Vera Mackie, Nicola J. Marks and Sarah Ferber reveal some of the stories that make up the global history of IVF and assisted reproduction.
Candice Reed was born on 23 June 1980 in Melbourne. She was conceived through in vitro fertilisation (IVF) and was the first such baby to be born in Australia. As her fortieth birthday approaches we expect to see a flurry of articles on the four decades of in vitro fertilisation (IVF) in Australia. Candice Reed was born after years of experimental procedures by scientists and medical practitioners in Australia, at times collaborating and at times competing with teams in the United Kingdom, the United States of America, India, Japan and other parts of the world.
For the last five years, we have been engaged in the project of writing the global history of IVF and assisted reproduction. Here, we would like to provide a sense of this history through stories of some of the babies conceived through these technologies. These are named individuals whose stories were reported in the press because their births were the result of ‘firsts’ in medical technology, or because their births resulted in controversy. These are just a few of the stories of the over eight million babies born through assisted reproductive technologies since 1978. In the four decades since, the conditions for human reproduction have been transformed – from a largely private matter concerning heterosexual married couples using their own genetic material, to a global industry involving the movement of genetic material, embryos, intending parents, gestational surrogates and medical practitioners across national borders.
Louise Brown was born on 25 July 1978 at Oldham General Hospital in Manchester. She was conceived with the sperm and ova of her parents, the married couple Lesley and John Brown. The medical team circumvented the problem of Lesley’s blocked fallopian tubes through IVF, and Louise was the first successful birth after conception in vitro. The British team included Patrick Steptoe (1913–1988), Robert Edwards (1925–2013), and Jean Purdy (1945–1985). Edwards was awarded the Nobel Prize for Medicine in 2010. (The Nobel Prize is not usually awarded posthumously, so the other team members could not share the prize with Edwards.) While the British team was able to claim the first birth after fertilization ex utero, an Australian team took credit for the first pregnancy conceived ex utero back in 1973, although it was some years before they had a successful full-term birth with Candice Reed in 1980. Australia was a leader not only in technological and scientific developments but also in the regulation of assisted reproduction.
At the same time as the British team was developing the procedures which led to the birth of Louise Brown, scientists in other countries were also developing IVF techniques. The second baby born after conception through IVF was Kanupriya Agarwal in India. She was born in Kolkata (Calcutta) on 3 October 1978, at the time of the local Hindu festival, so she was nicknamed ‘Durga’ in honour of the goddess being celebrated. Her birth was surrounded by controversy. The veracity of Dr Subhash Mukhopadhyay’s (1931–1981, also known as Mukerjee) claim to have facilitated the first IVF birth in India was challenged. It was only in the early 2000s that his pioneering contribution was officially recognised. It was his successor T. C. Anand Kumar (1936–2010) who eventually cleared Mukhopadhyay’s name. (Kumar had for a time been given recognition for the first ‘scientifically documented’ IVF birth in India in 1986.) Mukhopadhyay, however, had committed suicide in 1981, after years of ill treatment and harassment in the medical profession. Mukhopadhyay is also now credited with the first birth from the implantation of a frozen embryo.
Once techniques of artificial insemination, in vitro fertilization and freezing of gametes and embryos were developed, it became possible for fertilisation, implantation and gestation to be separated in time and space. The first babies conceived through IVF had genetic material from both their parents – heterosexual married couples. Other forms of making babies became possible through assisted reproduction: a mother’s ovum could be fertilized with donor sperm through artificial insemination; an ovum from a third party could be fertilized with the intending father’s sperm and gestated by the intending mother; a mother could gestate an embryo created from third party sperm and a third party ovum; another woman could be engaged as a gestational surrogate in order to bear a child for intending parents – in some cases using her own ovum; in other cases using a third party ovum. The first birth through IVF and altruistic surrogacy took place in Australia in 1989. The practice of commercial surrogacy led to the first legal dispute in the USA as early as the mid-1980s.
Mary Beth Whitehead entered into a surrogacy contract with Elizabeth and William Stern. Whitehead became pregnant with her own ovum and Stern’s sperm. This was not an IVF birth, but is significant because the court case anticipated the disputes which would appear with the use of assisted reproduction. The baby, Sarah Elizabeth Whitehead (later renamed Melissa Elizabeth Stern) was born on 27 March 1986. She is known as ‘Baby M’, because this was how she was referred to in the ensuing legal dispute over her parentage. After the birth Mary Beth Whitehead challenged the surrogacy contract and wished to retain custody of the baby. The Supreme Court of New Jersey invalidated the surrogacy contract but awarded custody to the Sterns on the basis of the ‘best interests of the child’; a lower court then awarded visitation rights to Whitehead. In 2004 Melissa Stern terminated Mary Beth Whitehead’s parental rights and was adopted by Elizabeth Stern.
The practices of assisted reproduction, the use of third party gametes and the use of contracts for gestational surrogacy have led to new ways of describing parentage. We now talk of ‘intending’ mothers and fathers, ‘commissioning’ mothers and fathers, ‘social’ mothers and fathers, ‘biological’ mothers and fathers, ‘birth mothers’, ‘gestational’ and ‘surrogate’ mothers, as well as ‘diblings’ (siblings from the same gamete provider) and ‘gaybies’ (children of gay and lesbian parents).
Since the ‘Baby M’ case, several states in the USA have moved to regulate surrogacy. The State of Nevada is one such jurisdiction. Intending parents travel there from other parts of the USA and from other countries in order to make use of Nevada’s medical facilities and clear regulatory procedures. Increased access to international air travel has also facilitated such movements for reproductive services, at least for the relatively wealthy.
Banri and Yūta Takada
When radio. movie and television personality Mukai Aki became pregnant, she discovered that she had cervical cancer. She was advised to terminate the pregnancy in order to save her own life. She had a hysterectomy but her ovaries were saved. With the assistance of an agency in Japan which facilitates international gestational surrogacy, Mukai and her husband, Takada Nobuhiko, travelled to the USA. They made several attempts at gestational surrogacy. Eventually, their twins – Banri and Yūta – were born in November 2003. The twins were conceived with embryos from Mukai’s ova and her husband Takada Nobuhiko’s sperm. Cindy van Reed gestated the twins as part of a commercial surrogacy agreement. The birth certificate in Nevada named Mukai and Takada as the parents. On their return to Japan, however, they were unable to register the children in their own family register. Surrogacy is not regulated under the legal system in Japan, but the Japan Society of Obstetricians and Gynecologists discourages its members from facilitating surrogacy. When Mukai and Takada attempted to register the birth at the Shinagawa Ward Office, they came up against the legal convention that the birth mother is the legal mother of the child. The twins had US nationality on the jus soli (place of birth) principle. So that they would be able to attain Japanese nationality, Mukai and Takada adopted the children in 2008. After three years they could apply for the children’s naturalisation as Japanese nationals. Mukai and Takada’s medical and legal struggles have been documented in a series of memoirs, which have also been adapted as manga (graphic novels) for a Japanese audience. So far, there have been only two court cases in Japan concerning the registration of babies born through surrogacy. It is likely, though, that most other such parents have been able to successfully register their babies on the basis of birth certificates issued overseas. Some estimate the numbers of couples from Japan who have entered into surrogacy agreements overseas to be in the hundreds.
There are various reasons why intending parents travel overseas to access assisted reproduction or engage in surrogacy contracts. Places like Nevada offer a highly regulated environment, albeit at high cost. Until recently, places like Thailand and India offered sophisticated medical services to international clients in a loosely regulated environment with lower costs compared with First World destinations.
Yamada Ikufumi and Yamada Yuki entered into a surrogacy agreement with Pritiben Mehta in India. Their baby, ‘Manji’, was conceived from a third-party ovum and Yamada Ikufumi’s sperm. The Yamadas divorced shortly before Manji was born on 25 July 2008. As an unmarried man, Yamada could not adopt Manji in either India or Japan, due to each jurisdiction’s regulation of adoption. Manji was thus without a birth certificate or a passport. The Indian Supreme Court granted temporary custody to the grandmother Yamada Emiko; the Rajasthan regional passport office issued an identity document good for one trip to Japan; and the Japanese Embassy issued a one-year visa for Manji on humanitarian grounds. Manji was able to travel to Japan but was illegitimate and stateless.
India has since regulated assisted reproduction and surrogacy arrangements with the Surrogacy Regulation Bill which was passed in December 2018. Under this legislation, only altruistic (that is, non-commercial) surrogacy is allowed. The intending parents should be a heterosexual married couple of Indian citizenship resident in India who have been legally married for at least five years. The child will be deemed to be the legal offspring of the intending couple. Surrogacy is not available to singles, non-heterosexual couples or unmarried cohabiting couples. Similar to many other places, the current regulations in India thus privilege Indian nationality and the heteronormative family, in a pattern described by Sarah Franklin and Marcia Inhorn as ‘repronationalism’ (reproductive nationalism). Thailand, too, moved to regulate assisted reproduction after several international controversies.
Australian couple David and Wendy Farnell entered into a surrogacy contract with then twenty-one-year-old Pattaramon Chanbua in Thailand. Twins were conceived from Farnell’s sperm and third-party eggs. Pipah and Gammy were born in December 2013. The Farnells took their daughter, Pipah, back to Australia, but her brother Gammy – who had Down Syndrome and a congenital heart condition – remained with the birth mother. The Parnells’ custody of their daughter was challenged in the Western Australian Family Court. The Court decided that the Farnells could retain custody of Pipah and found that the couple had not abandoned the boy. Gammy (now known as Grammy) still lives with his birth mother in Thailand, but has also been granted Australian citizenship on the basis of descent.
Another controversy was stirred up around this time, where an unmarried business entrepreneur from Japan, Shigeta Mitsutoki, was found to have fathered at least sixteen children with nine Thai women acting as gestational surrogate mothers, and possibly more children in other countries. Shigeta’s parentage of the children was challenged but was eventually recognised by a Bangkok court.
These controversial cases involving international gestational surrogacy prompted the Thai government to act. The Protection for Children Born Through Assisted Reproductive Technologies Act was passed in 2015. It restricted the eligibility for surrogacy to heterosexual couples (at least one of whom must be Thai) who have been married for at least two years; and requires surrogates to be female relatives of the couples requesting surrogacy. As Andrea Whittaker has commented, the ‘legislation reasserted a heteronormative family as a Thai value and affirmed the boundaries of Thai-ness through citizenship, banning foreigners from utilizing Thai women’s bodies’. Once India, Thailand and several other countries restricted access to transnational gestational surrogacy, intending parents sought out reproductive services in other destinations, such as the Ukraine, one of the poorer countries to emerge from the break-up of the former Soviet Union.
ABC Investigative journalist Samantha Hawley has been following issues related to international surrogacy for some years, including coverage of the abovementioned ‘Baby Gammy’ case and the recent emergence of the Ukraine as a destination for those seeking gestational surrogacy. Matthew Etynre and Irmgard Pagan from the USA entered into a surrogacy contract in the Ukraine. Twins conceived through this arrangement were born in July 2015. One twin died at birth. His twin sister Bridget (known by the nickname ‘Brizzy’) was born at 25 weeks weighing just over 800 grams and with various developmental delays. Brizzy was left behind by the commissioning parents, but their names still appear on official documentation as Brizzy’s parents. They authorized turning off her life support at five months but she survived. Brizzy is now living in a children’s home in the Ukraine, stateless and with her legal status unclear. She has neither Ukraine nor US citizenship. Babies like Brizzy get caught in the gaps between different regulatory regimes, with no clear international agreements on children born through surrogacy.
The freezing of gametes and embryos and the separation of fertilization, implantation and gestation also means that a child can be gestated even after its biological parents are deceased. Numerous court cases in various jurisdictions have hinged on access to the genetic material of deceased persons.
Tian Tian’s parents had undergone fertility treatment in China. In 2013, before they could implant the embryo, Tian Tian’s parents were killed in a car crash. Tian Tian’s maternal and paternal grandparents petitioned to be able to use the embryo. The embryo was implanted in the womb of a Lao woman, who later traveled to China on a tourist visa to deliver the baby in December 2017. Tian Tian is now in the care of his maternal and paternal grandparents. In order to retain custody, they needed to undertake DNA tests to prove their genetic relationship to the child
While some countries, as we have seen, attempt to regulate assisted reproduction in ways which support the heteronormative nuclear family, some individuals are creating new forms of family with the assistance of these technologies.
Natalie Lovett had several unsuccessful attempts to become pregnant. She purchased third party ova and sperm in the USA and became pregnant with her daughter Alexis (‘Lexie’). Once Lexie was born, she needed to decide what to do with 25 unused embryos. Lovett decided to donate the embryos to other intending parents, on the condition that they would stay in contact with Lovett and her daughter Lexie. They practise a new form of family with Lexie and her ‘diblings’ (donor siblings). Lexie is not genetically related to Natalie – her birth mother and her social mother – but is related to the diblings who make up ‘Lexie’s village’.
Assisted reproductive techniques have also facilitated the formation of families composed of same-sex partners and their children, whether by artificial insemination by donor or by gestational surrogacy. In Maya Newell’s documentary, such children are known as ‘gaybies’. One of the ‘gaybies’ in Newell’s documentary, Gus Skattebol-James, went on to co-author a children’s book about growing up with gay parents.
More controversial are cases where medical practitioners have secretly used their own sperm in artificial insemination. There have been several controversies where children conceived through these means have discovered that they have dozens of half-siblings, as dramatized in the US docudrama, The Babymaker (also known as Seeds of Deception). A similar scenario formed the basis of the fictional Australian television drama, Sisters, in 2017, where the main character discovers that her Nobel Prize-winning medical practitioner father had inseminated dozens of female patients with his own sperm. The series follows her quest to know about her half-siblings.
In an early discussion of how the public comes to know about assisted reproduction, Rebecca Albury noted the importance of the print media for readers who would be unlikely to consult scientific and medical journals. In the five or so years since we commenced this project, television drama has become another site for thinking through the experiences of assisted reproduction – in such domestic dramas as Offspring and House Husbands, and medical and legal dramas such as MDA and Crownies. Because we are interested in thinking through the cultural meanings of assisted reproduction and new family forms, the sources for our history go well beyond the usual archival sources. We have, of course, consulted articles by medical and legal practitioners and ethicists in their professional journals, but we have also surveyed print media and online media, fiction, manga, children’s books, personal memoirs by medical practitioners and their clients, domestic dramas and documentary films and television programs from several countries. Together, these sources can provide a sense of the global ‘reproscape’, the landscape of reproduction in the twenty-first century, after four decades of IVF and assisted reproduction.’
Vera Mackie, Nicola J. Marks and Sarah Ferber from the School of Humanities and Social Inquiry at the University of Wollongong are the editors of The Reproductive Industry: Intimate Experiences and Global Processes, Lanham: Lexington Books, 2019. Their research was funded by Australian Research Council Discovery Project DP150101081 ‘IVF and Assisted Reproduction: The Global Experience’. Vera Mackie tweets as @veramackie. The authors are affiliated with the Centre for Critical Human Rights research which tweets as @humanrightsuow.