Sociocultural aspects of the medicalisation of infertility: a comparative reading of two illness narratives

This paper is a comparative reading of variations in the medicalisation of infertility caused by sociocultural aspects, in two illness narratives by patients: Elizabeth Katkin's Conceivability (2018), a story of navigating a fertility industry with polycystic ovarian syndrome and antiphospholipid syndrome in America and Rohini Rajagopal's What's a Lemon Squeezer Doing in My Vagina (2021), a discussion from India of a growing awareness of medicalisation in treatment of unexplained infertility. For this purpose, it first charts scholarship on illness narratives and medicalisation, noting a historical association. Following this, it shows how infertility, a physiological symptom of reproductive incapacity or failure to show clinical pregnancy, is generally medicalised. This paper reads the texts as showing hitherto unaddressed sociocultural aspects of infertility's medicalisation. At the same time, drawing from existing sociological and anthropological scholarship, it shows how a reading of sociocultural aspects in medicalised infertility nuances understanding of it's medicalisation. This comparative reading attends to sociocultural values and norms within the texts, including pronatalism, fetal personhood, kinship organisation, purity/pollution, individual reliance, sacred duty and so forth. It draws from scholarship on embodiment, rhetorical strategies and the language of medicine. It also shows how a patient's non-medicalised, affective history of 'deep' sickness caused by the biographical disruption of infertility is not that of a 'poor historian'. In laying out the particularisation of such sociocultural values and norms across America and India, medicalisation's migration from its origins to the margins reveals subjectivised, stratified reproduction in infertility illness narratives. This paper is part of a turn in scholarship away from understanding the medicalisation of infertility as naturalised and decontextualised.

For Women Only? Reconsidering Gender Requirements for Uterine Transplantation Recipients

Uterine transplantation is an experimental procedure currently available only to cisgender women recipients suffering from absolute uterine factor infertility. Clinicians, researchers, and advocates have advanced the possibility of providing these quality-of-life transplantations to transgender women. This article examines the ethical and practical implications of removing sex- and gender-based requirements entirely for uterine transplantation recipients. Given the significant costs and risks, and the modest quality-of-life benefits, ethical arguments against offering uterine transplantations to people who do not identify as women but are otherwise suitable recipients are dubious and prejudicial. Successful uterine transplantations with non-women recipients could potentially diminish the socio-cultural connection between uterine functionality and womanhood, which is a key motivation for women now seeking this high-risk procedure.

Options for acquiring motherhood in absolute uterine factor infertility; adoption, surrogacy and uterine transplantation

KEY CONTENT

Following the diagnosis of absolute uterine factor infertility (AUFI), women may experience considerable psychological harm as a result of a loss of reproductive function and the realisation of permanent and irreversible infertility.Adoption enables women with AUFI, and their partners, to experience social and legal parenthood, also often providing benefits for the adopted child.Surrogacy offers the opportunity to have genetically related offspring. Outcomes are generally positive in both surrogates and the children born as a result.Uterine transplantation is the only option to restore reproductive anatomy and functionality. While associated with considerable risk, it allows the experience of gestation and the achievement of biological, social and legal parenthood.

LEARNING OBJECTIVES

To gain an understanding of the routes to parenthood available for women with AUFI experiencing involuntary childlessness, such as adoption, surrogacy and, most recently, uterine transplantationTo consider a suggested management plan to facilitate counselling in women with AUFI who experience involuntary childlessness.

ETHICAL ISSUES

In the UK, while the number of children requiring adoption continues to increase, the number being adopted from care is decreasing.Some cultures may hold ethical or religious beliefs that surrogacy is unacceptable, and its legal position in many jurisdictions is problematic.Restrictive selection criteria and high costs may limit future availability of uterine transplantation.

Beyond pathology: women's lived experiences of melancholy and mourning in infertility treatment

Throughout history, melancholy and mourning are predominantly understood within the tradition of psychopathology. Herein, melancholy is perceived as an ailing response to significant loss, and mourning as a healing experience. By taking the philosophies of Freud, Ricoeur and Kristeva together with relevant social scientific research as a theoretical framework and by drawing on women's accounts of melancholy and mourning in infertility treatment, we offer an exploration of melancholy and mourning beyond this pathological ailing/healing logic. We do so by asking what it means for women to actually live with melancholy and mourning in infertility treatment. In answering this question, we show that women in infertility treatment may have different kinds of melancholic longings: they desire their lost time as a pregnant woman, lost love life and lost future. Within these longings, women derive their sense of self predominantly from their lost past: they understand themselves as the mothers or lovers they once were or could have been. We further reveal that some of these women attempt to escape this dwelling of identity and mourn their losses by (re)narrating their pasts or through performing rituals. While these results show how melancholy and mourning are coshaped in relation to these women's embodied, temporal, sociocultural and material lived context, they also give insight into how melancholy and mourning may be understood beyond infertility treatment. We reveal how the binary dynamic between melancholy and mourning is inherently ambiguous: melancholy instigates a joyous painfulness, something that is or is not overcome through the agonising exertion of mourning. We show, moreover, that underlying this melancholy/mourning dynamic is a pressing and uncontrollable reality of not being able to make (sufficient) sense of oneself. At the end of this work, then, we argue that it follows out of these conclusions' urgency to have context-sensitive compassionate patience with those who live with melancholy and mourning.

Which “New Eugenics”? Expanding Access to ART, Respecting Procreative Liberty, and Protecting the Moral Equality of All Persons in an Era of Neoliberal Choice

In The New Eugenics: Selective Breeding in an Era of Reproductive Technologies, Judith Daar (2017) advocates for increased access to assisted reproductive technologies (ART) and minimizes concerns about the potential “eugenic logic” of some procreative choices. Although Daar’s goal of expanded access is laudable, her argument suggests an unresolved tension between the moral equality of persons and individual reproductive freedom. Exploring that tension, this paper argues that efforts to expand access to ART must still grapple with the “eugenic mentality” of quality control that some forms of reproductive and genetic technologies enable.

Ethical and policy issues raised by uterus transplants

INTRODUCTION

In 2014, Brännström and colleagues reported the first human live birth following uterine transplantation (UTx). Research into this treatment for absolute uterine factor infertility has since grown with clinical trials currently taking place across centers in at least thirteen countries worldwide.

SOURCES OF DATA

This review summarizes and critiques the academic literature on ethical and policy issues raised by UTx.

AREAS OF AGREEMENT

There is general agreement on the importance of risk reduction and, in principle, to the sharing and maintenance of patient data on an international registry.

AREAS OF CONTROVERSY

There are numerous areas of controversy ranging from whether it is ethically justified to carry out uterus transplants at all (considering the associated health risks) to how deceased donor organs for transplant should be allocated. This review focuses on three key issues: the choice between deceased and living donors, ensuring valid consent to the procedure and access to treatment.

GROWING POINTS

UTx is presently a novel and rare procedure but is likely to become more commonplace in the foreseeable future, given the large number of surgical teams working on it worldwide.

AREAS TIMELY FOR DEVELOPING RESEARCH

Uterus transplantation requires us to re-examine fundamental questions about the ethical and social value of gestation. If eventually extended to transgender women or even to men, it may also require us to reconceptualize what it is to be a 'father' or to be a 'mother', and the definition of these terms in law.

Getting what you desire: the normative significance of genetic relatedness in parent-child relationships

People who are involuntarily childless need to use assisted reproductive technologies if they want to have a genetically related child. Yet, from an ethical point of view it is unclear to what extent assistance to satisfy this specific desire should be warranted. We first show that the subjectively felt harm due to the inability to satisfy this reproductive desire does not in itself entail the normative conclusion that it has to be met. In response, we evaluate the alternative view according to which the satisfaction of this desire is regarded as a way to meet one's presumed intermediate need for parenthood. This view presupposes that parenthood is one of those general categories of experiences and activities that contribute an irreplaceable value to people's lives, but the central difficulty is to find those characteristics that mark out parenthood as an irreplaceable constituent of a valuable life. We go on to argue, however, that even if one assumes that parenthood is such an irreplaceable constituent that makes life more valuable, this does not necessarily entail a moral duty to satisfy the desire for genetic parenthood. We conclude that there is a pro tanto obligation to help people conceive a genetically related child (if this is what they prefer), but that this can be outweighed by other moral considerations, such as safety and justice concerns.

Lived experience of infertility among Hong Kong Chinese women

PURPOSE

This study aims to explore and describe the phenomenon of women with infertility and to enhance understanding on how infertility affects their lives and the specific social consequence they encountered.

METHOD

A qualitative phenomenological design was adopted in this study. A total of 13 women who are infertile participated in the study. A snowball sampling method was adopted. Data were analysed through thematic analysis.

RESULTS

Four themes emerged in the study, including (i) non-escapable cultural burden in Chinese family; (ii) psychological distress: isolation caused by envy; (iii) disappointment towards reproductive health services; and (iv) self-compassion and religion as coping strategies.

CONCLUSIONS

The causes of infertility are highly complex. Apart from medical conditions, many social conditions would also probably trigger the difficulty of conceiving. Health care professional should also focus on the social and psychological aspects of women of infertility.