Lectures

Making embryos lively: The politics of embryo personhood when fertilization happens under a microscope

On May 25, 2022, Oklahoma governor Kevin Stitt signed into law the strictest ban on abortion to date, a policy that prohibits the termination of any pregnancy “from the moment of fertilization.” This law endows an embryo, no matter the stage—long before it has discernible heartbeat—with the same legal status as an unborn child. Almost exactly one month later, on June 24th, the Supreme Court overruled Roe v. Wade, overturning fifty years of legal precedent guaranteeing the constitutional right to abortion (Times 2022). Now, more than ever, we are grappling with the implications of a contemporary biopolitics of embryonic life, which deploys a particular understanding of fetal and embryo personhood while newly politicizing reproductive science (Crockin 2005; Cromer 2018). Following the overturning of Roe, trigger laws to ban abortion outright have gone into effect in twenty states. The effects of the Supreme Court’s decision are incalculable. We know that millions of people will lose access to legal abortion, with grave implications for pregnant peoples’ mental and physical health, financial security, risk of intimate partner violence, pregnancy-related mortality, and much more.

As an anthropologist of reproduction currently conducting research in several IVF clinics and embryology labs in the United States, I have seen embryologists, reproductive endocrinologists, and nurses grapple with what the Supreme Court decision will mean for their patients. In this essay, I pause to consider how and where the biopolitics of embryo personhood touch down in the clinics and labs where embryos are made, stored, and discarded every day. Drawing on ethnographic research in two fertility clinics and embryology labs in the northeast U.S., this post offers a glimpse of the places where science, politics, and kinship clash; where embryos are both reproductive material and lively agents, rascals and interlocutors; where embryonic life becomes slippery and the messy realities of in/fertility come to light.

Tracing the embryo’s journey, from the lab to the body

On a recent summer morning, I accompanied a reproductive endocrinologist to a large operating room in a quiet surgical wing of a small New England hospital. She was about transfer an awaiting embryo, which had been cultured in the adjoining lab, into her patient’s uterus. The patient’s last transfer was unsuccessful, the endocrinologist told me, most likely because fluid in her endometrial lining made her uterus an unwelcome environment. We stepped through the OR into the lab that abuts it, donning green scrubs, shoe covers, surgical masks, and head covers. An embryologist greeted us, and following his lead, we took turns looking under his microscope at the tiny embryo. It was a blastocyst, a rapidly dividing ball of cells, just five days old. The embryologist told me that it was a female and Euploid, an embryo considered chromosomally “normal” and thus most likely to produce a healthy baby.[1]

Back in the OR, the patient climbed up onto the surgical bed, and I asked her how she was feeling. She was blonde and tanned, with blue eyes and a large diamond on her finger. “I’m okay,” she replied. “I’ve learned to disconnect from the process. Physically, at least, I feel fine.” Her legs were strapped into stirrups, an ultrasound wand pushed against her abdomen. Standing behind the doctor, I watched as she positioned the speculum to see the patient’s cervix. I saw the patience wince. “I’m ready,” the doctor murmured, and the embryologist delicately handed her the catheter holding the embryo. She threaded a catheter through the patient’s cervix, into her uterus, finding the perfect spot to deposit the embryo. Searching the ultrasound screen, the patient asked us where to find her embryo. “Look for the white spot in the middle of the uterus,” the doctor responded, directing the patient to the air bubble at the tip of the catheter that marks the spot where the embryo is released. At five days old, the embryo is still a microscopic ball of cells. “It’s kind of hard to see,” the patient said, squinting, and I wished I could reach over the doctor and point to the spot myself. “All done!” the doctor announced, happily. It was a smooth, quick, easy transfer. Getting up off the bed, the patient thanked us. She exclaimed, “It’s a lucky day!” We smiled back and crossed our fingers, and the nurse handed her a printed image of the embryo taken moments before it was placed inside of her. Now, we would wait, in the hope that the embryo would successfully implant.

Embryos are many things

In the fertility clinic and the embryology lab, embryos are many things. They are genetic material, reproductive cells, private property, tissue, research material, and possible future babies. As one embryologist recently told me, “They are alive and full of potential.” They are at once social and biological, material and semiotic, human, nonhuman and more-than-human. Embryos, in this way, are cyborgs, ever-shifting assemblages of materials and relations, what Janelle Lamoreaux has called an “embodied ecology” (Franklin 2006; 2007; Lamoreaux 2019). They are alive, as alive as any of our trillions of cells. They grow and expand. They work. As Michelle Murphy writes, “assisted reproduction has shown how the animating, recombinatory, manipulable, and responsive capacities of micrological life (cells, eggs, nuclei, viruses, and so on) have been harnessed as a form of biolabor or biocapital in contemporary political economies” (Murphy 2013). Feminist scholars have explored how the multifarious relations and materials of reproduction extend well beyond the skin, well beyond the embryo, well beyond the uterus (Haraway 1987; Murphy 2017; 2013). In this vein, and in this political moment, it is critical that we work to examine the interior lives and agential power of the stuff of infertility—embryos, eggs, sperm, endometrial lining, fluid, mucus, blood, synthetic hormones, pharmaceuticals, oral contraceptives, syringes, hospital beds, and more (Mol 2003; Barad 2007; Bennett 2010). How do embryos come to act in the world?

In the embryology lab, I watch as an embryologist named Gina thaws embryos for transfers later that day and prepares the requisite paperwork. Nearby, another embryologist, Sasha, prepares to help perform a single embryo transfer. Out of the corner of my eye, I see Gina switch on the microscope laser, and I ask what she’s doing. “I’m just hatching [the embryo’s outer shell],” she tells me, to help the embryo emerge and implant once inside the patient. I nod and turn back to Sasha. In the next room, the doctor inserts the speculum and threads the catheter through the patient’s cervix. Sasha turns on a camera that projects an image of the embryo under her microscope for the patient to see. “Here it is,” she says, “already very well expanded. Good job embryo!” She moves the embryo up into the catheter and hands it to the doctor, who transfers it without issue. Gina, by now, has already begun collapsing another patient’s embryos to freeze them. They will be kept in liquid nitrogen—at -320 degrees Fahrenheit, or -196 degrees Celsius, it’s a substance much colder than ice, so cold that it freezes anything it touches—perhaps for days, months, or even years. She narrows her eyes and murmurs, “We’ll see how this guy behaves.” Later, as she hatches again, she’ll nod contently and say, “Now this is a nice one.”

All day, I watch as Gina and Sasha monitor, grade, care for, freeze, hatch, collapse, thaw, and transfer embryos. Often, in the process, I discover that embryologists endow reproductive cells and embryos with personalities, and understand them as full of potential to act in the world. Some behave well—completing meiosis, forming two pro-nuclei and two polar bodies, before rapidly developing into a blastocyst—while others misbehave, acting unruly or unpredictably. On a recent afternoon, lab director Emir took me to look at the lab’s embryoscope, an embryo incubator that allows embryologists to monitor their progress using time-lapse imaging. On the screen, he pointed to an embryo with three pro-nuclei and one polar body. It was “abnormal.” Emir explained that this embryo failed to extrude half of its genetic material, to take in the male genetic material, to complete meiosis. “There’s a 99.999% that they are going to be genetically abnormal. She’s 41, so her chances of having a normal embryo are already less than 20%, and this one is not [normal].” What are you going to do with them once they’ve grown? I ask. “We’re going to discard them,” he tells me, his tone suggesting that this is the obvious response. “They could still form a good blastocyst,” he explains, “but we wouldn’t want to transfer it.” In other words, “she doesn’t have anything. It’s going to obviously fail.” He clicks on another, and says, “This one is doing worse today, there’s something mysterious about that.” And another one, developing late: “This happens normally at 26 hours—took too long. This embryo will likely not make it.” Through their affective relationships to and with the embryos in their care, Emir, Sasha and Gina make embryos lively, but not alive. “Say ‘bye baby’, and see you in two weeks!”, I hear a doctor tell her newly pregnant patient as she removes the ultrasound wand. Her words remind me that embryos are many things.

“They are so beautiful”

That the Oklahoma law and others like it restrict abortion beginning at the “moment of fertilization’ is significant to the embryology lab, because it is there that embryologists come to fertilize eggs every day. After reproductive endocrinologists aspirate follicular fluid from a patient’s uterus, embryologists get to work searching for mature eggs, before inseminating them and placing the fertilized cell in an incubator. Then, the eggs are monitored daily for proper cell division and development. Do two pro-nuclei develop? Does the fertilized cell begin to divide? After five days, fertilized eggs that develop properly will form a blastocyst, and signal that the embryo ready to be frozen or transferred. The embryo might be biopsied for preimplantation genetic testing, or dehydrated and plunged into liquid nitrogen. Eventually, some of the ‘normal’, best-looking embryos will be thawed and transferred back into the patients from whence they came. Others will be transferred into gestational carriers, or donated to patients who cannot make their own embryos. Through this process of meticulous care, embryologists develop complex affective orientations toward the embryos they culture. “Baby’s first rollercoaster ride!”, I once heard an embryologist exclaim as we watched his colleague take an embryo up into her catheter. “If [the embryo] sticks to the catheter, that means it’s a boy,” the doctor joked. And Sasha often croons, in a sweet voice, “Good job embryos!” as she watches them expand. With a smile, she’ll add, “They are so beautiful.”

Embryologists themselves thus have moral, political, and affective orientations to their work in the lab (Ehrich, Williams, and Farsides 2008). As eggs fertilize and develop, embryos take on a liveliness cultivated by their handlers. Embryologists talk about them, and to them, as “cute” and “beautiful”, or sometimes say regretfully that “they’re not looking so good”; they wish the patient good luck and cross their fingers that the embryos implant. These accounts gesture to embryologists’ nuanced perspectives and feelings about oocyte fertilization and embryo culture, life, and death in the lab.

In the afternoon, Sasha performs the procedure known as ICSI, or intracytoplastic sperm injection, in which an embryologist uses a pipette to capture a single sperm under a microscope before plunging it directly into a mature egg. Having watched hundreds of eggs fertilized in this manner, I have seen how eggs and sperm can act in sometimes predictable, and sometimes peculiar ways. Eggs can look healthy, but collapse when poked. A semen sample that seems full of healthy sperm might, once washed and spun in the centrifuge, reveal very few that move properly. Some sperm have three heads; others swim in frenzied circles, unable to make a straight path. The embryologist has the weighty task of selecting the chosen sperm to inseminate each oocyte. As Sasha prepares to inseminate a patient’s lone mature egg, I watch her focus on the sperm swimming in the dish under the microscope. She tells me, “I will pick the most beautiful one. Ohhh! Two of them are running. Ding ding ding ding!” I watch as she meticulously grasps it with her pipette, with Gina watching. It’s a lot of pressure, she tells me, to pick the right one. She breaks the sperm’s tail with a quick cutting motion, immobilizing it. The doctor who performed the retrieval joins us to watch, and tells us that the patient was “tearful when she heard it was only one egg [retrieved].” I watch with bated breath as she punctures the egg’s outer membrane and deposits the lone sperm inside. Blink and it’s over; the moment of fertilization.

Embryo arrest, loss, and death in the lab

While most of the work of the lab involves growing, monitoring, and caring for embryos, the lab is also, inevitably, a space of embryo arrest, loss, and death. Many excess embryos are never transferred. Some of them are donated to embryonic stem cell research, others are donated to an embryo bank to help other infertile couples, and many ultimately end up in the discard incubator, destined to be incinerated. Couples break up, plans change, patients reach their desired family size. Embryos that are biopsied and found to be chromosomally abnormal, or Aneuploidy, are almost never implanted. Even for patients in their early thirties, the chance that an embryo will be ‘normal’ is 50%. Recently, I sat in a medical office as a doctor told her tearful patient that none of her embryos tested chromosomally normal. Patients are often forced to make difficult choices about their embryos, a decision with profound personal, political and epistemological implications.[2]

In the lab office, a folder bulges with lists of patients whose embryos are waiting to be discarded, each attached to an ironclad consent form. In a paradigm in which embryos are persons, fertility clinics and embryology labs are increasingly politicized spaces. When couples split up, the question of what happens to their frozen embryos can become contentious. A few weeks ago, security had to be called when a patient’s former husband threatened the fertility clinic for having followed a court order to destroy their frozen embryos. He was an abusive partner, I was told, and was forbidden to contact his ex-wife. “You guys are an abortion clinic,” he wrote in an irate email to the nurse supervisor. He added a threat: “The world is watching.” In a highly publicized 2015 case, actor Sofia Vergara’s ex-husband sued her for use of their frozen embryos. In a New York Times opinion piece, he wrote, “When we create embryos for the purpose of life, should we not define them as life, rather than as property?… These are issues that, unlike abortion, have nothing to do with the rights over one’s own body, and everything to do with a parent’s right to protect the life of his or her unborn child” (Loeb 2015). In both of these cases, the politicization of embryo personhood brings anti-abortion rhetoric into the IVF clinic and embryology lab. In both of these cases, because the embryos were cultured in the lab and thus outside of the reproductive body, ex-partners make claims for parental rights while erasing their former partners’ claims to parentage. They seek to nullify their former partners’ legal rights while imbuing their embryos with legal personhood. Suddenly, embryologists and reproductive endocrinologists are political and politicized actors, whether or not they consider themselves as such.

Back in the office, I notice an embryo discard sheet sitting next to my desk. It details the case of a couple who had come to the lab in order to retrieve the small plastic devices holding their frozen embryos. Sasha tells me that they wanted to give their excess embryos a burial. When I ask about it, Gina tells me, “This happened when I wasn’t here… normally I would take it out [of the liquid nitrogen] before the patient arrives, and just hand it to them, like here you go, so they could feel like they had no part [in killing them].” In this case, however, her colleague had led the couple into the lab to see the embryo straws removed from the liquid nitrogen in front of their eyes, and, as Sasha described, the patient “got really emotional, started to cry,” and found herself needing to leave the room. “[The embryologist] was very emotional, he took it close to his heart,” she said. The patient’s husband stayed in the lab and watched as the embryologist finished the procedure, and the two took the devices home. When I ask Sasha what she would have done in their situation, she replies, “I would donate my embryos for research… so they wouldn’t be killed for nothing.” In this story, both the patients’ and Sasha’s orientation to their (real and hypothetical) embryos are remarkable because they reveal the fraught, complicated, and highly affective ways in which patients and scientists think about embryo life and death. This story also lays bare how legislation that defines personhood from the moment of fertilization will continue to implicate the fertility clinic, both for the embryologists who culture embryos and for the patients who intend to parent them.    

In the new reality of post-Roe America, the Oklahoma law that restricts termination after the very moment of conception might become the status quo. It is a chilling thought for reproductive justice and health advocates, for all of us who have a stake in reproductive autonomy. In this context, it is more important than ever that scholars of reproduction and science grapple with the embryo as a material and political-legal-social-scientific entity. Here, we see that the embryo is mutable; it transforms; it comes alive in different ways for different people; it is made lively, though not person; it is made waste. As Franklin writes in her discussion of embryonic stem cell research, “To understand the cyborg embryo, and its legacy of transbiology, we need an anthropology of the embryos around us, who are and who are not becoming part of our futures, and who are reshaping our understandings of life, death, health, kin, progress, hope, sex, capital and cure” (Franklin 2006:170). Answering the question of what an embryo is will require us to pay close attention to the perspectives and embodied knowledges of those who work closely with and for embryos, who create them and plunge them into liquid nitrogen, who place them in uteruses, and who dispose of them.


Manon Lefèvre is a PhD candidate in Anthropology and Environmental Studies at Yale University, specializing in the anthropology of reproduction and science. Her work explores the landscape of in/fertility from above and below, bringing together ethnographic perspectives from demographers, embryologists, reproductive endocrinologists, and patients to explore themes including the politics of reproductive knowledge, embryo personhood, disability, and more. She is currently conducting research in several fertility clinics and labs in the Northeast U.S.

Notes

[1] Within IVF, it has become common practice for embryologists to perform a trophectoderm biopsy of five to six-day old embryos, to detect number of chromosomes. Embryologists and reproductive endocrinologists most often will only transfer embryos that biologists would consider euploid embryos considered “chromosomally normal,” found to have 46 chromosomes in 23 pairs, because studies indicate these embryos are most statistically most likely to result in a live birth. However, many embryos are found to be aneuploidy, chromosomally “abnormal”, found to have an “incorrect” number of embryos (whether too few or too many). A trisomy embryo has an extra or dupliate chromosome; a monosomy embryo is missing a chromosome. Experts contend that aneuploidy embryos are more likely to result in a miscarriage, or will result in a baby with a disability. For these reasons, aneuploidy embryos are considered “not viable” and are rarely transferred back into patients. Disability studies scholars and disability rights advocates have examined the political, economic, and social milieu through which the biological and biomedical categories of ‘normal’ and ‘abnormal’ emerged in the 19th Century. These categories themselves reify ableist discourse of disabled people as ‘abnormal’ and therefore somehow ‘wrong’, justifying the harm and dispossession of disabled people in the name of ‘cure’ (Clare 2017; Canguilhem c1978). Feminist scholars of reproduction have extended these critiques to explore the implications of pre-implantation genetic testing of embryos, which reifies a hierarchy of normal/abnormal and selects for “normality”, reinforcing the eugenic dream of a white, cis, straight, able-bodied society (Rapp 1999; Parens and Asch 2000; Stern 2005).

[2] Anthropologists have explored the ways in which patients mobilize complex and mutable understandings of their own embryos—as reproductive material, as potential children, as tissue for research—as they navigate what to do with those that remain frozen in cryotanks, waiting for their outcomes (de Lacey 2007; Franklin 2013; Cromer 2020).  

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