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Оглавление1 The Birth of Assisted Reproductive Technology in China
It’s about 1978, and the first IVF baby was born in the United Kingdom, but during that time, you know, China had had ten years of Cultural Revolution, so we didn’t hear any news from foreign countries and we couldn’t read any materials from foreign countries. So during that time, we didn’t know this great news until 1979, when my father was able to read some newspapers and magazines from foreign countries. That way he learned that a test-tube baby was born in the U.K. in 1978. So he thought that in China, because of the Qing dynasty Chinese people have suffered a lot not only from the war, but also from drugs, because some of them became addicted to drugs. He said that if you want to change the whole country, you must have a healthy body, so it is also important to have a healthy baby for every Chinese family. At that time, my team was doing prenatal diagnosis for genetic diseases and we found many couples with such diseases, but they could only choose to do an abortion; this was the only option for them. My father thought that maybe if we can find a good way to have a sperm and oocyte cultured in vitro, then we can identify not-good genes and choose the good ones. So his first thought for doing IVF technology was not for infertile couples, but for couples with genetic diseases. But this was a long way off and we also found that it was not easy to do this work. After all our research we decided, then, to also do the treatment for infertile couples. (Lu Guangxiu)
There is an almost precise coincidence of timing in the births of Louise Brown in July 1978 and China’s restrictive family planning policy a few months after in 1979. These two landmark events stand at odds with each other in many ways. For Robert Edwards and Patrick Steptoe, the two doctors who helped Lesley and John Brown give birth to Louise using the technique of in vitro fertilization (IVF), infertility was the problem that needed to be overcome. In contrast, for systems engineer Song Jian, mathematician Li Guangyuan, and other architects of the so-called “one-child-policy,” fertility was the problem that needed to be addressed (Greenhalgh, 2008). The technique of IVF alone has brought an estimated 5 million babies into the world globally (in China, some 200,000),1 while it is said that the one-child policy has prevented some 140 million births in China.
It is worth remembering that, as Martin Johnson and colleagues (2010; see also Johnson, 2011) have shown, Edwards and Steptoe faced numerous setbacks during the early days of their research on IVF in the United Kingdom. They were refused funding by the Medical Research Council in the early 1970s in a scientific climate where research into infertility “was accorded a low priority” (Johnson et al., 2010, p. 2158) when compared to contraception and abortion. Similarly, beginning in the early 1980s, reproductive scientists Lu Guangxiu, Zhang Lizhu, and He Cuihua also faced many setbacks (albeit eventually securing government funding for their research in 1986) in a country where concerns about overpopulation were immediately national rather than global.
What, then, were the conditions that allowed assisted reproductive technologies (ARTs) to be developed in China during the exact same period that one of the world’s most comprehensive family planning policies aimed at preventing birth was being rolled out? First of all, in what follows, we will see how ARTs would have be molded into a suitable form to fit within China’s restrictive reproductive complex before they could gain formal authorization through national law as late as 2003. In doing so, these technologies eventually settled alongside contraception, sterilization, and abortion as just another technology of birth control. This might seem counterintuitive, seeing as birth control is most often defined as fertile couples’ active efforts to prevent unwanted pregnancies as a matter of (in China, state-stipulated) family planning. Nonetheless, as we will see, for ARTs to be legalized, infertile couples would have to be subject to the same kinds of family planning restrictions as fertile couples. We can say that for increasing numbers of infertile couples in China, birth control can be defined as an active effort to achieve wanted pregnancies using ARTs in order to have one child in strict accordance with family planning policies. Moreover, since China’s reproductive complex came to be configured around the dual objectives of controlling population growth and improving population quality, the medical genetic potentials of reproductive technologies were actively mobilized from the outset in China, as highlighted by Lu Guangxiu in this chapter’s opening quotation.
Secondly, I will show how even if ARTs such as sperm banking or IVF were invented in the United States and United Kingdom, this did not relieve scientists of a need for experimentation in China, and hence we should not view their development and routinization as an “importation of Western reproductive technologies” (Handwerker, 2002, p. 310; cf. Inhorn, 2003). Instead, we need to trace the transformation of such technologies from pioneering to mundane within China (rather than across borders). By tracing the ways in which ARTs came to be accepted in China we gain insights into the particular form—what we might think of as “one-child ART”2—they have taken (cf. Knecht, Beck, and Klotz, 2012).
I begin by looking at how two of the pioneers of reproductive science in China—Lu Guangxiu in Changsha and Zhang Lizhu in Beijing—began experimenting with assisted reproduction, eventually embarking on a collegial yet competitive race to achieve the country’s first test tube baby, culminating in the birth of Zheng Mengzu in March 1988 in Beijing, closely followed by a baby girl in Changhsa three months later. Their recollections, recorded in interviews, are interwoven to capture a sense of the pioneering spirit that carried their efforts forward. I will use Zhang and Lu as narrators of the story of the difficult birth of ARTs in China. As we will see, there is a certain style to nostalgic remembering when legacies have already been consolidated, allowing for playful self-deprecation as a means of emphasizing the hurdles and challenges that had to be overcome. Zhang and Lu’s personal recollections are balanced against additional interviews with some of the other scientists as well as Ministry of Health officials who were active in reproductive research and policy through the 1980s and 1990s; participation in a series of workshops and conferences on assisted reproduction in China held in Beijing, Shanghai, and Changsha, which gave insights into the history of ART in these cities; as well as on secondary archival sources. Accounting for the birth and routinization of sperm banking in China requires accounting for the development of IVF since, as we saw in the introduction, China’s first sperm bank was established by Lu Guangxiu in Changsha to facilitate lab research on in vitro fertilization. Therefore this chapter chronicles the rise of both forms of reproductive technology.
ORIGIN STORIES
Helping You Have a Healthy Little Angel
Our hospital is the first modern large-scale reproductive and genetics hospital in China, and a model for putting technological developments to practical use. . . . From 1980 it was under the direction of Professor Lu Huilin, the founder of the study of medical genetics in China. Professor Lu Guangxiu was the first to begin developing human-assisted reproduction research and clinical medical work in China. In 1980, the Human Reproductive Engineering Research Department, a platform for human-assisted reproductive technology, was founded. . . . [T]his was the first center in China to begin studying human ovum development, external maturation of ovum, and in vitro fertilization. Projects became national key scientific projects of the Seventh Five-Year Plan. There are world-class equipment and a very talented team. The center has made great achievements in the area of assisted reproduction and preimplantation diagnosis in the past twenty years. . . . Founded in 1981, the technological instruction center of the National Sperm Bank of the Ministry of Health was China’s first sperm bank, with a very talented team, advanced quality control equipment, computer-based data management, and the ability to preserve 120,000 frozen sperm samples. (Hospital presentation flyer, CITIC-Xiangya Reproductive and Genetic Hospital)
Scientific teams, clinics, and indeed countries often engage in a race to be the first when it comes to “new” or “frontier” technologies; whether in the United Kingdom or in India there is prestige to be won from achieving a first in the ever-growing field of reproductive technologies (Bharadwaj, 2002; Franklin & Roberts, 2006). Global firsts (such as Louise Brown or Dolly the sheep) are perhaps the most prestigious, but by no means at the cost of national firsts. In China, as already noted, two scientists have in particular been recognized, not least through national awards and prizes, as the pioneers of ART—Zhang Lizhu of Beijing’s Medical University Third Hospital and Lu Guangxiu of the CITIC-Xiangya Reproductive and Genetic Hospital in Changsha. If ARTs are completely routinized today in China, they were very much experimental technologies in 1980, which was a pivotal post–Cultural Revolution year for reproductive science in China. It was in 1980 that the Human Reproductive Engineering Research Department was founded at the Xiangya Medical College in Changsha by Lu Huilin, father of Lu Guangxiu. It was also in that year that Zhang Lizhu, a trained gynecologist, returned to prominence as invited speaker on China’s one-child policy and related public health issues at the United Nation’s Second World Conference on Women held in Copenhagen.
Yet, Zhang and Lu arrived at assisted reproduction along very different paths, as endocrinologist and geneticist respectively. Having studied gynecology in Shanghai, New York, and Baltimore through the 1940s, Zhang took up her first position as resident gynecological physician at the Marie Curie Hospital in London in 1949.3 She returned to China in 1951, eventually becoming the director of Gynecology and Obstetrics at the Peking University Third Hospital in 1958. During the 1960s, her endocrinological research was focused on the increasing numbers of patients reporting menstrual irregularity. By 1965, as the Cultural Revolution began, Zhang’s international background was turned against her. She was demoted from her position as director and sent to work in the countryside for a year where she trained so-called “barefoot doctors,” followed by a job as hospital janitor at the Third Hospital back in Beijing.4 Zhang was able to resume her work as clinician and researcher only once the Cultural Revolution had ended in 1978, in a newly established endocrinology laboratory at the Third Hospital. This change in fortune was directly linked to the Four Modernizations program that Deng Xiaoping had launched that year to repair some of the many setbacks that agriculture, industry, defense, and science and technology had suffered during the Cultural Revolution. Zhang picked up where she had left off, concentrating on her patients’ menstrual irregularities, a specialization that would inevitably draw her into the field of infertility, as she recalled in an interview with the Chinese Obstetrics and Gynecology forum:
My expertise was in reproductive endocrinology. When I treated patients with period issues in the 1980s, I found that many of them not only wanted to cure their period problems, but also mainly wanted to get pregnant. A lot of them had been married for over two years but still couldn’t get pregnant. Therefore I began to look into what was causing their infertility. After research and analysis I found out it was due to blocked fallopian tubes. In most cases this was the major problem. Blocked fallopian tubes were mainly an issue in China, which was completely different from other counties. In China 31.3 percent of female infertility was caused by tuberculosis. We proved that they had tuberculosis through research and biopsy. So this cause was not necessarily the same as in other counties. The main clinical manifestation was pelvic adhesions, and the surface of the ovary couldn’t even be seen. (Zhang, Interview 1)
Lu, on the other hand, was introduced to the field of ART by her father Lu Huilin, one of the founders of medical genetics in China. Lu Huilin had traveled to the United States in 1924 to further his education at Columbia University, studying under Thomas Hunt Morgan and Edmund Beecher Wilson for a master’s degree in genetics. Armed with a number of Morgan’s works, such as Human Inheritance (1924) and Evolution and Genetics (1925), Lu returned to China in 1929. Disrupted by illness and the Japan-China war (1937–1945), Lu eventually set about translating Morgan’s texts in the late 1940s with a view to spreading his theories to a Chinese audience. In 1950, he published a book on the theory of the gene and Mendelian inheritance and began teaching this theory at the medical college in Changsha. He was widely criticized in a newly communist China, which officially favored the now discredited ideas of Russian scientist Trofim Lysenko on the heritability of acquired characteristics (see Lamoreaux, 2016). Lu’s studies and teaching were interrupted as the Cultural Revolution took hold in the 1960s. As a result, he shifted his attention to medical genetics in the 1970s, forming a research group in Changsha that would develop prenatal diagnosis and genetic counseling techniques. It was this group that would be formally institutionalized in 1980 as the Human Reproductive Engineering Research Department of the Xiangya Medical College. And thus Lu Huilin’s interest in reproductive technologies began to take shape. His initial excitement upon hearing news of Louise Brown some months after her birth in 1979 was sparked by the possibilities of utilizing IVF not so much to overcome infertility as to avoid transmission of genetic diseases.5 It was at this time, in the late 1970s, that Lu Huilin’s daughter, Lu Guangxiu, would unknowingly be enlisted in China’s efforts to develop reproductive technologies. As she explained in an interview in her office surrounded by a forest of indoor plants one late afternoon in May 2011:
Figure 3. Lu Guangxiu and her father, medical geneticist Professor Lu Huilin. (Photo courtesy of Lu Guangxiu.)
I was a surgeon in Guangdong in 1979, and at that time, because my father’s health was not very good, I came back to Changsha to take care of him. During that time, he posed a question to me, asking: “Do you know how we can get an oocyte?” I was astonished to get this question! Because I had never observed any oocytes during ultrasound and the technical equipment was also very poor at that time. So, as a surgeon, I answered, “Maybe you have to open the abdomen to get this oocyte.” I also wondered why he would ask this question. When I came back to Changsha, I had become a teacher of anatomy. In those days, I could teach for half of the year and have my own time for the other half of the year. Being a surgeon was hectic every day, so I was used to the old busy days. I felt I had too much free time in Changsha and I hadn’t many things to do. So I asked my father why he asked this question and he said that he would like to try for an IVF baby. I then said, “Why don’t you let me have a try?” But my father said that I am a surgeon and so I lack basic knowledge of this research and he would think about it. After several days, he gave me some examples of what preparations I would make if I was going to be engaged in this research, such as the equipment, technology, and knowledge; so all these things, I had to begin from scratch. “You will encounter many difficulties and you have to overcome them,” he told me. I thought about it and accepted it and began the research.
Lu Huilin sent his daughter to Beijing on a three-month study trip in 1980 to learn how to fertilize eggs and culture embryos from cows, rats, and mice. Lu Guangxiu’s sister was studying at Beijing University at the time and had many friends and classmates working at the Chinese Academy of Sciences in the field of genetics. So, whereas Zhang Lizhu’s attention had been drawn to infertility by the patients she encountered as a clinical gynecologist, Lu Guangxiu was introduced to reproductive science by her medical geneticist father whose initial interests focused on the use of reproductive technologies to engineer and improve the strength of China’s population. This intersection of clinical infertility and medical genetics, as we will see, turned out to be propitious for the development of ART in China. As they set out to develop reproductive technologies in the early 1980s, one of the first hurdles faced by Zhang and Lu (much like all other early reproductive science pioneers) was how to get a hold of human gametes.
GETTING GAMETES
While artificial insemination (AI) using donor sperm has a long history, it was not until the first techniques for viable cryopreservation of sperm were developed in the 1950s that sperm banks —repositories of frozen sperm samples—became feasible (see Swanson, 2012). Working with animal sperm in 1949, a group of British researchers led by Chris Polge “made the discovery that glycerol had the remarkable property of protecting living cells from damage during freezing and thawing” (Polge, 2007, p. 513). A few years later, Polge and his team had engineered the birth of Frosty, the first calf born from frozen sperm with “millions more to follow . . . [as] the technique spread rapidly round the world until nearly all the cows bred by AI were with frozen semen” (ibid., p. 514). Encouraged by Polge’s work, Jerome Sherman and Raymond Bunge from the University of Iowa in America were the first to apply these findings to human sperm in the early 1950s (see Swanson, 2012). By 1953, they reported that “clinical application of practical storage banks for human spermatozoa in infertility problems is now in progress” (Sherman & Bunge, 1953, p. 688) and (following three successful pregnancies using frozen sperm) that “the ability of glycerol-treated, frozen, and thawed human spermatozoon to fertilize and actuate the human ovum has been observed” (ibid., p. 768).
Notwithstanding this early work on the use of cryopreserved human sperm for insemination in the 1950s, historian Kara Swanson has shown that doctors in America continued to prefer using fresh semen for insemination in the ensuing decades and as a result “frozen sperm would not become a significant part of reproductive medicine until the 1980s” (2012, p. 272). This was also the case in China. As we saw in the introduction, by 1980 Chinese breeders had established a sperm bank for bulls in Beijing, which Lu Guangxiu had visited during her three-month study trip to learn how to freeze sperm with liquid nitrogen. It was on the basis of this visit that she would establish China’s first human sperm bank upon her return to Changsha toward the end of that year, ensuring a significant place for sperm banking in Chinese reproductive medicine during the 1980s, as we will see.
If the main challenge for Sherman and Bunge and for Lu was to transfer techniques for storing bovine sperm to storing human sperm, scientists working with human oocytes in the same period had to tackle the problem of how to retrieve oocytes in a medically and ethically responsible manner. In a 1968 letter to the editor in The Lancet, Patrick Steptoe had reported that “all aspects of the ovaries . . . can be inspected in minute detail through the modern laparoscope” (Steptoe, 1968, p. 913). This microscopic technique, which allowed surgeons to see inside the abdomen through a small incision using a viewing instrument attached to a tube, had initially been developed in France for purposes of sterilization, but upon reading Steptoe’s letter, Robert Edwards saw its potential as a technique for obtaining oocytes, prompting him to initiate what would become a famous collaboration with Steptoe. It was through the retooling of laparoscopic techniques for purposes of egg retrieval that Edwards and Steptoe would go on to develop IVF in the United Kingdom during the 1970s.
Not only did the carrying out of early research on fertilization and embryo development require gametes, it also required having access to them in highly coordinated and controlled ways. This was among the reasons Lu Guangxiu gave for learning how to freeze sperm using egg yolk and glycerol in 1980, that is, to have access to sperm in the laboratory for in vitro research purposes. However, it was one thing to know how to cryopreserve sperm; when it came to human sperm, getting the sperm proved to be quite a challenge in Changsha. The director of the sperm bank in Changsha today, Fan Liqing, worked closely with Lu in the 1980s and he explained to me what they saw as their primary obstacle in the early days:
At that time, the technical conditions were not the biggest problem. The problem was how to overcome the ideas of ordinary people, because during that time, all the people were still conservative and they were very sensitive when talking about sex. So it was very hard to collect semen to establish our sperm bank. We tried to find people with a good educational background in the university. But everyone declined. I remember we talked with an old professor, and because during that time, we still lived in quite poor life conditions, we said that if you can donate sperm, we can provide some compensation for you. The guy said, “I’d rather beg than donate sperm!” So it was very hard for people to accept it.
Lu concurs: “China had just undergone the Cultural Revolution, so collecting sperm was like a dirty thing. So when I built the sperm bank [in 1980] we did everything covertly and it was very difficult to collect sperm.” Initially, Lu and Fan tried to collect “leftover sperm” from outpatients, but quickly found that there were no such leftovers. Consequently, Lu discussed her quandary with her husband and asked whether he would be willing to provide sperm for research purposes. “He agreed immediately!” and indeed one day in early 1981, when Lu wanted to do some research, she brought sperm samples from her husband and put them on her desk:
When one of the vice directors [of the Xiangya Medical College] had a look at the sperm samples and asked where I got them from I replied that they were from the outpatients, but the vice director responded that they can’t be from outpatients because they are of good quality! [laughter] So I said: “This is from my husband; you are male teachers, but you can’t donate any sperm for research purposes?” So from that time on, our male teachers also donated their sperm for research, like volunteers.
Once they had mastered the art of freezing and thawing sperm (on which more in a later section), the next step was to secure donors who would be willing to donate their sperm for reproductive purposes rather than solely for research. One of Lu’s colleagues, who had worked in the countryside like so many others during the Cultural Revolution, suggested that they pay a visit to a steel factory to ask whether workers there would be willing to donate. When this did not pan out (the workers refused to provide sperm samples), they moved on to a mine in a mountainous region of Hunan. “We had to take a bus first and then change to a train and we had to bring the liquid nitrogen . . . carrying it by hand, it was very hard at that time.” This time they succeeded in convincing workers to participate in a physical examination that included the provision of a sperm sample for analysis and possible donation in return for a small compensation fee. “We collected like forty people’s, more than forty people’s sperm samples and brought them back to Changsha.” This group of men became in effect China’s first frozen sperm donors.
Then, in early 1982, with donor sperm in their bank’s tanks, Lu Huilin contacted the man who had originally written to him asking about sperm banks for humans (see the introduction). The man arrived in Changsha with his wife and after two attempts at insemination—“we didn’t know when the best time for ovulation was so I had to read in a book about contraception, which described at what time in a cycle contraception was needed, so I guessed this is the ovulation time [laughter] because there is no information in other books”—in January 1983 Lu Guangxiu and her team succeeded in using frozen donor sperm to secure the birth of a healthy baby boy for the first time in China. Bearing in mind the moral disapproval they met from many of their medical colleagues, Lu Huilin decided to keep news of this achievement a secret.
Meanwhile, in Beijing Zhang Lizhu was busy trying to develop a method for retrieving eggs. As noted earlier, Zhang had traveled to Copenhagen in 1980 to speak at the UN Women’s Conference. Upon being asked whether she had learned about in vitro fertilization on this trip, she responded: “I went abroad in 1980 with some women’s groups to visit many places. However, our visit at the time didn’t consider test tube baby technology at all. What we looked at was how to do female health care, how to do family planning—meaning abortions and birth control—as well as learning about condoms and intrauterine devices; therefore we didn’t really keep up with the trends at the time” (Zhang, Interview 2). Instead, once she did begin focusing her attention on the infertility problems of her patients, she embarked on her own forms of experimentation. Lu had been astonished when her father had asked her “Do you know how to get an oocyte?” since she had worked as a surgeon rather than an obstetrician or gynecologist. Zhang, on the other hand, had experience from working with her patients. She recalls how she began working to locate and retrieve oocytes:
There were test tube babies elsewhere in the world at this time. The first test tube baby was born in 1978 in the U.K. At that time they were all using laparoscopic surgery to retrieve eggs. Once the laparoscope was put in, the surface of the ovary could be seen, and the ovary follicle could be seen too, which was the place the needle needed to penetrate. However, in China we couldn’t do the same because the surface of the ovary couldn’t be seen at all using a laparoscope [due to tissue damage from tuberculosis in some cases, or difficulties in manipulating the laparoscope]. So the only method we had at the time was retrieving ova by hand while treating pelvic cavity disease. Manually reaching the ovary follicle and judging by instinct where to insert the needle, sucking the ovarian follicular fluid out, and then finding the ova in the ovarian follicular fluid. Therefore we used a different strategy by finding ova in the ovarian follicular fluid we retrieved, and learned more about the ova. (Zhang, Interview 2)
Jiang has argued that we should take this account of an “indigenous method” with a grain of salt, since the fact was that laparoscopy was a difficult technique for anyone to learn, let alone in China where clinical and laboratory conditions were so poor in the early 1980s (Jiang, 2015, pp. 46-47). There were not many patients who were willing to undergo experimental procedures solely for egg retrieval.6 Instead, patients were asked if they would agree to egg retrieval for research purposes once open pelvic surgery for a medical indication had been safely completed.
Lu Guangxiu’s initial attempts to secure oocytes during this time were also through surgery, because as she told me “we didn’t know how to do laparoscopy.” Zhang has recounted how in these early years “we [started] from not being able to identify ova” just as Lu has recalled, “I didn’t know what the eggs looked like at that time.” As a result, there was a lot of trial and error involved. For Lu, this involved countless trips throughout Changsha to hospitals that carried out surgery for the treatment of gynecological disease to ask for assistance in getting oocytes:
Egg retrieval had been done in Xiangya hospital; however, as they didn’t support our work, and I was refused permission to go into the surgery room I had to go to other hospitals for eggs. I sometimes rode a bicycle and carried a bucket as I visited many hospitals in Changsha. But I had little chance to get eggs, since sometimes we couldn’t find follicles in ovarian tissues. Besides, it was also very hard for me to recognize eggs, as human eggs were different from mouse eggs. That’s why I set up a sperm bank at that time, because I couldn’t tell whether the eggs were mature or immature when I got eggs, so I had to fertilize all the eggs [and see which were mature enough]. So I set up a sperm bank in order to fertilize the eggs once I got them. Without ovulation induction, it was very difficult at that time.
Zhang, on the other hand, was familiar with and had direct access to the departments at the Third Hospital that carried out routine open pelvic surgery for a variety of conditions. Yet, she would also have trouble finding willing patients, and when she did there were numerous practical challenges related to timing operations such that they coincided with ovulation. Without a sperm bank of her own in Beijing, Zhang relied on the husbands of her infertile patients to provide sperm samples, not all of whom agreed to do so. Moreover, Zhang was initially hampered by not having seen a human egg before, having only microscopically observed pig and mouse eggs.
The early 1980s were truly experimental years for assisted reproduction in China. Those scientists who became interested in reproductive technologies had to devise ways of getting gametes in China, and were faced with at least as many (if not more) challenges in this as their colleagues anywhere else in the world.
EXPERIMENTING
Let us now take a closer look at how Zhang and Lu were able to lead their respective teams to achieve China’s first IVF births in 1988. Lu and her team had already secured the birth of the first baby using frozen donor sperm, but Lu and her father continued to pursue IVF research with the hopes of securing yet another first. Both Zhang and Lu were working under incredibly crude conditions and with meager resources, just as both had to negotiate the disapproval they were met with by some colleagues and officials, whether for moral or demographic reasons. Not surprisingly, both would enlist the help of others, nationally and internationally. And it was in partnership (together with He Cuihua from the Peking Union Medical College) that they would secure funding for their research from the National Natural Science Foundation in 1986.
When it came to both sperm and eggs, much of the first half of the 1980s was spent not just experimenting with cryopreservation and retrieval techniques, but also grappling with the harsh aftermath of the Cultural Revolution. This was a motif that ran through many of the interviews and discussions I had with those researchers who had been active in reproductive science during the 1980s and 1990s. Visiting China’s gridlocked metropolises today it can be easy to forget just how much cities like Beijing and Changsha have transformed over the last twenty-five years. Following the Cultural Revolution, which ended in 1976, many laboratories had become almost derelict and there were no reliable suppliers of laboratory equipment or chemical agents. The bicycle was still the most common form of urban transportation.
In recollections of the many difficulties they had faced, both Zhang and Lu convey a sense of pride and perhaps also nostalgia for the excitement of the times. When it came to freezing sperm for the first time in Changsha, Lu recalls:
We did not have any equipment to do this research. I also needed a protective agent for freezing the sperm and we knew that we could use egg to do that, but you have to pasteurize the egg at a temperature of about 56 degrees Celsius. But without any equipment—we only had an oven, which was in poor condition [laughter], so when I put the egg inside the oven to pasteurize it, after half an hour, the egg became a cake [laughter]. All the people laughed! And there was no freezing agent or liquid nitrogen either. During that time, we didn’t have any equipment; we hadn’t even seen a fridge before. But at the Dermatology Department in our hospital, they had a new laboratory and certain equipment to freeze the skin from the pig. The director was also very kind and offered that I could use his laboratory to do this research, so we went to the laboratory, myself and a male colleague. . . . They brought some liquid nitrogen into the laboratory to have the sperm frozen. But it was the first time for them to see the steam, they were afraid that maybe it will explode! [laughter]. . . . So they measured the temperature through the whole night, they just observed the temperature and they dared not to cover the tank with a lid, because they were afraid that if you cover it with the lid, it will explode. So for the whole night, they were just sitting there and observing all the things, also through the next day until the evening. They succeeded in freezing the sperm and were very happy at that time!
Figure 4. China’s first frozen sperm bank for humans, 1983. (Photo courtesy of Lu Guangxiu.)
Similarly, Zhang recalled how equipment shortages were a constant problem when she and her colleagues were trying to develop egg retrieval techniques:
We described the difficulties we faced as “poor and blank” (yiqiong erbai). Conditions were really poor. All equipment had to be used repeatedly. For example, there were only a few ova-retrieving needles, which were brought back from overseas. They had to be washed and high-pressure sanitized. Vessels had to be used again and again too, and then washed and high-pressure sanitized. At that time we had a lot of cases but there were no infections. This was very impressive and staff in our laboratory worked really hard. There were whorls at the very top of the needles . . . which made it easy to know where to penetrate. The whorls got worn down. We took the needles to watchmaker shops to sharpen them. After being sharpened and reused so many times, we had to throw them away, since the whorls could barely be seen anymore. The conditions really were poor at the time. (Zhang, Interview 3)
Since Zhang had not had experience with identifying oocytes, she allied herself with embryologist Liu Bin who had studied mammalian developmental biology in the 1970s in Belgium. It was in collaboration with Liu that Zhang would learn how to identify human eggs by watching and discussing one of the films Liu had brought back from Belgium showing how animal embryos developed, as well as by studying images of human oocytes published in international scientific journals, which were slowly becoming available in Beijing (Jiang, 2015, p. 15).
YOUSHENG—SUPERIOR BIRTHS
By 1984, Zhang had developed her own technique of egg retrieval, just as Lu had established China’s first sperm bank. Up to that point, the two had worked without much knowledge of each other’s work. That would change in late 1983 when an exhibition on “superior births” (yousheng)7 was organized by the Family Planning Department of the provincial government in Hunan Province. Participants at the exhibition discussed prenatal screening and both “negative” (abortion) and “positive” ways of improving population quality. Since preimplantation genetic diagnosis was a long way off at that stage, sperm banking was discussed as one possible method of improving population quality. A group of journalists who were attending the exhibition got wind that a sperm bank had in fact been established in Changsha:
They came here for an interview and then they sent out a report saying that in Hunan there is a sperm bank. This was kind of explosive news in China, because every newspaper carried this information and they kept reporting it. And suddenly we got very famous around China! [laughter] And we got hundreds of letters from patients and from other institutes. Although many people praised us, some people criticized us[;] . . . they thought we were treating people like animals, since we are just collecting sperm.
Shortly after news of Changsha’s sperm bank had broken nationally, Zhang Lizhu and Lu Guangxiu began communicating. Together with one of Zhang’s peers in Beijing, He Cuihua from the Peking Union Medical College (who had been introduced to assisted reproduction during a study trip to Singapore), the trio agreed to prepare an application for research funding, which would be sent to the Ministry of Health. After some discussion between them, they agreed to title their application “Yousheng: The Protection, Preservation, and Development of Early Embryos,” a decision that cannot be detached from the restrictive family planning measures that were being rolled out across China in this exact same period, as well as the growing interest in population quality on the part of family planning officials. As Zhang put it: “There were other voices at the time. Some people said: China already has such a huge population, why do you still want to work on test tube babies? They said this went against the national family planning policy” (Interview 3). Similarly, when I asked Lu about the apparent contradictions of carrying out IVF research in China in the 1980s, she replied, “There were many doctors and researchers who asked the same question as you did just now. Under this population policy we are doing this kind of technology, something that is contradictory.” As we saw earlier, Lu Guangxiu’s route to reproductive science had been through medical genetics. Her team at the Human Reproductive Engineering Research Department was as engaged in prenatal genetic testing as it was in IVF research. The medical genetic potentials of reproductive technologies had been at the very core of Lu Huilin’s and Lu Guangxiu’s early engagements with reproductive science. In the way that their research application was framed, reproductive technologies emerged as techniques that could contribute to the improvement of population quality in China (rather than infertility treatment as such), a demographic aim that was beginning to emerge alongside the controlling of population growth as a primary family planning objective (see Greenhalgh, 2008; Jiang, 2015).
Having witnessed the great difficulties that his daughter was facing in trying to get gametes and equipment for fertilization research, Lu Huilin decided in 1984 that she needed to travel outside China for more training. She recalls, “My father said that we can’t go on like this, so he told the university that I need to have some training in foreign countries.” Arrangements were made for Lu Guangxiu and her colleague Xu Lili to travel to Yale University, a long-time partner of the Xiangya Medical College, in 1985. Lu was charged with learning laboratory procedures such as sperm washing, determination of the level of maturity of an egg, culture medium preparation, and embryo morphology assessment, while Xu received training in clinical procedures such as control ovarian hyperstimulation and egg retrieval. Six months later, the pair returned to Changsha, bringing back with them as much equipment as they could carry, including electronic scales, an osmotic pressure tester, and even a bottle of ultrapure water. “I came back in 1986 and established a laboratory immediately with all the equipment. . . . Doctor Xu did egg retrieval here in Changsha. I had learned how to recognize eggs, but Doctor Xu was responsible for the surgery on egg retrieval while another group who were at the Xiangya Hospital did laparoscopy for egg retrieval, so we began the work in 1986.”
Now, one might be tempted to argue that clearly Lu Guangxiu, Zhang Lizhu, and He Cuihua received training and inspiration outside of China; hence perhaps this is after all a story of importing Western technologies into China. However, we know that, for example, Robert Edwards and Patrick Steptoe interacted with numerous international colleagues, and Steptoe traveled to France to learn laparoscopy from Raoul Palmer (Litynski, 1998), yet it is the United Kingdom that is most often credited as the “birthplace” of IVF. My point is that regardless of where they received training and where IVF was invented, Lu and Zhang had to experiment in order to develop it in China; they were not able to “skip” experimentation and merely set about routinizing IVF. Moreover, in setting out to develop reproductive technologies in China they were responding to local concerns arising out of the clinic (in Zhang’s case) as well as out of a growing interest in population quality on the part of government officials (in Lu’s case). As was the case with Edwards and Steptoe, Zhang and Lu built upon a range of already established procedures, technologies, and lab equipment that were circulating through global flows of technology and knowledge as they developed IVF in China.
It was also in 1986 that the “yousheng” research project received funding from the National Natural Science Foundation of China, which had been established under the auspices of the Four Modernizations program. The foundation awarded RMB 100,000 to be split between the three researchers and their laboratories. The amount was therefore hardly sufficient, although the recognition that came with being awarded such a grant was perhaps of even more importance, as theirs became a so-called key research project of the Seventh Five-Year Plan. Reproductive science had become a part of China’s overall modernization program, just as the race to produce China’s first IVF child was in effect on.
This time, Zhang won. After thirteen attempted cycles with different women, thirty-nine-year-old Zheng Guizhen from Gansu became pregnant and gave birth to Zheng Mengzu on March 10, 1988, in Beijing. “There were three hospitals at the time working on this. . . . We were the first to produce test tube babies” (Zhang, Interview 3). In a television program called Fendou aired on China’s CCTV network in August 2011, Zhang tells of her nerves on the scheduled day of Zheng Mengzu’s birth by caesarean section with the nation’s eyes fixed on her:
When the first test tube baby was born, there were a lot of reporters waiting outside the operating room. So when I was on the way to the operating room I didn’t really want to face them. I passed by with a blank face without even nodding at them, without a word, because I was worried. I was not worried about the operation. What I was worried about was the baby’s being born with some kind of malformation, such as a harelip. So this is what I was worrying about when I performed the surgery. Then I saw the baby and checked her whole body and she was totally fine, crying really loudly. I felt I could relax afterward. They said at this point I looked happy, with a little smile. So I really didn’t know how to cope with the media at the time. I should have talked to them a little bit, which I didn’t do at all. (Zhang, Interview 4)
It is telling that the health of Zheng Mengzu was foremost on Zhang’s mind. Since Zhang, Lu, and He had claimed that IVF was a technique that would contribute to “superior births,” it would have been a major setback had the child not been healthy.
Meanwhile, in Changsha, yet another race was playing out: Lu recalls, “We didn’t succeed for more than one year [after 1986], so I worried much about that. The country had spent so much money on my training and there were a lot of expectations on me from others, especially from my father. He was eighty-eight years old at that time, so I also hoped to succeed as soon as possible. However, I failed for over one year so that I felt a lot of pressure.” Changsha’s first IVF babies were finally born exactly three months after Zheng Mengzu in June of 1988. As it happened, two patients had had their eggs retrieved and fertilized around the same time in the second half of 1987. Once their eggs had been fertilized with their respective husbands’ sperm, one of the patients ended up with very poor quality embryos while the other patient ended up with leftover good-quality embryos. Since “there was no freezing equipment and technology, we usually had to abandon the spare embryos. Instead, we asked her [the woman who only had poor-quality embryos] if she would like to accept the other couple’s embryo, and she said yes. Actually she was the first one who got pregnant in our center. . . . We don’t know how we succeeded in the first one, maybe it’s because we had done this work for a certain time and had gained some experience. However, the success rate at that time was still very low and it was probably less than 5 percent.” And so, Zhang Minxing, Changsha’s first IVF baby (China’s second) was born on June 5, 1988, closely followed by Luo Youqun, China’s first embryo donation baby, on June 7, 1988. In all, a flurry of four IVF babies were born in 1988, two in Beijing and two in Changsha. Both Zhang and Lu had used open pelvic surgery to retrieve eggs in their first successful IVF cases. He Cuihua had used laparoscopic methods to try to obtain eggs and never did succeed in her quest for a “first” IVF baby at the Peking Union Medical College in the late 1980s.
LEGALIZATION—THE BIRTH OF “ONE CHILD” ART
