ICSI for all! : How an Unnecessary Biomedical Technology Became the Standard. Manuela Perrotta

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1 STS Conference Graz 2015 SESSION 3: Emerging Configurations of Biomedical Technologies May 2015 Graz, Austria ICSI for all! : How an Unnecessary Biomedical Technology Became the Standard Manuela Perrotta Queen Mary, University of London m.perrotta@qmul.ac.uk

2 Biomedicalization and the the notion of health Biomedicalization: the increasingly complex, multisited, multidirectional process of medicalization that today is being both extended and reconstituted through the emergent social forms and practices of a highly and increasingly technoscientific biomedicine (Clark et al., 2010, p. 47) The body and its boundaries come to be re-inscribed through the intervention of biomedical ecologies that manipulate them and even the definition of ideas of healthy/sick comes to be problematic (Van der Ploeg, 1995)

3 The Success of an Unnecessary Technology Assisted Reproductive Technologies (ARTs) as a common alternative for overcoming unintended childlessness (Inhorn and Van Balen 2002). The emergence of a new technique : ICSI (Intracytoplasmic Sperm Injection).

4 Background of the research: Zooming in and zooming out Participant observation in 3 ART centres in Italy plus 25 interviews with professionals Review of the medical literature 12 interviews with patients

5 New Research Questions How a technology becomes socially acceptable and desirable? How social acceptability/desirability emerges?

6 What is ICSI? Test tube for IVF Sperm microinjection

7 IVF (In vitro fertilization) 1979 IVF vs ICSI ICSI (IntraCytoplasmic Sperm Injection) 1991 Same pregnancy rate (20-25%) Medical doubts about ICSI effect on the newborns ICSI is more expensive and time-consuming IVF and ICSI both affect the female body, regardless of female or male subfertility (hermaphrodite couples Van Der Ploeg, 1995, 2004)

8 In the medical community The proposition for universal use of ICSI (ICSI for all!) Several professional opinion leaders in the ART field recently criticized the overuse of ICSI (see Fleming, 2013) Missing data about follow up (Bergh et al. 2011) Epigenetic modifications have been found to be transmitted to the offspring in mouse embryos (Calle et al. 2012) Children conceived by in vitro fertilization (IVF) are at an increased risk of developing Beckwith-Wiedemann syndrome (an imprinting disorder first described an Exomphalos-Macroglossia-Gigantism, caused by epigenetic alterations or genomic imbalances at the chromosome 11p15.5) nine times greater than that of the general population (Halliday et al 2004, Chen 2012).

9 IVF vs ICSI Use of IVF and ICSI from 1994 to 2005 Cycles begun in 2005 by type of service and technique utilized 2011: IVF 17%, ICSI 83% 2012: IVF 16,7%, ICSI 83,3%

10 A typical ART story (in Italy ) Medical examinations Intra-Uterine Insemination IUI Infertility: When a couple cannot conceive after 12 months of regular unprotected intercourses IntraCytoplasmic Sperm Injection ICSI Timing intercourse In Vitro Fertilization IVF

11 When to do ICSI? Severe male infertility, the presence of which does not allow IVF (or better, offers only low probability) to achieve the fertilization of the oocytes, based on an assessment of seminal parameters such as the number of spermatozoa, their motility and their morphology; The failed fertilization of the oocytes in preceding IVF cycles, the only exception shared by all the biologists to criteria based on seminal parameters.

12 Causes of infertility 1% male infertility 15% 13,20% 35,40% female infertility male and female infertility 35,40% idiopathic infertility Source: Istituto Superiore Sanità other factors

13 Other issues Feminine factors (oocyte quality) Law restrictions (three embryos until 2009; no external donors until 2014) Technical issues (oocyte maturation and control over the process)

14 The production of embryos

15 Concluding remarks: The socio-material co-production of an «unnecessary» biomedical technology ICSI for all! ICSI as a panacea for male infertility ICSI solves the problem of embryo production, but it does not mean for the couple to have more chance for pregnancy What s a successful treatment? Reproductive biomedicine is not about diagnosing and cure fertility, but producing embryos ICSI as a gendered technology: Does ICSI saved masculinity? ICSI alliances: organizational performance, materiality of reproductive practices, embeddedness in biomedical discourses, gendered power relations

16 Thank you!

Clinical Policy Committee

Northern, Eastern and Western Devon Clinical Commissioning Group South Devon and Torbay Clinical Commissioning Group Clinical Policy Committee Commissioning policy: Assisted Conception Fertility assessment