Challenging conception: A clinical and cultural history of in vitro fertilization in the United States.

Abstract

In vitro fertilization (IVF) came into existence in the United States not only because of the particular technical innovations achieved by reproductive scientists, but because of the ways in which reproduction intersected with American social ideologies and political structures. Specifically, IVF was built upon a trio of cultural phenomena that emerged in this country after World War II: delayed childbearing, as women entered the professional workforce in increasing numbers in the 1970's and 1980's; specific forms of capitalism and consumer culture, including the fee-for-service health care system; and the complex social and political impasse on abortion that arose in response to Roe v. Wade. Ideologies of race and class stratified access to reproductive technology, promoting its use among affluent white women, and inhibiting its access by poor women and women of color. This dissertation reconstructs the clinical and cultural history of IVF in the US from its emergence in the 1970's, through 2002. Drawing on oral histories with American IVF innovators, the archival documents of the first US IVF clinic, medical literature, national IVF outcomes databases, government reports, and popular media representations of infertility and IVF, it demonstrates that in vitro fertilization, <italic>as clinical procedure and as a social discourse,</italic> moved through five phases in its twenty-five year US history. The period prior to the birth of the first US IVF baby in 1981 was characterized by technical challenges and strident objections from religious forces nationwide. Between 1982 and 1984, IVF became a national phenomenon, and the moral and ethical questions of the earlier period were superseded by legal ones. From 1985 to 1991, the patient profile for IVF dominated developments, as both the media and clinicians sorted out which individuals would receive in vitro treatment. During this period the government did not articulate a national response to IVF's social and moral implications, determining instead that consumer protection measures were best. Between 1992 and 1997, scandal and critique from within and without tested IVF's resilience. Most recently, from 1997 to 2002, the role of IVF as a controversial object of inquiry diminished as the technology was integrated into medical practice in a manner that truly transformed American culture. IVF altered the relationship between reproduction and the market, re-invigorated controversy over abortion, and eclipsed public discussion of non-technological solutions to the difficulties generated by American women's growing commitments to balancing work and family. My dissertation explores the intimate relationship between medical technology and social and political life. The history of IVF gets to the heart of some of the most crucial issues of American life in the 20<super>th</super> century.