The University of Chicago Assisted Reproduction In
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THE UNIVERSITY OF CHICAGO ASSISTED REPRODUCTION IN GERMANY AND THE UNITED STATES: REGULATING THE FAMILY AND NEGOTIATING CONCEPTIONS A DISSERTATION SUBMITTED TO THE FACULTY OF THE DIVISION OF THE SOCIAL SCIENCES IN CANDIDACY FOR THE DEGREE OF DOCTOR OF PHILOSOPHY DEPARTMENT OF SOCIOLOGY BY ALICIA JEAN VANDEVUSSE CHICAGO, ILLINOIS JUNE 2016 TABLE OF CONTENTS List of Tables ............................................................................................................................................... iii Acknowledgments ........................................................................................................................................ iv Dissertation Abstract .................................................................................................................................... vi Chapter 1: Introduction ..................................................................................................................................1 Chapter 2: Regulating Assisted Reproduction in Germany and the United States ......................................23 Chapter 3: The Interplay of Regulations and Personal Beliefs on Physicians’ Practices ............................53 Chapter 4: Conception Worldviews and Trajectories ..................................................................................82 Chapter 5: Sperm Donor Selection Processes ............................................................................................113 Chapter 6: Conclusion ................................................................................................................................141 Appendix A: Tables of Respondents .........................................................................................................150 Appendix B: Methodology ........................................................................................................................152 Appendix C: Glossary of Terms ................................................................................................................158 Bibliography ..............................................................................................................................................161 ii LIST OF TABLES Table 3.1: Physician Respondents’ Expressed Beliefs about Families by Country……………..56 Table 4.1: Conception Worldviews of Lesbian Respondents………………………………...….89 Table 4.2: Conception Locations of Lesbian Respondents………………………………………96 Table 5.1: Respondent Sperm Donor Selection Trajectories by Country………………………118 Table A.1: Physician Respondents’ Self-reported Characteristics…….….……………………150 Table A.2: Lesbian Respondents’ Self-reported Characteristics……………………………….151 iii ACKNOWLEDGMENTS This dissertation would not have been possible without the unwavering support I have received over the years from family, friends, faculty, and funders. First and foremost, I could not have completed this project without generous fellowship funding from the University of Chicago, the Center for Gender and Sexuality Studies, the American Journal of Sociology, and the Free University’s Berlin Program for Advanced German and European Studies. Thank you all for keeping the lights on as I completed this project. Next, I gratefully acknowledge the debts I owe to my committee members, Michael Geyer and Edward Laumann, who took on this project with open minds and who provided encouraging feedback at critical moments during the research and writing stages. In addition, I appreciate the support I received from Richard Taub and Betty Farrell, who helped me keep my eyes on the prize throughout my years in graduate school and who dispensed candid and kind words as needed. Finally, I am extremely grateful to my dissertation chair, Kristen Schilt, who has given generously of her time, attention, energy, and expertise throughout the development of this project. I have been inspired by her enthusiasm and untiring devotion to scholarship, and my work has benefitted immensely from her careful, prompt comments and targeted, friendly advice. Furthermore, I greatly appreciate the friendships I have made during graduate school, as they have enriched my intellectual development, sustained me through bouts of uncertainty and self-doubt, encouraged me to keep on trucking, and reminded me that there is more to life than graduate school. My work over the years has been greatly improved by feedback from many readers, including but not limited to: Amy Brainer, Brian Cody, Piper Coutinho-Sledge, Gordon C.C. Douglas, Clare Forstie, Lizzy Kate Gray, Naomi McCormick, and Abi Ocobock, who deserves additional accolades for her initiative in organizing and sustaining writing groups. iv Thank you also to Kimberly Austin, who helped me through our coursework and pushed me to keep moving forward; Eileen Bevis, who is unmatched in her hospitality, dependability, listening skills, and beer pairing ability; Elisabeth (Damböck) Chavez, whose translation skills clarified innumerable ambiguities and whose companionship made it worth staying in the “Brain” until the melody played; and Natalie Vena, whose support, advice, and commiseration during our weekly check-ins have given me the strength to finish this marathon. Words simply cannot express my gratitude to my family. Thank you for reading and editing drafts, gently (and not so gently) pushing me to finish, and knowing when not to ask about my dissertation. You have propelled me through this seemingly never-ending process with humor, love, and sustenance. Most of all, thank you to my partner, for being there through the good, the bad, and the ugly of the dissertation process. Without you, I might never have stumbled upon my topic, learned German, or completed this project. I am forever grateful for your love and support. Danke schön, Schatzi, und jetzt: ein bisschen Spaβ muβ sein! Finally, this research would not be possible without the many respondents who gave generously of their time and stories. Thank you for letting me into your homes, offices, and histories. v DISSERTATION ABSTRACT This project compares the reproductive experiences of lesbians and the related treatment decisions of fertility physicians in Germany and the United States, which provide notably different regulatory contexts for lesbian reproduction. In Germany, several facets of regulations serve to discourage lesbian use of fertility medicine, whereas in the United States, few regulations on fertility medicine exist. Drawing on a review of country regulations, content analysis of media coverage, and in-depth interviews with lesbians and physicians, I argue that the regulatory context (including legislation, medical professional guidelines, health insurance policies, and case law regarding families) both reflects and reinforces the reproductive cultural practices in these two countries. Overall, I find that the regulations have notable effects on physician treatment decisions and lesbian reproductive decisions regarding the logistics of conception and the choice of sperm donor. In particular, regulations in Germany discourage lesbian use of fertility medicine and inadvertently encourage novel kinship practices, while the regulatory context in the US encourages the medicalization of lesbian conception and the reproduction of the two-parent, tightly bounded family unit. vi CHAPTER 1: INTRODUCTION In this dissertation, I explore the ways in which different regulatory contexts influence the reproductive decisions of lesbian couples, as well as the treatment decisions of fertility physicians in Germany and the United States. My initial interest in a comparison of these two countries stemmed from the surprise I felt when I learned that Germany, which is generally regarded as a progressive nation regarding gay and lesbian rights, had stricter and more discriminatory policies toward lesbian reproduction than the US. My surprise became academic curiosity, as I learned that Germany had successfully implemented civil union partnerships and prohibitions on employment discrimination with little political turmoil and that there were several prominent, openly gay politicians on the German political stage. In 2010, when I was designing this project, the US appeared considerably less tolerant, as gay marriage was highly controversial and expressly prohibited in a majority of the states, employment discrimination on the basis of sexual orientation was legal in many places, and openly gay American politicians were quite rare. Thus, I was confounded to learn that policies toward gay and lesbian reproduction in these two nations exhibited a different, arguably paradoxical pattern. Whereas the American Medical Association (AMA) expressly allowed for the treatment of lesbians with techniques of fertility medicine, the Bundesärztekammer (German Medical Association, hereafter BӒK) holds that lesbian couples and single women should not receive such treatments because their children would lack connection to a social father. Thus, I set out to examine how the different regulatory frameworks impacted lesbian reproduction in these two countries, both with regard to the physicians who provide access to treatment and for the women attempting to conceive outside of a heterosexual partnership. My results are best illustrated by the following two case studies. 1 I met Alexandra1, a 39-year-old, white lesbian, in her homey, spacious apartment in Berlin. She was dressed comfortably in jeans and a fitted black long-sleeved t-shirt. We sat in her kitchen with high ceilings