Lecture 20

0:04[music]

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0:17Hello everyone. I welcome you once again

0:19to the course introduction to medical

0:21humanities. This is lecture 20 and the

0:24last of the lecture in this unit. uh

0:28most of the lectures that we have dealt

0:31with in this particular unit have dealt

0:34with the theme of reproductive justice

0:36or reproductive rights and associated

0:39themes. This is the final lecture which

0:42will discuss a particular text called

0:44what's a lemon squeezer doing in my

0:46vagina by Rohini S. Raj Gopal. The title

0:49of the lecture is artificial

0:51reproductive technology and the trauma

0:53of infertility. Now we know that

0:57infertility is an issue that is

1:01prevalent across the globe and not

1:05particularly in India. But this memoir

1:08by Rohini takes us through the journey

1:11that she felt she experienced

1:15and she lived through IVF and uh that is

1:21not her journey alone and there are

1:23quite a few people who must have

1:24experienced the same kind of phenomena

1:27and that is what we are going to talk

1:29about.

1:31Before I go ahead, let me go ahead and

1:33discuss a little bit of uh overview of

1:36what I'm going to talk about. I will

1:38discuss what infertility means. What is

1:40the meaning of infertility in the

1:42context of society? Uh what then

1:47happens when infertility gets into the

1:49art market which is assisted

1:51reproductive technology market and take

1:54up the case study of Rohini S. Raj

1:57Gopal's what's a lemon squeezer doing in

1:59my vagina in uh which was published in

2:022021 follow it up with conclusion and

2:06discuss the commercialization of

2:08infertility treatments amidst the

2:11conclusion as well according to WH

2:14infertility is a disease of the male or

2:17female reproductive system defined by

2:19the failure to achieve a pregnancy after

2:2112 months or more of regular unprotected

2:24sexual intercourse infert Fertility can

2:27be of two types, primary or secondary.

2:30When it comes to primary infertility, it

2:33means that the pregnancy has never been

2:36achieved by the person. The secondary

2:38infertility is when at least once the

2:43person has been pregnant. Now most of

2:46the times when we talk about art, there

2:49are two common methods. One is IVF and

2:52the other is IUI which is intrauterine

2:56insemination. So just quickly we will

2:59take you through the definition. IVS is

3:02considered the most successful method of

3:04fertility treatment employed currently

3:07to help the couples to conceive. The

3:09fundamental components of the IVF

3:11procedure include stimulation of the

3:14ovaries to generate multiple eggs at a

3:17time, removal of the eggs from the

3:19ovary, fertilization of eggs in the

3:22laboratory and the subsequent placement

3:24of resulting embryos into the uterus.

3:27The change of conceiving from IVF

3:29primarily depends on the age of woman,

3:32cause of infertility and other factors

3:34related to the quality of the IVF

3:36laboratory.

3:38in IUI. It's a procedure through which

3:41concentrated and processed motile sperm

3:44are injected directly into a woman's

3:47uterus. This procedure is clogged

3:50according to a woman's ovolution and may

3:53be conducted one or two times on the

3:55days immediately after the evolution.

3:57After the evolution, the woman's egg is

3:59picked up at the fallopian tube and

4:02waits there for the sperm. Since the IUI

4:04procedure delivers higher concentrations

4:06of good quality sperm near the egg, the

4:09chance of fertilization is increased.

4:12While I thought it was important for us

4:14to also

4:16not overlap the methods but if you ask

4:21in a very layman's language, IVF happens

4:24outside the body, IUI takes place inside

4:28the body. So within both the procedure

4:33the woman faces a lot of trouble and

4:37that trouble u is what this memoir is

4:41all about.

4:44Before I go on to do a textual analysis

4:46of Rohini's text, I want to take you

4:50through the uh infertility and expanding

4:53art market in India. And if you look at

4:56some of the statistics, you will find

4:57that according to Indian Society of

5:00Assisted Reproduction, India faces a

5:03significant infertility burden with 27.5

5:07million couples experiencing

5:09infertility. Globally 60 to 80 million

5:13couples are infertile and India accounts

5:16for nearly 14th of this total. This is a

5:19very large number uh that is being

5:22quoted. We think when we see the

5:24population statistics that perhaps uh

5:26infertility is not an issue India is

5:29grappling with. But when you look at

5:31data, when you look at statistics, you

5:33find that it is not the case. India's

5:36total fertility rate has declined from

5:383.4 in the early 1990s to 1.9 into 2025

5:44despite the country being the world's

5:47most populous notion. So it's very

5:49contradictory what I what the statistics

5:52kind of indicate.

5:55The growth of infertility treatment has

5:57made India a major hub for IVF with the

6:01market valued at USD 746 million in 2021

6:06and projected to reach USD14531453

6:10million by 2027. Uh, additionally the

6:14Indian IVF services market is expected

6:17to grow at the CAGGR of 16.65

6:222025 to 2034 increasing from USD 1410.11

6:28million in 2025 to USD 4915.01

6:33million by 2034. Now why do I bring

6:36these statistics to your table or to

6:40your monitors is because I want to

6:42indicate the rapid expansion of art

6:46market in the context of India. Even if

6:50you see in the last 5 years around you,

6:54you will find that many infertility

6:56clinics have come up clearly indicating

6:59the fact that the IVF market has

7:02I mean grown uh very much uh especially

7:08after 2021 when art act and surrogacy

7:11regulation act came which kind of uh uh

7:16which kind of altered the way surrogacy

7:18was perceived. received earlier to what

7:20it became later on when commercial

7:22surrogacy was not in practice. It became

7:25illegal and only altruistic model of

7:27surrogacy was practiced art market which

7:31is assisted reproductive technology

7:33market that kind of took a boom and that

7:36is what we see also in statistics. I

7:39mean uh the prim primary reason why I

7:42brought it here was to indicate that

7:46now when we read Rohini's memoir we keep

7:49in mind these statistics because they

7:52are vital to the understanding of the

7:54infertility discourse in India I mean

7:56there are so many clinics so many people

7:58are going there it increasingly means

8:01that the taboo the shame the stigma

8:05associated with infertility is surely ly

8:09going down but there is more to what

8:11meets the eye.

8:13Uh quickly I will go through this text

8:16the uh I mean Rohini's text what's a

8:19lemon squeezer doing in my vagina was

8:21published in 2021 and it follows the

8:25journey of Rohini and Ranjit. Uh they

8:29are a couple and they wanted to start

8:32their family

8:34after establishing

8:36themselves in their career. They bought

8:38a house. They had secure job. They had

8:41had they had a marriage of more than 5

8:43years and now they thought it was a good

8:45idea to start their family and have a

8:49child but they keep on trying and Rohini

8:52writes that after 3 years of trying to

8:55conceive naturally she still couldn't

8:59get pregnant and that created immense

9:02amount of turmoil in her mind because

9:05she became all the more desperate

9:09like it happens There were relatives who

9:11were asking questions and there was so

9:13much of societal expectations that

9:15eventually they decided that they will

9:17take the help of the infertility

9:21treatment for which they went ahead with

9:25one of the clinics. In one of these

9:27clinics, she went through multiple

9:29rounds of IVF. And uh this she says was

9:35full of uh physical strain, emotional

9:39uncertainty and financial burden. So it

9:43was not like she went and there was some

9:46pill which she had to uh eat and it's

9:49done. It's not they were procedure

9:51based. In fact, most of the technology

9:54induced infertility treatments are

9:57hugely uh technology oriented and

10:01therefore they come with a a lot of

10:05physical, mental,

10:08emotional and economical burden. So that

10:12is very much reflected in Rohini's text

10:15as well. And the narrative through the

10:18memoir we come across a narrative which

10:21reveals the stigma, psychological

10:24distress and marital challenges that

10:26accompany infertility and assisted

10:28reproductive treatments. In fact, I had

10:31the opportunity to interview uh Rohini

10:34uh Raj Gopal once and uh it's a

10:37published interview where she talks in

10:40great detail about her experiences and

10:43in one of the uh questions I remember

10:46she answered of how

10:50difficult it was to bear the burden

10:52alone. So she says that her uh partner

10:56did join her for all the sessions. Uh

10:59but he was so helpless and the very fact

11:03that he was helpless and could not add

11:05to that entire procedure she was uh uh

11:09she was full of anxiety related to that.

11:11So she said that uh it was a very

11:13difficult procedure but she wanted to

11:15belong to the club which was uh a

11:18parents club and she wanted to be there

11:20and that is why just like all the

11:22medical technologies they build some

11:24kind of hope IVS was also a hope for her

11:27to become a parent in subsequent time.

11:31Uh she writes in her memoir pregnancy

11:35was an exclusive club and I wanted to

11:38break in.

11:40So uh she calls it a club and if you

11:45look at the choice of the word it's very

11:48consumeristic.

11:50Now if you ever happen to go to a club

11:53or you uh join a club there is a

11:56membership fee that comes in this she

12:00uses the that particular metaphor very

12:02carefully because pregnancy for her was

12:06not something that was just given to

12:08her. she opted for it and all those

12:11treatments had a particular kind of cost

12:14she had to pay and that is why she

12:17refers to being pregnant as belonging to

12:19a club and talks about it in a very

12:23desperate way. She said I just wanted to

12:26break in. So clearly indicating uh the

12:29fact the choice of word once again where

12:32do you break in where you can't enter?

12:35So she because she could not enter that

12:37club she wanted to break in. So you know

12:40language also plays a very seminal role

12:45in reflecting the emotion with which the

12:49writing has been done. And in this case

12:52in just one small sentence we find at

12:55least one word and one phrase that

12:58definitely indicates more than what it

13:01says. So if you look at this particular

13:05sentence that is here which says after

13:08trying for a continuous 3 years and

13:11failing to conceive and under mounting

13:14pressures from their relatives they

13:17sought medical assistance to get

13:19pregnant. So this is a line from the

13:21text. She said that finally she just

13:23succumbed to it and she said okay I I

13:26just uh will go ahead with the IVF

13:28treatment. And then once she was going

13:31through the treatment, she was extremely

13:34surprised because she says, "What would

13:36a lemon squeezer be doing in my vagina?"

13:40Clearly, the vagina was not designed for

13:43anything this cold, sharp or hard. Why

13:47wedge in an iron and steel contraception

13:50to keep it open? And then she also talks

13:54about the entire process in which the

13:58body has to take the strain of something

14:02that probably it is not ready for or

14:06maybe because of the social pressure

14:08she's opting for for that. So it very

14:10clearly uh indicates that kind of a

14:14sentiment which Rohini went for. Now

14:18through these lines these are three

14:22themes that we come across on your

14:25screen. First is that the nature of

14:30technology

14:33in assisted reproductive technology is

14:36very intrusive

14:38but also intrusive in terms of medical

14:42treatment because they just expose the

14:46woman's body in front of people where

14:52they use it as it is for the treatment.

14:56Now,

14:58additionally, if you look at how

15:01intrusivity she talks about, she also uh

15:04talks about intrusivity in the sense

15:06that how uh it is only most of the times

15:11the woman's body that bears the burden

15:14of dealing with such physical trauma. So

15:19when you look at this particular text

15:22you find that the medical procedures

15:25often require repeated examinations.

15:29Not just that the test the interventions

15:34they all make woman's body feel

15:39watched

15:41under surveillance.

15:43And that is why when you think of

15:47intrusion, it is not just intrusion in

15:51terms of

15:53some kind of intervention taking place

15:56but also monitored

16:00or opened, scrutinized

16:03all this together.

16:06Additionally, this particular memoir

16:08indicates is of IVF being an elitist

16:11technology. What does this mean? That

16:15when you talk about these treatments,

16:18they are extremely expensive and

16:21therefore not everybody can afford

16:25these kind of expensive treatments. So

16:29this raises a very important question

16:32and what is that question? who can

16:35access reproductive technology,

16:38somebody who has information, somebody

16:42who has economic power.

16:46Clearly, it is not meant for everybody.

16:49So it definitely is a theme that is

16:52worth noting in this memoir in which we

16:55can think of IVF as an elitist

16:59technology clearly indicating also the

17:02class struggle within the discourse of

17:06something which is supposed to be a

17:08reproductive right. So when we talk

17:11about reproductive right, how can we say

17:13when there is absence of resource for

17:16everybody? So the access depends on

17:19one's economic potential. So that is why

17:23she refers to it as elitist in nature.

17:27The third theme that she picks up is

17:30commercialization of infertility

17:32treatment. Which means that over the

17:35past two decades,

17:37infertility clinics and IVF services

17:39have grown rapidly, turning infertility

17:42treatment into what you can call a large

17:45and expanding medical industry. She also

17:49uh talks about societal pressures around

17:53infertility

17:55as she herself after trying for 3 years

17:58finally went on to take the help of one

18:03of these technologies for her pregnancy.

18:08What I do now is because this is the

18:11first text that we are analyzing. I pick

18:13up different paragraphs, different

18:15excerpts so to say and I try to closely

18:18read them. So one by one we will go

18:22ahead. The first one in the first exerpt

18:25it says the last time I am here. The

18:28last time we had felt like objects in a

18:32factory unit being sent from one

18:34assembly line to another. Despite the

18:37eminence of the doctor, she seemed too

18:40removed from her patients and too

18:42imperious in her ways. Now Raj Gopal

18:46describes how she and other patients

18:49felt over there. And this object in a

18:53factory unit is a powerful metaphor.

18:56Why? because it suggests that IVF

18:58process can sometimes feel mechanical

19:01and impersonal where patients are moved

19:04from one test, one doctor and one

19:07procedure to another without much

19:10emotional engagement. And she says that

19:13even though the doctor

19:15for her was highly qualified, very

19:18competent, still the doctor being

19:21impersonal and not very uh sensitive

19:25because she's doing that if you if you

19:27look at from a clinician's point of

19:29view, it's like she's doing that every

19:31day. But for Rohini, it was the first

19:36time she was even uh I mean getting into

19:39the procedure of conceiving. And that's

19:41why probably she wanted more empathy uh

19:44more sympathy from the doctor. So she

19:46says that uh it was very mechanical. It

19:48was very commercial. It was very

19:50technical so to say and that is what she

19:52points out and that's why she says I

19:55felt like an object in a factory unit.

19:57You are getting packaged sold packaged

19:59sold like that you know so she does

20:02mention uh this particular uh in

20:05metaphor for her expression of how she

20:09felt over there.

20:10>> [snorts]

20:10>> The second is this particular line in

20:15which she says what you need is a stance

20:18of a warrior not the long-suffering

20:20bearing of a patient. So Rohini says

20:24that the postures in which she was made

20:28to lie down the kind of physical

20:32intervention or interfering or uh

20:35intrusion that happened in her body.

20:38This was all very painful and at some

20:40point of time she did not feel like a I

20:44mean uh human being who's doing ordinary

20:47job. She felt that you needed that

20:49stance of a warrior. You needed to be a

20:51of a fighter spirit in fact to even go

20:55through the treatment. And I'm sure this

20:57is all uh uh to become pregnant. But

21:01this must have been so much of trauma to

21:03her while going through. So she mentions

21:06uh this particular uh theme here and

21:09there are two theorists who we can think

21:11of at this point of time because uh this

21:15whole idea of object in a factory unit

21:18connects to an argument made by Emily

21:21Martin Steinberg who points out that

21:23during IVF procedures women's bodies are

21:27often forced into spaces of constant

21:29medical observation and intervention. In

21:32this process, the body which is normally

21:34private becomes something that is

21:37examined, tested and managed with

21:39medical institutions.

21:41In the second paragraph with the stance

21:45of warrior, we find that while she's

21:49also

21:51going through the stance of a warrior,

21:54she's thinking of it as a fighterike

21:56spirit. This relates to the argument

21:59made by Patricia Spalon who suggests

22:02that the production of scientific

22:04knowledge about reproduction has often

22:06relied on women's body as the primary

22:09site of experimentation and

22:11intervention. In other words, what I

22:15mean to say is that medical progress in

22:18reproductive technologies frequently

22:20depend on the intense physical

22:23involvement of the bodies. The memoir

22:26thus allows us to look at IVF from a

22:29renewed focus. While technologies like

22:32IVF offer hope and new possibilities,

22:36they also raise questions. Questions

22:39about medical control over women's

22:42bodies and patients emotional experience

22:45and power dynamics within clinical

22:47spaces. So when you talk about medical

22:51professionals and pharmaceutical

22:53companies, they play a significant role

22:56in promoting art as a solution to

22:59infertility, often exploiting the

23:02socioultural dynamics that stigmatize

23:05childlessness. And within the stigma

23:08what happens that the whole idea of

23:13social pressure social stigma around the

23:16person being infertile plays a vital

23:19role. I mean the industry the technology

23:24where it is employed the clinics the

23:26advertisement if you look at it they

23:28they kind of capitalize on that

23:31particular stigma and that is what

23:33Rohini tries to point out. The second

23:36exerpt here is this one. With IVF I had

23:40hope. Without IVF I had nothing. clearly

23:44indicating that you know in contemporary

23:46times when we are thinking of the

23:48technological intervention within the

23:51scope of uh medicine or medical science

23:56even if I talk about particularly in the

23:58area of reproduction and or infertility

24:01with IVF she did have hope and that is

24:04what uh the neoliberal idea is as well

24:08that it sells some kind of hope so she

24:12said With that I had hope and without

24:15IVF I had nothing. So despite all the

24:18hardships of treatment it was tempting

24:21to keep on trying. It was easy to think

24:24that the next turn would bring a change

24:26of luck. But there is a line that

24:29separates determination from

24:31self-destruction and with IVF that line

24:35was dissolving

24:37repeated attempts and that is when she

24:40says she uses the word selfdestruction

24:43and she says that yes it's a good idea

24:46the technology can help it can play out

24:48on hope but it also

24:52is self-destructive

24:53and she says that at some point of time

24:56she did not know what she was doing,

24:59whether it was the determination to

25:02belong to that club of pregnancy that

25:05was driving her. Was it

25:08to

25:10remove the stigma that was associated

25:13with her being in an infertile woman? Or

25:17was it being a childless couple? What

25:21was it? or

25:24it was getting into a space of

25:25self-destruction which was coming with

25:28uh a lot of physical pain, mental

25:31exhaustion

25:33and also economic burden. So she she

25:36brings in those aspects as well into

25:38this. The second important point that

25:41she tries to make is uh which I I think

25:45also uh you can connect it with the

25:48personal experience to a broader

25:49critique made by Deborah Spur. In fact,

25:53Deborah argues that in their intense

25:56desire to have a child, prospective

25:58parents often begin to behave like

26:01bioconsumers.

26:02What this means is that reproduction

26:04slowly enters the logic of the

26:07marketplace and fertility clinics offer

26:10services that can be purchased at high

26:13rates. Even though parents do not

26:15usually see themselves as buying a

26:17child, they unintentionally become

26:20participants in a larger bio capitalist

26:23economy where reproduction is

26:25increasingly linked to markets,

26:27services, and commercial transactions.

26:30IVF offers new possibilities for

26:33parenthood but at the same time it also

26:36turns reproduction into something that

26:39is deeply intertwined with medical

26:41markets and consumer culture. So if you

26:45look at this particular quotation that

26:48is what it talks about at some point of

26:51time the whole space of art becomes so

26:54commercial that you are bound to feel

26:57like a customer. So you become a

26:59consumer in that sense.

27:02Other excerpt that I take up is uh this

27:05from page 69 and she says and therefore

27:08it is the woman's body that is sight for

27:11all fertility interventions. Infertility

27:15is not an equal opportunity employer. So

27:18this means that she also talks about the

27:20gender dimension over there. Naturally

27:24uh it is only the woman's body that is

27:26capable of uh bearing the child. But she

27:30does mention the space in which she was

27:33very helpless of the situation in which

27:36nobody could help her. She and Ranjit

27:39had bore the responsibility of the

27:41household together. But in this case she

27:44felt that most of the time she was

27:47handling the pressure of being pregnant

27:50or the handling the pressure of uh

27:53treatment all over on her shoulders.

27:56Emily Martin is an important theorist

27:58who examines that this whole situation

28:01is deeply ingrained in patriarchal

28:04mentality and claims that because

28:06women's sex organs are internal, unseen

28:09or occasionally absent from the body in

28:12comparison to male, these

28:14interpretations indirectly portray

28:16women's biological bodies as inferior

28:19and submissive. And uh when you look at

28:22some of the statistics mentioned here

28:26that coraborate to the excerpt it says

28:28that infertility affect both sexes about

28:3140% of cases are due to male factors 40%

28:35female factors and around 10 remain

28:38unexplained. So if you look at the whole

28:41idea of how infertility is perceived in

28:46India, you will find that the ratio is

28:50more or less same. But whenever there is

28:53an infertile couple, automatically

28:57the stigma is primarily associated with

29:00the woman.

29:02In India, it's also said that 15 to 20%

29:06of the couples experience infertility

29:08with male factors contributing to 40 to

29:1150% of cases. And this is a study by

29:14Neil Kantf center that I have mentioned

29:17here. And lastly, I think cultural norms

29:20construct reproduction as a feminized

29:23responsibility while male fertility is

29:26typically assumed and rarely questioned.

29:29which means that the initial burden of

29:33being an infertile couple usually falls

29:37on the woman and not on the man. And

29:40there are several cultural narratives

29:43that will discuss these kind of

29:46prejudices.

29:49Uh lastly, uh we talk about another

29:54excerpt from

29:56Rohini's memoir. She says, "You went

29:59through four IUI, two IVF, two frozen

30:02embryo transfer, and two miscarriages.

30:05And though you could afford it, your

30:08book mentions that it took a toll on you

30:10financially. Do you think that women or

30:13rather couples from a disadvantaged

30:15background and not financially equipped

30:18would be able to access these

30:19treatments?" So this was a question I

30:22had asked Rohini and uh uh because uh

30:25while I was doing some uh research on

30:28the surrogacy market in India, I

30:32realized that probably she was the best

30:34person to talk about and hence I

30:37interviewed her and I asked her this

30:39particular question which had huge

30:41amount of class implications so to say

30:43in in in it. So she says it is a fact

30:47that art is prohibitively expensive and

30:51it is not accessible to large sections

30:53of society. I fully acknowledge the

30:56class cast privilege and my urban

30:59location that allowed me to benefit from

31:01the technology. I hope as more people

31:04seek fertility assistance there is

31:07greater democratization of access to

31:09technology with good quality regulatory

31:12control and transparency. So she brought

31:16in several other dimensions also in her

31:18answer which I thought was important and

31:22that's why probably I take this

31:23particular question answer from her

31:25interview here. Finally, scholarly

31:28perspectives on assisted reproduction in

31:31India suggest that while technologies

31:32may reduce social stigma for the

31:35affluent economic constraints contribute

31:37to stratified reproduction. This is

31:39Colon's statement but uh this is very

31:42true in the context of India where there

31:44is so much of economic spectrum that

31:48exists where just because there is a

31:51resource available doesn't mean the

31:54accession is also possible and therefore

31:57rap's concept of reproductive hierarchy

32:00that suggest that some struggle for

32:02basic reproductive technology such as

32:05clinic with sterile conditions for

32:07C-section while others turn to

32:09cuttingedge genetic techniques. This

32:11kind of disparity is something we should

32:13be discussing in the context of India.

32:16Additionally, we also take up Shelley

32:18Colin who defines the power relations by

32:21which some categories of people are

32:24given the ability to nurture and

32:25reproduce where others are denied this

32:28ability. Again condition which defines

32:33categories am amid society in which

32:37there are resources but the access to

32:40resources depends on like Rohini said

32:44also her urban setting was important in

32:48her accession to clinic. So it's not

32:50just about one intersection of class.

32:53There are other intersections like

32:55education, information, economic, being

32:59mentally prepared, all those things. The

33:01totality of it that comes at play when

33:04you talk about accessing technology

33:06especially within the case of

33:08reproduction. That is where I will end

33:10my lecture today. I will see you next

33:12time uh in another class with the

33:15disability quotient in the childhood

33:18narratives. Thank you so much.