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Reproduction reclaimed

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Title:
Reproduction reclaimed the medicalization of infertility in United States History, 1850-1981
Alternate title:
Medicalization of infertility in United States History, 1850-1981
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McNaughton, Jessica ( author )
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English
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1 electronic file (111 pages) : ;

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Subjects / Keywords:
Artificial insemination, Human -- United States ( lcsh )
Artificial insemination, Human -- Moral and ethical aspects ( lcsh )
Fertilization in vitro, Human -- Moral and ethical aspects -- United States ( lcsh )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Review:
The birth of the first American “test-tube” baby on December 28, 1981 was a watershed moment in medical history and marked the zenith of over one hundred years of work by physicians and scientists. These medical professionals had dedicated their careers to assisting infertile couples by “curing” their childlessness and made in vitro fertilization a reality. While medical intervention into conception has become commonplace in American society today, due to widespread media coverage, many questions still remain regarding the process that this nation underwent to view infertility as a “disease” and the avenues that have been explored to provide “cures.” What was the role of the medical community in shaping understandings of reproduction and infertility in the nineteenth and twentieth centuries? What types of medical interventions and technologies did doctors create and to what ends? What were the societal perceptions of medical interventions for infertility in the nineteenth and twentieth centuries? These questions have driven this investigation and granted much insight into the process of the medicalization of infertility and the role that reproduction played in family formation and gender expectations. ( , )
Review:
The secondary scholarship as well as a wide-array of primary sources has revealed that over the course of the last one hundred years, doctors and scientists have developed new techniques and new technologies to “cure” the “disease” of infertility. Infertile couples sought doctor’s assistance and women often underwent invasive treatments in hopes of becoming pregnant. Through the efforts of the medical community, more and more couples were able to achieve pregnancy but the work of infertility specialists aroused concerns regarding the moral, legal, and ethical consequences of medical intervention in infertility. The arguments for and against medical intervention in cases of infertility shed light on the role of reproduction in forming and maintaining family ideals and gender expectations. Ultimately, the medicalization of infertility has been marked by a distinct desire by medical practitioners to “treat” infertility through the development of technologies, which has challenged the traditional understandings of parenthood and gender roles and established the endurance of the perceived necessity of a nuclear family in American culture.
Thesis:
Thesis (M.A.) - University of Colorado Denver.
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Includes bibliographic information
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Department of History
Statement of Responsibility:
by Jessica McNaughton.

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|University of Colorado Denver
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|Auraria Library
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ocn944963373
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REPRODUCTION RECLAIMED:
THE MEDICALIZATION OF INFERILITY IN UNITED STATES HISTORY, 1850-1981
By
JESSICA MCNAUGHTON
B.A., Colorado State University, 2008
A thesis submitted to the
Faculty of the Graduate School of the
University of Colorado in partial fulfillment
of the requirements for the degree of
Master of Arts
History Program
2015


This thesis for the Master of Arts degree by
Jessica McNaughton
has been approved for the
History Program
by
Maijorie Levine-Clark, Chair
Rebecca Hunt
William Wagner


McNaughton, Jessica (M.A., History)
Reproduction Reclaimed: The Medicalization of Infertility in United States History, 1850-1981
Thesis directed by Associate Professor Maijorie Levine-Clark
ABSTRACT
The birth of the first American test-tube baby on December 28, 1981 was a watershed
moment in medical history and marked the zenith of over one hundred years of work by
physicians and scientists. These medical professionals had dedicated their careers to assisting
infertile couples by curing their childlessness and made in vitro fertilization a reality. While
medical intervention into conception has become commonplace in American society today, due to
widespread media coverage, many questions still remain regarding the process that this nation
underwent to view infertility as a disease and the avenues that have been explored to provide
cures. What was the role of the medical community in shaping understandings of reproduction
and infertility in the nineteenth and twentieth centuries? What types of medical interventions and
technologies did doctors create and to what ends? What were the societal perceptions of medical
interventions for infertility in the nineteenth and twentieth centuries? These questions have driven
this investigation and granted much insight into the process of the medicalization of infertility and
the role that reproduction played in family formation and gender expectations.
The secondary scholarship as well as a wide-array of primary sources has revealed that
over the course of the last one hundred years, doctors and scientists have developed new
techniques and new technologies to cure the disease of infertility. Infertile couples sought
doctors assistance and women often underwent invasive treatments in hopes of becoming
pregnant. Through the efforts of the medical community, more and more couples were able to
achieve pregnancy but the work of infertility specialists aroused concerns regarding the moral,
legal, and ethical consequences of medical intervention in infertility. The arguments for and
against medical intervention in cases of infertility shed light on the role of reproduction in
forming and maintaining family ideals and gender expectations. Ultimately, the medicalization of


IV
infertility has been marked by a distinct desire by medical practitioners to treat infertility
through the development of technologies, which has challenged the traditional understandings of
parenthood and gender roles and established the endurance of the perceived necessity of a nuclear
family in American culture.
The form and content of this abstract are approved. I recommend its publication.
Approved: Maijorie Levine-Clark


V
DEDICATION
I dedicate this work to my family, without their love and support this accomplishment
would not have been possible. To my mom and dad, thank you for your countless hours of
babysitting help and for always being there to guide me with encouraging words when I was
feeling overwhelmed. You have always been my cheerleaders and I am thankful to have been
blessed with such a strong family. To my amazing husband Chris, you are my rock and I cannot
imagine tackling this task without you by my side. You are cool and calm and provide me with
endless support. You love me completely and make me feel like I can do anything. You have
sacrificed so much of your own time and energy to help me get to this point. I am humbled by
your devotion and selflessness. Thank you for putting up with me and pushing me to be my best.
And finally, I dedicate this work to my daughter Harper Lu, who without the intervention of
infertility specialists would not be a part of my world. You are my sunshine, my heart, and my
soul. Thank you for your giggles, snuggles, and vocal renditions which have brightened my days
and made this process so much easier. I love you more than you will ever know.


VI
ACKNOWELDGEMENTS
I would like to recognize the contributions of my professors throughout the course of my
time at the University of Colorado at Denver. I have had the opportunity to learn and grow
through the efforts of many astonishing historians. Thank you to my thesis committee, Maijorie
Levine-Clark, Rebecca Hunt, and Bill Wagner, for your time and feedback. Thank you to Chris
Agee for serving as my major field advisor and guiding me through the depths of comprehensive
exams. And finally, special thanks to Maijorie Levine-Clark for all of your support over the past
few years and for igniting my own passion for gender history.


vii
TABLE OF CONTENTS
CHAPTER
I. INTRODUCTION.................................................. 1
II. MARITAL ADVICE, SURGICAL INTERVENTION, AND
EARLY ARTIFICIAL INSEMINATION
EXPERIMENTATION, 1850-1918.................................... 10
Sterility Treatment through Medical Marriage Advice........... 14
Dr. J. Marion Sims and Artificial Fructification.............. 26
Conclusion.................................................... 39
III. REPRODUCTIVE ENDOCRINOLOGY AND THE ARTIFICIAL
INSEMINATION DEBATE, 1918-1934................................41
Clinical Research and the Birth of Reproductive Endocrinology.44
Artificial Insemination Advocates.............................55
Artificial Insemination Opponents............................. 63
Conclusion.....................................................70
IV. IN VITRO FERTILIZATION IN HUMANS, 1934-1981................... 73
Gregory Pincus and the In Vitro Fertilization of Rabbits.......77
The Rock-Menkin Extra-Uterine Human Embryo Trials..............82
The Births of the First Human Test-Tube Babies.................85
Conclusion.....................................................95
V. CONCLUSION: FIVE MILLION BABIES LATER -
THE UNITED STATES AFTER IVI ...................................97
BIBLIOGRAPHY
100


LIST OF FIGURES
FIGURE
2.1 Instrument used by Dr. J. Marion Sims for artificial insemination........ 13
2.2 Image of Dr. Edward Bliss Foote...........................................21
2.3 Dr. Edward Bliss Footes depictions of local inadaptation...............23
2.4 Dr. Edward Bliss Footes depictions of healthy versus sickly
and inanimate spermatozoa................................................25
2.5 Dr. J. Marion Simss vaginal speculum.....................................28
2.6 Dr. J. Marion Simss sketch of a proper uterine examination
by sight and touch....................................................... 30
2.7 Dr. J. Marion Simss depictions of spermatozoa in various forms...........34
2.8 Dr. J. Marion Simss images of a cervix and uterus before and after
the use of a sponge tent for cervical dilation...........................35
2.9 Dr. J. Marion Simss curette and ecraseur tools..........................37
3.1 Dr. Samuel Meakers depiction of the gradations of fertility.............49
3.2 Dr. Samuel Meakers Positive Data in Endocrinologic Relationships........50
3.3 Data collected and published by Dr. Samuel Meaker regarding
the outcomes of his patients sterility treatments....................... 52
3.4 Image of the Lauricella twins who were conceived using
artificial insemination, 1934............................................ 56
3.5 Illustration depicting the possible outcomes of artificial insemination
by donor published, 1934................................................. 68
4.1 Dr. Gregory Pincus and his fatherless rabbit...........................81
4.2 Life Magazine poll regarding new methods of human reproduction............90


1
CHAPTERI
INTRODUCTION
NORFOLK, Va. (AP) Elizabeth Jordan Carr yawned and kicked off a sock at her public
debut Thursday, as the parents of Americas first test-tube baby said they looked forward
to the day when their daughter would be just one of a crowd. In her pink dress, brown-
haired, hazel-eyed Elizabeth snuggled in her mothers arms, lulled into drowsiness by the
clicking of cameras that were kept 15 feet sneeze distance away. Smile, said her
father Roger Carr. But Elizabeth settled for a yawn, waving her hands and kicking off a
sock for the audience at Norfolk General Hospital, where she was bom Monday. Isnt
she beautiful? the father said. Elizabeth, the result of sciences ability to fertilize a
human egg outside of a mothers body, is a normal healthy child, according to
pediatrician, Dr. Frederick Wirth...1
Daily Herald Suburban Chicago, January 1, 1982.
The birth of Elizabeth Carr on December 28, 1981 was a long-awaited blessing to her
parents, Roger and Judith Carr, who had battled infertility for numerous years. After several
miscarriages and invasive surgeries on Mrs. Carrs fallopian tubes the couple decided to
participate in the experimental new procedure known as in vitro fertilization or IVF.2 The couple
sought the help of infertility specialists Doctors Howard and Georgeanna Jones and after many
months of hormone treatments and operations, the couple defied the odds and Mrs. Carr became
pregnant.3 The eventual birth of their miracle baby was not just a monumental event for the
Carr family but a watershed moment for the entire medical community. The first test-tube baby
in the United States marked the apex of over one hundred years of work by physicians and
scientists dedicated to assisting infertile couples by curing their childlessness.
Even though medical intervention into conception has become commonplace in
American society due to widespread media coverage of successful treatments over the past
several decades, many questions still remain regarding the process that people in the United
1 Attention Bores Test-Tube Baby, Daily Herald Suburban Chicago, January 1, 1982.
2 Daily Herald Suburban Chicago, January 1, 1982.
3 Daily Herald Suburban Chicago, January 1, 1982.


2
States underwent to view infertility as a disease and the avenues that have been explored to
provide cures and treatments to assist infertile couples to get pregnant. Particularly, what
was the role of the medical community in shaping understandings of reproduction and infertility
in the nineteenth and twentieth centuries? What types of medical interventions did doctors create
and to what ends? How did the medicalization of infertility evolve and change over time and
why? What were the societal perceptions of medical interventions for infertility in the nineteenth
and twentieth centuries?
The scholarship on the history of childlessness has been fairly limited but the works that
have been created are exceptional and provide an essential foundation for an investigation into the
medicalization of infertility. The works established by Paul Starr, Margaret Marsh, and Wanda
Ronner explore the rise of the medical profession and the role of the medical community in
treating childlessness over time as well the experiences of couples facing infertility and
accompanying societal perceptions. The publications produced by these scholars, as well as a
wide-array of primary sources, are used to assess the medicalization of infertility and provide the
framework for how childlessness has been diagnosed and treated as a disease from 1850-1981 in
the United States.
Paul Starrs The Social Transformation of American Medicine: The Rise of a Sovereign
Profession and the Making of a Vast Industry provided the context necessary to understand the
prestige and respect enjoyed by physicians beginning in the mid-1800s. He argues that medical
professionals benefitted from the market revolution in the latter half of the nineteenth century and
were able to expand markets and increase services.4 Starr determines that the expansion of
medical services allowed doctors to enjoy an unprecedented amount of cultural authority over
the general public.5 Many medical men enjoyed the new prestige associated with their position.
4 Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign
Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 77.
5 Starr, The Social Transformation of American Medicine, 3.


3
During this same time period, a sector of doctors broke from the rest to focus on womens health
concerns. These medical men claimed power over the female form and continued to invade the
birthing room, a place which had traditionally been the domain of only women.6 Numerous
historians including Judith Walter Leavitt and Richard Wertz have analyzed the impact of the
medicalization of childbirth in America, but few historians have commented on the impact of the
rise of the medical profession on the treatment of infertility. Starrs work as well as the works of
Leavitt and Wertz provides insight into why the medicalization shift occurred in the mid-1800s
and how the medicalization of childbirth mimicked the medicalization of childlessness.
In The Empty Cradle: Infertility in America from Colonial Times to the Present, Margaret
Marsh and Wanda Ronner provide the most complete analysis of infertility over time and explore
the controversial history of childlessness while placing emphasis on the medicalization of the
condition. They examine the experiences of infertile couples from the colonial era onward and
outline the sharp differences between colonial barrenness and nineteenth century sterility.
They assert that colonial women generally viewed their failure to procreate as the will of God and
in such sought spiritual guidance and in some cases the skills of midwives.7 There was no
prescribed treatment for the condition and it was not viewed as a disease, rather a womans
salvation was the key to ridding her of her childlessness.8 By the late nineteenth century, women
more frequently sought the assistance of doctors to diagnose and treat their involuntary
childlessness through questionable surgeries or prescribed tonics.9 The effectiveness of such
treatments was limited at best but illustrated a clear shift from spirituality to medicalization as the
6 Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750-1950 (Oxford: Oxford
University Press, 1986), 4.
7 Margaret Marsh and Wanda Ronner, The Empty Cradle: Infertility in America from Colonial
Times to the Present (Baltimore: John Hopkins University Press, 1996), 3.
8 Marsh and Ronner, The Empty Cradle, 40.
9 Marsh and Ronner, The Empty Cradle, 2.


4
means for dealing with infertility.10 The Empty Cradle not only provides an important
understanding of the experience of infertility prior to its medicalization, it also outlines and
analyzes the progression of the medicalization of the condition which will be used as a
springboard for this investigation. While Marsh and Ronner provide the most comprehensive
account of childlessness in America, works from historians such as Elaine Tyler May, Wendy
Kline, Rickie Solinger, and Rima Apple among others who focus on reproduction and families,
will also be used throughout this examination to provide a more thorough context to understand
the social framework of the medicalization of infertility.11
To understand both the medical viewpoint as well as the societal perspective of the
treatment of infertility from 1850-1981 I have called upon a wide-array of primary sources. To
investigate medical practitioners methods and motivations in diagnosis and treatments I have
surveyed their medical correspondences, journal articles, books, and personal records. These
sources reveal a true desire among these men (and occasionally women) to assist couples facing
infertility by helping them to fulfill their perceived innate desires for parenthood. However, these
sources also expose that a leading motivation for these doctors was not just to help the couple but
to assist society by ensuring that only the worthy reproduced so that the integrity of the
American family was protected by medical professionals. To examine the societal perspective of
the medicalization of infertility I have analyzed doctors communications, newspaper articles,
medical publications, magazine articles, popular novels, as well as religious correspondences.
These sources divulge an interesting dichotomy of perspectives regarding medical intervention
into conception. Many seem to be intrigued by the advancements in technology and the
10 Marsh and Ronner, The Empty Cradle, 40.
11 Elaine Tyler May, Barren in the Promised Land: Childless Americans and the Pursuit of
Happiness (Cambridge: Harvard University Press, 1995). Wendy Kline, Building a Better Race:
Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (Berkley:
University of California Press, 2011). Rickie Solinger, Reproductive Politics: What Everyone
Needs to Know (Oxford: Oxford University Press, 2013). Rima D. Apple. Mothers &
Motherhood: Readings in American History (Columbus: Ohio State University Press, 1997).


5
possibilities they could produce, but others are quite hesitant and concerned with the
repercussions that may arise. The medical as well as societal sources provide the timeline for this
argument as well as the basis for how my analysis is divided.
I have broken this examination into three separate time periods covering the distinct
turning points in the medicalization of infertility in America. Chapter II of this analysis covers the
years 1850-1918 and follows the onset of the medicalization of infertility through the early years
of artificial insemination experimentation. This chapter reveals that the medicalization of
infertility was first marked by the belief among doctors that sterility was a disease and it could
be cured through marital education on reproduction and by surgical intervention. These doctors
acknowledged that men could also be to blame for sterility but focused their efforts on the
female form and subjected women to invasive operations which were often ineffective in terms of
leading to pregnancy. These doctors also used rudimentary forms of artificial insemination (the
injection of sperm into the vagina), in an attempt to cure sterility. They provided little follow-
up with their patients and assumed their procedures worked even if they had no evidence of a
patient becoming pregnant. Regardless of their minimal success in curing sterile women,
couples still regularly sought their service which speaks volumes to the desire among the infertile
to add a child to their family. These medical men believed that women had an innate desire for
motherhood and that their feminine identity rested in their ability to reproduce. They used the
cultural construct of inherent motherhood to justify their diagnosis of disease and developed
various medical technologies to treat their patients.
Chapter III identifies a clear shift in technological capabilities among infertility
physicians as well as a dramatic increase in public awareness of medical intervention in the
procreative process. From 1918-1934, the term medical men gave way to doctors of obstetrics
and gynecology (OBGYNs) and the term sterile turned to infertile.12 The OBGYNs of the
12 Marsh and Ronner, The Empty Cradle, 141.


6
first half of the twentieth century explored new avenues to treat their infertile patients which
included less invasive surgical approaches, reproductive endocrinology, and improved methods of
artificial insemination. They used clinical research methods to investigate the role of hormones in
conception and applied their findings to their attempts at artificial insemination. While their
predecessors viewed the uterus as an independent organ functioning in isolation from much of the
rest of the body, the OBGYNs of the early twentieth century viewed the body in its entirety and
used hormones to understand the connections within the body that could lead to infertility. While
they benefitted from improvements in technology, doctors of this era also faced much more
public scrutiny. Media coverage of births from the use artificial insemination prompted a cautious
response from the general public. Many shared concerns regarding the consequences of such a
practice and questions of legality and legitimacy aroused suspicion.13 Newspaper articles as well
as legal documents demonstrated the anxieties felt by the public in regard to the impact of
assisted reproduction on the Americans family, specifically the role of the father if his lineage
could not be established. While there was heavy criticism, these doctors also practiced at the
height of the eugenics movement in the United States and enjoyed significant support from those
who argued artificial insemination could create a superior race.14
Chapter IV marks another significant turning point in the progression of the
medicalization of infertility in the United States by focusing on the work of physicians in
achieving extra-uterine conception. Starting in 1934, infertility specialists began experimenting
with the fertilization of eggs outside of the natural womb. Successful in vitro fertilization (IVF) of
rabbits led to experimentation in humans which prompted a volatile response from the public.
The Catholic Church staunchly condemned medical intervention into reproduction and the
13 Test Tube Birth is Explained: Dr. Morris Fishbein, Editor of the Journal of the American
Medical Association."' Syracuse Herald, May 7, 1934.
14 Test Tube Twins Bom to Mother in New York: Announcement Reveals 13 Other Laboratory
Children Living; Method Becoming Scientifically Popular. The El Paso Gazette, April 30, 1934.


7
general public continued to question the legal and moral repercussions of such a technique. The
Catholic Church was not the only opponent of IVF: countless newspaper articles and popular
magazines covered the topic from an uneasy perspective. Surveys of the general public exposed
genuine concerns over the impact of IVF on the American family and questioned whether the
process would forever alter gender roles within the family and ultimately destroy the iconic image
of the nuclear family structure.15 Regardless of the backlash physicians endured for their new
treatments, they continued their efforts and the first American IVF human baby was bom in
1981,16 Her birth marked a pivotal moment for the medical community as the process of
conception was completely removed from the problematic human form and done within a
laboratory.
While investigating the evolution of the medicalization of infertility in United States
history interesting continuities of basic cultural paradigms have emerged. A constant theme
throughout the work is that of inevitable motherhood, or the relentless desire of women to achieve
motherhood as fulfillment of their feminine identity. While the sources revealed an overwhelming
desire among women to sacrifice physically as well as emotionally to achieve pregnancy, that
was not necessarily the case for all women over time. Womens increased presence in the
workplace as well as demands for political enfranchisement and social equality all altered
perceived desires for motherhood. In the wake of the second-wave of feminism many American
women even began to question their predestined role of mother. They lashed back at traditional
family structures as well as assisted reproductive technologies in an attempt to identify
themselves as something other than mom. Even though women have questioned the role of
mother over time, the sources surveyed in this work revealed that women seeking infertility
treatments desired motherhood and saw it as essential component in their identity formation.
15 Louis Harris, The Life Poll: Brave New World With Reservations. Life Magazine, June 13,
1969, 52-55.
16 Daily Herald Suburban Chicago, January 1, 1982.


8
The ideal of family in America also proves to be a strong undercurrent driving the
progression of medical intervention into childlessness. The nuclear family (a pair of adults and
their children) has been viewed as the ideal throughout much of United States and global history.
This strict understanding of family with wife, husband, and children has shaped gender roles and
gender expectations while determining dominance and submissiveness within the home as well as
society. Traditionally, this model of the nuclear family asserted that the husband was the
dominant figure at the head of the household while the wife was the submissive nurturer. This
fixed image of family has been challenged over time by such as things as women entering the
workforce, single moms/dads, or the assurance of equality through legislation. The medicalization
of infertility aroused an intense response from critics who argued it disrupted the idyllic model of
the nuclear family and confused gender expectations within the family unit. Regardless of the
many changes within American families over the years, the static notion of the perfect nuclear
family maintained its supremacy as the accepted cultural paradigm and shaped arguments for and
against medical intervention for childlessness even as the American family itself has evolved.
The medicalization of infertility in the United States began in the mid-1800s alongside
the rise of the medical profession. Over the course of the last one hundred years, doctors and
scientists motivated by the cultural expectations that all women wanted to become mothers
developed new techniques and new technologies to cure the disease of infertility. Infertile
couples sought their assistance and women often underwent invasive treatments in hopes of
becoming pregnant. Through the efforts of the medical community, more and more couples were
able to achieve pregnancy but the work of infertility specialists aroused concerns regarding the
moral, legal, and ethical consequences of medical intervention in infertility. The arguments made
by opponents and proponents of assisted reproductive technologies provided interesting insight
into the role of reproduction in forming and maintaining family ideals and gender expectations.
Ultimately, the medicalization of infertility has been marked by a distinct desire by medical
practitioners to treat infertility through the development of assisted reproductive technologies,


9
which has challenged the traditional understandings of parenthood and gender roles and
established the endurance of the perceived necessity of a nuclear family in American culture.


10
CHAPTER II
MARITAL ADVICE, SURGICAL INTERVENTION, AND EARLY ARTIFICIAL
INSEMINATION EXPERIMENTATION, 1850-1918
... Suffice it to say that I have seen conception follow this artificial fructification once,
and only once. The case is of sufficient importance to give it in detail. My patient was
twenty-eight years old; had been married nine years without issue; and had had more or
less dysmenorrhea all her menstrual life. It was often attended with great constitutional
disturbance, such as nausea, vomiting, and sick headache. She had retroversion, with
hypertrophy of the posterior wall, an indurated conical cervix, a contracted canal.. .the
vagina never retained the semen. I examined this case several times very soon after
sexual intercourse, and I never found a drop of semen in the vagina, although it was
placed there with great abundance...
... In this particular case, about four drops of semen were taken up; the instrument was
cautiously carried into the canal of the cervix, till the point was in close contact.. .then the
piston-rod was slowly turned half a revolution, which as slowly forced out half a drop of
semen, the instrument was in situ for ten or fifteen seconds and then withdrawn, and the
patient lay quietly in bed for two or three hours afterwards.
Under these circumstances, at this, the tenth trial conception took place... I have related
this case minutely, because I presume it is the first and only authentic case in which
artificial fertilization has been successful in the human species; and because it furnishes
about the sum and substance of my knowledge on the subject which may be of any
possible service as a guide to future observers, who may have the curiosity, leisure,
courage, and perseverance to experiment further in this direction.17
Dr. J. Marion Sims, Clinical Notes on Uterine Surgery, 1873 edition
According to Dr. J. Marion Sims, after nine years of a childless marriage, his unnamed
patient and her husband sought his assistance for a cure to their distressing sterility. Sims did a
thorough gynecological examination of the 28-year-old wife and determined that she was
suffering from a plethora of mechanical obstructions.18 Sims examined the husbands
17 J. Marion Sims, Clinical Notes on Uterine Surgery, with Special Reference to the Management
of the Sterile Condition (New York: William Wood & Company, 1873), 366-369. Uterine
retroversion refers to the tipping backward of the organ. Hypertrophy refers to an increase in
mass of the uterine muscle. An indurated conical cervix means that it has hardened. The
contracted canal that Sims refers to is the shortened length of the womens birth canal which
stems from vagina to cervix.
18 Sims, Clinical Notes on Uterine Surgery, 366.


11
spermatozoa and found that it was adequate but that, due to the wifes obstructions, the sperm
would not stay in the vagina following intercourse.19 Sims determined that gynecological surgery
was the best course of action to correct the malposition of his patients uterus. However, the
patient would not submit to surgery. Due to her unwillingness to go under the knife, Sims agreed
to obtain sperm from her husband and inject it into the wifes canal in hopes of artificially
impregnating the patient.
Over a period of twelve months Sims used a specially altered syringe to perform dozens
of uterine injections of sperm into the young woman, and after the tenth trial his patient became
pregnant.20 Unfortunately, in her fourth month of her pregnancy the woman sustained a fall and
a fright and miscarried.21 Sims adamantly maintained that this was the first successful artificial
conception ever achieved within the human species, even if the baby was not carried to term.22
While Sims attempted these experiments on over half-a-dozen young women over a period of two
years, this patient was the only one to become pregnant.23 Sims claimed that he performed over
55 uterine injections on various women seeking an end to their sterility, but due to his self-
proclaimed badly made instruments and little understanding of the laws of conception he only
succeeded in this singular instance of assisted conception.24 Sims acknowledged that his
ignorance and ineptitude in regards to conception and embryology led to little success with his
experiments, but he recognized the importance of his work in providing foundational principles
19 Sims, Clinical Notes on Uterine Surgery, 366.
20 Sims, Clinical Notes on Uterine Surgery, 367. See Figure 1 for view of uterine injection
instrument.
21 Sims, Clinical Notes on Uterine Surgery, 367.
22 Sims, Clinical Notes on Uterine Surgery, 366.
23 Sims, Clinical Notes on Uterine Surgery, 369.
24 Sims, Clinical Notes on Uterine Surgery, 369.


12
that would be helpful to other doctors in the future who were brave enough to take on the
responsibility.25
Dr. Sims was one of a handful of medical men exploring and experimenting with
womens reproductive bodies in the latter half of the nineteenth century. While many of these
doctors did not begin their practices with infertility in mind, they eventually gravitated toward
experimentation on infertile women after perceiving a need among their patients. They focused
on women more heavily because they sought treatment much more often than men.26 Men
typically denied or hid the possibility that they could be infertile, so doctors more often than not
tailored their services to women.27 Sims, as well as doctors such as Frederick Hollick and Edward
Bliss Foote all acknowledged that childless women suffered greatly and that medical expertise
might cure their sterility and subsequently ease the suffering that childlessness had caused.
Prior to the development of surgical techniques and medical diagnoses, women struggling with
childlessness sought spiritual advice or communal support. According to Paul Starr, professor of
sociology and public affairs, the medical profession underwent a drastic transformation during the
nineteenth century due to the expansion of markets and improvement of transportation in the form
of roads and canals.28 The widening of the market allowed for practitioners to gain access to
larger areas and increased demand for their services. The Market Revolution ushered in an era of
unprecedented power for medical doctors and allowed them to enjoy a remarkable amount of
authority and control over the decisions their patients made regarding their health and well-being.
The pairing of new technologies and increased cultural authority allowed medical men in the
latter half of the twentieth century to exert much autonomy and power over the realm of
25 Sims, Clinical Notes on Uterine Surgery, 370.
26 Marsh and Ronner, The Empty Cradle, 41-74.
27 Marsh and Ronner, The Empty Cradle, 41-74.
28 Starr, The Social Transformation of American Medicine, 77.


13
reproductive matters. The medical men who began focusing on womens reproductive issues in
the latter half of the nineteenth century took pleasure in their knowledge and position of authority.
They believed it was their duty to use their position and abilities to assist sterile women to obtain
motherhood.
Figure 2.1: The instrument used by J. Marion Sims for uterine injections for artificial
insemination published in Clinical Notes on Uterine Surgery in 1873. The uterine injection
instrument was made of glass with a piston with the purpose of taking up semen. There was also a
screw nut added which could be turned against the piston-rod to let out a drop or half of a drop of
semen at a time.
These medical men were the first documented in America to medicalize infertility by
inventing medical technologies and treatments that were specifically designed to correct
perceived anatomical abnonnalities in women that they believed led to sterility. They viewed
reproductive irregularities in their patients as evidence of sterility. These practitioners set the
foundation for the development of assisted reproductive technologies in American history. They
were visionaries in their fields who sought to help their patients when others believed they could
not be helped. These men differed from doctors who came before them due to their superior
understanding of the mechanics of conception and the importance of healthy female and male
reproductive bodies. These doctors were among the first to openly acknowledge that sterility was
not just a female disorder and that men could also suffer from disorders that caused infertility.
While these doctors were pioneers and acknowledged the role of sperm and the
importance of male reproductive health, they were still influenced by societal perceptions of male
dominance and the notion that women should desire motherhood and be willing to sacrifice for


14
family. Though they recognized male accountability in childlessness, they remained focused on
the female form and developed very few techniques to treat men. Women bore the brunt of
invasive infertility treatments as doctors invented new tools and attempted to master new surgical
techniques. These medical men shared the belief that womens reproductive bodies were
machines and if that machine failed to function it was due to obstructions or malpositions which
needed to be manually corrected.29 Due to their mechanical understanding of the female
reproductive system and the societal notion of female sacrifice and devotion to motherhood, these
medical men gravitated toward surgical techniques that would remedy perceived failures in a
womans reproductive anatomy and allow a woman to go from barren to fruitful.
I have no doubt that a very large portion of the disease and unhappiness which many
married persons suffer under arises directly from their forced ignorance:
Sterility Treatment through Medical Marriage Advice
The medical community often remembers Dr. Frederick Hollick as a controversial
physician and sex educator of the nineteenth century. He aroused debate and anger among many
of his colleagues when he published several books on healthy sexual practices and openly
lectured in public venues on topics as taboo as female orgasms, sexual pleasure, and impotence.
He was even charged with obscenity after bringing papier-mache models of the female body to
his lectures to illustrate where the organs were located and how they should be manipulated
during intercourse to enhance pleasure.30 In the mid-nineteenth century Hollick was not alone in
his attempts to educate the public on sexual and reproductive matters (although he might have
been the most outspoken) and was joined by several other medical men who published popular
works focused on instructing married couples on their sexuality and generative powers. These
doctors sought to give couples knowledge that would aid their physical and mental well-being by
29 Marsh and Ronner, The Empty Cradle, 74.
30 Marsh and Ronner, The Empty Cradle, 68-69.


15
providing them with guidance on healthy relationships as well as clinical understandings of sex.
Although many of these medical men covered a wide array of topics in their self-help books,
the focus of many of their works was how to treat impotence and sterility. These doctors
acknowledged that childlessness was a burden to many couples, and they wanted to use their
medical prowess to assist needy couples in their pursuit of family.
In 1860, Hollick published The Marriage Guide or Natural History of Generation: A
Private Instructor for Married Persons and Those About to Marry, both Male and Female, in
Everything Concerning the Physiology and Relations of the Sexual System and the Production or
Prevention of Offspring Including all the New Discoveries Never Before Given in the English
Language, this text outlined the sum of information he believed couples should be privy to in
order to live a fulfdled and happy life. He believed that doctors needed to share their invaluable
knowledge and educate couples about sex and marriage. In the preface to his work, he argued that
his book was especially intended for the use of married persons and those about to marry, and
will be found to give full and practically useful information on every medical and physiological
topic in which such persons may be interested.31 He was appalled that doctors did not
communicate in laymans terms to their patients and sought to communicate in clear and simple
terminology. He argued that a very large portion of the disease and unhappiness which many
married persons suffer under ascended directly from their forced ignorance.32 In his opinion,
physicians had done their patients an injustice by not allowing them access to medical
knowledge. He used his medical knowledge and the popular press to provide married couples
31 Frederick Hollick, The Marriage Guide or Natural History of Generation: A Private Instructor
for Married Persons and Those About to Marry, both Male and Female, in Everything
Concerning the Physiology and Relations of the Sexual System and the Production or Prevention
of Offspring Including all the New Discoveries Never Before Given in the English Language,
(New York: T.W. Strong, 1860), 4.
32 Hollick, The Marriage Guide, vi.


16
with clinical knowledge of their bodies so they might have a better chance at maintaining health
and happiness, specifically with their ability to understand and treat their own childlessness.
Hollicks The Marriage Guide provided a detailed description of conception to couples
and assisted them with diagnosing and treating their sterility. He believed that if couples were
well versed in the mechanics of conception then they would vastly improve their probability of
pregnancy. He outlined for his untrained readers medical descriptions of female and male
generative organs, menstruation, semen, copulation, the process of impregnation, and pregnancy.
He also included other topics of interest for married couples such as the influence of imagination
over generative powers, sterility and impotence, the influence of drugs over generative powers,
the prevention of conception, and sexual indulgence and pleasure. In his analysis of sterility he
acknowledged that physicians, generally speaking, know little to nothing about such matters.33
He then conceded that his findings were based on his own empirical research of observation and
reflection, and his novel discoveries about humans generative powers were among the first to be
published in the English language.34 He separated himself from practitioners before him by
identifying the important difference between sterility and impotency in men.
Before the rise of the medical profession in the mid to late nineteenth century doctors
often linked sterility with impotency and believed that if a man was able to engage in sexual
intercourse he could not be sterile. Hollick, as well as fellow medical men of his time like J.
Marion Sims, moved away from this one dimensional understanding of male infertility and
recognized not only the possible separation of impotency from sterility but also that men could be
to blame for childlessness. Hollick declared that a man may be impotent without being
sterile.35 He argued that impotency, or the inability for a male to associate with the other sex,
33 Hollick, The Marriage Guide, 316.
34 Hollick, The Marriage Guide, vi-viii.
35 Hollick, The Marriage Guide, 317.


17
was linked to deformity, deficiency, and acute disease but could frequently be cured.36 While
Hollick believed that impotency could be cured, he linked a mans ability to associate with his
wife as a marker of masculinity and if a man was unable to engage in sex and could not produce
offspring then he would lose his manliness.37 Hollick assisted impotent men by creating medical
technologies that could treat their afflictions and allow them to restore their masculinity through
procreation. Specifically, he invented a medical device which he called the congester which could
assist impotent men in attaining an erection. The instrument consisted of a tube, the size of which
was adapted to the organ, and an exhausting air pump.38 Hollick argued that the congester had
assisted many of his patients in allowing blood flow to rush to the penis to create an erection.
Once an erection was achieved, he encouraged his patients to associate with their wives in
hopes of conceiving. He also argued that this could increase the size of a mans penis which could
make it easier for him to have intercourse with his wife and assert his manliness.39 Although
Hollick argued that the congester could treat impotent men by restoring their masculinity and
fulfilling their husbandly duty to procreate, he also noted that sterility could exist outside of
impotency in the male and recognized that spermatozoa quality was crucial in a couples attempts
to conceive and was also directly linked to husbands manliness.
Hollick noted that the male is often sterile from imperfection of the semen and that
semen quality was linked to mans virility.40 He asserted that these imperfections came in the
form of dead spermatozoa, or the absence of sperm from the seminal fluid, which made it
36 Hollick, The Marriage Guide, 317.
37 Hollick, The Marriage Guide, 320.
38 Frederick Hollick, The Male Generative Organs in Health and Disease, from Infancy to Old
Age Being a Complete Practical Treatise to the Anatomy and Physiology of the Male System,
(New York: Nafis and Cornish, 1850), 170.
39 Hollick, The Male Generative Organs in Health and Disease, 166-177.
40 Hollick, The Marriage Guide, 320.


18
impossible for a husband to impregnate his wife. Hollick claimed that if a man was able to engage
in sexual intercourse but had imperfect sperm, eventually he would lose his power to have sex,
for the organs soon lose all sensibility if they are not stimulated by perfect semen.41 Hollick
directly linked a mans sperm quality to his ability to engage in sex and ultimately to procreate.
He viewed these men as inevitably void of virility and destined to lose their manly ability to
engage in intercourse and produce offspring. To explain the reason for imperfections such as
these Hollick looked to the patients morality as a root cause. He identified that the most common
source of sterility was excessive seminal loss.42 This seminal loss stemmed from masturbation
which he argued deteriorated the system and depleted a mans ability to impregnate his wife.
Hollick argued against masturbation, for it led to much suffering, disease, and untimely death.43
If men would suppress their carnal urges their spermatozoa quality would improve and thus they
would be cured of their sterility. Historian Thomas Laqueur explained the anti-masturbation
culture, expressed by Hollick, of the late nineteenth century as being constructed of fears of
unleashing desires, which could lead to disease of the body and mind.44 While Hollick used
his medical expertise to educate married couples on the importance of sperm in conception; he
also took his position of medical authority to instruct married men on what he believed to be
moral and immoral sexual behavior which could lead to infertility. Hollick believed a mans
masculinity was rooted in his ability to produce offspring and was willing to offer his medical and
ethical advice on how these men could reestablish their virility.
Although Hollick discussed the importance of the male body in reproduction, he offered
very few medical treatments for men aside from the congester instrument for impotency and self-
41 Hollick, The Marriage Guide, 320.
42 Hollick, The Marriage Guide, 319.
43 Hollick, The Marriage Guide, 320.
44 Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud, (Cambridge:
Harvard University Press, 1990), 229.


19
control for excessive masturbation. Because Hollick believed true infertility (not impotency) in
men was ultimately untreatable, he focused much of his instruction for barren couples on treating
female infertility. He argued that there were a multitude of reasons for female infertility, but the
principal causes were due to the absence of the womb, ovaries, or fallopian tubes, closure of the
os tincae or tubes, incurable retroversion, or anteversion or obliquity [of the uterus].45 According
to Hollick, these causes were ultimately anatomical complications within the female reproductive
system an could be corrected through surgical intervention. He argued that sterility in women
with malformation of their reproductive system was often marked by painful menstruation and
that his surgeries to open the mouth of the womb or closed fallopian tubes were uniformly
successful and relieved the patient from suffering as well as sterility.46 Although Hollick boasted
that these invasive surgeries cured women of their sterility he provided no empirical evidence as
to how many of his surgical patients were able to conceive following their procedures. His
mechanical understanding of the female reproductive system led him to believe that once
blockages were removed, conception should occur without any further investigation.
Whereas Hollick believed that morality and masculinity were directly linked to a mans
infertility, he argued the opposite was the case for women facing childlessness. He declared that
[M]oral causes do not operate so strongly and uniformly with the female as with the male,
because she is in a great measure passive, and may even be made to conceive in spite of
herself.47 According to Hollick, womans natural passivity led her not to fall into immoral
temptation as easily as man and therefore her infertility was due to anatomical obstructions rather
than flaws in her character and ethical behavior. Although he believed womens infertility for the
45 Frederick Hollick, The Diseases of Women Their Causes and Cure Familiarly Explained; with
Practical Hints for Their Prevention and for the Preservation of Female Health, (New York:
Burgess Stringer, 1847), 218.
46 Hollick, The Marriage Guide, 321.
47 Hollick, The Marriage Guide, 322.


20
most part was not linked to moral misbehavior, he did recognize one exception. In The Diseases
of Women Their Causes and Cure Familiarly Explained, Hollick argued that while women were
typically sterile due to their anatomical impediments and reproductive malformations, sterility
could also be experienced by women with unfeminine temperaments and constitutions.48 He
argued that women who possessed masculine traits and resembled the other sex in their habits,
form, and features were frequently attended by sterility.49 Interestingly enough, while Hollick
commented on unfeminine behavior as a cause of infertility, he did not comment on female
masturbation. He recommended surgery for those women facing obstructions and a correction in
feminine conduct to those appearing to be too masculine. Hollicks understandings of masculinity
and femininity influenced his recommendations on courses of treatment for each; for men he
offered few medical interventions and focused on advising them on moral behavior and for
women he believed they were already of high moral virtue (for the most part) and that their
sterility could be corrected through surgical treatments.
Other medical men, aside from Hollick, also published popular works to provide medical
marital advice to couples seeking an end to their barrenness and other information regarding their
overall health. Dr. Edward Bliss Foote was a popular (yet unconventional) physician in the mid to
late nineteenth century. He was a birth control advocate and proponent of free-love lifestyles
which gained him a reputation of being quite radical. However radical he may have appeared a
large sector of the American public found his advice books useful, as the books went through
several revised editions, and sought his guidance through mail correspondences.50 His first advice
48 Hollick, The Diseases of Women Their Causes and Cure Familiarly Explained, 218.
49 Hollick, The Diseases of Women Their Causes and Cure Familiarly Explained, 218.
50 Edward Bliss Foote, Plain Home Talk About the Human System The Habits of Men and
Women The Causes and Prevention of Disease Our Sexual Relations and Social Natures:
Embracing Medical Common Sense Applied to Causes, Prevention, and Cure of Chronic
Diseases The Natural Relations of Men and Women to Each Other Society Love Marriage
- Parentage Etc., (New York: Murray Hill Publishing Company, 1896), iv.


21
Book, Medical Common Sense was published in 1858 and its overwhelming popularity led to an
expanded and revised edition titled Plain Home Talk published in 1896. His advice books sought
to infonn the general public in a language strictly mundane and comprehensible alike to the
lowly inmate of a basement and the exquisite student of an attic studio.51 He provided medical
information in laymens tenns to married couples so the human family could grow wiser and
happier.52 Even though his advice books were extensive and covered a variety of topics from
prostitution to polygamy, he did devote an entire section solely to the childless.
Figure 2.2: Image of Dr. Edward Bliss Foote provided in the 1896 edition of his Plain Home Talk
medical advice book.
Foote described barrenness as a physical condition abhorrent to everyone in married life
and compared it to the great desert which spreads it vast expanse wearily before the eye.53 His
description of the miserable anguish felt by childless couples illustrated the sympathies he felt
toward those facing sterility as well as his belief that a fulfilled life must consist of progeny for
51 Foote, Plain Home Talk, v.
52 Foote, Plain Home Talk, vi.
53 Foote, Plain Home Talk, 485.


22
both men and women. He expanded on the desperate situation that barren couples faced and
argued that to females the grave is more cheerfully looked forward to than childless longevity,
and not a few husbands would rather die in the prime of manhood, leaving an heir, than to live to
gray old age and be esteemed incapable of reproduction.54 Foote believed that neither a woman
nor man could truly be fulfilled if they did not produce offspring. To achieve true womanhood or
manhood an individual must leave behind an heir and procreate. If an individual could not
procreate he/she in essence failed to fulfill his/her masculine or feminine destiny. As a medical
professional, Foote saw it as his duty to assist these needy couples by providing them with a
clinical education on the causes of infertility and curative ways to promote childbearing.
Much like Hollick, Foote acknowledged the unique responsibilities of the male and
female reproductive bodies in successful conception. He outlined the following as the causes of
infertility: local inadaptation, diseased condition of the wife, diseased condition of the husband,
excessive amativeness, and temperamental inadaptation.55 He elaborated on each of the causes
and claimed that local inadaptation was in his experience the most common cause of barrenness
for couples. This referred to the displacement of a womans womb which caused pelvic pain and
discomfort as well as sterility.56 The displacement or malformation of her womb made it difficult
for the sperm to be placed correctly or stay within the vagina after intercourse.57 Foote provided
detailed sketches and descriptions of the various malpositions that could afflict his female
patients and suggested that surgery would be the best means to correct the perceived problems
with female reproductive systems. For patients unwilling to undergo surgery, Foote also provided
meticulous directions on coital positions that should be used by couples to optimize conception.
54 Foote, Plain Home Talk, 485.
55 Foote, Plain Home Talk, 485.
56 Foote, Plain Home Talk, 485.
57 Foote, Plain Home Talk, 485.


23
Rather than surgery, the couples could attempt to use modified sexual positions to assist with
placement of sperm. If modified positions did not work, Foote suggested that couples purchase
one of his impregnating syringes (available through mail order) which would allow them to draw
up the husbands sperm and deposit it correctly into the wifes vagina.58 His suggestion of the use
of an impregnating syringe illustrated early development of assisted reproductive technologies to
support infertile couples, although his design was most likely built upon Dr. J. Marion Sims
invention since it only appeared after Sims had published his research on seminal uterine
injections for the purpose of impregnation. Footes endorsement of surgery and willingness to use
new technologies and methods aligned with Hollicks understanding of the mechanical nature of
the reproductive system and also illustrated the aggressive means by which doctors sought to
remedy female infertility. However, Footes willingness to provide alternative treatment
techniques (such as coital positioning and the use of the impregnating syringe) in lieu of surgery
suggested that patients had agency over their medical decision-making and provided their own
input in the management of their condition.
&OOAA IS ir'wrf'rATUJK. LOCAL nt ADAPTATION.
Figure 2.3: Dr. Edward Bliss Footes depictions of various forms of local inadaptation in sterile
couples published in Plain Home Talk in 1896.
Foote also linked morality and ethical behavior to male sterility but not to female
sterility. When discussing diseases of the wife that could causes sterility, Foote referred mostly to
58
Foote, Plain Home Talk, 512.


24
concerns with inflammation, obstructions, tumors, and ovarian afflictions. Many of these he
believed could be helped with surgical intervention. He did not link a womans behavior to her
ability to reproduce. However, when explaining the diseases of the husband that caused sterility,
Foote greatly detailed the influence of a mans behavior upon his ability to conceive. Specifically,
Foote noted that production of non-vital semen was often to blame for male infertility, which
was often linked to a mans excessive masturbation in boyhood as well as manhood.59 According
to Foote, superfluous venery weakened the testicular glands and caused spermatozoa to be sickly
or inanimate.60 Foote elaborated on the risks associated with carnal excess in his section on
excessive amativeness as a cause of barrenness. He argued that men who engaged in excessive
or violent coition did not allow the spermatozoa to become sufficiently developed for
impregnation.61 Footes recommendations against excessive sex and masturbation align with the
historiography presented by Laqueur, where he established that the anti-masturbatory culture of
the late nineteenth century stemmed from fears of the consequences of giving into desires.62
Footes suggestion to men was to be virtuous and practice self-control as a means to improve
semen quality.63 Although Foote held fairly progressive beliefs on sexuality, he still aligned with
other popular medical men of the day who argued that masturbation and sexual indulgence in
men was immoral and led to male infertility.
59 Foote, Plain Home Talk, 505.
60 Foote, Plain Home Talk, 505.
61 Foote, Plain Home Talk, 507.
62 Laqueur, Making Sex, 229.
63 Foote, Plain Home Talk, 505.


25
Ktg. 132.
A. B.
a, Microscopic view of healthy sper-
matozoa .
b, Microscopic view of sickly
and inanimate spermatozoa
found in the seminal fluids
of a barren man.
l
Figure 2.4: Dr. Edward Bliss Footes depictions of healthy versus sickly and inanimate
spermatozoa published in Plain Home Talk in 1896.
Both Dr. Frederick Hollick and Dr. Edward Bliss Foote used the popular press to educate
married couples on their clinical understandings of sex and fertility. Their attempts to provide
medical education for lay persons was a departure from previous physicians who had kept the
mysteries of conception shrouded in secrecy due to its taboo reputation.64 With improved
understanding of the natural laws of conception and expanded authority with the rise of the
medical profession in the mid-nineteenth century medical men like Hollick and Foote sought to
treat sterility through clinical education and marital advice for the general public. They informed
their readers of the mechanics of conception and the causes of childlessness while offering
medical instruction on inventive techniques to improve fertility. These doctors acknowledged
male infertility but linked it to masculinity and morality whereas womens infertility was often
seen to be the byproduct of anatomical obstructions or malpositions of reproductive organs. Self-
help doctors like Hollick and Foote introduced the public to the medicalization of childlessness
and invented some of the first instruments used to treat sterility such as the congester and
impregnating syringe. Their work in educating the general public was an initial step in the
medicalization of infertility. Doctors like J. Marion Sims who would also be at the onset of
medicalization, directed their attention to advancing the field by publishing their work for fellow
64 Marsh and Ronner, The Empty Cradle, 42-48.


26
doctors rather than for the lay community. Their work in the treatment of sterility through
medical marriage advice ushered in the era of infertility medicalization and laid the foundation
for subsequent physicians to experiment further with gynecological surgeries and artificial
impregnation.
For the perpetuation of names and families, the descent of property, the happiness of
individuals, and occasionally the welfare of the state:
Dr. J. Marion Sims and Artificial Fructification
Dr. J. Marion Sims was an American physician and surgeon during the latter half of the
nineteenth century. He was highly venerated within the medical community in his time and is still
often regarded as a surgical pioneer and hailed as the Father of Modem Gynecology. His rise to
prominence began with his development of the first consistently successful surgical technique to
repair vesicovaginal fistulas, a catastrophic childbirth complication in which a hole developed
between a womans bladder and her vagina, which led to constant, unremitting, and
uncontrollable urinary incontinence.65 The complication arose following prolonged obstructed
labor where the fetus became lodged in the womans birth canal. In many cases the fetus and
mother did not survive. If the mother lived she was often cursed with a painful and debilitating
vesicovaginal fistula and in severe cases a rectovaginal fistula as well.66 Simss breakthrough
procedure relieved women of this crippling postpartum ailment and allowed them to significantly
improve their quality of life.67 While Sims enjoyed overwhelming popularity and success during
his life, his legacy has since become shrouded in controversy as historians and medical
65 L.L. Wall, The Medical Ethics of J. Marion Sims: a Fresh Perspective, Journal of Medical
Ethics, 32 (2006): 346.
66 Mayo Clinic: Diseases and Conditions. Rectovaginal Fistula.
http://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/basics/defmition/con-
20034033, (accessed June 10, 2015) A rectovaginal fistula refers to the escape of feces through
the wall of the anal canal or rectum leading to painful and uncontrollable loss of fecal control
where stool and gas may pass through the vagina.
67 Wall, The Medical Ethics of J. Marion Sims, 346.


27
professionals debate his questionable methods of experimentation on African-American slaves
during the antebellum years.68
Dr. Sims used enslaved women for medical research. Slave masters would bring their
female slaves who were suffering from vesicovaginal fistulas to Sims for surgical repair. He
initially denied to treat the condition and believed it was incurable but eventually he took on the
difficult cases and mastered the technique to repair the injuries.69 He accomplished this through
his development of the first of many vaginal specula which allowed him to internally view the
vagina.70 He engaged in repeated surgeries on slaves to perfect his technique and modify his
instruments in an attempt to cure the vexing birth complication. He used a trial-and-error
approach to improve his vesicovaginal technique and relieve women of their pain. While he did
succeed in curing many of the enslaved women, the women often had to undergo a dozen or more
surgeries without anesthesia or the ability to consent to their own treatment.71 Dr. Simss medical
experimentation on slaves has divided the historical and medical communities fueling a heated
debate over medical ethics and leaving his legacy in an ambiguous state.72
68 Wall, The Medical Ethics of J. Marion Sims, 346.
69 Wall, The Medical Ethics of J. Marion Sims, 346-347.
70 J. Marion Sims, On the Treatment of Vesicovaginal Fistula (Philadelphia: Blanchard and Lea,
1853), 10-11.
71 Durrenda Ojanuga, The Medical Ethics of the Father of Gynecology, Dr. J. Marion Sims,
Journal of Medical Ethics, 19 (1993): 28-30.
72 Sarah Spettel and Mark Donald White, The Portrayal of J. Marion Sims Controversial
Surgical Legacy, The Journal of Urology, 185 (2011): 2424-2427.


28
Fi*. i. Fia. a
Figure 2.5: The first vaginal speculum invented by J Marion Sims and used to perform procedures
to correct vesicovaginal fistulas. This image of his speculum was published in On the Treatment
of Vesicovaginal Fistula in 1853.
Regardless of where modem scholars align on their arguments concerning Simss
medical conduct, Simss early work on fistulas and his experimentation on enslaved women set
the stage for his eventual work with infertility. As Sims developed new instruments and
techniques to cure fistulas and other uterine irregularities, he began to become keenly aware of
the ability of medical intervention to assist infertile women. In 1855, he opened the revolutionary
Womans Hospital in New York City. The hospital was the first in America devoted to surgery
involving womens reproductive organs. It was at this institution that Sims expanded on his
earlier revelations regarding fistulas and advanced his knowledge of womens diseases and
infertility. According to medical historian Margaret Marsh and OBGYN and medical historian
Wanda Ronner in The Empty Cradle: Infertility in America from Colonial Times to the Present,
the hospital served a variety of women from all walks of life who suffered from a number of
complaints ranging from menstrual disorders to severe pelvic pain and complications from birth.73
Marsh and Ronner established that at the Womans Hospital, Sims and his assistants provided
73 Marsh and Ronner, The Empty Cradle, 53.


29
surgical solutions for these women by performing fistula repairs, the removal of large ovarian
tumors, and even a clitoridectomy to ease the pain and suffering of women and treat their gender
specific afflictions.74 Simss time at the Womans Hospital improved his skills and led him to an
accidental interest in treating women suffering from sterility.
In several of his publications, Sims noted that improved fertility was often a byproduct of
the surgeries he performed on women suffering from a variety of complaints such as
dysmenorrhea, menorrhagia, fibrous polypus, and vaginitis.75 Although infertility was not his
intended subject of focus, he found more and more women seeking his treatment for their
childlessness and felt moved to assist them. He spent many years at the Womans Hospital
researching infertility in women and operating on womens uterine afflictions in hopes of finding
a treatment. In 1866 Sims published his first edition of his research on sterility in Clinical Notes
on Uterine Surgery with Special Reference to Management of the Sterile Condition and outlined
the complexity of diagnosing and treating sterile women.
Simss innovative Clinical Notes on Uterine Surgery was received with curiosity and
widely read. However, it also aroused controversy among many of his professional colleagues.
He discussed the inner most workings of the female anatomy in a frank and casual tone, which
was viewed by many as inappropriate and vulgar. Since gynecology was a newer field, many
practitioners were uncomfortable with the amount of intimate contact they had to have with
female patients and often horrified by the thought of so closely inspecting a womans most
private areas. Although Sims had few hesitations in openly examining womens reproductive
organs, he understood the importance of doing so in a respectful and professional manner. His
74 Marsh and Ronner, The Empty Cradle, 53. A clitoridectomy refers to the removal of the
clitoris.
75 Sims, Clinical Notes on Uterine Surgery, ix-xi. Dysmenorrhea refers to a painful menstruation.
Menorrhagia refers to abnormally prolonged menstrual periods which come at irregular intervals.
Fibrous polyps refer to excess skin growths or tumors. Vaginitis refers to inflammation of the
vagina.


30
lengthy and detailed instruction on the proper protocol for a pelvic examination offered great
insight into late nineteenth century understandings of propriety and female modesty. His
exhaustive directions on uterine examination techniques span a total of seventeen pages. Sims
pinpointed suitable methods to identify irregularities through touch and sight while promoting
delicacy and respectability. His text is vastly different from the works of Hollick and Foote,
whereas they targeted the lay population; he is speaking directly to the medical community. A
few of Simss suggestions to maintain respectability included insisting on a third person being
present during examinations and the use of a catheter after examination to release air silently
from the vagina so not to create a noise that may mortify his tired and sensitive patients.76
Simss meticulous discussion of proper uterine examination protocol serves to inform doctors of
routine gynecological etiquette while maintaining feminine diffidence.
Figure 2.6: Dr. J. Marion Simss sketch of a proper uterine examination by sight and touch
published in Clinical Notes on Uterine Surgery in 1873.
While Simss procedural advice assisted in creating uniform practices among physicians
exploring gynecology and helped to ease concerns over decorum, it was his groundbreaking
analysis of conception, causes of sterility, and possible treatment techniques that helped to lay the
foundation for the medicalization of infertility in the United States. In his introductory chapter of
76
Sims, Clinical Notes on Uterine Surgery, 14-20.


31
Clinical Notes on Uterine Surgery, Sims established that in the course of treating the diseases of
women... I found many cases of sterility cured simply by curing uterine affliction.77 He boasted
that his surgical approach was the key to unlocking fruitfulness for barren couples and believed
that he had a moral duty to assist couples in need. He claimed he was moved to compassion by
his childless patients because children were the greatest source of individual happiness.78 Sims
acknowledged that sterility was complex and that the subject was of great importance, for the
perpetuation of names and families, the descent of property, the happiness of individuals, and
occasionally the welfare of the State, and even the permanence of dynasties and governments,
may depend upon it.79 His preliminary remark in Clinical Notes on Uterine Surgery on why he
chose to treat infertility mimic those of Hollick and Foote as well as subsequent physicians and
suggests that he felt an obligation to use his power and influence to provide couples with what he
believed was essential for a fulfilled life: children. He became a gate keeper of sorts ensuring that
American families continued to be abundant and multiply. Sims believed his work was culturally
important and that medical expertise and authority were essential in upholding social norms and
cultural institutions by helping married couples to produce offspring and continue family names
and customs.
In Clinical Notes on Uterine Surgery Sims expanded upon the previous work of doctors
like Hollick and Foote and tackled the complexity of conception and sterility while he outlined
the various factors that could influence reproduction in the human species. He acknowledged that
he had encountered sterility in many forms but that ultimately it fell into one of two categories for
women: natural sterility or acquired sterility.80 According to Sims, natural sterility referred
77 Sims, Clinical Notes on Uterine Surgery, 1.
78 J. Marion Sims, The Story of My Life (New York: D. Appleton and Company, 1884), 338.
79 Sims, Clinical Notes on Uterine Surgery, 5.
80 Sims, Clinical Notes on Uterine Surgery, 2.


32
to those women who had never conceived and acquired sterility to those women who had
conceived previously but for some reason had ceased to do so for a period of five or more years.81
He established that there were certain conditions that were essential for conception to occur:
1. It occurs only during menstrual life.
2. Menstruation should be as such as to show a healthy state of the uterine cavity.
3. The os and cervix uteri should be sufficiently open to permit the free exit of the
menstrual flow, and also to admit the ingress of the spermatozoa.
4. The cervix should be of proper form, shape, size, and density.
5. The uterus should be in a normal position, i.e., neither ante-verted, nor retro-verted
to any great degree.
6. The vagina should be capable of receiving and of retaining the spermatic fluid.
7. Semen, with living spermatozoa, should be deposited in the vagina at the proper
time.
8. The secretions of the cervix and vagina should not poison or kill the spermatozoa.82
Each of these conditions was specific to the various disorders that Sims came in contact with
while working at the Womans Hospital. According to Sims, the conditions he presented here to
be essential for conception could almost all can be treated with surgical intervention and he
offered detailed instructions on how to perform gynecological surgeries that could correct any
irregularities that could prevent pregnancy. He understood female infertility in mechanical terms
and believed he could manually fix anatomical defects in a womans reproductive system.
The one essential condition noted above which could not be corrected with surgery was
that of living spermatozoa. Sims recognized that the male partner could be to blame for
childlessness and identified that, [F]or impregnation, the semen must contain living
spermatozoa.83 He detailed the various forms that living sperm could appear in, including the
shape, the motility, and the sensitivity to surroundings.84 Just like Hollick and Foote, he
81 Sims, Clinical Notes on Uterine Surgery, 2. The two types of infertility that Sims refers to are
now known as primary and secondary infertility among medical practitioners.
82 Sims, Clinical Notes on Uterine Surgery, 5. Os refers to any body orifice, opening, or cavity.
For Sims work this will typically refer to the cervical or vaginal opening.
83 Sims, Clinical Notes on Uterine Surgery, 354.
84 Sims, Clinical Notes on Uterine Surgery, 352.


33
challenged earlier physicians who argued that infertility was solely a female affliction and argued
that sterility in the male does positively exist, and that it may depend upon 1st congenital
malposition of the testes; 2nd chronic inflammation of the glands; and 3rd stricture.85 In the first
and second complications that Sims outlined, the testes failed to produce spermatozoa and in the
third, the semen was regurgitated into the bladder.86 Prior to Sims and fellow late-nineteenth
century medical men, physicians believed that only impotent men could be held accountable for
infertility and that if a man could engage in intercourse he was deemed fertile. Just like Hollick,
Sims challenged that assumption as well and noted that a man may be impotent and not sterile;
and sterile but nor impotent.87 Previous doctors had associated a mans sexual rigor with his
ability to procreate, but Sims refuted this notion of male virility through simple semen analysis.
Simss groundbreaking acknowledgement that men could also bear responsibility for infertility
set him apart from earlier doctors and illustrated a shift among physicians regarding reproduction
and the relationship between the sexes. To him, men and women were both essential in
reproduction and had their appropriate roles. While Sims fully recognized that men could be to
blame in a couple dealing with sterility, he did little research in terms of treatment for men since
he believed their conditions were most likely irreversible.
85 Sims, Clinical Notes on Uterine Surgery, 354.
86 Sims, Clinical Notes on Uterine Surgery, 354.
87 Sims, Clinical Notes on Uterine Surgery, 355.


34
/

/

\
\
Fio. 13?.
Fia. m
Figure 2.7: Dr. J. Marion Simss depictions of spermatozoa in various forms published in Clinical
Notes on Uterine Surgery in 1873. Fig. 136, a, represents normal sperm, b represents the straight
movement of the normal sperm. Fig. 137 and Fig. 138 represent the injured sperm swimming in a
circular motion. Fig. 139 represents an injured sperm doubled in on itself.
Since Sims explored few options to assist infertile men, women continued to be the focus
of his invasive surgical interventions. Sims often found that the uterine cavity of infertile women
was plagued with polyps or fibroid tumors. He developed several techniques and various medical
instruments to remove polyps and fibroids and hesitantly endorsed the use of his modified sponge
tent to dilate the cervix, open the uterus, and allow the passage of his tools into the uterine cavity.
The sponge tent was in essence a plug made out of compressed sponge material which was placed
in the cervix where it remained over a period of one to three days to expand and dilate the
cervical opening. The process of sponge tenting was incredibly painful and very uncomfortable
for the patient. Sims spoke frankly of the unpleasant nature of sponge tents and declared


35
repeatedly that they were a sort of necessary evil.88 Sims used them to hopefully make for an
easier surgery for the patient but stated that I never use them if I can possibly avoid it, and I
never apply them without apologizing to my patient for the very unpleasant effects they
produce.89 The sponge was used prior to surgery to open the canal so instruments like Sims
curette and ecraseur could be placed directly into the uterus.90
Figure 2.8: Simss images of a cervix and uterus before and after the use of a sponge tent for
cervical dilation published in Clinical Notes on Uterine Surgery in 1873.
Both Sims's curette instrument and his ecraseur were used to clear the uterine walls of
any growth obstructions like polyps and fibroids. Simss curette instrument had a malleable
handle which could be bent side-to-side and forwards and backwards and a loop on the end to
snag debris from the uterine cavity.91 This instrument is still used in various forms today but was
initially developed by Sims to clear the uterus so an infertile woman might be able to conceive.
His ecraseur tool was essentially dilating forceps with a spring blade and expanding chain.92
Sims took this tool from another doctor and modified it for the means of clearing the uterine
cavity for infertility surgery. Sims affixed the spring blades and expanding chain to the forceps
portion of the instrument and was then able to insert it into the vagina where it could be looped
88 Sims, Clinical Notes on Uterine Surgery, 57.
89 Sims, Clinical Notes on Uterine Surgery>, 53.
90 Sims, Clinical Notes on Uterine Surgery, 61-81.
91 Sims, Clinical Notes on Uterine Surgery, 55.
92 Sims, Clinical Notes on Uterine Surgery, 79.


36
around growths. The growths could then be cut away by triggering the spring blades. While
Simss surgeries focused heavily on clearing uterine blockages in infertile women he also
developed many devices and procedures to further open the cervical canal (aside from the sponge
tent). He argued that the cervix must be of proper form, shape, size, and density.93 If the cervix
was malformed in any way he believed that ferility was compromised. He cut away portions of
womens cervixes in hopes of further opening the canal or at least making them appear more
porportional. The sponge tent, curette, ecraseur, and cervical curettage techniques used by Sims
were just a few of many methods which were used to assist in clearing an unhealthy uterine
cavity and correcting malformed cervixes. While these procedures opened up the uterine
cavity there is little to no evidence to show they were effective in curing infertility. Although
these instruments and techniques were innovative and allowed for growths to be more easily
removed they illustrated the invasive and painful practices that were used in Sims sterility
treatments as well as his focus on advancing medical technology for the purpose of assisting
infertile couples.
93
Sims, Clinical Notes on Uterine Surgery, 5.


37
Figure 2.9: Simss curette and ecraseur tools used to clear blockages in the uterine cavity in
infertile women published in Clinical Notes on Uterine Surgery in 1873.
Sims wrote extensively on dozens of surgical techniques to correct perceived anatomical
malpositions within his patients reproductive systems but failed to provide data regarding
whether or not the women became pregnant. He referred to many specific patients throughout
Clinical Notes on Uterine Surgery and detailed the reasons why they sought his help, his
diagnoses, and surgical methods that were used but rarely mentioned whether the woman was
able to achieve pregnancy following his treatments. He ultimately declared the women cured if
their surgical procedures went as planned and moved on to the next case. His lack of follow up on
whether these women achieved pregnancy offered insight into his mechanical understanding of
the female reproductive system. Since he believed that he corrected the malfunctioning portion of
the system he no longer needed to treat the patient.
Among all of the case studies provided by Dr. Sims there is one only one instance where
he referenced a patient becoming pregnant after treatment. Near the latter portion of Clinical
Notes on Uterine Surgery, Sims broached a taboo topic and discussed his use of what he referred


38
to as artificial fructification.94 He claimed that he used a specially modified syringe to inject his
patient with her husbands sperm over a period of twelve months. As referred to at the beginning
of this chapter, the woman became pregnant after the tenth trial of injections but unfortunately
miscarried in her fourth month of pregnancy. Sims claimed that he performed a series of
injections on several women but this was the only pregnancy which occurred due to his lack of
knowledge of the timing of when conception could happen. In his discussion of artificial
fructification Sims declared that this method was not a treatment of first resort and that surgery
was the best option for women seeking an end to their sterility.95 However, Sims acknowledged
that if a woman was not willing to submit to surgery he would perform artificial fructification as a
last ditch effort to treat his patient. To obtain the sperm for the injection, Sims waited in another
room while his patient and her husband had intercourse.96 He would enter the room immediately
after and withdraw the semen from her vagina with his specially altered syringe. He would then
dilate the cervix if needed and inject the sperm into the womans uterus.97 Sims never asked a
male patient to masturbate in order to obtain sperm, because he believed it was emasculating for
the husband and he did not want to encourage what he believed to be an immoral act. Sims
typically performed the uterine injection a few days after his patients menses ceased which he
believed was their most fertile time.98 While only one patient became pregnant, Sims
acknowledged the importance of the breakthrough and hoped that his work would help future
doctors in achieving more success in assisting couples to reproduce.
94 Sims, Clinical Notes on Uterine Surgery, 366.
95 Sims, Clinical Notes on Uterine Surgery, 366.
96 Sims, Clinical Notes on Uterine Surgery, 366369.
97 Sims, Clinical Notes on Uterine Surgery, 360-371. See figure 1 for an image of Sims
instrument created for artificial insemination injections.
98 Sims, Clinical Notes on Uterine Surgery, 368.


39
Conclusion
Simss contributions to the field of gynecology and the advancement of assisted
reproductive technologies like artificial insemination cannot be overlooked. He not only
developed protocol for proper pelvic examinations that are still used today he also invented
dozens of instruments which made intrauterine examinations and surgeries possible. The work of
doctors like Hollick, Foote, and Sims in infertility education and treatment ushered in an era of
medicalization of infertility. While Hollick and Foote differed in their approach by focusing on
educating the general public, they were the first in the process of medicalization. Sims on the
other hand kept his work within the realm of the medical community and focused on only sharing
his knowledge with fellow physicians. Regardless of the avenues the doctors used to advance the
medicalization of infertility, they held the common belief that women could not live a fulfilled
life if they were childless. Because of this shared understanding of the necessity of motherhood,
doctors found themselves moved to use their expertise to assist women to become mothers. All of
the doctors surveyed during this era only assisted married couples. There is no evidence to point
to the treatment of infertility for single men/women or for couples who were not married. During
the latter half of the nineteenth century marriage was clearly viewed as the prerequisite for
parenthood by doctors as well as society. Doctors and their patients also viewed children as an
essential component of the ideal family and investigated a variety of interventions to achieve the
idyllic nuclear family unit. While Sims acknowledged that men played a very important role in
reproduction he failed to advance infertility treatments for men and solely focused on his female
patients malformations. This led to the development of a multitude of invasive surgeries.
There is no hard evidence of whether or not Simss surgical patients were able to become
pregnant following his treatments but the fact that these women sought his care (often times
repeatedly) illustrated a desire amongst these women to become mothers and their willingness to
undergo painful and aggressive procedures to hopefully achieve motherhood. These women do
not have a voice in Simss publications but they do appear to have some agency over their course


40
of treatment. Specifically, when Sims discussed artificial fructification he mentioned that it was
only performed on women who refused surgery. While Simss patients were absolutely pushed
toward surgery (and Sims was clearly irritated if they refused) they were able to determine what
was best for them as they sought an end to their childlessness. Sims was among the first medical
men to publish his experimentation with artificial insemination, though he had little to no success
his ideas were used by his successors to attempt to bring fertility to barren couples. The surgical
practices and treatment recommendations offered by doctors like Hollick, Foote, and Sims
defined infertility treatment through the end of the nineteenth century. By the dawn of the
twentieth century, a new wave of medical men expanded on their work by identifying the
hormone variables responsible for ovulation and challenging accepted understandings of marriage
and fidelity by experimenting with artificial insemination by donors rather than by husbands.


41
CHAPTER III
REPRODUCTIVE ENDOCRINOLOGY AND THE ARTIFICIAL INSEMINATION
DEBATE, 1918-1934
Birth of Test Tube Twins Reveals Lab Baby Technique
New York, April 30. Birth of test tube twins disclosed Monday a laboratory baby
technique that has been successful in 12 cases. Mr. and Mrs. Salvatore Lauricella who
had been childless eight years were so pleased when their two babies were bom that they
disclosed the secret. Dr. Frances Seymour and Dr. Alfred Koemer both graduates of the
Medical College of Virginia and now practicing in New York, then said they had
conducted a series of successful experiments for the last two years but expressed surprise
at the public interest in the results.. .A process of artificial insemination has resulted in
eight births and five more deliveries are expected at an early date, Dr. Seymour said... Dr.
Seymour asserted none of the women could have borne children except through the
intervention of science...
The Billings Gazette, May 1, 1934
Salvatore and Lillian Lauricella tried unsuccessfully to become pregnant for eight years.
In the face of her diagnosed sterility, Mrs. Lauricella underwent a series of unspecified treatments
in an attempt to add a child to their family.* 100 In spite of her constant efforts she still failed to
conceive, and the Lauricellas hopes for a child quickly faded. In desperation, Mr. Lauricella
turned for help to infertility specialist Dr. Frances Seymour, who happened to be a customer at his
Manhattan service garage. Seymour agreed to look into the problem and quickly identified that
the issue lay not with his wife, but rather with Mr. Lauricella. She diagnosed Mr. Lauricella with
azoospermia, or the absence of sperm from his seminal fluid, and recommended artificial
insemination. After several inseminations the couple became pregnant, and in April 1934 Mrs.
Lauricella gave birth to healthy twin girls.
Although the Lauricellas were thrilled with the birth of their children, controversy soon
ensued as newspapers across the nation published sensational articles documenting the successful
use of artificial insemination to cure the Lauricellas sterility. Just like the above mentioned
excerpt from the Billings Gazette, the editorials contained loaded language and broached the
"Birth of Test Tube Twins Reveals Lab Baby Technique. Billings Gazette, May 1, 1934.
100 Marsh and Ronner, The Empty Cradle, 161.


42
subject with shock and awe. Terms such as test-tube, laboratory, artificial and synthetic
appeared in headlines and alluded to the scientific, and questionable, practice of Dr. Frances
Seymour. Journalists relied on the opinions of various doctors in the field to discuss approval or
disapproval of the procedure and made sure to interview Dr. Seymour and her associate Dr.
Alfred Koemer. The use of artificial insemination divided the medical community and led to
heated discussions among doctors about the repercussions of using such a procedure. Physicians
on either side of the debate (for artificial insemination or against) ultimately used gendered
language and assumptions regarding reproduction and family structure to make their arguments.
Even though the debate revolved around medical professionals, the opinions of church officials
and columnists also shaped the discussion since they aligned themselves either for or against the
practice of artificial insemination.
In the first half of the twentieth-century medical men who had focused on womens
procreative health transitioned into obstetricians and gynecologists (OBGYNs) as the field gained
increased legitimacy. Like physicians before them, they invented new medical technologies to
advance infertile couples possibilities of becoming pregnant. While they used many of the
instruments and techniques that were established in the latter half of the nineteenth-century, they
separated themselves from their predecessors by gaining new evidence of female sex hormones
and introducing innovative, less-invasive (and in some cases even nonsurgical) techniques to
improve female reproductive capabilities. Doctors like John Rock, Samuel Meaker, Frances
Seymour, and Alfred Koemer used new scientific discoveries and innovative new technologies to
dramatically alter and expand infertility treatment options and further medicalize the condition.
With increased knowledge of ovulation and improved surgical techniques, OBGYNs of the first
half of the twentieth-century were able to refine artificial insemination practices and generate
results with increased success rates.
While OBGYNs in the early twentieth century enjoyed more success in assisting infertile
couples to get pregnant, they also faced much more critical attention from spectators outside of


43
the medical community. The work of infertility specialists gained much public attention and was
hotly debated by doctors, lay persons, journalists, lawyers, and the religious leaders. New
infertility treatments offered by doctors like John Rock and the publications of successful
artificial impregnation by doctors like Seymour and Koemer prompted the general public to
respond and critique the ethical behavior of these physicians. The legal, moral, and medical
discourse on the topic of artificial insemination and medical intervention into infertility offered
interesting insight into how gendered assumptions of reproduction and family structure were
constructed and how those assumptions evolved through the intervention of the medical
community.
Infertility specialists of the early twentieth century differed from those before them not
only in their advanced knowledge and attention from the public, but also in their motivations for
treating infertile couples. While these doctors still viewed infertility as a disease and developed
techniques to cure couples, they practiced under very different cultural contexts. These doctors
were influenced by the popularity of the eugenics movement following World War I and the
desire for a superior race. While the eugenics movement had been gaining ground since the late
1880s, historian Wendy Kline argues that fear of foreigners and disillusionment following the
devastating brutality of the war prompted a huge surge in support for eugenics organizations.101
Eugenics supporters argued for the advancement of the human race through selective breeding
and sterilization and often turned to the medical community to support their efforts to create a
superior nation.102 Doctors used accepted eugenics rhetoric to defend their research and often
framed their medicalization efforts in terms of national responsibility.103
101 Wendy Kline, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the
Century to the Baby Boom, (Berkley: University of California Press, 2011), 14-18.
102 Kline, Building a Better Race, 105.
103 Kline, Building a Better Race, 30.


44
Careful analysis of newspaper articles, medical journal articles, and various works by
respected physicians of the era shed light on the motivations for the advancement of assisted
reproductive technologies and the impact of gendered thinking in the shaping of social
perceptions of infertility and reproduction. The aggressive and divisive discourse among the
medical and legal communities during the first half of the twentieth-century potently
demonstrated the desire for experts to maintain power over societal norms, especially in the realm
of gender relations and reproduction. The medicalization of infertility granted doctors cultural
authority over womens attempts at pregnancy but also elicited criticism from those outside of the
medical community. Regardless of their stance on the argument, doctors who approved and
disapproved of the use of assisted reproductive technologies like artificial insemination were
influenced by cultural acceptance of eugenics and used gendered language and gendered
assumptions about reproduction to make their arguments and reinforced traditional notions of
masculinity, femininity, and family formation just like the doctors who had come before them.
Ultimately, the new technologies and techniques embraced by physicians to treat infertility in the
first half of the twentieth-century helped to shape understandings of reproduction and infertility
by reinforcing traditional beliefs of womens inevitable motherhood role and the necessity of a
nuclear family in American culture to support the power of the state.
A fruitless marriage is one of natures saddest tragedies, and from whatever angle it be
regarded the results are detrimental to society:
Clinical Research and the Birth of Reproductive Endocrinology
Medical men in the late nineteenth-century still faced many uncertainties regarding the
process of conception and lacked scientific knowledge of ovulation timing and hormone
variables. Due to their ignorance of such important information, they struggled to find much
success with their courses of treatment for infertile couples. They acknowledged importance of
healthy sperm for successful conception but offered little aid to men who faced sterility. Rather,
these physicians focused on the female form in an attempt to help childless couples to procreate.


45
They invented new medical technologies like the vaginal speculum and ecraseur tools to peer
more closely into womens wombs to detect irregularities and attempt to correct any malpositions
that could hinder fertility. They used invasive surgical techniques and found little success with
their attempts at artificial impregnation through uterine injections of sperm. While they did not
document much (if any) success at curing infertile couples they did lay the foundation for the
reproductive trailblazers of the twentieth century who continued their work with the same
idealistic goal in mind: to fulfill womens inherent longing for motherhood and restore a mans
virility by providing him the ability to procreate and perpetuate his name.
Dr. Isidor Clinton Rubin was among these OBGYNs who wanted to provide non-
operative and less-invasive diagnoses techniques for women seeking infertility treatment. In
1920, he published his successful account of the development of a nonsurgical test to determine
the patency (openness) of the fallopian tubes. Prior to the Rubin Test for fallopian patency,
physicians would either neglect to investigate a womans fallopian tubes or have the patient
undergo aggressive major surgery via the laparotomy method in which the abdomen was opened
to reveal the uterus, tubes, and ovaries.104 A closed or blocked fallopian tube was (and is) a
common cause of female infertility and the Rubin Test allowed women to avoid major surgery
and be diagnosed by a simple apparatus set up in the doctors office. Rubin argued that he
practiced the procedure on over 55 patients, claiming that complications were minimal and at
most his patients were just temporarily uncomfortable.105 His nonsurgical procedure eradicated
the need for laparotomies as a diagnosis method for infertility and illustrated a shift away from
invasive surgeries for twentieth-century OBGYNs. The Rubin Test in the 1920s is just one
example of physicians willingness in the first half of the twentieth-century to explore innovative
medical techniques that would encourage women to seek treatment.
104 Margaret Marsh and Wanda Ronner, The Fertility Doctor: John Rock and the Reproductive
Revolution, (Baltimore: John Hopkins Press, 2008), 64.
105 Rubin, Nonoperative Determination of Patency in Fallopian Tubes in Sterility, 1017.


46
Although innovative diagnosis techniques like the Rubin Test made infertility treatment
less threatening for many women, it was the discovery of female sex hormones which forever
altered the medical communitys understanding of female infertility and improved its ability to
cure infertility. Doctors had speculated on the existence of sex hormones since the late
nineteenth century but were unable to prove their presence or determine the role they played in
ovulation, conception, and pregnancy. This all changed in 1923 when scientists Edgar Allen and
Edward Doisy successfully isolated estrogen followed closely thereafter with the isolation of
progesterone. Clinical research to isolate and synthesize reproductive hormones was advanced by
the Committee for Research in Problems of Sex which was established in the early 1920s and
funded by the Rockefeller Foundation.106 The Committee for Research on the Problems of Sex
funded much of the exploration of reproductive endocrinology from the 1920s to 1940 and was
largely responsible for the eventual creation of synthetic forms of hormones.107 The Committee
also funded much research on the advancement of birth control which coincided with nationwide
endorsement of eugenics and limiting family size for those less desired. The popularity of the
eugenics trend is evident not just in physicians attempts to help worthy couples to procreate but
also their attempts to limit perceived inferior groups from further procreating.108 Ironically
enough throughout much of the twentieth century infertility and birth control research coincided.
The isolation of estrogen and progesterone allowed for scientists to map the workings of the
human female reproductive cycle from the menstrual phase, through the follicular phase, ending
at the luteal phase. The knowledge of the two female sex hormones was revolutionary in the
physicians understanding of reproduction and allowed them to manipulate womens abilities to
ovulate and dramatically increase success rates for artificial insemination.
106 Marsh and Ronner, The Fertility Doctor, 162.
107 Marsh and Ronner, The Empty Cradle, 140.
108 Kline, Building a Better Race, 14-18.


47
Dr. John Rock was among the first OBGYNs to research hormone variables and apply his
findings to treat infertility in his female patients. He used meticulous research methods to collect
data and analyze his findings within his observation pools. He opened the Sterility Clinic at the
Free Hospital for Women in Brookline, Massachusetts in 1926 and devoted his practice to
assisting women battling infertility.109 Rock spent hours not just treating patients but also acting
as a research endocrinologist seeking to further unlock the secrets of hormone factors by
practicing research methods to collect and analyze data. By cataloging his patients histories, the
treatments, and outcomes he was able to refine his practice and contribute much to the overall
specialty of infertility treatment. Rock laid out his motives for treating sterility as well as his
theoretical causes and treatment methods in his 1928 article The Problem of Sterility published
in The New England Journal of Medicine. He clearly sought to end the unhappiness of his
patients but also saw his treatments as a means to better the nation and the further strengthen the
populous. He noted that:
Whatever may be the spiritual purpose in mans existence, there can be little doubt that
his physical end, like that of all other species of animal and vegetable life, is to perpetuate
his kind. The normal man or woman is endowed with an instinctive desire for offspring;
the permanency of the state depends on the replacement of its citizens; and the proper
utilization of a countrys resources to support the largest effective number of individuals
is essential to its autonomy among the nations of the world.110
He understood his attempts to help the infertile as serving a larger purpose to ensure the strength
of the nation as well as provide man with the ability to fulfill his inherent destiny to procreate.
His language was filled with assumptions that American men and women should seek an end to
sterility to be normal and perpetuate traditional families, not just for themselves but so that
America would remain free from the pressures of outside nations.
Much like John Rock, OBGYN Robert L. Dickinson believed in advancing knowledge of
the female reproductive hormones through clinical research so physicians could have the ability
109 Marsh and Ronner, The Fertility Doctor, 116.
110 John Rock, The Problem of Sterility, The New England Journal of Medicine 199 (1928): 79.


48
to treat infertility while at the same time assisting patients with limiting pregnancies. Dickinsons
medical career began in 1882, and he was among the first medical men to focus on womens
reproductive health. While he worked among early practitioners such as J. Marion Sims and had
been an active practitioner of gynecological surgeries to cure infertility, by the late 1910s he had
altered his outlook and adjusted his practice to include less invasive diagnosis and treatment
options as well as clinical research to advance understandings of endocrinology and the
reproductive system. In 1920 Dickinson retired from his private practice but devoted the rest of
his life to research through the formation of the Committee on Maternal Health.111 Much like the
Committee for the Research of the Problems of Sex, the Committee on Maternal Health was
funded by the Rockefeller Foundation, a vocal proponent of eugenics policies.112 With eugenic
principles in mind the Committee on Maternal Health initially focused on contraceptive matters
but quickly embraced infertility treatment as a means to encourage procreation of desirable stock.
The Committee on Maternal Health standardized the systematic collection of data for patients
seeking infertility treatment and provided detailed accounts of findings for other doctors to utilize
in their treatment efforts.
Dickinson and the Committee on Maternal Health are also credited with enabling the
publishing of the Samuel Meakers Human Sterility: Causation, Diagnosis, and Treatment: A
Practical Manual for Clinical Treatment. Meakers Human Sterility encouraged clinical research
as well as the investigation of noninvasive procedures, reproductive endocrinology and lifestyle
behaviors as necessary in dealing with infertile couples. He identified gradations of sterility from
absolute fertility to absolute sterility.113 He demonstrated that clinical research with clear recorded
data was essential for understanding sterility and being able to treat patients effectively. By using
111 Marsh and Ronner, The Empty Cradle, 149-151.
112 Marsh and Ronner, The Fertility Doctor, 120.
113 Samuel Meaker, Human Sterility: Causation, Diagnosis, and Treatment: A Practical Manual
for Clinical Treatment, (Baltimore: Williams and Wilkins Company, 1934), 6.


49
clinical research Meaker found that he was more successful in treating some of the gradations of
infertility and ultimately fulfilled eugenic ideals of preserving superior bloodlines by assisting
worthy couples in procreating, hi Human Sterility he argued that a fruitless marriage is one of
natures saddest tragedies, and from whatever angle it be regarded the results are detrimental to
society.114 His belief that sterility was detrimental to society led him to pursue clinical research
for infertility treatment where he embraced his eugenic understanding that reproduction of
superior families was necessary for the progression of society and such superior families must
perpetuate their numbers for the welfare of the nation.113
Clinical fertility
Threshold of conception
Clinical sterility
100--
95--
90
85---_
80--
70_
65"
60--
55_
!-50----
--45"
--40--
55_
50
Zb
20_
Absolute fertility
High grades of
relative fertility
Moderate grades of
relat ive fertility
Low grades of
relative fertility
Slight grades of
relative sterility
Moderate grades of
relative sterility
Severe grades of
relative sterility
Absolute sterility
Infertility,,*
Figure 3.1: Dr. Samuel Meakers depiction of the gradations of fertility based on his clinical
research. The numerals have no concrete significance, but serve to emphasize the gradation of the
scale. Charts published in Human Sterility in 1934.
Meakers Human Sterility set a new standard for clinical research protocol when
diagnosing and treating infertile couples especially when it came to identifying endocrine
malfunctions. Meaker detennined that efficient clinical management of sterility must include a
diagnostic study adequate to establish or rule out the presence of endocrinopathy in each partner,
114 Meaker, Human Sterility, 10-11.
113 Rock, The Problem of Sterility, 79.


50
and to identify as far as possible the primary focus when such a disorder is present.* 116 Meaker
argued that each patient should provide thorough family and personal health histories, which
would grant insight into possible endocrine deficiencies that could inhibit fertility. He linked
specific ailments with pituitary, thyroid, or ovarian malfunctions and detemiined courses of
treatments based on those findings. Since blood examinations to determine various hormone
levels were not adequate at this point, Meaker provided detailed explanations for secondary
symptoms of hormone malfunctions which would alert the practitioner to endocrine problem and
allow him to establish a course of treatment.
TABLE IX TARIX lX-CotuliM
mtmit rstaota nvm
rcr*ar vsvaots OTAST
Family history Eadocrioopathy . Detfom of unknown origin X
Obesity a* XX XX n u
Cardiovascular dims*

Abnormalities of end changes in weight Mrostrual abnoraulitim

Rapid changes u
XX X
8kin diseases . IrwguUr interval
l*e I 'b>
Keloid Arne .. Pigmentation X XX Scanty amount X X
Dywrnorrhoea IX
Rapid lues or abnormal growth of hair
Low XX
Overgrowth Uaarulimsation in female X X X Ubido

Headache XX Dimittubed X X X
Vertigo ... . X X X Focal inlwtiona. I i X
Fatigability ...
A* n Coldi and catarrh
Nervous instability X XX XXX I i X
Abnormal mental states
Neurosis X X XX
Psyehoneumets or psychosis XX X * Nocturnal enurnia in later childhood
Palpitation ... X s 1
Dyspnoea. . Hypothermia ., X
Disturbances nf vision Orular fatigue Blurring, spots, photophobia, pain Prcioi ahdominopclric operation! .. . X

Figure 3.2: Dr. Samuel Meakers Positive Data in Endocrinologic Relationships identifying his
findings of correlations between health history and certain endocrine dysfunction. Charts
published in Human Sterility in 1934.
Meaker acknowledged that infertility could be a combination of factors, and to treat the
patient die physician must attempt to remove as many impediments as possible. He believed diat
116
Meeker, Human Sterility, 158.


51
lifestyle choices influenced the patients fertility and noted the importance of weight, diet, and
exposure to toxins in a patients ability to conceive.117 While he asserted that endocrinology and
overall health were important factors for fertility, he also recognized the importance of sound
structural makeup of both partners reproductive systems. He condoned the cooperation of
gynecologists, urologists, endocrinologists, and internists to assist infertile couples with the
various procedures and treatments they may require, as he believed all parts of the human body
worked together for fertility. Although he endorsed treatment of endocrine issues for infertile
couples, this often still necessitated surgeries since synthetic hormone replacements were still in
experimental stages. While OBGYNs like Meaker sought less invasive surgical approaches to
treat infertility they often still turned to operations to treat sterile couples after diagnosing
endocrine abnormalities, and failed to identify male hormone variables.
An important contribution that Meaker provided in his Human Sterility was data on his
cured patients. Unlike Sims, he openly acknowledged that documenting successful pregnancies
following treatment was a difficult undertaking but thought it to be a crucial component of his
clinical research. He documented his success rates for treatment with his former methods and
then with present methods and found that his results with his present methods including the
use of endocrinology to be twice as good and published charts for comparing his patients
results.118 His willingness to explore less invasive diagnosis and treatment options as well as his
devotion to clinical research and follow up and documentation on the success rates of his patients
illustrates a clear difference between the medical men of the late nineteenth century and the
OBGYNs of the early twentieth century.
117 Meaker, Human Sterility, 156-158.
118 Meaker, Human Sterility, 257.


52
TABLE XIII
Result* in tSt Personal Cmm of Sterility Investtt paterf and Treated by Former
Method*
Cm*
No follow-up.............. .. ................ .. ................ .. ......... IT
Fallow-up, na pregfuuicy................................... 161
Pregnancy, wtopac ............................................... 1
miac a triage...,...... ,............................... fi
antenatal death............ .............. .... ...... ... 1
living baby.................. ............... .. .......... .. 61
total...................................................... 68 5S
Grand total............................ .. .. ..................... .. .. .. .. 338
TABLE XVI
ifca u lie m 36 Personal Case* of Sterility Investigated and Treated bp Present .1fethod*
Na foltow-up-....... ..............
Two-year folks ¥r~u.pp no pregnancy.
Pregnoxvny, ectopic...............
raufitrrhge,....... .. .r
living baby........ ....
2
16
1
2
la
total
18 IS
Grand total
35
Figure 3.3: Data collected and published in Human Sterility by Dr. Samuel Meaker regarding the
outcomes of his patients sterility treatments.
Meaker also explored the advantages and disadvantages of artificial insemination for
barren couples using Simss earlier work as a springboard. He argued that artificial insemination
had often been viewed as a last resort by his predecessors and some even viewed it as repulsive
or refused to perfonn the procedure.119 He noted that doctors before him who had attempted
artificial insemination found minimal success because they imperfectly practiced the technique
with the lack of a scientific basis. He claimed that they did not acknowledge two crucial
prerequisites that must exist for artificial insemination to be of value to a barren couple: the
semen must be of high quality and the female supracervical genital tract must be generally
normal.120 If both conditions existed he encouraged physicians to perform artificial insemination.
119 Meaker, Human Sterility, 222.
120 Meaker, Human Sterility, 222.


53
A simple technique is adequate. The time of choice falls generally between the twelfth
and fifteenth days after the beginning of menstruation. Semen may be collected in a
condom, and should be used as promptly as possible. A syringe graduated in minims is
equipped with a fine cannula long enough to pass well above the os internum. Syringe
and cannula, after being sterilized together, are immersed in water at body temperature;
the tip of the cannula should meanwhile be guarded by a cork in order to keep all of the
water out of the instruments. The cervix is exposed and wiped dry. With everything in
readiness, semen is drawn up from the condom into the syringe. The cannula is
introduced into the cervical canal... [T]wo to three drops of semen are then injected. The
patient does not require special after-care.121
Meakers procedure used the same basic principles as Sims but differed in two important
ways. First, because of his superior understanding of reproductive endocrinology he held a better
understanding of ovulation timing. His recommendation of performing the procedure between
days twelve and fifteen of a womans cycle aligns with the most common time for a woman to
ovulate. Because Sims did not have this knowledge he performed his procedures days seven to
nine which was far too early for many women to ovulate. Second, Meaker was also willing to
obtain a sperm specimen from a condom whereas Sims acquired the specimen directly from the
wifes vagina after intercourse. Sims found that asking a man to use a condom was emasculating
and vulgar for the husband. Meakers willingness to have a male patient participate in a manner
that had been previously viewed as vulgar marks a distinct difference in doctors understanding of
male accountability in fertility treatments as well as their shifting cultural perceptions of
masculinity and intercourse.
While Meakers artificial insemination method was more successful than his
predecessors, he still warned against the possible consequences of such a technique and
acknowledged that there could be backlash from the public on moral and legal grounds if a couple
used donor sperm rather than sperm from the husband. Meaker argued that if a husband was
diagnosed with permanent absolute sterility then conception was not possible for a couple unless
alien semen from a healthy donor might be artificially introduced into the wifes cervix.122 His
121 Meaker, Human Sterility, 223.
122 Meaker, Human Sterility, 214.


54
admission of the artificial insemination by donor was ground-breaking for it allowed hope to
couples who faced grim prospects for procreation, but it also raised questions about the moral,
legal, and spiritual costs.
Although he was the first physician to openly approve of insemination by donor, he
foreshadowed the possible disputes that could arise. He conceded that, aside from moral and
social objections.. .there may be legal difficulties in assuring the status of the desired child and of
protecting the physician against a charge of malpractice.. .the procedure should never be
undertaken without explicit consent of husband, wife, and donor.123 Meakers theories on the
possible problems that could arise shed light on his understanding of the impact of reproduction
on family formation and gender roles. He saw clear complications with a woman bearing another
mans child, even if that child was desired by her and her husband. The notion of artificial
insemination by donor elicited concern for Meaker, because it allowed a married woman the
opportunity to become pregnant by another man, which could have larger consequences for
society regarding the perpetuation of family names and patriarchy. Meaker was the first to openly
reveal the technique of artificial insemination by donor which exploded into a very public debate
in the mid-193 Os regarding the legal and ethical risks of such a procedure and whether or not
physicians had the authority to separate reproduction from sex.
Infertility specialists in the early twentieth-century like Rock and Meaker enjoyed much
more success with artificial insemination than earlier doctors but eventually were attacked by
observers outside of the medical community once the topic hit the public arena through the
publication of sensationalized newspaper articles and scandalous editorials. The sensational
headlines regarding artificial insemination incited public debates among doctors, lawyers, and
laypeople over reproduction, family formation, and gender roles. By the mid-1930s, doctors took
to their comers to defend their use or abstention from the practice of artificial insemination and
employed eugenic arguments and accepted notions of femininity and masculinity to make their
123
Meaker, Human Sterility, 214.


55
claims, Physicians no longer enjoyed absolute authority, like they had at the early onset of
medicalization, over all things medical and had to answer to the public regarding the treatments
they provided and what it meant for society.
Through the intervention of science:
Artificial Insemination Advocates
The publication of hundreds of news articles announcing the birth of the Lauricella twins
incited massive attention from observers outside of the medical community and officially
introduced the topic of artificial insemination into public consciousness. The public discourse
surrounding the Lauricella controversy soon revealed that doctors had been aware of the method
for some time and had already aligned themselves as either advocates or opponents of the
technique. In an attempt to defend their actions and to further encourage the use of artificial
insemination within the medical community, Dr. Frances Seymour and Dr. Alfred Koemer
became the most vocal proponents of artificial insemination during the early 1930s. In
newspapers across the nation Dr. Seymour indicated that artificial insemination was the only
answer for some couples facing sterility and that only through the intervention of science were
many women able to have children.124 She acknowledged that eight other babies had been bom
using the process of artificial insemination and that she was expecting five more births within the
next few months.125 Throughout the articles she adamantly defended her actions by asserting that
science was the only answer for these women who desperately sought motherhood.
124 Billings Gazette, May 1, 1934.
125 Billings Gazette, May 1, 1934.


56
Figure 3.4: Image of the Lauricella twins whom were conceived using the artificial insemination
technique published in The Ogden Standard Examiner, June 17, 1934.
Seymour defended the use of artificial insemination but also took the opportunity to
educate the public on the differences between two types of artificial impregnations. According to
The El Paso Herald, Seymour described that, [I]n the more common form of artificial
impregnation, the child is actually the offspring of the husband and wife except that scientific
means had been taken to assure birth.126 This type of artificial insemination was often referred to
as artificial insemination by husband, or AIH, and was seen as the most acceptable form of
assisted reproduction among the medical community. Seymour elaborated on the second type of
insemination and explained that in this type of impregnation an anonymous man known only to
the physician becomes the father.127 This kind of artificial insemination was referred to as
artificial insemination by donor, or AID, and created a rift within the medical community. Due to
Meakers Human Sterility, the medical community was already abuzz regarding the controversial
126 Test Tube Twins Bom to Mother in New York: Announcement Reveals 13 Other
Laboratory Children Living; Method Becoming Scientifically Popular. The El Paso Gazette,
April 30, 1934. The El Paso Gazette was just one of many newspapers which explored
Seymours discussion of artificial insemination by husband versus artificial insemination by
donor.
127
The El Paso Gazette, April 30, 1934.


57
treatment but the general public had been ignorant of such a technique. Seymour took the
opportunity to educate the public about its use and more importantly justify its use as an
acceptable way to cure a womans sterility. Even though it was the husband who was sterile, the
wife was still viewed as also being sterile since she could not be impregnated by her husband.
Seymours framing of this medical condition as a female burden grants insight into the
importance of motherhood and pregnancy as part of a womans identity.
On the heels of the Lauricella controversy, Seymour and her associate and husband Dr.
Alfred Koemer continued their vocal support of AIH and AID by publishing several articles in
the Journal of the American Medical Association (JAMA). In Medicolegal Aspect of Artificial
Insemination," Seymour and Koemer responded to the increased condemnation of insemination
and addressed the moral and legal concerns regarding the practice. They identified that the
physician was bound by many legal restrictions in the practice of medicine, and, however morally
certain he may feel in aiding or abetting certain acts, he must live within the legal restrictions and
also comply with the dictates of society, which form the moral code of the country.128 They
recognized the most pressing legal and moral concern of AID was the issue of the legitimacy (as
defined by the legal status of a child bom to married parents) from the technique and outlined
their process for ensuring legitimacy while ensuring that all parties involved were acting with
morality in mind.
In the article, Seymour and Koemer dismissed claims that artificial insemination was
equivalent to adultery. They contended that according to New York State law, adultery was
defined as the physical relationship between a woman or man with a partner other than the legal
mate.129 They argued that since the prospective mother did not know or even see the donor, the
technique of insemination could not be viewed as adulterous. While they handily invalidated any
128 Frances I. Seymour and Alfred Koemer, Medicolegal Aspect of Artificial Insemination,
Journal of the American Medical Association, Vol. 107, (1936): 1531.
129 Seymour and Koemer, Medicolegal Aspect of Artificial Insemination, 1531.


58
claims that AID was adultery, they recognized that the actual legitimacy of the child could be
more problematic since parentage could not be connected to the husband of the prospective
mother. To combat this criticism they urged doctors practicing the technique to use a specific
consent form which was completed by both the husband and wife. They argued that this consent
form essentially legitimatized the child under the law and established it as the legal heir of the
family unit.130 This argument justified AID by asserting that a nuclear family could still be
created and maintained through proper documentation.
Aside from Seymour and Koemers legal analysis of AID and legitimacy, their moral
defense of AID also promoted the righteousness of a nuclear family and the importance of
motherhood. They claimed that for all parties involved (mom, dad, baby, and donor), there were
positive outcomes. They argued that the mothers relationship to the husband is strengthened
after the birth of a child obtained in this manner.131 According to Seymour and Koemer, the wife
would be happy and the marriage was sturdier since their years of childlessness were behind
them. They also asserted that the wife was clearly of high moral character because she opted to
seek a physicians help rather than resort to more natural means which would have prevented her
husband from ever knowing of his sterility by bearing him one or more children by questionable
sources.132 Here they allude to the idea that a woman in an infertile marriage who was of low
moral character would turn to adultery to fulfill her desire for a child, which would inevitably
deny the husband knowledge of his infertility and cause the decay of their marital bonds. By
establishing that AID was consistent with moral and faithful behavior, Seymour and Koemer
endorsed the gendered assumption that womens happiness lay in their ability to reproduce and
please their mates.
130 Seymour and Koemer, Medicolegal Aspect of Artificial Insemination, 1532.
131 Seymour and Koemer, Medicolegal Aspect of Artificial Insemination, 1532.
132 Seymour and Koemer, Medicolegal Aspect of Artificial Insemination, 1532.


59
Aside from the positive outcomes of AID for the mother, Seymour and Koemer also
provided reflection on the benefits for the husband. They emphasized that since the husband had
been denied paternity he would sublimate his feelings and raise the child even more carefully
than he would his own.133 They argued that he would make up for infertility by being an
outstanding father. They also argued that the husband would be a better father because he knew
the child was a eugenic baby because the doctor has spent a great deal of time in procuring the
right type of donor and that if he, as the father, gives the child the proper opportunities in life
there is no limit to what he can develop him into.134 Seymour and Koemer embraced the early
twentieth century eugenics movement and used societal perceptions of the improvement of the
human race through selective breeding to further justify AID. While they spend much time
discussing the factors that would lead to the husband being a superior father, they also claimed
that the husband would appreciate his wife more for her sacrifice and willingness to undergo such
an unusual procedure. The doctors focused on the necessity of a strong marriage and reinforced
the desire for nuclear families in American culture which helped Seymour and Koemer to make
their case that AID was beneficial to not just to individual families but to society as a whole.
Just like many advocates within the medical community, social critics across the nation
relied on popular eugenic theories to endorse artificial impregnation. Columnist Jane Stafford
argued that [A]s a means of improving the race artificial impregnation with a donor may have
some value.135 She defended her positive opinion of artificial insemination by putting her faith in
the opinions of medical professionals. She told her readers that doctors were exceptionally careful
when choosing donors and they were selected for their healthiness, and freedom from inheritable
133 Seymour and Koemer, Medicolegal Aspect of Artificial Insemination, 1533.
134 Seymour and Koemer, Medicolegal Aspect of Artificial Insemination, 1533.
135 Are Laboratory Babies the First Step Toward a Race of Supermen? The Ogden Standard
Examiner, June 17, 1934.


60
disease or defect, as well as their fertility.136 She asserted that donors should also be tall and of
the same ethnicity of the mother. According to Stafford, these donors should be the most
exceptional men the nation has to offer because the children of these proxy fathers may bring us
nearer to a race of supermen.137 Newspapers around the country published editorials that
supported Staffords assumptions of a race of supermen who embodied the most desirable
physical and mental qualities and argued that although the donors were ghost fathers who were
never going to be part of their childs life, they served an important function in improving
mankind.138 Staffords arguments reflected the same pro-eugenic policies that were presented by
doctors like Rock and Meaker and suggested that families should indeed multiply but only if the
resulting children were of desirable stock.
Throughout their assessment of the medicolegal features of AID Seymour and Koemer
made it clear that doctors should wield ultimate authority over AID decision-making and act as
guardians of social morality and reproduction. They endorsed subterfuge and voluntary deception
when dealing with couples undergoing AID. They believed that the prospective mother should be
ignorant of the identity of the donor because it would block any future idle hours of imagining,
which could torture her, and it would allow her to focus her attention on the husband where it
should very properly be.139 Once again they reaffirmed the importance of a strong marriage and
validated notions of the necessity of a wifes devotion to her husband.
Seymour and Koemer also warned against using family members, such as a brother, as
donors because it would be psychologically unsound. According to Seymour and Koemer, if the
mother should know who the actual father of her child was there would be transference of her
136 The Ogden Standard Examiner, June 17, 1934.
137 The Ogden Standard Examiner, June 17, 1934.
138 Ghost Fathers: Children Provided for the Childless. Newsweek, (May 1934): 16.
139 Seymour and Koemer, Medicolegal Aspect of Artificial Insemination, 1533.


61
affections to the brother, especially if he resembles her husband, particularly if he is single.140
Assuming that a wife would fall in love with the donor provides no agency for these women and
makes her appear to be at the mercy of her biological instincts to be with the childs father.
Although Seymour and Koemer appear to be quite innovative in their legal and moral
understandings of legitimacy and AID, in reality their arguments only reaffirmed gendered
notions of proper nuclear family structure and the belief that wifehood and motherhood were
essential in the development of female identity.
While Seymour and Koemer were the most vocal in their promotion of artificial
insemination, other doctors also voiced their support for the practice. Dr. Victor Lespinasse, for
example, reported to the Chicago Tribune that he had arranged donor inseminations for couples
suffering from sterility.141 Newsweek also reported that doctors were endorsing artificial
insemination and specifically at the Marriage Consultation Center in New York, Drs. Hannah and
Abraham Stone referred desperate couples to doctors who performed AIH and AID.142 These
doctors employed the same consent form protocol as Seymour and Koemer and justified the use
of artificial insemination as a necessity for the mutual happiness of the couple and the well-being
of the wife.143 Many of the doctors demanded that all other options be exhausted before AID was
used. For instance, Dr. William H. Cary popularized the term semiadoption to refer to AID and
argued that physicians should be prepared to render the service of semiadoption to couples in
need once the infertility of the husband was established beyond a reasonable doubt.144 Although
140 Seymour and Koemer, Medicolegal Aspect of Artificial Insemination, 1533.
141 Kara W. Swanson, Adultery by Doctor: Artificial Insemination, 1890-1945, Chicago-Kent
Law Review, 87, (2012): 608.
142 Swanson, Adultery by Doctor, 608.
143 Swanson, Adultery by Doctor, 608.
144 William H. Cary, Experience with Artificial Impregnation in Treating Sterility: Report of
Thirty-Five Cases Journal of the American Medical Association, Vol. 114,No. 22 (1940): 2185.


62
several doctors did confirm that they practiced both AIH and AID, they often were not as
enthusiastic about its endorsement as Seymour and Koemer.
While some doctors were willing to come forward to discuss their use of AID as
beneficial for families and society, most doctors practiced AID in secrecy and did not publicly
acknowledge the technique. Seymour and Koemer tried to combat the secrecy of AID by
conducting a survey of physicians and publishing the findings in the Journal of the American
Medical Association. In Artificial Insemination: Present Status in the United States as Shown by
a Recent Survey, Seymour and Koemer claimed that doctors throughout the nation confirmed
9,489 pregnancies were achieved using the method of artificial impregnation.145 Of those
pregnancies two-thirds were achieved through the use of the husbands sperm alone and donors
were used in the remaining one-third.146 They emphasized the popularity of AIH among
physicians but acknowledged the growing use of AID across the nation. They established that
97% of pregnancies initiated by artificial insemination resulted in live births. Their emphasis on
the success of live births points to their attempt to legitimize artificial insemination as a viable
and safe means to treat sterility.147 Seymour and Koemer published the survey in an attempt to
justify artificial insemination by making it appear commonplace and expansive throughout the
nation. Although the artificial insemination debate encouraged some doctors to publicly endorse
their use or support of AIH and/or AID, other doctors vehemently opposed the use of such
techniques.
145 Frances Seymour and Alfred Koemer, Artificial Insemination: Present Status in the United
States as Shown by a Recent Survey, Journal of the American Medical Association, Vol. 116,
(1941): 2747.
146 Seymour and Koemer, Artificial Insemination, 2747.
147 Seymour and Koemer, Artificial Insemination, 2749.


63
Medical intervention reduces the whole matter to animalism:
Artificial Insemination Opponents
Many of the doctors who publicly condemned the practice of AI reported to newspapers
across the nation that the knowledge of the technique was as old as the Greeks, but, due to its
improper nature, it had been denounced by medical experts. Dr. W.T. Dannreuther, president of
the New York County Medical Society, was one of many physicians who declared that just
because a practice was possible did not mean it was ethical. According to the Fayetteville Daily
Democrat, Dannreuther claimed that the practice was largely discredited by experts for three
reasons: first, because it is seldom successful; second because of the danger of infection and
third, because it may result in tubal pregnancy.148 Although Dannreuther did not directly cite
evidence of these assertions, his opinion was representative of the arguments of many physicians
who opposed artificial insemination. He showed clear disdain for the use of artificial insemination
and argued that it was not in the best interest of a prospective mother to undergo such a process,
because it could cause further emotional distress if the wife did not become pregnant and fulfill
her desires for motherhood.
Dannreuther also claimed that organized medicine highly disapproved of not just the
method of artificial insemination but also the attendant publicity that Dr. Seymour was
receiving due to the announcement of the Lauricella twins.149 He stated that since Dr. Seymour
was not a member of the New York County Medical Society, an investigation into any violations
of professional ethics would be impossible. Dannreuthers disgust towards not just the technique
of artificial insemination but also Dr. Seymours public discussion of the method exemplified the
desire of the medical community to maintain control over certain aspects of reproduction by
148 Test Tube Babies Not New It Seems; Idea Ancient One. Galveston Daily News, May 2,
1934.
149 Test Tube Babies Not New Practice: New York Society Head Give Three Reasons for
Opposition." Fayetteville Daily Democrat, May 1, 1934.


64
limiting discussion of its use to doctors rather than the general public. He acknowledged
awareness of the technique but at the same time demanded secrecy concerning its use; this
contradiction highlights attempts by doctors to ultimately regulate social understandings of
reproduction and scientific intervention to assist infertility.
To reduce the media attention and public interest sparked by the Lauricella twins, the
New York Academy of Medicine quickly released a statement condemning artificial
insemination. In the release, the Academy declared that artificial insemination was not new, was
potentially dangerous, and not very effective.150 The statement was meant to reassure the public
that artificial insemination was not a conventional practice among medical professionals and that
it should be avoided as a means to treat infertility due to its contentious connection to illegitimacy
and adultery. The New York Academys adamant opposition to artificial insemination stemmed
from their attempt to maintain control over reproductive matters as increased awareness of
controversial techniques became public knowledge.
Dr. Morris Fishbein, editor of the Journal of the American Medical Association, was
another vocal opponent of artificial insemination. To denounce the practice and educate the
public on the perceived problems with such a technique, he released a statement which was
published in nearly a dozen newspapers across the country. Fishbein claimed that the idea of test
tube babies was nothing new, but due to objections to such births on moral, social, and even
legal grounds further experimentation had been prevented.151 He explained how the actual
process of insemination worked and identified that in recent years the practice had become more
popular among couples whose physical conditions prevented them from becoming pregnant.
Although he outlined how and why the process was used, he ultimately concluded that due to the
delicate nature of the process, there are numerous numbers of failures as against those of
150 Swanson, Adultery by Doctor, 608.
151 Test Tube Birth is Explained: Dr. Morris Fishbein, Editor of the Journal of the American
Medical Association."' Syracuse Herald, May 7, 1934.


65
success.152 He also endorsed adoption as a more appropriate way to add a child to an infertile
couple because it could be legally traced and did not jeopardize the perceived health of the
patient. Fishbeins analysis of artificial insemination and his endorsement of adoption for married
couples facing infertility reaffirmed the societal notion of the ideal nuclear family in the making
of identity regardless of whether or not the couple was able to procreate themselves.
Opponents of artificial insemination often pointed to the legal problems with artificial
insemination and specifically denounced the technique because it created illegitimate children.
According to an anonymous editorial in The Journal of the American Medical Association, [I]f
the semen of the husband is used, the child obviously is as legitimate if it were the result of
normal and usual intercourse between husband and wife.153 To this author AIH was an
appropriate treatment for sterility because it did not allow for a third-party (a donor) to enter into
the marriage. The author argued that if the semen from some other male is utilized, the resulting
child would seem to be illegitimate and have no claims to inheritance from the family because it
was bom out of adulterous circumstances.154 The problem for the author is that AID ultimately
allowed the wife to bear a child from another man and disrupted traditional understanding of
marriage and marital vows of fidelity as well as the importance of heredity in the perpetuation of
family names and customs.
The author of this editorial addressed Seymour and Koemers advice to use a consent form
to ensure legitimacy but dismissed this as unsatisfactory. He argued that the fact that the
husband has freely consented to the artificial insemination does not have a bearing on the
question of the childs legitimacy.155 Use of a form did not rectify the occurrence of illegitimacy
152 Syracuse Herald, May 7, 1934.
153 Artificial Insemination and Illegitimacy. The Journal of the American Medical Association.
Vol. 112, (1939): 1832.
154 Artificial Insemination, 1832.
155 Artificial Insemination, 1832.


66
but rather just proved that the husband consented to his wifes adultery. Therefore, the child
remained illegitimate. Interestingly, while the author clearly favored AIH and found AID to be
problematic due to the legal issues of legitimacy, he did acknowledge that AID was going to be
used regardless and urged doctors to use absolute secrecy with patients and endorsed formal
adoption of the resulting children. To him, adoption of the child by the husband of the mother
after birth was the only true way to protect the child from a life of illegitimacy and ensured that
the child was the product of a proper marriage.
Judge Joseph Sabath, a Chicago divorce jurist cited in many of the articles published on the
test-tube technique, concurred with the opinion published in JAMA and declared that any
children bom under the synthetic method would be illegitimate until adopted by the father.156
According to the arguments of the editorial and Judge Sabath, fathers of babies bom using
artificial insemination had to depend on legal means to certify parentage. This line of reasoning
used by opponents of artificial insemination illustrates the desire of doctors (and to some extent
lawyers) to maintain control over what they considered appropriate reproduction and endorsed the
creation of a nuclear family that would be recognized in the eyes of the law through formal
adoption.
The issue of introducing a third-party into a marriage provoked a response from not just
doctors and lawyers but community members as well. Following the public announcement of the
birth of the Lauricella twins, the Catholic Church responded with sound disapproval. According
to The Galveston Daily News, Reverend George Craig Stewart, bishop of the Episcopal Diocese
of Chicago, condemned every substitute for normal parenthood and argued that medical
intervention reduces the whole matter to animalism.157 The Reverend claimed that the Church
cherished the spiritual view of marriage and that the addition of an outsider into a marriage defied
156 Galveston Daily News, May 2, 1934.
157 Galveston Daily News, May 2, 1934.


67
the sacramental union.158 The Church viewed the separation of sex from reproduction as an
abomination and a direct challenge to the institution of marriage. Doctors and spiritual advisors
alike were uncomfortable with the notion that a donor was welcomed into a traditional marriage
thus violating acceptable understandings of fidelity and family structure.
Criticisms from the general public also appeared in editorials and mimicked the arguments
of doctors and spiritual leaders. Social critic Florence W. McGehee argued that people bom from
this technique would be cold, calculating, eye-to-the-main-chance creatures without any nice
human frailties about them.159 She assumed that babies who were the product of artificial
insemination would inevitably be inferior humans due to their scientific beginnings and lack of a
traditional family structure, since the identity of a father could not be confirmed. Her opinion
relied heavily on the opinions of those doctors who opposed artificial insemination and reinforced
societal notions of proper formation of a nuclear family.
Lillian G. Genn, another social critic, analyzed whether or not test tube babies were normal
human beings in an editorial published in The Oakland Tribune. According to her interview with
Henry Fairchild, professor of sociology, in cases where an unknown man was used for
insemination no one can foretell the physical characteristics through a microscope and the
family history would be unknown.160 Genn argued that not knowing a childs heredity could lead
to many uncertainties about the type of person the test-tube baby would become; it could turn out
to be a midget, giant, honor student, or criminal.161 Genn concluded that test tube babies were
indeed normal but could face more challenges in life if they were the product of AID and
especially if they were the product of an unmarried mother.
158 Galveston Daily News, May 2, 1934.
159 Artificial Babies. Woodland Daily Democrat, May 10, 1934.
160 Are Test Tube Babies Normal Human Beings? The Oakland Tribune, June 24, 1934.
161
The Oakland Tribune, June 24, 1934.


68
Figure 3.5: Illustration depicting the possible outcomes of artificial insemination by donor
published in The Oakland Tribune, June 24, 1934.
Florence McGehee highlighted a major point of contention addressed by doctors and critics
on both sides of the argument, die insemination of unmarried women. She opined that
[Ujnmarried women with a strong wish to become mothers while keeping that so-desirable
independence go in for the test-tube baby thing. She clearly took issue with single women using
this method but suggested die distinctive yearning for motherhood was strong enough for women
to resort to artificial insemination. In spite of her acknowledgement of the innate desire for
motherhood by unwed women, she argued diat this was a selfish choice. To her, these mothers
were bringing forth unfathered children, and their test-tube babies would be cheated out of
having a father and would always wonder about their papa.162 She argued that children had the
right to a mother and a father, and when the test tube baby was grown he/she would certainly be
at a disadvantage in society because of a lack of knowledge of family history and a traditional
upbringing. McGehees editorial endorsed a nuclear family structure as the only appropriate
arrangement and frowned on medical intervention to create babies even in the face of a woman's
unrelenting desire for motherhood.
162
Woodland Daily Democrat, May 10, 1934.


69
Prior to Seymour, physicians specializing in infertility only saw couples and did not even
mention single men or women in their findings. Married couples were the only patients worthy of
receiving medical attention for their infertility, for they were denied their cultural right to
procreate and create a nuclear unit. Dr. Seymour however changed this ideology and admitted to
inseminating single women and received harsh criticism from doctors as well as social critics.
Her opponents argued that she was advocating for the destruction of American values since she
allowed for single women to have children without husbands. Those who challenged Seymours
insemination of unwed women were uncomfortable with the removal of sexuality from
reproduction and felt it made a mockery of the sacred bonds of marriage. Their belief that single
women should not be inseminated reinforced the traditional belief that a nuclear family was
essential to American culture and a womans role as both mother and wife was essential to her
identity and the well-being of her children.
Seymour combatted the criticisms of AID for unmarried women and defended her choice by
emphasizing the eugenic possibilities of such a practice. She argued that the donors were in good
health and of better than average height.163 She also emphasized physician control over the type
of women who would be candidates for such a procedure. Specifically, she referred to two
unmarried women she inseminated who desperately wanted motherhood. According to the
Manitowoc Herald Times, she believed that regardless of a womans marital status, she had a
right to have children.164 She justified her decision by stating that the women were prominent
businesswomen who could be able to financially and emotionally care for the children. Her
assertion that only a certain type of woman should be given access to single motherhood
reiterated physician control over reproductive matters while maintaining that maternal instinct
was strong enough to break traditional social norms.
163 Twins are Bom Via the Test Tube Route. Manitowoc Herald Times, May 1, 1934.
164Manitowoc Herald Times, May 1, 1934.


70
Conclusion
Infertility physicians in the first half of the twentieth-century embraced less invasive or
nonsurgical techniques for diagnostic purposes and opted for treating the entire patient rather than
just the reproductive system. These physicians used the same language as their predecessors to
justify their treatment of patients and believed it was their medical obligation to provide women
the opportunity to fulfill their roles as mothers and provide men the opportunity to prove their
virility by becoming a patriarch. While OBGYNs did have some of the same motivations for
treatment as those before them, they differed somewhat from the nineteenth century medical men
in that they were more influenced by the popular eugenic movement in America. Much of their
work illustrated a clear desire to improve the human race by allowing worthy couples to procreate
and assist others who were viewed as undesirable in limiting pregnancies. They saw their work as
not just assisting an individual couple but as a noble duty which elevated the entire nation.
These OBGYNs separated themselves from the nineteenth century medical men by
incorporating clinical research and new understandings of reproductive endocrinology into their
courses of treatment for patients facing sterility. Whereas medical men viewed the reproductive
system as functioning independently of other body parts, OBGYNs recognized the cohesiveness
of the human form and elected to treat the overall patients health. Their treatments typically
addressed internist, endocrine, and surgical needs while incorporating both the husband and wife.
However, even if the husband was included in diagnostic attempts the brunt of treatment
procedures still lay with the wife, as she underwent various procedures and examinations.
OBGYNs in the early twentieth century expanded overall knowledge of male infertility, but just
like their predecessors they neglected to establish any clear courses of treatment devoted to the
male form. Instead they circumvented mens sterility in terms of inadequate sperm by improving
and expanding the practice of artificial insemination.
With increased knowledge of reproductive endocrinology the practice of artificial
insemination became a more viable option for infertile couples, and its success rates dramatically


71
increased in the first half of the twentieth-century. While the artificial insemination technique
became more popular among infertile couples, the debates over its use prompted physicians to
defend their use of it or condemn it altogether. Advocates as well as opponents of artificial
insemination relied on accepted understandings of nuclear family structure to make their claims.
In spite of the contrasting arguments made by people on both sides of the debate, each side relied
on gendered principles of motherhood, marriage, and family structure to defend their positions on
the medical intervention into infertility.
Professional and public assumptions about the inevitability of motherhood and the
prominence of a nuclear family structure fueled the debate over artificial insemination in the
1930s and led many to question the medicalization of infertility. Doctors, lawyers, and critics on
both sides of the argument justified their positions using gendered language that rested on the
assumption that women wanted to be mothers and that motherhood should be granted to all
women (as long as they were married, in the eyes of the opponents.) Those in favor of artificial
insemination claimed that they provided the possibility of pregnancy to women facing
childlessness and filled the void caused by their husbands infertility, whereas those who opposed
insemination argued that women facing childlessness should still have access to motherhood but
only through adoption. Whichever position doctors took, they argued that they had the best
interest of prospective mothers in mind and that they knew better than these women what action
should be taken to add a child to their family. The medical community defended its positions by
claiming their desire and right to protect women and motherhood and ultimately asserted
authority over artificial insemination and reproduction.
Eventually Lillian Lauricella denied that her twin daughters were the product of artificial
insemination. In the wake of the sensationalized media coverage she opted to downplay her
familys tie to the controversial procedure and quietly settle down. Dr. Frances Seymour and Dr.
Alfred Koemer, however, took the opposite approach. They used the publicity from the Lauricella
twins to further their research of assisted reproductive technologies and continued to endorse the


72
procedure for the rest of their careers. By 1945, artificial insemination had been accepted by the
majority of the medical community as it was seen as a valiant effort to repopulate after a horrific
World War and encouraged the baby boom ambitions of the post war years. However,
controversy would soon return to the front page of newspapers as infertility physicians advanced
assisted reproductive technologies even further by promoting the idea of extra-uterine conception


73
CHAPTER IV
IN VITRO FERTILIZATION IN HUMANS, 1934-1981
Couple Suing Doctor In Death Of Their Test-Tube Offspring
NEW YORK Ethical and legal dilemmas posed by so-called test-tube babies will
surface in court today when a Florida couple seeks damages from a doctor they claim
destroyed their offspring. John and Doris Del Zio, of Fort Lauderdale, Fla., seek $1.5
million from Columbia Presbyterian Medical Center and its chief of obstetrics and
gynecology, charging that a laboratory-fertilized embryo was maliciously and
arbitrarily destroyed in 1973, three days before it was to be implanted in Mrs. Del Zios
womb... Lesley Brown, a British housewife, is waiting to give birth within the next few
weeks in Oldham, England, to a child who was conceived in a laboratory test-tube. If
Mrs. Brown carries successfully to term, it is believed it will be the first case of a
laboratory-fertilized human egg being carried to birth... The Del Zios say they would
have had the first such child but for a doctors decision to destroy their fertilized egg
because of his qualms about the morality of the procedure...165
Santa Ana Orange County Register Evening, July 17, 1978
Doris Del Zio had been under the care of OBGYN and infertility specialist Dr. Landrum
Shettles for nearly two years. She had been diagnosed with blocked fallopian tubes six months
after her marriage to husband John Del Zio. After three failed surgeries to correct her tubes, the
Del Zios were running out of options. After conferring with Dr. Shettles, Mrs. Del Zio agreed to
participate in a new experimental procedure known as in vitro fertilization (IVF) in hopes of
achieving pregnancy. The process of IVF was described to the Del Zios as the fertilization of an
egg outside of the body in a petri dish or test tube and then the eventual transfer of the embryo
back into the uterus.166 While Dr. Shettles was confident that the procedure would be a success it
had never been achieved in human beings and would require Mrs. Del Zio to adhere to a strict
hormone drug regimen and eventually undergo surgeries. In spite of the complexity and
uncertainty of the new technique, the Del Zios eagerly agreed to participate since the process
165 Couple Suing Doctor In Death Of Their Test-Tube Offspring. Santa Ana Orange County
Register Evening, July 17, 1978.
166 Brave New Baby Aborted Before Conceived: Moral-Minded Skeptic Halts First Test-Tube
Attempt. Lima News, July 13, 1978.


74
would ultimately allow them to bypass Mrs. Del Zios blocked tubes and give them the
opportunity to have their own child.167
On September 12, 1973 Doris Del Zio underwent painful abdominal surgery where
follicular fluid containing eggs was removed from her ovaries.168 The eggs were put in an air-
tight beaker to maintain a sterile environment and taken across town to the office of Dr. Shettles.
Mr. Del Zio provided Dr. Shettles with a fresh sperm specimen which was then mixed with the
eggs and placed in a hospital incubator to mimic the temperatures of a natural womb. Within
three days time, embryos would be formed and surgically positioned back into Mrs. Del Zios
uterus by Dr. Shettless colleague and gynecological surgeon Dr. William Sweeney. However,
before the newly formed embryos could be placed back into Mrs. Del Zios womb, they were
purposefully destroyed by the hospital chief OBGYN Dr. Raymond Vande Wiele.169
Dr. Vande Wiele had fought with Dr. Shettles for some time regarding proper hospital
protocol, and when he learned about the extra-uterine conception experiments he took what he
believed was the moral high-ground and destroyed the monstrosity of the in vitro embryo.170
Mrs. Del Zio was devastated to hear that her last chance of pregnancy was foiled and that her
unborn child was maliciously and arbitrarily destroyed.171 Eventually the Del Zios sought
justice for the loss of their unborn child and sued Columbia Presbyterian Medical Center and Dr.
Vande Wiele for $1.5 million.172 The media descended on the court case as it went to trial in 1978
and once again legal, medical, and lay communities clashed over who ultimately held authority
161 Lima News, July 13, 1978.
16S Lima News, July 13, 1978.
169 Lima News, July 13, 1978.
170 Halted Test-Tube Baby: Woman Wins Lawsuit. Annapolis Capital, August 19, 1978.
171 Santa Ana Orange County Register Evening, July 17, 1978.
112 Annapolis Capital, August 19, 1978.


75
over reproductive matters and the impact of advanced reproductive technologies on gender,
family, and faith.
The 1930s had witnessed an amazing amount of change in the medicalization of
infertility in the United States. Artificial insemination was being used more frequently by
OBGYNs than it had been in the past and with much more success than in previous years. The
discovery of hormone variables and the incorporation of less-invasive techniques into treatment
protocols encouraged more women to seek assistance in ending their sterility and prompted
doctors to become more outspoken regarding new methods. When news of successful artificial
insemination births hit the news, open debate ensued as doctors, lawyers, clergymen, and the
general public all weighed in on the legal and moral consequences of artificial insemination.
Specifically, much of the debate surrounded the use of donor sperm for insemination. Those
against artificial insemination by donor (AID) argued that if a wife carried a baby that was of
another mans sperm then she, in essence, was adulterous. To those opposed, AID undermined
the institution of marriage by removing reproduction from sex and allowing a third party into a
sacred union of two. On the other hand, those who promoted AID argued that it allowed couples
to fulfill their innate desires for parenthood while promoting popular eugenic ideals of the era.
Both sides of the artificial insemination debate used cultural constructs of marriage, family
structure, and gender roles to make their arguments. The heated debate that was sparked in 1934
reduced to a simmer by the early 1940s as infertility became a staple topic of popular journalism.
By the 1940s the assisted reproductive technique of artificial insemination was common
knowledge for the public, and doctors continued to use science to push the laws of nature in an
attempt to aid infertile couples. While AIH and AID allowed doctors to assist many infertile
couples, it was still not a perfect fit for all patients. OBGYNs struggled to assist sterile women
who suffered from blocked fallopian tubes or men who had poor sperm counts or quality. The
delicate fallopian tubes did not respond well to surgeries, and physicians had not found successful
techniques that improved sperm quality or quantity. Artificial insemination was not a viable


76
option for these patients because, with blocked tubes, there was no egg to fertilize, and with poor
spermatozoa quality and counts, the sperm was unable to fertilize an egg even with the placement
of the sperm using an impregnating syringe. The ground-breaking research of the 1930s regarding
hormones and artificial insemination provided the foundation for physicians to explore other
options that could hopefully assist their toughest infertility cases. Specifically, they began
developing techniques that would remove all conception from the human body and place it within
the laboratory thus bypassing troublesome tubes or sperm.
By the late-1930s, OBGYNs began experimenting with in vitro fertilization (which
literally translates to in glass) as a way to treat infertile patients and further medicalize the
condition.173 The physicians aimed to remove the egg from a patient, fertilize it in a petri dish,
encourage the growth of an embryo by mimicking the conditions of the natural womb, and finally
place the embryo back into the uterus where a woman would then enjoy a normal pregnancy.
They intended to circumnavigate any issues that were preventing pregnancy by removing the
entire process of conception from the human form. Whereas the doctors of the first half of the
twentieth century viewed the body as a single entity working in accord, the doctors of the latter
half of the twentieth century viewed the body itself as problematic and established techniques
where the process of conception could be done outside of the body. The process of human IVF
proved to be extraordinarily challenging for doctors to perfect and revived the controversies of
artificial insemination as the public became aware of such experiments.
Doctors like Gregory Pincus, John Rock, and Howard and Georgeanna Jones all worked
during the latter half of the twentieth century to make test-tube babies a reality and faced much
public attention for their developments concerning assisted reproductive technologies and the
medicalization of infertility. Although these doctors no longer operated within the context of the
eugenics movement, many of them worked during the frantic pronatalist movement of the post-
World War II years. The pronatalist environment provided them with more public support for
173
Lima News, July 13, 1978.


77
their efforts. These doctors also worked during the height of various civil rights movements and
the Cold War, which were all key developments that influenced the types of techniques they
developed as well as how they were perceived by society. Even if infertility specialists enjoyed
growing popularity with the push for babies, they still faced harsh criticism from religious leaders
and those who were concerned with the moral and legal repercussions of such a practice. By the
1970s, feminist advocates also began to question doctors motives for developing IVF as an
attempt to commodify womens reproductive capabilities and condemn them to a life of
inevitable motherhood. From 1945 onward, fluctuating expectations of parenthood and the
demand for social, political, and economic equality for numerous groups such as African
Americans, women, and same-sex couples influenced the types of techniques infertility
physicians developed as well as public perceptions of the medicalization of infertility and medical
intervention into human reproduction.
If the experiment could be applied to human beings, it would eliminate the part of the male
and make possible test-tube babies:
Gregory Pincus and the In Vitro Fertilization of Rabbits
In 1932, Aldous Huxley published Brave New World and introduced the public to his
imagined dystopia, which lay in the not-so-distant future. Huxley envisioned a world where
natural reproduction had been abolished and human embryos were raised artificially in hatchery
and conditioning centres.174 His fictitious novel presented a view of technological advancement
where the controlling dictatorship (The World State) established stability and order by
conditioning its citizens to accept their station in life. This was established by breeding children
in labs and placing them into a caste system upon birth where they were subconsciously educated
and denied independent thought. Huxleys frightening vision captivated the public and exposed
societal fears regarding the advancement of technology and the use of science to reproduce.
Although artificial insemination was on the rise and gaining more public attention by 1932,
174 Aldous Huxley, Brave New World (New York: Doran and Doubleday, 1932), 1.


78
notions of in vitro fertilization (IVF), or the growing of human embryos outside of a womans
womb, were still just something of the storybooks. Huxleys vivid narrative describing embryos
being grown outside of the human body in laboratory incubators was the first novel to address the
possibility of IVF and anticipated the work of infertility physicians in the latter half of the
twentieth century. His negative view of reproductive technologies sheds light on the disdain many
felt for medical intervention in sterility cases and the fear and uncertainty associated with
scientific reproduction and the possibly damaging societal consequences that could accompany
such a technique.
The fabricated world in Huxleys book became far too real for many Americans just two
short years after its publishing when Harvard University biologist and researcher Dr. Gregory
Pincus (later known for his work with the development of the birth control pill) reported that
baby rabbits, developed from eggs that were fertilized outside the mothers body and brought to
birth in the body of a second mother rabbit, have been produced.175 Scientists of all sorts were
captivated by Pincuss declaration and research journals around the nation published professional
commentary on his successful use of ectofertilization.176 In the March edition of The Science
News Letter the authors explained Pincuss technique:
To produce their "ectofertilized" rabbits, the Harvard scientists first mated a female rabbit
with a male which had been rendered incapable of producing sex cells by a simple
surgical operation. The mating act stimulated the first steps in the development of the
ova, or female sex cells, which however, still remained unfertilized. Then the ova were
removed from the mother rabbit's body and placed in a suitable fluid in a glass vessel.
Sperm from a normal male rabbit was added, and allowed to remain with the ova until
each one had received the fertilizing male cell. Certain changes observable under the
microscope indicated to the watchers that this process had taken place. In the meantime,
the "foster-mother" rabbit had been prepared for her role by being mated with another
male incapable of producing functional sex cells. Into her maternal tissues, thus
stimulated to activity, the ova of the other rabbit, fertilized in a glass vessel with the
175 Baby Rabbits Bom Normally after Fertilizing in Glass, The Science News Letter, Vol. 25,
No. 674 (1934): 149.
176 Baby Rabbits Bom Normally after Fertilizing in Glass, 149.


79
sperm of a male she had never seen, were introduced. They developed, and in due time
the young rabbits were brought forth.177
Pincuss success galvanized the scientific community as researchers raised interesting questions
regarding the moral implications for creating a process that could eventually be accessible to
human beings. Researchers articulated many concerns regarding the process and its consequences
for ectogenesis for human procreation, but two distinct concerns appeared to stand out among the
others and elicited a response from not just the scientific community but that of general public as
well: the idea that the baby rabbits were in essence fatherless and that the offspring were only
females.
Newspaper articles published on the Pincus experiments highlighted the anxiety felt by
many over the belief that the baby rabbits were in principle fatherless and that they had been
purposefully made to be female. According to the Logansport Pharos Tribune, Pincus had
asserted that the offspring from such a process would be females since the necessary
chromosome for creating males would be absent.178 The realization that only female rabbits had
been produced provoked much concern from the public as journalists surmised that if the process
was used in humans a manless world would be created where the human race would be
composed entirely of women.179 The dozens of newspaper articles published on the Pincus
experiments surprisingly give little detail regarding the process itself and focus much more on the
catastrophe of a female-only race possibility. The journalists fascination with the gender of the
rabbits grants insight into the fears of IVF and its possible impact on the roles of men and women
in the family and in society. Specifically, if women were able to reproduce without men, the
media assumed they would do just that and eliminate the part of the male and make possible
177 Baby Rabbits Bom Normally after Fertilizing in Glass, 149.
178 Rabbit Fertilization Experiment a Success, Logansport Pharos Tribune Saturday, March 28,
1936.
119 Athens Messenger, April 2, 1936.


80
test-tube babies.180 This prospect appeared to alarm the public as it would make men obsolete
and allow women to dominate the population and become superior within society. This notion of
a female dominated populous where men were no longer needed for reproduction visibly rattled
the public.
Pincuss IVF work with rabbits became further entrenched in controversy in 1939 when
he announced that he had synthetically fertilized a rabbit egg outside of the womb without the use
of sperm.181 The process known today as parthenogenesis is a form of asexual reproduction in
which the growth of an embryo happens without fertilization, a development which commonly
occurs in invertebrate species.182 Pincus explained he had produced that rabbit by fertilizing the
ovum of a female rabbit with a saline solution instead of cells and later transplanted the fertilized
ova to another female rabbit whose body developed it to normal birth.183 Along with the saline
solution, Pincus declared the same results could be achieved by exposing the ovum to various
temperature changes or hormone treatments.184 Popular media grabbed hold of the scientific
development and sensationalized the story by questioning what fatherless rabbits meant for the
future of mankind, especially because rabbits produced in such a manner would continue to be
female. According to Time Magazines coverage of Pincuss breakthrough, normally the male
spermatozoa is what determines the sex of the offspring... .since there is no spermatozoa in the
case of the fatherless rabbit, therefore there is no male-determining pattern and the progeny is
female.185 Once again concerns regarding the gender of the rabbits consumed media attention as
180 Logansport Pharos Tribune Saturday, March 28, 1936.
181 Synthetic Rabbit, Whose Father was a Solution of Ordinary Table Salt; Her Offspring All
Female, Danville Bee, November 3, 1939.
182 Science: Pincogenesis, Time Magazine, Vol. XXXIV, (1939): 39.
183 Danville Bee, November 3, 1939.
184 Science: Pincogenesis, Time Magazine, 39.
185 Science: Pincogenesis, Time Magazine, 39.


81
the general public feared a world where humans could be reproduced without fathers and would
only be of the female sex.
Fatherless Rabbit & Dr. 1incvs
Gmirtintct ii not ti disturb, . .
Figure 4.1: Dr. Gregory Pincus and his fatherless rabbit produced through the process of
parthenogenesis appearing in Time Magazine in 1939.
Pincuss experiments with parthenogenesis have never been recreated by scientists and
have since been dubbed Pincogenesis.186 In spite of the failure to recreate the process that led to
the fatherless babies, the reaction from the public during the experiments grants interesting
perspective into mid-twentieth century understandings of assisted reproduction. Scientists as well
as the general public demonstrated concern over the possibility of IVF and parthenogenesis in
humans and the ability to altogether eliminate men from human procreative processes and the
creation of an all-female human race. The anxieties present within newspaper and magazine
articles demonstrate the value that was placed on a nuclear family structure (dad, mom, and
children) in American culture in the mid-twentieth century. The notion of fatherless babies
frightened the nation as people believed it would cause a disruption in traditional understanding
of parental roles and societal perceptions of the stronger vs. the weaker sex. At the heart of the
Pincus controversy is the fear of upsetting accepted cultural constructs of male authority and
186 N. T. Werthessen, R. C. Johnson, PincogenesisParthenogenesis in Rabbits, Perspectives
in Biology and Medicine, Vol. 18, (1974): 86-88.


82
female submissiveness within the family unit and society as a whole. People feared that if
science intervened in infertility cases or even became the sole source of reproduction it could lead
to the demise of conventional cultural gender expectations. Regardless of the fears expressed with
Pincogenesis, Gregory Pincuss legacy in terms of assisted reproductive technologies cannot be
overlooked, because it served as a foundation for future IVF endeavors while allowing interesting
insight into public perceptions of scientific reproduction and gender norms in the mid-twentieth
century.
Although this is technically the first actual step in test tube babies which for years have
been rumored in laboratories, the experiments indicate absolutely no way to produce babies
artificially:
The Rock-Menkin Extra-Uterine Human Embryo Trials
While Gregory Pincus published his experimentations with rabbit embryo growth, Dr.
John Rock and lab technician Miriam Menkin began their work to fertilize a human egg outside
of the natural womb. Rock had long been involved in infertility research and had been on the
cutting edge of reproductive endocrinology advancement at his research center located in the
Sterility Clinic at the Free Hospital in Brookline Massachusetts.187 His associate Miriam Menkin
had wanted to become a doctor but settled as a technician to assist putting her husband through
medical school.188 Together the two (with the eventual assistance of Dr. Gregory Pincus) worked
for six years to fertilize a human egg outside of a womb and in 1944 they published their
groundbreaking research on the first successful fertilization of human ova outside of the human
body.189
187 Marsh and Ronner, The Fertility Doctor, 45-52.
188 Stephen Ruffenach, "Rock-Menkin Experiments. Embryo Project Encyclopedia, last
modified September 25, 2013, accessed July 5, 2015, http://embryo.asu.edu/handle/10776/1963.
189 Artificial Fertilization, The Science News Letter, Vol. 46, (1944): 99.


83
In 1944, Rock and Menkin published In Vitro Fertilization and Cleavage of Human
Ovarian Eggs in Science and impacted the evolution of assisted reproductive technologies.
While their advancement in the growing of human embryos was seen by many inside and outside
of the medical community as the eventual inevitability of test-tube babies, Rock and Menkin
staunchly declared that they had no intentions to see the experiment through the birth of a child,
and ultimately the purpose of the study was to understand the earliest moments of conception and
gather information on the rather baffling problem of human sterility.190 The coverage of their
success began as technical in nature but eventually became increasingly sensationalized, much
like the coverage of the Pincus experiments had unfolded. The Science Newsletter published the
work of Rock and Menkin and detailed the process which they had used to achieve the
extraordinary:
[T]he human eggs for the experiments were obtained from the ovaries of women who
found it necessary to lose them through surgery in order to save their own lives. Careful
searching was needed to find unfertilized eggs at the right stage for further development.
These were nourished on human blood serum in glass dishes... [N]ormal male
spermatozoa were released in the dishes, and carried out the fertilization. The three-celled
stage, and one of the two celled stages, were subsequently fixed, stained and sectioned
for closer microscopic work and for permanent preservation.191
The clinical description of the process of in vitro fertilization of human ovum highlighted a
detachment present in the early accounts of the revolutionary technique. The clinical and
somewhat cold reporting of the success of Rock and Menkin soon turned much more emotional
as the general public was made aware of the scientific breakthrough and popular media embraced
the topic.
In the early 1930s, artificial insemination (by husband and donor) had aroused anxieties
regarding the legality of such a procedure and legitimacy of the offspring produced in such a
manner. By 1945, the Rock-Menkin experiments had reinvigorated the debate on assisted
reproductive technologies and the legitimacy of children who might be produced using the test-
190 Artificial Fertilization of Human Ova Succeeds, Hattiesburg American, August 4, 1944.
191 Artificial Fertilization, The Science News Letter, 99.


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tube method. Although the actuality of producing children in this manner was still far from
reality, the creation of human embryos outside of the human womb once again provoked strong
responses from the general public and the Catholic Church. The Catholic Church had long been
uncomfortable with scientific interference in reproduction but found new reason to be alarmed
with the success of the Rock-Menkin trials. The Church anticipated the eventual possibility of the
birth of test-tube babies, and in 1949 Pope Pious XII, speaking at the Fourth National Convention
of Catholic Physicians, condemned the use of spousal and donor insemination as well as the
creation of human embryos outside of the body.192 The Catholic Church adamantly opposed the
use of medical intervention for reproduction and asserted that married couples were not
guaranteed the right to children and disruption of the natural act of conception was immoral and
to be rejected.193 The Church contended that it was Gods will if a couple was to reproduce and ti
was immoral for them to assert they had a right to have children. Catholic Church argued that
reproduction and sex should remain linked to continue to protect the sacred bonds of marriage.194
Although the Catholic Church promoted pronatalist ideologies, the interference of science into
the natural process of reproduction was unacceptable. John Rock was a devout Catholic and
struggled immensely with the criticism he received from the Catholic Church over the course of
his research. Eventually he abandoned his work with human embryo growth and focused the
remainder of his career on the development of an oral contraceptive that led to Rocks eventual
very public showdown with Catholic leaders who adamantly opposed birth control and the
invention of the pill.
192 Albert R. Jonsen, The Birth of Bioethics, (New York: Oxford University Press, 1998), 304.
193Pope Pius XII, Discourse to Those Taking part in the 4th International Congress of Catholic
Doctors, September 29, 1949: AAS 41 (1949) 560.
194 Discourse to Those Taking part in the 4th International Congress of Catholic Doctors, AAS
41 (1949)560.


85
Elizabeth was the first infant born in the United States who was conceived in a laboratory
dish, a procedure called in vitro fertilization:
The Births of the First Human Test-Tube Babies
In the frantic pronatalist post-World War II years, unprecedented numbers of infertile
couples sought medical advice for their childlessness.195 According to historian Paul Starr, the
research funds that began to pour into medical training within a decade or so after World War II
radically altered academic medicine.196 This alteration in academic medicine was marked by
the establishment of federal funds for research and increased support from private foundations
and pharmaceutical companies. Medical practitioners of all sorts benefitted from the increased
financial support, but infertility specialists works were funded particularly well by government
subsidies, due to the societal push for increased birth rates. According to historians Margaret
Marsh and Wanda Ronner, many infertility physicians established their own stand-alone clinics
which were dedicated to the treatment of sterility and research that could benefit the childless.197
Their practices thrived in the frenzied pronatalist climate of the early Cold War, and something
of a boom in infertility treatment emerged alongside the baby boom in postwar America.198
Countless couples sought out the assistance of infertility specialists and OBGYNs used their new
funding to develop new techniques and procedures.
Many of the OBGYNs who focused on sterility in the 1950s continued to use such
techniques as tubal insufflation, gynecological surgery, and artificial insemination to treat their
patients but they also worked to improve reproductive endocrinology. Using the earlier work of
Dr. John Rock, postwar infertility specialists focused on developing fertility drugs that could
195 Marsh and Ronner, The Empty Cradle, 209.
196 Starr, The Social Transformation of American Medicine, 352-353.
197 Marsh and Ronner, The Empty Cradle, 181.
198 Marsh and Ronner, The Empty Cradle, 183.


86
assist women with ovulation.199 Dr. C. Lee Buxton was among the pronatalist physicians who
focused on fertility drug development and in 1963 he developed a technique which took the
pituitary secretions from women who died during their childbearing years and created an
injectable hormone serum that could encourage ovulation in women suffering from ovulatory
dysfunction.200 He experienced hopeful success and soon after other infertility doctors followed
suit by developing their own fertility cocktails for non-ovulating women. Specifically, the
development of the popular fertility drug Clomid and others like it came out of the postwar
pronatalist era and gave hope to infertile women across the nation. The fertility drugs developed
during the 1950s and 1960s not only assisted infertile women with reclaiming their reproduction
but allowed for further advancement with human IVF experiments and the eventual birth of the
first IVF babies.
By the 1970s, IVF had entered the public consciousness, but funding for infertility
research and the pronatalist frenzy had slowed. In spite of less funding and continued questions
regarding the morality of assisted reproductive techniques, doctors continued to push the limits of
science in the hopes of achieving improved rates of successful pregnancy for their infertile
patients. Dr. Landrum Shettles was among OBGYNs in the latter years of the twentieth-century
who hoped to make IVF a reality. In 1960, he replicated the Rock-Menkin experiments by
producing human embryos outside of the natural womb and published colored photographs of the
miraculous first moments of human conception in Ovum Humanum: Growth, Maturation,
Nourishment, Fertilization, and Early Development201 His work shed light on the process of
human conception and offered opportunities for further experimentation with IVF in humans.
199 Marsh and Ronner, The Empty Cradle, 208.
200 C. Lee Buxton, The Effect of Human FSH and LH on the Anovulatory Ovary, typescript of
paper presented at the annual meeting of the American Gynecological Society, May 13-15, 1963,
p. 3.
201 Landrum Shettles, Ovum Humanum: Growth, Maturation, Nourishment, Fertilization, and
Early Development (New York: Hafner, 1960), 18.


87
Shettless innovative work was well-received within the medical community but once again
elicited condemnation from the Catholic Church. In 1968 Pope Paul VI issued papal encyclical
Humanae Vitae (Of Human Life) and discussed the transmission and regulation of human
life.202 Although the main focus of his declaration was to discuss the Churchs stance on birth
control and his disapproval of the intervention of medical science in regulating and limiting
births, he also alluded to the immoral act of intervening to achieve pregnancy as well.203 He
endorsed the notion that the fundamental nature of sexual activity within a marriage was for the
purpose of procreation and that there should be no external interference with this act.204 He
specifically referenced the interruption of natural procreation with the birth control pill but also
used the same argument to condemn IVF. To Pope Paul VI, IVF interfered with the sexual act of
procreation between man and wife and challenged Gods design.205 The issuance of Humanae
Vitae further illustrated the Churchs disapproval of medical intervention in reproductive matters
and demonstrated shifting societal perceptions of acceptable and unacceptable forms of assisted
reproductive technologies.
While the advancement of reproductive endocrinology and the successful growth of
human embryos outside of the natural womb encouraged the baby boom even further and
provided optimism to many, there were still many (outside of the Catholic Church) who
questioned the moral consequences of the method. The June 13, 1969 cover of Life Magazine
featured a provocative image of a human embryo next to a loving mother embracing her new bom
202 Encyclical Letter Humanae Vitae of the Supreme Pontiff Paul VI to His Venerable Brothers
the Patriarchs, Archbishops, Bishops, and Other Local ordinaries in Peace and Communion with
the Apostle, to the Clergy and Faithful of the Whole Catholic World, and to All Men of Good
Will on the Regulation of Birth, The Vatican, accessed August 10, 2015,
http://w2.vatican.va/content/paul-vi/en/encyclicals/documents/hf_p-vi_enc_25071968_humanae-
vitae.html.
203 Encyclical Letter Humanae Vitae.
204 Encyclical Letter Humanae Vitae.
205 Encyclical Letter Humanae Vitae.


88
baby to advertise that weeks special coverage of new methods of human reproduction.206 The
topic of the cover referenced the special segment of the issue which included a damning editorial
about the detrimental social consequences of assisted reproductive technologies as well as a Life
Poll regarding public perceptions of the use of new methods of reproduction such as IVF.207 The
editorial written by Albert Rosenfeld and titled Science, Sex and Tomorrows Morality:
Challenge to the Miracle of Life, provided curious insight into the fears held by those surveyed
regarding the use of new methods to possibly assist in human reproduction in the late 1960s.
Specifically, the article argued that the introduction of medical intervention into
procreation with the use of in vitro fertilization or even parthenogenesis threatened the traditional
family structure that had developed over many millennia for good cause. Rosenfeld argued that
over time institutions of marriage and family, buttressed by religion, law, politics, philosophy,
education, commerce, and the arts had all developed for the perpetuation of the rearing of the
young.208 He believed that a nuclear family structure was created with purpose for the safety and
well-being of all involved and that assisted reproductive technologies threatened its existence
because it would challenge the accepted gender expectations within the home. According to
Rosenfeld, the nuclear family had been formed as a way for all involved to have their needs met:
the child was provided with protection during his/her vulnerable helpless years, the woman was
provided with security while she was in her most vulnerable times of pregnancy and childbearing,
and the man was provided with a mate who would provide progeny to carry on his name and
fulfill his need for sex.209 He argued that IVF would disrupt the natural formation of a nuclear
family and challenge the place of each person within the family leading to infidelity, broken
206 Albert Rosenfeld, Science, Sex and Tomorrows Morality: Challenge to the Miracle of Life,
Life Magazine, June 13, 1969, 37-50.
207 Rosenfeld, Challenge to the Miracle of Life, 37-55.
208 Rosenfeld, Challenge to the Miracle of Life, 40.
209 Rosenfeld, Challenge to the Miracle of Life, 40.


89
marriages, and children who were emotionally void and detached from their parents.210 His
argument used gendered language that suggested that women were essentially dependent upon
men to fulfill innate feminine instincts for motherhood and that men were ultimately driven by
masculine desires for sex and progeny. His understandings of femininity, masculinity, and family
structure defined his arguments against IVF and all intervention of medical science into
procreation.
An intriguing poll follows Rosenfelds critique of IVF. The Life Poll was conducted by
Louis Harris and Associates Incorporated and sampled a representative nationwide cross-section
of 1,600 adults.211 The polling company shared interesting data and quotes regarding public
perceptions of artificial insemination, egg implantation, and IVF and concluded that the results
revealed a surprising degree of acceptance of the new techniques, but a widespread skepticism
about putting such an intimate and important matter in the hands of scientists.212 Those who
were polled were less offended by the biological process and more concerned with the moral
implication of the method and the scientists who were performing the procedure. Many voiced
worry over the interruption in family life and the possibility that family love could be altered if a
child was produced in vitro.213 Those who believed it could disrupt family life questioned whether
women would feel attached to their child and if men would ultimately feel emasculated and turn
to infidelity.214 However, even if those polled believed family structure and gender roles were
vulnerable and could be destroyed by the new methods, they still supported IVF (after all other
210 Rosenfeld, Challenge to the Miracle of Life, 47-49.
211 Harris, The Life Poll: Brave New World With Reservations, 52.
212 Harris, The Life Poll: Brave New World With Reservations, 52.
213 Harris, The Life Poll: Brave New World With Reservations, 54.
214 Harris, The Life Poll: Brave New World With Reservations, 54.


90
avenues had been exhausted) if it allowed an infertile couple the opportunity to have a child.215
The article and poll from Life Magazine highlighted interesting changes in cultural
understandings of assisted reproductive technologies rooted in gendered language and accepted
notions of family roles by portraying medical intervention into reproduction as a possible
challenge to accepted gender expectations within the family unit.
ACCEPTANCE Of NEW
METHODS Of REPRODUCTION
Approve hormone treatments Men Women 40% 7B%
Approve pyytbutric help 43 65
Agree to insemmjtwn with husband s sperm 44 62
Approve Insemination with anonymous donor sperm 24 28
Approve egg impljnialmn 12 30
Approve in vitro bahws 25 25
Anonymous donor Justified if husband is infertile 33 37
[|X impfjnl luslifted d wife is Infertile 34 43
tn vitro babies justified it wife might die ur be crippled from duirtbirih 30 35
Opposed tu all three new methods 42 3B
Morally wiring Bo haw balm* through new methods 45 40
Would ieel Icne toward m uiro baby with own sperm and egg 47 S3
Would feel losv toward egg implant child or own 37 48
Would lcc< love toward in srlro bihv nuf n( own spem and egg 30 10
An vrfro ch4d would frH tove for family 55 61
Know unfaithful husband or toiU* SI SO
Unta*lhlui prrwm daw lu me ' 20 22
Incidence of nsisi Jtncge or trouble conceiving n imn family 27 41
CONTROVERSY AND CONFLICT
OVER THE NEW REPRODUCTIVE METHODS
(The percentage of agreement and disagreement It grven in pamiilw-*-s)
MORALITY
They are not morally wrong 147% agree, 42% diugri*'l
BUT They an* agaimi Cod's will (53% agree, 34% disagrrel
PARENTHOOD
No family nawl he cImUIm anymore 151% (A 15%)
RUT It would mean the end of babies bom through kwe (71% Bo 21%)
And H vmH reduce love making to a physical act (S4% tu 31%)
FAMILY LOVE
A child bom through new methods would reel thr same love
for its family (S6% to 16%)
BUT It is more natural for parents to tote a normally
tiNKeivrd baby 51% So J7%)
KIND OF BABY PRODUCED
The new methods are genetically talc 139% to 16% I
BUT It (s wrong to timed children (or fecial
characteristics IbNY lo 20%)
Sew methods ran be used to mold birth defects (50% to 26% 1
BUT It is wrong to produce superior c twklren from superior
sperm and eggs (57% Bn 21%|
ADVANTAGES
Mure convenient 150% lo 40% |
BUT ft rs wrong ior women toavnwl problems of
pregnancy (B0% to 11% I
POPULATION CONTROL
Overpopulation ran be avoided 146% to 14% I
BUT tegutalron oi who can haw babies is wrong tnO% an 2J% I
STRAIN ON FAMILY
Husband and wife would hive each other no levs (52% to 26% I
BUT Men will feel emasculated (76% tu 17%;
It wsR not lead to more infidelity {45% to 35% l
BUT It will encourage promiscuity (51% lo 24% I
Figure 4.2: Tables provided by the Life Magazine poll regarding new methods of human
reproduction.216
215 Harris, The Life Poll: Brave New World With Reservations, 54.
216 Harris, The Life Poll: Brave New World With Reservations, 52-54.


91
Regardless of concerns over IVF from the public as well as from the Catholic Church,
doctors and scientists continued their work to make IVF a reality. In 1973 Landrum Shettles, who
had made headlines with his photography of human embryos, attempted the first human embryo
transfer with the Del Zio couple. Unfortunately, the embryo transfer would never come to be, as
the embryos were purposely destroyed by Dr. Vande Wiele. Several years after receiving the
devastating news of the destruction of their fertilized embryos, the Del Zios decided to take legal
action and sued the Columbia Presbyterian Medical Center and Dr. Raymond Vande Wiele for
damages in emotional stress amounting to $1.5 million.217 Throughout the duration of the trial Dr.
Vande Wiele defended his actions by declaring that he feared the procedure might prove fatal to
Mrs. Del Zio or that an infant bom of result might turn out to be a monstrosity.218 Vande Wiele
believed the procedure itself was unethical and that the results for mother, baby, and society
could be detrimental.219 Although the court case was filed by both John and Doris Del Zio, the
coverage focused on Mrs. Del Zio and her desire for motherhood. The reporting appeared to favor
Mrs. Del Zio in her fight for her family and demonized Dr. Vande Wiele for taking the possibility
of children away from her without her consent or prior knowledge. The fact that Mrs. Del Zio
became the central focus of the narrative provided understanding of societal beliefs that
parenthood was essentially more important to women or was more innate for women than for
men. Mrs. Del Zio gave a multitude of interviews regarding her court case and declared that
regardless of how a baby was conceived it was sacred.220 As the trial concluded and the case was
released to the jury, many wondered what the future held for in vitro fertilization and the
struggles of infertile couples in the United States.
217 Woman Gets Cash for Tost Test-Tube Baby, Helena Independent Record, August 19, 1978.
218 Helena Independent Record, August 19, 1978.
219 Helena Independent Record, August 19, 1978.
220 Mother Sues Doctor for Destruction of Test-tube Baby, Lima News, October 21, 1974.


92
On August 18, 1978 the jury awarded the Del Zios $50,000 in damages for the emotional
stress inflicted on them when their test-tube experiment was halted.221 Mrs. Del Zio declared that
the decision was a vindication for all women.222 Although Mrs. Del Zio argued justice would
never replace her unborn child, she had accomplished what she had set out to do by heightening
interest in in vitro fertilization and letting other women know they had access to a safe
procedure.223 The Del Zioss court case was a remarkable example of the many perspectives for
and against the use of assisted reproductive technologies. The case became a battle between not
just a woman and a doctor, but over morality of medical decision making and ultimately who
holds authority over an individuals procreative powers. The eventual win for Mrs. Del Zio
illustrated the courts decision to grant her agency over her own reproductive decisions and
authority over her own potential procreative powers even if her desires conflicted with the beliefs
of her physician. The case highlighted the conflicting legal, moral, medical, and emotional
perceptions of IVF and its consequences.
While the dramatic Del Zio court case unraveled, the birth of the worlds first IVF baby
occurred in London, England. On July, 25, 1978 Lesley Brown and Gilbert John Brown
welcomed baby Louise. She made international headlines as the first baby to ever be bom
through in vitro fertilization. The press descended upon the hospital and interviewed not just the
new parents but the doctors responsible for the new little miracle. Drs. Patrick Steptoe and Robert
Edwards had worked for years to aid infertile couples and now stood at the precipice of
accomplishment as IVF became a reality for the world. According to the newspaper coverage,
Mrs. Brown was unable to conceive naturally due to blocked fallopian tubes and turned to Drs.
221 Helena Independent Record, August 19, 1978.
222 $50,000 Awarded in Test-Tube Case, Winnipeg Free Press, August 19, 1978.
223 Santa Ana Orange County Register Evening, July 17, 1978.


Full Text

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REPRODUCTION RECLAIMED: THE MEDICALIZATION OF INFERILITY IN UNITED STATES HISTORY, 1850 1981 By JESSICA MCNAUGHTON B.A., Colorado State University, 2008 A thesis submitted to the Faculty of the Graduate School of the University of Colorado in partial fulfillment of the requirements for the degree of Master of Arts History Program 2015

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ii This thesis for the Master of Arts degree by Jessica McNaughton has been approved for the History Program by Marjorie Levine Clark, Chair Rebecca Hunt William Wagner October 28, 2015

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iii McNaughton, Jessica (M.A., History) Reproduction Reclaimed: The Medicalization of Infertility in United States History, 1850 1981 Thesis directed by Asso ciate Professor Marjorie Levine Clark ABSTRACT moment in medical history and marked the zenith of over one hundred years of work by physicians and scientists. These medical professionals had dedicated their careers to assisting medical intervention into conception has become commonplace in American society today, due to widespread media coverage, many questions still rema in regarding the process that this nation and infertility in the n ineteenth and twentieth centuries? What types of medical interventions and technologies did doctors create and to what ends? What were the societal perceptions of medical interventions for infertility in the nineteenth and twentieth centuries? These questi ons have driven this investigation and granted much insight into the process of the medicalization of infertility and the role that reproduction played in family formation and gender expectations. The secondary scholarship as well as a wide array of prima ry sources has revealed that over the course of the last one hundred years, doctors and scientists have developed new went invasive treatments in hopes of becoming pregnant. Through the efforts of the medical community, more and more couples were able to achieve pregnancy but the work of infertility specialists aroused concerns regarding the moral, legal, and ethical cons equences of medical intervention in infertility. The arguments for and against medical intervention in cases of infertility shed light on the role of reproduction in forming and maintaining family ideals and gender expectations. Ultimately, the medicalizat ion of

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iv through the development of technologies, which has challenged the traditional understandings of parenthood and gender roles and established the enduranc e of the perceived necessity of a nuclear family in American culture. The form and content of this abstract are approved. I recommend its publication. Approved: Marjorie Levine Clark

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v DEDICATION I dedicate this work to my family, without their love and support this accomplishment would not have been possible. To my mom and dad, thank you for your countless hours of babysitting help and for always being there to guide me with encouraging words when I was feeling overwhelmed. You have always been my cheerleaders and I am thankful to have been blessed with such a strong family. To my amazing husband Chris, you are my rock and I cannot imagine tackling this task without you by my side. You are cool and calm and provide me with endless support. You love me completely and make me feel like I can do anything. You have sacrificed so much of your own time and energy to help me get to this point. I am humbled by your devotion and selflessness. Thank you for p utting up with me and pushing me to be my best. And finally, I dedicate this work to my daughter Harper Lu, who without the intervention of infertility specialists would not be a part of my world. You are my sunshine, my heart, and my soul. Thank you for y our giggles, snuggles, and vocal renditions which have brightened my days and made this process so much easier. I love you more than you will ever know.

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vi ACKNOWELDGEMENTS I would like to recognize the contributions of my professors throughout th e course of my time at the University of Colorado at Denver. I have had the opportunity to learn and grow through the efforts of many astonishing historians. Thank you to my thesis committee, Marjorie Levine Clark, Rebecca Hunt, and Bill Wagner, for your t ime and feedback. Thank you to Chris Agee for serving as my major field advisor and guiding me through the depths of comprehensive exams. And finally, special thanks to Marjorie Levine Clark for all of your support over the past few years and for igniting my own passion for gender history.

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vii TABLE OF CONTENTS CHAPTER I. II. MARITAL ADVICE, SURGICAL INTERVENTION, AND EARLY ARTIFICIAL INSEMINATION EXPERIMENTATION 1850 Sterility Treatment through Medical Marriage Advice Dr. J. Marion Sims and Artificial Fructification Conclusi 9 III. REPRODUCTIVE ENDOCRINOLOGY AND THE ARTIFICIAL INSEMINATION DEBATE, 1918 1934 4 1 Clinical Research and the Birth of Reproductive Endocrinology 4 Artificial Insemination Advocates 5 Artificial Insemination Opponents 3 Conclusio 70 IV. IN VITRO FERTILIZATION IN HUMANS, 1934 1981 3 Gregory Pincus and the In Vitro Fertilization of Rabbits 7 The Rock Menkin Extra Uterine Human Embryo Trials 2 The Birth s of the First Human Test Tube Babies 5 5 V. CONCLUSION: FIVE MILLION BABIES LATER THE UNITED STATES AFTER IVF 7 0

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viii LIST OF FIGURES FIGURE 2.1 Instrument used by Dr. J. Marion Sims for artificial 2.2 2.3 3 2.4 2.5 2.6 2.7 2.8 2.9 7 3.1 Dr. Samuel 9 3.2 50 3.3 Data collected and published by Dr. Samuel Meaker regarding 2 3.4 Image of the Lauricella twins who were conceived using artificial insemination 6 3.5 Illustration depicting the possible outcomes of artificial insemination 6 8 4.1 1 4.2 Life Magazine poll regarding new method 90

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1 CHAPTER I INTRODUCTION NORFOLK, Va. (AP) Elizabeth Jordan Carr yawned and kicked off a sock at her public tube baby said they looked forward haired, hazel eyed Elizabeth snuggl clicking of cameras that were kept 15 feet father Roger Carr. But Elizabeth settled for a yawn, waving her hands and kicking off a sock for the audience at pediatrician, Dr. Frederic 1 Daily Herald Suburban Chicago January 1, 1982. The birth of Elizabeth Carr on December 28, 1981 was a long awaited blessing to her parents, Roger and Judith Carr, who had battled infertility for numerous years. After several miscarriages and in participate in the experimental new procedure known as in vitro fertilization or IVF. 2 The couple sought the help of infertility specialists Doctors Howard and Georgeanna Jones and afte r many m onths of hormone treatments and operations the couple defied the odds and Mrs. Carr became pregnant. 3 Carr family but a watershed moment for the entire medical comm in the United States marked the apex of over one hundred years of work by physicians and Even though medical intervention into conceptio n has become commonplace in American society due to widespread media coverage of successful treatments over the past several decades, many questions still remain regarding the process that people in the United 1 Daily Herald Suburban Chicago January 1, 1982. 2 Daily Herald Suburban Chicago January 1, 1982. 3 Daily Herald Suburban Chicago January 1, 1982.

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2 States been explored to Particularly, what was the role of the medical community in shaping understandings of reproduction and infertility in the ninete enth and twentieth centuries? What types of medical interventions did doctors create and to what ends? How did the medicalization of infertility evolve and change over time and why? What were the societal perceptions of medical interventions for infertilit y in the nineteenth and twentieth centuries? The scholarship on the history of childlessness has been fairly limited but the works that have been created are exceptional and provide an essential foundation for an investigation into the medicalization of infertility. The works established by Paul Star r, Margaret Marsh, and Wanda Ronner explore the rise of the medical profession and the role of the medical community in accompanying societal perceptions. The publ ications produced by these scholars as well as a wide array of primary sources, are used to assess the medicalization of infertility and provide the framework for how childlessness has been diagnosed and treated as a disease from 1850 1981 in the United S tates. The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry provided the context necessary to understand the prestige and respect enjoyed by physicians beginning in the mid 1800s. He argues that medical professionals benefitted from the market revolution in the latter half of the nineteenth century and were able to expand markets and increase services. 4 Starr determines that the expansion of the general public. 5 Many medical men enjoyed the new prestige associated with their posi tion 4 Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982), 77. 5 Starr, The Social Transformation of American Medicine 3.

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3 During this same time period, a concerns. These medical men claimed power over the female form and continued to invade the birthing room, a place which had traditionally been the domain of only women. 6 Numerous historians including Judith Walter Leavitt and Richard Wertz have analyzed the impact of the medicalization of childbirth in America, but few historians have commented on the impact of the rise of the medical profession on the tre ks of Leavitt and Wertz provides insight into why the medicalization shift occurred in the mid 1800s and how the medicalization of childbirth mimicked the medicalization of childlessness. In The Empty C radle: Infertility in America from Colonial Times to the Present Margaret Marsh and Wanda Ronner provide the most complete analysis of infertility over time and explore the controversial history of childlessness while placing emphasis on the medicalizatio n of the They assert that colonial women generally viewed their failure to procreate as the will of God and in such sought spiritual guidance and in some cases the skills of midwives. 7 There was no salvation was the key to rid ding her of her childlessness. 8 By the late nineteenth century, women more frequently sought the assistance of doctors to diagnose and treat their involuntary childlessness through questionable surgeries or prescribed tonics. 9 The effectiveness of such tre atments was limited at best but illustrated a clear shift from spirituality to medicalization as the 6 Judith Walzer Leavitt, Brought to Bed: Childbearing in America, 1750 1950 (Oxford: Oxford University Press, 1986), 4. 7 Margaret Marsh and Wanda Ronner, The Empty Cradle: Infertility in America from Colonial Times to the Present (Baltimore: John Hopkins University Press, 1996), 3. 8 Marsh and Ronner, The Empty Cradle 40. 9 Marsh and Ronner, The Empty Cradle 2.

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4 means for dealing with infertility. 10 The Empty Cradle not only provides an important understanding of the experience of infertility prior to its medicaliza tion, it also outlines and analyzes the progression of the springboard for this investigation. While Marsh and Ronner provide the most comprehensive account of childlessness in America, works from h istorians such as Elaine Tyler May, Wendy Kline, Rickie Solin ger, and Rima Apple among others who focus o n reproduction and families, will also be used throughout this examination to provide a more thorough context to understand the social framework of the medicalization of infertility. 11 To understand both the medical viewpoint as well as the societal perspective of the 1981 I have called upon a wide array of primary sources. To s and motivations in diagnosis and treatments I have surveyed their medical correspondences, journal articles, books, and personal records. These sources reveal a true desire among these men (and occasionally women) to assist couples facing infertility by helping them to fulfill their perceived innate desires for parenthood. However, these sources also expose that a leading motivation for these doctors was not just to help the couple but d so tha t the integrity of the American family was protected by medical professionals To examine the societal perspective of the medicalization of infertility I have analyzed newspaper articles, medical publications, magazine articles, popular novels, as well as religious correspondences. These sources divulge an interesting dichotomy of perspectives regarding medical intervention into conception. Many seem to be intrigued by the advancements in technology and the 10 Marsh and Ronner, The Empty Cradle 40. 11 Elaine Tyler May, Barren in the Promised Land: Childless Americans and the Pursuit of Happiness (Cambridge: Harvard University Press, 1995). Wendy Kline, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (Berkley: University of California Press, 2011). Rickie Solinger, Reproductive Politics: What Everyone Needs to Know (Oxford: Oxford University Press, 2013). Rima D. Apple, Mothers & Motherhood: Readings in American History (Columbus: Ohio State University Press, 1997).

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5 poss ibilities they could produce but others are quite hesitant and concerned with the repercussions that may arise. The medical as well as societal sources provide the timeline for this argument as well as the basis for how my analysis is divided. I have bro ken this examination into three separate time periods covering the distinct turning points in the medicalization of infertility in America. Chapter II of this analysis covers the years 1850 1918 and follows the onset of the medicalization of infertility th rough the early years of artificial insemination experimentation. This chapter reveals that the medicalization of eproduction and by surgical intervention. These doctors female form and subjected women to invasive oper ations which were often in effective in terms of leading to pregnancy. These doctors also used rudimentary forms of artificial insemination (the up with their patients and assumed their proced ures worked even if the y had no evidence of a couples still regularly sought their service which speaks volumes to the desire among the infertile motherhood and that their feminine identity rested in their ability to reproduce. They used the cultural construct of inherent motherhood to justify their diagnosis of disease and developed v arious med ical technologies to treat their patients. Chapter III identifies a clear shift in technological capabilities among infertility physicians as well as a dramatic increase in public awareness of medical intervention in the procreative process. From 1918 19 34, the term medical men gave way to doctors of obstetrics and gynecology ( OBGYNs ) 12 The OBGYNs of the 12 Marsh and Ronner, The Empty Cradle 141.

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6 first half of the twentieth century explored new avenues to treat their infertile patients which included le ss invasive surgical approaches, reproductive endocrinology, and improved metho ds of artificial insemination. They used clinical research methods to investigate the role of hormones in conception and applied their findings to their attempts at artificial i nsemination. While their predecessors viewed the uterus as an independent organ functioning in isolation from much of the rest of the body, the OBGYNs of the early twentieth century viewed the body in its entirety and used hormones to understand the connec tions within the body that could lead to infertility. While they benefitted from improvements in technology, doctors of this era also faced much more public scrutiny. Media coverage of births from the use artificial insemination prompted a cautious respons e from the general public. Many shared concerns regarding the consequences of such a practice and questions of legality and legitimacy aroused suspicion. 13 Newspaper articles as well as legal documents demonstrate d the anxieties felt by the public in regard to the impact of assisted reproduction on the Americans family, specifically the role of the father if his lineage could not be established While there was heavy criticism, these doctors also practiced at the height of the eugenics movement in the United States and enjoyed significant su pport from those who argued artificial insemination could create a superior race. 14 Chapter IV marks another significant turning point in the progression of the medicalization of infertility in the United States by focusing on the work of physicians in achieving extra uterine conception. Starting in 1934, infertility specialists began experimenting with the fertilization of eggs outside of the natural womb. Successful in vitro fertilization (IVF) of rabbits led to experimentation in humans which prompted a volatile response from the public. The Catholic Church staunchly condemned medical intervention into reproduction and th e 13 Journal of the American Medical Association. Syracuse Herald, May 7, 1934. 14 The El Paso Gazette April 30, 1934.

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7 general public continued to question the legal and moral repercussions of such a technique. The Catholic Church wa s not the only opponent of IVF: countless newspaper articles and popular magazines covered the topic from an uneasy perspective. Surveys of the general public expose d genuine concerns over the impact of IVF on the American family and question ed whether the process would forever alter gender roles within the family and ultimately destroy the iconic image of the nuclear family structure. 15 Regar dless of the backlash physicians endured for their new treatments, they continued their efforts and the first American IVF human baby was born in 1981. 16 Her birth marked a pivotal moment for the medical community as the process of conception was completely laboratory. While investigating the evolution of the medicalization of infertility in United States history interesting continuities of basic cultural paradigms have emerged. A constant theme th roughout the work is that of inevitable motherhood, or the relentless desire of women to achieve motherhood as fulfillment of their feminine identity. While the sources reveal ed an overwhelming desire among women to sacrifice physically as well as emotiona l ly to achieve pregnancy that was not necessarily the case for all women over time. workplace as well as demands for political enfranchisement and social equality all altered perceived desires for motherhood. In the wake of the second wave of feminism many American women even They lashed back at traditional family structures as well as assisted reproductive technologies in an attempt to identify themselves as something mother over time, the sources surveyed in this work reveal ed that women s eeking infertility treatments desired motherhood and saw it as essential component in their identity formation. 15 Poll: Brave New World Life Magazine June 13, 1969, 52 55. 16 Daily Herald Suburban Chicago January 1, 1982.

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8 The i progression of medical intervention into childlessness. The nuclear family (a pair of adults and their children) has been viewed as the ideal througho ut much of United States a nd global history This strict understanding of family with wife, husband, and children has shaped gender roles and gender expectations while determining dominance and submissiveness within the home as well as society Traditionally, this mod el of the nucl ear family asserted that the husband wa s the dominant figure at the head of the household while the wife wa s the submissive nurturer. This fixed image of family has been challenged over time by such as things as women entering the workforce, single moms/da ds, or the assurance of equality through legislation. The medicalization of infertility aroused an intense response from critics who argued it disrupted the idyllic model of the nuclear family and confused gender expectations within the family unit. Regard less of the family maintained its supre macy as the accepted cultural paradigm and shaped arguments for and against medical intervention for childlessness even as the American family itself has evolved. The medicalization of infertility in the United States began in the mid 1800s alongside the rise of the medical profession. Over the course of the last one hundr ed years, doc tors and scientists motivated by the cultural expectations that all women want ed to become mothers developed n ew techniques and new technologies couples sought their assistance and women often underwent inv asive treatments in hopes of becoming pregnant. Through the efforts of the medical community, more and more couples were able to achieve pregnancy but the work of infertility specialists aroused concerns regarding the moral, legal, and ethical consequences of medical intervention in infertility. The arguments made by opponents and proponents of assisted reproductive technologies provide d interesting insight into the role of reproduction in forming and maintaining family ideals and gender expectations. Ultim ately, the medicalization of infertility has been marked by a distinct desire by medical practitioners to treat infertility through the development of assisted reproductive technologies,

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9 which has challenged the traditional understandings of parenthood and gender roles and established the endurance of the perceived necessity of a nuclear family in American culture.

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10 CHAPTER II MARITAL ADVICE, SURGICAL INTERVENTION, AND EARLY ARTIFICIAL INSEMINATION EXPERIMENTATION, 1850 1918 seen conception follow this artificial fructification once, and only once. The case is of sufficient importance to give it in detail. My patient was twenty eight years old; had been married nine years without issue; and had had more or less dysmenorrhea a ll her menstrual life. It was often attended with great constitutional disturbance, such as nausea, vomiting, and sick headache. She had retroversion, with vagina never retained the semen. I examined this case several times very soon after sexual intercourse, and I never found a drop of semen in the vagina, although it was ; the instrument was piston rod was slowly turned half a revolution, which as slowly forced out half a drop of semen, the instrument was in situ for ten or fiftee n seconds and then withdrawn, and the patient lay quietly in bed for two or three hours afterwards. this case minutely, because I presume it is the first and only aut hentic case in which artificial fertilization has been successful in the human species; and because it furnishes about the sum and substance of my knowledge on the subject which may be of any possible service as a guide to future observers, who may have th e curiosity, leisure, courage, and perseverance to experiment further in this direction. 17 Dr. J. Marion Sims, Clinical Notes on Uterine Surgery 1873 edition According to Dr. J. Marion Sims, after nine years of a childless marriage his unnamed patient an d her husband sought his assistance for a cure to their distressing sterility. Sims did a thorough gynecological examination of the 28 year old wife and determined that she was suffering from a plethora of mechanical obstructions. 18 Sims examined the husban 17 J. Marion Sims, Clinical Notes on Uterine Surgery, with Special Reference to the Management of the Sterile Condition (New York: William Wood & Company, 1873), 366 369. Uterine retroversion refers to the tipping backward of the organ. Hypertrophy refers to an increase in mass of the uterine muscle. An indurated conical cervix means that it has hardened. The contracted ca stems from vagina to cervix. 18 Sims, Clinical Notes on Uterine Surgery 366.

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11 spermatozoa and found that it was adequate but that , the sperm would not stay in the vagina following intercourse. 19 Sims determined that gynecological surgery was the best course of action to correct the malposition o f owever, the patient would not submit to surgery. Due to her unwillingness to go under the knife, Sims agreed impregnating the patient. Over a period of twelve months Sims used a specially altered syringe to perform dozens of uterine injections of sperm into the young woman and after the tenth trial his patient became pregnant. 20 Unfortunately, in her fourth month of her pregnancy the woma 21 Sims adamantly maintained that this was the first successful artificial conception ever achieved within the human species, even if the baby was not carried to term. 22 While Sims attempted t hese experiments on over half a dozen young women over a period of two years, this patient was the only one to become pregnant. 23 Sims claimed that he performed over 55 uterine injections on various women seeking an end to their sterility but due to his self proclaimed ba dly made instruments and little understanding of the laws of conception he only succeeded in this singular instance of assisted conception. 24 Sims acknowledged that his ignorance and ineptitude in regards to conception and embryology led to little success w ith his experiments but he recognized the importance of his work in providing foundational principles 19 Sims, Clinical Notes on Uterine Surgery 366. 20 Sims, Clinical Notes on Uterine Surgery 367 See Figure 1 for view of uterine injection instrument. 21 Sims, Clinical Notes on Uterine Surgery 367. 22 Sims, Clinical Notes on Uterine Surgery 366. 23 Sims, Clinical Notes on Uterine Surgery 369. 24 Sims, Clinical Notes on Uterine Surgery 369.

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12 that would be helpful to other doctors in the future who were brave enough to take on the responsibility. 25 Dr. Sims was one of a handful of medical men e xploring and experimenting with doctors did not begin their practices with infertility in mind, they eventually gravitated toward experimentation on infertile wo men after perceiving a need among their patients. They focused on women more heavily because they sought treatment much more often than men. 26 Men typically denied or hid the possibility that they could be infertile, so doctors more often than not tailored their services to women. 27 Sims as well as doc tors such as Frederick Hollick and Edward Bliss Foote all acknowledged that childless women suffered greatly and that medical expertise might cure their sterility and subsequently ease the suffering that chil dlessness had caused. Prior to the development of surgical techniques and medical diagnoses, women struggling with childlessness sought spiritual advice or communal support. According to Paul Starr, professor of soc iology and public affairs the medical profession underwent a drastic transformation during the nineteenth century due to the expansion of markets and improvement of transportation in the form of roads and canals. 28 The widening of the market allowed for practitioners to gain access to larger ar eas and increased demand for their services. The Market Revolution ushered in an era of unprecedented power for medical doctors and allowed them to enjoy a remarkable amount of authority and control over the decisions their patients made regarding their he alth and well being. The pairing of new technologies and increased cultural authority allowed medical men in the latter half of the twentieth century to exert much autonomy and power over the realm of 25 Sims, Clinical Notes on Uterine Surgery 370. 26 Marsh and Ronner, The Empty Cradle 41 74. 27 Marsh and Ronner, The Empty Cradle 41 74. 28 Starr, The Social Transformation of American Medicine, 77.

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13 reproductive matters. The medical men who began focusin the latter half of the nineteenth century took pleasure in their knowledge and position of authority. They believed it was their duty to use their position and abilities to assist sterile women to obtain motherhood. Figure 2.1: The instrument used by J. Marion Sims for uterine injections for artificial insemination published in Clinical Notes on Uterine Surgery in 1873. The uterine injection instrument was made of glass with a piston with the purpose of taking up s emen. There was also a screw nut added which could be turned against the piston rod to let out a drop or half of a drop of semen at a time. These medical men were the first documented in America to medicalize infertility by inventing medical technologies and treatments that were specifically designed to correct perceived anatomical abnormalities in women that they believed led to sterility. They viewed reproductive irregularities in their patients as evidence of sterility These practitioners set the found ation for the development of assisted reproductive technologies in American history. They were visionaries in their field s who sought to help their patients when others believed they could not be helped. These men differed from doctors who came before them due to their superior understanding of the mechanics of conception and the importance of healthy female and male reproductive bodies. These doctors were among the first to openly acknowledge that sterility was not just a female disorder and that men could also suffer from disorders that caused infertility. While these doctors were pioneers and acknowledged the role of sperm and the importance of male reproductive health they were still influenced by societal perceptions of male dominance and the notion t hat women should desire motherhood and be willing to sacrifice for

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14 family. Though they recognized male accountability in childlessness they remained focused on the female form and developed very few techniques to treat men. Women bore the brunt of invasiv e infertility treatments as doctors invented new tools and attempted to master new surgical techniques. These medical men shared the belief that wo machine s and if that machine failed to function it was due to obstructions or malp osition s which needed to be manually corrected. 29 Due to their mechanical understanding of the female reproductive system and the societal notion of female sacrifice and devotion to m otherhood, these medical men gravitated toward surgical techniques that would remedy perceived failures in a to go from barren to fruitful. iness which many Sterility Treatment through Medical Marriage Advice The medical community often remembers Dr. Frede rick Hollick as a controversial physician and sex educator of the nineteenth century. He aroused debate and anger among many of his colleagues when he published several books on healthy sexual practices and openly lectured in public venues on topics as taboo as female orgasms, sexual pleasure, and impotence. He was even charged with obscenity after bringing papir mache models of the female body to his lectures to illustrate where the organs were located and how they should be manipulated during intercourse to enhance pleasure. 30 In the mid nineteenth century Hollick was not alone in his attempts to educate the public on sexual and reproductive matters (although he might have been the most outspoken) and was joined by several other medical men who published popular works focused on instructing married couples on their sexu ality and generative powers. These doctors sought to give couples knowledge that would aid their physical and mental well being by 29 Marsh and Ronner, The Empty Cradle, 74. 30 Marsh and Ronner, The Empty Cradle, 68 69.

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15 providing them with guidance on healthy relationships as well as clinical understandings of sex. Although many of these medic the focus of many of their works was how to treat impotence and sterility. These doctors acknowledged that childlessness was a burden to many couples and they wanted to use their medical pr owess to assist needy couples in their pursuit of family. In 1860, Hollick published The Marriage Guide or Natural History of Generation: A Private Instructor for Married Persons and Those About to Marry, both Male and Female, in Everything Concerning the Physiology and Relations of the Sexual System and the Production or Prevention of Offspring Including all the New Discoveries Never Before Given in the English Language this text outlined the sum of information he believed couples should be privy to in o rder to live a fulfilled and happy life. He believed that doctors needed to share their invaluable knowledge and educate couples about sex and marriage In the preface to his work he argued that will be found to give full and practically useful information on every medical and physiological 31 He was appalled that doctors did not sought to communicate in clear and simple terminology. married persons suffer under asc 32 In his opinion, physicians had done their patients an injustice by not allowing them access to medical knowledge. He used his medical knowledge and the popular press to provide married couples 31 Frederick Hollick, The Marriage Guide or Natural History of Generation: A Private Instructor for Married Persons and Those About to Marry, both Male and Female, in Everything Concerning the Physiology and Relations of the Sexual System and the Production or Prevention of Offspr ing Including all the New Discoveries Never Before Given in the English Language (New York: T.W. Strong, 1860), 4. 32 Hollick, The Marriage Guide vi.

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16 with clinical kno wledge of their bodies so they might have a better chance at maintaining health and happiness, specifically with their ability to understand and treat their own childlessness. The Marriage Guide provided a detailed description of conception t o couples and assisted them with diagnosing and treating their sterility. He believed that if couples were well versed in the mechanics of conception then they would vastly improve their probability of pregnancy. He outlined for his untrained readers medic al descriptions of female and male generative organs, menstruation, semen, copulation, the process of impregnation, and pregnancy. He also included other topics of interest for married couples such as the influence of imagination over generative powers, st erility and impotence, the influence of drugs over generative powers, the prevention of conception, and sexual indulgence and pleasure. In his analysis of sterility he 33 He then conceded that his findings were based on his own empirical research of observation and reflection, and his novel discoveries about human s generative powers were among the first to be published in the English language. 34 He separated himself from practitioners before him by identifying the important difference between sterility and impotency in men. Before the rise of the medical profession in the mid to late nineteenth century doctors often linked sterility with impotency and believed that if a man was able to engage in sexual intercourse he could not be sterile. Hollick, as well as fellow medical men of his time like J. Marion Sims, moved away from this one dimensional understanding of male infertility and recognized not only the possible s eparation of impoten cy from sterility but also that men could be 35 He argued that impotency or the inability for a male t o associate with the other sex, 33 Hollick, The Marriage Guide 316. 34 Hollick, The Marriage Guide vi viii. 35 Hollick, The Marriage G uide 317.

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17 was linked to deformity, deficiency, and acute disease but could frequently be cured. 36 While Hollick believed that impotency could be cured associate with his wife as a marker of masculinity and if a man was unable to engage in sex and could not produce offspring then he would lose his manliness. 37 Hollick assisted impotent me n by creating medical technologies that could treat their affliction s and allow them to restore their masculinity through procreatio n. Specifically, he invented a medical device which he called the congester which could assist impotent men in attaining an erection. The instrument consisted of a tube, the size of which was adapted to the organ, and an exhausting air pump. 38 Hollick argue d that the congester had assisted many of his patients in allowing blood flow to rush to the penis to create an erection. Once an erection was achieved hopes of conceiving. He also argued that make it easier for him to have intercourse with his wife and assert his manliness. 39 Although Hollick argued that the congester could treat impotent men by restoring their masculinity and fulfilling their husbandly duty to procreate, he also noted that sterility could exist outside of impotency in the male and recognized that spermatozoa quality was crucial in a couples attempt s to conceive and was also directly linked to manliness. Holli 40 He asserted that these imperfections came in the form of dead spermatozoa or the absence of sperm from the seminal fluid which made it 36 Hollick, The Marriage Guide 317. 37 Hollick, The Marriage Guide 320. 38 Frederick Hollick, The Male Generative Organs in Health and Disease, from Infancy to Old Age Being a Complete Practical Treatise to the Anatomy and Physiology of the Ma le System, (New York: Nafis and Cornish, 1850), 170. 39 Hollick, The Male Generative Organs in Health and Disease 166 177. 40 Hollick, The Marriage Guide 320.

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18 impossible for a husband to impregnate his wife. Hollick claimed that if a man was able to engage in sexual intercourse but had imperfect sperm eventually he would lose his power to have sex, 41 Hollick He viewed these men as inevitably void of virility and destined to lose their manly ability to engage in intercours e and produce offspring. To explain the reason for imperfections such as source of sterility was excessive seminal loss. 42 This seminal loss stemmed from mast urbation Hollick argued against masturbation 43 If men would suppress their carnal urges their spermatozoa quality would improve and thus they would be cured of their sterility. Historian Thomas Laqueur explained the anti masturbation culture, expressed by Hollick, of the late nineteenth century as bei ng constructed of fears of 44 While Hollick used his medical expertise to educate married couples on the importance of sperm in conception; he also took his position of medical authori ty to instruct married men on what he believed to be masculinity was rooted in his ability to produce offspring and was willing to offer his medical and ethical adv ice on how these men could reestablish their virility. Although Hollick discussed the importance of the male bo dy in reproduction he offered very few medical treatments for men aside from the congester instrument for impotency and self 41 Hollick, The Marriage Guide 320. 42 Hollick, The Marriage Guide 319. 43 Hollick, The Marriage Guide 320. 44 Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud (Cambridge: Harvard University Press, 1990), 229.

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19 control for excess ive masturbation. Because Hollick believed true infertility (not impotency) in men was ultimately untreatable, he focused much of his instruction for barren couples on treating female infertility He argued that there were a multitude of reasons for female infertility but the 45 According to Hollick, t hese causes were ulti mately anatomical complications within th e female reproductive system an could be corrected through surgical intervention. He argued that sterility in women with malformation of their reproductive system was often marked by painful menstruation and that hi s surgeries to open the mouth of the womb or closed fallopian tubes were uniformly successful and relieved the patient from suffering as well as sterility. 46 Although Hollick boasted that these invasive surgeries cured women of their sterility he provided n o empirical evidence as to how many of his surgical patients were able to conceive following their procedures. His mechanical understanding of the female reproductive system led him to believe that once blockages were removed conception should occur witho ut any further investigation. infertility he argued the opposite was the case for women facing childlessness. He declared that ly and uniformly with the female as with the male, because she is in a great measure passive, and may even be made to conceive in spite of 47 According to Hollick, woma not to fall into immoral temptation as easily as m an and therefore her infertility was due to anatomical obstructions rather infertility for the 45 Frederick Hollick, The Diseases of Women Their Causes and Cure Familiarly Explained; with Practical Hints for Their Prevention and for the Preservation of Female Health (New York: Burgess Stringer, 1847), 218. 46 Hollick, The Marriage Guide 321. 47 Hollick, The Marriage Guide 322.

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20 most part was not linked to moral misbehavior, he did recognize one exception. In The Diseases of Women Their Cause s and Cure Familiarly Explained Hollick argued that while women were typically sterile due to their anatomical impediments and reproductive malformations, sterility could also be experienced by women with unfeminine temperaments and constitutions. 48 He argued that women who possessed masculine traits and resembled the other sex in their habits, form, and features were frequently attended by sterility. 49 Interestingly enough, while Hollick commented on unfeminine behavio r as a cause of infertility, he did not comment on female masturbation. He recommended surgery for those women facing obstructions and a correction in and fem ininity influenced his recommendations on courses of treatment for each; for men he offered few medical interventions and focused on advising them on moral behavior and for women he believed they were already of high moral virtue (for the most part) and th at their sterility could be corrected through surgical treatments. Other medical men, aside from Hollick, also published popular works to provide medical marital advice to couples seeking an end to their barrenness and other information regarding their ove rall health. Dr. Edward Bliss Foote was a popular (yet unconventional) physician in the mid to late nineteenth century. He was a birth control advocate and proponent of free love lifestyles which gained him a reputation of being quite radical. However radi cal he may have appeared a large sector of the American public found his advice books useful as the books went through several revised editions, and sought his guidance through mail correspondences. 50 His first advice 48 Hollick, The Diseases of Women Their Causes and Cure Familiarly Explained 218. 49 Hollick, The Diseases of Women Their Causes and Cure Familiarly Explained 218. 50 Edward Bliss Foote, Plain Home Talk About the Human System The Habits of Men a nd Women The Causes and Prevention of Disease Our Sexual Relations and Social Natures: Embracing Medical Common Sense Applied to Causes, Prevention, and Cure of Chronic Diseases The Natural Relations of Men and Women to Each Other Society Love Marriage Parentage Etc. (New York: Murray Hill Publishing Company, 1896), iv.

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21 Book, Medical Common Sense was publish ed in 1858 and its overwhelming popularity led to an expanded and revised edition titled Plain Home Talk published in 1896. His advice books sought lowly inmate of 51 He pr ovided medical information in layme could grow wiser and happier. 52 Even though his advice books were extensive and covered a variety of topics from prostitution to polygamy, he did devote an entire section solely to the childless. Figure 2.2: Image of Dr. Edward Bliss Foote provided in the 1896 edition of his Plain Home Talk medical advice book. Foote described barrenness as a physical condi tion abhorrent to everyone in married life 53 His description of the miserable anguish felt by childless couples illustrated the sympathies he felt toward those facin g sterility as well as his belief that a fulfilled life must consist of progeny for 51 Foote, Plain Home Talk, v. 52 Foote, Plain Home Talk, vi. 53 Foote, Plain Home Talk, 485.

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22 both men and women. He expanded on the desperate situation that barren couples faced and ss longevity, and not a few husbands would rather die in the prime of manhood, leaving an heir, than to live to 54 Foote believed that neither a woman nor man could truly be fulfilled if they did not p roduce offspring. T o achieve true womanhood or manhood an individual must leave behind an heir and procreate. If an individual could not procreate he/she in essence failed to fulfill his/her masculine or feminine destiny. As a medi cal professional, Foote saw it as his duty to assist these needy couples by providing them with a clinical education on the causes of infertility and curative ways to promote childbearing. Much like Hollick, Foote acknowledged the unique responsibilities o f the male and female reproductive bodies in successful conception He outlined the following as the causes of infertility : local inadaptation, diseased condition of the wife, diseased condition of the husband, excessive amativeness, and temperamental inad aptation. 55 He elaborated on each of the causes and cl aimed that local inadaptation was in his experience the most common cause of barrenness discomfort as well as sterility. 56 The displacement or malformation of her womb made it difficult for the sperm to be placed correctly or stay within the vagina after intercourse. 57 Foote provided detailed sketches and descriptions of the various malpositions that c ould afflict his female patient s and suggested that surgery would be the best means to correct the perceived problems with female r eproductive system s For patient s unwilling to undergo surgery, Foote also provided meticulous directions on coital positions that should be used by couple s to optimize conception. 54 Foote, Plain Home Talk, 485. 55 Foote, Plain Home Talk, 485. 56 Foote, Plain Home Talk, 485. 57 Foote, Plain Home Talk, 485.

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23 Rather than surgery the couples could attempt to use modified sexual positions to assist with placement of sperm. If modified positions did not work Foote suggested that couples purchase one of his impregnating syringes (available through mail order) which would allow them to draw 58 His suggestion of the use of an impregnating syringe illustrated early development of assisted reproductive tech nologies to support infertile couples, although his design was most likely built upon Dr. J. Marion Sims invention since it only appeared after Sims had published his research on seminal uterine nt of surgery and willingness to use new technologies and methods aligned the reproduc tive system and also illustrated the aggressive means by which doctors sought to remedy female infertility Howev techniques (such as coital positioning and the use of the impregnating syri nge) in lieu of surgery suggested that patients had agency over their medical decision making and provided their own input in the management of their condition. couples published in Plain Home Talk in 1896 Foote also linked morality and ethical behavior to male sterility but not to female sterility. When discussing diseases of the wife that could causes sterility, Foote referred mostly to 58 Foote, Plain Home Talk, 512.

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24 concerns with inflammation, obstructions, tu mors, and ovarian afflictions. Many of these he believed could be helped with surgical intervention He ability to reproduce. However, when explaining the diseases of the husband that cause d sterility Foote greatly d infertility which anhood. 59 According to Foote, superfluous venery weakened the testicular glands and caused spermatozoa to be sickly or inanimate. 60 Foote elaborated on the risks associated with carnal excess in his section on He argued that men who engaged in excessive or violent coition did not allow the spermatozoa to become sufficiently developed for impregnation. 61 recommendations against excessive sex and masturbation align with the historiography presented by Laq ueur, where he established that the anti masturbatory culture of the late nineteenth century stemmed from fears of the consequences of giving in to desires 62 suggestion to men was to be virtuous and practice self control as a means to improve semen quality. 63 Although Foote held fairly progressive beliefs on sexuality he still aligned with other popular medical men of the day who argued that masturbation and sexual indulgence in men w as immoral and led to male infertility. 59 Foote, Plain Home Talk, 505. 60 Foote, Plain Home Talk, 505. 61 Foote, Plain Home Talk, 507. 62 Laqueur, Making Sex, 229. 63 Foote, Plain Home Talk, 505.

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25 spermatozoa published in Plain Home Talk in 1896 Both Dr. Frederick Hollick and Dr. Edward Bliss Foote used the popular pr ess to educate married couples on their clinical understandings of sex and fertility. Their attempts to provide medical education for lay persons was a departure from previous physicians who had kept the mysteries of conception shrouded in secrecy due to i ts taboo reputation. 64 With improved understanding of the natural laws of conception and expanded authority with the rise of the medical profession in the mid nineteenth century medical men like Hollick and Foote sought to treat sterility through clinical e ducation and marital advice for the general public They informed their readers of the me chanics of conception and the causes of childlessness while offering medical instruction on inventive techniques to improve fertility. These doctors acknowledged male infertility was often medicalization of childlessness and invented some of the first instruments used to treat sterility such as the congester and impregnating syringe. Their work in educating the general public was an initial step in the medicalization of infertility. Doctors like J. Marion Sims who would also be at the onset of medicalization, directed their attention to advancing the field by publishing their work for fellow 64 Marsh and Ronner, The Empty Cradle 42 48.

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26 doctors rather than for the lay community. Their work in the treatment of sterility through medical ma rriage advice ushered in the era of infertility medicalization and laid the foundation for subsequent physicians to experiment further with gynecological surgeri es and artificial impregnation. Dr. J. Marion Sims and Artificial Fructification Dr. J. Marion Sims was an American physician and surgeon duri ng the latter half of the nineteenth century. He was highly venerated within the medical community in his time and is still prominence began with his developm ent of the first consistently successful surgical technique to repair vesicovaginal fistulas, a catastrophic childbirth compl ication in which a hole developed which le d to constant, unremitting, and uncontrollable urinary incontinence. 65 The c omplication arose following prolonged obstruct ed labor where the fetus became ny cases the fetus and mother did not survive. If the mother lived she wa s often cursed with a painful and deb ilitating vesicovaginal fistula and in severe cases a rectovaginal fistula as well. 66 breakthrough procedure relieved women of this crippling postpartum ailment and allowed them to significantly improve their quality of life. 67 W hile Sims enjoyed over whelming popularity and success during his life, his legacy has since become shrouded in controversy as historians and medical 65 Journal of Medical Ethics 32 (2006): 346. 66 http://www.mayoclinic.org/diseases conditions/rectovaginal fistula/basics/definition/con 20034033, (accessed June 10, 2015) A rectovaginal fistula refers to the escape of feces through the wall of the anal canal or rectum leading to painful and uncontrollable loss of fecal control where stool and gas may pass through the vagina. 67

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27 professionals debate his questionable methods of experimentation on African American slaves during the antebellum years. 68 Dr. Si ms used enslaved women for medical research. Slave masters would bring their female slaves who were suffering from vesicovaginal fistulas to Sims for surgical repair. He initially denied to treat the condition and believed it was incurable but eventually h e took on the difficult cases and mastered the technique to repair the injuries. 69 He accomplished this through his development of the first of many vaginal specula which allowed him to internally view the vagina. 70 He engaged in repeated surgeries on slave s to perfect his technique and modify his instruments in an attempt to cure the vexing birth complication. He used a trial and error approach to improve his vesicovaginal technique and relieve women of their pain. While he did succeed in curing many of the enslaved women, the women often had to undergo a dozen or more surgeries without anesthesia or the ability to consent to their own treatment. 71 Dr. Sim s medical experimentation on slaves has divided the historical and medical communities fueling a heated debate over medical ethics and leaving his legacy in an ambiguous state. 72 68 69 347. 70 J. Marion Sims, On the Treatment of Vesicovaginal Fistula (Philadelphia: Blanchard and Lea, 1853), 10 11. 71 Journal of Medical Ethics 19 (1993): 28 30. 72 The Journal of Urology 185 (2011): 2424 2427.

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28 Figure 2.5: The first vaginal speculum invented by J Marion Sims and used to perform procedures to correct vesicovaginal fistula s This image of his speculum was published in On the Treatment of Vesicovaginal Fistula in 1853. Regardless of where modern scholars align on their arguments concerning Sim s medical conduct, Sim s early work on fistulas and his experimentation on enslaved women set the stage for his eventual work wi th infertility. As Sims developed new instruments and techniques to cure fistulas and other uterine irregularities he began to become keenly aware of the ability of medical intervention to assist infertile women. In 1855, he opened the revolutionary Woman first in America devoted to surgery diseases and infertility. According to medical historia n Margaret Marsh and OB GYN and medical historian Wanda Ronner in The Empty Cradle: Infertility in America from Colonial Times to the Present the hospital served a variety of women from all walks of li fe who suffered from a number of complaints ranging from menstrual disorders to severe pelvic pain and complications from birth. 73 Marsh and Ronner establish ed Sims and his assistants provided 73 Marsh and Ronner, The Empty Cradle, 53.

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29 surgical solutions for these women by performing fistula repairs, the removal of large ovarian tumors, and even a clitoridectomy to ease the pain and suffering of women and treat their gender specific afflictions. 74 Sim accidental interest in treating women suffering from sterility. In several of his publications Sims noted that improved fertility was often a byproduct of the surgeries he performed on women suffering from a variety of complaints such as dysmenorrhea, men orrhagia, fibrous polypus, and vaginitis. 75 Although infertility was not his intended subject of focus he found more and more women seeking his treatment for their res earching infertility in women and operating on uterine afflictions in hopes of finding a treatment. In 1866 Sims published his first edition of his research on sterility in Clinical Notes on Uterine Surgery with Special Reference to Management of t he Sterile Condition and outlined the complexity of diagnosing an d treating sterile women Sim s innovative Clinical Notes on Uterine Surgery was received with curiosity and widely read. H owever, it also aroused controversy among many of his professional colleagues. He discussed the inn er most workings of the female anatomy in a frank and casual tone which was viewed by many as inappropriate and vulgar. Since gynecology was a newer field many practitioners were uncomfortable with the amount of intimate c ontact they had to have with organs, he understood the importance of doing so in a respectful and professional manner. His 74 Marsh and R onner, The Empty Cradle, 53. A clitoridectomy refers to the removal of the clitoris. 75 Sims, Clinical Notes on Uterine Surgery ix xi. Dysmenorrhea refers to a painful menstruation. Menorrhagia refers to abnormally prolonged menstrual periods which come a t irregular intervals. Fibrous polyps refer to excess skin growths or tumors. Vaginitis refers to inflammation of the vagina.

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30 lengthy and detailed instruction on the proper protocol for a pelvic examination offered great insight into late nineteenth century understandings of propriety and female modesty. His exhaustive directions on uterine examination techniques span a total of seventeen pages. Sims pinpointed suitable methods to identify irregularities through touch and sight while promoting delicacy and respectability. His text is vastly different from the works of Hollick and Foo te, whereas they targeted the lay population; he is speaking directly to the medical community. A few of suggestions to maintain respectability include d insisting on a third person being present during examinations and the use of a catheter after ex amination to release air silently 76 Sim s meticulous discussion of proper uterine examination protocol serves to inform doctors of routine gynecological etiquet te while maintaining feminine diffidence. Figure 2.6: Dr. J. Marion Sim s sketch of a proper uterine examination by sight and touch published in Clinical Notes on Uterine Surgery in 1873 While Sim s procedural advice assisted in creating uniform practices among physicians exploring gynecology and helped to ease concerns over decorum, it was his groundbreaking analysis of conception, causes of sterility, and possible treatment techniques that helped to lay the foundation for the medicalization of infertility in the United States. In his introductory chapter of 76 Sims, Clinical Notes on Uterine Surgery 14 20.

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31 Clinical Notes on Uterine Surgery ed simply by curing uterine affl iction 77 He boasted that his surgical approach was the key to unlocking fruitfulness for barren couples and believed that he had a moral duty to assist couples in need. He claimed he was moved to compassion by his childless p atients because children were the greatest source of individual happiness. 78 Sims perpetuation of names and families, the descent of property, the happiness of in dividuals, and occasionally the welfare of the State, and even the permanence of dynasties and governments, 79 His preliminary remark in Clinical Notes on Uterine Surgery on why he chose to treat infertility mimic those of Hollick and Fo ote as well as subsequent physicians and suggests that he felt an obligation to use his power and influence to provide couples with what he believed was essential for a fulfilled life: children. He became a gate keeper of sorts ensuring that American famil ies continued to be abundant and multiply. Sims believed his work was culturally important and that medical expertise and authority were essential in upholding social norms and cultural institutions by helping married couples to produce offspring and conti nue family names and customs. In Clinical Notes on Uterine Surgery Sims expanded upon the previous work of doctors like Hollick and Foote and tackled the complexity of conception and sterility while he outlined the various factors that could influence rep roduction in the human species. He acknowledged that he had encountered sterility in many forms but that ultimately it fell into one of two categories for women 80 77 Sims, Clinical Notes on Uterine Surgery 1. 78 J. Marion Sims, The Story of My Life (New York: D. Appleton and Company, 1884), 338. 79 Sims, Clinical Notes on Uterine Surgery 5. 80 Sims, Clinical Notes on Uterine Surgery 2.

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32 conceived previously but for some reason had ceased to do so for a period of five or more years. 81 He established that there were certain conditions that were essential for conception to occur: 1. --It occurs only during menstrual life. 2. --Menstruation should be as such as to show a healthy state of the uterine cavity. 3. --The os and cervix uteri shoul d be sufficiently open to permit th e free exit of the menstrual flow, and also to admit the ingress of the spermatozoa. 4. --The cervix should be of proper form, shape, size, and density. 5. --The uterus should be in a normal position, i.e ., neither ante ver ted, nor retro verted to any great degree. 6. --The vagina should be capable of receiving and of retaining the spermatic fluid. 7. --Semen, with living spermatozoa, should be deposited in the vagina at the proper time. 8. --The secretions of the cervix and vag ina should not poison or kill the spermatozoa. 82 Each of these conditions wa s specific to the vario us disorders that Sims came in contact with conception could almost all can be treated with surgical intervention and he offered detailed instructions on how to perform gynecological surgeries that could correct any irregularities that could prevent pregnancy. He understood female infertility in mec hanical terms and believed he could manually fix as Sims recognized that the male partn er could be to blame for childlessness 83 He detailed the various forms that living sperm could appear in including the shape, the motility, and the sensitivity to surroun dings. 84 Just like Hollick and Foote, he 81 Sims, Clinical Notes on Uterine Surgery 2. The two types of infertility that Sims refers to are now known as primary and secondary infertility among medical practitioners. 82 Sims, Clinical Notes on Uterine Surgery 5. Os refers to any body orifice, opening, or cavity. For Sims work this will typically refer to the cervical or vaginal opening. 83 Sims, Clinical Notes on Uterine Surgery 354. 84 Sims, Clinical Notes on Uterine Surgery 352.

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33 challenged earlier physicians who argued that infertility was solely a female affliction and argued --1 st congenital malposition of the testes; 2 nd chronic inflammation of the glands; and 3 rd 85 In the first and second complications that Sims outlined the testes fail ed to produce spermatozoa and in the third the semen was regurgitated into the bladder. 86 Prior to Sims and fellow late nineteenth century medical men, physicians believed that only impotent men could be held accountable for infertility and that if a man could engage in intercourse he was deemed fertile. Just like Hollick, Sims challenged that 87 Previous doctors his ability to procreate but Sims refuted this notion of male virility through simple seme n analysis. Sim s groundbreaking acknowledgement that men could also bear responsibility for infertility set him apart from earlier doctors and illustrated a shift among physicians regarding reproduction and the relationship between the sexes. To him, men and women were both essential in reproduction and had their appropriate roles. While Sims fully recognized that men could be to blame in a couple dealing with sterility, he did little research in terms of treatment for men since he believed their conditio ns were most likely irreversible. 85 Sims, Clinical Notes on Uterine Surgery 354. 86 Sims, Clinical Notes on Uterine Surgery 354. 87 Sims, Clinical Notes on Uterine Surgery 355.

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34 Figure 2.7: Dr. J. Marion Sim s depictions of spermatozoa in various forms published in Clinical Notes on Uterine Surgery in 1873 Fig. 136, a, represents normal sperm, b represents the straight movement of the norma l sperm. Fig. 137 and Fig. 138 represent the injured sperm swimming in a circular motion. Fig. 139 represents an injured sperm doubled in on itself Since Sims explored few options to assist infertile men, women continued to be the focus of his invasive surgical interventions. Sims often found that the uterine cavity of infertile women was plagued with polyps or fibroid tumors. He developed several techniques and various medical instruments to remove polyps and fibroids and hesitantly endorsed t he use of his modified sponge tent to dilate the cervix, open the uterus, and allow the passage of his tools into the u terine cavity. The sponge tent wa s in essence a plug made out of co mpressed sponge material which wa s place d in the cervix where it remained over a period of one to three days to expand and dilate the cervical opening. The process of sponge tenting wa s incredibly painful and very uncomfortable for the patient. Sims spoke frankly of the unpleasant nature of sponge tents and declared

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35 rep 88 Sims used them to hopefully make for an never apply them without apologizing to my patient for the very u npleasant effects they 89 The sponge was used prior to surgery to open the canal so instruments like Sims curette and craseur could be placed directly into the uterus. 90 Figure 2.8: Sim s images of a cervix and uterus before and after the use o f a sponge tent for cervical dilation published in Clinical Notes on Uterine Surgery in 1873. Both Sim s curette instrument and his craseur were used to clear the uterine walls of any growth obstructions like polyps and fibroids. Sim s curette instrume nt had a malleable handle which could be bent side to side and forwards and backwards and a loop on the end to snag debris from the uterine cavity. 91 This instrument is still used in various forms today but was initially developed b y Sims to clear the uteru s so an infertile woman might be able to conceive. 92 Sims took this tool from another doctor and modified it for the means of clearing the uterine cavity for infer tility surgery. Sims affixed the spring blades and expanding chain to the forceps portion of the instrument and was then able to insert it into the vagina where it could be looped 88 Sims, Clinical Notes on Uterine Surgery 57. 89 Sims, Clinical Notes on Uterine Surgery 53. 90 Sims, Clinical Notes on Uterine Surgery 61 81. 91 Sims, Clinical Notes on Uterine Surgery 55. 92 Sims, Clinical Notes on Uterine Surgery 79.

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36 around growths. The growths could then be cut away by triggering the spring blades. While Sim s surgeries focused heavily on clearing uterine blockages in infertile women he also developed many devices and procedures to further open the cer vical canal (aside from the spo nge tent). He argued that the cervix must be of proper form, shape, size, and density. 93 If the cervix was malformed in any way he believed that ferility was compromised. He cut away portions of porportional The sponge tent, curette, craseur, and cervical curettage techniques used by Sims were just a few of many methods which were used to assist in clearing an unhealthy uterine uterine Although these instruments and techniques were innovative and allowed for growths to be more easily removed they illustrate d the invasive and painful practi ces that were used in Sims sterility treatments as well as his focus on advancing medical technology for the purpose of assisting infertile couples. 93 Sims, Clinical Notes on Uterine Surgery 5.

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37 Figure 2.9: Sim s curette and craseur tools used to clear blo ckages in the uterine cavity in infer tile women published in Clinical Notes on Uterine Surgery in 1873 Sims wrote extensively on dozens of surgical techniques to correct perceived anatomical malpositions within his reproductive systems but failed to provide data regarding whether or not the women became pregnant. He referred to many specific patients throughout Clinical Notes on Uterine Surgery and detailed the reasons why they sought his help, his diagnoses, and surgical methods th at were used but rarely mentioned whether the wom an was their surgical procedure s went as planned and moved on to the next case. His lack of follow up on whether these women achieved pregnancy offered insight into his mechanical understanding of the female reproductive system. Since he believed that he corrected the malfunctioning portion of Among all of the case studies provided by Dr. Sims there is one o nly one instance where he referenced a patient becoming pregnant after treatment. Near the latter portion of Clinical Notes on Uterine Surgery Sims broached a taboo topic and discussed his use of what he referred

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38 94 He claimed that he used a specially modified syringe to inject his of this chapter, the woman became pregnant after the tenth trial of injections but unfortun ately miscarried in her fourth month of pregnancy. Sims claimed that he performed a series of injections on several women but this was the only pregnancy which occurred due to his lack of knowledge of the timing of when conception could happen. In his disc ussion of artificial fructification Sims declared that this method was not a treatment of first resort and that surgery was the best option for women seeking an end to their sterility. 95 However, Sims acknowledged that if a woman was not willing to submit t o surgery he would perform artificial fructification as a last ditch effort to treat his patient. To obtain the sperm for the injection, Sims waited in another room while his patient and her husband had intercourse. 96 He would enter the room immediately aft er and withdraw the semen from her vagina with his specially altered syringe. He would then 97 Sims never asked a male patient to masturbate in order to obtain sperm because he believ ed it was emasculating for the husband and he did not want to encourage what he believed to be an immoral act. Sims believed was their most fertile time. 98 While only one patient became pregnant Sims acknowledged the importance of the breakthrough and hoped that his work would help future doctors in achieving more success in assisting couples to reproduce. 94 Sims, Clinical Notes on Uterine Surgery 366. 95 Sims, Clinical Notes on Uterine Surgery 366. 96 Sims, Clinical Notes on Uterine Surgery 366369. 97 Sims, Clinical Notes on Uterine Surgery 360 371. See figure 1 for an image of Sims instrument created for artificial insemination injections. 98 Sims, Clinical Notes on Uterine Surgery 368.

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39 Conclusion Sim s contributions to the field of gyneco logy and the advancement of assisted reproductive technologies like artificial insemination cannot be overlooked. He not only developed protocol for proper pelvic examinations that are still used today he also invented dozens of instruments which made intr auterine examinations and surgeries possible. The work of doctors like Hollick, Foote and Sims in infertility education and treatment ushered in an era of medicalization of infertility While Hollick and Foote differed in their approach by focusing on ed ucating the general public, they were the first in the process of medicalization. Sims on the other hand kept his work within the realm of the medical community and focused on only sharing his knowledge with fellow physicians. Regardless of the avenues the doctors used to advance the medicalization of infertility, they held the common belief that women could not live a fulfilled life if they were childless Because of this shared understanding of the necessity of motherhood, doctors found themselves moved t o use their expertise to assist women to become mothers. All of the doctors surveyed during this era only assisted married couples. There is no evidence to point to the treatment of infertility for single men/women or for couples who were not married. Duri ng the latter half of the nineteenth century marriage was clearly viewed as the prerequisite for parenthood by doctors as well as society. Doctors and their patients also viewed children as an essential component of the ideal family and investigated a variety of interventions to achieve the idyllic nuclear family unit. While Sims acknowledged that men played a very important role in reproduction he failed to advance infertility treatments for men and solely focuse d on his female patient s malformations. This led to the development of a multitude of invasive surgeries. There is no hard evidence of whether or not Sim s surgical patients were able to become pregnant following his treatments but the fact that these w omen sought his care (ofte n times repeatedly) illustrated a desire amongst these women to become mothers and their willingness to undergo painful and aggressive procedures to hopefully achieve motherhood. These women do not have a voice in Sim s publicat ions but they do appear to have some agency over their course

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40 of treatment. Specifically, when Sims discussed artificial fructification he mentioned that it was only performed on women who refused surgery. While Sim s patients were absolutely pushed towar d surgery (and Sims was clearly irritated if they refused) they were able to determine what was best for them as they sought an end to their childlessness. Sims was among the first medical men to publish his experimentation with artificial insemination, th ough he had little to no success his ideas were used by his successors to attempt to bring fertility to barren couples. The surgical practices and treatment recommendations offered by doctors like Hollick, Foote, and Sims defined infertility treatment thro ugh the end of the nineteenth century. By the dawn of the twentieth century, a new wave of medical men expanded on their work by identifying the hormone variables responsible for ovulation and challenging accepted understandings of marriage and fidelity by experimenting with artificial insemination by donors rather than by husbands.

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41 CHAPTER III REPRODUCTIVE ENDOCRINOLOGY AND THE A RTIFICIAL INSEMINATION DEBATE, 1918 1934 New York, April 30. Birth of technique that has been successful in 12 cases. Mr. and Mrs. Salvatore Lauricella who had been childless eight years were so pleased when their two babies were born that they disclosed the secret. Dr. Frances Seymour and Dr. Alfred Koerner both graduates of the Medical College of Virginia and now practicing in New York, then said they had conducted a series of successful experiments for the last two years but expressed surprise at the public interest i Seymour asserted none of the women could have borne children except through the intervention of sci 99 The Billings Gazette May 1, 1934 Salvatore and Lillian Lauricella tried unsuccessfully to become pregnant for eight years. In the face of her diagnosed sterility, Mrs. Lauricella underwent a series of unspecified treatments in an attempt to add a child to their family. 100 In spite of her constant efforts she still failed to conceive, and the Lauricella s hopes for a child quickly faded. In desperation, Mr. Lauricella turned for help to infertility specialist Dr. Frances Seymour, who happened to be a customer at his Manhattan service garage. Seymour agreed to look into the problem and quickly identified that the issue lay not with his wife, but rather with Mr. Lauricella. She diagnosed Mr. Lauricella with azoospermia, or the absence of sperm from his seminal fluid, and recommended artificial insemination. After several inseminations the couple became pregnant and in April 1934 Mrs. Lauricella gave birth to healthy twin girls. Although the Lauricellas were thrilled with the birth of their children, controversy soon ensued as newspapers across the nation published sensational articles documenting the successful s sterility. Just like the above mentioned excerpt from the Billings Gazette, the edit orials contained loaded language and broached the 99 Billings Gazette May 1, 1934. 100 Marsh and Ronner, The Empty Cradle 161.

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42 appeared in headlines and alluded to the scientific, and questionable, practice of Dr. Frances Seymour. Jour nalists relied on the opinions of various doctors in the field to discuss approval or disapproval of the procedure and made sure to interview Dr. Seymour and her associate Dr. Alfred Koerner. The use of artificial insemination divided the medical community and led to heated discussions among doctors about the repercussions of using such a procedure. Physicians on either side of the debate (for artificial insemination or against) ultimately used gendered language and assumptions regarding reproduction and fa mily structure to make their arguments. Even though the debate revolved around medical professionals the opinions of church officials and columnists also shaped the discussion since they aligned themselves either for or against the practice of artificial insemination. In the first half of the twentieth procreative health transitioned into obstetr icians and gynecologists (OBGYN s) as the field gained increased legitimacy. Like physicians before them they inven ted new medical technologies to advance infertile couples possibilities of becoming pregnant. While they used many of the instruments and techniques that were established in the latter half of the nineteenth century, they separated themselves from their pr edecessors by gaining new evidence of female sex hormones and introducing innovative less invasive (and in some cases even nonsurgical) techniques to improve female reproductive capabilities. Doctors like John Rock, Samuel Meaker, Frances Seymour, and Alf red Koerner used new scientific discoveri es and innovative new technologies to dramatically alter and expand infertility treatment options and further medicalize the condition With increased knowledge of ovulation and impr oved surgical techniques, OBGYN s of the first half of the twentieth century were able to refine artificial insemination practices and generate resul ts with increased success rates. While OBGYN s in the early twentieth century enjoyed more success in assisting infertile couples to get pregn ant they also faced much more critical attention from spectators outside of

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43 the medical community. The work of infertility specialists gained much public attention and was hotly debated by doctors, lay persons, journalists, lawyers, and the religious lead ers. New infertility treatments offered by doctors like John Rock and the publications of successful artificial impregnation by doctors like Seymour and Koerner prompted the general public to respond and critique the ethical behavior of these physicians. T he legal, moral, and medical discourse on the topic o f artificial insemination and medical intervention into infertility offered interesting insight into how gendered assumptions of reproduction and family structure were constructed an d how those assumptions evolved through the intervention of the medical community. Infertility specialists of the early twentieth century differed from those before them not only in their advanced knowledge and attention from the public, but also in their motivations for treating infertile couples. While these doctors still viewed infertility as a disease and developed techniques to cure couples, they practiced under very different cultural contexts. These doctors were influenced by the popularity of the eu genics movement following World War I and the desire for a superior race. While the eugenics movement had been gaining ground since the late 1880s, historian Wendy Kline argues that fear of foreigners and disillusionment following the devastating brutality of the war prompted a huge surge in support for eugenics organizations. 101 Eugenics supporters argued for the advancement of the human race through selective breeding and sterilization and often turned to the medical community to support their efforts to cr eate a superior nation. 102 Doctors used accepted eugenics rhetoric to defend their research and often framed their medicalization efforts in terms of nation al responsibility 103 101 Wendy Kline, Building a Better Race: Gender, Sexuality, and Eugenics from the Turn of the Century to the Baby Boom (Berkley: University of California Press, 2011), 14 18. 102 Kline, Building a Better Race 105. 103 Kline, Building a Better Race 30.

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44 Careful analysis of newspaper articles, medical journal articles, and various works by respected physicians of the era shed light on the motivations for the advancement of assisted reproductive technologies and the impact of gendered thinking in the shapin g of social perceptions of infertility and reproduction. The aggressiv e and divisive discourse among the medical and legal communities during the first half of the twentieth century potently demonstrate d the desire for experts to maintain power over socie tal norms, especially in the realm of gender relations and reproduction. The medicalization of infertility granted doctors cultural medical community. Regard less of their stance on the argument, doctors who approved and disapproved of the use of assisted reproductive technologies like artificial insemination were influenced by cultural acceptance of eugenics and used gendered language and gendered assumptions about reproduction to make their arguments and reinforced traditional notions of masculinity, femininity, and family formation just like the doctors who had come before them Ultimately, the new technologies and techniques embraced by physicians to treat i nfertility in the first half of the twentieth century helped to shape understandings of reproduction and infertility nuclear family in American culture to suppo rt the power of the state. Clinical Research and the Birt h of Reproductive Endocrinology Medical men in the late nineteenth century still faced many uncertainties regarding the process of conception and lacked scientific knowledge of ovulation timing and hormone variables. Due to their ignorance of such important information they struggled to find much success with their courses of treatment for infertile couples. They acknowledged importance of healthy sperm for successful conception but offered little aid to men who faced sterility. Rather, these physicians focused on the female form in an attempt to help childless couples to procreate.

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45 They invented new medical technologies like the vaginal speculum and craseur tools to peer that could hinder fertility. They used invas ive surgical techniques and found little success with their attempts at artificial impregnation through uterine injections of sperm. While they did not document much (if any) success at curing infertile couples they did lay the foundation for the reproduct ive trailblazers of the twentieth century who continued their work with the same idealistic goal in mind: to virility by providing him the ability to procreate and perpetuate his name. Dr. Isidor Clin ton Rubin was among these OBGYN s who wanted to provide non operative and less invasive diagnoses techniques for women seeking infertility treatment. In 1920, he published his successful account of the development of a nonsurgical test to determ ine the patency (openness) of the fallopian tubes. Prior to the Rubin Test for fallopian patency undergo aggressive major surgery via the laparotomy method in wh ich the abdomen was opened to reveal the uterus, tubes, and ovaries. 104 A closed or blocked fallopian tube was (and is) a common cause of female infertility and the Rubin Test allowed women to avoid major surgery and be diagnosed by a simple apparatus set up practiced the procedure on over 55 patients claiming that complications were minimal and at most his patients were just temporarily uncomfortable. 105 His nonsurgical procedure eradicated the nee d for laparotomie s as a diagnosi s method for infertility and illustrated a shift away from invasive surger ies for twentieth century OBGYN s. The Rubin Test in the 1920s i s just one example of physicians willingness in the first half of the twentieth century to explore innovative medical techniques that would encourage women to seek treatment. 104 Ma rgaret Marsh and Wanda Ronner, The Fertility Doctor: John Rock and the Reproductive Revolution (Baltimore: John Hopkins Press, 2008), 64. 105

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46 Although innovative diagnosi s techniques like the Rubin Test made infertility treatment less threatening for many women, it was the discovery of female sex hormones which foreve r s understanding of female infertility and improved its ability to infertility Doctors had speculated on the existence of sex hormones since the late nin eteenth century but were unable to prove their presence or determine the role they played in ovulation, conception, and pregnancy. This all changed in 1923 when scientists Edgar Allen and Edward Doisy successfully isolated estrogen followed closely thereaf ter with the isolation of progesterone. Clinical research to isolate and synthesize reproductive hormones was advanced by the Committee for Research in Problems of Sex which was established in the early 1920s and funded by the Rockefeller Foundation. 106 The Committee for Research on the Problems of Sex funded much of the exploration of reproducti ve endocrinology from the 1920s to 1940 and was largely responsible for the eventual creation of synthetic forms of hormones. 107 The Committee also funded much research on the advancement of birth control which coincided with nationwide endorsement of eugenics and limiting family size for those less desired. The popularity of the eugenics trend i s evident not just in physician s attempts to help worthy couples to procrea te but also their attempts to limit perceived inferior groups from further procreating. 108 Ironically enough throughout much of the twentieth century infertility and birth control research coincided. The isolation of estrogen and progesterone allowed for sci entists to map the workings of the human female reproductive cycle from the menstrual phase, through the follicular phase, ending at the luteal phase. The knowledge of the two female sex hormones was revolutionary in the physicians understanding of reprod ovulate and dramatically increase success rates for artificial insemination. 106 Marsh and Ronner, The Fertility Doctor 162. 107 Marsh and Ronner, The Empty Cradle, 140. 108 Kline, Building a Better Race 14 18.

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47 Dr. John Rock was among the first OBGYN s to research hormone variables and apply his findings to treat infertility in his female patients. He used meticulous research methods to collect data and analyze his findings within his observation pools. He opened the Sterility Clinic at the Free Hospital for Women in Brookline, Massachusetts in 1926 and devoted his practice to as sisting women battling infertility. 109 Rock spent hours not just treating patients but also acting as a research endocrinologist seeking to further unlock the secrets of hormone factors by practicing research methods to collect and analyze data. By catalogin treatments, and outcomes he was able to refine his practice and contribute much to the overall specialty of infertility treatment. Rock laid out his motives for treating sterility as well as his theoretical causes and treatme in The New England Journal of Medicine. He clearly sought to end the unhappiness of his patients but also saw his treatments as a means to better the nation and the further strengthen the populous. He noted that: his physical end, like tha t of all other species of animal and vegetable life, is to perpetuate his kind. The normal man or woman is endowed w ith an instinctive desire for offspring; the permanency of the state depends on the replacement of its citizens; and the proper is essential to its autonomy among t he nations of the world. 110 He understood his attempts to help the infertile as serving a larger purpose to ensure the strength of the nation as well as provide man with the ability to fulfill his inherent desti ny to procreate. His language was filled with assumptions that American men and women should seek an end to America would remain free from the pressures of outside nations. Much like John Rock, OBGYN Ro bert L. Dickinson believed in advancing knowledge of the female reproductive hormones through clinical research so physicians could have the ability 109 Marsh and Ronner, The Fertility Doctor 116. 110 The New England Journal of Medicine 199 (1928): 79.

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48 medic al career began in 1882 reproductive health. While he worked among early practitioners such as J. Marion Sims and had been an active practitioner of gynecological surgeries to cure infertility, by the late 1910s he had a ltered his outlook and adjusted his practice to include less invasive diagnosis an d treatment options as well as clinical research to advance understandings of endocrinology and the reproductive system. In 1920 Dickinson retired from his private practice but devoted the rest of his life to research through the formation of the Committee on Maternal Health. 111 Much like the Committee for the Research of the Problems of Sex, the Committee on Maternal Health was funded by the Rockefeller Foundation, a vocal pro ponent of eugenics policies. 112 With eugenic principles in mind the Committee on Maternal Health initially focused on contraceptive matters but quickly embraced infertility treatment as a means to encourage procreation of desirable stock. The Committee on M aternal Health standardized the systematic collection of data for patients seeking infertility treatment and provided detailed accounts of findings for other doctors to utilize in their treatment efforts. Dickinson and the Committee on Maternal Health ar e also credited with enabling the Human Sterility: Causation, Diagnosis, and Treatment: A Practical Manual for Clinical Treatment. Human Sterility encouraged clinical research as well as the investigation of nonin vasive procedures, reproductive endocrinology and lifestyle behaviors as necessary in dealing with infertile couples. He identified gradations of sterility from absolute fertility to absolute sterility. 113 He demonstrated that clinical research with clear re corded data was essential for understanding sterility and being able to treat patients effectively. By using 111 Marsh and Ronner, The Empty Cradle 149 151. 112 Marsh and Ronner, The Fertility Doctor 120. 113 Samuel Meaker, Human Sterility: Causation, Diagnosis, and Treatment: A Practical Manual for Clinical Treatment (Baltimore: Williams and Wilkins Company, 1934), 6.

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49 clinical research Meaker found that he was more successful in treating some of the gradations of infertility and ultimately fulfilled eugenic ideal s of preserving superior bloodlines by assisting worthy couples in procreating. In Human Sterility 114 H is belief that sterilit y was detrimental to society le d him to pursue clinical research for infertility treatment where he embraced his eugenic understanding that reproduction of superior families was necessary for the progression of society and such super ior families must perpetuate their numbers for the welfare of the nation. 115 research. The numerals have no concrete significance, but serve to emphasize the gra dation of the scale. Charts published in Human Sterility in 1934. Human Sterility set a new standard for clinical research protocol when diagnosing and treating infertile couples especially when it came to identifying endocrine malfunctions. Mea ker diagnostic study adequate to establish or rule out the presence of endocrinopathy in each partner, 114 Meaker, Human Sterility 10 11. 115

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50 and to identify as far as possible the primary focus when such a disorder is p 116 Meaker argued that each patient should provide thorough family and personal health histories which would grant insight into possible endocrine deficiencies that could inhibit fertility. He linked specific ailments with pituitary, thyroid, or ova rian malfunctions and determined courses of treatments based on those findings. Since blood examinations to determine various hormone levels were not adequate at this point, Meaker provided detailed explanations for secondary symptoms of hormone malfunctio ns which would alert the practitioner to endocrine problem and allow him to establish a course of treatment. Positive Data in Endocrinologic Relationships identifying his findings of correlations between health history and certain endocrine dysfunction. Charts published in Human Sterility in 1934. Meaker acknowledged that infertility could be a combination of factors and to treat the patient the physician must attempt to remove as many impediments as possible. He believed that 116 Meaker, Human Sterility 158.

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51 conceive. 117 While he asserted that endocrinology and overall health were important factors for fertility he also recognized the importance of sound structural makeup of both partners reproductive systems. He condoned the cooperation of gynecologists, uro logists, endocrinologists, and internists to assist infertile couples with the various procedures and treatments they may require as he believed all parts of the human body worked together for fertility. Although he endorsed treatment of endocrine issues for infertile couples, this often still necessitated surgeries since synthetic hormone replacements were still in e xperimental stages. While OBGYN s like Meaker sought less invasive surgical approaches to treat infertility they often still turned to operati ons to treat sterile couples after diagnosing endocrine abnormalities and failed to identify male hormone variables An important contribution that Meaker provided in his Human Sterility was data on his ed that documenting successful pregnancies following treatment was a difficult undertaking but thought it to be a crucial component of his clinical research. He documented his success rates for treatment with his former methods and results. 118 His willingness to explore less invasive diagnosis and treatment options as well a s his devotion to clinical research and follow up and documentation on the success rates of his patients illustrates a clear difference between the medical men of the late n ineteenth century and the OBGYN s of the early twentieth century. 117 Meaker, Human Sterility 156 158. 118 Meaker, Human Sterility 257.

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52 Figure 3.3: Data collected and published in Human Sterility by Dr. Samuel Meaker regarding the Meaker also explored the advantages and disadvantages of artificial insemination for barren couples using Sim s earlier wo rk as a springboard. He argued that artificial insemination or refused to perform the procedure. 119 He noted that doctors before him who had attempted artificial insemination found minimal success because they imperfectly practiced the technique with the lack of a scientific basis. He claimed that they did not acknowledge two crucial prerequisites that must exist for artificial insemination to be of value to a barren couple: the semen must be of high quality and the female supracervical genital tract must be generally normal. 120 If both conditions existed he encouraged physicians to perform artificial inse mination. 119 Meaker, Human Sterility 222. 120 Meaker, Human Sterility 222.

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53 A simple technique is adequate. The time of choice falls generally between the twelfth and fifteenth days after the beginning of menstruation. Semen may be collected in a condom, and should be used as promptly as possible. A syringe graduated in minims is equipped with a fine cannula long enough to pass well above the os internum. Syringe and cannula, after being sterilized together, are immersed in water at body temperature; the tip of the cannula should meanwhile be guarded by a cork in order to keep all of the water out of the instruments. The cervix is exposed and wiped dry. With everything in readiness, semen is drawn up from the condom into the syringe. The cannula is injected. The patient does not require special after care. 121 procedure used the same basic principles as Sims but differed in two important ways. First, because of his superior understanding of reproductive endocrinology he held a better understan ding of ovulation timing. His recommendation of performing th e procedure between days twelve and ovulate. Because Sims did not have this knowledge he performed his procedures days s even to nine which was far too early for many women to ovulate. Second, Meaker was also willing to obtain a sperm specimen from a condom whereas Sims acquired the specimen directly from the se a condom was emasculating a manner that had been previously viewed as vulgar marks a distinct difference in doctors understanding of male accountability in fertility treatments as well as their shifting cultural perceptions of masculinity and intercourse. predecessors, he still warned against the possible consequences of such a technique and ac knowledged that there could be backlash from the public on moral and legal grounds if a couple used donor sperm rather than sperm from the husband. Meaker argued that if a husband was diagnosed with permanent absolute sterility the n conception was not poss ible for a couple unless 122 His 121 Meaker, Human Sterility 223. 122 Meaker, Human Sterility 214.

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54 admission of the artifi cial insemination by donor was ground breaking for it allowed hope to couples who faced grim prospects for proc reation but it also raised questions about the moral, legal, and spiritual costs. Although he was the first physician to openly approve of insemination by donor, he and undertaken without explicit consent of husband, wife, and donor 123 possible problems that could arise shed light on his understanding of the impact of reproduction on family formation and gender roles. He saw clear complications with a woman bearing another desired by her and her husband. The notion of artificial insemination by donor elicited concern for Meaker because it allowed a married woman the opportunity to become pregnant by another man, which could have larger consequences for society regarding th e perpetuation of family names and patriarchy. Meaker was the first to openly reveal the technique of artificial insemination by donor which exploded into a very public debate in the mid 1930s regarding the legal and ethical risks of such a procedure and w hether or not physicians had the authority to separate reproduction from sex. Infertility specialists in the early twentieth century like Rock and Meaker enjoyed much more success with artificial insemination than earlier doctors but eventually were attac ked by observers outside of the medical community once the topic hit the public arena through the publication of sensationalized newspaper articles and scandalous editorials. The sensational headlines regarding artificial insemination incited public debate s among doctors, lawyers, and laypeople over reproduction, family formation, and gender roles. By the mid 1930s, doctors took to their corners to defend their use or abstention from the practice of artificial insemination and employed eugenic arguments and accepted notions of femininity and masculinity to make their 123 Meaker, Human Sterility 214.

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55 claims, Physicians no longer enjoyed absolute authority like they had at the early onset of medicalization, over all things medical and had to answer to the public regarding the treatments they provided and what it meant for society. Ar tificial Insemination Advocates The publication of hundreds of news articles announcing the birth of the Lauricella twins incited massive attention from observers outside of the medical community and officially introduced the topic of artificial insemination into public consciousness. The public discourse surrounding the Lauricella controversy soon revealed that doctors had been aware of the method for some time and had alr eady aligned themselves as either advocates or opponents of the technique. In an attempt to defend their actions and to further encourage the use of artificial insemination within the medical community, Dr. Frances Seymour and Dr. Alfred Koerner became the most vocal proponents of artificial insemination during the early 1930s. In newspapers across the nation Dr. Seymour indicated that artificial insemination was the only many women able to have children. 124 She acknowledged that eight other babies had been born using the process of artificial insemination and that she was expecting five more births within the next few months. 125 Throughout the articles she adamantl y defended her actions by asserting that science was the only answer for these women who desperately sought motherhood. 124 Billings Gazette May 1, 1934. 125 Billings Gazette May 1, 1934.

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56 Figure 3.4: Image of the Lauricella twins whom were conceived using the artificial insemination technique published in The Ogden Stand ard Examiner June 17, 1934. Seymour defended the use of artificial insemination but also took the opportunity to educate the public on the differences between two types of artificial impregnations. According to The El Paso Herald Seymour described that impregnation, the child is actually the offspring of the husband and wife except that scientific 126 This type of artificial insemination was often referred to as artificial ins emination by husband, or AIH, and was seen as the most acceptable form of assisted reproduction among the medical community. Seymour elaborated on the second type of to 127 This kind of artificial insemination was referred to as artificial insemination by donor, or AID, and created a rift within the medical community. Due to Human Sterility the medical community was already abu zz regarding the controversial 126 Laboratory The El Paso Gazette April 30, 1934. The El Paso Gazette was just one of many newspapers which explored donor. 127 The El Paso Gazette April 30, 1934.

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57 treatment but the general public had been ignorant of such a technique. Seymour took the opportunity to educate the public about its use and more importantly justify its use as an ven though it was the husband who was sterile, the wife was still viewed as also being sterile since she could not be impregnated by her husband. importance of motherhoo On the heels of the Lauricella controversy, Seymour and her associate and husband Dr. Alfred Koerner continued their vocal support of AIH and AID by publishing several articles in the Journal of the American Medical Association Insemination," Seymour and Koerner responded to the increased condemnation of insemination physici an was bound by many legal restrictions in the practice of medicine, and, however morally certain he may feel in aiding or abetting certain acts, he must live within the legal restrictions and also comply with the dictates of society, which form the moral 128 They recognized the most pressing legal and moral concern of AID was the issue of the legitimacy (as defined by the legal status of a child born to married parents) from the technique and outlined their process for ensuring legitimac y while ensuring that all parties involved were acting with morality in mind. In the article, Seymour and Koerner dismissed claims that artificial insemination was equivalent to adultery. They contended that according to New York State law, adultery was de 129 They argued that since the prospective mother did not know or even see the donor the technique of insemination could not be viewed as adulterous. While they handily invalidated any 128 Journal of the American Medical Association Vol. 107, (1936): 1531. 129

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58 claims that AID was adultery they recognized that the actual legitimacy of the child could be more problematic since parentage could not be connected to the husband of the prospective mother. To combat this criticism they urg ed doctors practicing the technique to use a specific consent form which was completed by both the husband and wife. They argued that this consent form essentially legitimatized the child under the law and established it as the legal heir of the family uni t. 130 This argument justified AID by asserting that a nuclear family could still be created and maintained through proper documentation. defense of AID also promoted the rig hteousness of a nuclear family and the importance of motherhood. They claimed that for all parties involved (mom, dad, baby, and donor) there were after the birt 131 According to Seymour and Koerner, the wife would be happy and the marriage was sturdier since their years of childlessness were behind them. They also asserted that the wife was clearly of high moral character becaus e she opted to husband from ever knowing of his sterility by bearing him one or more children by questionable 132 Here they allude to the idea that a wo man in an infertile marriage who was of low moral character would turn to adultery to fulfill her desire for a child which would inevitably deny the husband knowledge of his infertility and cause the decay of their marital bonds. By establishing that AID was consistent with moral and faithful behavior, Seymour and Koerner endorsed the gendered assum in their ability to reproduce and please their mates. 130 131 132

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59 Aside from the positive outcomes of AID for the mother, Seymour and Koern er also provided reflection on the benefits for the husband. They emphasized that since the husband had been denied paternity he would sublimate his feelings and raise the child even more carefully than he would his own. 133 They argued that he would make up for infertility by being an outstanding father. They also argued that the husband would be a better father because he knew right type of donor and that if he, as the father, gives the child the proper opportunities in life 134 Seymour and Koerner embraced the early twentieth century eugenics movement and used societal perceptions of the improvement of the human ra ce through selective breeding to further justify AID. While they spend much time discussing the factors that would lead to the husband being a superior father they also claimed that the husband would appreciate his wife more for her sacrifice and willingness to undergo such an unusual procedure. The doctors focused on the necessity of a strong marriage and reinforced the desire for nuclear families in American culture which helped Seymour and Koerner to make their case that AID was beneficial to not just to individual families but to society as a whole. Just like many advocates within the medical community, social critics across the nation relied on popular eug enic theories to endorse artificial impregnation. Columnist Jane Stafford 135 She defended her positive opinion of artificial insemination by putting he r faith in the opinions of medical professionals. She told her readers that doctors were exceptionally careful 133 134 135 The Ogden Standar d Examiner June 17, 1934.

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60 136 She asserted that donors should also be tall and of the same ethnicity of the mother. According to Stafford, these donors should be the most nearer to a race 137 Newspapers around the country published editorials that n they served an important function in improving mankind. 138 eugenic policies that were presented by doctors like Rock and Meaker and suggested that families should indeed multiply but only if the resulting children were of desirable stock. Throughout their assessment of the medicolegal features of AID Seymour and Koerner made it clear that doctors should wield ultimate authority over AID decision making and act as guardi ans of social morality and reproduction. They endorsed subterfuge and voluntary deception when dealing with couples undergoing AID. They believed that the prospective mother should be ignorant of the identity of the donor because it would block any future idle hours of imagining which could torture her 139 Once again they reaffirmed the importance of a strong marriage and validate d notions of the necessity of a w Seymour and Koerner also warned against using family members, such as a brother, as mother should know who the actual father of he r child was there would be transference of her 136 The Ogden Standard Examiner June 17, 1934. 137 The Ogden Standard Examiner June 17, 1934. 138 Newsweek (May 1934): 16. 139

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61 140 Assuming that a wife would fall in love with the donor provides no agency for these women and makes her appear Although Seymour and Koerner appear to be quite innovative in their legal and moral understandings of legitimacy and AID, in reality their arguments only reaffirmed gendered not ions of proper nuclear family structure and the belief that wifehood and motherhood were essential in the development of female identity. While Seymour and Koerner were the most vocal in their promotion of artificial insemination, other doctors also voice d their support for the practice. Dr. Victor Lespinasse, for example, reported to the Chicago Tribune that he had arranged donor inseminations for couples suffering from sterility. 141 Newsweek also reported that doctors were endorsing artificial insemination and specifically at the Marriage Consultation Center in New York, Drs. Hannah and Abraham Stone referred desperate couples to doctors who performed AIH and AID. 142 These doctors employed the same consent form protocol as Seymour and Koerner and justified th e use of artificial insemination as a necessity for the mutual happiness of the couple and the well being of the wife. 143 Many of the doctors demanded that all other options be exhausted before AID was used. For instance, Dr. William H. Cary popularized the argued that physicians should be prepared to render the service of semiadoption to couples in 144 Although 140 141 Kara W. Swanson, Chicago Kent Law Review 87, (2012): 608. 142 143 144 Thirty Journal of the American Medical Association, Vol. 114, No. 22 (1940): 2185.

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62 several doctors did confir m that they practiced both AIH and AID they often were not as enthusiastic about its endorsement as Seymour and Koerner. While some doctors were willing to come forward to discuss their use of AID as beneficial for families and society, most doctors prac ticed AID in secrecy and did not publicly acknowledge the technique. Seymour and Koerner tried to combat the secrecy of AID by conducting a survey of physicians and publishing the findings in the Journal of the American Medical Association Insemination: Present Status in the United States as Shown by 9,489 pregnancies were achieved using the method of artificial impregnation. 145 Of those pregnancies two were used in the remaining one third. 146 They emphasized the popularity of AIH among physicians but acknowledged the growing use of AID across the nation. They established that 97% of pregnancies initiated by artificial insemination resulted in live births. Their emphasis on the success of live births points to their attempt to legitimize artificial insemination as a viable and safe means to treat sterility. 147 Seymour and Koerner publ ished the survey in an attempt to justify artificial insemination by making it appear commonplace and expansive throughout the nation. Although the artificial insemination debate encouraged some doctors to publicly endorse their use or support of AIH and/o r AID, other doctors vehemently oppo sed the use of such techniques. 145 Frances Se Journal of the American Medical Association, Vol. 116, (1941): 2747. 146 147 Seymour a

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63 Ar tificial Insemination Opponents Many of the doctors who publicly condemned the practice of AI reported to newspapers , due to its improper nature it had been denounced by medical experts. Dr. W.T. Dannreuther, president of the New York County Medical Society, was one of many physicians who declared that just because a practice was possible did not mean it was ethical. According to the Fayetteville Daily Democrat, Dannreuther claimed that the practice was largely discredited by experts for three ssful; second because of the danger of infection and 148 Although Dannreuther did not directly cite evidence of these assertions his opinion was representative of the arguments of many physicians who opposed artificial insemination. He showed clear disdain for the use of artificial insemination and argued that it was not in the best interest of a prospective mother to undergo such a process because it could cause further emotional distress if the wife did not become pregnant and fulfill her desires for motherhood. Dannreuther also claimed that organized medicine highly disapproved of not just the receiving due to the anno uncement of the Lauricella twins. 149 He stated that since Dr. Seymour was not a member of the New York County Medical Society an investigation into any violations ue desire of the medical community to maintain control over certain aspects of reproduction by 148 Galveston Daily News May 2, 1934. 149 Fayetteville Daily Democrat, May 1, 1934.

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64 limiting discussion of its use to doctors rather than the gener al public. He acknowledged awareness of the technique but at the same time demanded secrecy concerning its use; this contradiction highlights attempts by doctors to ultimately regulate social understandings of reproduction and scientific intervention to as sist infertility. To reduce the media attention and public interest sparked by the Lauricella twins, the New York Academy of Medicine quickly released a statement condemning artificial insemination. In the release semination was not new, was 150 The statement was meant to reassure the public that artificial insemination was not a conventional practice among medical professionals and that it should be avoided as a means to treat infertility due to its contentious connection to illegitimacy from their attempt to maintain control over reproductive matters as increased awareness of contr oversial tec hniques became public knowledge. Dr. Morris Fishbein, editor of the Journal of the American Medical Association was another vocal opponent of artificial insemination. To denounce the practice and educate the public on the perceived problems with such a technique he released a statement which was published in nearly a dozen newspapers across the country. Fishbein claimed that the idea of test tube babies was nothing new legal 151 He explained how the actual process of insemination worked and identified that in recent years the practice had become more popular among couples whose physical conditions prevented them from becoming p regnant. Although he outlined how and why the process was used, he ultimately concluded that due to the 150 151 Journal of the American Medical Association. Syracuse Herald, May 7, 1934.

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65 152 He also endorsed adoption as a more appropriate w ay to add a child to an infertile couple because it could be legally traced and did not jeopardize the perceived health of the patient couples facing infertility reaffirmed the societal notion of the ideal nuclear family in the making of identity regardles s of whether or not the couple wa s able to procreate themselves. Opponents of artificial insemination often pointed to the legal problems with artificial insem ination and specifically denounced the technique because it created illegitimate children. According to an anonymous editorial in The Journal of the American Medical Association the semen of the husband is used, the child obviously is as legitimate if it were the result of 153 To this author AIH was an appropriate treatment for sterility because it did not allow for a third party (a donor) to enter into semen from some other male is utilized, the resulting it was born out of adulterous circumstances. 154 The problem for the author is that AID ultimately allowed the wife to bear a child from another man and disrupted traditional understanding of marriage and marital vows of fidelity as well as the importance of heredity in the perpetuation of family names and customs. The author of this editorial addressed Seymour a husband has freely consented to the artificial insemination does not have a bearing on the 155 Use of a form did not rectify the occurrence of illegitimacy 152 Syracuse Herald May 7, 1934. 153 The Journal of the American Medical Association. Vol. 112, (1939):1832. 154 155

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66 but rather just proved that the husband consented to herefore, the child remained illegitimate. Interestingly, while the author clearly favored AIH and found AID to be problematic due to the legal issues of legitimacy, he did acknowledge that AID was going to be used regardless and urged doctors to use absolute secrecy with patients and endorsed formal adoption of the resulting children. To him, adoption of the child by the husband of the mother after birth was the only true way to protect the child from a life of illegitimacy and ensured that the child was the product of a proper marriage. Judge Joseph Sabath, a Chicago divorce jurist cited in many of the articles pu blished on the test tube technique, concurred with the opinion published in JAMA and declared that any 156 According to the arguments of the editorial and Judge Saba th, fathers of babies born using artificial insemination had to depend on legal means to certify parentage. This line of reasoning used by opponents of artificial insemination illustrates the desire of doctors (and to some extent lawyers) to maintain contr ol over what they considered appropriate reproduction and endorsed the creation of a nuclear family that would be recognized in the eyes of the law through formal adoption. The issue of introducing a third party into a marriage provoked a response from no t just doctors and lawyers but community members as well. Following the public announcement of the birth of the Lauricella twins, the Catholic Church responded with sound disapproval. According to The Galveston Daily News Reverend George Craig Stewart, bi shop of the Episcopal Diocese 157 The Reverend claimed that the Church cherished the spiritual view of marriage and th at the addition of an outsider into a marriage defied 156 Galveston Daily News May 2, 1934. 157 Galveston Daily News May 2, 1934.

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67 the sacramental union. 158 The Church viewed the separation of sex from reproduction as an abomination and a direct challenge to the institution of marriage. Doctors and spiritual advisors alike were uncom fortable with the notion that a donor was welcomed into a traditional marriage thus violating acceptable understandings of fidelity and family structure. Criticisms from the general public also appeared in editorials and mimicked the arguments of doctors and spiritual leaders. Social critic Florence W. McGehee argued that people born from this technique to the main chance creatures without any nice 159 She assumed that babies who were the product of artificial insemination would inevitably be inferior humans due to their scientific beginnings and lack of a traditional family structure, since the identity of a father could not be confirmed. Her opinion relied heavily on the opinions of those doctors who opposed artificial insemination and reinforced societal notions of proper formation of a nuclear family. The Oakla nd Tribune According to her interview with Henry Fairchild, professor of sociology, in cases where an unknown man was used for family history would be unknown. 160 G to many uncertainties ab out the type of person the test tube baby would become; it could turn out to be a midget, giant, honor student, or criminal. 161 Genn concluded that test tube babies were indeed especially if they were the product of an unmarried mother. 158 Galveston Daily News May 2, 1934. 159 Woodland Daily Democrat, May 10, 1934. 160 The Oakland Tribune, June 24, 1934. 161 The Oakland Tribune, June 24, 1934.

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68 Figure 3.5: Illustration depicting the possible outcomes of artificial insemination by donor published in The Oakland Tribune, June 24, 1934. Florence McGehee highlighted a major point of contention addressed by doctors and critics on both sides of the argument, the insemination of unmarried women. She opined that mothers while keeping that so desirable independence go in for the test this method but suggested the distinctive yearning for motherhood w as strong enough for women to resort to artificial insemination. In spite of her acknowledgement of the innate desire for motherhood by unwed women, she argued that this was a selfish choice. To her, these mothers and their test tube babies would be cheated out of having a father 162 She argued that children had the right to a mother and a father and when the test tube baby was grown he/she would certainly be at a disadvantage in society because of a lack of knowledge of fa mily history and a traditional unrelenting desire for motherhood. 162 Woodland Daily Democrat, May 10, 1934.

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69 Pri or to Seymour, physicians specializing in infertility only saw couples and did not even mention single men or women in their findings. Married couples were the only patients worthy of receiving medical attention for their infertility for they were denied their cultural right to procreate and create a nuclear unit. Dr. Seymour however changed this ideology and admitted to inseminating single women and received harsh criticism from doctors as well as social critics. Her opponents argued that she was advocati ng for the destruction of American values since she allowed for single women to have children without husband s insemination of unwed women were uncomfortable with the removal of sexuality from reproduction and felt it made a mockery of the sacred bonds of marriage. Their belief that single women should not be inseminated reinforced the traditional belief that a nuclear family was and wife was essential to her ide ntity and the well being of her children. Seymour combatted the criticisms of AID for unmarried women and defended her choice by health and of better than 163 She also emphasized physician control over the type of women who would be candidates for such a procedure. Specifically, she referred to two unmarried women she inseminated who desperately wanted motherhood. According to the Manitowoc Her ald Times she had a right to have children. 164 She justified her decision by stating that the women were prominent businesswomen who could be able to financially and emotionally care for the children Her assertion that only a certain type of woman should be given access to single motherhood reiterated physician control over reproductive matters while maintaining that maternal instinct was strong enough to b reak traditional social norms. 163 Manitowoc Herald Times May 1, 1934. 164 Manitowoc Herald Times May 1, 1934.

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70 Conclusion Infertility physicians in the first half of the twentieth century embraced less invasive or nonsurgical techniques for diagnostic purposes and opted for treating the entire patient rather than just the reproductive system. These physicians used the same l anguage as their predecessors to justify their treatment of patients and believed it was their medical obligation to provide women the opportunity to fulfill their roles as mothers and provide men the opportunity to prove their virility by be coming a patri arch. While OBGYN s did have some of the same motivations for treatment as those before them, they differed somewhat from the nineteenth century medical men in that they were more influenced by the popular eugenic movement in America. Much of their work ill ustrated a clear desire to improve the human race by allowing worthy couples to procreate and assist others who were viewed as undesirable in limiting pregnancies. They saw their work as not just assisting an indi vidual couple but as a noble duty which elevated the entire nation. These OBGYN s separated themselves from the nineteenth century medical men by incorporating clinical research and new understandings of reproductive endocrinology into their c ourses of treatment for patient s facing s terility. Whereas medical men viewed the reproductive system as functioning independe ntly of other body parts, OBGYN s recognized the cohesiveness addressed inte rnist, endocrine, and surgical needs while incorporating both the husband and wife. However, even if the husband was included in diagnostic attempts the brunt of treatment procedures still lay with the wife as she underwent various pro cedures and examinat ions. OBGYNs in the early twentieth century expanded overall knowledge of male infertility but just like their predecessors they neglected to establish any clear courses of treatment devoted to the male form Instead they circumvented men erms of inadequate sperm by improving and expanding the practice of artificial insemination. With increased knowledge of reproductive endocrinology the practice of artificial insemination became a more viable option for infertile couples and its success rates dramatically

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71 increased in the first half of the twentieth century. While the artificial insemination technique became more popular among infertile couples the debates over its use prompted physicians to defend their use of it or condemn it altogeth er. Advocates as well as opponents of artificial insemination relied on accepted understandings of nuclear family structure to make their claims. In spite of the contrasting arguments made by people on both sides of the debate, each side relied on gendered principles of motherhood, marriage, and family structure to defend their positions on the medical intervention into infertility Professional and public assumptions about the inevitability of motherhood and the prominence of a nuclear family structure fue led the debate over artificial insemination in the 1930s and led many to question the medicalization of infertility Doctors, lawyers, and critics on both sides of the argument justified their position s using gendered language that rested on the assumption that women wanted to be mothers and that motherhood should be granted to all women (as long as they were married in the eyes of the opponents.) Those in favor of artificial insemination claimed that they provided the possibility of pregnancy to women fac ing infertility whereas those who opposed insemination argued that women facing childlessness should still have access to motherhood but only through adoption. Whichever position doctors took th ey argued that they had the best interest of prospective mothers in mind and that they knew better than these women what action should be taken to add a child to their family. The medical community defended its positions by claiming their desire and right to protect women and motherhood and ultimately asserted authority over artificial insemination and reproduction. Eventually Lillian Lauricella denied that her twin daughters were the product of artificial insemination. In the wake of the sensationalized media coverage she opted to downplay her Alfred Koerner, however, took the opposite approach. They used the publicity from the Lauricella twins to further thei r research of assisted reproductive technologies and continued to endorse the

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72 procedure for the rest of their careers. By 1945, artificial insemination had been accepted by the majority of the medical community as it was seen as a valiant effort to repopul ate after a horrific World War and encouraged the baby boom ambitions of the post war years. However, controversy would soon return to the front page of newspapers as infertility physicians advanced assisted reproductive technologies even further by promot ing the idea of extra uterine conception.

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73 CHAPTER IV IN VITRO FERTILIZATION IN HUMANS, 1934 1981 Tube Offspring NEW YORK Ethical and legal dilemmas posed by so surface in court today when a Florida couple seeks damages from a doctor they claim destroyed their offspring. John and Doris Del Zio, of Fort Lauderdale, Fla., seek $1.5 million from Columbia Presbyterian Medical Center and its chief of obstetrics and gynecology, chargin g that a laboratory weeks in Oldham, Eng land, to a child who was conceived in a laboratory test tube. If Mrs. Brown carries successfully to term, it is believed it will be the first case of a laboratory have had the first s 165 Santa Ana Orange County Register Evening July 17, 1978 Doris Del Zio had been under the care of OBGYN and infertility specialist Dr. Landrum Shettles for nearly two years. She had been diagnosed with blocked fallopian tubes six months after her marriage to husband John Del Zio. After three failed surgeries to correct her tubes, the Del Zio s were running out of options. Af ter conferring with Dr. Shettles, Mrs. Del Zio agreed to participate in a new experimental procedure known as in vitro fertilization (IVF) in hopes of achieving pregnancy. The process of I VF was described to the Del Zio s as the fertilization of an egg outs ide of the body in a petri dish or test tube and then the eventual transfer of the embryo back into the uterus. 166 While Dr. Shettles was confident that the procedure would be a success it had never been achieved in human beings and would require Mrs. Del Zi o to adhere to a strict hormone drug regimen and eventually undergo surgeries. In spite of the complexity and uncertainty of the new technique, the Del Zios eagerly agreed to participate since the process 165 Santa Ana Orange County Register Evening July 17, 1978. 166 Minded Skeptic Halts First Test Tube Lima News July 13, 1978.

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74 s blocked tubes and give them the opportunity to have their own child. 167 On September 12, 1973 Doris Del Zio underwent painful abdominal surgery where follicular fluid containing eggs was removed from her ovaries. 168 The eggs were put in an air tight beaker t o maintain a sterile environment and taken across town to the office of Dr. Shettles. Mr. Del Zio provided Dr. Shettles with a fresh sperm specimen which was then mixed with the eggs and placed in a hospital incubator to mimic the temperatures of a natural womb. Within embryos would be formed uterus by Dr. Shettle s colleague and gynecological surgeon Dr. William Sweeney. However, before the newly formed embryos could be placed back into purposefully destroyed by the hospital chief OBGYN Dr. Raymond Vande Wiele. 169 Dr. Vande Wiele had fought with Dr. Shettles for some time regarding proper hospital protocol and when he learned about the extra uterine conceptio n experiments he took what he believed was the moral high 170 Mrs. Del Zio was devastated to hear that her last chance of pregnancy was foiled and that her 171 Eventually the Del Zios sought justice for the loss of their unborn child and sued Columbia Presbyterian Medical Center and Dr. Vande Wiele for $1.5 million. 172 The media descended on the court case as it went to trial in 1978 and once aga in legal, medical, and lay communities clashed over who ultimately held authority 167 Lima News July 13, 1978. 168 Lima News July 13, 1978. 169 Lima News July 13, 1978. 170 Annapolis Capital August 19, 1978. 171 Santa Ana Orange County Register Evening July 17, 1978. 172 Annapolis Capital August 19, 1978.

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75 over reproductive matters and the impact of advanced reproductive technologies on gender, family, and faith. The 1930s had witnessed an amazing amount of change in the medi calization of infertility in the United States. Artificial insemination was being used more frequently by OBGYN s than it had been in the past and with much more success than in previous years. The discovery of hormone variables and the incorporation of les s invasive techniques into treatment protocols encouraged more women to seek assistance in ending their sterility and prompted doctors to become more outspoken regarding new methods. When news of successful artificial insemination births hit the news open debate ensued as doctors, lawyers, clergymen, and the general public all weighed in on the legal and moral consequences of artificial insemination. Specifically, much of the debate surrounded the use of donor sperm for insemination. Those against artifici al insemination by donor (AID) argued that if a wife carried a baby that was of the institution of marriage by removing reproduction from sex and allowing a third pa rty into a sacred union of two. On the other hand, those who promoted AID argued that it allowed couples to fulfill their innate desires for parenthood while promoting popular eugenic ideals of the era. Both sides of the artificial insemination debate used cultural constructs of marriage, family structure, and gender roles to make their arguments. The heated debate that was sparked in 1934 reduced to a simmer by the early 1940s as infertility became a staple topic of popular journalism. By the 1940s the as sisted reproductive technique of artificial insemination was common knowledge for the public and doctors continued to use science to push the laws of nature in an attempt to aid infertile couples. While AIH and AID allowed doctors to assist many infertile couples it was still not a perf ect fit for all patients. OBGYN s struggled to assist sterile women who suffered from blocked fallopian tubes or men who had poor sperm counts or quality. The delicate fallopian tubes did not respond well to surgeries and p hysicians had not found successful techniques that improved sperm quality or quantity. Artificial insemination was not a viable

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76 option for these patients because with blocked tubes there was no egg to fertilize and with poor spermatozoa quality and coun ts the sperm was unable to fertilize an egg even with the placement of the sperm using an impregnating syringe. The ground breaking research of the 1930s regarding hormones and artificial insemination provided the foundation for physicians to explore othe r options that could hopefully assist their toughest infertility cases. Specifically, they began developing techniques that would remove all conception from the human body and place it within the laboratory thus bypassing troublesome tubes or sperm. By t he late 1930s, OBGYN s began experimenting with in vitro fertilization ( which and further medicalize the condition 173 The physicians aimed to remove the egg from a patient, fertilize it in a petri dish, encourage the growth of an embryo by mimicking the conditions of the natural womb and finally place the embryo back into the uterus where a woman would then enjoy a norm al pregnancy. They intended to circumnavigate any issues that were preventing pregnancy by removing the entire process of conception from the human form. Whereas the doctors of the first half of the twentieth century viewed the body as a single entity work ing in accord, the doctors of the latter half of the twentieth century viewed the body itself as problematic and established techniques where the process of conception could be done outside of the body. The process of human IVF proved to be extraordinarily challenging for doctors to perfect and revived the controversies of artificial insemination as the public became aware of such experiments. Doctors like Gregory Pincus, John Rock, and Howard and Georgeanna Jones all worked during the latter half of the tw entieth century to make test tube babies a reality and faced much public attention for their developments concerning assisted reproductive technologies and the medicalization of infertility Although these doctors no longer operated within the context of t he eugenics movement, many of them worked during the frantic pronatalist movement of the post World War II years The pronatalist environment provided them with more public support for 173 Lima News July 13, 1978.

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77 their efforts. These doctors also worked during the height of various c ivil rights movements and the Cold War, which were all key developments that influenced the types of techniques they developed as well as how they were perceived by society. Even if infertility specialists enjoyed growing popularity with the push for babie s, they still faced harsh criticism from religious leaders and those who were concerned with the moral and legal repercussions of such a practice. By the 1970s, feminist advocates also b egan to question doctor motives for developing IVF as an attempt to inevitable motherhood. From 1945 onward, fluctuating expectations of parenthood and the demand for social, political and economic equality for numerous groups such as African Americ ans, women, and same sex couples influenced the types of techniques infertility physicians developed as well as public perceptions of the medicalization of infertility and medical intervention into human reproduction. human beings, it would eliminate the part of the male and make possible test Gregory Pincus and the In Vitro Fertilization of Rabbits In 1932, Aldous Huxley published Brave New World and introduced the public to his imagined dystopia whic h lay in the not so distant future. Huxley envisioned a world where 174 His fictitious novel presented a view of technological advanceme nt where the controlling dictatorship (The World State) established stability and order by conditioning its citizens to accept their station in life. This was established by breeding children in labs and placing them into a caste system upon birth where th ey were subconsciously educated societal fears regarding the advancement of technology and the use of science to reproduce. Although artificial insemination was o n the rise and gaining more public attention by 1932, 174 Aldous Huxley, Brave New World (New York: Doran and Doubleday, 1932 ) 1.

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78 being grown o utside of the human body in laboratory incubators was the first novel to address the possibility of IVF and anticipated the work of infertility physicians in the latter half of the twentieth century. His negative view of reproductive technologies sheds lig ht on the disdain many felt for medical intervention in sterility cases and the fear and uncertainty associated with scientific reproduction and the possibly damaging societal consequences that could accompany such a technique. The fabricated world in Hu short years after its publishing when Harvard University biologist and researcher Dr. Gregory Pincus (later known for his work with the development of the birth control pill) reported that 175 Scientists of all sorts were tion published professional 176 In the March edition of The Science News Letter To produce their "ectofertilized" rabbits, the Harvard scientists first mated a female rabbit with a male which had been rendered incapable of producing sex cells by a simple surgical operation. The mating act stimulated the first steps in the development of the ova, or female sex cells, which however, still remained unfertilized. Then the ova were removed from the mother rabbit's body and placed in a suitable fluid in a glass vessel. Sperm from a normal male rabbit was added, and allowed to remain with the ova until each one had received the fertilizing male cell. Certain changes observable under the microscope indicated to the watchers that this process had taken place. In the meantime, the "foster mother" rabbit had been prepared for her role by being mat ed with another male incapable of producing functional sex cells. Into her maternal tissues, thus stimulated to activity, the ova of the other rabbit, fertilized in a glass vessel with the 175 The Science News Letter Vol. 25, No. 674 (1934):149. 176

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79 sperm of a male she had never seen, were introduced. They developed and in due time the young rabbits were brought forth. 177 regarding the moral implications for creating a process that could eventually be accessible to human beings. Researchers articulated many concerns regarding the process and its consequences for ectogenesis for human procreation but two distinct concerns appeared to stand out among the others and elicited a response from not just the scientific community but that of general public as females. Newspaper articles published on the Pincus experiments highlight ed the anxiety felt by many over the belief that the b purposefully made to be female. According to the Logansport Pharos Tribune Pincus had chromosome for cr 178 The realization that only female rabbits had been produced provoked much concern from the public as journalists surmised that if the process composed entirely of women. 179 The dozens of newspaper articles published on the Pincus experiments surprisingly give little detail regarding the process itself and focus much more on the catastrophe of a female only ra ce possibility. The journalist s fasc ination with the gender of the rabbits grants insight into the fears of IVF and its possible impact on the roles of men and women in the family and in society. Specifically, if women were able to reproduce without men, the media assumed they would do just 177 178 Logansport Pharos Tribune Saturday March 28, 1936. 179 Athens Messenger April 2, 1936.

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80 test tube 180 This prospect appeared to alarm the public as it would make men obsolete and allow women to dominate the population and become superior within society. This notion of a female d ominated populous where men were no longer needed for reproduc tion visibly rattled the public. in controversy in 1939 when he announced that he had synthetically fertilized a rabbit egg outside of th e womb without the use of sperm. 181 The process known today as parthenogenesis is a form of asexual reproduction in which the growth of an embryo happens without fertilization, a development which commonly occurs in invertebrate species. 182 ovum of a female rabbit with a saline solution instead of cells and later transplanted the fertilized 183 Along with the s aline solution, Pincus declared the same results could be achieved by exposing the ovum to various temperature changes or hormone treatments. 184 Popular media grabbed hold of the scientific ant for the future of mankind, e specially because rabbits produced in such a manner would continue to be female. According to spermatozoa is what determines the sex of t case of the fatherless rabbit, therefore there is no male determining pattern and the progeny is 185 Once again concerns regarding the gender of the rabbits consumed media attention as 180 Logansport Pharos Tribune Saturday March 28, 1936. 181 Danville Bee November 3, 1939. 182 Time Magazine Vol. XXXIV, (1939) : 39 183 Danville Bee November 3, 1939. 184 Time Magazine 39 185 Time Magazine 39

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81 the general pu blic feared a world where human s could be reproduced without father s and would only be of the female sex. parthenogenesis appearing in Time Magazine in 1939. 186 In spite of the failure to recreate the process that led to the reaction from the public during the exper iments grants interesting perspective into mid twentieth century understandings of assisted reproduction. Scientists as well as the general public demonstrated concern over the possibility of IVF and parthenogenesis in humans and the ability to altogether eliminate men from human procreative processes and the creation of an all female human race. The anxieties present within newspaper and magazine articles demonstrate the value that was placed on a nuclear family structure (dad, mom, and children) in Americ an culture in the mid twentieth century. The notion of fatherless babies frightened the nation as people believed it would cause a disruption in traditional understanding of parental roles and societal perceptions of the stronger vs. the weaker sex. At the heart of the Pincus controversy is the fear of upsetting accepted cultural constructs of male authority and 186 Perspectives in Biology and Medicine, Vol. 18, (1974): 86 88.

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82 female submissiveness within the family unit and society as a whole. People feared that if science intervened in infertility cases or even became the sole source of reproduction it could lead to the demise of conventional cultural gender expectations. Regardless of the fears expressed with overlooked because it served as a foundation for future IVF endeavors while allowing interesting insight into public perceptions of scientific reproduction and gender norm s in the mid twentieth century. babies which for years have been rumored in laboratories, the experiments indicate absolutely no way to produce babies The Rock Menkin Extra Uterine Human Embryo Trials While Gregory Pincus published his experimentation s with rabbit embryo growth, Dr. John Rock and lab technician Miriam Menkin began their work to fertilize a human egg outside of the natural womb. Rock had long been involved in infertility research and had been on the cutting edge of reproductive endocrinology advancement at his research center located in the Sterility Clinic at the Free Hospital in Brookline Massachusetts. 187 His associate Miriam Menkin had wanted to become a doctor but settled as a technician to assist putting her husband through medical school. 188 Together the two (with the eventual assistance of Dr. Gregory Pincus) worked for six years to fertilize a human egg outside of a womb and in 1944 they published their groundbreaking research on the first successful fertilization of human ova outside of the human body. 189 187 Marsh and Ronner, The Fertility Doctor 45 52. 188 Stephen Ruffenach, "Rock modified September 25, 2013, accessed July 5, 2015, http://embryo.asu.edu/handle/10776/1963. 189 The Science News Letter Vol. 46, (1944): 99.

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83 Science and impacted the evolution of assisted reproductive technologies. While their advancement in the growing of human embryos was seen by many inside and outside of the medical community as the eventual inevitability of test tube babies, Rock and Menkin staunchly declared that they had no intentions to see the experiment through the birth of a child and ultimately the purpose of the study was to unders tand the earliest moments of conception and 190 The coverage of their success began as technical in nature but eventually became increasingly sensationalized, much like the coverage of th e Pincus experiments had unfolded. The Science Newsletter published the work of Rock and Menkin and detailed the process which they had used to achieve the extraordinary: [T]he human eggs for the experiments were obtained from the ovaries of women who fou nd it necessary to lose them through surgery in order to save their own lives. Careful searching was needed to find unfertilized eggs at the right stage for further development. These were nourished on human blood serum in glass dishes... [N]ormal male spe rmatozoa were released in the dishes, and carried out the fertilization. The three celled stage, and one of the two celled stages, were subsequently fixed, stained and sectioned for closer microscopic work and for permanent preservation. 191 The clinical des cription of the process of in vitro fertilization of human ovum highlighted a detachment present in the early accounts of the revolutionary technique. The clinical and somewhat cold reporting of the success of Rock and Menkin soon turned much more emotiona l as the general public was made aware of the scientific breakthrough and popular media embraced the topic In the early 1930s, artificial insemination (by husband and donor) had aroused anxieties regarding the legality of such a procedure and legitimacy o f the offspring produced in such a manner. By 1945, the Rock Menkin experiments had reinvigorated the debate on assisted reproductive technologies and the legitimacy of children who might 190 Hattiesburg American August 4, 1944. 191 The Science News Letter 99.

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84 producing children in this manner was still far from reality, the creation of human embryos outside of the human womb once again provoked strong responses from the general public and the Catholic Church. The Catholic Church had long been uncomfortable with scientific interference in reproduction but found new reason to be alarmed with the success of the Rock Menkin trials. The Church anticipated the eventual possibility of the birth of test tube babies and in 1949 Pope Pious XII speaking at the Fourth Nat ional Convention of Catholic Physicians condemned the use of spousal and donor insemination as well as the creation of human embryos outside of the body. 192 The Catholic Church adamantly opposed the use of medical intervention for reproduction and asserted that married couples were not guaranteed the right to children and disruption of the natural act of conception was immoral and to be rejected. 193 was immoral for them to assert they had a right to have children. Catholic Church argued that reproduction and sex should remain linked to continue to protect the sacred bonds of marriage. 194 Although the Catholic Church promoted pronatalist ideologies, the interference of science into the natural process of reproduction was unac ceptable. John Rock was a devout Catholic and struggled immensely with the criticism he received from the Catholic Church over the course of his research. Eventually he abandoned his work with human embryo growth and focused the remainder of his career on the development of an oral contraceptive that very public showdown with Catholic leaders who adamantly opposed birth control an d the 192 Albert R. Jonsen, The Birth of Bioethics (New York: Oxford University Press, 1998), 304. 193 Pope Pius XII, Discourse to Those Taking part in the 4th International Congress of Catholic Doctors 194 Discourse to Those Taking part in the 4th International Congress of Catholic Doctors 41 (1949) 560.

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85 The Birth s of the First Human Test Tube Babies In the frantic pronatalist post World War II years, unprecedented numbers of infertile couples sought medical advice for their childlessness. 195 According to historian Paul Starr, the research funds that began to pour into medical training within a decade or so after World War II 196 Th is alteration in academic medicine was marked by the establishment of federal funds for research and increased support from private foundations and pharmaceutical companies. Medical practitioners of all sorts benefitted from the increased financial support but infertility works were funded particularly well by government subsidies, due to the societal push for increased birth rates. According to historians Margaret Marsh and Wanda Ronner, many infertility physicians established their own stand alone clinics which were dedicated to the treatment of sterility and research that could benefit the childless. 197 of a boom in infertility treatment emerged a 198 Countless couples sought out the assistance of in fertility specialists and OBGYN s used their new funding to develo p new techniques and procedures. Many of the OBGYN s who focused on sterility in the 1950s continued to use such techniques as tubal insufflation, gynecological surgery, and artificial insemination to treat their patients but they also worked to improve reproductive endocrinology. Using the earlier work of Dr. John Rock, postwar infertility specialists focused on developing fertility drugs that could 195 Marsh and Ronner, The Empty Cradle 209. 196 Starr, The Social Transformation of American Medicine 352 353. 197 Marsh and Ronner, The Empty Cradle 181. 198 Marsh and Ronner, The Empty Cradle 183.

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86 assist women with ovulation. 199 Dr. C. Lee Buxton was among the pronatalist physicians who focused on fertility drug development and in 1963 he developed a techn ique which took the pituitary secretions from women who died during their childbearing years and created an injectable hormone serum that could encourage ovulation in women suffering from ovulatory dysfunction. 200 He experienced hopeful success and soon afte r other infertility doctors followed suit by developing their own fertility cocktails for non ovulating women. Specifically, the development of the popular fertility drug Clomid and others like it came out of the postwar pronatalist era and gave hope to in fertile women across the nation. The fertility drugs developed during the 1950s and 1960s not only assisted infertile women with reclaiming their reproduction but allowed for further advancement with human IVF experiments and the eventual birth of the firs t IVF babies. By the 1970s, IVF had entered the public consciousness but funding for infertility research and the pronatalist frenzy had slowed. In spite of less funding and continued questions regarding the morality of assisted reproductive techniques, doctors continued to push the limits of science in the hopes of achiev ing improved rates of successful pregnancy for their infertile patients. Dr. L andrum Shettles was among OBGYN s in the latter years of the twentieth century who hoped to make IVF a reality. In 1960, he replicated the Rock Menkin experiments by producing hum an embryos outside of the natural womb and published colored photographs of the miraculous first moments of human conception in Ovum Humanum: Growth, Maturation, Nourishment, Fertilization, and Early Development. 201 His work shed light on the process of huma n conception and offered opportunities for further experimentation with IVF in humans. 199 Marsh and Ronner, The Empty Cradle 208. 200 paper presented at the annual meeting of the American Gynecological Society, May 13 15, 1963, p. 3. 201 Landrum Shettles, Ovum Humanum: Growth, Maturation, Nourishment Fertilization, and Early Development (New York: Hafner, 1960), 18.

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87 Shettle s innovative work was well received within the medical community but once again elicited condemnation from the Catholic Church. In 1968 Pope Paul VI issued papa l encyclical Humanae Vitae 202 control and his disapproval of the intervention of medical sci ence in regulating and limiting births, he also alluded to the immoral act of intervening to achieve pregnancy as well. 203 He endorsed the notion that the fundamental nature of sexual activity within a marriage was for the purpose of procreation and that the re should be no external interference with this act. 204 He specifically referenced the interruption of natural procreation with the birth control pill but also used the same argument to condemn IVF. To Pope Paul VI, IVF interfered with the sexual act of proc 205 The issuance of Humanae Vitae and demonstrated shifting societal perceptions of acceptable and unacceptable forms of assisted reproductive technologies. While the advancement of reproductive endocrinology and the successful growth of human embryos outside of the natural womb encouraged the baby boom even further and provided optimism to many, there were still many (outside of the Catholic Church) who questioned the moral consequences of the m ethod. The June 13, 1969 cover of Life Magazine featured a provocative image of a human embryo next to a loving mother embracing her new born 202 the Patriarchs, Archbishops, Bishops, and Other Local ordinaries in Peace and Communion with the Apostle, to the Clergy and Faithful of the Whole Catholic World, and to All Men of Good http://w2.vatican.va/content/paul vi/en/encyclicals/documents/hf_p vi_enc_25071968_humanae vitae.html. 203 204 205

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88 206 The topic of the cover refer enced the special segment of the issue which included a damning editorial about the detrimental social consequences of assisted reproductive technologies as well as a Life Poll regarding public perceptions of the use of new methods of reproduction such as IVF. 207 The Challenge t curious insight into the fears held by those surveyed regarding the use of new methods to possibly assist in human reproduction in the late 1960s. Specifically, the article argued that the introduction of medical intervention into procreation with the use of in vitro fertilization or even parthenogenesis threatened the traditional family structure that had developed o ver many millennia for good cause. Rosenfeld argued that youn g. 208 He believed that a nuclear family structure was created with purpose for the safety and well being of all involved and that assisted reproductive technologies threatened its existence because it would challenge the accepted gender expectations within t he home According to Rosenfeld, the nuclear family had been formed as a way for all involved to have their needs met: the child was provided with protection during his/her vulnerable helpless years, the woman was provided with security while she was in he r most vulnerable times of pregnancy and childbearing, and the man was provided with a mate who would provide progeny to carry on his name and fulfill his need for sex. 209 He argued that IVF would disrupt the natural formation of a nuclear family and challen ge the place of each person within the family leading to infidelity, broken 206 Challenge to the Miracle of Life Life Magazine June 13, 1969, 37 50. 207 37 55. 208 40. 209 40.

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89 marriages, and children who were emotionally void and detached from their parents. 210 His argument used gendered language that suggested that women were essentially dependent upon me n to fulfill innate feminine instincts for motherhood and that men were ultimately driven by masculine desires for sex and progeny. His understandings of femininity, masculinity and family structure defined his arguments against IVF and all intervention o f medical science into procreation. Louis Harris and Associates Incorporated and sampled a representative nationwide cross section of 1,600 adults. 211 The polling company shared interesting data and quotes regarding public revealed a surprising degree of acceptance of the new techniques, but a widespread skepticism about putti 212 Those who were polled were less offended by the biological process and more concerned with the moral implication of the method and the scientists who were performing the procedure. Many voiced worry over the interruption in family life and the possibility that family love could be altered if a child was produced in vitro. 213 Those who believed it could disrupt family life questioned whether women would feel attached to their child and if men would ultimately feel emasculated and turn to infidelity. 214 However, even if those polled believed family structure and gender roles were vulnerable and could be destroyed by the new methods, they still supported IVF (after all other 210 47 49 211 212 l: Brave New World 213 214

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90 avenues had been exhausted) if it allowed an infertile couple the opportunity to have a ch ild. 215 The article and poll from Life Magazine highlight ed interesting changes in cultural understandings of assisted reproductive technologies rooted in gendered language and accepted notions of family roles by portraying medical intervention into reproduc tion as a possible challenge to accepted gender expectations within the family unit. Figure 4.2 : Tables provided by the Life Magazine poll regarding new methods of human reproduction. 216 215 54. 216 52 54.

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91 Regardless of concerns over IVF from the public as well as from the Catholic Church, doctors and scientists continued their work to make IVF a reality. In 1973 Landrum Shettles, who had made headlines with his photography of human embryos, attempted the first human embryo transfer with the Del Zio couple. Unfortunately, t he embryo transfer would never come to be, as the embryos were purposely destroyed by Dr. Vande Wiele. Several years after receiving the devastating news of the destruction of their fertilized embryos, the Del Zios decided to take legal action and sued the Columbia Presbyterian Medical Center and Dr. Raymond Vande Wiele for damages in emotional stress amounting to $1.5 million. 217 Throughout the duration of the trial Dr. atal to 218 Vande Wiele believed the procedure itself was unethical and that the results for mother, baby, and society could be detrimental. 219 Although the court case was filed by both John and Doris Del Zio, the coverage focused on Mrs. Del Zio and her desire for m otherhood. The reporting appeared to favor Mrs. Del Zio in her fi ght for her family and demonized Dr. Vande Wiele for taking the possibility o f children away from her without her consent or prior knowledge. The fact that Mrs. Del Zio became the central focus of the narrative provided understanding of societal beliefs that parenthood was essentially more important to women or was more innate for women than for men Mrs. Del Zio gave a multitude of interviews regarding her court case and declared that regardless of how a baby was conceived it was sacred. 220 As the trial concluded and the case was released to the jury many wondered what the future held for in vitro fertiliza tion and the struggle s of infertile couples in the United States. 217 Tube Helena Independent Record August 19, 1978. 218 Helena Independent Record August 19, 1978. 219 Helena Independent Record August 19, 1978. 220 Lima News October 21, 1974.

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92 On August 18, 19 78 the jury awarded the Del Zio s $50,000 in damages for the emotional stress inflicted on them when their test tube experiment was halted. 221 Mrs. Del Zio declared that the dec ision 222 Although Mrs. Del Zio argued justice would never replace her unborn child ccess to a safe procedure. 223 The Del Zio s a remarkable example of the many perspectives for and against the use of assisted reproductive technologies. The case became a battle between not just a woman and a doctor, but over morality of medi cal decision making and ultimately who win for Mrs. Del Zio illustrated authority over her own potential procreat ive powers even if her desires conflicted with the beliefs of her physician. The case highlighted the conflicting legal, moral, medical, and emotional perceptions of IVF and its consequences. While the dramatic Del Zio court case unraveled, the bi occurred in London, England. On July, 25, 1978 Lesley Brown and Gilbert John Brown welcomed baby Louise. She made international headlines as the first baby to ever be born through in vitro fertilization. The press descend ed upon the hospital and interviewed not just the new parents but the doctors responsible for the new little miracle. Drs. Patrick Steptoe and Robert Edwards had worked for years to aid infertile couples and now stood at the precipice of accomplishment as IVF became a reality for the world. According to the newspaper coverage, Mrs. Brown was unable to conceive naturally due to blocked fallopian tubes and turned to Drs. 221 Helena Independent Record August 19, 1978. 222 Winnipeg Free Press August 19, 1978. 223 Santa Ana Orange County Register Evening July 17, 1978.

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93 Steptoe and Edwards as her last hope. 224 The newspapers detailed the procedures that the do ctors used in vivid detail: a needle is inserted to draw them out. A ripe egg is placed in a dish of blood serum and nutrients, then sperm is added for fertilization. Wh en fertilized, the egg is transferred to another dish and divides into a blastocyst. The woman then receives more hormone treatments to prepare the uterine lining, the blastocyst is placed in the uterus, attached to the wall and normal embryo development p roceeds. 225 Steptoe and Edwards benefitted from muc h of the work done by John Rock and Landrum Shettles and succeeded in providing a technique which allowed a previously barren couple to add a child to their family. Many of the same questions regarding the moral implications surfaced in the wake of the Louise Brown birth announcement but they did not slow other doctors from trying to recreate the success of Steptoe and Edwards. In 1980 celebrated fertility specialists Drs. Howard and Georgeanna Jones who had earned stellar reputations within the medical community for their work with reproductive endocrinology, opened the Eastern Virginia Medical School in Norfolk, Virginia and committed themselves and their team to the advancement of IVF. 226 They worked from the foundations of those who had come before them and used the clinic as a research facility where patients paid up to $4,000 to be experimental subjects. 227 They experimented with various techniques such as superovulation and delayed fertilization and by the second year in operation one of their patients became pregnant. 228 On December 28, 1981 Judith and Roger Carr welcomed their baby girl Elizabeth Jordan Carr to the world. She was the first test tube baby to born in the United States and her 224 Dover Times Reporter July 26, 1978. 225 Dover Times Reporter July 26, 1978. 226 Marsh and Ronner, The Empty Cradle 239. 227 Marsh and Ronner, The Empty Cradle 239. 228 Marsh and Ronner, The Empty Cradle 239.

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94 appear ance was marked by an outpouring of media attention. Although there were thousands of initial newspaper articles commenting on the birth, they were surprisingly upbeat and lack much of the anxiety that previous coverage of test tube babies had elicited. Ma ny of the journalists joke d by the new parents. 229 The journalists also intervie wed the Jone s a nd Howard Jones himself lightened the tone of the articles by decla have the smallest American 230 He expressed hope and welcomed the birth of the Carr baby as a major stepping stone in the treatment of infertile couples. The tone of the articles is one of hope a nd optimism rather than anxiety or uncertainty The coverage remarked that an additional six IVF babies had been born in England, twelve in Australia, and that five more of 231 The p ositive tone within the article could be attr ibuted to the fact that the general public was just much more aware and more comfortable with assisted reproductive technologies The upbeat quality of the media coverage could also be attributed to women and men of their childlessness and allowed have a child of their own and establish their own idyllic nuclear families. While the coverage of the birth of the Carr baby appeared mostly positive there were sti ll many questions regarding the repercussions of successful IVF. Many of the same concerns over family structure and gender roles continued to worry some (especially the Catholic Church) but hts movement of the 1960s and 1970s. In this second wave of feminism, women demanded to be included in much of the civil rights legislation which barred discrimination in the workplace but also challenged 229 Kannapolis Daily Independent January 1, 1982. 230 Daily Herald Suburban Chicago January 1, 1982. 231 Kannapolis Daily Independent January 1, 1982.

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95 ternal instincts or sexual submissiveness. In 1984 the Feminist International Network of Resistance to Reproductive and Genetic Engineering (FINRRAGE) was formed by a group of vocal feminists with the intent to oppose reproductive technologies. According t o Janice Raymond, member of FINRRAGE, reproductive technologies 232 Raymond opined that women only agree d to undergo such invasive procedures because they are coerced into believing that there life is of no value without children. 233 technologies can be understood in the context of the second wave of feminism and the attempts by women of the era to secure a status in society equal to that of men and distinctly separate from identities as m others or sex objects. Although reproductive technologies were challenged by many feminists through the 1980s and into today, women still seek out medical assistance to treat their infertility and undergo invasive techniques suc h as IVF to achieve pregnanc y. Conclusion In 1932 Aldous Huxley published his classic novel Brave New World and imagined the future as a dystopia where reproduction was done artificially outside of the body and humans were placed into a caste system upon birth based on their specifi c genetic breeding. His frightening imagined world illustrated the fears that many associated with medical intervention into procreation and assumed that it would have devastating effects which would lead to the demise of society and the destruction of the family unit. While his imagined world grants insight into his perspective and the anxieties many felt, his theory about the fall of society in the face of artificial reproduction never came to fruition. Physicians in the latter half of the twentieth centu ry were motivated by many of the same inspirations as their predecessors but chose to tackle the 232 Janice Raymond, Freedom (San Francisco: Harper San Francisco, 1993): viii. 233 Raymond, Women as Wombs viii.

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96 troublesome issue of infertility in a different way. They removed the act of conception from the human body and thus circumvented any blocked fallopian tubes o r sperm deficiencies that were causing infertility. Eventually, doctors were able to achieve what seemed impossible and by the late 1970s IVF babies became a reality. In the climate of postwar pronatalism many infertility doctors were able to benefit from additional funding and witness breakthroughs in reproductive endocrinology, extra uterine embryo growth, and in vitro fertilization. While their advancements did assist numerous infertile couples, many viewed the interventions as immoral or detrimental to society. The Catholic Church, medical doctors, journalists, and feminists all questioned the consequences of test tube babies and used understandings of gender roles and family formation to make their claims against IVF.

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97 CHAPTER V CONCLUSION FIVE MILLIO N BABIES LATER THE UNITED STATES AFTER IVF By the end of 2014, news outlets around the world reported that the total number of babies born via the process of IVF exceeded five million. 234 The use and success rate of assisted reproductive technologies by in fertile couples have been on the rise in the United States (and globally) since the birth of Elizabeth Carr in 1981 and shows no evidence of slowing. While assisted reproductive technologies specifically refers to those procedures in which both eggs and sperm are handled outside of the body, other forms of medical intervention into the procreative process like intrauterine insemination (artificial insemination) are often categorized in this 235 With more and more babies being born through the intervention of science, the general public has become acutely aware of cure infertility. Since the mid 1800s, doctors and scientists h ave used their biological and technological d women with the opportunity to achieve their desires of motherhood. At the onset of the medicalization of infertility the techniques used were often invasive and the fe male reproductive system was often viewed as isolated from the rest of the body. The success rates during this early time period appear to minimal at best due to the crude understanding of hormone variables. By the early twentieth century doctors refined their surgical techniques to be somewhat less invasive and focused on reproductive endocrinology. Their groundbreaking research allowed for the more successful use of artificial insemination and more and more couples began to reap 234 Helen Massy The Guardian l ast modified November 23, 2014, accessed August 26, 2015, http://www.theguardian.com/society/2014/nov/23/whats next for worlds 5 million ivf babies. 235 http://www .cdc.gov/reproductivehealth/infertility/#m.

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98 the b enefits of seeking t reatment by becoming pregnant and adding a child to their families. While artificial insemination techniques improved, it was not always the right fit for all couples facing infertility. The doctors of the latter half of the twentieth century investigated ways to remove the entire process of conception from the human body and to grow human embryos outside of the natural womb. Their efforts eventually led to and the victory of science over nature. Although many of the d iagnosis techniques used during the twentieth century were somewhat less invasive, the process of infertility treatments was still quite intrusive for the woman. By the close of the twentieth century, women undergoing infertility treatment were often subje cted to months and months of hormone treatments and monitoring through transvaginal ultrasounds and frequent blood work. While the treatments for these women were less surgical than in earlier eras, they process of infertility treatment was still emotional ly and physically demanding. Although treatments options were often aggressive, t hrough the determination of doctors, scientists, and countless couples facing infertility reproduction was reclaimed and infertility conquered. While th e work of infertility sp ecialists was welcomed by many, there have been vocal critics along the way who have questioned the motives and consequences of assisted reproductive technologies The anxiety expressed by those against medical intervention provide s interesting insight into the role of reproduction in forming or maintaining family ideals and gender expectations. Concerns over the legitimacy of children bo rn in such a manner demonstrated the importance that Americans place d on lineage and the ability of a man to produc e an heir. This Americans strove not just to create nuclear families but ones that were biological in nature. To opponents of medical intervention families had t o be legitimized through biological reproduction Whereas assisted reproductive technologies challenged the role of father in the family unit, the role of the mot her was elevated since she might no longer need her husband to become pregnant. In the eyes of adve rsaries to intervention, t he wife could ultimately fulfill her

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99 motherhood and claim her femininity, but at what cost? The arguments made by those against medical inte rvention for infertility revealed a sense among the general publ ic that assisted reproductive technologies would disrupt the idyllic model for the all American nuclear family and alter traditional relationships and expectations within the home. Although many have challenged intervention into reproductive matters, th e desire for family still drove doctors, scientists and couples to pursue what seemed to be the impossible. The not the end of the story of medicalization but rather just one more interesting turning point. Perhaps in the next chapter of the medicalization of infertility the process of conception for the most infertile patients will be placed back within the womb a nd the body will no longer be viewed as the problem which needs to be circumvented Questions regarding the moral, ethical, and legal repercussions of interventions still rage and are only becoming more complex through developments such as the increase i n surrogacy or the surge in No matter what the future holds for the medicalization of infertility, reproduction will remain a key component in the formation and maintenance of family ideals and gender expectations in the United States.

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