“perhaps the most important change during routinization is the change in who actually performs the [. . .] procedure” (1988, p. 476) once its novelty has worn off and standardized protocols have enabled a hierarchized division of laborious and repetitive tasks in hospitals and clinics. There is what I would call a “daily grind” to the emergence of any medical technology, and in the case of sperm banking in China this has involved donors, doctors, andrologists, laboratories, egg yolks, chemicals, cryotanks, regulations, paperwork, computers, medical files, money, recruiters, leaflets, patients, university campus dormitories, social media, and more. Buildings have to be maintained, cryotanks need to be procured, liquid nitrogen stocks have to be replenished, staff must commute to work, rosters have to be planned and monitored, workflows developed and managed, students recruited and screened, telephone calls made, accreditations maintained, straws of sperm shipped to clinics, activities assessed, and so forth. While this is true of any sperm bank, the particular ways in which these daily practices play out in different sperm banks are never the same, not least because of the reproductive complexes within which they operate. In China, a five-woman’s-pregnancies limit coupled with family planning policies have resulted in a unique style of sperm banking, which requires mass recruitment and appropriate logistics to achieve that. The largest sperm banks in China assess the sperm quality of up to 100 men per day, which profoundly shapes workflows, socialities, and donation processes.
Thirdly, and finally, for a medical technology to become routine it must also be a normalized part of daily life, in the sense that it is available to and used by its (un)intended users in a routine manner. As Gay Becker observed, “When a specific medical technology is no longer viewed by medicine as experimental, that technological innovation may be increasingly accepted by the public and may eventually be viewed as commonplace” (Becker, 2000, p. 13). New reproductive technologies have tended to go through variegated patterns of “acceptance”: starting from pioneering “breakthroughs,” surrounded or followed by a period of concern and resistance, then by normalization through regulation and eventually by routinization as particular procedures are scaled up and made available (Wahlberg & Gammeltoft, 2017). Today in China, artificial insemination with donor sperm (AID) from a sperm bank has become a realistic and accepted option, albeit for those involuntarily childless couples (where the man is azoospermic) who are able to afford it and who are willing to accept a wait of up to three years. As the cases that will be discussed in chapter 6 attest, engagement with donor sperm is not somehow restricted to a middle-class elite; rather, knowledge of it has become commonplace and a shadow black market exists not least because of China’s chronic donor sperm shortage. And although use of AID continues to be shrouded in secrecy—sperm banks operate according to strict “double-blind” principles that keep donor identity secret from both doctor and patients and vice versa, just as many patients insist on keeping their use of AID a secret from all but their most trusted relations—donor recruitment is an open practice on university campuses, sperm bank directors are regularly in local and national media appealing for more donors, and clinics have lengthy waiting lists for donor sperm. In short, as we will see, the pursuit of conception through ARTs including AID has become a “way of life” (Franklin, 1997) for the increasing numbers of couples in China who look to and can afford medical technology in their quests to overcome infertility (cf. Inhorn, 1994).
I propose to insist that sperm banking practices cannot be detached from the reproductive complexes within which routinization is unfolding. Sperm banking and AID are medical technologies that, like others, are constantly in the making, and as such we must, as scholars, relentlessly attend to the productive and often unintended effects of their making. Through my assemblage ethnography I have set out to identify the contours of the configurations that allow for sperm banking in China today (chapters 1, 2, and 3), to track the “daily grind” practices that constitute it (chapters 4 and 5), and to examine how sperm banking comes to be used in the treatment of infertility (chapter 6). This requires attendance to the styles of knowing and rationalities of governing that shape and are shaped by regimes of reproductive practice on the ground, in the clinics and laboratories currently developing and scaling up individual techniques, from IVF to AID. Hence, akin to the analytical work that has been done around the emergence of particular “styles of thought” in biomedical science (Fleck, 1979), my central argument in this book is that—as the cryopreservation and insemination of third-party sperm have come to be translated into routinized medical practice over the last thirty years—a certain style of sperm banking has emerged in China that is unique because of the ways in which it has been shaped by the particular cultural, juridical, economic, and social configurations that make up China’s restrictive reproductive complex.
In making this argument, I want to mobilize Ludwik Fleck’s insights into how thought collectives can form in biomedical research settings. However, the sciences of sperm cryopreservation and artificial insemination have long since been translated into the medical technology of sperm banking–AID in China and elsewhere. Sperm banking is a routinized medical technology and as such the primary task of the sperm bank is to deliver quality-assured donor sperm to fertility clinics that provide regular AID treatment to couples living with male-factor infertility. And so rather than a thought collective, I will show how the sperm bank in Changsha (and in other cities) is better conceived of as a practice collective within which we find routinized and protocolled daily procedures as well as socialities of lab workers, nurses, recruiters, doctors, donors, and administrators. Fleck argued that “like any style, the thought style also consists of a certain mood and of the performance by which it is realised” (1979, p. 99), and indeed in what follows we will gain insights into the mood and performance within the practice collectives that make up sperm banking in China today.10 For, while each sperm bank in China can be analyzed as a practice collective in its own right, I will show that there are commonalities linking each of these practice collectives in China together to the extent that it makes sense to talk about a specific cyclic and high throughput style of sperm banking. This style of sperm banking manifests itself in the ways in which daily routines are organized around tasks of recruitment, screening, semen analysis, record-keeping, cryopreservation, and distribution, which, in turn, shape the ways in which donor sperm is made available to and accessed by certain bureaucratically circumscribed infertile couples who can afford AID cycles in China.
In carrying out the research for this book, I have been guided by two overarching analytical and methodological objectives. Firstly, I have wanted to broaden the empirical scope of social studies of sperm banking beyond America and Europe. Research from this part of the world has often pointed to and been critical of an ongoing commodification of the body and its substances. In a global reproductive bioeconomy, gamete procurement, fertilization, implantation, gestation, termination, and birth have each become specialized fields of laboratory-clinic practice. Rene Almeling and others have shown how “the practice of clinically transferring eggs and sperm from body to body is now part of a multi-billion-dollar market” in countries like the United States and Denmark (Almeling, 2011, p. 2; see also Adrian, 2010; Kroløkke, 2009; Mamo, 2005; Martin, 2017; Mohr, 2016; Moore, 2008; Tober, 2001; Waldby et al., 2013), a market that is but one subfield within ever expanding exchanges of human biological material—from organs to blood, bone, and cadavers—across the globe (Hoeyer, 2013; Scheper-Hughes, 2000). Sperm banks, egg agencies, and commercial fertility clinics recruit and screen donors, pay for their eggs and sperm, and market extended profiles of “super donors” to infertile couples, single women, as well as gay and lesbian couples who can “click-a-donor” as they shop around. What we have yet to see, however, are social studies focusing on the development and routinization of sperm banking outside of a Western setting.
In the following chapters, I will argue that while ARTs in general and sperm banking in particular are certainly being commercialized in China today (they are seriously big business); alongside health care in general, the analytical traction that commodification provides in accounting for the daily routines of sperm banking in China is limited (cf. Hoeyer, 2007). First of all, Ministry of Health guidelines in China specify that “it is prohibited to market sperm [which] shall not be treated as a commodity in market transaction” (MoH, 2003b, p. F3), even if a case can be made that it to some extent is, not least
