The fertility narratives lab was born with a dual purpose; on the one hand, to collect wider information on patients’ fertility, on the other, to serve as a dialogic space between different voices, such as staff, patients, and me as
Fertility Narratives 91
Ricerche
a researcher. This applied anthropology project, mainly designed to bring critical and reflective anthropological knowledge into a clinical context, has been particularly fruitful for collecting several facets of timing and reproduction within a fertility clinic. The establishment of the laboratory, although it had many favorable conditions, was not easy to achieve because the slow knowledge of anthropology clashed with the precise and frenetic timing of a fertility center.
Time has been a constant thematic of the Fertility Narratives Lab. From the collected narratives, time has emerged as one of the crucial aspects of ARTs for different reasons, and from different perspectives. In this ar-ticle, I have highlighted three different temporalities collected during the fertility narratives lab. The first temporality described has been the time of the bodies, intended as a decisive factor for the deterioration of repro-ductive abilities, more in women than in men. The second mentioned has been the staff temporality, strongly focused on a specific organization of time based on previous staff knowledge and success rates that have imple-mented the idea of the need to act within a specific time window and avoid jeopardizing the success of the entire journey. The third, and last one, it was connected to patients’ time perception that collided and shaped with the other two temporalities. ivf gives the impression of being an extremely controllable practice, since it is possible to plan in detail every action, when it escapes every possible prevision. The staff mainly described the respect of the execution of precise, albeit imprecise, manipulations of the “times of the bodies” – follicular maturation, egg retrieval, etc. – as fundamen-tal actions for the success of any ivf treatment. From their point of view, the precise execution of these phases would have laid the foundations for a positive path; on the contrary, any change of program – even if mini-mal – could have compromised the success of the ivf. Patients eager to con-ceive before it was “too late”, represented their experiences as “suspended in time”, mainly characterized by a persistent uncertainty due to the way in which ARTs operate. While on the one hand, patients felt the need to
“chase time” by asking to speed up the steps necessary to complete the steps necessary to achieve conception, on the other hand, the staff high-lighted the importance of waiting for the “right moment” for the execution of the techniques. These representations fed the imagery of patients, who viewed in vitro reproduction as a highly controllable, manipulable, and predictable practice.
Fertility narratives can be seen as and proves to be an opportunity to find a politicized voice of fertility, but also to reflect on the way in which
92 Corinna Sabrina Guerzoni
AM 52. 2021
reproductive bodies are represented. Fertility narratives as a theoretical concept help me to show how the time has been perceived and co-con-structed between patients and staff. From the collected data, time was de-voted more to technique practices rather than to listen to patients. Thanks to the critical knowledge of anthropology, and especially thanks to the information acquired during the fertility narratives lab, some practices given as praxis have been questioned by the staff. In a similar way, patients involved in the lab were able to reflect on their journey in a different way compared to their previous experiences gaining awareness on how the only certainty of ivf is its uncertainty.
In conclusion, I believe that fertility narratives – meaning the set of nar-ratives relating to the temporal, emotional and biopolitical stratification of reproductive pathways – can offer a space for reflection both for the patients and for the staff, to approach the patients in a less mechanical way and embrace more the subjective dimension, without therefore seeing patients as body parts.
Notes
(1) All the names reported in this article have been changed to ensure the anonymity and protect the privacy of the subjects involved in this research.
(2) Third-party coordinators are assigned only to patients who use surrogacy to have children. Third-party coordinators are a liaison among patients and all the parties involved in a surrogacy journey, such as fertility lawyers, egg donors, gestational sur-rogates, insurance brokers, and obgyn doctors.
(3) The average age of patients who used ivf and surrogacy at whfc was around 43 years.
On the website of the Italian Ministry of Health, for example, like in the majority of scientific database, it is highlighted the crucial role played by the time: «Fertility, both male and female, is affected by the normal aging processes of the organism, chang-ing with age. In humans, the sperm production process does not stop with agchang-ing, but gradually decreases and deteriorates in quality, in relation to a gradual decline of the hormone levels and the appearance or worsening of various andrological diseases. In women, however, age plays a very important role in reproductive capacity. For an in-formed choice, it is important that young women are inin-formed that the female ‘fertile window’ is limited, and that the quality of the oocytes decreases with increasing age.
The fertility of women, therefore, is maximum between the ages of 20 and 30, then undergoes a first significant decline, albeit gradual, already around the age of 32 and a second fastest decline after age 37 […]» – https://www.salute.gov.it/portale/fertility/
dettaglioContenutiFertility.jsp?lingua=italiano&id=4556&area=fertilita&menu=stilivita.
Fertility Narratives 93
Ricerche
(4) International societies of reproductive medicine and fertility clinics show rates of success of specific practices based on different factors (age, quality of semen, egg and embryos etc.).
(5) The experimental project involved a period of testing and observation with respect to what I have defined fertility narratives. Weekly, exclusively European patients were selected to participate in this initiative which included a long interview between pa-tients and third party-coordinators before the video consultation with Dr. Paulson.
(6) One example of a fresh cycle is the aligned of egg donor/or intended mother men-strual cycle with the surrogate one. An example of frozen cycle is preparing surrogate’s uterus to receive a frozen embryo cryopreserved at the clinic.
(7) At whfc this room was in front of the ivf lab. Inside of the collection room there was a sofa and a television with a large collection of porn available for patients. A medi-cal assistant was generally accompanying patient inside this room, giving them some instructions to follow. When the patient collected the semen inside a cup, he had to call the andrology lab by ringing a bell.
(8) This information is shared not only by whfc, but also by other fertility clinics and some latest articles on embryos quality and ivf success rates, such as, for example Does Maternal Age at Retrieval Influence the Implantation Potential of Euploid Blastocysts?, pub-lished in 2019 on the American Journal of Obstetrics and Gynecology.
References
Bell S.E. (2020), Experiencing Illness In/And Narrative, pp. 184-199 in Bird C.E., Conrad P., Fre-mont A.M., (eds.), Handbook of Medical Sociology, Prentice Hall, Upper Saddle River, NJ.
Baldwin K. (2019), Egg Freezing, Fertility and Reproductive Choice: Negotiating Responsibility, Hope and Modern Motherhood, Emerald Publishing, Bingley.
Barnes L.W. (2014), Conceiving Masculinity: Male Infertility, Medicine, and Identity, Temple Univer-sity Press, Philadelphia, USA.
Birenbaum-Carmeli D., Inhorn M.C., Vale M., Patrizio P. (2021), Cryopreserving Jewish Moth-erhood: Egg Freezing in Israel and the United States, “Medical Anthropology Quarterly”, Vol. 35(3):
346-363.
Brown E., Patrick M. (2018), Time, Anticipation, and the Life Course: Egg Freezing as Temporarily Disentangling Romance and Reproduction, “American Sociological Review”, Vol. 83(5): 959-982.
Bruner E.M. (1986), Ethnography as Narrative, pp. 139-155 in Turner V.W., Bruner E.M. (eds.), The Anthropology of Experience, University of Illinois Press, Urbana.
Bühler N. (2021), When Reproduction meets Ageing: The Science and Medicine of the Fertility Decline, Emerald Publishing, Bingley.
Clarke A.E., Mamo L., Fosket J.R., Fishman, J.R., Shim J.K. (2010), Biomedicalization: Techno-science, Health, and Illness in the U.S., Duke University Press, Durham/London.
Crow J., Amso N.N., Lewin J., Shaw R.W. (1994), Physiology: Morphology and Ultrastructure of Fal-lopian Tube Epithelium at Different Stages of the Menstrual Cycle and Menopause, “Human Reproduc-tion”, Vol. 9(12): 2224-2233.
94 Corinna Sabrina Guerzoni
AM 52. 2021
Davis G., Loughran T. (ed.) (2017), The Palgrave Handbook of Infertility in History Approaches, Contexts and Perspectives, Palgrave Macmillan, London.
Frank A. (2002), The Extrospection of Suffering: Strategies of First-Person Illness Narratives, pp. 165-177 in Patterson W. (ed.), Strategic Narrative: New Perspectives on the Power of Personal and Cultural Stories, Lexington Books, Lanham, MD.
Hinton L., Miller T. (2013), Mapping Men’s Anticipations and Experiences in the Reproductive Realm:
(In)Fertility Journeys, “Reproductive BioMedicine Online”, Vol. 27(3): 244-252.
Garro L., Mattingly C. (2000), Narratives as Construct and Construction, pp. 1-50, in Garro L., Mattingly C. (eds.), Narratives and the Cultural Construction of Illness and Healing, University of California Press, Berkeley.
Good B. (2014), Narrare la malattia. Lo sguardo antropologico sul rapporto medico-paziente, Einaudi, Torino.
Guerzoni C.S. (2017), Generare oltre i corpi. Progetti genitoriali, percorsi riproduttivi e pratiche di sur-rogacy: il viaggio oltreoceano di padri gay italiani, pp. 61-88 in Mattalucci C. (ed.), Antropologia e riproduzione. Attese, fratture e ricomposizioni nelle esperienze di procreazione e genitorialità in Italia, Raffaello Cortina, Milano.
Guerzoni C.S. (2020), Sistemi procreativi. Etnografia dell’omogenitorialità in Italia, Franco Angeli, Milano.
Inhorn M.C., van Balen F. (ed.) (2002), Infertility around the Globe: New Thinking on Childlessness, Gender, and Reproductive Technologies, University of California Press, Berkeley.
Inhorn M.C. (ed.) (2007), Reproductive Disruptions. Gender, Technology, and Biopolitics in the New Millennium, Berghahn, New York-Oxford.
Inhorn M.C., Birenbaum-Carmeli D., Yu R., Patrizio P. (2021), Egg Freezing at the End of Ro-mance: A Technology of Hope, Despair, and Repair, “Science, Technology & Human Value”, Vol. 47(1):
1-36.
Infertility Network UK, (2008), The Infertility Network UK Fertility Tourism Survey Results, avail-able from http://www.hfea.gov.uk/fertility-clinics-treatment-abroad.html.
Irani M., Zaninovic N., Rosenwaks Z.Z, Xu K. (2019), Does Maternal Age at Retrieval Influence the Implantation Potential of Euploid Blastocysts?, “American Journal of Obstetrician and Gynecology”, Vol. 220 (4): P379.E1-379.E7.
Kleinman A. (1998), The Illness Narratives: Suffering, Healing, and the Human Condition, Basics Books, New York.
Linconstant L. (in press), Infertility as a Gendered Social Experience in Italy (Lombardy): Sense of Self and Modality of Action, in Guerzoni C.S, Mattalucci C. (eds.), Reproductive Governance and Bodily Materiality: Flesh, Technologies, and Knowledge, Emerald Publishing, Bingley.
Lombardi L. (2018), Riproduzione e salute nella società globale, Maggioli Editore, Santarcangelo di Romagna.
Mattalucci C. (2017), Antropologia e riproduzione. Attese, fratture e ricomposizioni nelle esperienze di procreazione e genitorialità in Italia, Raffaello Cortina, Milano.
Melhuus M. (2007), Procreative Imaginations: When Experts Disagree on the Meanings of Kinship, pp.37-56, in Lien M.E., Melhuus M. (eds.), Holding Worlds Together: Ethnographies of Knowing and Belonging, Berghahn Books, New York/Oxford.
Mol A. (2008), The Logic of Care. Health and the Problem of Patient Choice, Routledge, London/
New York.
Fertility Narratives 95
Ricerche Pennings G. (2004), Legal Armonization and Reproductive Tourism in Europe, “Human
Reproduc-tion”, Vol. 19(12): 2689-2694.
Pennings G. (2009), International Evolution of Legislation and Guidelines in Medically Assisted Repro-duction, “Reproductive Biomedicine Online”, Vol. 18(2): 515-518.
Pennings G., de Wert G., Shenfield F., Cohen J., Tarlatzis Basil, Devroey Paul (2008), ESHRE Task Force on Ethics and Law 15: Cross-Border Reproductive Care, “Human Reproduction”, Vol. 23(10): 2182-2184.
Sulik Gayle A., Eich-Krom A. (2008), No Longer a Patient: The Social Construction of the Medical Con-sumer, pp. 3-28 in Chambré S., Goldner M. (eds.) Patients, Consumers and Civil Society, “Advances in Medical Sociology”, Vol. 10: 3-28.
van de Wiel L. (2014), For Whom the Clock Ticks: Reproductive Ageing and Egg Freezing in Dutch and British News Media, “Studies in the Maternal”, Vol. 6(1): 1-28.
Waldby C. (2015), Banking in Time: Egg Freezing and the Negotiation of Future Fertility, “Culture, Health and Sexuality”, Vol. 17(4): 470-82.