The baby-making business

Where preimplantation genetic diagnosis can be harnessed to not only select the sex of your unborn baby, but also to screen embryos for life-threatening diseases or even to create a healthy potential 'saviour sibling' to act as a donor to an existing child.

Just a few decades ago, these scenarios would have sat squarely in the realm of science fiction. In the 40 years since the controversial birth of the first baby conceived through in vitro fertilisation, though, Assisted Reproductive Technologies (ARTs) can now offer possibilities for designer babies that few would have predicted.

"IVF both reinforces and challenges the biological desire to be a parent."

- Dr Nicola Marks

Baby making has become big business, with the global market tipped to grow in value beyond US$21 billion by 2020. The technology − IVF (in vitro fertilisation) − was initially harnessed to help infertile heterosexual couples achieve a dream of parenthood, but can now be employed to create families of a much less traditional nature.

It is hard to think of another medical technology that has been so life-changing on an individual level, while constantly courting controversy and bringing cultural understandings into question.

^{Researchers Dr Nicola Marks, Professor Vera Mackie and Professor Sarah Ferber are tracing the history of fertility treatment around the world. Photo; Paul Jones}

"The IVF debate resonates with people because it is about children − about creating new human beings. It is emotional and it is complex," says Professor Sarah Ferber, a historian and author of Bioethics in Historical Perspective from the University of Wollongong (UOW). "Everybody has their own reproductive journey, even if that is a choice not to have children."

The ways in which ART became routine and acceptable in many parts of the world, while at the same time potentially being ethically and culturally disruptive, are at the heart of a research collaboration between Professor Ferber and UOW colleagues Professor Vera Mackie, a leading scholar in Asian history, gender and sexuality and cultural studies, and Dr Nicola Marks, an expert in genetics, sociology of medicine and public engagement in science.

The wide-ranging project − IVF and Assisted Reproductive Technologies: The Global Experience - is funded to the tune of more than $500,000 by the Australian Research Council. The project traces the history of fertility treatment around the world.

"The IVF debate resonates with people because it is about children − about creating new human beings. It is emotional and it is complex."

- Professor Sarah Ferber

Rather than a compiling a purely medical history, the multidisciplinary team is examining the ways ART has become a fact of life globally in different ways, in different places for different people. They are interested in the meanings attached to assisted reproduction.

It's a field where science fiction has given way to science fact through unexpected twists and turns. From Aldous Huxley's 1932 satirical novel, A Brave New World, to recent warnings about the dangers of 'designer babies', assisted reproduction has been a constant feature in public debate and media commentary over the past four decades.

In the fictional year 2540 society depicted by Huxley, reproduction takes place in a vast, impersonal, central hatchery, where racks of tailor-made babies in test tubes are tended to by staff in white overalls and families are considered obsolete.

Embed from Getty Images

In 1982, Rene Frydman, Jacques Testart and Emile Papiernik produced the first baby born in France through IVF.

In reality, the term 'test tube baby' was never accurate, but petri dish - the glassware currently used - doesn't quite have the same ring to it. IVF means 'fertilisation in glass' and Louise Brown, like the estimated five million IVF babies born across the world since, was conceived after her father's sperm was combined with her mother's egg in a laboratory jar.

Her birth was celebrated across the world, although Professor Mackie points out that the world's second IVF birth in India a matter of months later barely gets a mention in medical journals or histories, indicative, she says, of the US- and UK-centric nature of the medical profession.

Louise Brown's arrival was controversial, with some religious leaders questioning the artificial intervention and others raising fears about science being used to create designer babies - 'Frankenbabies'. Many years later, in an autobiography published in 2015, Ms Brown revealed that her parents, Lesley and John, had received blood-splattered hate mail following her birth at Oldham General Hospital in July 1978.

Professor Ferber says that few commentators would have predicted at the time the speed with which IVF would become routine, the ways in which ART is currently applied and also the impact of the internet in connecting patients, both with each other in search of support and also to clinics around the world.

In this version of the brave new world, one in every 100 babies born in Australia is conceived through ART and would-be parents, regardless of marital status or sexual orientation, are able to engage in reproductive travel − at a price.

^{Professor Sarah Ferber. Photo: Paul Jones}

While routine IVF became accepted in many societies as a way to help heterosexual couples have a family, Professor Ferber says its use to create less traditional families brings many more complexities. Professor Mackie describes the way in which IVF and ART have forced a reimagining of traditional notions of family and brought new challenges to our understanding of gender relations.

"IVF began as a way of being able to conceive outside of the body, but it is now much more than putting the ova and sperm together. The technology is constantly being used in new ways," she says.

In the documentary Google Baby, for instance, an agent in Israel procures an ovum over the internet, takes the ovum and the sperm of a commissioning father to India, and enters into a surrogacy agreement on behalf of the commissioning parents.

"These new families provide legal challenges. In many places, like Japan, the birth mother is considered to be the legal mother, so that there will be difficulties in registering a baby born through a surrogacy arrangement. These legal difficulties are compounded when parents cross borders and must deal with more than one legal system," Professor Mackie says.

^{Professor Vera Mackie. Photo: Paul Jones}

These kinds of scenarios are creating ever-widening gaps between medical practice, legal regulation and everyday understandings of the technology, the researchers say. "International surrogacy, in particular, was not something that was considered 40 years ago," Professor Ferber says. "Advances in freezing technology mean that people can access and transport gametes (reproductive cells), sperm in particular, in ways that would not have been imaginable."

Compare, for example, Louise Brown's birth with that of a baby known as Manji, born 30 years later in India. Lesley Brown had blocked fallopian tubes, so doctors Patrick Steptoe and Robert Edwards took an egg from one of her ovaries, under anaesthetic, and fertilised it with a sperm from her husband in the lab before placing it in her uterus.

The birth of baby Manji, in 2008, was the result of the same technology, but that is where the similarities end. She was born in India to a gestational mother who had been commissioned by a married Japanese couple, using the sperm from the husband and the egg of another Indian woman. This was all arranged through a fertility clinic.

Before Manji was born, the commissioning parents divorced, leaving the father unable to adopt the child either in India or Japan and facing a lengthy court battle before he was able to take the baby to Japan, where Manji was stateless and illegitimate.

The complexities surrounding Manji's conception and birth were echoed in recent media coverage of United States panel show host Sherri Shepherd and her unsuccessful court battle to extricate herself from any legal responsibility for a child borne by another woman through a surrogacy agreement. Like Manji's parents, Shepherd and then husband Lamar Sally were divorced before the baby was born.

"IVF both reinforces and challenges the biological desire to be a parent," Dr Marks says. At the heart of the research are extremely emotional stories articulating the lengths that people are prepared to go to in turning to cutting-edge technology to try to achieve their dreams of a family.

The ambitious project will shine a light on not only the cultural history of ART, but also how it is used and understood in different communities across the world. The research team will draw on a wide range of sources to investigate the cultural impact of IVF, including memoirs, interviews, online support forums, academic research, government policy and documents, and media coverage.

^{Dr Nicola Marks. Photo: Paul Jones}

The team combines research strengths including history, cultural studies, bioethics, genetics, science and technology studies, and public engagement in science, as well as interests in different countries and regions across the world.

The global focus of the research is twofold, both tracking the development of the worldwide ART industry and drilling down to produce case studies from specific regions, including Japan, Australia and New Zealand, India, the Philippines, the French Pacific and France.

The team has already hosted an international conference, co-sponsored by the Academy of the Social Sciences in Australia, and the project will produce a series of journal articles, an edited collection of essays and a major book − IVF: The Global Experience − to be published next year.

"Part of this history has been the controversy that has surrounded this historical change, even before it took place," Professor Ferber says. "The book will accentuate the personal nature of the developments in medical history, showing it to be part of the history of countries, professions and communities, as well as the stories of individuals and families."

This article is the first in a series of stories looking at IVF The Global Experience, which will explore reproductive travel, the experiences of ARTs in different cultures, and regulation in more detail.