Each year, more and more Americans travel out of the country seeking low cost medical treatments abroad, including fertility treatments such as in vitro fertilization (IVF). As the lower middle classes of the United States have been priced out of an expensive privatized “baby business,” the Czech Republic has emerged as a central hub of fertility tourism, offering a plentitude of blonde-haired, blue-eyed egg donors at a fraction of the price.
Fertility Holidays presents a critical analysis of white, working class North Americans’ motivations and experiences when traveling to Central Europe for donor egg IVF. Within this diaspora, patients become consumers, urged on by the representation of a white Europe and an empathetic health care system, which seems nonexistent at home. As the volume traces these American fertility journeys halfway around the world, it uncovers layers of contradiction embedded in global reproductive medicine. Speier reveals the extent to which reproductive travel heightens the hope ingrained in reproductive technologies, especially when the procedures are framed as “holidays.” The pitch of combining a vacation with their treatment promises couples a stress-free IVF cycle; yet, in truth, they may become tangled in fraught situations as they endure an emotionally wrought cycle of IVF in a strange place.
Offering an intimate, first-hand account of North Americans’ journeys to the Czech Republic for IVF, Fertility Holidays exposes reproductive travel as a form of consumption which is motivated by complex layers of desire for white babies, a European vacation, better health care, and technological success.
Acknowledgments ix
Introduction 1
1. From Hope to Alienation: North Americans Enter the
Baby Business 17
2. Virtual Communities and Markets 41
3. Intimate Labor within Czech Clinics 63
4. Contradictions of Fertility Holidays 101
5. Separate but Connected Paths 118
Conclusion: An Eye to the Future 143
Notes 151
Bibliography 153
Index 163
About the Author
Introduction
In my small bed-and-breakfast room in Moravia, I interviewed April, a
blonde, blue-eyed music educator, and her husband, Larry, a teddy bear of
a man. The two sat side by side, squished on my maroon leather loveseat,
as I perched across from them on the edge of my bed. They took turns
answering my questions about their experience with infertility and the
world of assisted reproduction. The ease and flow of the conversation indicated
a close, loving relationship and their mutual support. High school
sweethearts, April and Larry were ready to have a baby once they had been
married several years. After a year of seeing what would happen when they
stopped using contraception, they began to wonder. April started charting
her temperature to find out when she ovulated, and they began having
“timed relations.” After another six months of making a more concerted
effort, April decided to speak to her ob-gyn. Sadly, they learned that Larry
had “weak” sperm, and they were referred to a fertility specialist.
April and Larry were frustrated at what they felt was an interruption
in their planned life cycle. Larry’s low sperm count affected his sense of
masculinity, while April panicked because she had always wanted children.
As they watched the families of their close friends grow, they felt
increasingly isolated in their struggles. April joined an online support
group for infertility called RESOLVE, where she basked in the support
and information shared among women.
At the fertility clinic, the doctor suggested April and Larry begin with
noninvasive intrauterine injections (IUIs) to give Larry’s sperm a “jump
start.” They underwent three cycles of IUI, at which point they decided
that April should take fertility drugs to help stimulate the growth of
more eggs, aiming to increase chances for conception. After another
three unsuccessful rounds of IUI, their doctor suggested they begin to
think seriously about in vitro fertilization (IVF).
The doctor sent April and Larry to the clinic’s business office, which
handled payment issues. The woman at the business office tallied the
2 | Introduction
costs of future office visits at $300 per visit, the various procedures
they would need, such as intracytoplasmic sperm injection (ICSI),1
and costly medications. With only partial insurance coverage, they
found themselves having to pay for nearly everything out of pocket.
The price tag kept climbing until it reached $15,000. The two of them
decided to put off renovating their bathroom and dipped into their
savings.
When their first cycle was unsuccessful, the doctor suggested they
try IVF using donor egg, which again increases the chance of conception.
But the price tag for IVF using an egg donor skyrocketed to nearly
$35,000. Their jaws dropped, and they felt like a concrete road barrier
had crashed in front of them, ending all chances for a semibiological
family. They knew they could not afford it. The clinic suggested that
they remortgage their house. Once again, April, heartbroken, turned to
her online support group.
A fellow RESOLVE member told April about a company called IVF
Holiday that was arranging IVF with donor egg in the Czech Republic
at dramatically lower prices. At first, April thought traveling so far away
was a crazy idea, and she dismissed it immediately. But she kept returning
to the IVF Holiday website, reading testimonials about couples’ successful
IVF cycles. The website proffered images of smiling white babies
as well as beautiful European landscapes, claiming couples would have
“plenty of time to see exactly what you want and leave with wonderful
experiences.” One day she contacted IVF Holiday, whose owners gave
her contact information for previous clients, whom she called to speak
with about their experiences. April knew she could convince Larry to
go abroad, simply because the price would be a third of the price of an
IVF cycle at home. Also, they had always talked about traveling around
Europe. Once again, April and Larry began to be excited about the prospect
of trying to have a baby.
April sent her medical history to the IVF broker, who arranged all
their clinical appointments. Larry and April were assured they would be
picked up at the airport and taken to a small town in Moravia where the
clinic was located. They decided to stay at a pension, a small bed-andbreakfast.
April and Larry were stunned by the dramatically lower costs
of the medications they received in the mail from the Czech clinic. As
April began her medications, Larry perused travel websites, fantasizing
Introduction | 3
about trips to Prague or Vienna with thoughts of romantic castles on his
mind. They were riding on clouds of hope.
Early in June 2010, April and Larry flew to Prague, Czech Republic,
where they met another couple—Jessica and Doug—who arrived the
same day, rode with them to the eastern Czech town, and stayed in the
same small, intimate pension, where they ate breakfast together every
day for three weeks. During their stay in the Czech Republic, April and
Jessica visited the clinic together and even had their embryo transfers
the same day. The two couples shared stories of trying to get pregnant as
they explored local attractions together.
April and Larry were pleasantly surprised by the friendly owners of
the bed-and-breakfast, a small family whose kindness and generosity
were unsurpassed. They felt respected by the Czech doctors, whose
names seemed unpronounceable but who spent a lot of time answering
their questions, never rushing them. They felt like they had a navigator
in their IVF brokers, who showed they truly cared by checking on them
while they were in the Czech Republic. Everyone seemed to want April
to get pregnant.
Larry surprised April by booking a four-star hotel in Prague, directly
under the castle, as a last splurge before heading home, hoping for
pregnancy. They dined on the rooftop, serenaded by a quartet playing
Dvořák and Smetana. April felt like a queen and was optimistic. She
thought the music must be soothing to the two embryos recently transferred
into her uterus. April and Larry were sad to say good-bye to Jessica
and Doug, and the women vowed to stay in touch and keep track of
one another’s progress. They joked that maybe their roads would cross
once again if they decided to return to the Czech Republic for another
round of IVF, trying for siblings of their future babies. Sadly, April and
Larry’s cycle was not successful this time,2 although Jessica and Doug
welcomed twin boys the following spring.
Fertility Tourism?
This is the story of a North American couple I met, who, like so many
others, encountered financial barriers to accessing fertility treatment at
home. Reproductive travel, what Briggs (2010:51) has referred to as “offshore
(re)production,” has grown as one of the main forms of medical
4 | Introduction
travel due to the high cost of infertility treatment in the United States
(Spar 2006; C. Thompson 2005); the unavailability of gamete donors, as
in Germany (Bergmann 2011); strict regulatory laws, as in Italy (Zanini
2011); or a lack of general access to biomedical technologies, as in Nigeria
(Pennings 2002). Given the global scope of reproductive travel,
there is a “wide range of very different forms of regulation, bans, and
approvals as well as considerable differences in clinical practice, public
or private financing, and moral or ethical reasoning” (Knecht, Klotz,
and Beck 2012:12).
Scholars have debated the terminology of fertility tourism, referring
to it as “reproductive tourism,” “procreative tourism,” or “cross-border
reproductive care” (Gürtin and Inhorn 2011; Whittaker and Speier
2010). Franklin has called it “reproductive trafficking” (2012:34), and
many qualify the word “tourism” with quotation marks. The majority of
scholars find the term problematic, since it connotes pleasure “and thus
trivializes fertility problems” (Knoll 2012:265). Some argue that in the
case of same-sex couples or unmarried individuals the label “reproductive
exiles” is more appropriate, since they are forced to seek treatment
abroad (Matorras 2005; Inhorn and Patrizio 2009). Most assume it is
the wealthy who can afford to travel abroad for medical care, yet Elisa
Sobo and her collaborators claim that “medical travelers seeking biomedical
treatment overseas may be disproportionately representative of
the working poor” (2011:133). Admittedly, because infertile couples are
otherwise healthy, “IVF treatment can lend itself to a combination of
treatment and tourism between appointments” (Whittaker and Speier
2010:370).
I argue that since IVF Holidays are branded as vacations, the “tourism”
terminology should be retained. Knoll is in agreement when she
writes, “From my anthropological perspective, tourism is an analytic
term that captures the complexities of various kinds of peaceful movements
across borders” (2012:265) and, more specifically, that “the notion
of reproductive tourism therefore captures new forms of choice
and consumerism in health care that tend to undermine the distinction
between tourism and health care” (267). Whatever term used, it is
a phenomenon enabled by globalization and the commercialization of
reproductive medicine (Gürtin and Inhorn 2011).
Introduction | 5
The multitude of reproductive travel routes is “varied”; a recent symposium
on cross-border reproductive care includes twenty-two nations
and five continents (Gürtin and Inhorn 2011). Ironically, the United
States is a destination site because of the scant amount of regulation,
though laws do vary from state to state. California is a favorite destination
for gay couples, as well as for surrogacy—but it is largely for the
wealthy elite, with the cost of treatments estimated at $100,000. Typically,
however, destination sites of fertility travel can offer medical infrastructure
and expertise, certain regulatory frameworks, and lower wage
structures, which allow reproductive technologies to be performed at
competitive, lower costs. In addition to a sense of cultural familiarity
(which may mean a common language), patients are often seeking specific
services such as sex selection, surrogacy, or commercial ova donation
(Blyth and Farrand 2005).
Given the global scope of reproductive tourism, as well as the methodological
complexities of tracing these travel routes, data are fragmented
regarding this “patchwork of widely diverging national laws”
(Klotz and Knecht 2012:284). It is impossible to know how many people
are traveling internationally for this type of care (Nygren et al. 2010).
There are well-established “hubs” of reproductive tourism. India is
known for its surrogacy market, offering some of the most affordable
cycles at $20,000. Thailand is a hot spot for couples wanting to select the
sex of their offspring using preimplantation genetic diagnosis (PGD) on
embryos (Whittaker 2011). Other areas of the globe involved in reproductive
travel are South Africa, Mexico, and the United States.
A reported 24,000 to 30,000 cycles of IVF are performed in Europe
each year, serving 11,000 to 14,000 patients (Inhorn and Patrizio 2012).
The Czech Republic is emerging as one of the top European destinations
for reproductive travel because, unlike most countries, it offers anonymous
egg donation. Spain is the largest and oldest provider of reproductive
medicine to foreign patients, and the Czech industry largely mimics
the Spanish model in terms of regulations. However, the Czech Republic
presently has “gaps” in regulations. Bergmann has named these “two of
the main European destinations for egg donation” (2012:333).
There are 200 clinics in Spain, which attests to the fact that reproductive
travel has been an established industry for much longer than
6 | Introduction
in the Czech Republic. In addition, since 2006 Spanish clinics may
not discriminate against any person as a potential client, whereas the
43 Czech clinics will treat only married heterosexual couples. Because
the Czech Republic’s population is largely atheist, limiting treatment to
couples is related not to religious belief but rather to heteronormative
state policies.
Czech clinical websites advertise in English, German, Italian, and
Russian, promising a ready availability of student egg donors with only
a three-month waiting period. The Czech reproductive medical field is
profiting from its lower price structure and liberal legislation stipulating
that sperm and egg donation must be voluntary and anonymous. Donors
cannot be paid for their eggs but are offered attractive “compensatory
payments” of approximately 1,000 euros ($1,134) for the discomfort
involved in ovarian stimulation and oocyte retrieval. For North American
patients traveling to the Czech Republic during the time of this research,
treatment for IVF was $3,000, and for an egg donor cycle the
cost was $4,000. North Americans spend, on average, $10,000 for the
entire trip to the Czech Republic. In comparison, a round of IVF with
egg donation in the United States costs between $25,000 and $40,000.
The European reproductive medical industry oriented toward foreign
patients seems to be expanding eastward, as several Eastern European
countries have recently emerged in this global market with slight differences
in regulation. The Ukraine allows for “virtually everything,”
including surrogacy, while Bulgaria does not have legislation about
surrogacy yet (Global IVF 2012). Like the Czech Republic, Hungary restricts
clients to heterosexual couples. However, if a single woman suffers
from a medical condition like cancer that requires chemotherapy,
which will likely lead to infertility, a clinic in Hungary will allow her to
undergo IVF. Romania used to provide gamete donation for foreigners,
until the practice was outlawed in 2008 (Nahman 2013).
The global market of reproductive technologies as painted here obviously
offers a vast array of choices for patients aiming to create a family
using reproductive technologies. As North Americans are shopping the
globe for different destination countries, they are acting as consumers
with respect to their health care. One objective of this book is to trace
North American quests for parenthood along this global care route to
the Czech Republic.
Introduction | 7
Most assume that this phenomenon of reproductive travel needs no
further explanation beyond cost-effectiveness. However, as consumers,
North Americans do not decide to travel abroad only for lower
prices: indeed, the Czech Republic does not offer the lowest prices in
the market. Thus, much more needs to be understood about this recent
phenomenon because it reveals the complex interplay between global
neoliberal shifts in health care and individual experiences of reproductive
travel. The existence of the global care chain between North America
and the Czech Republic can be credited to two entrepreneurial Czech
women, Hana and Petra, both of whom married American men and
subsequently suffered infertility. Both transnational couples had been
“return reproductive travelers” (Inhorn 2011) to their Moravian hometowns
in the Czech Republic, where they had access to state-funded
assisted reproductive technologies (ARTs). After receiving treatment,
each woman created an IVF broker agency, hoping to help other North
Americans unable to afford treatment in the United States. These fertility
brokers, who began offering “fertility holidays” in 2006, are important
new actors at the center of reproductive travel.
Websites of IVF brokers must be considered “political economies of
hope” (Rose and Novas 2005). Political economies of hope, which are
propelled by organizations of infertile patients, extend the “hope” already
embedded in reproductive technologies (Franklin 1997a). Brokers
lure North Americans who desperately want a baby with the promise of
white donors, a European vacation, and top-notch health care. Roughly
two-thirds of the twenty-nine couples I met in the Czech Republic were
pursuing IVF with an egg donor, rather than IVF with their own eggs.
In addition, North Americans are seeking a European vacation alongside
excellent health care. Doctors who care are painfully lacking in the
United States’ profit-hungry “baby business” (Spar 2006). Couples who
choose to follow the path of reproductive travel make decisions based on
complex notions of kinship, health care, and what constitutes a vacation.
However, hope is the underlying basis of all of these factors.
Typically, North Americans traveling to the Czech Republic for in
vitro fertilization are seeking gamete donation that will assure a biological
connection with one parent and at least a physical resemblance to
the other parent. We can distinguish these couples from those seeking
children through international adoption from a country with children
8 | Introduction
of markedly different ethnicity (Jacobson 2008). North Americans traveling
to the Czech Republic are almost always seeking “white” babies
from Czech egg or sperm donors (see also Kahn 2000:132; Nahman
2008). In using the term “white” I am referring to the dominant sociocultural
logic of U.S. race and color lines. North Americans use the term
“white” as if there is one variant of “white” (Rothman 2005:79). Racial
categories label sets of physical characteristics that we can locate on the
body (Rothman 2005:90). Notions of white have often been tied to ideas
of purity, but in these cases whiteness is also tied closely to notions of
relatedness.
This desire for “white” babies reflects an “appeal of European heritage”
(Nash 2003:184). Scholars of international adoption to Russia and
Eastern Europe have written about the ways that North Americans
assume they can forge a deeper kinship connection through “sharing
whiteness with a child” (Jacobson 2008:42). Jacobson further elaborates
that whiteness is often assumed to be stable and passed through bloodlines
(2008:63). North Americans traveling to the Czech Republic are
trying to ensure racial stability for their families.
A Global Marketplace of Health Care
A global reproductive tourism industry indicates shifts in global policies
of health care. Whittaker bears witness to “neoliberal readjustments
of societies across the world to meet the demands of economic globalization”
(2008:273). Countries across the globe have been shifting away
from nationalized systems whereby the government assumes responsibility
in providing universal health care to all citizens. Transitioning
toward neoliberal health care models is often touted for its efficiency.
The way patients make the decision to travel abroad for health care
reflects a strengthening of the global, neoliberal model of consumer
health care. In this model, patients essentially become consumers
“choosing” from various possible treatment options. As consumers
believe themselves to be free actors, they are simply choosing from various
possible menu items. Responsibility has fallen on them as ostensibly
free actors in a global medical marketplace.
As I traced North American fertility journeys halfway around the
globe, I uncovered layers of contradiction embedded in global repro-
Introduction | 9
ductive medicine. Scholars have already shown how reproductive technologies
are “hope” technologies (Franklin 1997a) that both empower
women, by offering new opportunities to try to have a baby, and disempower
them, by pressuring women to continuously subject their bodies
to these medical technologies with no end point in sight.
Medical anthropologists have often examined the power inherent in
biomedicine, and feminist scholars note further the power embedded
in reproductive medicine (Martin 1989; Rapp 2000; Davis-Floyd 2003).
Many anthropologists have written about medicalization as disempowering
to women, in that it assumes management over their bodies (Martin
1989; Turiel 1998). Even further, Sandelowski (1991) has written of
how the promises of reproductive technologies often “compel” women
to keep trying. However, even though reproductive medicine may in fact
disempower some women, Sundby (2002) has insisted on the recognition
of the empowering nature of reproductive technologies. Though
these technologies tend to be distributed unevenly, they do offer couples
a chance to conceive. Feminist theory has often failed to consider the
actual experiences of women suffering infertility (Sandelowski 1990).
This book explores the extent to which reproductive technologies remain
complicated and even more ambiguous in a foreign setting.
This book focuses on the multiple contradictions that occur as reproductive
travelers embrace an ideological vision of vacation proposed by
brokers. These contradictions, largely embedded in the term “IVF holiday,”
point to the tensions and disjunctures of a global marketplace for
health care. As consumers, these patients must make difficult decisions
regarding their health, and medical tourism brokers have packaged fertility
holidays to aid in their decision making. This volume argues that
reproductive travel exacerbates the hope embedded in reproductive
technologies, especially when they are marketed as holidays. It frames
reproductive travel as a form of consumption motivated by complex layers
of desire for white babies, a European vacation, better health care,
and technological success. Each of these desires is further mired within
its own contradictions. The volume demonstrates that reproductive
tourists must be diligent consumers within a global neoliberal market of
health care that perpetuates stratified reproduction.
10 | Introduction
Methods
I first heard of IVF Holiday in 2008, when a friend sent me a link to the
company’s website. I consider my initial foray into the world of reproductive
travel somewhat akin to how most North Americans learn about
it: through Google searches and word of mouth. This research is based
on a multisited project conducted in North America and the Czech
Republic between 2010 and 2012. It is the first in-depth ethnographic
study of North American reproductive travel to the Czech Republic
from the consumer’s point of view. I gathered data through participant
observation, surveys, focus groups, and interviews with the three primary
social actors involved in the reproductive travel industry: North
American reproductive travelers, Czech reproductive medicine providers,
and brokers. Ethnographic research at two reproductive clinics in
the Czech Republic, as well as with patient tourists after they returned
from their travels, provides insight into their complex behaviors, motivations,
and experiences of reproductive travel.
Anthropologists have discussed the logistical, ethical, and technical
difficulties of gaining access to infertile couples, especially those who
travel abroad seeking services (Inhorn 2004; Whittaker and Speier
2010). The anthropologist must rely on various intermediaries, depending
on the circumstances. The two main brokers for the Czech Republic,
IVF Holiday and IVF Choices, put me in contact with Czech clinics as
well as former clients. Both brokers sent out a survey to past clients who
had already traveled to the Czech Republic, which garnered thirty respondents.
Many of these respondents agreed to a follow-up interview
that took place during the fall of 2010.
During the summers of 2010 and 2011, I conducted participant observation
at two Moravian clinics, as well as at sites of lodging for North
Americans (see figure I.1). I also interviewed Czech coordinators and
doctors and North American patient-travelers. The town of Zlín (pronounced
Zleen) is small, with a population of 80,000, offering one or
two family-owned accommodations, whereas Brno (pronounced BIRno),
the second-largest city in the Czech Republic, provides couples with
various options, ranging from four-star hotels to apartment-like studios.
North Americans in Brno are much more isolated from one another, un-
Introduction | 11
like couples in Zlín, who often seek the comfort of other North Americans
while abroad.
I conducted a total of thirty preliminary surveys with former reproductive
travelers and fifty interviews: twenty-nine with reproductive
travelers (seventeen with women only, eleven with couples together, and
one with a man only), ten with fertility brokers, and eleven with Czech
clinic personnel. Because infertility is often considered a woman’s problem,
and reproductive technologies are played out on women’s bodies, it
was primarily women who were the more vocal informants. Sometimes
I interviewed only the woman, or, if I interviewed the couple together,
the woman usually had more to say. I interviewed only one husband and
wife separately. From December 2011 to September 2012, I traveled to
Canada and thirteen different states within the United States to follow
up with patients I had met in the Czech Republic. I conducted a total
of nineteen follow-up life history interviews with North American patients
and brokers. In total, I met twenty-nine couples. My informants
have made fifty-one total trips to the Czech Republic, and twenty-eight
children have been born.3
Figure I.1. The favorite pension.
12 | Introduction
Overwhelmingly, couples were very positive and willing to speak to
me. They were happy to have another American to speak English with,
particularly one who asked about their struggles. In the Czech Republic,
I conducted interviews outside the North American–favored pension,
in cafés and restaurants, in my room or their room, in the main lobby,
at the local mall, or at the clinic (see figures I.2 and I.3). I shared many
meals with American couples: breakfasts in the lobby of the pension or
outside if the weather permitted and dinners at local favorite restaurants.
I went to the town center, the local museum, the observation tower, and
even the zoo, joining couples on their small excursions around town.
During my final phase of research in North America, I met some
couples at their favorite local restaurants in their hometowns, while others
invited me into their homes. I shared cappuccinos or Little Caesar’s
pizza and sweet tea with them. I maintain electronic communication
with most, through either social media or e-mail. They keep me updated
with news of their burgeoning families. Of course, I was not able to follow
up with every couple that I met. Often those who suffer the pain of
a failed cycle retreat to heal. As Throsby has shown in her study of failed
cycles, “Those whose treatment fails literally drop out of the sight of the
treatment providers” (2004:7).
Figure I.2 The clinic waiting room.
Introduction | 13
Fertility Vacationers
Those traveling to the Czech Republic for fertility treatment are predominantly
white, lower-class to middle-class North Americans. Two
Canadian women are included in this research because gamete donors
cannot be paid in Canada (which makes it difficult for those who need
an egg donor to find one). Canadians who can afford treatment in the
United States will generally travel south for treatment. However, those
who cannot afford treatment in the United States will also travel to the
Czech Republic. I encountered women whose husbands worked three
jobs to provide for the entire family, working-class couples, and uppermiddle-class
couples and women. The majority of reproductive travelers
I met were from the lower middle class.4 The reproductive traveler is
careful with her “fertility dollar,” a savvy consumer.
Typically, North American reproductive travelers are in their late thirties
or early forties, since the majority need IVF with an egg donor. Of
thirty survey respondents, the average age was 40.3, with ages ranging
from 27 to 53. They are from all over North America, including Florida,
Georgia, South Carolina, Tennessee, Indiana, Illinois, Nebraska, WisFigure
I.3 The operating room of the clinic.
14 | Introduction
consin, Minnesota, California, Washington, and Texas. My respondents
are mainly white, although I did interview one Puerto Rican couple and
one African American couple. The majority of travelers are experienced
in the world of ARTs, having undergone several IUIs in the United
States, often with the help of fertility drugs. They may have even tried
one or more IVF cycles before reaching the limits of their budget. North
American reproductive tourists are relatively well traveled, although
several were venturing abroad for the first time.
Tracing Fertility Journeys
This book traces North American fertility journeys, which can be considered
a form of biological citizenship (Rose and Novas 2005). Rose
claims that “conceptions of ‘biological citizenship’ have taken shape that
recode the duties, rights, and expectations of human beings in relation
to their sickness, and also to their life itself, reorganize the relations
between individuals and their biomedical authorities, and reshape the
ways in which human beings relate to themselves as ‘somatic individuals’”
(2007:6). Petryna, who uses the label “biological citizenship” to
capture collective and individual social practices of Ukrainians demanding
social welfare within a democratizing, post-Soviet post-Chernobyl
nation-state, considers the complex ways citizens “use biology, scientific
knowledge and suffering to have access to cultural resources” under
harsh market transitions (2003:3). Rose builds on this by noting that
biological citizenship can take many forms (2007:25). One form is the
patient support networks that develop online and abroad. While North
Americans are not undergoing a harsh transition to a market economy,
nor are they demanding social welfare; they are assuming responsibility
for managing their own bodies and also assuming risk when they venture
abroad for treatment.
The book’s first chapter introduces North Americans who have been
diagnosed with infertility and describes their reactions and the culturally
meaningful ways they respond. Often, their responses are contradictory.
There are particular stages of treatment using reproductive
technologies, and this chapter traces these patients’ movement through
the “baby business” in the United States (Spar 2006). Ultimately, the
Introduction | 15
chapter ends with their alienation and disillusionment with overpriced
treatment options.
Chapter 2 follows North Americans who turn to various forms of
social media as a way of learning about possible routes toward parenthood.
It is on the Internet that they learn of reproductive travel to the
Czech Republic and become diligent consumers conducting research.
This chapter follows female patients as they enter virtual biosocial communities
where they join online gendered support groups and engage
in biomedical global citizenship. With the North American patients, we
encounter IVF brokers who are packaging fertility holidays that promise
a stress-free IVF cycle in a relaxing European setting. The marketing
of fertility holidays online speaks to North American hopes, both for a
child who resembles them and for the liberating aspects of travel (Löfgren
1999).
In chapter 3 we witness the global encounters between North American
patients and Czech doctors. The chapter uncovers the shifting role
of the Czech clinics as they provide patient-centered care. I frame the
entire industry as a global care route and trace global technologies, finance,
images, and people enmeshed in “intimate labor” (Boris and Parreñas
2010). Czech fertility clinics are global checkout lanes for North
American global biocitizens opting to purchase IVF with egg donation.
Yet the economic nature of these transactions is minimized by affective
discourse.
The book continues in chapter 4 with a consideration of the social
kinship bonds that are created and sustained at the local pension. At
the same time, I deconstruct the fundamental contradictions embedded
within “fertility holidays.” Women internalize the pressure to “relax”
and treat their trip as a vacation in the hope of ensuring a successful
pregnancy.
Finally, chapter 5 follows North Americans as they return home, with
or without a successful pregnancy. It traces the new difficulties many
have with complicated pregnancies and raising multiples, and the sorrow
of those who are not successful. It continues with an analysis of
social kinship as it is sustained by women’s kin work via social media (di
Leonardo 1987; Pande 2015). Essentially, social kinship networks of families
with children born of egg donation in the Czech Republic continue
