Cosmopolitan Conceptions: IVF Sojourns in Global Dubai

The media frenzy surrounding the Baby Gammy case in 2015 drew attention to the issue of people travelling across national borders to pursue reproductive treatments, ova donation and surrogacy. A new trade in medically assisted reproduction has grown across the world, aided by the advent of affordable transport linkages, information technologies, and the movement of assisted reproductive expertise across the world. Although a common stereotype is that people travelling for reproductive care do so because of cost differentials, as this book explores, most travel because their home country either does not have the procedure they require or limits it in such a way that they are unable to access it. Differences between jurisdictions exist in various aspects of assisted reproductive treatments and people move between jurisdictions to obtain the services and procedures they need. In Cosmopolitan conceptions, Marcia Inhorn, a Professor of Anthropology and International Affairs at Yale University, provides an indepth sympathetic ethnographic account of reproductive travellers seeking in vitro fertilisation (IVF) treatments at ‘Conceive’ clinic in Dubai. Inhorn is known for her superb ethnographies of gender, patriarchy and infertility issues in the Middle East. This book is based upon long-term fieldwork, and first-hand accounts from 220 ‘reprotravellers’ to provide insight into lives of people in their quests for children. Most are people who cannot find safe, affordable, legal or effective fertility and IVF services in their home countries. They undergo painful, frustrating and financially crippling journeys to seek the care they need. A few are mobile cosmopolitan couples whose work and business brought them to the Emirates. The book is organised around the concept of the ‘global reproductive assemblage’: the network of technologies, personnel, expertise, finance, media and imaginaries that animates the global trade in assisted reproduction. Drawing on detailed case studies, each chapter explores a theme such as: the development of particular hubs for ‘reprotravel’; the experiences of those people forced to seek care due to shortages in clinical expertise or technology in their home countries; those whose travel is motivated by restrictions due to legislation, religious bans or clinical protocols bans on certain procedures such as egg freezing, third party assistance or age limits; and the histories of medical harms and reproductive damage experienced by infertile people that cause them to seek high quality IVF. She concludes: “reprotravel often connotes the failures of states to grant safe, legal, affordable, and effective IVF as a right of citizenship” (p.301) and says that ensuring access to IVF is an important humanitarian and reproductive justice issue. Of particular interest for public health is the discussion of the two main infertility problems encountered at the Conceive clinic: male infertility and polycycstic ovary syndrome (PCOS). Both are linked to lifestyle factors, although with a genetic predisposition. Male smoking is linked to male infertility; and for women, being overweight and obese with the resultant insulin resistance and diabetes is associated with PCOS. Inhorn notes “the Emirates is now a global hub for a triad of linked problems, including overweight/obesity, insulin resistance/diabetes and PCOS/infertility” and one cannot help wondering whether this is a vision of things to come for Australia (p.75). She suggests PCOS is often under diagnosed – although 70% of females attending this clinic were diagnosed with PCOS, few had a PCOS diagnosis from their previous specialists before coming to the Conceive clinic. Throughout the book, Inhorn makes a strong case for the necessity of advocacy for reducing preventable forms of infertility, support for people suffering from infertility, and the need for the availability of low-cost IVF worldwide.