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A thought-provoking volume traces the medical, social, and political histories of in vitro fertilization

The Pursuit of Parenthood: Reproductive Technology from Test-Tube Babies to Uterus Transplants

Margaret Marsh and Wanda Ronner
Johns Hopkins University Press
2019
274 pp.
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Major academic figures admonish “immoral experiments on the unborn.” An advertisement in The New York Times cautions about the “unknowable risks to human lives.” A government official calls for an ethics board to investigate “attempts to control the genetic makeup of offspring.” No, these are not the latest outcries over germline gene editing. The concerns raised above came from debates in the 1970s about a technology many of us now take for granted: in vitro fertilization (IVF). In their illuminating and highly readable new book, The Pursuit of Parenthood, historian Margaret Marsh and physician Wanda Ronner tell the medical, social, and political story of IVF from its prehistory in the mid-1900s to the present day, sweeping in adjacent technologies toward the book’s end.

In the first half of the book, Marsh and Ronner masterfully interweave narrative, historical, and demographic materials in beautiful prose to tell a compelling story that will enlighten even those who specialize in this area. That story begins with John Rock, born in 1890, who would go on to become the director of the Fertility and Endocrine Clinic at the Free Hospital for Women in Brookline, Massachusetts. Together with his research assistant Miriam Menkin, in August 1944 Rock published a report in Science describing a procedure in which four fully fertilized eggs from three women were cultured in a glass dish.

While Rock, Menkin, and others made huge progress toward realizing IVF, efforts in the United States ultimately waned, setting the stage for the United Kingdom to bring the technology to fruition. Here, Marsh and Ronner shift to describing the academic odd couple of Patrick Steptoe and Robert Edwards, who enabled the birth of the world’s first IVF baby in Oldham, England, on 25 July 1978. Far from a dry recitation of the medical history, the book goes deep into each man’s background, describing their somewhat unlikely pairing—the two were separated by age, class, and training—and peppering the story with engaging anecdotes along the way. (My favorite was an incident in which Edwards was denounced by Prince-ton theologian Paul Ramsey at a 1971 forum on medical ethics. Edwards described his response: “I was a Yorkshireman and I would be blunt as Yorkshiremen are reputed to be.”)

The book then pivots to early efforts to bring IVF to the United States. Here, the authors describe Howard and Georgeanna Jones’s pioneering IVF work in Norfolk, Virginia, and Richard Marrs’s establishment of an IVF practice in California. They also present a deep dive into the accompanying political maneuverings around federal funding of human embryo and IVF research. The book then insightfully traces the expansion of IVF practices and explores some of the shadier elements of today’s reproductive medicine—including fertility fraud and the infamous case of Ricardo Asch, who stole eggs and embryos from patients—before more briefly surveying IVF-adjacent technologies, including surrogacy and egg and embryo freezing.

Although more careful than most commentators, Marsh and Ronner do buy into the common trope that paints the United States as the “wild west” of reproductive technology usage. They describe, for example, how a shift to a “consumer protection” model facilitated what little federal legislation exists with regard to IVF—the Fertility Clinic Success Rate and Certification Act of 1992—and correctly call out its relatively weak enforcement mechanism. Where they misstep slightly, however, is in focusing almost exclusively on federal-level legislation, and especially in their comparison to the UK Human Fertilisation and Embryology Authority (HFEA).

Although the United Kingdom, like many other countries, has adopted a unitary country-wide approach, the authors give too short a shrift to a distinctly American regulatory configuration that has largely left much of IVF governance to individual states. The result is a continuum of legal approaches to reproductive technologies. Regarding surrogacy, for example, in the United States one sees everything from criminalization of the practice to judicial approval and enforcement of contracts. Meanwhile, in states such as California, huge reproductive technology industries thrive, whereas in Louisiana, fertilized embryos have been declared “juridical persons.”

Another minor disappointment of the book was how rushed its last two chapters felt. Although the subtitle references uterus transplants, the book only manages three pages on this topic. I also wished the authors had taken the time to more deeply reflect on what implications the history of IVF might have for technologies such as gene editing. But these are minor quibbles.

Ultimately, Marsh and Ronner have stitched together an amazing amount of historical, legal, medical, and quantitative material. This book is a must-read for anyone interested in the history of reproductive technology.

About the author

The reviewer is at the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, MA 02138, USA.