In June 2021, Manuela Perrotta and I submitted written evidence to the UK government’s Women’s Health Strategy for England. We believe the consultation presents a key opportunity to improve the treatment experiences of IVF patients.
In our response, which you can find in full on our Publications page, we make five policy recommendations:
Women need a more coordinated provision of up-to-date information about IVF, especially information about novel IVF treatment add-ons
Improving the clarity, visibility and accessibility of already available information is a relatively low-cost measure that will bring timely positive change for IVF patients
There is an opportunity for the NHS A-Z website to direct IVF patients to the Human Fertilisation and Embryology Authority’s website for information specifically about new IVF treatment add-ons
Different understandings of evidence should be considered to improve the quality of information on new treatment add-ons
Accurate information about the nature of available evidence should be provided when treatment add-ons are experimental
We are very grateful to Inflect Partners for their advice in preparing our submission for this call.
At the beginning of May we were delighted to spend an afternoon on Zoom with visual artist Sally Butcher, who is currently working on her Arts Council England funded project re.conceive. Sally approached us a while back to explore some of the synergies between our projects, which in different ways explore how reproduction, fertility and (non-)reproductive bodies are visualised or, sometimes, become invisible. Sally very generously shared some of her work-in-progress with us and we shared details about our research process and findings.
Each member of the research team was able to spend some time with Sally individually, and I include our reflections in our own words below.
Giulia: Sally’s work has inspired our conversation around reproduction in its different forms. We have especially discussed the relationship between medical knowledge, technologies and tools to visualise reproductive body parts or phenomena, and embodied experiences of them. We talked about the role of visual experiences in the construction of dominant narratives of gendered reproductive lives, and about the visibility and invisibility of specific reproductive experiences (for example infertility, miscarriages, abortion). We explored the notions of common and uncommon, known and unknown, expected and unexpected, we discussed how individual experiences relate to standardised measures and protocols and how people adjust and react to these, especially when these intersect with other medical, legal and geographical infrastructures (for example in the context of transnational reproductive travels).
Manuela: Among the many things we talked about, Sally and I had an interesting conversation regarding some of her work-in-progress – in my interpretation, an inspiring visualisation of the current developments in the field of embryology. Sally’s representation of sets of data embedded within an image of an embryo captured the current turn in embryology, by highlighting visually the novel and increasing use of data-driven algorithms in this field. In our research, analysing the case of Time-lapse incubators and their incorporated algorithms, we have investigated how new knowledge about embryos is generated in the complex interactions between professionals and machines. Although the use of algorithms has the potential to release unknown biological information on embryos (and therefore reveal their hidden secrets), algorithms do not simply add medical and reproductive knowledge as they require human input and therefore still rely on professional expertise.
Josie: During our conversation, Sally and I found many shared interests: for instance in how themes of absence and presence, and proximity and distance, shape ideas about reproduction as well as experiences of infertility. Being a geographer (academically and at heart!), I was drawn to how the body exterior and interior are ‘mapped’ in some of Sally’s work. We talked about the role of measurements, ordering, boundaries and boundary-making in relation to how reproductive processes are visualised and described. We also talked about the intrigue and mystery of magnifying or looking inside things.
Sally’s work also drew my attention to all the other kinds of imagery that fertility patients encounter before or during their IVF treatment. The focus of our research is on images and videos of embryos, which are exterior to the body or in vitro. But fertility patients often encounter a whole range of other visualising techniques that allow them to see inside their bodies. Ultrasound scans and dye tests, for instance, are routinely used to medically investigate female reproductive organs and check that these appear to be functioning ‘normally’. Ways of visualising bodies and embryos have (personal and political) implications for how infertility is seen and known, and therefore very real consequences for patients’ treatment experiences and trajectories.
Sally: My conversations with the Remaking the Human Body team have been invaluable in my research project. As a visual artist, Re.conceive was driven by the invisibility of Infertility within the new wave of maternal visual arts, where, as in society at large, infertility still remains mostly hidden and shrouded in silence. My project aims to explore and visually theorise the transformational process of ‘becoming’ a (M)Other, challenging traditional reproduction to reconceive a form of sub-maternal.
My meetings with Giulia, Josie and Manuela helped thoroughly contextualise my thinking, aiding my understanding of how infertility connects with the broader narrative of reproduction, as well as giving me greater insight into the scientific procedures within embryology and new practices with AI, and drew my focus onto patient interpretation of these new technologies. It especially moved my thinking toward the visual and verbal languages used within infertility. As a cultural researcher, I am drawn to the rhetoric of medical terminology, weighted in ‘success’ and ‘failure’, aimed at potential ‘geriatric mothers’ with ‘inhospitable uteruses’, and how this may sit alongside hidden personal testimonies, confessional spaces of the coded #TTC online community, or conversations with family and friends where it so often generates a real sense of unease. As an artist, I try to use a feminist gaze to challenge institutionalised power within visual tropes of medical and commercial imagery of infertility. These meetings enlightened me as to how much power we place in these visuals and how these become naturalised into our knowledges of reproduction, with narratives of the embryo constructed from the encounters we have with these visuals. The immediate resonances I felt between my own practice and the fantastic work being done by this team, has encouraged me to continue using this imagery, exploring its symbolism alongside the power of the maternal imagination.
We were very pleased that two papers from the project were presented at the Nordic Science and Technology Studies conference on 20-21 May, which was hosted (online) by Copenhagen Business School. I presented a paper on IVF treatment ‘add-ons’ from the perspectives of IVF patients and partners, fertility professionals, and the UK regulator. This paper explored the category of add-ons as something that exists ‘outside’ or on the boundary of what is considered ‘routine’ IVF. It considered how such a category works differently across national regulation, professional practice and patient experiences of treatment. Manuela presented a paper on ‘the travel of reproductive imaging from the lab to the social world’, drawing on material from patient interviews to explore what happens when images of embryos are encountered outside of the lab or clinic setting.
Now that all of our fieldwork is completed, we are excited to be able to start thinking across all the elements of our research. We will be sharing more of these findings over the course of the next months.
Three months after our event on Visions of Reproduction at the Being Human Festival, we are glad to offer a new way to engage with our research project. If you are more comfortable with hearing than reading about vision (no jokes!), connect and listen to the wonderful podcast that Natalie Silverman has produced for The Fertility Podcast (also embedded below).
In this podcast, Natalie accompanies the audience through the topic of visualising reproduction in historical, sociological and aesthetic terms, introducing and interrogating expert scholars and artists whose work dives into visual representations of conception, pregnancy, and miscarriage. The listening experience is a gripping one, where vision becomes imagination, shaped by the words of people who describe the making and meaning of imagery in ancient books, biology labs, contemporary fertility clinics, and in personal artistic creations and performance. We hope you enjoy!
Natalie Silverman, founder and voice of the Fertility Podcast, led the audience through our first event ‘Visions of Reproduction’ where speakers shared and discussed a wide range of videos, pictures, drawings, prints and embroideries of embryos, foetuses, pregnancy tests, pregnant and not pregnant bodies.
As part of this event, we ran a poll among the audience asking them (anonymously) to enter three images about reproduction that they had come across in their life. We received so many fascinating responses! Pregnancy tests, ultrasound and embryo were definitely the most chosen words, but people had also come across paintings, celebrity pregnancy photos, a real-life foetus-museum, 3D scans and many more. People are confronted with reproductive images multiple times in their lives and in very different situations.
Josie Hamper, from our research team, opened the event by presenting some unpublished results from the study. She launched a poll where the audience was invited to select the correct description for an image shown on-screen. People selected almost all available answers, including: A human embryo; An IVF embryo; Eight cell embryo; Grade one embryo; A potential baby; and baby’s first picture. It was revealed that all answers did in fact describe the image and that the diverse responses reflect different perspectives according to people’s expertise, experience or agendas. Josie accompanied the audience through the data of her own research on IVF patient’s experiences of receiving time-lapse videos of embryo development. She illustrated how videos may be welcome by some who receive them, while creating more uncertainties for others, especially if they feel unequipped to interpret what they are seeing. She ended by inviting a more nuanced public discussion around time-lapse embryo imaging technology, and the use of the videos and images that derive from this technology, beyond the clinic.
This question was taken up by Tabitha Moses who talked about her artwork around IVF experiences, involving photography and intricately embroidered hospital gowns. She accompanied the audience through the experience of various visualising technologies throughout infertility journeys, IVF treatments and pregnancy loss, and she discussed the possibility of trusting or privileging the feeling of a pregnancy through quickening or other embodied sensations, including those of pregnancy loss, over the images produced through medical technologies.
Isabel Davis developed the theme of vision versus feeling in her talk on the history of potential pregnancy. She dealt with the experience of un-pregnancy, meaning the condition of not really being pregnant yet but possibly being, through the work of natural scientist William Harvey on non-generation. Isabel’s talk prompted us to reflect upon ambiguous moments after a non-protected heterosexual intercourse takes place or after an embryo transfer where someone may wonder whether or not a pregnancy has started. These are all important dimensions of reproductive imagination and experience.
The topic of the uncertain time where pregnancy is not (yet) but could be is something Liv Pennington also reflected on when she talked about her artwork on pregnancy tests and the challenges of photographing them on different occasions. Liv’s talk accompanied the audience through her performative artwork Private View, which took place in 2002 and in 2019, and how the performance differed in so many ways between these dates as people’s relationships to pregnancy tests, images and sharing have changed, for instance through the increased familiarity with sharing and commenting on images via social media. Liv reflected on how visualising a pregnancy test result opens up possibilities that may change over time and how this makes her work controversial because of the vulnerability involved in exposing someone’s private reproductive moment while acknowledging the dynamic and uncertain process of pregnancy.
Funnily enough, technical issues prevented Liv from sharing her slides with the audience, which meant that we relied on Liv’s descriptions of her images, her facial expressions and ability to represent pictures through words. An experience that turned out to be powerful for an event on visualisation!
Nick Hopwood was the last speaker on the panel. His contribution proposed a long-term historical perspective on images of embryos and foetuses to unpack how the ordering of these along a narrative of development has, since the late eighteen century, come to stand for the course of a pregnancy. Nick underlined how images of reproduction produced over the last centuries have overwhelmingly represented a linear process, leaving out experiences of miscarriage or unsuccessful stories of fertility treatment, both of which are frequent ‘events’ in people’s reproductive lives, but underrepresented and thus erroneously considered the exception.
A conversation among all the speakers, with questions asked by the audience, allowed everyone to engage with the common threads or connections among such different approaches to common and less common reproductive images. The conversations highlighted how these images evoke questions of temporality in reproductive processes; how selection and standardisation have been embedded in the use and fruition of images concerning reproduction in the last centuries; and how images have been used for defining normality, normal variations and abnormality. The talks and discussion especially emphasised how a certain production and use of images facilitates the diffusion of dominant narratives of reproduction, leaving out meaningful and relevant experiences, which do not find space in the public representation.
We are exceptionally grateful to all the speakers and the audience who made this panel so engaging and rich in content. We also want to extend our thanks to the Centre for Public Engagement at Queen Mary and the Being Human Festival for making this event possible.
Keep an eye out for further details about our next events!
We are very excited to introduce our first public engagement event after a series of cancellations earlier this year. This online event is entitled Visions of Reproduction: The Making and Meaning of Reproductive Imaging and it brings together sociologists, historians and artists who will speak about their work on this theme. We are also delighted to have partnered with the Fertility Podcast founder Natalie Silverman, who will moderate the event and take questions from the audience.
Join us on 12 November 2020 at 6pm.
For more information and a link to the booking site, please visit the Being Human Festival event page.
The first RHB article is now out in Social Science & Medicine! The publication, entitled “The trouble with IVF and randomised control trials: Professional legitimation narratives on time-lapse imaging and evidence-informed care,” highlights how IVF professionals navigate the complex landscape of add-ons and evidence when it comes to using time-lapse imaging in embryology labs across the UK. Drawing from our interview data, we show that clinic staff see several benefits in the use of imaging technologies. These benefits are diverse and not always captured in current public conversations on add-ons. The main contribution of the article is to highlight how professionals think about the benefits of time-lapse more widely. In light of our findings, we suggest that it is worth thinking about a more nuanced understanding of evidence-based-medicine as it relates to the IVF sector specifically. Read the full (open access) article here: https://doi.org/10.1016/j.socscimed.2020.113115
In response to the COVID-19 pandemic and all the uncertainties involved going forward, we are in the midst of significantly and carefully rethinking our planned activities, especially those relating to public engagement. We look forward to sharing the new details of our events as soon as we can.
In the meantime we will keep updating the blog with other news and short reflections from the project.
Update (31 March 2020): We have decided to also postpone our three May workshops. We plan to re-schedule all of our events for the autumn.
Update (14 March 2020): Following careful consideration of the current COVID-19 pandemic, we have decided to postpone our March workshops. We will evaluate whether our May events can go ahead in due course. Please check back for updates and we hope to see you on a future date!
We invite you to a workshop where all will have a chance to participate in a conversation about infertility, fertility treatment, scientific knowledge, embryo/medical imaging and patient decision-making. You will have the opportunity to hear more about our ongoing research in the area.
There will be snacks and drinks and lots of space for sharing ideas, opinions and experiences.
The workshop will take place in London on five dates across March and May 2020. For more information and to book your place, follow the links to our eventbrite pages:
CANCELLED 14 March 2020. Timber Lodge café, 1A, Timber Lodge Queen Elizabeth Olympic Park, Honour Lea Ave, London E20 1DY. Starts at 2.30pm. SIGN UP HERE.
CANCELLED 17 March 2020. The Vagina Museum, Unit 7&18 Stables Market, Chalk Farm Road, London, NW1 8AH. Starts at 6.30pm. SIGN UP HERE.
CANCELLED 13 May 2020. Yurt café, St. Katharine’s Precinct, 2 Butcher Row, London E14 8DS. Starts at 6.30pm. SIGN UP HERE.
CANCELLED 16 May 2020. Poplar Union, E5 Roasthouse, 2 Cotall St, Poplar, London E14 6TL. Starts at 2.30pm. SIGN UP HERE.
CANCELLED 28 May 2020. The Canvas: Café & Creative Venue, 42 Hanbury St, Spitalfields, London E1 5JL. Starts at 6.30pm. SIGN UP HERE.
These events are funded by the Wellcome Trust and supported by Fertility Network UK.
The RHB team had a productive summer with amazing conferences and manuscript writing. Having received so much useful feedback as of late, we are ready to publish some of the first project findings. The conferences we attended in the past months have really helped us contextualize our research and hone our arguments.
In August, RHB was at the annual meeting of the American Sociological Association, where we were part of one of the five (!) Sociology of Reproduction panels. Given that RHB is UK-based, we were able to assess how the issues raised in our research relate to wider concerns regarding technology, medicine, and reproduction. Although the UK IVF conversation has lately involved a sustained critique of commercialisation, audiences have remarked that the industry here is quite tightly regulated when compared to other countries (the U.S. especially), where healthcare is largely driven by a strong consumer logic. This is particularly true of fertility treatment, where multiple IVF cycles can cost tens of thousands of US dollars. As reproduction researchers, however, we strongly feel that fertility care should be an integral part of public healthcare services for all.
The ethics of new biomedical technologies was the focus of the first of our two panels at the 4S (Society for Social Studies of Science) meeting in late summer. Here, scholars raised excellent questions about the introduction of new medical technologies and the value they add to practice. As we have grappled with the role of time-lapse in IVF, we have found that the meanings of this technology can be different depending on one’s position and perspective. For example, time-lapse can be a great lab tool for embryologists, while also a reassuring technology for patients who want to know that their embryos are kept in a stable environment 24/7. This is an aspect of time-lapse that our audience has found incredibly interesting.
We have also recognized in our presentations that efficiency evidence is currently an important criteria for assessing new IVF technologies, especially in the UK add-on conversation. Based on our findings so far, this is one of the most salient themes that arises when talking to professionals about the value of new treatments. In the near future, we aim to publish our data on how fertility professionals in the NHS conceptualise evidence and its relation to time-lapse tools. In the meantime, we are also working on finishing up data collection, so that we can share findings on patient perspectives as well in the coming year. Last but not least, planning for public engagement activities in underway, with several events that will take place in 2020. Stay tuned!