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

Asian Bioethics Review volume 13, pages 39–55 (2021)Cite this article

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’.

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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.

Funding

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

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  1. Department of Liberal Arts, Indian Institute of Technology Hyderabad, Kandi, Telangana, India

    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