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Good Quality explores the issues behind the crisis, including declining sperm quality in the country due to environmental pollution, as well as a chronic national shortage of donors. In doing so, Wahlberg outlines the specific style of Chinese sperm banking that has emerged, shaped by the particular cultural, juridical, economic and social configurations that make up China’s restrictive reproductive complex. Good Quality shows how this high-throughput style shapes the ways in which men experience donation and how sperm is made available to couples who can afford it.
Product Details
| ISBN-13: | 9780520969995 |
|---|---|
| Publisher: | University of California Press |
| Publication date: | 04/03/2018 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 248 |
| File size: | 8 MB |
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CHAPTER 1
The Birth of Assisted Reproductive Technology in China
It's about 1978, and the first IVF baby was born in the United Kingdom, but during that time, you know, China had had ten years of Cultural Revolution, so we didn't hear any news from foreign countries and we couldn't read any materials from foreign countries. So during that time, we didn't know this great news until 1979, when my father was able to read some newspapers and magazines from foreign countries. That way he learned that a test-tube baby was born in the U.K. in 1978. So he thought that in China, because of the Qing dynasty Chinese people have suffered a lot not only from the war, but also from drugs, because some of them became addicted to drugs. He said that if you want to change the whole country, you must have a healthy body, so it is also important to have a healthy baby for every Chinese family. At that time, my team was doing prenatal diagnosis for genetic diseases and we found many couples with such diseases, but they could only choose to do an abortion; this was the only option for them. My father thought that maybe if we can find a good way to have a sperm and oocyte cultured in vitro, then we can identify not-good genes and choose the good ones. So his first thought for doing IVF technology was not for infertile couples, but for couples with genetic diseases. But this was a long way off and we also found that it was not easy to do this work. After all our research we decided, then, to also do the treatment for infertile couples. (Lu Guangxiu)
There is an almost precise coincidence of timing in the births of Louise Brown in July 1978 and China's restrictive family planning policy a few months after in 1979. These two landmark events stand at odds with each other in many ways. For Robert Edwards and Patrick Steptoe, the two doctors who helped Lesley and John Brown give birth to Louise using the technique of in vitro fertilization (IVF), infertility was the problem that needed to be overcome. In contrast, for systems engineer Song Jian, mathematician Li Guangyuan, and other architects of the so-called "one-child-policy," fertility was the problem that needed to be addressed (Greenhalgh, 2008). The technique of IVF alone has brought an estimated 5 million babies into the world globally (in China, some 200,000), while it is said that the one-child policy has prevented some 140 million births in China.
It is worth remembering that, as Martin Johnson and colleagues (2010; see also Johnson, 2011) have shown, Edwards and Steptoe faced numerous setbacks during the early days of their research on IVF in the United Kingdom. They were refused funding by the Medical Research Council in the early 1970s in a scientific climate where research into infertility "was accorded a low priority" (Johnson et al., 2010, p. 2158) when compared to contraception and abortion. Similarly, beginning in the early 1980s, reproductive scientists Lu Guangxiu, Zhang Lizhu, and He Cuihua also faced many setbacks (albeit eventually securing government funding for their research in 1986) in a country where concerns about overpopulation were immediately national rather than global.
What, then, were the conditions that allowed assisted reproductive technologies (ARTs) to be developed in China during the exact same period that one of the world's most comprehensive family planning policies aimed at preventing birth was being rolled out? First of all, in what follows, we will see how ARTs would have be molded into a suitable form to fit within China's restrictive reproductive complex before they could gain formal authorization through national law as late as 2003. In doing so, these technologies eventually settled alongside contraception, sterilization, and abortion as just another technology of birth control. This might seem counterintuitive, seeing as birth control is most often defined as fertile couples' active efforts to prevent unwanted pregnancies as a matter of (in China, state-stipulated) family planning. Nonetheless, as we will see, for ARTs to be legalized, infertile couples would have to be subject to the same kinds of family planning restrictions as fertile couples. We can say that for increasing numbers of infertile couples in China, birth control can be defined as an active effort to achieve wanted pregnancies using ARTs in order to have one child in strict accordance with family planning policies. Moreover, since China's reproductive complex came to be configured around the dual objectives of controlling population growth and improving population quality, the medical genetic potentials of reproductive technologies were actively mobilized from the outset in China, as highlighted by Lu Guangxiu in this chapter's opening quotation.
Secondly, I will show how even if ARTs such as sperm banking or IVF were invented in the United States and United Kingdom, this did not relieve scientists of a need for experimentation in China, and hence we should not view their development and routinization as an "importation of Western reproductive technologies" (Handwerker, 2002, p. 310; cf. Inhorn, 2003). Instead, we need to trace the transformation of such technologies from pioneering to mundane within China (rather than across borders). By tracing the ways in which ARTs came to be accepted in China we gain insights into the particular form — what we might think of as "one-child ART" — they have taken (cf. Knecht, Beck, and Klotz, 2012).
I begin by looking at how two of the pioneers of reproductive science in China — Lu Guangxiu in Changsha and Zhang Lizhu in Beijing — began experimenting with assisted reproduction, eventually embarking on a collegial yet competitive race to achieve the country's first test tube baby, culminating in the birth of Zheng Mengzu in March 1988 in Beijing, closely followed by a baby girl in Changhsa three months later. Their recollections, recorded in interviews, are interwoven to capture a sense of the pioneering spirit that carried their efforts forward. I will use Zhang and Lu as narrators of the story of the difficult birth of ARTs in China. As we will see, there is a certain style to nostalgic remembering when legacies have already been consolidated, allowing for playful self-deprecation as a means of emphasizing the hurdles and challenges that had to be overcome. Zhang and Lu's personal recollections are balanced against additional interviews with some of the other scientists as well as Ministry of Health officials who were active in reproductive research and policy through the 1980s and 1990s; participation in a series of workshops and conferences on assisted reproduction in China held in Beijing, Shanghai, and Changsha, which gave insights into the history of ART in these cities; as well as on secondary archival sources. Accounting for the birth and routinization of sperm banking in China requires accounting for the development of IVF since, as we saw in the introduction, China's first sperm bank was established by Lu Guangxiu in Changsha to facilitate lab research on in vitro fertilization. Therefore this chapter chronicles the rise of both forms of reproductive technology.
ORIGIN STORIES
Helping You Have a Healthy Little Angel
Our hospital is the first modern large-scale reproductive and genetics hospital in China, and a model for putting technological developments to practical use. ... From 1980 it was under the direction of Professor Lu Huilin, the founder of the study of medical genetics in China. Professor Lu Guangxiu was the first to begin developing human-assisted reproduction research and clinical medical work in China. In 1980, the Human Reproductive Engineering Research Department, a platform for human-assisted reproductive technology, was founded. ... [T]his was the first center in China to begin studying human ovum development, external maturation of ovum, and in vitro fertilization. Projects became national key scientific projects of the Seventh Five-Year Plan. There are world-class equipment and a very talented team. The center has made great achievements in the area of assisted reproduction and preimplantation diagnosis in the past twenty years. ... Founded in 1981, the technological instruction center of the National Sperm Bank of the Ministry of Health was China's first sperm bank, with a very talented team, advanced quality control equipment, computer-based data management, and the ability to preserve 120,000 frozen sperm samples. (Hospital presentation flyer, CITIC-Xiangya Reproductive and Genetic Hospital)
Scientific teams, clinics, and indeed countries often engage in a race to be the first when it comes to "new" or "frontier" technologies; whether in the United Kingdom or in India there is prestige to be won from achieving a first in the ever-growing field of reproductive technologies (Bharadwaj, 2002; Franklin & Roberts, 2006). Global firsts (such as Louise Brown or Dolly the sheep) are perhaps the most prestigious, but by no means at the cost of national firsts. In China, as already noted, two scientists have in particular been recognized, not least through national awards and prizes, as the pioneers of ART — Zhang Lizhu of Beijing's Medical University Third Hospital and Lu Guangxiu of the CITIC-Xiangya Reproductive and Genetic Hospital in Changsha. If ARTs are completely routinized today in China, they were very much experimental technologies in 1980, which was a pivotal post–Cultural Revolution year for reproductive science in China. It was in 1980 that the Human Reproductive Engineering Research Department was founded at the Xiangya Medical College in Changsha by Lu Huilin, father of Lu Guangxiu. It was also in that year that Zhang Lizhu, a trained gynecologist, returned to prominence as invited speaker on China's one-child policy and related public health issues at the United Nation's Second World Conference on Women held in Copenhagen.
Yet, Zhang and Lu arrived at assisted reproduction along very different paths, as endocrinologist and geneticist respectively. Having studied gynecology in Shanghai, New York, and Baltimore through the 1940s, Zhang took up her first position as resident gynecological physician at the Marie Curie Hospital in London in 1949. She returned to China in 1951, eventually becoming the director of Gynecology and Obstetrics at the Peking University Third Hospital in 1958. During the 1960s, her endocrinological research was focused on the increasing numbers of patients reporting menstrual irregularity. By 1965, as the Cultural Revolution began, Zhang's international background was turned against her. She was demoted from her position as director and sent to work in the countryside for a year where she trained so-called "barefoot doctors," followed by a job as hospital janitor at the Third Hospital back in Beijing. Zhang was able to resume her work as clinician and researcher only once the Cultural Revolution had ended in 1978, in a newly established endocrinology laboratory at the Third Hospital. This change in fortune was directly linked to the Four Modernizations program that Deng Xiaoping had launched that year to repair some of the many setbacks that agriculture, industry, defense, and science and technology had suffered during the Cultural Revolution. Zhang picked up where she had left off, concentrating on her patients' menstrual irregularities, a specialization that would inevitably draw her into the field of infertility, as she recalled in an interview with the Chinese Obstetrics and Gynecology forum:
My expertise was in reproductive endocrinology. When I treated patients with period issues in the 1980s, I found that many of them not only wanted to cure their period problems, but also mainly wanted to get pregnant. A lot of them had been married for over two years but still couldn't get pregnant. Therefore I began to look into what was causing their infertility. After research and analysis I found out it was due to blocked fallopian tubes. In most cases this was the major problem. Blocked fallopian tubes were mainly an issue in China, which was completely different from other counties. In China 31.3 percent of female infertility was caused by tuberculosis. We proved that they had tuberculosis through research and biopsy. So this cause was not necessarily the same as in other counties. The main clinical manifestation was pelvic adhesions, and the surface of the ovary couldn't even be seen. (Zhang, Interview 1)
Lu, on the other hand, was introduced to the field of ART by her father Lu Huilin, one of the founders of medical genetics in China. Lu Huilin had traveled to the United States in 1924 to further his education at Columbia University, studying under Thomas Hunt Morgan and Edmund Beecher Wilson for a master's degree in genetics. Armed with a number of Morgan's works, such as Human Inheritance (1924) and Evolution and Genetics (1925), Lu returned to China in 1929. Disrupted by illness and the Japan-China war (1937–1945), Lu eventually set about translating Morgan's texts in the late 1940s with a view to spreading his theories to a Chinese audience. In 1950, he published a book on the theory of the gene and Mendelian inheritance and began teaching this theory at the medical college in Changsha. He was widely criticized in a newly communist China, which officially favored the now discredited ideas of Russian scientist Trofim Lysenko on the heritability of acquired characteristics (see Lamoreaux, 2016). Lu's studies and teaching were interrupted as the Cultural Revolution took hold in the 1960s. As a result, he shifted his attention to medical genetics in the 1970s, forming a research group in Changsha that would develop prenatal diagnosis and genetic counseling techniques. It was this group that would be formally institutionalized in 1980 as the Human Reproductive Engineering Research Department of the Xiangya Medical College. And thus Lu Huilin's interest in reproductive technologies began to take shape. His initial excitement upon hearing news of Louise Brown some months after her birth in 1979 was sparked by the possibilities of utilizing IVF not so much to overcome infertility as to avoid transmission of genetic diseases. It was at this time, in the late 1970s, that Lu Huilin's daughter, Lu Guangxiu, would unknowingly be enlisted in China's efforts to develop reproductive technologies. As she explained in an interview in her office surrounded by a forest of indoor plants one late afternoon in May 2011:
I was a surgeon in Guangdong in 1979, and at that time, because my father's health was not very good, I came back to Changsha to take care of him. During that time, he posed a question to me, asking: "Do you know how we can get an oocyte?" I was astonished to get this question! Because I had never observed any oocytes during ultrasound and the technical equipment was also very poor at that time. So, as a surgeon, I answered, "Maybe you have to open the abdomen to get this oocyte." I also wondered why he would ask this question. When I came back to Changsha, I had become a teacher of anatomy. In those days, I could teach for half of the year and have my own time for the other half of the year. Being a surgeon was hectic every day, so I was used to the old busy days. I felt I had too much free time in Changsha and I hadn't many things to do. So I asked my father why he asked this question and he said that he would like to try for an IVF baby. I then said, "Why don't you let me have a try?" But my father said that I am a surgeon and so I lack basic knowledge of this research and he would think about it. After several days, he gave me some examples of what preparations I would make if I was going to be engaged in this research, such as the equipment, technology, and knowledge; so all these things, I had to begin from scratch. "You will encounter many difficulties and you have to overcome them," he told me. I thought about it and accepted it and began the research.
Lu Huilin sent his daughter to Beijing on a three-month study trip in 1980 to learn how to fertilize eggs and culture embryos from cows, rats, and mice. Lu Guangxiu's sister was studying at Beijing University at the time and had many friends and classmates working at the Chinese Academy of Sciences in the field of genetics. So, whereas Zhang Lizhu's attention had been drawn to infertility by the patients she encountered as a clinical gynecologist, Lu Guangxiu was introduced to reproductive science by her medical geneticist father whose initial interests focused on the use of reproductive technologies to engineer and improve the strength of China's population. This intersection of clinical infertility and medical genetics, as we will see, turned out to be propitious for the development of ART in China. As they set out to develop reproductive technologies in the early 1980s, one of the first hurdles faced by Zhang and Lu (much like all other early reproductive science pioneers) was how to get a hold of human gametes.
(Continues…)
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Table of Contents
List of Illustrations ixAcknowledgments xi
List of Abbreviations xv
Introduction: Sperm Crisis 1
1. The Birth of Assisted Reproductive Technology in China 29
2. Improving Population Quality 58
3. Exposed Biologies 77
4. Mobilizing Sperm Donors 100
5. Making Quality Auditable 131
6. Borrowing Sperm 157
Conclusion: Routinization 188
Coda 192
Notes 195
References 205