Science, Medicine & Health

IVF and Assisted Reproduction: Why a Global History?

The discipline of history is closely bound up with the history of the nation-state. For centuries, to write history was to write national history. In recent decades there have been challenges to the writing of national histories. One challenge has taken the form of global history, whereby local and national histories are understood as being embedded in global processes. A similar challenge has been posed by transnational history, which focuses on the flows and connections between different national and local histories. Both of these approaches informed our writing of the history of in vitro fertilisation (IVF) and assisted reproduction.

We knew that the history of IVF had to be informed by these global and transnational perspectives, but we also had to find ways of connecting the intimate experiences of conception, gestation and parturition with these global processes. For this reason, we first produced an edited collection on the global reproductive industry with the subtitle, Intimate Experiences and Global Processes, with an introduction which referred to ‘the body and the globe’ in order to focus attention on questions of scale: intimate, embodied, personal, local, national, regional, transnational and global. Chapters in this collection analysed a range of case studies from the intimate scale of personal memoirs to the global scale of the routes of reproductive travel. We then embarked on writing our global history.

We can date the history of IVF to two events in 1978 – the birth of Louise Brown in the United Kingdom and the birth of Kanupriya Agarwal (then known as ‘Baby Durga’) in India. In the four or so decades since then, around ten million babies have been born through IVF and associated technologies. Assisted reproduction is a global industry which involves the movement of gametes, embryos, babies, commissioning parents, gestational carriers, medical practitioners, scientists, finance, and capital across national borders.

The birth of Louise Brown at Oldham General Hospital in Manchester in 1978 may have initially seemed like quite a local and intimate affair. Patrick Steptoe (1913–1988), Robert Edwards (1925–2013) and Jean Purdy (1945–1985) were a team which facilitated Louise’s birth to a married couple resident in the area. Louise was born from the gametes of her parents Lesley and John Brown, from an embryo which was implanted into Lesley’s womb after fertilisation ex utero. Similarly, Subhas Mukhopadhyay (1931–1981) and his team facilitated Kanupriya Agarwal’s birth to a local married couple –Prabhat and Bela Agarwal – at the Bellevue Nursing Home in Calcutta (present-day Kolkata).

Well before the first IVF-conceived births in the United Kingdom and India in 1978, medical practitioners and scientists in places such as the USA, Australia, France and Japan were also undertaking research which contributed to the development of IVF.  These teams included practitioners from gynecology, embryology, clinical medicine, endocrinology, reproductive physiology and developmental biology, who were already integrated into globalising circuits of power and knowledge. Both Steptoe and Edwards spent time in the USA; Mukhopadhyay had undertaken doctoral research at the University of Edinburgh; and several other members of IVF teams moved internationally. When Tōhoku University practitioners in Japan were setting up their embryo research ethics protocols they travelled to Melbourne to learn about the procedures carried out at Monash University. Tōhoku University, in turn, hosted a series of international visitors. The State of Victoria was one of the first jurisdictions to regulate IVF, and legal scholars travelled there to learn about the legal situation.

Scientists and clinicians communicated internationally through conferences, workshops and professional journals. After Steptoe, Edwards and Purdy moved their IVF practice to Bourn Hall Clinic (near Cambridge) in 1980, they held regular meetings there with international practitioners from 1981.

Attendees at the world’s first international IVF conference, Bourn Hall, 1981. Wikimedia Commons

Successful IVF-conceived births were achieved in the United Kingdom (1978), India (1978), Australia (1980), the USA (1981), France (1982), Israel (1982), Japan (1983), Germany (1983), Singapore (1983) and other places. Patients then started to move across national borders to seek treatment. Bourn Hall in Cambridge and the Royal Women’s Hospital and hospitals linked to the Monash University program in Melbourne attracted prospective parents from around the world – at least among those who could afford international travel and the fees for medical treatment. In most cases prospective parents travelled to one of these clinics for treatment, and then returned to their home countries for the birth.

IVF was closely associated with techniques such as artificial insemination by donor (AID), which had been practised for decades. Artificial insemination by donor allowed the separation of conception from the act of copulation. IVF made possible the separation of conception and gestation. Freezing technologies made it first of all possible to transport sperm across national borders, then embryos and eventually ova (which were more difficult to freeze). This allowed for providers of gametes, gestational carriers and intending parents to be separated in time and space, in turn making possible the transnational reproductive industry. Cheaper and more accessible air travel also facilitated access to cross-border reproductive treatment. These assisted reproductive technologies also made it possible for those outside the heteronormative nuclear family – unmarried couples, single people, gays, lesbians and transgendered individuals – to become parents.  It also became possible to gestate babies conceived from the gametes of a deceased person, or gestate an embryo conceived by genetic parents who are now deceased.

From this time the intimate processes of conception and gestation were integrated into global processes. We can thus say that the development of the global reproductive industry was coterminous with the processes of globalisation, which involved new communications technologies, improved transportation techniques, increased access to international air travel and the movement of elite professionals such as medical practitioners and scientists across borders. Clinics like the Bourn Hall Clinic and Monash IVF now have international branches. The International Federation of Fertility Societies estimates that assisted reproduction is available in 132 countries around the world. International investment advisors expect that the global fertility services market will go beyond US$25 billion by 2026. This global medical industry is supported by ancillary industries in pharmaceuticals, legal services and other intermediaries.

The advent of the internet has facilitated international advertising on the part of assisted reproductive services clinics, communication between prospective parents and clinics and agencies, the sale and purchase of gametes across national borders, and the commissioning of surrogacy agreements. A prospective parent can browse on-line catalogues of providers of sperm or ova from all over the world. The internet has also facilitated more grassroots peer-to-peer communication between those considering embarking on assisted reproduction, purchasing gametes or entering into gestational surrogacy agreements.

The need for a global perspective is apparent when we see the complex family trees of babies born through transnational assisted reproduction. The documentary Google Baby depicts an Israeli agent who procures ova from women in the USA, sperm from the intending fathers in Israel, has the ova fertilised in India and gestated by an Indian woman. This specific scenario is no longer possible as India now has strict regulation of assisted reproduction and restricts it to Indian nationals. The stories of such babies as those depicted in Google Baby cannot be encompassed in a national history.

Recent years have seen moves towards more openness in matters of adoption and gamete provision. In some jurisdictions – like Australia or New Zealand – adoption and sperm donation were originally conducted under conditions of secrecyand anonymity. It is now possible for children to seek information about their birth parents or gamete providers when they come of age. There has also been a movement for transnational adoptees to seek out information about their birth parents – with varying degrees of success. The rift between intimate experiences and global processes will become apparent when the children of the cross-border reproductive industry try to trace their roots. How will they be able to trace their ancestry when they are descended from anonymous gamete providers on an on-line catalogue, or when their parents purchased ova or sperm from anonymous providers and entered into a contract with a woman who provided gestational labour?

We need to pay attention to global processes to understand the destinations of reproductive travel. Some intending parents will travel to places where they are permitted to access techniques that are not permitted to them in their place of residence; where costs are more affordable; or where, in the case of surrogacy, they can obtain a birth certificate that identifies them as the sole legal custodians.  These choices are made in a globe which is riven by structured inequalities. These inequalities inform who sells gametes or gestational labour and who purchases these ‘goods and services’.

A global perspective is also necessary in order to understand shifts in the destinations for cross-border reproductive travel. Tightening of regulation in India or Thailand affects not only those nation-states, but also neighbouring nation-states which (sometimes briefly) become destinations. It also informs the movements of clinicians who may cross borders in order to perform procedures not allowed in the country of their main practice, and gestational surrogates who may cross borders to undergo the implantation of an embryo and cross back in order to give birth. In other words, a global perspective is necessary in order to understand why the destinations from cross-border reproductive travel shifted from India and Thailand, for example, to places such as Nepal and Laos.

To think about history in global terms is to think about mobility. We need to ask who and what moves; what are the reasons for this mobility; what are the routes of mobility; and what are the limits of mobility. The limits of mobility have been brought home, for example, by the travel restrictions prompted by the global COVID-19 pandemic. To write a global history is to pay attention not just to temporalities, but also to spatialities, mobilities, structured relationships of inequality, and questions of scale. All of these perspectives were necessary in writing the global history of IVF and assisted reproduction.

Vera Mackie, Sarah Ferber and Nicola J. Marks are in the School of Humanities and Social Inquiry at the University of Wollongong in Australia. They are the authors of IVF and Assisted Reproduction: A Global History (Palgrave Macmillan 2020) and the editors of The Reproductive Industry: Intimate Experiences and Global Processes (Lexington 2019). This research was supported by Australian Research Council Discovery Project No 150101081. Vera Mackie tweets as @veramackie.

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