The Business of Being Made: Exploring the Production of Temporalities in Assisted Reproductive Technologies

Abstract

As with other forms of biotechnology, assisted reproductive technologies (ARTs) have become a normative part of women's reproductive health care with critical impact on women's subjectivities. Yet as these technologies have proliferated, feminist and cultural theories have taken up the challenges of theorizing the subjectivities produced through these interventions, while psychoanalysis has remained relatively mute, and certainly uncritical. This article uses interview research conducted by a psychoanalyst with women and men who went through some form of ART. Of particular interest is the creation of liminal and asynchronous temporalities that situate people in spaces marked by a particular futurity of being “not yet pregnant.” Within this uncertainty, temporal forms of affect regulation emerge for self-preservation, especially for survivors of sexual trauma, for whom ART interventions and a “confusion of tongues” surrounding them can be profoundly retraumatizing.

Notes

¹IVF stands for in vitro fertilization. The process involves controlling a woman's hormonal cycle in order to predict ovulation. Eggs are harvested and joined with sperm in a lab setting. If the eggs are successfully fertilized, a certain number of embryos will be chosen to be implanted back into the woman's uterus. Any remaining viable embryos are usually frozen for future procedures. IUI—interuterine insemination—is a form of insemination where the sperm is injected into the uterus. Hormones to control a woman's ovulation can be paired with it but they are not necessary. Usually some form of ovulation monitoring is done in order identify the optimal time for insemination.

²In general fertility statistics are messy at best. According to Twenge (2013), most stats used in current studies are actually based on French population studies from 1670 to 1830. The difference in pregnancy rates at age 28 versus 37 is only about 4 percentage points. As she reports, data culled from a Danish study on women who had at least one child demonstrate no decline in fertility from the 20 s to the 40 s.

³Each person participated in an interview lasting approximately 1–2 hr. The interview protocol focused on general questions about reproductive history; decision making around ARTs; experiences with ARTs; and when relevant, questions about how they decided to stop treatments.

⁴This patronizing attitude insults the choices these women make and of course in the case of animals, it renders illegitimate the genuine care and ethical treatment of animals, reinforcing and condoning neglect of animals when the “real thing” finally comes along. Additionally, such compensatory behaviors are not used to describe childless men's behaviors (Cain, 2001; i.e., there is not the gender equivalent of the “crazy cat lady”).

⁵The organized critiques of ARTs that do exist originate in other countries, in particular the United Kingdom and Australia, home to the organization Feminist International Network of Resistance to Reproductive and Genetic Engineering (FINNRAGE). FINNRAGE calls for doctors to explore environmental causes of infertility and seek nonbiological interventions to infertility. They see ARTs as producing “mother machines” (Corea, 1985), “test tube women,” and “living laboratories” (Klein, 1989). Of the feminist critiques, they alone discuss overpopulation as a central concern fueling resistance to ARTs.

⁶This approach avoiding intervention with men is uniquely Western. In Chinese medicine, for example, there are detailed diagnoses and multiple different interventions for male infertility (Ann Vitolo, personal communication, November 3, 2009).

⁷As noted previously (Gentile, 2010), this liberation is exemplified in the movie of P. D. James's book The Children of Men from 1992. In the book humans have lost the capacity to reproduce because adult men are unable to produce sperm. Men's bodies are subject to monthly monitoring by the state in hopes of finding sperm. In the book men's bodies are the objects of regular medical surveillance. In the movie released in 2006, this central plot was changed making women infertile. Few if any reviewers discussed this major plot change. Clearly there is a cultural tendency to turn our collective heads to disavow the vulnerabilities of the phallus/male body.

⁸For instance, whereas other countries have equated selling eggs to selling organs and thus rendered it illegal, the United States has not, so international brokers can pay unlimited fees for designer eggs. As more donor eggs become available the price increases, not decreases, because the market has begun to differentiate eggs with “ideal” qualities. Here people do not purchase sperm or eggs, they purchase the qualities of the donor that match those they want their child to have (Spar, 2006). The fact that genes need to be activated by an environment is not considered. The hormone market too is another booming success with 75% of sales being total profit, around $390 million annually (Spar, 2006). Medical profits alone are estimated to be about $3 billion per year and this does not include profits made by consultants, therapists, lawyers, equipment suppliers, or laboratory workers separate from the office. According to Spar (2006) the only aspect of the ART market that has remained stable is that of surrogacy but only because there is a large supply of poor women in the United States and in developing countries who are willing to serve as inexpensive surrogates. Gestation, the cheapest form of labor, is that conducted outside the lab and purview of the doctor. Additionally, reproductive labor is developing similar to other transnational systems of women's labor such as domestic, sexual, and maternal, and these spheres are fluid in that women in one often migrate from one to another (Cooper, 2008).

⁹Medical costs for twins are 3 times that of single babies for first 5 years (Mundy, 2008). In 2004 12.5% or 1 in 8 of all live births were premature, a 33% increase in the past 30 years. The average premature baby costs $42,000, a significant increase of health care costs, and 20% have severe learning disabilities; 45% need special education. In 2003 there were more triplet births than ever before, rising from an average of 37 to 200 per 100,000 births at a cost of more than $500,000 per baby (p. 217).

¹⁰Ironically ARTs emerged out of experiments and protocols used with farm animals, in particular breeding cattle—meat—using superovulation, IUI, and forms of IVF (Corea, 1985).