Reproducing whiteness and enacting kin in the Nordic context of transnational egg donation: Matching donors with cross-border traveller recipients in Finland

Mapping Ethical, Legal, and Social Implications (ELSI) of gamete donation

RESEARCH QUESTION

This scoping review investigates the Ethical, Legal, and Social Implications (ELSI) of gamete donation, a critical facet of Assisted Reproductive Technologies, by analyzing the evolving research scope, methodological approaches, and the geographical skew in the literature. Despite the increased global uptake of donor gametes, current scholarship predominantly emanates from Western contexts and focuses on majoritized groups. This bias constrains the universality of research findings and limits their applicability across varied legal, cultural, and social contexts, underscoring a need for broader inclusivity.

DESIGN

We addressed 867 pivotal articles published between 1999 and 2019.

RESULTS

Our analysis reveals a discernible escalation in research volume, with 62% based on empirical research. The intellectual landscape unfolds into four dominant clusters: Regulatory Frameworks, Incentives, and Access; Family Dynamics and Genetic Linkages; Identity and Privacy in Donor Conception; and Cultural and Societal Attitudes towards GD. Each cluster highlights nuanced dimensions of gamete donation, from regulatory intricacies and psychological welfare to identity ethics and cultural perceptions.

CONCLUSION

Our findings advocate for a shift towards more globally representative and methodologically inclusive research. By integrating diverse cultural narratives and expanding geographical breadth, future research can offer holistic understandings of gamete donation, fostering equitable and culturally resonant practices and policies worldwide.

The case for reframing known donation

Contemporary UK egg and sperm donation exists in two predominant forms: (i) clinic-based, identity-release donation; and (ii) known donation, which can take place either inside or outside of the clinic context. Regulatory and clinical discussions of the latter currently focus, almost exclusively, on risk whereas identity-release is widely presented as the default route for both donors and recipients. Consequently, there is little support available for those potential donors and recipient parents who might prefer a known donor arrangement. In this commentary, we reflect on our sociological research with donors and parents through donor conception and argue that there are a number of reasons why known donation may, in some contexts, offer advantages over identity-release donation. Whilst this research also demonstrates that there can be challenges involved in known donation, these are not inevitable nor are challenges absent from identity-release routes. It is timely and important to question whether the current de-valuing of known donation compared with identity-release donation holds up to academic scrutiny. We argue for a more balanced approach in which the benefits and challenges of both known and identity-release routes are discussed with donors and recipients and for increased support for known donation in clinics and by regulatory bodies.

Queer decisions: Racial matching among gay male intended parents

How does race and location shape the reproductive decisions of gay men who are intended parents? In this article, we propose the concept of strategic racialization to characterize the ways in which gay male parents employ racial matching in their selection of egg donors and surrogates in the United States and United Kingdom. We argue that racial matching is a strategy of stigma management. This study draws upon interview data from 40 gay male couples who formed families through surrogacy. We find that pre-conception fathers seek racialized resemblance to reinforce kinship between themselves and their children. In California and England, gay men seeking donor eggs engage in racial matching, which reveals that the racialized biogenetic model of kinship remains dominant. This study makes a significant contribution to the literature on race and queer family formation.

Patient and clinician experiences with cross-border reproductive care: A systematic review

OBJECTIVES

This review analyzes the experiences of patients and clinicians with regards to international cross-border reproductive care (CBRC) for the purpose of conception.

METHODS

Electronic databases PubMed, Embase, Web of Science, and Scopus were searched using 'medical tourism' AND 'assisted reproductive technology' from 1978 to 2020.

RESULTS

Predominant patient motivators for CBRC were cost and legality of assisted reproduction technology (ART) in one's home country, followed by cultural factors like shared language, religion, and cultural familiarity. Clinicians suggested global laws for CBRC would reduce the potential for exploitation of vulnerable populations but believed the enactment of international regulations unlikely and, even if enacted, difficult to enforce.

CONCLUSIONS

While patient and clinician experiences with CBRC varied, patients frequently cited financial and legal reasons for pursuing CBRC, while many providers had concern for the patient's safety.

CLINICAL PRACTICE IMPLICATIONS

This review recommends clinicians involved in family planning counsel patients seeking treatment abroad by: (i) informing patients of the risks and benefits of treatment abroad, (ii) establishing guidelines and standards for clinicians on resuming patient care post-CBRC, and (iii) creating a directory of reputable CBRC clinicians and experts.

When craft kicks back: Embryo culture as knowledge production in the context of the transnational fertility industry

The multibillion-dollar fertility industry promotes standardization in in vitro fertilization laboratories. Transnational pharmaceutical and biotechnological giants distribute a wide range of fertility products, from embryo culture mediums and incubator technologies to add-ons such as time-lapse embryo monitoring. These technologies are designed to standardize and automate knowledge production regarding embryonic viability. More effective knowledge production enables the more effective selection of embryos for transfer, which in turn leads to more future babies and enables economic scaling-up. Drawing on two multi-sited ethnographic studies at eight fertility clinics in Finland during 2013-2020, this article discusses how knowledge about embryos is produced in the processes and practices of embryo culture. We argue that automation and standardization in clinical practice are not always perceived as economically desirable. Sometimes standard technologies do not replace hands-on knowledge production, although they may transform it. The technologies are also perceived as modifying the object of knowledge itself in undesired or unnecessary ways. In such cases, concerns are raised regarding the best interests of patients, embryos and future babies, who might be better served by masterful laboratory craftwork. We conclude that embryo culture is not only a site of knowledge production - one that aims to make babies and parents through standard and craftwork knowledge practices - but also a site of multiple bio-economies of assisted reproduction, some of which resist automation and standardization.

Outsourcing problems or regulating altruism? Parliamentary debates on domestic and cross-border surrogacy in Finland and Norway

This article employs the concept of respectability and the discursive representation of gender equality policies to discuss how surrogacy is represented in Nordic parliamentary debates and policy documents. The article’s objective is to study how respectability, problems and equality are represented and discursively and rhetorically produced through a comparative study of Finnish and Norwegian political discourses on domestic unpaid surrogacy and cross-border commercial surrogacy. The article uses rhetorical and discursive analysis to analyse the Finnish and Norwegian Parliaments’ bills, members’ initiatives and proceedings from 2002 to 2018. Finland’s policy on surrogacy has evolved from an unregulated and permissive approach towards a more restrictive one, with discourses focusing on medicalisation, equality, altruism and safety concerning domestic surrogacy and problems and risks concerning cross-border surrogacy. Norway’s policy on surrogacy has been restrictive consistently, with discourses focusing on surrogacy as a transnational social problem involving exploitation of women and children, and biocentrism. Analysing surrogacy regulation in Nordic welfare states, the author concludes that policies and parliamentary debates in both countries have expressed expectations for inclusive health policies and social security for families. Cross-border surrogacy is characterised as an unwanted consequence of globalisation and marketisation of reproduction. Surrogate mothers’ respectability is constructed through rhetoric on differences in terms of nationality, class and binary representations of female caring and instrumentalism.

"Mix or Match?": Transnational Fertility Industry and White Desirability

Does the transnational process of gamete selection challenge ways of mobilizing race and whiteness? Based on a mobile ethnography of the transnational fertility industry, I argue that fertility experts and intended parents (IP) co-produce the desirability of whiteness through "racial matching" for white, heterosexual IP, and "strategic hybridization", or strategic mixing of gametes, for some same-sex IP who do not identify as white. Although disruptive of notions of racial purity of whiteness and the heteronormative focus on resemblance match, the transnational legitimizing of such desires as intimate and innocuous choices depoliticizes conversations around race, racialization and whiteness as privilege.

Changing Fertility Landscapes: Exploring the Reproductive Routes and Choices of Fertility Patients from China for Assisted Reproduction in Russia

Global reproductive landscapes and with them cross-border routes are rapidly changing. This paper examines the reproductive routes and choices of fertility travellers from China to Russia as reported by medical professionals and fertility service providers. Providing new empirical data, it raises new ethical questions on the facilitation of cross-border reproductive travel and the commercialisation of reproductive treatment. The relaxation of the one-child policy in 2014 in China, the increasing demand for ART exceeding the capacity of national fertility clinics and the difficulty of accessing treatment with donor eggs concomitant with a growing economic power of the upper–middle class are shaping the ART industry in Asia in new ways. A new development is Chinese citizens increasingly seeking ART treatment in Russia, which has a long-standing practice of ART governed by a liberal legislation. Furthermore, as China prohibits the export of gametes, Chinese fertility travellers rely on acquiring donor gametes once starting treatment abroad. Clinicians in Russia report three strategies amongst their Chinese patients: One group is using donor eggs of women of Asian appearance living in Russia or is hiring women of resembling appearance from third-party countries to donate their eggs in Russia to create resemblance in their offspring. Another group is buying white donor gametes to create Eurasian mixed children and thus ‘enhance’ their offspring. Providing novel empirical data, this article informs ethical deliberation and raises imminent questions for further research in this understudied geographic region and on cross-border reproductive treatment.

'Our family picture is a little hint of heaven': race, religion and selective reproduction in US 'embryo adoption'

People use selective reproductive technologies (SRT) in various family-making practices to assist with decisions about which children should be born. The practice of 'embryo adoption', a form of embryo donation developed by white American evangelical Christians in the late 1990s, is a novel site for reconceptualizing SRT and examining how they function among users. Based on ethnographic research conducted between 2008 and 2018 on US 'embryo adoption', this study provides an anthropological analysis of media produced by and about one white evangelical couple's race-specific preferences for embryos from donors of colour. This article shows how racializing processes and religious beliefs function as mutually reinforcing SRT for some 'embryo adoption' participants. Evangelical convictions justify racialized preferences, and racializing processes within and beyond the church reinforce religious acts. Race-specific preferences for embryos among white evangelicals promote selective decision-making not for particular kinds of children, a current focus in studies of SRT, but for particular kinds of families. This study expands the framework of SRT to include selection for wanted family forms and technologies beyond biomedical techniques, such as social technologies like racial constructs and religious convictions. Broadly, this article encourages greater attention to religion within analyses about race and reproduction by revealing how they are deeply entwined with Christianity, especially in the USA. Wherever constructions of race and religious convictions co-exist with selective reproductive decision-making, scholars should consider race, reproduction and religion as inextricable, rather than distinct, domains of analysis.

Lingering technological entanglements: Experiences of childlessness after IVF

For over four decades, feminist studies of assisted reproductive technologies (ART) have been interested in the ethical, political and personal implications of in vitro fertilization (IVF) and other infertility treatments. Most work on the implications of ART for women has focused on the demanding cyclical process of trying to become pregnant by using the technology. However, less attention has been paid to the implications of experiencing IVF after the conception phase. This article tackles the under-researched topic of the aftermath of IVF, and discusses the temporality of affective embodied experiences of infertility after one has stopped IVF. Drawing on an ethnographic study of peer support groups for the involuntarily childless in Finland, and on in-depth interviews with women suffering from infertility, this article juxtaposes two groups of women who have had IVF: those who have had children as a result of the procedure, and those who have not. The article proposes an exploration of experiences of childlessness after IVF as ‘lingering technological entanglements’ – that is, as affective and embodied experiences of the effects of IVF, including after the cessation of treatment. It argues that the lingering of these entanglements manifests itself in the enactment of childlessness in relation to the available technology. Furthermore, this results in parents identifying themselves as childless, even after they have gained temporal distance from IVF practices.

Making a Match: Curating Race in South African Gamete Donation

What shapes would-be parents' choices of gamete donors for third-party IVF? Following extensive ethnographic fieldwork in South African fertility clinics and egg donor agencies, I explore the work of donor matching, a process in which translational figures mediate patient desires, donor biography and corporeality, and racial imaginaries to assist would-be parents. In doing so, these figures, or "matchers," draw upon both historical schemas and novel articulations to enact race, and certain forms of whiteness. I describe this through the concept of "curature," a post-apartheid technology of racialization that reflects a neoliberal shift to privatized sites of power.

Oocyte provision as a (quasi) social market: Insights from Spain

The provision of oocytes plays an important role in human fertility treatments. Spain alone performs half of oocyte provision cycles in the European Union whilst all other European countries face an oocyte shortage. How do Spanish fertility clinics manage to match the increasing domestic and foreign demand for female oocytes? Adopting a weak performativity approach and drawing insights from interviews carried out with 20 fertility clinic representatives, this study suggests that Spanish clinics are successful thanks to an egg provision system designed as a (quasi) social market. In the absence of traditional market mechanisms based on price fluctuations, the combination of fixed monetary compensation for providers and altruistic framing of oocyte provision as an act of donation, are used to mobilize relatively high numbers of women. Fertility clinics optimize this supply through a set of supplementary strategies to ensure oocyte supply always meets oocyte demand. Though successful, this market design reinforces gender stereotypes and relies on manipulative notions of altruism. A clear but unacknowledged appropriation of women's bodies and reproductive labour are also operated, which reinforces and reproduces racial and social stratifications. Therefore, we ask whether alternative mechanisms to promote female solidarity across different generations, to raise awareness of the risks of advanced maternal age, and to explore alternative market designs should be considered.

Globalised quests for assisted conception: Reproductive travel for infertility and involuntary childlessness

The global movement of people across international borders to undergo assisted reproductive treatment is common, although there is little accurate data. In this article, we synthesise findings from our own empirical research on reproductive travel in addition to a review of clinical, ethical, legal, and regulatory complexities from studies on reproductive travel since 2010. Motivations for travel include legal and religious prohibitions; resource considerations; lack of access to gametes and reproductive assistors; quality and safety concerns; and personal preferences. Higher risks to mothers and children are associated with multiple embryo transfer and subsequent multiple and higher order pregnancies and the average older age of women undertaking reproductive travel. The potential exploitation of other women as providers of oocytes or surrogacy services, the lack of equity in access to assisted reproduction and the ambiguous legal status of children conceived from international reproductive travel are important ethical considerations. A range of significant legal issues remain given variable and limited international regulation. Scholarship on this trade necessarily engages with issues of power and gender, social inequities, global capitalism and the private decision-making of individuals seeking to form families. Research gaps remain given recent changes in the organisation, demands and destinations of the trade.

Making the Ethnic Embryo: Enacting Race in US Embryo Adoption

How are frozen embryos donated for procreation racialized as "ethnic" subjects and what are the political implications of these enactments? Based on ethnographic research within an embryo adoption program in the United States, I examine the practices through which staff and participants produce "ethnicity" in embryos and trace its multiple permutations. Strategies used to stabilize race in embryos also disturb, fracture, and confound the bases for designating race. Analyzing race-making practices in embryo adoption reveals the interplay between practical challenges in assisted family-making practices and their wider political implications for reproductive politics.

Ethical problems with ethnic matching in gamete donation

Assisted reproduction using donor gametes is a procedure that allows those who are unable to produce their own gametes to achieve gestational parenthood. Where conception is achieved using donor sperm, the child lacks a genetic link to the intended father. Where it is achieved using a donor egg, the child lacks a genetic link to the intended mother. To address this lack of genetic kinship, some fertility clinics engage in the practice of matching the ethnicity of the gamete donor to that of the recipient parent. The intended result is for the child to have the phenotypic characteristics of the recipient parents. This paper examines the philosophical and ethical problems raised by the policy of ethnic matching in gamete donation. I consider arguments for the provision of ethnic matching based on maximising physical resemblance and fostering ethnic identity development. I then consider an argument against ethnic matching based on the charge of racialism. I conclude that while the practice of ethnic matching in gamete donation could promote positive ethnic identity development in donor-conceived children from historically subjugated ethnic minorities, it also risks endorsing the problematic societal attitudes and assumptions regarding ethnicity that enabled such subjugation in the first place.

Migrant extractability: Centring the voices of egg providers in cross-border reproduction

This paper explores reproductive justice from the perspective of those at the beginning of the value chain of reproduction. This vantage point of egg providers can help lend important insights into the wider processes of family-making across borders today. It centres on ethnographic research conducted on contemporary cross-border egg provision performed by female migrant workers in Spain. Through this intersectional perspective, we stand to gain deeper insights into cross-border reproduction more widely. Egg provision can be a way for migrant women to gain temporary financial benefit. In a system that does not provide equal access for migrants to work and care, female migrants make themselves extractable commodities. As such, they are both a commodity and a worker at the same time. The example of female migrant workers providing eggs can be used to reflect more generally on egg provision, and on cross-border reproduction and reproductive justice models as used in queer cross-border family-building. Taken within the broader framework of reproductive justice, and with the struggles of lesbian, gay, bisexual and transgender cross-border reproduction in mind, the paper begins by asking how three intersecting inequalities due to (1) migration/citizenship, (2) joblessness/contract working and (3) race facilitate the industry of cross-border reproduction? In what ways do female migrant workers mobilize their reproductive potential, including time, whiteness, other racial/phenotypic similarity to commissioning parents, and unstable work lives in cross-border egg donation? The paper ends with an argument for focusing analytical and political attention on the needs of those providing eggs; the most prized material resources for cross-border reproduction.