Fertility Holidays. IVF Tourism and the Reproduction of Whiteness. Amy Speier, New York: New York University Press, 2016, 192 pp.
Fertility Holidays is an ethnographic monograph about the motivations, expectations, and gendered experiences of the growing number of lower middle-class Northern Americans who struggle with infertility and its unaffordably high treatment prices at home and travel to the Czech Republic for IVF treatment. Known for its low-cost prices, empathetic health care, and availability of white donors, the Czech Republic has emerged as a hub of fertility tourism. Speier’s work provides novel insight into the neoliberalization of the American health system, individuals’ cross-border movements for assisted reproduction, and their intrinsic hope for white babies.
For this multisided, multi-year ethnography (2008–2012), Speier interviewed 29 “reproductive tourists”—heterosexual couples, of working-class or lower middle-class background and predominantly white—on Skype, in the United States and in the Czech Republic. In addition, she interviewed 11 Czech clinical personnel and 10 IVF brokers, who advertised and packaged the fertility holidays abroad, and conversed with the owners of the Czech bed-and breakfasts where she and the Northern American “reproductive travelers” stayed during their treatment.
The book consists of five chapters. Speier presents her research findings by taking her readers through the milestones her informants passed on their infertility journeys: from fertility clinics in the United States into the “virtual biosocial communities” (p. 44) of online fertility forums. Here they learned about the clinics that they subsequently visited in the Czech Republic. Back in the United States in the summer 2012, Speier undertook “a monthlong road trip zigzagging across North America, from Florida to Seattle” (p. 130) to interview those for whom treatment had been successful and had become parents. Speier traces how these routes were pioneered by two U.S.–Czech couples (in both cases, American husbands and Czech wives living in the United States) who resolved their own fertility problems by resorting to cheaper IVF treatment in the wives’ birth country. Seeing the potential of making these routes visible and accessible to other Northern Americans, both couples independently began offering assisted “fertility holidays” to the Czech Republic, featuring more affordable treatment and the pleasure of holidays.
In the first two chapters, Speier introduces the neoliberal scene of assisted reproductive technologies (ARTs) in United States and presents her participants’ disappointment in ARTs providers’ carelessness and focus on profit-making. In addition, Speier illustrates patients’ gendered axioms in response to infertility. First and foremost, women assumed the responsibility to resolve the couple’s struggle with infertility by thinking positively and never giving up trying. Speier identifies how her participants grew disillusioned with the U.S. health system. As a result, they turned to the Internet to seek advice at online support groups, where they turned from patients into patient–consumers and began “navigating a global health care market” (p. 62). She notes how in these online spaces they come across the advertisements for fertility treatment in the Czech Republic and previous travelers’ feedback, promising the hope of a white baby, lower prices, better care, and less stress—as well as a holiday.
In Chapters Three and Four, Speier introduces the IVF scene in the Czech Republic. She sketches the entrepreneurial endeavors of doctors and brokers who turned the Czech fertility market into a swiftly proliferating reproductive tourist industry. In particular, Speier examines the intimate labor of fertility travel brokers who navigate their clients through their fertility journey’s “critical junctions” (p. 77), where “local cultures, values, practices, histories and regulations intrude upon technological zones” (Whittaker 2008:285, in Speier p. 77). While living among the fertility tourists in the Czech bed-and-breakfasts, Speier grappled with the inherent paradox of fertility holidays. While fertility holidays compellingly promised a ‘low-stress’ IVF cycle, Speier demonstrates that the lived experience of reproductive tourists was controversial and not always pleasant or recreational. She concludes that while on fertility holidays, many couples surrendered themselves to even geater pressures not to stress and positively affect the treatment outcome by “conscientiously trying to treat the trip like a vacation” (p. 110) than they did before embarking on their trip abroad.
In concluding her research in 2012, Speier visited 19 of the 29 participants, most of them couples, at their homes for follow‑up interviews. These follow-up interviews took place in California, Florida, Wisconsin, Nebraska, Oklahoma, Washington, Texas, and Quebec, Canada. In Chapter Five, Speier highlights the parents’ efforts at “naturalizing their bonds in various ways” (p. 131) and their considerations about whether to tell their children about their conception and disclose donor conception, if applicable. She also discusses the frequently prevailing notion of compulsion to return to the Czech Republic for yet another attempt—a notion she encountered among both successful and unsuccessful reproductive tourists.
Fertility Holidays may be of interest to academics seeking empirical insights into inner workings of the growing reproductive medicine tourist industry, especially the role of brokers in cross-border fertility treatment. The rich accounts of the various (technological) service providers—brokers, mediators, and doctors—are a welcome, valuable, and novel contribution to this field of research, as these voices and experiences have remained on the sideline in most previous ethnographic work on cross-border reproduction. This book provides many nuanced and original insights into reproductive tourism. As such, Speier could have represented her findings with greater authority and less recourse to other studies undertaken in this area. Further, the discussion of the concept of whiteness is rather latent within the text and given the focus of this book, “the reproduction of whiteness” could have been further unpacked and subjected to more explicit articulation throughout.
Speier specifies that of the 29 interviews she conducted with reproductive tourists, she conducted 17 with women only, one with a man, and 11 with couples. She notes that in her research “it was primarily women who were the more vocal informants” (p. 11), and when interviewing couples together, “the woman usually had more to say” (p. 11). Her approach of interviewing the couples together instead of separately can be considered as further perpetuating the marginalization of men and men’s voices in fertility research. The relative omission of men’s voices in this research means that this book does not provide insight as to how men’s attitudes and expectations can lead to the reproduction of whiteness or whether men’s attitudes reproduce whiteness in similar or different ways to women.
Nevertheless, Speier’s novel insights provides make the book an important contribution to the empirical scholarship on individuals who seek low-cost medical treatment abroad. Most noteworthy are the insights into the intimate labor of brokers and clinic personnel and the detailed outlining of how particular cross-border routes to fertility treatment emerge are (increasingly) traveled and change over time as both the fertility travelers as well as the local service providers adapt to new and ever-changing global dynamics.