, Volume 14, Issue 1, pp 1–22 | Cite as

Assembling Viability: The Art of Mundane Embryo Selection in IVF

  • Elina HelosvuoriEmail author
Original Article


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.


IVF 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 Approval

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.


  1. Act on Assisted Fertility Treatments, 22 December 2006/1237.Google Scholar
  2. ALPHA and ESHRE. 2011. Istanbul Consensus Workshop on Embryo Assessment: Proceedings of an Expert Meeting. Reproductive Biomedicine Online 22(6): 632–646.Google Scholar
  3. Cussins, C. 1996. Ontological Choreography: Agency through Objectification in Infertility Clinics. Social Studies of Science 26 (3): 575–610.CrossRefGoogle Scholar
  4. 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
  5. Ehrich, K., C. Williams, B. Farsides, J. Sandall, and R. Scott. 2007. Choosing Embryos: Ethical Complexity and Relational Autonomy in Staff Accounts of PGD. Sociology of Health & Illness 29 (7): 1091–1106.CrossRefGoogle Scholar
  6. Ehrich, K., C. Williams, and B. Farsides. 2008. The Embryo as Moral Work Object: PGD/IVF Staff Views and Experiences. Sociology of Health & Illness 30 (5): 772–787.CrossRefGoogle Scholar
  7. Ehrich, K., C. Williams, and B. Farsides. 2010. Fresh or Frozen? Classifying ‘Spare Embryos for Donation to Human Embryonic Stem Cell Research. Social Science and Medicine 71 (2010): 2204–2211.CrossRefGoogle Scholar
  8. 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
  9. Falzon, M. 2009. Multi-sited Ethnography: Theory, Praxis and Locality in Contemporary Research. Farnham: Ashgate Publishing.Google Scholar
  10. Franklin, S. 1997. Embodies Progress. A Cultural Account of Assisted Conception. London: Routledge.Google Scholar
  11. Franklin, S. 2006. Embryonic Economies: The Double Reproductive Value of Stem Cells. BioSocieties 1 (1): 71–90.CrossRefGoogle Scholar
  12. Franklin, S. 2013. Biological Relatives. IVF, Stem Cells, and the Future of Kinship. Durham and London: Duke University Press.Google Scholar
  13. Franklin, S., and C. Roberts. 2006. Born and Made. An Ethnography of Preimplantation Genetic Diagnosis. Princeton and Oxford: Princeton University Press.CrossRefGoogle Scholar
  14. Gammeltoft, T.M., and A. Wahlberg. 2014. Selective Reproductive Technologies. The Annual Review of Anthropology 43: 201–216.CrossRefGoogle Scholar
  15. Gardner, D.K., M. Lane, J. Stevens, T. Schlenker, and W.B. Schoolcraft. 2000. Blastocyst Score Affects Implantation and Pregnancy Outcome: Towards a Single Blastocyst Transfer. Fertility and Sterility 73 (6): 1155–1158.CrossRefGoogle Scholar
  16. Hannerz, U. 2003. Being There… and There… and There! Reflections on Multi-site Ethnography. Ethnography 4 (2): 201–216.CrossRefGoogle Scholar
  17. Hashiloni-Dolev, Y., and S. Shkedi. 2007. On New Reproductive Technologies and Family Ethics: Pre-implantation Genetic Diagnosis for Sibling Donor in Israel and Germany. Social Science and Medicine 65: 2081–2092.CrossRefGoogle Scholar
  18. Helén, I. 2011. The Depression Paradigm and Beyond: The Practical Ontology of Mood Disorders. Science Studies 24 (1): 82–112.Google Scholar
  19. Helosvuori, E. forthcoming. Lingering technological entanglements: Childlessness after IVF.Google Scholar
  20. Huijer, M. 2009. Storytelling to Enrich the Democratic Debate: The Dutch Discussion on Embryo Selection for Hereditary Breast Cancer. BioSocieties 4: 223–238.CrossRefGoogle Scholar
  21. 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
  22. Knorr-Cetina, K. 1981. The Manufacture of Knowledge. An Essay on Constructivist and Contextual Nature of Science. Oxford: Pergamon Press.Google Scholar
  23. 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
  24. Latour, B., and S. Woolgar. 1986. Laboratory Life. The Construction of Scientific Facts. Princeton: Princeton University Press.Google Scholar
  25. Law, J. 2010 [2004]. After Method: Mess in Social Science Research. New York and London: RoutledgeGoogle Scholar
  26. Lie, M. 2015. Reproduction Inside/Outside: Medical Imaging and the Domestication of Assisted Reproductive Technologies. European Journal of Women’s Studies 22 (1): 53–69.CrossRefGoogle Scholar
  27. 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
  28. Lock, M., and V.-K. Nguyen. 2010. An Anthropology of Biomedicine. Malden, Oxford and West Sussex: Wiley-Blackwell.Google Scholar
  29. 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
  30. Malin, M. Silverio, and E. Hemminki. 1996. Practice of In-Vitro Fertilization: A Case Study from Finland. Social Science and Medicine 42 (7): 975–983.CrossRefGoogle Scholar
  31. Marcus, G.E. 1995. Ethnography In/of the World System: The Emergence of Multi-Sited Ethnography. Annual Review of Anthropology 24 (1): 95–117.CrossRefGoogle Scholar
  32. 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
  33. Martin, L.J. 2014. The World’s Not Ready for This: Globalizing Selective Technologies. Science, Technology and Human Values 39 (3): 432–455.CrossRefGoogle Scholar
  34. McGowan, M.L., and R.R. Sharp. 2013. Justice in the Context of Family Balancing. Science, Technology and Human Values 38 (2): 271–293.CrossRefGoogle Scholar
  35. Meskus, M. 2012. Personalized Ethics: The Emergence and the Effects in Prenatal Testing. BioSocieties 7 (4): 373–392.CrossRefGoogle Scholar
  36. Meskus, M. 2015. Agential Multiplicity in the Assisted Beginnings of Life. European Journal of Women’s Studies 22 (1): 70–83.CrossRefGoogle Scholar
  37. Meskus, M. 2018. Craft in Biomedical Research: The iPS Cell Technology and the Future of Stem Cell Science. Basingstoke and New York: Palgrave Macmillan.CrossRefGoogle Scholar
  38. Mol, A. 2002. The Body Multiple: Ontology in Medical Practice. Durham, NC: Duke University Press.CrossRefGoogle Scholar
  39. Mol, A. 2008. The Logic of Care: Health and the Problem of Patient Choice. Abingdon, Oxon, New York: Routledge.CrossRefGoogle Scholar
  40. National Institute for Health and Welfare (2017) Statistical Report. Assisted fertility treatments 2015–2016. Accessed 19 Sept 2017.
  41. 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
  42. Parry, S. 2006. (Re)constructing Embryos in Stem Cell Research: Exploring the Meaning of Embryos for People Involved in Fertility Treatments. Social Science and Medicine 62 (2006): 2349–2359.CrossRefGoogle Scholar
  43. Pavone, Vincenzo, and Flor Arias. 2012. Beyond the Geneticization Thesis: The Political Economy of PGD/PGS in Spain. Science, Technology and Human Values 37 (3): 235–261.CrossRefGoogle Scholar
  44. Rabeharisoa, V., T. Moreira, and M. Akrich. 2014. Evidence-Based Activism: Patients’, Users’ and Activists’ Groups in Knowledge Society. BioSocieties 9 (2): 111–128.CrossRefGoogle Scholar
  45. Roberts, E.F.S. 2007. Extra Embryos: The Ethics of Cryopreservation in Ecuador and Elsewhere. American Ethnologist 31 (1): 181–199.CrossRefGoogle Scholar
  46. Rothman, B.K. 1986. The Tentative Pregnancy: Prenatal Diagnosis and the Future of Motherhood. New York: Viking Press.Google Scholar
  47. Scully, L.J., S. Banks, and T.W. Shakespeare. 2006. Chance, Choice and Control: Lay Debate on Prenatal Sex Selection. Social Science and Medicine 63 (2006): 21–31.CrossRefGoogle Scholar
  48. Squier, S.M. 2004. Liminal Lives: Imagining the Human at the Frontiers of Biomedicine. Durham: Duke University Press.CrossRefGoogle Scholar
  49. 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
  50. Svendsen, M.N., and L. Koch. 2008. Unpacking the ‘Spare Embryo’: Facilitating Stem Cell Research in a Moral Landscape. Social Studies of Science 38 (93): 93–110.CrossRefGoogle Scholar
  51. TemaNord (2006) Assisted Reproduction in the Nordic Countries, 505. Copenhagen: Nordic Council of Ministers.Google Scholar
  52. Thompson, C. 2005. Making Parents: the Ontological Choreography of Reproductive Technologies. Cambridge: MIT Press.Google Scholar
  53. 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
  54. Wahlberg, A., and T.M. Gammeltoft. 2018. Introduction: Kinds of Children. In Selective Reproduction in the 21st Century, ed. A. Wahlberg, and T.M. Gammeltoft, 1–24. Basingstoke and New York: Palgrave Macmillan.CrossRefGoogle Scholar
  55. 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
  56. Wittel, A. 2000. Ethnography on the Move: From Field to Net to Internet. Forum: Qualitative Social Research 1: 1 Art. 21. Accessed 1 Jan 2010.

Copyright information

© Macmillan Publishers Ltd., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Social ResearchUniversity of HelsinkiHelsinkiFinland

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