In Vitro Fertilisation and Multiple Births: International Context and Policy Consideration
Coven, Victoria Jane
Thesis or dissertation
University of Exeter
In Vitro Fertilisation (IVF) may be viewed as a sociological problem because its widespread adoption has influenced the structure of the family unit. This in turn has had consequences for wider society and especially for health and social care institutions. A key objective of this study is to provide further theoretical development of the sociology of IVF initiated by Karen Throsby. Throsby takes a feminist approach and critically analyses discourses from women and couples engaged in the IVF process. Much of her work focuses upon IVF failure. Throsby situates IVF within 2 cultural narratives; 1) Reproduction is normal and natural, and 2) IVF is successful. She finds that the patient’s experience of the IVF process produces a profoundly gendered discourse orientated towards locating the self and engagement with the treatment as ‘normal’. My investigation situates IVF within the same cultural narratives, and how they contribute to the phenomenon of multiple births that result from the adoption of this method of assisted conception. I investigate how public health policy may reduce these types of pregnancy for potential parents undergoing fertility treatment in the UK. Specifically, my research looks at the types of support that clinics in the UK are offering patients to decrease stress and distress, and whether and how such support mechanisms incorporate government mandates to decrease the multiple birth rate at UK clinics. My research question is therefore broad sociologically as I have dissected narratives contributing to the problem of multiple births and within the context of these narratives have sought to investigate how patient support in the form of counselling could be implemented as a policy response. An objective of this research was to discover if counselling could act as a forum to discuss and inform a patient about the benefits of a single pregnancy; the implications of multiple embryo transfer and explore any patient negative response to SET. Secondarily, there is some evidence that counselling may be effective in decreasing stress and distress surrounding the procedure for some patient’s and so may also help to maximise the chances of successful implantation of the single embryo. Throsby’s research focused upon the naturalisation of IVF ‘success’ and resulting impact this had on the location the patient’s self-identity within the context of her medical condition. This study acknowledges the naturalisation of multiple embryo transfer techniques. Throsby’s observation was that the naturalisation of both treatment success and multiple embryo transfer can be harmful for the emotional and physical health of the individuals engaged in the IVF process. However she suggested that resistance to the IVF process was possible and observed it arising spontaneously through the process of some patient’s engagement with it (Throsby 1994:43). However through a Foucauldian perspective it is possible to speculate that because the patient’s perception of their self-identity as an infertile woman within the context of treatment is fluid, such resistance is difficult. Patient resistance can help to redefine the cultural narratives inherent in the procedure. I extend Throsby’s work by proposing that counselling offers a site for reflection within the clinical treatment cycle. Through engagement in counselling a patient may be able to more fully understand and contemplate their position in relation to each of the clinical processes. With professional counselling assistance a patient may find that such reflection can allow for an exploration of and relocation of their self-identity within the cultural narratives that surround IVF. Multiple births occur because women receiving IVF treatment regularly have more than one embryo transferred into their uterus during a treatment cycle. The literature suggests that multiple births are detrimental to the health and well being of women using IVF and the children they bear. Multiple births also place stress on public health care. Accordingly, some countries have introduced legislation or regulations to limit the number of embryos transferred in an effort to decrease multiple birth rates. In the UK, policy is currently being implemented to encourage single embryo transfer (SET) for suitable patients. My study provides an analysis of how this policy is being incorporated with existing policy surrounding the IVF procedure, specifically in the implementation of counselling My findings indicate that SET is often met with resistance from users of IVF. My analysis suggests that, while existing cultural narratives leave little room for women to resist IVF practices such as those leading to the acceptability of multiple births, counselling could provide a space for such resistance. I use a Foucauldian framework in this analysis. My research methods included qualitative interviews with fertility counsellors. This gave me valuable perspectives about the current administration of counselling in fertility clinics. Another key objective of this study is to “give voice” to the users of IVF. Therefore, to gain insight into the patient’s opinions about and experiences surrounding the IVF procedure I undertook an in-depth analysis of online patient Internet support sites. In addition I used observational data, and reflection upon personal experience to gain insights into patient’s experiences of the IVF procedure. To support this investigation, statistics, data and information from the UK, Europe and other countries have also been examined. This investigation concentrates on support services in the United Kingdom and ends with some recommendations for the promotion of and reference for these valuable services in conjunction with promoting policy to reduce multiple births. This work, in the form of both a sociological and policy analysis aims to contribute towards ongoing developments and debates regarding equitable administration of IVF fertility treatment in the UK.
MPhil in Sociology