The Push and Pull of IVF Treatment vs. Socioeconomics, Tradition, and Culture Today

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Worldwide, there are more than 70 million couples who struggle with infertility and low fertility. Since the first “test tube baby” in July of 1978¹, in vitro fertilization has evolved and improved to provide hope to families who otherwise may have found it impossible to grow. Since that time, over 40 million babies have been born through IVF methods.

However, as the science has advanced over time, challenges to law, tradition, ethics, and parenthood struggle to keep up. Debates continue to arise within the public policy and the meaning of “family” across countries, cultures, and religious sects. This struggle between tradition and science has caused many IVF patients to hide their participation in such methods, for a variety of reasons.

Incognito IVF in the 1980s

While Europe lead the way for IVF introduction and advancement beginning back in the 1930s, the United States was not so quick to embrace IVF, in part because of the disapproval of the Catholic Church, as well as the press. Despite this general public disapproval that spanned decades, two NY doctors opened an IVF clinic in March of 1980. A year and a half later, baby Elizabeth Carr was born to Judy and Rodger Carr in December of 1981. Because of concerns of privacy and negative press, Judy’s identity was kept confidential, and she stayed in another city under an assumed name for some time.

This is certainly not to say that the United States is the only country or group of people with “issues” concerning IVF. Several countries that place a high value on tradition are generally slower to be accepting of such methods. Many countries, groups, and religious sects who place priority on lineage and family lines are much more accepting of IVF, but often only to the extent that treatment involves only the family. This is in part because children born through IVF may otherwise have less access to information about their familial and genetic origins.

Cross-Border Reproductive Care

Many people in countries that discourage IVF do travel to other countries for treatment – this is known as Cross-Border Reproductive Care, or CBRC. Complications can arise, however, if donors are from diverse cultures, do not speak one’s native language, or live far away in another country. Will the child resulting from IVF not be able to have a strong relationship with the donor parent? Will the child not know his or her genetic origins?

These are just a couple of issues that are consistently cited by those against IVF and CBRC. Other criticism includes an increased risk of multiple pregnancy along with associated mortality and morbidity. Legal norms can leave patients without recourse for personal injury or malpractice, and if a patient is injured by treatment abroad, recovery of compensation from a foreign provider can prove almost impossible. For these and other reasons, many people choose to remain in their own countries for IVF treatment but keep it a secret because of social stigmas still associated with IVF.

Other concerns are relevant to both IVF and CBRC; one of these is the concern over medical and life insurance coverability. Advances in molecular genetics can lead to diagnosis of many genetic maladies from stored blood samples and cord blood samples; this could allow researchers to identify certain diseases in donors and offspring, rendering them uninsurable.

The World’s Religions and IVF

Several religions, including Islam, Buddhism, Christianity, Hinduism, and Judaism address IVF and play active roles concerning the use of it and other assisted reproductive technologies. Religious views can often conflict with options that are available to people; advances in IVF continue to raise religious questions that do not always have clear answers. In general, views regarding IVF vary widely amongst the world’s religions:

• Jewish law is clear with its stand on IVF in respect to motherhood when a gestational surrogate is used; the law teaches that the child is related to the one who formed him/her, not the one who gave birth (Broyde, 2010)².
• Islamic law endorses and encourages attempts to treat and cure infertility; this law also considers it a duty and an obligation to do so (Qur’an, 23:5). IVF is accepted by Islam, but it can only be practiced by a husband and wife during their marriage. The fusion of sperm and egg cannot be intruded upon by a third party, so third-party gamete sources are unacceptable because it leads to confusion of purity and genealogy, both of which are of prime importance in Islam.
• The Catholic Church remains against IVF because it claims it disregards human life and separates sexual intercourse within marriage from human procreation (Catechism of the Catholic Church)³. Pregnancies must occur within heterosexual marriages as a result of the conjugal act between wife and husband. The Catholic Church believes IVF, surrogate motherhood, use of donor semen, and even the cryopreservation of embryos as contrary to marriage unity and to the child’s right to be a “product” of a holy act.
• Eastern Orthodox Christianity supports the surgical and medical treatments of infertility; however, it should be noted that this church does reject IVF and additional assisted reproductive techniques. They also oppose gamete donation on the basis that it is an adulterous act.
• Hinduism places foremost importance on procreation and reproduction. Wives can be granted permission to have intercourse with a sterile partner’s brother or other family member for the purpose of having offspring. In India, assisted reproduction is acceptable.
• Buddhists believe that people can procreate in any manner they want to, as long as they bring no harm to anyone else. While assisted reproduction is acceptable, donating sperm and oocytes is to be avoided as much as possible.
• In the country of Japan, it is practiced and acceptable to donate sperm. However, on the other hand, the donating of ovum is strictly prohibited.

IVF has certainly delivered on the promise of helping couples achieve parenthood. In the process, it has paved the way for ample consideration of much broader social, economic, ethical, cultural, and religious questions surrounding parenting and families.

The Special Case of China and Reproductive Assistance

Egg freezing is popular with Chinese women, even though the process is forbidden for unmarried women in China. For those who have the option of traveling abroad for CRBC, however, it remains an attractive possibility. Famous for its previous “One Child” Policy, which has now been lifted, China has witnessed an enormous surge in the number of women (married and unmarried) who are interested in expanding their families. Some of these women had their eggs cryogenically frozen in the past and are ready to “use them” since, by law, they are now allowed to have more than one child.

This has, in turn, created some problems within China. Paul McTaggart, CEO of Bangkok-based healthcare consultancy Medical Departures, explained to China Daily that “Excess demand for IVF treatment, limited clinics available, and months in waiting for consultation appointments” are some of the factors that make Chinese women participate in programs abroad. “The legality of pre-implantation genetic diagnosis and gender selection are also reasons Chinese mothers don’t go through IVF domestically,” he said, referring to genetic profiling of an embryo prior to uterine implantation.

Those who cannot or do not wish to travel abroad for IVF, then, are often compelled to keep their involvement in domestic IVF programs hidden. Infertile Chinese women find themselves increasingly pressured by both tradition and state to adhere to strict reproduction regulations. The country has the rare and complex problem that women are frowned upon if they cannot conceive, yet they are also frowned upon for seeking IVF treatment. This pressure, or yali, is a key factor in motivating the women to begin their IVF cycles. These collisions of personal belief, culture, and IVF create tensions that amplify, giving rise to the pressure in a never-ending cycle.

The Chinese Media and IVF

Between the One Child Policy recently being lifted and the traditional notion that women “must” conceive a child, it’s no wonder that the IVF market in China has exploded. Chinese media raises questions asking why infertility is now the focus of a country that is overpopulated already. At the same time, infertile women in the country are still largely stigmatized for their inability to conceive a child.

With this surge in IVF popularity in China, much of the romanticism of IVF methods has been discarded and replaced by an industrialized, almost commercialized style; this further increases the pressure many women feel to hide their involvement in receiving IVF treatment. IVF has, in recent years, boomed nevertheless, and is now standardized to stricter protocols to the point that it, some would say, produces babies as if they were assembled in an assembly line (Jiang 2014:41). What’s worse, is that no one can really be sure of the true extent of the IVF boom in China because of the inevitable black market and inadequate regulations that have stemmed from the limitations of the One Child Policy.

In Conclusion

The collision of tradition, science, state, and religion has heightened pressure for women overall, regardless of whether they are fertile or not. The intersecting motivations and pressures that are at play in the world of reproduction for women are certainly entangled in a web of political, religious, and socioeconomic influences, proving to be too much for many women who are either forced or pressured to keep their IVF treatment a secret.

1. Steptoe, P., & Edwards, R. (1978). Birth after Reimplantation of a Human Embryo. The Lancet, 2, 366. http://dx.doi.org/10.1016/S0140-6736(78)92957-4.
2. Broyde, M. (2010). The Establishment of Maternity and Paternity in Jewish and American Law. Jewish Law Articles: Examining Halacha, Jewish Issues and Secular Law.
3. Catechism of the Catholic Church, Part Three, Section Two, Chapter Two, Article 6, III, Paragraphs 2376-2378.