̽��ֱ�� of Cambridge - Reprosoc

Egg freezing: An empowering option for women?

fpjl2 — Mon, 17 Nov 2014 10:41:39 +0000

Recently, Facebook and Apple announced their decision to offer to pay for female employees to freeze their eggs, in theory, allowing women to ‘have it all’ - to pursue their career aspirations and to have biologically related ‘children’. ̽��ֱ��announcement by these companies has generated much international debate about social egg freezing itself, and the companies’ offer. While proponents of social egg freezing argue that it is liberating for women, opponents contest that the technology provides an individualist solution to a social problem.

In October 2012, the American Society for Reproductive Medicine declared that egg freezing should no longer be considered experimental. As a young woman scholar of assistive reproductive technologies I have spent much time considering the debates in favor and opposing this technology.

Much of what has been written about egg freezing has come from women, often older, with families, and more established in their careers. Along with three other scholars of assistive reproductive technologies, Alana Cattapan, Lesley Tarasoff, and Jennie Haw, we sought to explore this question regarding the empowerment of these technologies, and to offer our perspective, as women at whom these types of technologies are directed. Coinciding with the media reports about Apple and Facebook was the publication, in the International Journal of Feminist Approaches to Bioethics (IJFAB), of a piece we wrote that arose from our discussion and debate of the topic.

In the article, we combine our personal experiences with our collective academic knowledge and reflections to challenge the promotion of social egg freezing on a number of grounds. Social egg freezing has been largely lauded for its potential on the basis that it enables women to ‘have it all’, by allowing them to focus on their careers and have children later on. This, however, is a tremendous oversimplification of the real world challenges of working in increasingly competitive environments. This individual ‘solution’ to social reasons for delayed childbearing takes the focus away from much needed structural change surrounding childbearing and parenthood in the workplace and home. While Apple and Facebook’s offer to pay for egg freezing makes it accessible for their female employees, it should not be forgotten that these are expensive technologies that are inaccessible to many women.

̽��ֱ��marketing and media coverage of egg freezing has also been problematic. We are concerned about how the marketing of the technology sets out a moral imperative for women to engage in egg freezing, a risky biomedical intervention. ̽��ֱ��media coverage of the ASRM’s decision to list the experimental label on egg freezing downplayed the physiological risks of the procedure. At this point in time there is little known about the health effects of egg retrieval, and to date there has been no longitudinal research on the health effects of the procedure. There are also risks associated with undergoing pregnancy at an advanced reproductive age. A moral imperative to use this risky technology may be exacerbated by its acceptance and accessibility for Apple and Facebook employees. This may also be accompanied by an expectation of employees to then wait to have children.

Finally, as with other assisted reproductive technologies, the context of this technology continues to be forgotten. This technology should be considered in context of the for-profit, largely unregulated industry providing this service, and the broader politics surrounding the commodification of women’s bodies and tissues in reproductive and scientific research. Little attention has been paid to what will happen with the surplus frozen eggs, and potential for a transnational market for surplus eggs for use in scientific research, or personal use.

While social egg freezing has been lauded for its potential to allow women to ‘have it all’, we argue that there are strong reasons to challenge it. Similarly, there are strong reasons to be critical of offers such as those by Facebook and Apple that condone this technology and that may contribute to a moral imperative for their employees to engage in this risky technology, and to postpone childbearing. To stress our argument in the commentary, egg freezing is not necessarily an empowering option. It is a risky, intrusive procedure for which there is still little research. It is shortsighted, and simultaneously fails to challenge the very conditions that produce its need.

Katie Hammond, a PhD candidate in the Department of Sociology researching the experience of egg donation in Canada, discusses the recent decision by tech giants Facebook and Apple to offer egg freezing to female employees, and why she co-authored a recent commentary on this subject.

This technology should be considered in context of the for-profit, largely unregulated industry providing this service

Katie Hammond

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ICSI sperm injection into oocyte

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Tiny sperm, big stories

amb206 — Wed, 10 Sep 2014 08:00:00 +0000

In 1881 a German couple – Herr and Frau B - were trying to get pregnant with no success. They consulted Dr Levy, a gynaecologist based in Munich, for help. Levy was determined to approach the problem in a scientific manner and make a thorough investigation into the man’s fertility. Over a period of several months, Levy made 12 pre-arranged home visits to the couple to conduct a study that he knew to be fraught with “obnoxiousness”.

To determine whether the ejaculate contained living spermatozoa, Levy took mucus from the woman’s vagina and cervix shortly after the couple had had sex and while the woman was still resting in the marital bed. ̽��ֱ��microscope Levy brought with him revealed that Herr B was sterile, a condition that a tough regime of physical exercise and the faradisation (treatment with electrical currents) of his testicles would prove unable to change. After trying for years to conceive a child, Herr and Frau B were reported to be content to have done their duty by exploiting every possibility that modern medicine had to offer.

̽��ֱ��case of Herr and Frau B, and the ordeal they underwent 130 years ago, is taken from the medical literature that forms the primary source of research by historian Dr Christina Benninghaus, who has worked at Cambridge for the past two years. At a conference later this week she will give a snapshot of her research into the history of human reproduction in the decades around 1900 and, in particular, the emergence of medical studies of male infertility.

“Knowledge about some vital aspects of human reproduction was hazy. ̽��ֱ��concept of hormones had not been developed and the connection between menstruation and ovulation had yet to be fully understood. However, infertility was already an important sphere of medical intervention. Inflammation of male and female reproductive organs was treated with ointments, douches and massages. Women, and sometimes men, were sent to watering places to improve their health, couples were offered sexual advice, and attempts at artificial insemination were not unheard of,” said Benninghaus.

Surgery was also undertaken to increase the chances of conception. And it was often, though not exclusively, directed at the female body. Attempts at widening the cervix and at repositioning the uterus were not only painful, but also dangerous, and from the 1870s their effectiveness was very much doubted. To spare women from unnecessary surgery, gynaecologists increasingly considered the possibility of male sterility and advocated sperm testing.”

̽��ֱ��late 19th century witnessed a quest for rational forms of diagnosis and a fascination with microscopy. "However, sperm testing was by no means easy to introduce," said Benninghaus. "Medical and religious objections against masturbation severely hampered the collection of semen. Men found it hard to accept a diagnosis that both destroyed their hopes of fathering children and appeared to threaten their bodily experience of potency."

Experts debated how best to engage with male patients unwilling to agree to testing. Benninghaus explained: “Physicians were eager to spread knowledge about male sterility through talks and publications. And they warned the public that men often infected their wives with gonorrhea, a major cause of both male and female infertility. ̽��ֱ��association of male sterility with lazy or dead spermatozoa – an image that would not have made sense to earlier generations – now entered the public imagination.”

Benninghaus is one of a dozen speakers who will, during the course of the two-day conference, consider the narratives that surround sperm: our historically changing understanding of its biological make-up and its contribution to the process of generation, its materiality as a marker of collective health, its identity as a scientific object and a commodity, and its symbolic value within shifting perceptions and negotiations of masculinity.

As an experience central to life itself, and with technologies offering new possibilities, human reproduction recognises no neat disciplinary boundaries. When Benninghaus sat down with Cambridge ̽��ֱ�� sociologist Dr Liberty Barnes to plan a meeting that would encourage wide-reaching conversations, they opted to bring together historians, sociologists and anthropologists to look at the topic of sperm, and male infertility, from a broad range of perspectives.

Barnes said: “What’s cool about the conference is that we contacted a bunch of male infertility scholars and invited them to submit paper abstracts -- and nearly all of the submissions were about sperm. Tiny sperm tell big stories. Sperm serve as something akin to cultural artefacts for telling all kinds of stories about human history and social problems.”

Since the 1960s a revolution has taken place in reproductive technologies – such as IVF, sperm and egg donation, and surrogacy – and has been accompanied by shifts in social attitudes. Increasingly available across the globe, these developments have challenged the meanings of family and kin, reproduction, and opened up new routes for mothering or fathering a child. Most recently, the use of mitochondrial transplantation (resulting in an embryo with genes from three biological parents) has led to intense ethical debate.

Advances in reproductive sciences have inspired new strands of academic research. ̽��ֱ��ethical debates surrounding the new technologies, and their very real consequences for the lives of people worldwide, have encouraged historians to look more closely at the history of reproduction and how past narratives continue to inform the way we navigate these matters today.

Recent studies have re-examined common assumptions like the belief that infertility was routinely ‘blamed’ on women primarily to save men from the social stigma of impotency. Benninghaus’s research reveals that this was far from the case. Her study of the medical literature from the second half of the 19th and the early 20th century reveals that medical experts took a great interest in male sterility in order to help families have children.

“Increased efforts to identify the causes of male infertility were prompted by a deadlock in the diagnosis and treatment of female sterility, paired with a continuous demand for treatment, growing interest in microscopy and the possibilities it offered, and a new understanding of the dangers of venereal disease,” she said.

“ ̽��ֱ��impulses for greater research into the morphology and the physiological functions of sperm came not just from within science and medicine but also from patients who expected medicine to provide an answer to their quest for a child. Already a century ago, couples experiencing infertility, had to make choices regarding the kind of treatment they wanted to pursue and they had to come to terms with diagnoses that could be devastating.”

̽��ֱ��proliferation of assisted reproductive technologies (ART) around the globe in recent decades has inspired the work of many sociologists and anthropologists. While most ART research has focused on women’s experiences, this week’s conference considers the role of men (and sperm) in new reproductive science. For example, Barnes’s research shows that infertile men are willing to undergo rigorous and painful procedures to increase their sperm production and restore sperm to their ejaculate to make “natural” conception possible.

Sperm stories are about more than making babies. Robert Pralat, a PhD candidate in sociology at Cambridge, will draw attention to the fact that semen, the fluid containing sperm, can be both reproductive and destructive. Pralat will talk about the different roles semen plays in donor insemination and in HIV infection. He said: “It’s interesting how little dialogue there has been between scientists working on assisted reproduction and those that work on sexually transmitted diseases. After all, they are interested in the same substance! An interdisciplinary conference is a great opportunity to make those kinds of connections.”

Pralat’s research explores two challenges that face British healthcare: the shortage of ‘high-quality’ sperm, with many donation programmes relying on supplies from overseas, and the ‘surplus’ of infected semen, with new HIV infections among gay men at an all-time high. He said: “It’s ironic that while fertility clinics struggle to provide their services because of the lack of sperm, the uncontrollable spread of semen poses the main challenge for HIV prevention.” Pralat will ask whether the two areas of scientific study and clinical practice can learn anything from each other in addressing these challenges.

Because sperm can be easily assessed and analysed, they now serve as indicators of national health, enabling researchers to track changes in count, size, shape, and make-up across time and space. Dr Janelle Lamoreaux, a medical anthropologist at Cambridge, will look at the work of scientific laboratories in China that study environmental degradation by observing changes in sperm cells across the Chinese population. Her paper explores the ways both scientists and social scientists envision and establish the relationship between exterior environmental problems and interior reproductive health concerns through sperm.

"Sperm has become an important object in analyses of intertwining human and environmental health in China. ̽��ֱ��anxiety around declining national sperm counts is certainly about the threat to male reproductive capacity that reduced sperm quality and quantity might bring. But this anxiety is also about China’s potentially infertile future as it relates to environmental destruction amid rapid industrialisation, development and social change. Anxieties about the nation, masculinity, and environmental destruction are produced and reproduced through sperm," she said.

While much social scientific research on male infertility concentrates on clinical settings, Lamoreaux's research among toxicologists, who study sperm as a means of understanding toxic exposures, offers a perspective that stresses the connections between male reproductive health and environment, economy, and industry.

Con/Tested: Sperm Science, Sterility and Masculinity takes place at the Department of Sociology in Cambridge on 11 and 12 September, 2014.

̽��ֱ��conference is sponsored by: the Wellcome Trust; the Sociology of Health and Illness Foundation; ReproSoc, the reproductive sociology research group led by Dr Sarah Franklin; and Generation to Reproduction, a research programme led by Dr Nick Hopwood in the Department of History and Philosophy of Science.

Christina Benninghaus has recently taken up a position at the ̽��ֱ�� of Gießen. Her two-year stay at the Department of History and Philosophy of Science at the ̽��ֱ�� of Cambridge was made possible by a senior “Mobility for the Humanities” Fellowship provided by the Gerda-Henkel Foundation.

Inset images:In 1909, Magnus Gustaf Retzius (1842-1919) published these detailed images of morphological variations in human sperm.
(reprinted by Weisman, Abner I., Spermatozoa and Sterility. A Clinical Manual, New York: Paul B. Hoeber, 1941); a sperm race, 1888 (Gerard, J, Nouvelles causes de stérilité dans les deux sexes); syringe for artificial insemination (Giles, Arthur E, Sterility in Women, London: Frowde and Hodder & Stoughton); a modern sperm bank in China (Ayo Wahlberg).

Sperm will take centre stage at a conference in Cambridge later this week as researchers from a wide range of disciplines gather to consider the narratives that surround the male gametes necessary for human reproduction.

Sperm testing was by no means easy to introduce. Medical and religious objections against masturbation hampered the collection of semen. Men found it hard to accept a diagnosis that destroyed their hopes of fathering children and appeared to threaten their bodily experience of potency.

Christina Benninghaus

Gerard, J., Nouvelles causes de stérilité dans les deux sexes

Image from a popular French guidebook for infertile couples, published in 1888

Yes

Male infertility is ‘culturally invisible’, finds research

fpjl2 — Thu, 01 May 2014 09:13:38 +0000

Even though male infertility is responsible for half of all cases of infertile couples, decades of misogynistic limelight on infertile women has left a ‘categorical hole’ in medical systems, with very few male fertility specialists and no official board certification for practitioners in the US, says a medical sociologist.

Some men seeking treatment end up further damaged by malpractice – prescribed testosterone, for example, which arrests sperm production – resulting from treatment by specialists in the wrong areas, such as a general urologist or their wife’s doctor.

And those that do manage to engage with male infertility specialists are often fed information about their disorder through metaphors that mask infertility – frequently involving traditional male activities such as plumbing, sport or car mechanics – to the point where two thirds of infertile men interviewed for the study simply didn’t consider themselves infertile.

“This is not some kind of deep-seated denial on the part of these men. There is an entire culture and medical system that makes it possible for men to be infertile and not even realise it,” said Dr Liberty Barnes from the ReproSoc group in the Department of Sociology, who has authored the book Conceiving Masculinity based on the research.

“Male infertility is as prevalent as female infertility, but it’s invisible in our society. While female infertility support groups, blogs, news and literature abound, male infertility is hidden from public view.

“In fact, most cases of male infertility are referred to IVF clinics – a process in which women bear the brunt. For many, male infertility is repaired in female bodies.”

Barnes spent over 100 hours shadowing doctors in five clinics in different states right across the US, as well as interviewing many of the couples involved (men and women separately).

Most infertile men, even those who do self-identify as infertile, are able to ‘intellectually reframe’ their infertility issues as a medical condition somehow separate from their self, explains Barnes.

“This separation of body and self, while rare in female infertility, is the standard coping mechanism in men – that their ‘messed-up plumbing’ is not their fault and in most cases repairable.

“Many men cling to the notion that if you have a problem that can be fixed, you don’t have a problem. Instead of telling these men they’re infertile, you hear doctors saying ‘oh, it’s just an issue with your blocked exhaust’.

“ ̽��ֱ��doctors actually provide men with the linguistic strategies to separate body from self.”

Culturally, male fertility is intrinsically bound up with ideas of virility, machismo and sexual potency because it hinges on that very essence of manliness – semen. As William, a businessman in his late thirties interviewed for the research, puts it: “Men should be able to gush sperm all over the place”.

For Barnes, the prevarication around male infertility is symptomatic of widespread cultural nervousness to expose masculinity as in any way fragile. Masculinity is equated with power; protecting and expressing power is a key function of societies and states. In the book, she cites the global media panic around a 1992 study showing sperm counts were dropping.

Male infertility hits masculine identities – from the personal to the national – right where it counts, says Barnes. One interviewee described his desire for fatherhood as “kind of the only purpose of life”. Another said his infertility led him to “doubt the toughness” of his penis.

Consequently, once a man is diagnosed, almost as much effort is taken to socially alleviate this perceived trauma to masculinity as to treat it medically. When interviewed, doctors reeled out a progressive rhetoric. But in the infertility clinics Barnes found a culture designed to enforce gender stereotypes and bolster masculinity.

“Every doctor I spoke to and medical seminar I went to, I heard time and again: we’ve got to help society move past archaic ideas that reproduction is women’s work. Then when I was in the clinics, it was complete immersion in traditional gender ideology: penis jokes, talk of balls – everything was power and virility,” said Barnes.

Diagnoses were shrouded in metaphors invoking factories/bridges/engines – technological achievement hiding biological failure. One doctor that Barnes shadowed, when prescribing hormone treatment to boost testosterone, would tell patients that side effects include “the urge to hit a ball really hard or drive really fast”. Barnes describes this claim as scientifically debatable.

̽��ֱ��assumed functionality of male sexual biology also translated to the first experience of the clinic – the collection cup. Men describe being pushed into a room or even just behind a curtain with no instruction beyond “fasten the lid tightly”.

Medical institutions assume men can masturbate under any conditions, will enjoy it, and be able to shoot semen straight into a cup, says Barnes. Some interviewees told her the semen they provided was both of particularly poor quality and limited due to stress and the amount they were able to catch. In fact, most men found this confusing and uncomfortable – especially when bluntly confronted with the choice of ‘performing’ or extraction by needle from the testicle.

Barnes found the extraordinary lack of medical professionals specialising in male infertility as opposed to those in female infertility – as well as absence of official board certification for treating male infertility – to be part of a damaging cycle:

“When I spoke to organisations about this hole in the system, they would tell me it’s because it’s not needed. Men aren’t coming forward for treatment, so there appears to be little demand. But then those that do struggle to find help, which – combined with the social stigma – means that many give up.”

There is a medical and social price to pay, she says. Research into male infertility is nowhere near as advanced as that for female infertility. And societal silence on the subject means men who want and may well be able to have children if treated are not – or being treated by the wrong people.

Among what medical specialists there are, the cultural invisibility of infertile men is inherently conflicting, says Barnes. On the one hand, male infertility doctors complain about the lack of attention the topic receives. But on the other, they realise this invisibility protects men and masculinity by suppressing the issue.

“If you promote male infertility as a label to encourage more men to come forward for treatment, you will have a harder time helping them pretend they’re not actually infertile,” she said.

Research for a new book reveals a culturally sanctioned suppression of dialogue around male infertility – despite it being equally as common as female infertility – to the extent that many infertile men receiving treatment still don’t actually consider themselves infertile.

If you promote male infertility as a label to encourage more men to come forward for treatment, you will have a harder time helping them pretend they’re not actually infertile

Liberty Barnes

Stefanie Reichelt

Illustration of sperm

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