Good afternoon esteemed congressmen and congresswomen,
As an infertility specialist who has spent much time working at various clinics across the world, I am extremely honored to have the opportunity to present my testimony on one of the most important issues of our time: assisted reproductive technology. As biotechnology continues to advance at a rapid pace, it is only fitting that we discuss the role that we must play in deciding the funding of such technology. I have spent the majority of my time working at clinics in Israel as well as studying the infertility treatment options and funding made available to patients in other countries. Because I specialize in IVF, or in-vitro fertilization, I have spent a great amount of time interviewing with patients who are interested in pursuing this course of treatment if they are unable to become pregnant. I have spoken with women across the United States, both those can afford the treatment and those who cannot. I continue to conduct research on the subject and am excited to share my findings with the Congress today and ultimately explain why the United States must continue to support this practice, and even consider increasing its funding for it. I will begin by discussing what in-vitro fertilization entails and the benefits of providing such technology to women across the world. I will bring to light some arguments against IVF that the Congress has previously mentioned, and will discuss why these no longer need to be concerns. I will then explain how in-vitro fertilization in the United States avoids kinship issues and is thus, an uncomplicated process with respect to the parent of the conceived child. I will conclude my testimony by discussing the current funding situation and how the United States is currently failing to provide adequate funding for such technology and most importantly, its need to increase such funding.
As an IVF specialist at the Atlanta Center for Reproductive Medicine, I have undergone significant training for practicing this form of assisted reproductive technology. In-vitro fertilization entails a process by which fertilization occurs outside of the body, hence “in vitro”. IVF may involve any combination of a mother’s own eggs and a husband’s sperm or donor eggs and sperm. Once the egg and sperm cells have been obtained, they are brought together in a laboratory for fertilization. The fertilized egg is then taken and “placed in a catheter, which is inserted into the woman’s uterus and released in the location that will maximize the possibility of conception” (Kahn 39). In previous discussions, the Congress brought up its concern that the remaining fertilized eggs “will be destroyed after the success of one fertilization” and it must recognize the ethical considerations for this (Haimowitz, “Made in India”). However, as technology continues to progress, scientists and researchers are using the remaining fertilized eggs to be cyropreserved for future use, rather than merely destroying them. The countless stories of successful IVF procedures strengthens my argument that IVF should not merely be permitted in the United States, but rather, should be an event that is celebrated and made available to women from all socioeconomic backgrounds.
In Susan Kahn’s ethnographic work, Reproducing Jews, she describes a number of women’s experience with IVF, particularly those in Jerusalem. Most importantly, she makes it clear that the process is safe and continues to make pregnancy a possibility for women with a range of infertility issues. She shares an account with one of the women she interviewed who partook in the IVF process that felt much less clinical and more like that of a family atmosphere. Kahn shares the story of Etti who describes how “it was so un-clinical. It [felt] like an extended family that really [wanted] me to get pregnant. [She] found it warm (hamama) and pleasant” (Kahn 26). This should be the type of treatment and experience clinics in the United States models and provides for patients looking to engage in IVF treatments. In my experience as an IVF specialist, many of the women who come to me have accepted that they will become single mothers, and I recognize that this is not an easy decision to make. These intimate and intense relationships that Kahn describes in her book are quite similar to the relationships I have fostered with my patients in Israel. As technology continues to progress, the idea of the “nuclear family” is continuing to dissolve and as a country, it is imperative that we support this change. In Israel, reproductive clinics believe that, “every baby is a blessing and that every woman deserves to be a mother” (Kahn 27). This most likely stems from the Jewish interpretation of the first two chapters of Genesis. While these chapters tell a cosmology of how God created the universe, they also introduce ideas of kinship, marriage, and reproduction. In line 28, Genesis reads, “God blessed [male and female] and said to them, ‘Be fruitful and increase in number; fill the earth and subdue it” (Gen. 1:28). It is clear that the text supports God’s idea that humankind should reproduce. Because the Israeli Supreme Court believes that chapter one in Genesis makes it clear that God commands His people to reproduce, this support for reproductive practices despite marital status is found throughout Israel. Kahn notes that the Israeli government plays an extremely unique role in the lives of potential mothers– there is no separation of Church and state. It is important to note that I am not advocating for a separation of Church and state, but rather merely pointing out the importance of supporting of IVF practices for potential mothers.
In order to further understand the benefits of IVF, it is imperative to understand that “reproduction, in its biological and social senses, is inextricably bound up with the production of culture” (Rapp 88). It is therefore necessary to examine reproduction via IVF cross-culturally. If we examine the assisted reproductive technology practices in India, it is clear that the cost is significantly more affordable than in the United States. India recognizes the importance of IVF and the benefits it brings to women. In Bhattacharyyas’s Magical Progeny, Modern Technology: A Hindu Bioethics of Assisted Reproductive Technology, she delves into her interpretation of how the Mahabharata, the longest epic ever written, can be used to explain various bioethical issues in India. She outlines the “six key elements” of Hinduism: centrality of societal good, belief in the unity of all life, dharma, the multivalent nature of Hindu traditions, karma, and ahisma or commitment to do no harm (Bhattacharyya 49). IVF would most likely fall under the elements of dharma and karma. The decision to engage in IVF would follow the action of dharma, while the decision to take responsibility for that action would fall under the element of karma. Essentially, the decision for a mother to partake in IVF would not be dictated by a Hindu law, but would be left to the individual to decide and take responsibility for that action. Because the United States prides itself on individual freedom, it aligns similarly with these two Hindu principles when discussing the continuation of IVF. Women should have the freedom to decide whether or not they would like to partake in this form of reproductive technology, not the United States government.
As we continue to discuss IVF across various cultures, it is important to recognize Japan. In Japan, there are now over 600 fertility clinics and hospitals in operation nationwide. Similar to Israel, Japan is becoming known as a “superpower of fertility treatment” (Ivry 113). In Japan, women who are pregnant become labeled and redefined as an “important body” (Ivry 128) and they equate bearing children to “being blessed with treasure” or kodakara ni megumareru. Although this extreme is not the current culture in the United States, women across the country do “feel that having a child is a blessing” (Seeman 4), both those who have planned and unplanned pregnancies. As a result, when a woman in the United States faces infertility issues, she is presented with an option, such as IVF, to help circumvent such issues. Women who have ovulation disorders, genetic disorders, damaged fallopian tubes, or even have husbands whose sperm motility has been compromised, have the option to still bear children. IVF must be continued in order to provide women in the United States with the opportunity to, like women in Japan, be blessed with such “treasure”.
On the same vein, another benefit IVF can provide is the ability to provide gay and lesbian couples with the option to bear children. In her book, Kahn describes how, “Israeli lesbians often receive financial, emotional, and childcare support” (Kahn 53) and shares the interview she had with one lesbian woman who partook in IVF. The woman Kahn interviews describes how she was ostracized by her family for being both a lesbian and for wanting to have a child. However, after she engaged in IVF, “[her] mother changed completely and now comes by all the time, baby-sits, and even brings presents for her [partner’s] biological son” (Kahn 53). This is just one of the myriad of successful stories of reproduction that IVF makes possible for gay and lesbian couples. With the legalization of gay marriage in the United States three years ago, it is logical to continue to provide such technology for these couples. Times are progressing and changing. As a country, it is imperative that our laws and funding reflect these changing times, especially with respect to biotechnology and reproductive assistance.
Another angle in which to examine IVF practices is through the lens of kinship. In countries such as Israel, IVF can create kinship issues because as Broyde states, “genetic relationship does not establish legal relationship” (Broyde 328). In his work, Broyde describes how some assisted reproductive technology practices can create kinship issues because the gestational mother is considered to be the “real” mother. In this case, if a woman tries to use IVF and uses a surrogate mother, the Jewish law would deduce that the surrogate is the mother of the child. Thus, the child of the surrogate mother would not be permitted to marry any relatives of the surrogate. Broyde asserts that, “unlike the common law tradition and Jewish law, modern American law views status issues such as parenthood as something that law determines, rather than something that the law discovers” (Broyde 5). Congressmen and women, I urge you to understand the importance of Broyde’s statement: the American law can change the natural order of relationships in this view. As a society, we can avoid the kinship issues brought up in many, other countries because we have collectively decided to use court rulings and contracts in order to determine who the parents of children can be.
Although the United States has deemed IVF “acceptable,” it continues to hardly engage or provide funding for the practice. Unlike the United States, the Israeli government “heavily subsidizes all forms of technological treatment” (Kahn 16). The state policies set forth by the Israeli government not only help subsidize the treatment, they make it possible for unmarried women and single-mothers to have the option to reproduce. The Israeli state policies “subsidize the pursuit of single parenthood, contributing to the growing social acceptance of unmarried mothers” (Kahn 16). The United States should adopt similar principles, encouraging women who want to bear children, to do so. Unlike the United States, the Israeli government makes it possible for women from all socioeconomic classes to reproduce, not just those in the wealthy upper-class. It begs the question: why should money be the determinant of whether a woman in the United States can reproduce? It shouldn’t be. The United States must consider funding IVF more sufficiently in order to assist women who struggle to bear children.
As Dr. Seeman describes in his work, Ethnography, Exegesis, and Jewish Ethical Reflection, whether it is “in Israel, India, or Japan, each of these contexts shapes the ways in which ostensibly universal technologies like IVF or surrogacy are practiced and understood” (Seeman 5). IVF is being practiced, improved, and increasingly funded in countries across the world. In fact, it is important to understand how other countries view and use IVF in order to help the United States determine the benefits of continuing such technology. Because “when we learn to think of this diversity as a resource for comparative deliberation, it will become clear that what happens in Israel should be of concern to North Americans at least as much as North American paradigms” (Seeman 5). The benefits of IVF are immeasurable and are of paramount interest. This assisted reproductive technology makes it possible for women to have children despite any crippling infertility issues. This practice allows for gay and lesbian couples to bear children despite their sexual orientation. Most importantly, this form of biotechnology is not only one that needs to be continued, it must be more sufficiently funded in order to help future parents across the country have the reproductive freedom they deserve.
Bhattacharyya, Swasti. A Hindu Bioethics of Assisted Reproductive Technology. State University of New York Press, 2006.
Book of Genesis, chapters 1-2 <www.webpages.uidaho.edu/PDF/166/20Genesis.pdf)>.
Broyde, Michael J. Marriage, Sex, and the Family in Judaism. Rowman & Littlefield, 2005.
Ivry, Tispy. Embodying Culture: Pregnancy in Japan and Israel (Rutgers University Press, 2009).
Seeman, Don, et al. “Blessing Unintended Pregnancy: Religion and the Discourse of Women’s Agency in Public Health.” Medicine Anthropology Theory, vol. 3, no. 1, pp. 29–54.
Seeman, Don. “Ethnography, Exegesis and Jewish Ethical Reflection: The New Reproductive Technologies in Israel.” In Daphna Birenbaum-Carmeli and Yoram S. Carmeli editors, Kin, Gene, Community: Reproductive Technologies Among Jewish Israelis (Berghahn Books, 2010), pp. 340-362.
Kahn, Susan. Reproducing Jews: A Cultural Account of Assisted Conception in Israel (Duke University Press, 2000).
Rayna, Rapp. Testing Women, Testing the Fetus (Routledge, 2000).