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Test-tube Babies are Changing our Understanding of Parentage

The growth of assisted reproductive technologies (ART) such as in vitro fertilization (IVF), surrogate motherhood, etc, have changed our very idea of parentage. The concept of a parent as an integral and inseparable whole is now being broken down into a number of different roles – there are ‘genetic’ mothers, ‘birth’ mothers and ‘feeding’ mothers while fathers can be ‘genetic’ or ‘social’. This atomisation of parenthood explains the prevailing ambiguous attitude towards ART as Olga Isupova, Alexei Belianin and Anna Gusareva showed in their presentation at the HSE XV April International Conference ‘Economic and Social Development’, in the ‘Demography and Labour Markets’ Section

Assisted reproduction has been largely accepted in society as a set of new medical technologies to help infertile couples become parents. There is less prejudice against the idea of ‘test-tube babies’ nowadays. ART has made us consider traditional ideas about parenthood in a new light.

‘Whole mother’ and ‘whole father’ are the terms a number of experts are using to describe those who are both biological and social parents. However, we shouldn’t consider partial mother and fatherhood as something rare and exotic these days. IVF, surrogate motherhood, sperm and egg donation have led to the fragmentation of parental functions. This is underlined in the report by Olga Isupova, Senior Research Fellow at the HSE Institute of Demography, Alexei Belianin Head of the Laboratory of Experimental and Behavioural Economics and Embryologist Anna Gusareva, “Modernisation of “foundations and roots”: families and new reproductive technologies”.

The researchers tried to measure the feelings of people seeking help from ART, particularly their views on the new, ‘dispersed’ parentage, and also tried to determine what are the factors of success in artificial reproduction.

The research is based on discussions between 2005 and 2011 on the internet forum Пробирка.ру (test-tube.ru), the largest Russian language forum for ART patients (at the beginning of 2014 it had over 68,000 users), and on data from a reproductive clinic in Moscow on 1,340 treatment cycles.

IVF patients are more prepared to reveal their status

The researchers found that initially women who seek artificial fertility treatments have traditional views and orientation on family values. A number of them have specifically Russian, sometimes patriarchal views based on a strict division of gender roles – men must bring in the money while women do everything else especially to do with having babies. As the ART internet forum discussions show, It is this same traditionalism and these continuing old-fashioned social norms that often make women who have trouble producing babies feel ‘puny’, ‘vulnerable’ and ‘inferior’.

However, finding themselves in the spotlight of new medical technologies, and in a rather unusual situation, ART patients sometimes see themselves differently and lose their inferiority complex. If at first they try to hide how they produced their babies, with time the clients of fertility clinics decide that they must reveal the truth. Many of them are ready to defend themselves and their children openly against potential discrimination.

There is a noticeable increase in this desire for openness as a negative tone has entered the public discourse on ART (a number of calls for the government to ban surrogate motherhood, impassioned debates about IVF, the conservative position of the church and others).The risk of stigmatization of ‘test-tube babies’ has aroused the instincts of their mothers to defend them at all costs.

The demographic potential of ART is growing

IVF and other reproductive technologies account for no more than 1% of births in Russia annually (at 3% in 2005 the Czech Republic had one of the highest rates in Europe).

However, the researchers insist that the number of ART births in Russia is set to rise because the new technologies can solve both primary and secondary infertility (when a woman cannot produce a second child).

Between 2010 and 2013, around a third of those who came to the reproductive clinic which provided data for this research were women who wanted to have a second or third child.

Often people (both men and women) want to have another child when they remarry. Some of the posts on the forum Пробирка.ру were about how a ‘proper’ family has at least two children (these reproductive stereotypes are also prevalent among ‘ordinary’ mothers). But, as the researchers point out, these judgements don’t correspond to the whole, complex situation in reality.

Recipes for reproductive success

The cause of the patient’s infertility is one of the main factors determining the success of ART. This is mostly a medical rather than a demographic issue.

As far as demography goes, many expert records show that the number of healthy babies born using ART is highest in countries where on average the patients in fertility clinics are younger. The researchers reached the same conclusion remarking, “The chances of successful ART go down as the age of patients goes up”.

The researchers found that which marriage you were on was also significant. Women in their second marriage had the least success in trying for a baby. Changing clinics, continuing treatment elsewhere, or with another doctor could also be a factor.

The researchers add that the chances of success do not decrease with the number of attempts at treatment, neither do they fall or grow if the patient already has children or has given birth previously.

Surrogate motherhood is not popular

The most commonly applied reproductive technologies are IVF (where the eggs are removed from the mother’s body and introduced to sperm in a Petri dish) and ICSI (intracytoplasmic sperm injection – used in cases of male infertility). Of the 1,340 treatment cycles there were 539 instances of ICSI (40%) and 430 of IVF (32%).

So most procedures do not involve a third person but are connected with problems of conception. Egg donation is becoming less uncommon with 12% of cases - 163 examples in the clinic. Surrogacy is extremely rare, only 1% of cases (16 instances altogether at the clinic).

Carrying the unborn child is an important process in itself for ART patients

The researchers suggest the rationale behind patient choices of fertility treatments is subject for many further research projects. For example, the reason egg donation is more popular than surrogacy is because many fertility patients feel that the crucial bonding process between mother and child begins in pregnancy.

On the other hand, egg donation is a hidden process and means uncomfortable conversations can be avoided. Besides, female physiology is such that ovaries lose their reproductive function earlier than the uterus, so for ‘older’ patients, egg donation is one of the best options.

One final reason why surrogacy is unpopular is the high maintenance cost of the pregnant mother, but the researchers conclude that further investigations are needed to fully explain the preferences of patients at fertility clinics.


Author: Olga Sobolevskaya, April 03, 2014