Fertility Holidays

IVF Tourism and the Reproduction of Whiteness

Amy Speier

• Publisher: NYU Press
• Year: 2016
• ISBN:
  9781479863587
• Topic: Social Sciences
• Subtopic: Cultural & Social Anthropology
• Index: Social Sciences

Each year, more and more Americans travel out of the country seeking low cost medical treatments abroad, including fertility treatments such as in vitro fertilization (IVF). As the lower middle classes of the United States have been priced out of an expensive privatized “baby business,” the Czech Republic has emerged as a central hub of fertility tourism, offering a plentitude of blonde-haired, blue-eyed egg donors at a fraction of the price. Fertility Holidays presents a critical analysis of white, working class North Americans’ motivations and experiences when traveling to Central Europe for donor egg IVF. Within this diaspora, patients become consumers, urged on by the representation of a white Europe and an empathetic health care system, which seems nonexistent at home. As the volume traces these American fertility journeys halfway around the world, it uncovers layers of contradiction embedded in global reproductive medicine. Speier reveals the extent to which reproductive travel heightens the hope ingrained in reproductive technologies, especially when the procedures are framed as “holidays.” The pitch of combining a vacation with their treatment promises couples a stress-free IVF cycle; yet, in truth, they may become tangled in fraught situations as they endure an emotionally wrought cycle of IVF in a strange place. Offering an intimate, first-hand account of North Americans’ journeys to the Czech Republic for IVF, Fertility Holidays exposes reproductive travel as a form of consumption which is motivated by complex layers of desire for white babies, a European vacation, better health care, and technological success.

1

From Hope to Alienation

North Americans Enter the Baby Business

There are a lot of people out there that can’t afford it . . . better than half the country. It is still out of their price range for that kind of money. You know as long as they’ve got 45,000 people that are getting it done and paying them $15,000 to $30,000, they’re going to keep charging them. . . . If money dictates whether you can conceive or not, or you spend so much money to conceive that now the kid’s born and you lose your house because you’ve got nothing left. That’s problematic.

—Tom, IVF broker

Undoubtedly, parenthood remains a norm in our society (Throsby 2004:16). The couples with whom I spoke faced multiple layers of suffering, which included depression, bodily betrayal, social isolation, and stigma. They propelled themselves through the baby business armed with American cultural notions about health and hope. In fact, the market of infertility medicine produces and depends on this “hope.”

Infertile couples try to think “positively,” a cultural script they use to deal with the emotional toll of treatment. However, conflicting ideas about hard work and luck, or “stress” and positive thinking, incur more contradictions that have already been shown to be inherent in the world of ARTs. Assisted reproductive technologies exacerbate the extent to which “women feel compelled by their doctors and male partners to undergo medical treatments for infertility because of the strong cultural pressure for married couples to have children and to demonstrate their normality in reproducing” (Sandelowski 1991:33).

Patients I met embody the typical “compulsion to try” numerous cycles of treatment, as they are encouraged to never give up, to work hard, and to think positively. Yet as they move deeper into the baby business of North America, many become increasingly angered and disillusioned by what they interpret to be doctors’ greed and lack of care. They are critical of the process and feel as if they are being treated like a wallet or a number.1 The baby business of North America appears to them to have forgotten about the importance of providing care.

Becker’s classic study (2000) has revealed the ways in which global forces of consumer culture have influenced the growth of the reproductive medical industry in North America. Her work also elucidates North American patient responses to the dizzying array of medical options, showing how their responses reflect notions of biology, gender, and the body. My study uncovered similar experiences for infertile couples, but my focus is distinct in revealing the neoliberal ideology that permeates North American responses to infertility. As described by Horton and colleagues, “In advanced liberal societies, the notion of individual responsibility for health has become enmeshed with the idea of responsible citizenship, as prudent individuals voluntarily purchase health insurance plans and undertake preventative health checks, genetic testing, and lifestyle changes” (2014:3). Indeed, in the United States, “the right to health has been reconfigured as a right to consumer choice—in terms of health insurance plans, physicians, and pharmaceuticals” (3). Nikolas Rose identifies a general shift away from the governmental responsibility for the management of health as devolving to “quasi-autonomous regulatory bodies—bioethics commissions, for example; to private corporations—like private fertility clinics . . . to professional groups” (2007:3). In addition, patients must increasingly maneuver among these various private groups when managing their health.

Becker (2000) has described the commercial market for reproductive medicine in North America and the difficult decisions couples confront. She shows how access to reproductive medicine is a class and gendered phenomenon, as profit motives and medical care coalesce. Throsby (2004) has convincingly shown the centrality of women’s bodies and identities to the meaning and practice of IVF. In this chapter, I connect North American cultural responses to infertility with a medical model of individual responsibility for one’s health, which is rapidly escalating under neoliberal market conditions. Clarke and colleagues regard health within our biomedical system as “an ongoing moral self-transformation . . . something to work toward” (2003:172). Ultimately, infertile women are self-disciplining their bodies and their functions outside of the comprehensive care of a provider (Clarke et al. 2003:172). New patterns of patient behavior have developed in which individual responsibility for one’s own health is promoted and sustained. This is a central piece of the neoliberal model of health care.

When couples confront infertility, they often respond by embracing ideological notions of hard work in pursuing IVF within the United States (Franklin 1997a). Contradictions are embedded in cultural responses to infertility, as couples attempt to work hard while they gamble with reproductive technologies and try to embody good mental and physical health.

Couples Confront Infertility

The American Society for Reproductive Medicine estimates that infertility affects 6.1 million North American women; roughly one in eight couples of reproductive age experiences this inability to “make babies” (C. Thompson 2005:7). In narrating their infertility journeys, couples I met mentioned a point in their lives when their friends began having children, which can be understood as a social cue for the “normal” or right time to start a family. In the summer of 2011, I met Janice and Craig, who were in their early forties. Their tans from living in the Sunshine State gleamed under the streetlight when I first met them, sitting outside of the pension in Zlín across from Lauren and John. The two blonds, Janice and Craig, were both nurses and had met at work. They had been married for ten years, and they usually spent their summers in her home country, Canada, something I gleaned from Janice’s subtle accent. They were planning on building their own house on a piece of land they had already purchased in central Florida. Craig remembers, “[At] about thirty-five, maybe seven years ago, we had a large group of friends, all about the same age, you know, midthirties. We’re all teachers and nurses, and we all hung out. Then everybody started deciding to have children, and we just kept trying.” It took two years of trying, with one year of “timed” intercourse, before they realized something was wrong.

Since the advent of the birth control pill, North Americans have held onto the notion that they can prevent conception when they do not want it, but also can easily initiate it when they do. Unfortunately, contraception and conception are not the same things (Greil and McQuillan 2010). Over breakfast I met a very chatty couple from Los Angeles, Maureen and Daniel. I had seen many of Maureen’s postings on a website for women thinking about traveling to the Czech Republic, so I had anticipated their arrival, always eager to meet more people. Daniel described how they met at a community college in San Diego, where they realized they shared many of the same interests in film and editing. They carried a newly purchased iPad with them everywhere, pulling up Czech phrases, maps, and pictures of their travels. I could tell they were technologically savvy. They had been together for fifteen years and married for six. Daniel commented dryly that once they started trying to have children, on the heels of many of their friends, “A strange perception from a guy is that you spend most of your life hoping you don’t get pregnant. I’m sure women are the same way, but the guys really worry about it. It’s a big worry. Then all of a sudden, it’s like, God, it’s so much harder than you’re taught in school.” When conception does not happen immediately, North American couples often grow impatient and frustrated, assuming it should happen easily, the “natural” way (Becker 2000:7).

The Universal Declaration of Human Rights, Article 16, claims, “Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution” (United Nations 2015). The discourse of “rights” is prevalent when people speak of infertility, which is understood as hindering one’s right to have a child or start a family. Rothman links this discourse of rights to capitalism: “Women, like men, lay claim to their own bodies and to their own children and call on the basic values of capitalism to support those claims” (2006:21). She mentions our notions of the body as something that is “viewed not as a resource for the community or the society, but as private property, a personal resource” (21). The discourse on one’s right to have a family becomes a talking point for those who suffer infertility.

Infertility interrupts normative ideas of one’s life stages. However, the point at which North Americans begin to think about having children has shifted over the past few decades, reflecting cultural trends of women in higher education and the workforce and in divorce rates. “The timing of parenthood has changed,” and the delay of childbearing has complex effects (Becker 2000:37). In North America, there is a general trend of women seeking higher education and careers before getting married, and North Americans, on average, have children at twenty-four to twenty-six years of age (Kottak 2011:139, 141). The decline in marriage rates, along with high divorce rates combined with remarriage, can be credited with a drop in heterosexual reproduction (Stone 2014:240–248). After putting off marriage and childbearing, or marrying a second or third time, people are often shocked when they find that being older can hinder their ability to conceive. It “wreaks havoc on life plans” (Becker 2000:37). In addition to age-related infertility, there are other causes of infertility: roughly 30 percent of cases are male factor infertility, where men may have a low sperm count or low sperm motility. Another 30 percent of cases are female factor, where a woman’s tubes may be blocked or scarred from endometriosis or prior pelvic infection. In the other 40 percent of cases, infertility remains unexplained. However, the ways in which North Americans confront this knowledge reflect cultural notions about health.

Despite the fact that infertility can be either female or male factor, it has been well documented that dealing with infertility is a largely gendered phenomenon. According to Park, “Women appear to be more stigmatized for their childlessness than do their male counterparts” (2002:26). Women are the ones who must assume the “work” of pursuing medical treatment through reproductive technologies, and they “bear the burden of medical intervention” (Throsby 2004:18). Given the stigma of infertility, many keep their problem a secret or pursue treatment secretly (see also Nahar and van der Geest 2014:381). Furthermore, Rose identifies the individual moral responsibility for one’s health and one’s family’s health as the social obligation of women (2007:29).

Women I interviewed, in wondering why they are unable to conceive, often say defensively or perplexedly that they are healthy. They see themselves as following the medical model of how to get pregnant: they must first get healthy. They have been upstanding citizens who practice yoga, eat well, and take care of themselves, reinscribing the ideology that health is an individual responsibility. However, this ideology then leads to women feeling cheated by their bodies when they do not conceive easily. I met Claudia and Ben, a couple from Seattle, over my first breakfast at the pension in the summer of 2011. They were very calm and relaxed, having already spent more than a week in the Czech Republic. I was catching up with them on their second-to-last morning in Zlín. They are both very tall, fit, and health-conscious, maintaining a vegetarian diet—which I could tell when they left the delicious bacon untouched. When I interviewed the two of them later that afternoon in their third-floor apartment, Claudia exuded an air of calm, having just meditated and written in her journal. She repeatedly stated that she is a healthy person, which made it difficult for her to understand her infertility: “I have no idea, because I’m a very healthy person. I never thought I’d have a problem having a child, and it’s been unexplained. I’ve had every test, every whatever. I have a perfectly normal cycle. I always have, but this is all unexplained.”

In addition to this confusion about their infertility, some women wondered aloud why friends whom they considered unhealthy still were able to conceive. I met Valerie at the clinic during my second week in the summer of 2010. She pushed her long, dark hair behind her ears as she leaned in and spoke loudly over the quiet clinic sounds. She carried a stack of papers that included her medical history, as her husband, Dan, shrank into a corner holding tightly onto a tour book of Vienna. The two were from San Diego and had met when Valerie was in her late thirties. During our interview the next day outside of the pension, she remembered that they were both surprised when she accidentally became pregnant early in their relationship. They decided to get married, only to suffer successive miscarriages. In her anger and frustration, she lamented: “I had one girlfriend who’s forty-two years old, overweight, eats like crap, and she got pregnant and had a baby, damn it. Why can’t I? I’m healthier than her. You know?” There is a moral dimension that tinges the way many women speak of a person’s health, as if only the woman who assumes responsibility for a healthy diet and sensible weight deserves to get pregnant. The women in my sample recounted how, when they attempted to get pregnant, they had eliminated alcohol and caffeine from their diet or done other things to attain a healthy status. Many women not only feel morally compelled to assume self-care but also feel “morally obliged to avail [themselves] of new biotechnological resources” (Guell 2012:519). Thus, when confronted with infertility, they often turn to reproductive technologies.

The owner of one of the IVF broker companies, Petra, is a slim, stunning Czech woman with ash-blonde hair carelessly pulled into a ponytail, defining her high cheekbones as her blue eyes twinkle. I had contacted Petra over the phone and arranged to meet her in the early summer of 2010. She invited me to have an “American” breakfast in her sprawling suburban Atlanta home the first time I met her. Over crispy bacon and fried eggs, she told me about her personal experience as a woman who suffers infertility. She told me how she and her husband, though they married after dating for only four months, had waited until they were financially stable before trying to have children. Like most others, she thought she would get pregnant immediately. Petra remembers trying to conceive: “At some point I was so stressed, so obsessed, I mean, we were timing the intercourse to the minute. I was constantly talking about it. I was envious of those that told me they were pregnant. I mean, the whole shebam [sic]. I mean, it’s just a part of infertility.”

Petra speaks quickly, bluntly, and to the point. She is petite, and a powerhouse of energy. Petra claimed that some women, like her, are simply “stress control freaks” who can’t get pregnant because of their personalities. High levels of stress indicate the intense level of emotional investment women experience during this process. Petra complained, “Nobody told me that you might prevent it [conception] from actually happening just because you’re so stressed out.” The management of one’s stress can be considered an element of this individual control over one’s health. Thus, women not only are responsible for their physical health but also must monitor their mental health. A myth that circulates throughout conversations about getting pregnant (one that hinges on a woman’s ability or inability to contain her stress) is the idea that if you “relax,” you will get pregnant. Stories abound of couples who proceed with adoption, only to then find themselves pregnant.

In addition to the stress of infertility, women may suffer from depression. Craig, the nurse from Florida, described the emotional journey of infertility: “I will say one thing. Having been in the infertility thing and having so many years of disappointments, when you first start every month, it’s a disappointment, and then every procedure’s a disappointment. You prepare yourself, like right now, transfer is tomorrow and you’re all having fun, but you have these depressing moments. It’s like 50 percent, [I’m] prepared for the worst. I think too, I think my wife’s very positive.” This need for positive thinking amid stress, fear, and depression becomes another moral axiom and ties into the ideology of hope, particularly for women.

Stigmatized Childlessness

Becker examines the stigma associated with infertility as cultural and bodily, building on Irving Goffman’s classic sociological analysis of stigma as “an undesired differentness from what we had anticipated” (1963:5). Becker highlights infertility as a bodily stigma because it “belies abnormality” for the couple (2000:45). In addition to this stigma of infertility, couples I interviewed found their stigma to be compounded by indifferent treatment from doctors. For example, North American couples undergoing IVF must often undergo psychological testing, which entails going over alternative forms of family planning and promoting relaxation to help them prepare for a possible negative outcome. The promotion of relaxation techniques also plays into the myth that relaxing aids in conception. Some clinics require these procedures in order to protect themselves against possible future litigation.

In the early summer of 2011, I met a woman who was at the pension alone for a large part of her stay. She and I became fast friends, sharing breakfast daily and going for long hikes to fill the quiet summer days. Alison spent many nights Skyping with her family back in Minnesota, and I could tell how excited she was when her husband’s visit drew near. Alison and Andy were high school sweethearts who had decided to wait to have children until they were thirty. After a year of trying to conceive with no results, they learned Andy’s sperm count was extremely low. They had a failed IVF cycle in Minnesota, in which no embryos had been fertilized in vitro. According to the nurse at the clinic, this occurrence was a complete fluke. Alison was, of course, very frustrated. She wanted to undergo another cycle, but her doctor told her she needed another psychological assessment before continuing. Alison remembers reaching her limit:

Then [the doctor] made the nurse come in and say, “Oh you guys need to go through therapy again.” We already did it once, and we had to do it through their clinic. I had had it at that point, because I’ve already done it. Does everyone have to? Not only that, but no one else has to go through that to have a baby. Why do I? Why am I different? If I made this decision, it should be between myself, my husband, and our God. If we felt that we needed to go to a therapist, we would go to our own. So that was the end of that.

At that point, Alison was done seeking treatment in the United States. She also became irritated if she felt that her friends or family were pussyfooting around the topic of pregnancy, as if she were overly fragile. Her defenses were up against the label of being “too sensitive.”

Some women choose not to tell others about their attempts at getting pregnant, since they want to avoid any potential judgment that they are “desperate.” While Claudia and Ben felt that their friends were nothing but supportive, Claudia did worry that they would think she and Ben were trying “too hard.” It is often deemed “natural” that a woman desperately wants a child, but “it is also possible for that desire to be deemed dangerously out of control” (Throsby 2004:4). Women must walk a fine line between monitoring their mental and physical health, stress, and working hard to conceive yet not “too hard.”

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