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Donna J. Drucker, "Fertility Technology" (MIT Press, 2023)
00:30:20
An interview with Donna J. Drucker
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- [00:03]
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- [00:33]
Donna Drucker
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Donna Drucker
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- [00:48]
Caleb Zakrin
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- [00:50]
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Commercial Narrator
Welcome to the New Books Network.
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Caleb Zakrin
I'm Caleb Zakrin, Assistant Editor of the New Books Network. Today I'm speaking with Donna Drucker, Assistant Director of Scholarship and Research Development at the Columbia University School of Nursing. We're discussing her latest book from the MIT Press Essential Knowledge Series, Fertility Technology. Fertility Technology begins by examining the first instance of of artificial insemination performed over 150 years ago and takes us to the present, showcasing our wide range of fertility technologies today. The politics of pregnancy is one of the most contentious in current discourse. Understanding the technologies used in many pregnancies is of utter necessity and Donna shows why in this concise and highly readable volume. Donna, thank you for joining me today on the New Books Network.
- [02:20]
Donna Drucker
Thank you for having me.
- [02:21]
Caleb Zakrin
Of course, you know, as I said, you know, this is such, this is one of those topics where I feel like if people knew more about the technologies involved and more about the background, we could have a saner public debate. So hopefully after this people will have a little bit more knowledge and be able to contribute to discourse a little bit better. But before jumping into the book, I was wondering if you just tell us a little about yourself and your background yeah, sure.
- [02:48]
Donna Drucker
I received a PhD in history from Indiana University in 2008, and I wrote it on Alfred Kinsey and his intellectual history. Ever since then, I've been interested in the intersection of science and technology with gender and sexuality. And so that interest has manifested in now four books and a number of other academic publications and podcasts. And it's a intersection in human history that continues to fascinate me.
- [03:21]
Caleb Zakrin
And as far as this particular book is concerned, I know that this is part of the MIT Press Essential Knowledge series. So how did you get involved in this project?
- [03:31]
Donna Drucker
I wrote a different book for MIT Press's Essential Knowledge series that came out in April of 2020, just as the lockdowns were happening throughout the world. And as I realized I was living in Germany at the time, I wasn't going anywhere. I thought, why don't I write another book? Because that will keep me engaged alongside my regular work activities. And so Renee Almeling, who's a sociologist at Yale University, held a kind of symposium on her new book, Gynecology New Book at the time. And she organized groups of senior and junior scholars who were all working on some aspect of infertility or fertility technology. And so I met these fascinating scholars who are doing excellent work. And I thought, well, I've written a book on contraception. Now why don't I write a book on the opposite, which is fertility technology? And so this book is essentially a pandemic project that came out of my work on contraception.
- [04:39]
Caleb Zakrin
So you begin the book with a history of the first ever artificial insemination. So I was wondering if you could just tell our listeners a little bit about this moment and how it first happened.
- [04:49]
Donna Drucker
Sure. Listeners may have heard of a physician named J. Marion Sims, and he is notorious for having conducted gynecological experiments on enslaved African American women. And he did that for a period of time, and then he in Alabama. Then he moved to New York city in the 1850s and started working at a women's hospital. And it was there that he began to experiment with artificial insemination. And so what he did was stand by, basically, while a married couple had intercourse. He would syringe the semen out of the woman's vagina and then reinsert it further beyond the cervix in the hope that the placing the semen in the vagina further up in the cervix to get as close to the uterus as possible, in the hope that the semen would be more likely to stay in place and the sperm would be more likely to implant an egg. This only happened successfully once, and the woman lost the pregnancy several months in. But this type of experiment may have happened before, but this was the first time someone had written about it. And so Sims became well known in American and European gynecological circles. His work was republished several times in different languages. And he became known mostly for worse, but also for better, at least in terms of his instruments, the father of American gynecology. But this type of experiment with maneuvering semen rather quickly became a regular part of a lot of gynecology practice, not necessarily publicized, but became more or less available in Western European countries in the.
- [07:05]
Caleb Zakrin
US Why is it that some people seek a technological fix for infertility? Obviously it can be very personal reasons. But are there some broad reasons that people seek to do it as opposed to other avenues like adoption or things like that?
- [07:26]
Donna Drucker
People seek fertility treatments for a number of different reasons. In the past, it's most often been heterosexual married couples who have undiagnosed and unexplained fertility problems. They can't conceive in notice through regular heterosexual intercourse, and so they seek treatment. And most of the treatments that are the technologies that I'm discussing in this book are not necessarily fertility treatments in that they don't cure infantry fertility, but they help people become pregnant. So there's, there's a distinction there. But also people who are in same sex relationships, single people, people who have some kind of pelvic, gynecological, urological diseases, they undertake these treatments as well. So it's. As time moves forward, more and more people are seeking these kinds of treatments and more and more people are legally allowed in their countries to seek them. Because, for example, in a place like Denmark, fertility treatment was forbidden to lesbian women or single women until a certain amount of activism took place and encouraged the government to remove that restriction. So in general, it's to started out as a heterosexual, as a mechanism for heterosexual couples, but it's broadly expanded to a lot of other folks.
- [09:05]
Caleb Zakrin
So in addition to some of the work and experimentation that Dr. Sims was doing, what are some of the other early fertility technologies that were used prior to in vitro fertilization?
- [09:22]
Donna Drucker
Some of the technologies include insufflation and a cell pingogram, and these are diagnostic techniques that appeared in the 1910s and the 1920s and that were used through the 1960s. And insufflation came first. It's a technology in which the air is pushed into a woman's vagina, into her uterus, and the amount of compression that is or the amount of pressure that is produced or not produced is a measure of whether the fallopian tubes are blocked or not. So if the fallopian tubes are blocked, the air stays in the uterus for a longer amount of time. If they're clear, it dissipates. So it's diagnosing one type of infertility, which is some kind of disease in the fallopian tubes. And that was a Austrian physician who moved to the US who discovered that machine. A different man in the UK discovered a machine or invented a machine that uses liquid and pushes liquid into the uterus, looks at it under an X ray to see where blockages might be. You can imagine this is not a pleasant experience, but it does do a decent job of showing whether or not the fallopian tubes are clear. But lots of people see fertility as a place where they can experiment. And you could receive, for example, hormone injections. When hormones, identities of different kinds of hormones were discovered in the 1930s, especially progesterone and estrogen, people thought, hey, why not just inject yourself with some hormones and kind of see if that helps? It doesn't help that directly, but plenty of people made some money hawking them. So the other less technologically oriented method that was discovered in the 1920s and is still used in the present is timing. So up until the 1920s, in Japan, no one really knew exactly when an egg formed and dispersed into the uterus. There are lots of recommendations, there are lots of ideas, but no proof. And then a Japanese physician named Angino found that it happened approximately 15 days, 15 to 17 days before the next cycle. But you didn't know this unless you were reading gynecological journals in Japan until about the 1930s. In 1933, 34, when Anguino visited an Austrian physician named Knauss who was working on the same problem in Austria. They collaborated on some work, got work, translated into German, and from there, the knowledge of when ovulation occurs was more or less available to anyone who could read English or German. And then, of course, the Catholic Church adopts this method and has still continued to promote it ever, ever since. So there's a range of, like, diagnostic and planning technologies that people use in the hopes of having a child, you know, with these.
- [13:11]
Caleb Zakrin
These kind of early diagnostic tests and technologies in the background. I sort of could talk about in vitro fertilization or ivf, how this was discovered and the mechanism by which it works.
- [13:26]
Donna Drucker
Yes, sure. IVF was experimented on throughout the 1960s by a team in the UK and also a little bit later in the early 1970s by physicians in Australia. Those are the two main areas, or I'm sorry, the two main countries where this took place. There had been some work done in the 1940s in the US but that just kind of fell to the side. So there are two physicians and a laboratory assistant, Patrick Steeptoe, Robert Edwards and Gene Purdy, who are active in the uk and they, with the help of other people, they figure out a way to extract an egg artificially from, via artificial means, via, like a hormone injection. And they extract an egg from a woman's uterus. They get a sperm sample from, in this case a woman's husband, fertilize the egg with the sperm in a petri dish, thus in vitro, which means in glass rather than in vivo, which means in life. So they get the egg, they get the sperm, fertilize them in a petri dish and then re implant the fertilized egg in the woman's body. And the first birth of a IVF baby was Louise. Her name was Louise Brown and she's now, now in her 40s. The birth happened in July of 1978. It was a C section and it was a major world event to know that a baby, the first baby that was not conceived in the uterus was born, it was healthy and she was perfectly fine. So another Indian physician uses someone's natural cycle and creates an IVF baby a little bit later that year. Australian team does it a couple years later. And then, so to speak, the IVF races are off and hundreds of thousands of IVF babies are now out in the world.
- [15:59]
Caleb Zakrin
So, you know, with this major breakthrough, you know, by the way, only 40 years ago, that doesn't seem, seem much very long ago really. Really. This is, is recent history which just shows, you know, how, how new this all is. But you know, with these kind of technologies and, and history in mind, I was wondering if you could talk about some of the major legal and ethical complexities of using fertility technologies.
- [16:29]
Donna Drucker
Yeah, sure. There may first of all be people. First of all, people may have religious objections to fertilization outside the womb, occasionally as a risk of adultery. In case you come across an unscrupulous physician who uses their own sperm instead of the husbands or the partners and implant and father's children, usually of his own, without the woman's knowledge or consent. That's, that's the, the actual event is fairly rare, but the worry is very present for a lot of people that worry and also the ethical considerations of fertilization outside a natural or quote unquote natural process. The second is screening for particular kinds of genetic diseases. So someone may have a genetic disease or on the mother's side or the father's side, and I will use the gender terms here, and if an embryo is seen to carry the genetic disorder, then the would be parents will simply, not simply, but would discard it. And the question is whether that embryo, fertilized embryo, has any rights as a human. And so there are organizations that then now take over custody of fertilized embryos and try to give them to people with the parents consent. But the fate of fertilized embryos that go unused is another issue. Another more rare issue is the idea of producing children through IVF as what are called donor siblings or savior siblings. So for example, if a child has a blood disorder or a bone disorder and the only way to find healthy bone or blood or any cells to help cure the original sibling, the only way to do that can be to produce a, a second or third sibling that has a healthy, healthy DNA, healthy bones and blood that can then who can then donate that their genetic material to their sibling. It's fairly rare, but it does happen and it is an ethical conundrum. Somebody you're basically existing because your sibling was sick. So there are some definite restrictions around producing siblings in that regard. So those are three examples.
- [19:18]
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- [20:17]
Caleb Zakrin
Yeah, that last one especially is pretty, pretty mind boggling. And you know, it's, you know, every single day it feels like we're inventing a new trolley problem type moral questions, especially in this, in this realm. This is less about a. This next question is less about maybe ethical concerns, but just about how fertility technologies are possibly or possibly not changing the nature and meaning of family and Kinship ties. You know, obviously there's, you know, like you said, there might be certain religious objections, but how do you see, or have we seen how fertility technologies have made people reconsider what family or kinship means?
- [21:09]
Donna Drucker
That's a good question. I think it changes how people think of who families are and how they can come about. One example I discuss in the book is of people who are both female identified who want children and they have a good friend who's male and the they ask him if he can be a sperm donor. He says yes. And it's not, he's not just a donor and then, and then departs their lives. He becomes part of their family and so is incorporated as a, as a parent, but not like a full time parent. And I think what's funny is that the word that they use to describe his relationship to the child is spunkle, so sperm uncle. And so I think that there are lots of ways that, you know, especially people in same sex relationships or people who have more the same type of genetic material aren't able to produce a child together. But the DNA of a child can be at least half of one, one, one partner. And I think it's, we're going to see more and more families that come together with non heterosexual committed couple combinations.
- [22:48]
Caleb Zakrin
So taking us up to the present day, what is the current state of fertility research and technology development and what are some of the future? It's obviously impossible to predict what discoveries will be coming down the pike. But what's the future of fertility technology?
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Donna Drucker
Oh, you're asking a historian about the future? Oh, I'm not as quite, don't make any predictions.
- [23:12]
Caleb Zakrin
But what are the major, I suppose the major projects that are being worked on right now where you know, obviously, you know, in, you know, with genetic research, for example, you know, about, you know, with crispr, it's like we don't know that the future, but we might be able to predict. Okay, we can, we might be able to delete certain genes and change people's, you know, remove change people's predispositions towards certain traits. You know, obviously this is slightly different, but you know, just as far as what researchers are working on today, some of the major, major problems that they're looking at.
- [23:52]
Donna Drucker
Yeah, I think one of the major innovations of the past 10 years or so is time lapse imaging in which people can put together a fertilized embryo and then do time lapse imaging to show how the embryo will develop over a period of a few days and then decide which of those embryos looks the healthiest or the least likely to contain any genetic diseases and then decide to implant those embryos or one or more of those embryos. This is developed in the UK in the past seven or eight years. It's also in the us, but as you can imagine, it's not only very expensive, but it also takes a very trained eye to see how a disease might be predictable and manifest much later on in a child's life. But interestingly enough, there have not been any major breakthroughs in technology really since the 1990s. And that breakthrough was called intracytoplasmic sperm injection, or ICSI, which is the process of selecting an individual sperm and fertilizing an egg with it, rather than other kinds of IVF or other kinds of. Other kinds of techniques where you would just put a bunch of sperm or a drop of sperm or a drop of semen, rather, into a petri dish where the egg was, and then let the best sperm win. This is much more targeted, but that happened 30 years ago, that was 1993. And so, with the exception of the imaging, what a lot of fertility companies are doing is encouraging people to purchase these different kinds of, what are called add ons. So they might be something like. It's a kind of unpleasant term, but it's called uterine scratching. So they might, they being the company physicians, might incise a small scratch on the uterine wall, irritating it, in the hopes that that kind of activity would encourage an egg to implant. Other companies might recommend things like that are less invasive, like acupuncture, chiropractic care, things, things like that. But I think we're not seeing as much innovation on the technical side, more along the business side of fertility technology, especially in the us, because the US is basically very underregulated when it comes to fertility technologies. So a lot of companies have emerged and in packaging fertility services, especially for young women, say, oh, we'll give you the chance to freeze your eggs, you'll get ivf, you'll get these fertility, you'll get fertility storage, or, I'm sorry, egg storage, and it'll all come together in a package for you along with these other add ons. Whether or not that's a good idea for a lot of people is another question. But I think more of the innovation recently has come in the business side of fertility rather than the technology side.
- [27:30]
Caleb Zakrin
For those who are interested in this topic and want to know more or want to follow the research, how would you recommend a layperson go about learning about this topic? In addition to just this introductory book.
- [27:47]
Donna Drucker
I think a country that is more regulated and has more information, I guess is not unbiased or anything. What I would suggest is looking at the website of the Human Fertilization and Embryology Authority in the uk. It's called HFEA is the acronym. And what they do is publish a lot of information on these kinds of add ons that people might be encouraged to use. They evaluate the accuracy of them. They make sure that these add ons are tested in randomized control trials and if not, they recommend people are more cautious about taking on these add ons. For American listeners, the regulation that the HFEA website offers is not as relevant. I think it's a well organized, easy to read website that keeps track of developments in fertility technology that I think readers will appreciate regardless of where they are.
- [29:00]
Caleb Zakrin
And, you know, moving on from just this particular book, what else are you working on today?
- [29:09]
Donna Drucker
I've been working on a book that continues my interest in science and technology with gender and sexuality. I've been working on a book, Abortion, from about the 1860s through the soft present, and that's under contract with Reaction Books. And maybe down further down the road, I'll continue my interest with a book on menopause. But that's just an idea right now.
- [29:35]
Caleb Zakrin
Yeah, you're clearly very active writing about, writing about so many different topics. Well, Donna, thank you so much for being a guest on the New Books Network. We look forward to having you on again in the future when those, when those projects come to fruition.
- [29:50]
Donna Drucker
Great. Thank you for having me. My pleasure.