The two of us are sisters – Margaret is a historian, Wanda a gynecologist – and we have been writing about the history of infertility, reproductive sexuality, and reproductive medicine for close to three decades now. In our new book, The Pursuit of Parenthood, we turn our attention to the history of assisted reproductive technology, beginning with in vitro fertilization (IVF) and ending with such new developments as mitochondrial replacement techniques and uterus transplants. Linking the world of medical science and practice to the experience of patients, we tell the interconnected stories of the scientists and physicians who developed and employed these new technologies and the women and men who used them. We examine the controversies they engendered and explore the moral and ethical issues they raise.
One of those issues involves entrenched cultural attitudes in the United States that have contributed to significant racial and socioeconomic disparities in access to these procedures. Black women and couples, for example, have been consistently underrepresented as patients in America’s fertility centers. As Desiree McCarthy-Keith, a prominent African American fertility specialist who practices in Atlanta, explained to writer Reniqua Allen in 2016, “Historically, fertility treatments have been mostly targeted to and used by white women, middle-class women, so the initial presentation of fertility treatments, they didn’t really include us in the conversation.” The cost of assisted reproduction is also a deterrent. IVF should be covered by health insurance, but in most states, it is not. Cost alone, however, cannot fully account for racial disparities in access to care.
The history of IVF, as it played out in the pages of newspapers and on television in the early years, with a few exceptions, featured white middle-class couples. As Dr. McCarthy-Keith noted, black women were not included in “the conversation.” But what if an African American couple had been the first in the United States to have a baby after IVF? Would that have affected the way the media told the story? It may not have been enough to discourage discrimination, but this is not an abstract question. In 1978, Mary and John Patton – a medical technician and police officer – enrolled in a prospective clinical trial of IVF in Nashville, Tennessee, one of several black couples in a larger group of hopeful would-be parents. The researchers and the study volunteers were just waiting for a “temporary” federal funding ban on human IVF research to be lifted. But the ban remained in place (in fact, such a ban is still in place), and the trial never went forward. The Pattons were out of luck. The first IVF program in the United States to be successful, in 1981, was paid for with private funding and patient fees. Over the next few years, most of the happy parents shown on the front pages of newspapers with their newborn IVF babies were white.
There were also very few black physicians among the American IVF pioneers. We found just one African American woman, PonJola Coney, among this early group of researcher/practitioners. Dr. Coney, who had overcome considerable obstacles in her determination to enter this field, went on to direct IVF programs at two academic medical centers in the Midwest—both the first in their respective states – in the 1980s. She remembers that she always had a substantial number of African Americans among her patients. But she was a rarity.
When Reniqua Allen talked to Dr. McCarthy-Keith in 2016, she felt alone and a bit unmoored as a thirty-something black woman trying to decide whether assisted reproductive technology should play a role in her life. Would she have felt less so if she had known that First Lady Michelle Obama, when she was in her thirties, had wrestled with similar, if not exactly the same issues? The Obamas married in 1992, when she was twenty-eight and he was thirty-one. A few years later they were ready for children and when she failed to become pregnant right away the couple felt only disappointment, not worry. When she did conceive, their short-lived joy was cut short by a miscarriage. Disheartened, Michelle told a few friends. Some shared their own heartaches. One of them gave her the name of her own infertility specialist.
The Obamas tried medical treatments first, and when they failed, Michelle underwent IVF. Given their relatively modest incomes at the time, she said, the couple felt “inordinately lucky” that her university health insurance covered most of the cost of their treatments, including IVF. Actually, their luck likely derived from the fact that they lived in Illinois, which a few years earlier had become just the fifth state in the nation to require that employers offer comprehensive coverage for infertility treatment, including IVF. The Obamas’ story, we know, had a happy ending. Their daughter Malia, conceived using IVF, arrived on July 4, 1998. Their second daughter, Sasha, also conceived by IVF, was born three years later.
Michelle Obama wrote about her and Barack’s experience with infertility, and their decision to use IVF, in her best-selling 2018 memoir. Her candor about this experience recalls the forthrightness of another First Lady, Betty Ford, who in 1974 announced that she had been diagnosed with breast cancer during a screening mammogram. Ford brought into the open a diagnosis that at the time was so deadly that women did not disclose their cancer even to their friends or their children. Later, when she chronicled her surgery and recovery in interviews, Ford’s example encouraged thousands of women to make appointments for breast examinations and screenings. Michelle Obama’s story will not be enough to end racial and economic disparities to care, but by writing about her and Barack’s own decision to turn to assisted reproduction, our first black First Lady may have an impact far beyond her own moving story.
Margaret Marsh is a university professor of history at Rutgers University. Wanda Ronner is a professor of clinical obstetrics and gynecology at the Perelman School of Medicine of the University of Pennsylvania. They are the authors of The Pursuit of Parenthood: Reproductive Technology from Test-Tube Babies to Uterus Transplants, The Empty Cradle: Infertility in America from Colonial Times to the Present and The Fertility Doctor: John Rock and the Reproductive Revolution.
Reniqua Allen’s story and the quote from Dr. McCarthy-Keith can be found at Reniqua Allen, “Is Egg Freezing Only for White Women?,” New York Times, May 22, 2016, p. 5. Michelle Obama told her infertility story in her memoir, Becoming (New York: Crown, 2018), 187–199.