cultural complexities. Social Science & Medicine 56 (9): 1867–1880. https://doi.org/10.1016/S0277-9536(02)00210-1.

  • Bledsoe, Caroline H. 2002. Contingent lives: fertility, time, and aging in West Africa. Chicago: University of Chicago Press.

  • Cannell, Fenella. 1990. Concepts of parenthood: the Warnock Report, the Gillick debate, and modern myths. American Ethnologist 17 (4): 667–686. https://doi.org/10.1525/ae.1990.17.4.02a00040.

  • Chien, Li-Wei, Heng-Kien Au, Jean Xiao, and Chii-Ruey Tzeng. 2002. Fluid accumulation within the uterine cavity reduces pregnancy rates in women undergoing IVF. Human Reproduction 17 (2): 351–356. https://doi.org/10.1093/humrep/17.2.351.

  • Cohen, L. 1998. No aging in India: Alzheimer’s, the bad family, and other modern things. Berkeley: University of California Press.

  • Cooke, Lynne, and Scott M. Nelson. 2011. Reproductive ageing and fertility in an ageing population. Obstetrician and Gynaecologist 13 (3): 161–168. https://doi.org/10.1576/toag.13.3.161.27668.

  • Crampton, Alexandra. 2013. Population aging as the social body in representation and real life. Anthropology & Aging 34 (3): 100–112. https://doi.org/10.5195/aa.2013.11.

  • Daly, Irenee, and Susan Bewley. 2013. Reproductive ageing and conflicting clocks: King Midas’ touch. Reproductive Biomedicine Online 27 (6): 722–732. https://doi.org/10.1016/j.rbmo.2013.09.012.

  • Franklin, Sarah. 2002. Embodied Progress: a cultural account of assisted conception. London: Routledge.

    Book  Google Scholar 

  • Friese, Carrie. 2015. When research bleeds into real life: Studying reproductive ageing while ageing reproductively. Somatosphere, 4 November 2015. http://somatosphere.net/2015/11/when-research-bleeds-into-real-life-studying-reproductive-ageing-while-ageing-reproductively.html. Accessed 23 Mar 2016.

  • Friese, Carrie, Gay Becker, and Robert D. Nachtigall. 2008. Older motherhood and the changing life course in the era of assisted reproductive technologies. Journal of Aging Studies 22 (1): 65–73. https://doi.org/10.1016/j.jaging.2007.05.009.

  • Fruzzetti, Lina, and Ákos Östör. 1976. Seed and earth: a cultural analysis of kinship in a Bengali town. Contributions to Indian Sociology 10 (1): 97–132. https://doi.org/10.1177/006996677601000104.

  • Inhorn, Maria C. 1994. Quest for conception: gender, infertility and Egyptian medical traditions. Philadelphia: University of Pennsylvania Press.

  • Inhorn, Maria C., and Daphna Birenbaum-Carmeli. 2008. Assisted reproductive technologies and culture change. Annual Review of Anthropology 37: 177–196. https://doi.org/10.1146/annurev.anthro.37.081407.085230.

  • Kahn, Susan M. 2000. Reproducing Jews: a cultural account of assisted conception in Israel. Durham: Duke University Press.

  • Lamb, Sarah. 2000. White saris and sweet mangoes: Aging, gender, and body in North India. Berkeley: University of California Press.

  • Lock, Margaret M. 1994. Encounters with aging: Mythologies of menopause in Japan and North America. Berkeley: University of California Press.

  • Lock, Margaret M. 2007. The final disruption? Biopolitics of post-reproductive life. In Reproductive Disruptions: Gender, Technology and Biopolitics in the New Millennium, edited by Marcia C. Inhorn, 200-224. New York: Berghahn Books.

  • Mac Dougall, Kirstin, Yewoubdar Beyene, and R.D. Nachtigall. 2012. Age shock: misperceptions of the impact of age on fertility before and after IVF in women who conceived after age 40. Human Reproduction 28 (2): 350–356. https://doi.org/10.1093/humrep/des409.

  • Majumdar, Anindita. 2014. Nurturing an alien pregnancy: surrogate mothers, intended parents and disembodied relationships. Indian Journal of Gender Studies 21 (2): 199–224. https://doi.org/10.1177/0971521514525087.

  • Majumdar, Anindita. 2018. The rogue doctor: imagining legitimacy in assisted conception in India. Presented at Remaking Reproduction: The Global Politics of Reproductive Technologies. Reproductive Sociology Group, Department of Sociology, University of Cambridge, UK, 27–29 June 2018.

  • Markens, Susan, 2007. Surrogate motherhood and the politics of reproduction. Berkeley: University of California Press.

  • Martin, Emily. 2001. The woman in the body: a cultural analysis of reproduction. Boston: Beacon Press.

  • Martin, Lauren J. 2010. Anticipating infertility: egg freezing, genetic preservation, and risk. Gender & Society 24 (2): 526–545. https://doi.org/10.1177/0891243210377172.

  • Matsuo, Mizuho. 2019. Living with bodily contingency: pregnancy loss among childless women in West India. Paper presented at the 11th INDAS International Conference “Life and Death in Contemporary South Asia”, 14-15 December 2019, Kyoto, Japan.

  • Pande, Amrita. 2009. “It may be her eggs, but it’s my blood”: Surrogates and everyday forms of kinship in India. Qualitative Sociology 32 (4): 379–397. https://doi.org/10.1007/s11133-009-9138-0.

  • Patel, Tulsi. 2006. Fertility behaviour: population and society in a Rajasthan village. New Delhi: Oxford University Press.

  • Qadeer, Imrana, and Mary E. John. 2009. The business and ethics of surrogacy. Economic and Political Weekly 44 (2): 10–12. https://www.epw.in/journal/2009/02/commentary/business-and-ethics-surrogacy.html. Accessed 19 Dec 2020.

  • Rao, Hitender. 2015. Haryana’s per capita income tops charts, thanks to Gurgaon, 5 other districts. Hindustan Times, 3 March 2015. https://www.hindustantimes.com/chandigarh/haryana-s-per-capita-income-tops-charts-thanks-to-gurgaon-5-other-districts/story-4Bqn4HWeHnDul0bw1ewtQK.html.

  • Roberts, Elizabeth F. S. 2007. Extra embryos: the ethics of cryopreservation in Ecuador and elsewhere. American Ethnologist 34 (1): 181–199. https://doi.org/10.1525/ae.2007.34.1.181.

  • Roberts, Elizabeth F. S. 2012. God’s laboratory: assisted reproduction in the Andes. Berkeley: University of California Press.

  • Sama. 2010. Constructing Conceptions: The Mapping of Assisted Reproductive Technologies in India. New Delhi: Sama–Resource Group for Women and Health.

  • Sanabria, Emilia. 2016. Plastic bodies: sex hormones and menstrual suppression in Brazil. Durham: Duke University Press.

  • Sarojini, Nadimpally, Vrinda Marwah, and Anjali Shenoi. 2011. Globalisation of birth markets: a case study of assisted reproductive technologies in India. Globalization and Health 7 (1): 27. https://doi.org/10.1186/1744-8603-7-27.

  • Schermer, Maartje H. N., and F. W. Jozef Keulartz. 2002. How pragmatic is bioethics? In Pragmatist ethics for a technological culture, edited by F. W. Jozef Keulartz, Michiel Korthals, Maartje H. N. Schermer, and Tsjalling E. Swierstra, 41–68. Dordercht: Springer.

  • Shirai, Chiaki. 2019. Genetic ties and affinity: Longitudinal interviews on two mothers’ experiences of egg donation in Japan. East Asian Science, Technology and Society 12: 299–315. https://doi.org/10.1215/18752160-6995912.

  • Unnithan-Kumar, Maya. 2003. Spirits of the womb: migration, reproductive choice and healing in Rajasthan. Contributions to Indian Sociology 37 (1–2): 163–188. https://doi.org/10.1177/006996670303700108.

  • Vadlapatla, Sribala. 2019. Telangana’s per capita income touches Rs 2 lakh, grows 13.8%. Times of India, 10 September 2019. https://timesofindia.indiatimes.com/city/hyderabad/states-per-capita-income-touches-rs-2l-grows-13-8/articleshow/71056196.cms. Accessed 15 Oct 2020.

  • van de Wiel, Lucy. 2014. For whom the clock ticks: reproductive ageing and egg freezing in Dutch and British news media. Studies in the Maternal 6 (1): 1–28. https://doi.org/10.16995/sim.4.

  • Wahlberg, Ayo. 2018. Good quality: the Routinization of sperm banking in China. Berkeley: University of California Press.

  • Weigel, Moira. 2016. The foul reign of the biological clock. The Guardian, 10 May 2016. https://www.theguardian.com/society/2016/may/10/foul-reign-of-the-biological-clock.

  • Wellmann, Janina. 2017. The form of becoming: embryology and the epistemology of rhythm, 1760–1830. Boston: MIT Press.

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Acknowledgements

A version of this paper was presented at the international conference on ‘Reproduction, Demography and Cultural Anxieties in India and China in the 21st Century’ held in February 2020 at the Department of Humanities and Social Sciences, Indian Institute of Technology Delhi. I would like to thank Wellcome UK for their generous support of my fieldwork in North India, and the Indian Council of Social Science Research (ICSSR) for supporting the research in Hyderabad. I would like to thank Mounika Pellur for assisting in data collection in Hyderabad. Many thanks to Ravinder Kaur and Paro Mishra for their insightful comments on the paper; and to the anonymous peer reviewers for helping in restructuring the paper.

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The research was funded by Wellcome UK, and by the Indian Council of Social Science Research.

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Correspondence to Anindita Majumdar.

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Majumdar, A. Ageing and Reproductive Decline in Assisted Reproductive Technologies in India: Mapping the ‘Management’ of Eggs and Wombs. ABR 13, 39–55 (2021). https://doi.org/10.1007/s41649-020-00161-z

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Keywords

  • Infertility
  • Assisted reproductive technologies (ART)
  • India
  • Reproductive ageing
  • Fertility