Assembling Viability: The Art of Mundane Embryo Selection in IVF
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One of the mundane everyday practices of IVF is observing and classifying embryos. After the fertilisation, embryos are graded according to their quality which is an estimation of whether the embryogenesis—the embryo’s development—seems normal or deviant. This practice is called embryo selection and it is based on assessing the ‘good quality’ embryos as viable and ‘poor quality’ ones as inviable. Viability refers to the capacity of embryos to develop into foetuses and eventually become babies. However, the question of what kinds of embryos ultimately are viable is a complex issue, which also hinges upon several other factors than the quality estimation. This paper shows that the idea of embryo viability is an assemblage of multiple kinds of things. The paper is based on multi-sited ethnography and expert and patient interviews conducted in the private fertility service sector of Finland. I argue that embryo viability is a practical achievement that requires the successful combination of several factors: the scientific facts on embryo quality, the expert knowledge and laboratory practices and the patients’ engagements in the process. None of these factors alone is enough to explain the precarious embryo viability which nevertheless is the central issue in IVF.
KeywordsIVF Embryo selection Viability Laboratory practices Ethnography
I am grateful for the valuable comments provided by the two anonymous reviewers. I am indebted to Mianna Meskus for her support and numerous discussions on this work. I also want to thank Ilpo Helén for insightful feedback on the earlier versions of this article, as well as the participants of the TOTEMI (Knowledge, Technology and Environment) and SKY (Gender, Culture and Society) seminars for comments and peer support. Finally, thank you to all the clinics, experts and the ones experiencing involuntary childlessness themselves for taking part in my study.
Ethical approvals have not been sought for the PhD study from which the original empirical data come from. None of the funders (the Kone Foundation and the Doctoral Programme in Gender, Culture and Society, University of Helsinki) required ethical approvals for the study. The subject matter of, especially, the interviews and the peer-support groups touches issues of health and personal experience. All the participants of the study were informed of the purposes of the research and how the data will be used. All the interviewees gave a written informed consent. All the other participants gave an oral informed consent. According to the instructions of the University of Helsinki and the Finnish Advisory Board on Research Integrity, an ethics approval should be sought only in the following cases: (1) research is physically invasive; (2) a consent is not asked; (3) research is conducted among children or people aged under 15 years; (4) research participants are subjected to intense stimulus (for example, violence or pornography); (5) there is a risk of long-term mental harm (trauma, depression, insomnia) or; (6) the research can cause danger to participants’ safety.
As my research setting does not meet any of these criteria for the need of an ethics approval, the usual, careful process of providing enough information of the research and its purposes as well as careful handling of data and data anonymisation were deemed sufficient.
- Act on Assisted Fertility Treatments, 22 December 2006/1237.Google Scholar
- ALPHA and ESHRE. 2011. Istanbul Consensus Workshop on Embryo Assessment: Proceedings of an Expert Meeting. Reproductive Biomedicine Online 22(6): 632–646.Google Scholar
- Doing, P. 2008. Give Me a Laboratory and I Will Raise a Discipline: The Past, Present and Future on Laboratory Studies in STS. In The Handbook of Science and Technology Studies, ed. E.J. Hackett, O. Amsterdamska, M. Lynch, and J. Wajcman, 279–295. Cambridge, Massachusetts, London and England: The MIT Press.Google Scholar
- Eriksson, L. (2017) Finland as a Late Regulator of Assisted Reproduction: A Permissive Policy Under Debate. In Assisted Reproduction Across Borders. Feminist Perspectives on Normalization, Disruptions and Transmissions, eds. M Lie and N. Lykke, 124–136. New York and London: Routledge.Google Scholar
- Falzon, M. 2009. Multi-sited Ethnography: Theory, Praxis and Locality in Contemporary Research. Farnham: Ashgate Publishing.Google Scholar
- Franklin, S. 1997. Embodies Progress. A Cultural Account of Assisted Conception. London: Routledge.Google Scholar
- Franklin, S. 2013. Biological Relatives. IVF, Stem Cells, and the Future of Kinship. Durham and London: Duke University Press.Google Scholar
- Helén, I. 2011. The Depression Paradigm and Beyond: The Practical Ontology of Mood Disorders. Science Studies 24 (1): 82–112.Google Scholar
- Helosvuori, E. forthcoming. Lingering technological entanglements: Childlessness after IVF.Google Scholar
- Kieslinger, D.C., S. De Gheselle, C.B. Lambalk, P. De Sutter, E.H. Kostelijk, J.W.R. Twisk, J. Van Rijswijk, E. Van den Abbeel, and C.G. Vergouw. 2016. Embryo Selection Using Time-Lapse Analysis (Early Embryo Viability Assessment) in Conjunction with Standard Morphology: A Prospective Two-Center Pilot Study. Human Reproduction 21 (11): 2450–2457.CrossRefGoogle Scholar
- Knorr-Cetina, K. 1981. The Manufacture of Knowledge. An Essay on Constructivist and Contextual Nature of Science. Oxford: Pergamon Press.Google Scholar
- Latour, B. 1983. Give me a laboratory and I will raise the world. In Science Observed: Perspectives on the Social Study of Science, eds. K. Knorr-Cetina and M. Mulkay, 141–170. London: Sage.Google Scholar
- Latour, B., and S. Woolgar. 1986. Laboratory Life. The Construction of Scientific Facts. Princeton: Princeton University Press.Google Scholar
- Law, J. 2010 . After Method: Mess in Social Science Research. New York and London: RoutledgeGoogle Scholar
- Lie, M. and Lykke, N. 2017. Editorial Introduction: Assisted Reproduction Across Borders: Feminist Perspectives on Normalizations, Disruptions and Transmissions. In Assisted Reproduction Across Borders. Feminist Perspectives on Normalization, Disruptions and Transmissions, eds. M Lie and N. Lykke, 1–21. New York and London: Routledge.Google Scholar
- Lock, M., and V.-K. Nguyen. 2010. An Anthropology of Biomedicine. Malden, Oxford and West Sussex: Wiley-Blackwell.Google Scholar
- Lynch, M. 1985. Art and Artifact in Laboratory Science. A Study of Shop Work and Shop Talk in Laboratory Science. London: Routledge and Kegan Paul.Google Scholar
- Martikainen, H., Tiitinen, A., Tomás, C., Tapanainen, J., Orava, M., Tuomivaara, L., Vilska, S., Hydén-Granskog, C., Hovatta, O. and the Finnish ET Study Group (2001) One Versus Two Embryo Transfer After IVF and ICSI: A Randomized Study. Human Reproduction 16(9): 1900–1903Google Scholar
- National Institute for Health and Welfare (2017) Statistical Report. Assisted fertility treatments 2015–2016. http://urn.fi/URN:NBN:fi-fe201704136108. Accessed 19 Sept 2017.
- Nisker, J., F. Baylis, I. Karpin, C. McLeod, and R. Mykitiuk (eds.). 2010. The ‘Healthy’ Embryo. Social, Biomedical, Legal and Philosophical Perspectives. Cambridge: Cambridge University Press.Google Scholar
- Rothman, B.K. 1986. The Tentative Pregnancy: Prenatal Diagnosis and the Future of Motherhood. New York: Viking Press.Google Scholar
- Sugarman, J., D.C. McCrory, and D. Powell. 1999. Empirical Research on Informed Consent: An Annotated Bibliography. Special Supplement: A Hastings Center Report.Google Scholar
- TemaNord (2006) Assisted Reproduction in the Nordic Countries, 505. Copenhagen: Nordic Council of Ministers.Google Scholar
- Thompson, C. 2005. Making Parents: the Ontological Choreography of Reproductive Technologies. Cambridge: MIT Press.Google Scholar
- Van de Wiel, L. 2017. Cellular Origins: A Visual Analysis of Time-Lapse Embryo Imaging. In: M Lie and N. Lykke (eds.) Assisted Reproduction Across Borders. Feminist Perspectives on Normalization, Disruptions and Transmissions, 288–301. New York and London: Routledge.Google Scholar
- White, A. and Bluhm, R. (2010) Embryo health and embryo research. In The ‘Healthy’ Embryo. Social, Biomedical, Legal and Philosophical Perspectives, eds. J. Nisker, F. Baylis, I. Karpin, C. McLeod, and R. Mykitiuk. Cambridge: Cambridge University Press, pp. 187–199.Google Scholar
- Wittel, A. 2000. Ethnography on the Move: From Field to Net to Internet. Forum: Qualitative Social Research 1: 1 Art. 21. http://www.qualitative-research.net/index.php/fqs/article/viewArticle/1131/2517. Accessed 1 Jan 2010.