Reproductive Technology: What Is the Impact of Fertility Treatment and Regenerative Medicine on Society? by Azumi Tsuge (review)

The first page of this book summarizes the inquiry ventured by Azumi Tsuge, a professor in medical anthropology: what changes do fertility treatment and regenerative medicine bring to women and society? Primarily, the alienation and undermined autonomy of women were her answers, and she discusses these extensively in the subsequent nine chapters.

According to Tsuge’s description in the afterword, the process of writing the book was complicated. She first wrote what later became chapter 5, which was primarily a description of the voices of the women she had interviewed for her inquiry into how female identity is affected by the cutting edge of reproductive medicine. In the same year, she also wrote chapter 8, discussing how the subjects of her study are alienated and have their autonomy undermined, based on historical and theoretical perspectives. These two chapters were followed by the other chapters, looking at how this process of alienation arises from treating eggs, embryos, and fetuses as resources (chapter 1) and sperm and eggs as commodities (chapter 2); how it happens in the study of regenerative medicine, for example, embryonic stem (ES) cells and induced pluripotent stem (iPS) cells (chapters 3 and 4); how the Japanese family system has contributed (chapter 6); and how egg donation is involved (chapter 7). She also assessed the physician-patient relationship in chapter 9. The older chapters were then revised extensively prior to publication.

When a couple experiences trouble conceiving a child, they may “autonomously” choose to resort to reproductive technology. The author argues that such a description is overly simplified. “The new eugenics” or “liberal eugenics,” in which reproductive technology plays a major part, is often presented as a set of individual choices and preferences. Yet, the author suggests, the wish to have a child through reproductive technology is never entirely voluntary.

In chapter 5, Tsuge describes the reasons some women “choose” to undergo treatment for infertility. But underneath the list of reasons are the women’s voices, and these make her doubt that reproductive technology is used by fully autonomous women. In one highly revealing case, a woman apologized to a medical doctor after an attempted gamete intrafallopian transfer (GIFT) was unsuccessful (121). She acted as if she forgot for whom she was undergoing the treatment. The advent of reproductive technology is often said to have given infertile women hope of having a normal family. But advances in reproductive technology can be a curse in disguise. Tsuge senses, in the voices of women, that inappropriately understood and naively applied self-determination undermines the autonomy of infertile women. Perhaps it is pain, rather than hope, that drives infertile women to try these new technologies; Tsuge refers to “a distinction and a distance between being infertile and wanting to have a child” (207).

The suffering and pain of infertile women are not so much physical as sociocultural (118). Some ascribe their suffering to an unfulfilled maternal instinct, while others view pressure from the patriarchal system as the cause. Tsuge believes that several factors are responsible, namely, patriarchal ideology, motherhood ideology, gender norms, and the “natural body” model.

Despite the drastic changes that Japanese society has undergone in the last century, it is considered natural for a married couple to have a child, and a couple without a child remains somewhat strange. The diversification of social values has not changed this particular perception. The patriarchal system (ie seido 家制度) was legally abolished subsequent to World War II, but the legacy of patriarchy still continues to pressure women to have a child. The fact that reproductive technology has been available exclusively to legally married couples has reinforced the idea of traditional family, exacerbating the stigma of infertility (Cutting-edge technology does not necessarily put an end to the old system. Instead, as the author argues in chapter 6, in the present Japan, the...