Embryologist removing sperm from growth medium in order to combine with ova. The Virgin Mary stands over the microscope.

The purpose of my trip to Ecuador this summer was to ascertain the viability of my dissertation project idea concerning assisted reproduction in Ecuador. I needed to contact doctors who provide IVF (in vitro fertilization) to determine how possible it will be to gain access to those involved with assisted reproduction (such as infertility patients, and to see if this topic warrants further investigation. I am happy to report that these goals were met with great success. I carried out intensive observation in clinics and laboratories, as well as conducted many interviews. The data I collected makes it clear that a project on assisted reproduction in Ecuador will contribute to a theoretical understanding of comparative cultures of science and technology along with the social impact of these procedures within each country where they are practiced. In 2002 I will return to Ecuador for a year to carry out more in-depth research. This research will be the basis for my Ph.D. dissertation in Medical Anthropology.

In Ecuador, clinics that offer procedures such as IVF and gamete donation currently exist in only two sites, Quito, the capital, and Guayquil a large port town. There are three clinics in Quito which offer these procedures and I spent a considerable time in all three throughout the course of the summer. Among the people who I interviewed were; doctors who run each IVF clinic, the embryologists and nurses who work at these clinics, several women who have undergone IVF, and egg and sperm donors. I also carried out observation in these clinics, watching the entire process of IVF, beginning with the egg retrieval, subsequent fertilization in the laboratory, and eventual transfer to the recipient. To supplement these interviews and observations I carried out archival research at local newspapers which aided my understanding of how assisted reproduction is represented in the media in Ecuador.

Several themes emerged in the course of my research that I will be comparing to my previous fieldwork on assisted reproduction in the United States. Many of the practices integral to running an IVF clinic in Ecuador had much to do with the geographic, political and symbolic location of Ecuador as a poor, developing nation in Latin America, and were quite different to daily practice in clinics in the United States. Obviously Ecuador's economic situation affects how assisted reproduction is perceived and practiced there. Although the process of IVF is much cheaper than in the United States, ($2500 versus $7000 to $10000 in the U.S.), people are much poorer overall and Ecuador is in the midst of an ongoing economic crisis which is exacerbated by the dollarization process. The infertile couples who can afford these procedures are few, and I was told that the wealthiest infertile couples leave Ecuador to seek "superior" treatment elsewhere.

The daily operations of these clinics are hampered as well by their distance from the United States or Europe. This meant, for instance, that it was often difficult to obtain the biological mediums, such as growth hormones that are essential to the process of IVF. The largest center in Quito had to cancel all of it's IVF cycles for the month of August because the mediums they usually purchase from France via the United States were suddenly a subject of a trade restriction in the U.S. The medical director had no other means in which to obtain these mediums. This situation would never occur in the United States where availability of essential equipment and tools is never in question.

Ecuador's socio-economic position and location also contributes to the isolation of the IVF doctors from each other. All of the doctors that I spoke with had to go elsewhere for training in order to gain the skills and credibility to successfully offer assisted reproduction. All of them have spent long amounts of time in either Israel, Brazil, Columbia, Spain, the United States, Hungary or Chile. A consequence of this type of mandatory international education was that the doctors involved with assisted reproduction in Quito had very little to do with each other. It was as if having colleagues within Ecuador would be tainted by the hint of "backwardness" and that the only professional relationships worth having are international.

Crucifix attached to incubator door.

Another theme that emerged within my research was presence of religious imagery and practice in the laboratories of the clinics. In one clinic's laboratory a placard of the Virgin Mary hangs over the primary microscope where egg and sperm are combined. When the embryologist finishes all of her procedures in this combination process she touches the Virgin placard then makes the sign of the cross. She then places the petri dish containing the gametes in an incubator, attached to which is a crucifix hanging in a sterile plastic bag. When the embryologist closes the door she touches the crucifix and again makes the sign of the cross. She leaves the petri inside the incubator for twenty-four hours with the hope that they will fertilize. The director of this same clinic told me that "god was in the laboratory" because they, the doctors only place the egg and sperm together. Why any particular ovum is fertilized is a mystery. In another laboratory although there was no religious imagery in the laboratory the embryologist would always make the sign of the cross before he placed the petri dish with ovum and sperm in the incubator. When they were safely inside he would say "Vayan con dios" (Go with god).

There is much to say about these observations. It seems very fitting in some way that the Virgin Mary stands guard over the microscope, sanctifying a process that requires no sexual act to create a child. What is also fascinating is that the Catholic Church unequivocally bans the use in vitro fertilization or any form gamete donation. One reason for that ban concern the fact that in assisted reproduction "fertilization entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person" (Ratzinger, Jospeh Card, 1987, "Instruction on Respect for Human Life in its Origin and on the Dignity of Procreation", Given at Rome, from the Congregation for the Doctrine of the Faith, February 22). The doctor who told me that "god is in the laboratory" is denying this doctrine and naming god as the ultimate creator even in the practice of assisted reproduction.

Our common sense notions of the relationship of biomedicine and science to religion are also called into question with these observations. Within the modern era in Western Europe and the United States science and religion have been thought to inhabit very distinct spheres. As Bruno Latour has argued these spheres have never truly been separate but one characteristic of modernity has been the avowal of this separation (Latour 1993, We Have Never Been Modern, Harvard University Press). Thus scientists working in the United States do not tend to profess religious sentiments, and what I observed in Ecuador concerning religious ritual in the laboratory seems distinctly different from practices in IVF clinics in the United States. I do not mean to suggest that scientists or doctors in the United States working in field like assisted reproduction are never religious. On the contrary some are religious and indeed often publicly so. But in Ecuador for doctors who I interviewed religiosity was a matter of course, never contested or separated out from their work. Religious sentiment is a much greater part of everyday life in Ecuador which carries over into the laboratory and plays an important role in explain success or failure when making "new life" with practices such as IVF.

Embryologists checking for ovum fertilization

A third theme that emerged in my research had to do with the level of access I had to those I interviewed. I found it surprising easy to talk to the doctors and clinic personal and they were very open about me observing medical procedures. This contrasts with my experience in the United Starts where it was much harder to find a doctor who was willing to make time for an interview or to allow an outsider to observe medical procedures. What was more difficult though in Ecuador was finding people who had undergone IVF or egg donation who were willing to talk about it. In the United States IVF is thought to be a personal matter, but possibly because more people have undergone these procedures and possibly because of a different sense of privacy I found Ecuadorians to be much more reserved and unwilling to talk about these topics. This attitude in some way contributes to a greater tacit acceptance of assisted reproduction though. Assisted reproduction in general is less controversial in Ecuador than it is in the United States. Although the Catholic Church bans the procedure, the value placed on having children is much higher than in the U.S. and the use of these procedures even though private is not problematized. These procedures do not provoke the same sort so bio-ethical debates so common in discussions of assisted reproduction in the United States.

When I return to Ecuador I will carry out further research which will illuminate all these issue to a much greater degree. For the moment I collected enough data this summer to be able to begin to write my dissertation and grant proposals to support my continued long-term research on assisted reproduction in Ecuador.

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