A constant and loud huuummm.
A huuummm that encapsulates the place allowing you to hear the size of the room.
A never silencing huuummm.
On top of this huuummm, a new sound.
A tap tap tap.
Rhythmically, tap tap tap, tap tap, tap tap tap tap,
a few slightly different tones of âtapâ.
Each tap a sperm.
Each slightly different tone, a different way to count sperm.
Each tap one sperm passing in front of her eyes,
across a square,
under the microscope,
within the huuummm.
Her eyes moving between squares, catching each sperm, and taping to count it.
Then a bing!
All I could think of was: how on earth can someone count these tiny moving things?
It is like trying to count moving stars!
Portraits are purposely composed images of people aimed at representing, through the various details they encompass, the social position, psychological characteristics, personality, sometimes even mood of the person being depicted. These images also offer clues about the historical context in which they were created. Hence, given the richness of information they posses, portraits are useful points of departure to explore the cultural aspects of a given historical period. A clear example of this is the portraits painted by the Milanese artist Giuseppe Arcimboldo (1527â1593). He carefully and ingeniously assembled apparently disparate but related elements like plants, flowers, animals, vegetables, and tools of different trades and professions in such a way that they produced a multilayered visual narrative. Looked at from a distance and as a whole, you see the portrait of a person; then, looked at in more detail and with contextual knowledge, we identify visual and rhetorical paradoxes, allegorical meanings, puns, and even jokes. Yet upon closer examination, the narrative of each portrait tells us a story of the scientific, technological, and political characteristics of the period. I took inspiration from his work1 and wondered: How would the portrait of Mexicoâs assisted reproduction system look?
Imagine the following elements: a postal stamp circulating in the early 1930s, the symbols of public healthcare institutions and of medical associations, advertisements of fertility clinics displayed in public spaces like highways, buses, and backstreets; newspaper clippings and magazine articles telling the successful stories of peopleâs experience with different assisted reproduction techniques; scientific articles reporting the changes of these techniques; promotional materials like USBs in the shape of a sperm or a pen with a translucent capsule where plastic sperm and ova are swimming. Each of these elements begins to sketch a composite portrait of Mexicoâs assisted reproduction system.
Throughout the book, I gather different elements from the field and assemble them in such a way as to paint, through words, a composite portrait of Mexicoâs system of assisted reproduction, a ârepronational portrait â (Franklin and Inhorn, 2016) that depicts the social position and psychological characteristics of the field as well as the political and economic context in which assisted reproduction has been introduced, and has developed and flourished. This portrait highlights the particular social position occupied by the Mexican system of assisted reproduction and the work it does within contemporary culture. It talks about how assisted reproduction has been cutting edge in more ways than the biotechnological, how it has transformed the way Mexicans conceive of and engage with health care, reproduction, the social media, the global market, and even with kinship and family. It exemplifies how assisted reproduction diffused simultaneously among the wealthy population of potential users and within a wider sector of the population who, although perhaps not having the economic means to attain these services, are nonetheless influenced by their presence. This portrait depicts how infertility is no longer presented as a medical condition in need of a cure but as a problematic situation for which the solution is available at these clinics. It is assembled from the different reproductive policies and practices and talks about how this field has been co-constitutive with the process of globalisation and of the establishment of neoliberalism as a political economy. Overall, this portrait shows how assisted reproduction has undergone epistemic and material transformations. The procedures, the practitioners, the users, and the workplaces, as well as the condition itself, have all changed: from being patients to becoming consumers; from addressing only heterosexual couples to catering to same-sex couples and single individuals; from being performed in a medical office to being offered at larger more complex medical facilities; from being done by a single practitioner to requiring a multidisciplinary team of experts. This book offers elements to paint this portrait, it tells the story behind this portrait, it traces these changes, and it sets out the context for what is to come.
Structure
The book is divided into this introduction, followed by two parts with three chapters each. In the remaining of the introduction, I establish the boundaries of the object of this study, the Mexican AR system. Then, I briefly describe the methods and theoretical tools I used to generate and make sense of the information that is at the core of this book and I close this chapter with a preamble to the story of assisted reproduction in Mexico.
Part I, Origin, looks at the emergence of the Mexican system of assisted reproduction, specifically at the establishment of its material and epistemic infrastructure. This first part is focused on seeking to understand how Mexicoâs AR system got to be the size it is today, to work as it does, and to do what it does. It offers a story of medical specialisation and professionalisation as well as an origin story. This first part of the book comprises three chapters. In Chapter 2, Interest in Sterility, I look at the people and institutions concerned with infertility and sterility. This chapter covers from the 1940s to the 1960s, and it looks at how sterility became a field of interest for a group of physicians, leading them to create a specialised association and its journal. In Managing Reproduction, Chapter 3, I trace the epistemic shift taken by this association, from focusing on sterility to becoming interested in managing reproduction, as part of the family planning campaigns Mexico was engaged in. In Chapter 4, Turning to Reproductive Technologies, I look at a second epistemic shift, during which the growing interest in biotechnologies used to assist reproduction flourished in Mexico.
To tell these stories, I go back in time just a few decades. This flashback allows us to see what was happening before the first births or even the first clinics were established, and to see the origins of the system, not from the perspective of the first births but from the perspective of those first engaged in infertility. This chapter asks the following questions: Who was experimenting with ways of curing and overcoming infertility? Who began asking questions regarding assisted reproduction? Why did they become interested in this area? When and how did they begin experimenting with assisted reproductive technologies (ARTs)? And, how did they build the infrastructure to carry out their research in this field?
Part II, Reproducing Assisted Reproduction, covers the 25 years after the first successful birth in 1988, period during which the first generation of ART users who had to face the task of making assisted reproduction useable. It focuses on the discursive landscape where ARTs were being discussed and negotiated, in terms of their sociopolitical and moral aspects, with the purpose of understanding how ARTs became socially usable, in addition to biologically and technologically useful. I begin this second part of the book by setting out the conceptual framework, explaining how and why I approach ARTs as technological innovations and as cultural novelties. Then, I offer an overview of the events relevant to the field of assisted reproduction that took place between 1990 and 2010. The first chapter of this part, The Universe Is Expanding, looks at how the universe of assisted reproduction expanded from 3 clinics in 1985 to 17 by the year 2000. I highlight two points that are particularly relevant during this period: the configuration of the AR clinic and the establishment of the Latin American registry. In Chapter 6, the Discursive Landscape, I argue that through the discourses and narratives offered in different spaces like the media, support groups, trade shows , and recruiting events, assisted reproduction was made socially usable in the sense of making it an acceptable way of forming a family. The book closes with Contemplating a Repronational Portrait , a reflexive chapter in which I look at the portrait this book painted from a distance, to appreciate the larger picture and thus see what this book has done, what Mexican AR system has accomplished, and what could we expect to come.
Naming the Mexican Assisted Reproduction System
The Naming of Cats is a difficult matter,It isnât just one of your holiday games;You may think at first Iâm as mad as a hatterWhen I tell you, a cat must have THREE DIFFERENT NAMES.T. S. Eliot
Indeed, naming is a difficult matter; be it naming a cat, a book, or an object of study. Naming is not a game; it matters. It matters because by conjuring a name to designate the object of our thought, we bring it into being, for us and for those with whom we are in conversation. By naming it, we create it, we delimit and confine it, and we make it manageable. Each name speaks of a specific group of elements set in particular relations (think of your full name and how it indicates your family lineage, the culture you live in, and maybe even your religious heritage). Names evoke different histories and they enable different things. In this book, I name the object of my study: the Mexican Assisted Reproduction System.
As T. S. Elliott illustrates in his poem, the important thing about names is that they can do different things. For example, names can be confusing. In the first written feedback I received of my Ph.D. research project, the reviewer used the abbreviation NRT. I remember staring at those three letters not knowing what they stood for. It took me several minutes to figure out what they meant: New Reproductive Technologies. Ah, yes! I felt terribly silly for not knowing this immediately, particularly since my research project was precisely about reproductive technologies. In 2006, when I was beginning my Ph.D., in vitro fertilisation (IVF)2 and other techniques used to aid people in reproductive processes were no longer new. Louise Brown, the first child born after being conceived using IVF, was about to turn thirty; and in Mexico, the site for my research, new clinics were opening every year. So, in my eyes these technologies were no longer new. For me, they were simply technologies assisting reproduction or for short, ARTs.
Things change, and so do their names. A decade later, in 2016, the number of infertility clinics offering this sort of assistance had increased, from little over twenty in 2007 to around 100 in 2017. They were targeting other segments of the population beyond the heterosexual couple with a âmedical diagnosis...