Making

muslim

babies

Ivf

and

gamete

donation

in

sunni

versus

shi'a

islam

Medical

anthropological

research

on

science

biotechnology

and

religion

has

focused

on

the

local

moral

worlds

of

men

and

women

as

they

make

difficult

decisions

regarding

their

health

and

the

beginnings

and

endings

of

human

life

This

paper

focuses

on

the

local

moral

worlds

of

infertile

Muslims

as

they

attempt

to

make

in

the

religiously

correct

fashion

Muslim

babies

at

in

vitro

fertilization

-LRB-

IVF

-RRB-

clinics

in

Egypt

and

Lebanon

As

early

as

authoritative

fatwas

issued

from

Egypt

's

famed

Al-Azhar

University

suggested

that

IVF

and

similar

technologies

are

permissible

as

long

as

they

do

not

involve

any

form

of

third-party

donation

-LRB-

of

sperm

eggs

embryos

or

uteruses

-RRB-

Since

the

late

however

divergences

in

opinion

over

third-party

gamete

donation

have

occurred

between

Sunni

and

Shi'ite

Muslims

with

Iran

's

leading

ayatollah

permitting

gamete

donation

under

certain

conditions

This

Iranian

fatwa

has

had

profound

implications

for

the

country

of

Lebanon

where

a

Shi'ite

majority

also

seeks

IVF

services

Based

on

three

periods

of

ethnographic

research

in

Egyptian

and

Lebanese

IVF

clinics

this

paper

explores

official

and

unofficial

religious

discourses

surrounding

the

practice

of

IVF

and

third-party

donation

in

the

Muslim

world

as

well

as

the

gender

implications

of

gamete

donation

for

Muslim

marriages

Introduction

Medical

anthropology

and

science

and

technology

studies

In

recent

years

medical

anthropologists

have

been

turning

their

ethnographic

attention

to

issues

of

science

and

technology

including

how

science

is

produced

where

it

is

produced

by

whom

and

when

Anthropologists

have

also

highlighted

how

scientific

and

technological

advancements

spread

around

the

world

gradually

being

incorporated

into

the

lives

of

ordinary

people

in

many

global

sites

In

order

to

document

the

production

and

reproduction

of

new

scientific

and

technological

discoveries

medical

anthropologists

have

begun

to

take

their

ethnographic

research

projects

into

previously

unexplored

terrains

including

hospitals

scientific

research

laboratories

clinical

consultation

rooms

and

other

behind

the

scenes

places

where

the

culture

of

science

and

technology

is

perhaps

best

revealed

Furthermore

most

of

the

medical

anthropologists

working

in

this

field

have

documented

the

ways

in

which

the

scientific

and

the

divine

seem

to

have

intermingled

not

only

among

the

patients

who

turn

to

religious

theodicies

to

make

sense

of

their

suffering

but

also

among

the

scientists

and

clinicians

who

deliver

medical

services

and

attempt

to

offer

patients

hope

These

recent

medical

anthropological

efforts

to

document

the

intersections

of

science

technology

and

religion

are

clearly

reflected

in

the

theme

of

the

annual

meeting

of

the

American

Anthropological

Association

Magic

Science

and

Religion

Furthermore

this

special

issue

of

Culture

Medicine

and

Psychiatry

reflects

the

ongoing

importance

of

religion

to

science

medicine

and

biotechnology

including

in

the

Muslim

world

Medical

anthropology

has

much

to

offer

to

discussions

of

science

medicine

and

religion

as

demonstrated

in

a

number

of

award-winning

books

on

these

subjects

To

take

but

a

few

recent

examples

in

Testing

Women

Testing

the

Fetus

The

Social

Impact

of

Amniocentesis

in

America

medical

anthropologist

Rayna

Rapp

-LRB-

-RRB-

reveals

the

efforts

of

more

than

ten

years

worth

of

extensive

ethnographic

research

conducted

at

New

York

City

hospitals

genetic

counseling

and

testing

centers

and

genetics

laboratories

themselves

Her

book

focuses

on

the

difficult

decision-making

of

pregnant

women

from

multiple

ethnic

religious

and

economic

backgrounds

who

are

asked

by

clinicians

and

advised

by

genetic

counselors

to

undergo

amniocentesis

in

order

to

detect

genetic

anomalies

in

their

fetuses

Although

the

scientific

field

of

genetics

is

burgeoning

with

excitement

Rapp

's

intent

in

Testing

Women

Testing

the

Fetus

is

to

show

how

women

who

are

expected

to

use

new

genetic

tests

during

pregnancy

are

put

in

the

difficult

position

of

being

moral

pioneers

namely

they

are

forced

to

make

often

heart-wrenching

moral

decisions

about

what

constitutes

an

acceptable

human

life

Whereas

Rapp

's

book

focuses

on

decisions

about

bringing

life

into

the

world

a

book

by

medical

anthropologist

Margaret

Lock

asks

us

to

consider

decisions

about

ending

lives

considered

brain

dead

Twice

Dead

Organ

Transplants

and

the

Reinvention

of

Death

Lock

's

-LRB-

-RRB-

ethnography

examines

the

history

of

organ

transplantation

in

North

America

over

the

past

years

Scientific

advancements

in

transplant

technology

have

made

it

possible

for

North

American

surgeons

to

perform

thousands

of

transplants

each

year

In

the

majority

of

these

cases

individuals

diagnosed

as

brain

dead

are

the

source

of

the

organs

without

which

transplants

could

not

take

place

Lock

asks

her

readers

to

consider

what

is

meant

by

brain

death

and

how

it

might

be

viewed

differently

in

another

culture

namely

Japan

Despite

the

availability

of

the

necessary

technology

and

expertise

Japanese

society

has

not

accepted

the

notion

of

brain

death

as

a

sufficient

criterion

of

death

following

a

well-informed

but

heated

public

debate

on

the

topic

Although

brain

death

was

legally

recognized

in

Japan

in

it

is

authorized

only

in

limited

circumstances

meaning

that

organ

transplantation

in

Japan

is

not

widespread

Drawing

on

extensive

interviews

conducted

over

ten

years

with

Intensive

Care

Unit

-LRB-

ICU

-RRB-

physicians

transplant

surgeons

organ

recipients

donor

families

Japanese

political

activists

opposed

to

the

recognition

of

brain

death

and

members

of

the

general

public

in

both

Japan

and

North

America

Lock

shows

us

that

death

itself

is

not

a

self-evident

biological

event

Rather

it

is

surrounded

by

morally

troubling

cultural

medical

legal

and

political

dimensions

Lock

's

book

clearly

demonstrates

the

degree

to

which

medical

anthropology

is

concerned

with

comparative

cultural

perspectives

particularly

in

an

era

of

rapid

globalization

Indeed

medical

anthropology

as

a

discipline

can

be

said

to

focus

on

the

local

in

the

global

In

other

words

local

considerations

be

they

cultural

social

economic

or

political

shape

and

sometimes

curtail

the

way

that

Western-generated

scientific

technologies

are

both

offered

to

and

received

by

non-Western

subjects

New

forms

of

science

and

technology

are

not

transferred

into

cultural

voids

when

they

reach

places

like

Japan

Thus

the

assumption

on

the

part

of

global

producer

nations

that

new

biotechnologies

as

value-free

inherently

beneficial

medical

technologies

are

immune

to

culture

and

can

thus

be

appropriately

transferred

and

implemented

anywhere

and

everywhere

is

subject

to

challenge

once

local

formulations

perceptions

and

actual

consumption

of

these

technologies

are

taken

into

consideration

-LRB-

Inhorn

-RRB-

Indeed

the

global

spread

of

biotechnologies

provides

a

particularly

salient

but

little

discussed

example

of

what

anthropologist

Arjun

Appadurai

-LRB-

-RRB-

has

termed

a

technoscape

or

the

global

configuration

also

ever

fluid

of

technology

and

the

fact

that

technology

both

high

and

low

both

mechanical

and

informational

now

moves

at

high

speeds

across

various

kinds

of

previously

impervious

boundaries

Appadurai

reminds

us

that

this

movement

of

technologies

around

the

globe

is

both

a

deeply

historical

and

an

inherently

localizing

process

In

other

words

globalization

is

not

enacted

in

a

uniform

manner

around

the

world

nor

is

it

simply

culturally

homogenizing

necessarily

Westernizing

or

even

Americanizing

in

its

effects

The

global

is

always

imbued

with

local

meaning

such

that

local

actors

living

their

everyday

lives

at

particular

historical

moments

in

particular

places

mold

the

very

form

that

global

processes

take

-LRB-

Freeman

-RRB-

This

acknowledgment

of

the

importance

of

locality

in

the

global

dispersion

of

modern

biotechnologies

has

been

a

theme

of

much

recent

work

in

medical

anthropology

Similarly

much

of

this

anthropological

concern

with

locality

has

to

do

with

local

moral

systems

or

what

medical

anthropologist/psychiatrist

Arthur

Kleinman

-LRB-

-RRB-

has

called

local

moral

worlds

of

pain

and

suffering

According

to

Kleinman

-LRB-

-RRB-

local

moral

worlds

are

moral

accounts

-LSB-

which

-RSB-

are

the

commitments

of

social

participants

in

a

local

world

about

what

is

at

stake

in

everyday

experience

Through

an

ethnography

of

experience

Kleinman

urges

medical

anthropologists

to

pay

close

attention

to

the

moral

issues

that

may

accompany

the

arrival

of

new

biotechnologies

around

the

globe

In

his

recent

powerful

and

path-breaking

book

What

Really

Matters

Living

a

Moral

Life

amidst

Uncertainty

and

Danger

Kleinman

-LRB-

-RRB-

asks

us

to

carefully

consider

what

it

really

means

to

live

a

moral

life

particularly

in

the

midst

of

life-or-death

decision-making

This

focus

on

the

local

moral

is

found

in

another

award-winning

book

on

the

topic

of

IVF

Titled

Reproducing

Jews

A

Cultural

Account

of

Assisted

Conception

in

Israel

this

book

by

medical

anthropologist

Susan

Martha

Kahn

-LRB-

see

also

her

article

in

this

special

issue

-RRB-

takes

us

into

the

often

arcane

world

of

Jewish

Halakhic

law

where

male

rabbis

legislate

on

the

appropriate

uses

of

IVF

for

their

followers

Kahn

carefully

describes

how

these

rabbinical

debates

and

decisions

affect

the

actual

practice

of

Israeli

IVF

For

example

third-party

donation

of

gametes

including

sperm

donation

is

allowed

since

Jewishness

is

seen

to

be

conferred

through

the

mother

's

side

particularly

through

the

act

of

gestating

and

birthing

the

baby

However

most

conservative

rabbis

prefer

that

non-Jewish

donor

sperm

be

used

to

prevent

adultery

between

a

Jewish

man

and

a

Jewish

woman

and

to

prevent

future

genetic

incest

among

the

offspring

of

anonymous

donors

in

this

small

intermarrying

country

Furthermore

debates

have

revolved

around

whether

surrogacy

should

be

allowed

for

infertile

couples

using

single

or

married

surrogates

Generally

speaking

single

Jewish

women

are

preferred

as

surrogates

both

to

avoid

the

implications

of

adultery

for

married

surrogate

women

and

to

confer

Jewishness

through

a

Jewish

woman

's

gestation

of

the

fetus

Finally

because

the

Jewish

state

is

pronatalist

with

the

state

subsidizing

up

to

six

cycles

of

IVF

or

up

to

the

birth

of

two

IVF

children

for

any

given

Jewish

patient

rabbis

have

generally

been

permissive

when

it

comes

to

single

career

women

as

well

as

lesbian

Jewish

mothers

conceiving

children

through

assisted

conceptive

means

Kahn

's

fascinating

and

frankly

funny

book

details

the

sometimes

dizzying

rabbinical

arguments

regarding

morally

appropriate

and

inappropriate

reproduction

In

so

doing

the

book

bespeaks

the

importance

of

local

religious

moralities

in

the

contemporary

world

of

Israeli

assisted

conception

There

doctors

in

many

clinics

serving

orthodox

Jewish

patient

populations

attempt

to

practice

IVF

according

to

the

moral

dictates

set

forth

by

religiously

conservative

rabbis

The

IVF

laboratories

in

these

clinics

are

full

of

orthodox

women

called

maschigots

who

literally

peer

over

the

shoulders

of

laboratory

technicians

to

make

sure

that

the

correct

sperm

and

correct

eggs

are

being

united

so

as

not

to

produce

a

mamzer

or

an

illegitimate

child

In

her

book

Kahn

is

explicit

in

stating

that

the

American

consumer

model

of

free-market

reproductive

medicine

has

yet

to

take

hold

in

Israel

with

its

concern

over

religious

guidelines

Nonetheless

Israel

's

relative

permissiveness

over

the

use

of

donor

gametes

surrogacy

and

single

and

lesbian

motherhood

stands

in

stark

contrast

to

the

Muslim

Middle

East

including

both

neighboring

Egypt

and

Lebanon

where

I

have

conducted

my

own

ethnographic

research

on

IVF

Ivf

in

the

muslim

middle

east

With

this

background

in

mind

it

is

my

goal

in

this

article

to

take

readers

into

the

heart

of

the

Muslim

Middle

East

thereby

showing

how

the

practice

of

IVF

in

Israel

the

country

located

between

Egypt

and

Lebanon

differs

significantly

from

that

in

both

of

its

Muslim

neighbors

During

more

than

two

years

of

medical

anthropological

fieldwork

in

Egypt

-LRB-

-RRB-

and

Lebanon

-LRB-

-RRB-

I

conducted

in-depth

ethnographic

interviews

with

infertile

Muslim

IVF

patients

both

husbands

and

wives

now

totaling

nearly

patient

couples

Furthermore

since

the

I

have

focused

my

research

on

the

rapid

expansion

of

IVF

technologies

into

this

region

of

the

Muslim

world

Indeed

it

is

fair

to

assert

that

since

the

birth

in

of

Louise

Brown

the

world

's

first

test-tube

baby

IVF

has

spread

around

the

globe

reaching

countries

far

from

the

technology-producing

nations

of

the

West

Perhaps

nowhere

is

this

globalization

process

more

evident

than

in

the

nations

of

the

Muslim

Middle

East

where

a

private

IVF

industry

is

flourishing

As

of

Egypt

alone

-LRB-

population

million

-RRB-

boasted

IVF

centers

and

the

tiny

country

of

Lebanon

-LRB-

population

million

-RRB-

boasted

more

than

IVF

centers

one

of

the

highest

per

capita

concentrations

in

the

world

These

global

metrics

are

impressive

compared

to

the

IVF

technology-producing

nation

of

Israel

where

IVF

centers

cater

to

a

population

of

million

-LRB-

Kahn

-RRB-

In

both

Egypt

and

Lebanon

as

in

other

Muslim

countries

nonbinding

but

authoritative

Islamic

religious

proclamations

called

fatwas

have

profoundly

affected

the

practice

of

IVF

in

ways

that

are

not

commonly

seen

in

the

West

Indeed

in

the

Muslim

world

infertile

couples

are

usually

extremely

concerned

about

making

their

test-tube

babies

in

the

religiously

correct

fashion

To

that

end

they

seek

out

the

official

Islamic

opinion

on

the

practice

of

IVF

in

the

form

of

a

fatwa

In

recent

years

many

such

fatwas

on

a

wide

variety

of

reproductive

health

issues

have

been

issued

in

Egypt

and

other

Muslim

countries

-LRB-

Lane

and

Rubinstein

Zuhur

-RRB-

But

as

we

shall

see

in

this

paper

major

divergences

have

occurred

between

Sunni

and

Shi'ite

religious

authorities

regarding

the

permissibility

of

third-party

gamete

donation

with

new

fatwas

emerging

from

the

Shi'ite

world

in

recent

years

It

is

the

differences

between

Sunni

and

Shi'a

Islam

with

regard

to

third-party

gamete

donation

that

constitute

the

focus

of

this

article

Sunni

Islam

and

IVF

IVF

was

first

practiced

in

the

Sunni

Muslim

world

with

clinics

opening

in

the

in

Egypt

Saudi

Arabia

and

Jordan

all

Sunni-majority

countries

The

Grand

Shaikh

of

Egypt

's

famed

religious

university

Al

Azhar

issued

the

first

widely

authoritative

fatwa

on

medically

assisted

reproduction

on

March

This

fatwa

issued

only

two

years

after

the

birth

of

the

first

IVF

baby

in

England

but

a

full

six

years

before

the

opening

of

Egypt

's

first

IVF

center

has

proved

to

be

truly

enduring

in

all

its

main

points

-LRB-

Inhorn

-RRB-

In

fact

the

basic

tenets

of

the

original

Al-Azhar

fatwa

on

IVF

have

been

upheld

by

other

fatwas

issued

since

and

have

achieved

wide

acceptance

throughout

the

Sunni

Muslim

world

Sunni

Islam

it

must

be

emphasized

is

the

dominant

form

of

Islam

found

in

the

Middle

Eastern

region

and

throughout

the

Muslim

world

Between

and

percent

of

the

world

's

Muslims

are

Sunni

and

more

than

percent

of

Egypt

's

citizens

are

Sunni

Muslims

the

rest

being

predominantly

Coptic

Christian

The

degree

to

which

these

official

Sunni

Islamic

fatwas

on

IVF

have

affected

the

actual

practices

of

the

Middle

Eastern

medical

profession

is

also

quite

striking

For

physicians

the

dominant

Sunni

religious

opinion

on

IVF

has

been

made

known

to

the

Middle

Eastern

medical

community

through

the

writings

of

Gamal

I.

Serour

one

of

three

founding

members

of

the

first

Egyptian

IVF

center

and

the

director

of

Al-Azhar

's

International

Islamic

Center

for

Population

Studies

and

Research

In

article

after

article

-LRB-

Serour

Serour

and

Omran

Serour

El

Ghar

and

Mansour

Serour

Aboulghar

and

Mansour

-RRB-

Serour

has

spelled

out

the

main

points

of

the

Sunni

Islamic

position

on

medically

assisted

conception

as

follows

Artificial

insemination

with

the

husband

ssemen

is

allowed

and

the

resulting

child

is

the

legal

offspring

of

the

couple.In

vitro

fertilization

of

an

egg

from

the

wife

with

the

sperm

of

her

husband

followed

by

the

transfer

of

the

fertilized

embryo

-LRB-

s

-RRB-

back

to

the

uterus

of

the

wife

is

allowed

provided

that

the

procedure

is

indicated

for

a

medical

reason

and

is

carried

out

by

an

expert

physician.No

third

party

should

intrude

into

the

marital

functions

of

sex

and

procreation

because

marriage

is

a

contract

between

the

wife

and

husband

during

the

span

of

their

marriage

This

means

that

a

third

party

donor

is

not

allowed

whether

he

or

she

is

providing

sperm

eggs

embryos

or

a

uterus

The

use

of

a

third

party

is

tantamount

to

zina

or

adultery.Adoption

of

a

donor

child

from

an

illegitimate

form

of

medically

assisted

conception

is

not

allowed

The

child

who

results

from

a

forbidden

method

belongs

to

the

mother

who

delivered

him/her

He

or

she

is

considered

to

be

a

laqit

or

an

illegitimate

child.If

the

marriage

contract

has

come

to

an

end

because

of

divorce

or

death

of

the

husband

medically

assisted

conception

can

not

be

performed

on

the

ex-wife

even

if

the

sperm

comes

from

the

former

husband.An

excess

number

of

fertilized

embryos

can

be

preserved

by

cryopreservation

The

frozen

embryos

are

the

property

of

the

couple

alone

and

may

be

transferred

to

the

same

wife

in

a

successive

cycle

but

only

during

the

duration

of

the

marriage

contract.Multifetal

pregnancy

reduction

-LRB-

or

so-called

selective

abortion

-RRB-

is

only

allowed

if

the

prospect

of

carrying

a

high-order

pregnancy

-LRB-

i.e.

twins

triplets

or

more

-RRB-

to

viability

is

very

small

It

is

also

allowed

if

the

health

or

life

of

the

mother

is

in

jeopardy.All

forms

of

surrogacy

are

forbidden.Establishment

of

sperm

banks

is

strictly

forbidden

for

such

a

practice

threatens

the

existence

of

the

family

and

the

race

and

should

be

prevented.The

physician

is

the

only

qualified

person

to

practice

medically

assisted

conception

in

all

its

permitted

varieties

If

he

performs

any

of

the

forbidden

techniques

he

is

guilty

his

earnings

are

forbidden

and

he

must

be

stopped

from

his

morally

illicit

practice

But

to

what

degree

are

these

fatwa

declarations

particularly

the

explicit

prohibition

on

any

form

of

third-party

donation

of

reproductive

materials

actually

followed

by

physicians

in

the

Muslim

world

A

global

survey

of

sperm

donation

among

assisted

reproductive

technology

centers

in

countries

provides

some

indication

of

the

degree

of

convergence

between

official

discourse

and

actual

practice

-LRB-

Meirow

and

Schenker

-RRB-

In

all

of

the

Muslim

countries

surveyed

in

the

including

the

Middle

Eastern

countries

of

Egypt

Iran

Kuwait

Jordan

Lebanon

Morocco

Qatar

and

Turkey

as

well

as

a

number

of

non-Middle

Eastern

Muslim

countries

including

Indonesia

Malaysia

and

Pakistan

sperm

donation

in

IVF

and

all

other

forms

of

gamete

donation

were

strictly

prohibited

As

the

authors

of

this

global

survey

Meirow

and

Schenker

-LRB-

-RRB-

state

In

many

Islamic

countries

where

the

laws

of

Islam

are

the

laws

of

the

state

donation

of

sperm

was

not

practiced

AID

-LSB-

Artificial

Insemination

Donor

-RSB-

is

considered

adultery

and

leads

to

confusion

regarding

the

lines

of

genealogy

whose

purity

is

of

prime

importance

in

Islam

-LRB-

-RRB-

In

summary

in

the

Sunni-majority

countries

of

the

Middle

East

and

the

rest

of

the

Sunni

Muslim

world

prohibitions

against

gamete

donation

have

been

enacted

either

in

law

or

in

professional

medical

codes

of

ethics

As

a

result

gamete

donation

is

not

legally

practiced

in

the

Sunni

Muslim

world

with

clinics

turning

away

-LRB-

or

referring

to

other

European

countries

-RRB-

couples

who

require

these

services

In

Sunni

Muslim

countries

such

as

Egypt

the

thought

of

using

donor

gametes

is

reprehensible

to

most

infertile

Muslim

-LRB-

and

even

Christian

-RRB-

couples

who

agree

completely

with

the

bans

on

third-party

donation

dictated

by

the

religion

and

upheld

through

medical

codes

of

ethics

-LRB-

Inhorn

-RRB-

As

shown

in

the

next

section

however

the

situation

is

changing

for

Shi'ite

Muslims

whose

leading

cleric

has

taken

a

bold

step

in

a

new

direction

Shi'a

Islam

and

IVF

For

Shi'ite

Muslims

attitudes

toward

gamete

donation

have

changed

considerably

since

the

late

Shi'a

is

the

minority

branch

of

Islam

found

in

Iran

parts

of

Iraq

Lebanon

Bahrain

Syria

and

Saudi

Arabia

as

well

as

Afghanistan

Pakistan

and

India

It

has

been

much

in

the

news

lately

because

of

the

United

States

led

war

in

Iraq

the

conflict

between

Lebanon

and

Israel

and

the

current

tensions

between

the

United

States

and

Iran

Until

recently

most

Shi'ite

religious

authorities

have

supported

the

majority

Sunni

view

namely

they

have

agreed

with

Sunni

clerics

who

say

that

third-party

donation

should

be

strictly

prohibited

In

the

late

however

the

Supreme

Jurisprudent

of

the

Shi'a

branch

of

Islam

Ayatollah

Ali

Hussein

Khamanei

the

handpicked

successor

to

Iran

's

Ayatollah

Khomeini

issued

a

fatwa

effectively

permitting

donor

technologies

to

be

used

This

fatwa

has

proved

to

be

very

significant

for

those

Shi'a

who

follow

the

lead

of

Ayatollah

Khamanei

in

Iran

This

would

include

Lebanon

's

Hizbullah

leaders

who

consider

Ayatollah

Khamanei

to

be

their

marja

taqlid

or

spiritual

reference

-LRB-

literally

source

of

emulation

-RRB-

With

regard

to

egg

donation

Ayatollah

Khamanei

stated

in

his

initial

fatwa

that

egg

donation

is

not

in

and

of

itself

legally

forbidden

But

he

stated

that

both

the

egg

donor

and

the

infertile

mother

must

abide

by

the

religious

codes

regarding

parenting

Thus

the

child

of

the

egg

donor

has

the

right

to

inherit

from

her

as

the

infertile

woman

who

received

the

eggs

is

considered

to

be

like

an

adoptive

mother

With

regard

to

sperm

donation

Ayatollah

Khamanei

said

in

his

original

fatwa

that

the

baby

born

of

sperm

donation

will

follow

the

name

of

the

infertile

father

rather

than

the

sperm

donor

However

as

with

egg

donation

the

donor

child

can

only

inherit

from

his

biological

father

the

sperm

donor

since

the

infertile

father

is

considered

to

be

like

an

adoptive

father

The

situation

for

Shi'ite

Muslims

is

actually

much

more

complicated

than

this

however

given

two

Shi'ite

religious

practices

called

ijtihad

and

mutca

Unlike

Sunni

Muslim

scholars

who

are

scripturally

based

in

their

thinking

Shi'ite

religious

authorities

give

precedence

to

a

form

of

individual

religious

reasoning

known

as

ijtihad

Through

the

use

of

caql

or

intellectual

reasoning

various

Shi'ite

ulama

have

come

to

their

own

conclusions

regarding

the

rightness

or

wrongness

of

gamete

donation

Some

Shi'ite

clerics

continue

to

prohibit

gamete

donation

for

their

followers

while

others

have

allowed

it

under

certain

conditions

As

many

scholars

of

Shi'a

have

noted

-LRB-

Cole

Tober

-RRB-

the

practice

of

ijtihad

has

allowed

a

certain

flexibility

and

pragmatism

toward

new

technological

developments

including

IVF

and

a

number

of

other

new

medical

technologies

-LRB-

e.g.

contraception

organ

transplants

transgender

surgery

-RRB-

Furthermore

ijtihad

has

ultimately

led

to

great

heterogeneity

of

opinion

and

practice

within

the

Shi'ite

community

Additionally

Shi'a

Islam

allows

a

form

of

temporary

marriage

called

mutca

-LRB-

also

called

sigheh

in

Iran

-RRB-

which

is

not

recognized

by

Sunni

religious

authorities

-LRB-

Zuhur

-RRB-

In

Shi'a

Islam

mutca

is

a

union

between

an

unmarried

Muslim

woman

and

a

married

or

unmarried

Muslim

man

which

is

contracted

for

a

fixed

time

period

in

return

for

a

set

amount

of

money

It

is

practiced

in

Iran

-LRB-

Haeri

-RRB-

as

well

as

in

other

parts

of

the

Shi'ite

world

In

the

past

middle-aged

and

older

women

who

were

divorced

or

widowed

often

engaged

in

mutca

marriages

for

financial

support

In

Iran

following

the

loss

of

men

during

the

devastating

eight-year

Iran

Iraq

war

former

Iranian

President

Rafsanjani

recommended

mutca

as

a

means

of

protecting

the

large

numbers

of

single

or

widowed

women

who

had

no

other

source

of

income

For

Shi'ite

men

mutca

marriages

could

be

contracted

while

traveling

or

as

a

way

of

achieving

marital

variety

and

sexual

pleasure

-LRB-

Haeri

-RRB-

Since

the

arrival

of

donor

technologies

however

mutca

has

also

been

invoked

to

make

egg

donation

legal

within

the

parameters

of

marriage

Within

this

context

of

ijtihad

and

mutca

Shi'a

religious

authorities

who

now

accept

the

idea

of

donation

but

are

strict

in

their

interpretation

of

how

donation

should

be

practiced

argue

that

when

a

couple

needs

a

donor

they

should

go

to

a

Shi'ite

religious

court

where

a

decision

can

be

made

on

a

case-by-case

basis

there

should

be

a

determination

about

which

religious

reference

-LRB-

i.e.

source

of

spiritual

emulation

-RRB-

the

infertile

couple

follows

the

decision

should

be

made

in

the

presence

of

witnesses

the

IVF

doctor

and

with

the

agreement

of

both

parties

-LRB-

the

infertile

couple

and

the

donor

-RRB-

the

husband

should

do

a

mutca

marriage

with

the

egg

donor

for

the

period

of

time

in

which

the

whole

procedure

-LRB-

egg

retrieval

to

embryo

transfer

-RRB-

is

taking

place

because

polygyny

is

legal

in

Islam

and

avoids

the

implications

of

zina

or

adultery

but

because

a

married

Shi'ite

Muslim

woman

can

not

marry

another

man

other

than

her

husband

-LRB-

since

polyandry

is

illegal

in

Islam

-RRB-

she

can

not

do

a

mutca

marriage

with

a

sperm

donor

Technically

the

child

born

of

a

sperm

donor

would

be

a

laqit

or

out-of-wedlock

child

without

a

family

name

and

without

a

father

Thus

in

theory

only

widowed

or

otherwise

single

women

should

be

able

to

accept

donor

sperm

in

order

to

avoid

the

implications

of

zina

However

in

the

Muslim

countries

single

motherhood

of

a

donor

child

is

unlikely

to

be

socially

acceptable

-LRB-

Inhorn

Zuhur

-RRB-

Be

that

as

it

may

divergent

gamete

donation

practices

are

beginning

to

emerge

in

the

Shi'ite

Muslim

world

as

religious

authorities

come

to

their

own

conclusions

about

third-party

donation

Among

Shi'ite

religious

scholars

the

major

disagreements

or

religious

sticking

points

revolve

around

the

following

set

of

issues

whether

sperm

donation

should

be

allowed

at

all

whether

the

child

should

follow

the

name

of

the

infertile

father

or

the

sperm

donor

whether

the

child

should

inherit

from

the

infertile

father

or

the

sperm

donor

whether

donor

children

and

their

social

parents

are

related

at

all

and

if

not

whether

they

could

potentially

marry

each

other

which

has

implications

for

proper

comportment

in

domestic

life

-LRB-

e.g.

bathing

veiling

etc.

-RRB-

donation

is

permissible

at

all

if

the

donors

are

anonymous

whether

a

financial

transaction

should

be

allowed

between

gamete

donors

and

recipients

whether

the

husband

of

an

infertile

woman

needs

to

do

a

temporary

mutca

marriage

with

the

egg

donor

then

divorce

her

after

the

embryo

transfer

-LRB-

to

hours

later

-RRB-

in

order

to

avoid

zina

For

his

part

Khamanei

clearly

stipulates

that

mutca

marriage

is

not

required

for

he

believes

that

zina

requires

the

physical

act

of

intercourse

-LRB-

Clarke

-RRB-

andwhether

the

wife

of

an

infertile

husband

can

temporarily

divorce

her

infertile

husband

remarrying

him

after

accepting

sperm

from

a

donor

-LRB-

Tremayne

personal

communication

-RRB-

These

disagreements

of

opinion

have

played

out

in

interesting

ways

As

shown

in

anthropologist

Morgan

Clarke

's

-LRB-

-RRB-

recent

research

on

the

Shi'ite

religious

discourses

surrounding

gamete

donation

many

Shi'ite

ulama

do

not

agree

with

Khamanei

's

permissive

fatwa

on

donor

technologies

because

they

do

not

regard

him

as

a

brilliant

legal

thinker

For

example

Ayatollah

Muhammad

Husayn

Fadlallah

Lebanon

's

most

prominent

Shi'ite

religious

figure

does

not

agree

with

Ayatollah

Khamanei

's

permission

of

sperm

donation

although

he

agrees

with

the

permission

of

egg

donation

Neither

of

them

requires

the

use

of

mutca

marriages

to

solve

the

zina

issue

-LRB-

Clarke

-RRB-

Ayatollah

Fadlallah

's

positions

opposing

sperm

donation

but

supporting

egg

donation

square

with

the

dominant

religious

discourse

in

Iran

There

the

religious

rulings

regarding

gamete

donation

have

evolved

quickly

with

sperm

donation

now

effectively

banned

-LRB-

Soraya

Tremayne

personal

communication

July

July

-RRB-

Namely

a

law

on

gamete

donation

passed

in

in

the

Iranian

parliament

-LRB-

majlis

-RRB-

and

approved

by

the

Guardian

Council

-LRB-

i.e.

a

religious

watchdog

body

that

endorses

every

bill

before

it

becomes

law

-RRB-

has

restricted

gamete

donation

to

married

persons

Even

though

the

law

is

brief

-LRB-

less

than

one

page

-RRB-

it

states

clearly

and

succinctly

who

can

and

can

not

donate

and

receive

gametes

Egg

donation

is

allowed

as

long

as

the

husband

marries

the

egg

donor

temporarily

thereby

ensuring

that

all

three

parties

are

married

Sperm

donation

on

the

other

hand

is

legally

forbidden

because

a

sperm

donor

can

not

temporarily

marry

an

already

married

woman

whose

husband

is

infertile

Quite

interestingly

however

embryo

donation

which

involves

both

sperm

and

egg

from

another

couple

is

allowed

in

order

to

overcome

both

male

and

female

infertility

Because

an

embryo

comes

from

a

married

couple

and

is

given

to

another

married

couple

it

is

considered

hallal

or

religiously

permissible

The

social

and

biological

implications

of

embryo

donation

are

quite

interesting

For

Iranian

couples

unable

to

produce

a

child

because

of

male

infertility

embryo

donation

allows

them

to

bypass

the

problem

of

the

husband

's

weak

-LRB-

or

absent

-RRB-

sperm

However

embryo

donation

does

not

allow

a

presumably

fertile

wife

of

an

infertile

husband

to

contribute

her

own

ova

in

effect

severing

her

biological

ties

to

the

donor

child

Furthermore

and

most

strikingly

embryos

donated

from

another

married

couple

involve

both

egg

and

sperm

donation

Even

though

direct

sperm

donation

is

bypassed

via

the

injection

of

another

man

's

sperm

into

the

wife

's

womb/ova

embryo

donation

still

disrupts

male

paternity

and

involves

the

acceptance

by

an

already

married

woman

of

another

man

's

-LRB-

and

woman

's

-RRB-

gametes

Moreover

a

woman

's

acceptance

of

another

woman

's

egg

is

effectively

like

gestational

surrogacy

which

is

strictly

prohibited

in

Sunni

Islam

Indeed

in

recent

months

cases

of

surrogate

motherhood

have

occurred

in

Iran

despite

the

lack

of

firm

legislation

regarding

this

practice

Whether

these

problematic

complications

of

embryo

donation

have

been

carefully

thought

through

by

the

religious

and

legal

authorities

in

Iran

is

unclear

Based

on

her

path-breaking

research

carried

out

at

Iranian

IVF

clinics

anthropologist

Soraya

Tremayne

-LRB-

-RRB-

notes

My

first

and

possibly

superficial

interpretation

at

this

stage

can

only

be

that

the

moral

ethical

and

legal

aspects

of

the

whole

matter

have

not

yet

been

thought

through

and

the

consequences

dawned

on

either

the

doctors

and

legislators

or

on

people

themselves

It

seems

to

me

that

ethics

will

follow

rather

than

lead

the

issue

These

operations

have

been

in

place

only

for

the

past

ten

years

and

the

cases

are

too

new

to

cause

problems

as

yet

-LRB-

personal

communication

July

-RRB-

It

is

interesting

to

note

that

many

Shi'ite

religious

leaders

both

inside

and

outside

of

Iran

do

not

agree

with

the

relative

Iranian

permissiveness

vis-à-vis

donor

technologies

instead

they

abide

by

the

dominant

Sunni

Muslim

ban

on

all

forms

of

third-party

donation

For

example

I

recently

attended

a

two-day

conference

in

Tehran

Iran

on

Gamete

and

Embryo

Donation

sponsored

by

the

Avesina

Research

Institute

in

association

with

the

Law

and

Political

Science

Faculty

of

the

University

of

Tehran

The

conference

provided

a

fascinating

example

of

ijtihad

in

action

with

some

ulama

dressed

in

their

stately

robes

and

turbans

-LRB-

black

for

the

sayyids

or

descendants

of

the

Prophet

Muhammad

-RRB-

arguing

against

the

moral

permissibility

of

embryo

and

gamete

donation

The

disagreements

generated

in

public

between

pro

and

con

ulama

were

also

debated

in

the

more

private

recesses

of

the

conference

For

example

a

Shi'ite

shari'a

judge

from

Bahrain

who

was

staying

at

our

guest

residence

took

great

pains

to

describe

to

me

his

opposition

to

all

forms

of

gamete

donation

To

prove

this

point

he

provided

me

with

a

copy

of

his

book

on

Islamic

personal

status

law

which

had

been

translated

into

English

and

which

supported

his

anti

gamete

donation

position

based

on

evidence

from

the

traditional

Islamic

scriptures

According

to

him

Iranian

clergy

who

speak

Farsi

rather

than

Arabic

are

not

as

familiar

with

the

original

Islamic

scriptures

-LRB-

in

Arabic

-RRB-

that

demonstrate

the

immorality

of

third-party

donation

Thus

in

his

view

some

Iranian

clergy

are

innovating

in

ways

that

are

religiously

unacceptable

and

that

are

at

odds

with

the

rest

of

the

Muslim

world

A

case

in

point

ayatollahs

Ali

al-Sistani

and

Muhammad

Sa'id

al-Tabataba

i

al-Hakim

both

Shi'ite

religious

authorities

in

Iraq

advise

caution

against

third-party

donation

practices

viewing

them

as

largely

unacceptable

-LRB-

Clarke

-RRB-

Indeed

Ayatollah

al-Sistani

's

son

Muhammad

Rida

Al-Sistani

has

devoted

an

entire

volume

of

richly

documented

legal

analysis

to

this

debate

providing

an

invaluable

resource

for

other

scholars

-LRB-

-RRB-

According

to

Clarke

Sistani

's

work

while

perhaps

posing

more

questions

than

clear

answers

opens

up

for

other

scholars

a

fascinating

window

into

this

area

of

Shi'ite

jurisprudential

debate

at

a

time

when

the

Western

media

are

just

waking

up

to

the

vibrant

engagement

Shi'ite

scholars

have

had

with

other

such

new

technologies

-LRB-

-RRB-

Indeed

the

degree

to

which

some

Shi'ite

clergy

are

pushing

the

envelope

in

the

realm

of

reproductive

science

and

technology

is

quite

remarkable

At

the

recent

gamete

donation

conference

in

Iran

some

Iranian

clergy

and

physicians

present

advocated

for

future

laws

permitting

all

forms

of

donation

as

well

as

surrogacy

Once

passed

into

law

gamete

donation

of

all

kinds

will

be

difficult

to

stop

Meanwhile

in

the

absence

of

formal

legislation

some

IVF

physicians

in

Tehran

as

well

as

in

Shi'ite

dominant

Lebanon

which

is

closely

following

the

Iranian

lead

are

using

the

legal

vacuum

and

the

original

permissive

fatwa

of

Ayatollah

Khamanei

to

practice

all

forms

of

gamete

donation

among

their

desperate

infertile

patients

As

noted

by

Clarke

-LRB-

-RRB-

for

Lebanon

Doctors

keep

Khamanei

's

fatwa

collection

on

the

shelves

of

their

surgeries

to

demonstrate

the

permissibility

of

such

procedures

to

skeptical

Muslim

patients

and

many

such

patients

have

profited

from

it

to

undertake

donor

sperm

and

egg

procedures

even

surrogacy

arrangements

with

a

clear

conscience

-LRB-

-RRB-

Muslim

patient

opposition

to

donation

Although

donor

law

and

practice

are

headed

in

interesting

new

directions

in

both

Iran

and

Lebanon

it

must

be

reiterated

that

the

vast

majority

of

Muslims

both

Shi'ite

and

Sunni

do

not

accept

the

idea

of

third-party

gamete

donation

Why

are

they

opposed

to

donation

In

the

hundreds

of

interviews

that

I

have

conducted

since

in

Egypt

-LRB-

with

Sunni

Muslims

-RRB-

and

Lebanon

-LRB-

with

both

Sunni

and

Shi'ite

Muslims

-RRB-

the

majority

of

infertile

couples

were

clear

that

donation

is

haram

or

forbidden

by

the

religion

-LRB-

Inhorn

-RRB-

Patient

concerns

revolve

around

three

sets

of

related

issues

-LRB-

-RRB-

the

moral

implications

of

third-party

donation

for

marriage

-LRB-

-RRB-

the

potential

for

incest

and

-LRB-

-RRB-

the

moral

implications

of

donation

for

kinship

and

family

life

With

regard

to

marriage

Islam

is

a

religion

that

can

be

said

to

privilege

even

mandate

heterosexual

marital

relations

As

is

made

clear

in

the

original

Al-Azhar

fatwa

reproduction

outside

of

marriage

is

considered

zina

or

adultery

which

is

strictly

forbidden

in

Islam

Although

third-party

donation

does

not

involve

the

sexual

body

contact

of

adulterous

relations

or

presumably

the

desire

to

engage

in

an

extramarital

affair

it

is

nonetheless

considered

by

most

Islamic

religious

scholars

to

be

a

form

of

adultery

by

virtue

of

introducing

a

third

party

into

the

sacred

dyad

of

husband

and

wife

It

is

the

very

fact

that

another

man

's

sperm

or

another

woman

's

eggs

enter

a

place

where

they

do

not

belong

that

makes

donation

of

any

kind

inherently

wrong

and

threatening

to

the

marital

bond

The

other

aspect

of

third-party

donation

that

troubles

marriage

is

the

potential

for

incest

among

the

offspring

of

unknown

donors

Moral

concerns

have

been

raised

about

the

potential

for

a

single

anonymous

donor

's

offspring

to

meet

and

marry

each

other

thereby

undertaking

an

incestuous

union

of

half-siblings

The

final

moral

concern

voiced

by

Muslim

IVF

patients

is

that

third-party

donation

confuses

issues

of

kinship

descent

and

inheritance

As

with

marriage

Islam

is

a

religion

that

can

be

said

to

privilege

even

mandate

biological

inheritance

Preserving

the

origins

of

each

child

meaning

its

relationship

to

a

known

biological

mother

and

father

is

considered

not

only

an

ideal

in

Islam

but

a

moral

imperative

The

problem

with

third-party

donation

therefore

is

that

it

destroys

a

child

's

lineage

which

is

immoral

in

addition

to

being

psychologically

devastating

Muslim

IVF

patients

use

the

term

mixture

of

relations

to

describe

this

untoward

outcome

Such

a

mixture

of

relations

or

the

literal

confusion

of

lines

of

descent

introduced

by

third-party

donation

is

described

as

being

very

dangerous

forbidden

against

nature

against

God

in

a

word

haram

or

morally

unacceptable

It

is

argued

that

donation

by

allowing

a

stranger

to

enter

the

family

confuses

lines

of

descent

in

patrilineal

Islamic

societies

For

men

in

particular

ensuring

paternity

and

the

purity

of

lineage

through

known

fathers

is

of

paramount

concern

-LRB-

Inhorn

-RRB-

As

one

Sunni

Muslim

man

a

high

school

biology

teacher

summarized

the

problem

The

most

important

thing

is

that

we

are

Muslims

If

there

is

faith

in

carrying

out

this

operation

using

sperm

from

the

husband

and

ova

from

the

wife

then

this

is

okay

We

can

not

accept

what

happens

in

the

West

We

heard

some

women

hire

the

womb

of

another

woman

or

take

sperm

According

to

our

religion

this

is

called

ikhtilat

in-nasab

mixing

relations

We

consider

it

some

kind

of

zina

prostitution

Because

there

are

many

hadiths

from

the

Prophet

Muhammad

that

confirm

this

If

you

put

your

sperm

in

another

woman

besides

your

wife

you

go

to

hell

This

is

adultery

There

is

a

hadith

on

adultery

If

you

put

your

sperm

in

another

woman

other

than

your

wife

you

are

going

to

commit

a

sin

People

asked

the

Prophet

How

He

said

If

you

put

it

in

your

wife

you

are

going

to

be

rewarded

from

Allah

They

said

Yes

He

told

them

But

this

is

also

the

case

if

you

put

it

in

the

wrong

womb

You

are

going

to

have

punishment

In

addition

to

the

consequences

of

mixed

bloodlines

and

adultery

bringing

such

donor

children

into

the

world

is

considered

unfair

to

the

children

themselves

who

would

never

be

treated

with

the

love

and

concern

parents

feel

for

their

real

children

Such

a

child

could

only

be

viewed

as

a

bastard

an

ibn

haram

literally

son

of

sin

Thus

a

child

of

third-party

donation

starts

life

off

as

an

illegal

child

The

child

is

deemed

illegitimate

and

stigmatized

even

in

the

eyes

of

his

or

her

own

parents

who

will

therefore

lack

the

appropriate

parental

sentiments

-LRB-

Inhorn

-RRB-

As

one

Sunni

Muslim

IVF

patient

stated

My

baby

must

be

mine

and

from

my

husband

This

is

logical

A

mother

will

never

feel

this

is

her

child

if

it

is

from

another

-LSB-

man

's

-RSB-

donated

sperm

or

ova

It

's

only

natural

Everything

must

occur

naturally

If

the

child

is

from

the

father

and

mother

they

will

feel

this

is

actually

our

baby

If

not

we

'll

not

be

a

family

The

feeling

of

the

baby

and

our

feelings

You

will

feel

like

you

're

acting

making

a

movie

living

a

life

that

's

not

true

This

is

our

feeling

Of

course

people

take

babies

-LSB-

through

adoption

-RSB-

but

this

is

not

so

common

here

in

Egypt

We

do

n't

even

want

to

think

about

this

point

We

are

making

our

trial

-LSB-

of

IVF

-RSB-

and

hoping

God

will

help

us

Indeed

the

firm

conviction

that

parenthood

of

a

donor

child

is

an

impossibility

is

clearly

linked

to

the

legal

and

cultural

prohibitions

against

adoption

throughout

the

Muslim

world

The

Islamic

scriptures

including

the

Qur

an

encourage

the

kind

fostering

of

orphans

but

do

not

allow

legal

adoption

as

it

is

known

in

the

West

whereby

a

child

takes

its

adoptive

parents

surname

and

is

treated

as

one

's

own

child

-LRB-

Inhorn

Sonbol

Zuhur

-RRB-

In

the

Muslim

Middle

East

few

IVF

patients

either

Sunni

or

Shi'ite

will

contemplate

adoption

stating

with

conviction

that

it

is

against

the

religion

and

that

the

adopted

child

wo

n't

be

my

own

son

-LRB-

Inhorn

-RRB-

Even

though

legal

adoption

is

practiced

in

Iran

with

the

child

receiving

a

birth

certificate

in

the

adoptive

couple

's

name

after

a

six-month

period

of

adjustment

the

social

and

cultural

resistances

to

adoption

remain

strong

in

that

country

making

this

a

last

resort

for

infertile

Iranian

couples

-LRB-

Janet

Heindl

personal

communication

July

Tober

-RRB-

Nonetheless

Iran

's

acceptance

of

adoption

has

clearly

paved

the

way

for

gamete

donation

with

Ayatollah

Khamanei

's

initial

fatwa

deeming

the

infertile

couple

to

be

like

adoptive

parents

Indeed

Iran

's

clearly

adventurous

path

regarding

both

adoption

and

donation

is

leading

to

social

transformations

in

other

parts

of

the

Shi'ite

Middle

East

in

ways

described

in

the

following

section

Marriage

and

gender

relations

In

considering

infertility

and

IVF

in

the

Muslim

world

it

is

important

to

ask

What

happens

to

infertile

Middle

Eastern

Muslim

couples

who

are

not

allowed

to

adopt

and

who

do

not

accept

the

use

of

donor

gametes

In

the

absence

of

adoption

and

gamete

donation

infertile

Muslim

couples

have

no

choice

but

to

turn

to

IVF

and

other

assisted

reproductive

technologies

to

solve

their

infertility

problems

using

their

own

gametes

In

the

Middle

Eastern

Muslim

world

marriage

is

highly

valued

and

nearly

all

adults

marry

if

possible

in

most

Middle

Eastern

countries

-LRB-

Population

Reference

Bureau

Zuhur

-RRB-

Middle

Eastern

societies

are

also

pronatalist

they

highly

value

children

for

numerous

reasons

and

expect

all

marriages

to

produce

them

-LRB-

Inhorn

-RRB-

Thus

the

notion

of

a

married

couple

living

happily

without

children

is

unthinkable

Children

are

desired

from

the

beginning

of

marriage

in

most

cases

and

are

usually

loved

and

cherished

once

they

are

born

As

a

result

childless

couples

are

often

under

tremendous

social

pressure

to

conceive

In

the

Muslim

world

infertile

women

often

live

in

fear

that

their

marriages

will

collapse

for

Islamic

personal

status

laws

consider

a

wife

's

barrenness

to

be

a

major

ground

for

divorce

Although

Islam

also

allows

women

to

divorce

if

male

infertility

can

be

proven

a

woman

's

initiation

of

divorce

continues

to

be

so

stigmatizing

that

women

rarely

choose

this

option

unless

their

marriages

are

truly

unbearable

-LRB-

Inhorn

-RRB-

Instead

they

often

cover

for

their

infertile

husbands

accepting

the

social

responsibility

for

the

infertility

and

diffusing

the

embarrassment

of

their

husbands

reproductive

emasculation

-LRB-

Inhorn

-RRB-

The

emergence

of

the

revolutionary

new

IVF

technology

called

intracytoplasmic

sperm

injection

-LRB-

ICSI

-RRB-

however

has

ironically

increased

the

potential

for

divorce

in

the

Muslim

Middle

East

Namely

with

ICSI

infertile

men

with

very

poor

sperm

profiles

even

azoospermia

or

lack

of

sperm

in

the

ejaculate

are

now

able

to

produce

biological

children

of

their

own

As

long

as

a

single

viable

spermatozoon

can

be

retrieved

from

a

man

's

body

including

through

painful

testicular

aspirations

and

biopsies

this

spermatozoon

can

be

injected

directly

into

the

ovum

under

a

high-powered

microscope

What

ICSI

requires

then

is

high-quality

ova

despite

low-quality

sperm

However

the

wives

of

many

of

these

men

who

have

stood

by

their

infertile

husbands

for

years

even

decades

in

some

cases

may

have

grown

too

old

to

produce

viable

ova

for

the

ICSI

procedure

In

the

absence

of

adoption

or

of

any

kind

of

egg

donation

infertile

Muslim

couples

with

a

reproductively

elderly

wife

face

four

difficult

options

-LRB-

-RRB-

to

remain

together

permanently

without

children

-LRB-

-RRB-

to

legally

foster

an

orphan

which

is

rarely

viewed

as

an

acceptable

option

-LRB-

-RRB-

to

remain

together

in

a

polygynous

marriage

which

is

rarely

viewed

as

an

acceptable

option

by

women

themselves

or

-LRB-

-RRB-

to

divorce

so

that

the

husband

can

have

children

with

a

younger

wife

In

my

research

in

Egypt

and

Lebanon

the

first

option

has

proven

to

be

the

most

common

namely

infertile

husbands

and

their

wives

often

love

each

other

deeply

and

remain

together

in

long-term

marriages

without

producing

any

children

Thus

divorce

is

not

the

immediate

consequence

of

infertility

that

it

is

stereotypically

portrayed

to

be

Because

of

the

Sunni

Islamic

restrictions

on

the

use

of

donor

eggs

however

as

well

as

lack

of

acceptance

of

this

option

among

some

segments

of

the

Shi'ite

population

at

least

some

Muslim

men

are

choosing

to

divorce

or

take

a

second

wife

believing

that

their

own

reproductive

destinies

lie

with

younger

more

fertile

women

That

being

said

in

the

Shi'ite

Muslim

world

including

in

Iran

and

Lebanon

at

least

some

Shi'ite

couples

are

beginning

to

receive

both

donor

gametes

and

donor

embryos

as

well

as

donating

their

gametes

to

other

infertile

couples

For

infertile

Shi'ite

couples

who

accept

the

idea

of

third-party

donation

as

well

as

for

Ayatollah

Khamanei

who

originally

introduced

the

idea

of

donation

to

the

Muslim

world

the

introduction

of

donor

technologies

has

been

described

as

a

marriage

savior

helping

to

avoid

the

marital

and

psychological

disputes

that

may

arise

if

the

couple

's

case

is

otherwise

untreatable

Such

disputes

are

clearly

dramatized

in

the

popular

Iranian

film

Laila

which

documents

the

painful

separation

of

an

otherwise

happily

married

but

infertile

couple

and

which

was

released

in

the

before

the

Khamanei

fatwa

permitted

such

marriages

to

be

saved

through

the

use

of

donor

technologies

In

Iran

today

donor

egg

and

donor

embryo

programs

have

been

set

up

at

most

IVF

clinics

Donor

eggs

come

from

three

sources

other

IVF

patients

relatives

and

unmarried

women

who

agree

to

participate

as

egg

donors

in

one-day

mutca

marriages

for

a

fee

Such

marriages

only

require

a

witness

and

are

not

officially

registered

thus

they

take

place

in

confidence

in

the

back

rooms

of

IVF

clinics

Indeed

donors

who

wish

to

remain

anonymous

enter

these

mutca

marriages

only

by

written

agreement

without

ever

meeting

the

recipients

of

their

eggs

or

their

temporary

husbands

They

receive

their

money

following

egg

harvesting

-LRB-

usually

about

U.S.

-RRB-

provide

no

personal

information

about

themselves

to

the

recipient

couple

receive

no

information

about

the

recipient

couple

and

go

about

their

business

-LRB-

Soraya

Tremayne

personal

communication

July

-RRB-

In

short

egg

donation

as

well

as

embryo

donation

from

other

couples

is

largely

a

financial

transaction

in

Iran

with

very

little

regulation

or

control

over

who

donates

or

how

donation

is

enacted

The

same

is

not

true

for

the

receiving

of

embryos

According

to

Tremayne

the

recent

law

in

Iran

specifies

clearly

that

couples

desiring

an

embryo

as

a

result

of

infertility

must

apply

in

writing

to

a

court

in

order

to

receive

permission

for

embryo

transfer

The

law

specifies

that

the

couple

must

be

morally

sound

and

suitable

as

parents

and

must

be

Iranian

citizens

much

like

the

law

governing

adoption

in

Iran

-LRB-

Janet

Heindl

personal

communication

July

-RRB-

Still

the

donor

embryo

law

is

so

new

that

most

IVF

clinics

in

Iran

do

not

yet

own

a

copy

of

the

legislation

and

are

not

necessarily

abiding

by

the

legal

requirements

for

donor

embryo

transfer

at

their

clinics

If

the

husband

is

infertile

the

couple

simply

receives

another

couple

's

embryos

with

most

donor

couples

choosing

to

remain

anonymous

As

Tremayne

-LRB-

July

-RRB-

states

I

did

not

get

the

impression

that

people

desperate

to

have

a

child

thought

very

far

about

the

issues

of

kinship

and

family

relations

As

far

as

I

could

see

the

donation

is

considered

more

a

financial

transaction

than

a

donation/gift

and

once

you

have

paid

the

couple

to

buy

their

embryo

or

paid

the

temporary

wife

for

her

egg

they

have

no

further

claims

on

you

and

this

is

the

end

of

the

story

The

forms

filled

by

the

donors

leave

it

to

them

to

decide

whether

they

want

to

give

their

name

or

not

In

Lebanon

where

I

have

conducted

my

own

research

the

situation

is

very

similar

despite

the

lack

of

a

national

law

governing

any

aspect

of

IVF

or

third-party

donation

At

Lebanese

IVF

clinics

providing

donor

technologies

some

of

the

donors

are

other

IVF

patients

-LRB-

mostly

Shi'ite

Muslims

who

accept

the

idea

of

donation

-RRB-

some

are

friends

or

relatives

-LRB-

including

egg-donor

sisters

-RRB-

and

some

are

anonymous

donors

who

provide

their

ova

for

a

fee

In

at

least

one

clinic

catering

to

a

largely

conservative

Shi'ite

clientele

some

of

these

donors

are

young

non-Muslim

American

women

who

travel

to

Lebanon

for

extra

payment

to

donate

their

eggs

anonymously

to

infertile

Lebanese

couples

Ironically

those

most

likely

to

receive

these

American

eggs

are

conservative

Shi'ite

couples

who

accept

the

idea

of

donation

because

they

follow

the

teachings

of

Ayatollah

Khamanei

in

Iran

Thus

in

Lebanon

those

most

likely

to

follow

the

spiritual

guidance

of

Ayatollah

Khamanei

and

hence

to

receive

American

donor

eggs

are

generally

members

of

or

sympathizers

with

Lebanon

's

Hizbullah

political

party

which

is

officially

described

by

the

U.S.

administration

as

a

terrorist

organization

Furthermore

quite

interestingly

in

multisectarian

Lebanon

the

recipients

of

these

donor

eggs

are

not

necessarily

only

Shi'ite

Muslim

couples

Some

Sunni

Muslim

patients

from

Lebanon

and

from

other

Middle

Eastern

Muslim

countries

such

as

Egypt

and

Syria

are

quietly

slipping

across

transnational

borders

to

save

their

marriages

through

the

use

of

donor

gametes

thereby

secretly

going

against

the

dictates

of

Sunni

Muslim

orthodoxy

Such

border

crossing

has

also

been

noted

by

Clarke

-LRB-

-RRB-

for

Lebanon

he

writes

Indeed

patients

come

from

other

countries

to

benefit

from

this

relatively

relaxed

regime

-LRB-

-RRB-

The

same

is

true

in

Iran

where

according

to

IVF

clinic

staff

scores

of

Persian

Gulf

Arabs

from

countries

such

as

Saudi

Arabia

and

Kuwait

are

traveling

to

Tehran

in

pursuit

of

donor

gametes

Conclusion

In

conclusion

it

is

fair

to

state

that

global

reproductive

technoscapes

-LRB-

Appadurai

-RRB-

are

becoming

increasingly

expansive

as

we

enter

this

new

millennium

As

this

article

has

tried

to

show

the

Muslim

world

generally

positioned

on

the

receiving

end

of

global

reproductive

technology

transfers

has

nonetheless

embraced

assisted

reproductive

technologies

with

considerable

enthusiasm

while

at

the

same

time

reconfiguring

them

in

accordance

with

the

local

religious

moralities

so

important

in

this

region

Although

generally

portrayed

as

monolithic

Islam

itself

takes

several

different

forms

as

evident

in

this

essay

In

the

Sunni

Muslim

world

which

includes

most

Middle

Eastern

countries

the

use

of

IVF

and

related

assisted

reproductive

technologies

has

clearly

led

to

an

entrenchment

of

deeply

held

religious

beliefs

about

the

importance

of

biologically

based

kinship

family

life

and

parenthood

Yet

the

globalization

of

these

technologies

to

the

Shi'ite

Muslim

world

has

fundamentally

altered

understandings

of

the

ways

in

which

families

can

be

made

and

the

ways

in

which

marriages

can

be

saved

through

the

uses

of

assisted

reproductive

technologies

For

Shi'ite

Muslims

in

particular

the

frankly

adventurous

attitude

on

the

part

of

some

Shi'ite

religious

leaders

toward

third-party

donation

has

led

to

a

potential

transformation

in

gender

relations

among

infertile

Muslim

couples

For

example

in

Lebanon

the

recent

Shi'ite

fatwas

allowing

egg

donation

have

been

a

great

boon

to

marital

relations

There

both

fertile

and

infertile

men

with

reproductively

elderly

wives

are

lining

up

at

IVF

clinics

to

accept

the

eggs

of

donor

women

Furthermore

in

multisectarian

Lebanon

the

recipients

of

donor

gametes

are

not

necessarily

only

Shi'ite

Muslim

couples

but

include

some

Sunni

Muslim

and

Christian

couples

as

well

In

short

the

arrival

of

donor

technologies

in

the

Muslim

Middle

East

has

led

to

a

brave

new

world

of

reproductive

possibility

never

imagined

when

these

technologies

were

first

introduced

there

nearly

years

ago

These

technologies

have

engendered

-LRB-

-RRB-

significant

medical

transnationalism

and

reproductive

tourism

-LRB-

-RRB-

mixing

of

gametes

across

ethnic

racial

and

religious

lines

and

-LRB-

-RRB-

the

birth

of

thousands

of

ICSI

and

now

donor

babies

to

devout

infertile

Muslim

couples

Infertile

couples

have

begun

to

reconsider

traditional

notions

of

biological

kinship

even

if

social

parenthood

of

a

donor

child

is

still

not

widely

embraced

-LRB-

Inhorn

-RRB-

And

because

donor

technologies

are

now

widely

available

in

both

Iran

and

Lebanon

the

power

of

the

Sunni

Muslim

ban

on

third-party

donation

is

being

weakened

across

the

region

with

some

infertile

Sunni

Muslim

couples

reconsidering

their

own

antidonation

moral

stances

As

a

result

Shi'ite

gametes

are

finding

their

ways

into

Sunni

bodies

an

interesting

variation

on

the

making

of

Muslim

babies

In

my

view

these

multiple

transformations

are

powerful

indicators

of

the

profound

social

effects

that

reproductive

technologies

may

engender

in

the

new

world

order

As

the

assisted

reproductive

technologies

become

further

entrenched

in

the

Muslim

world

and

additional

forms

of

global

reproductive

technology

become

available

it

is

important

to

examine

the

new

local

moral

worlds

that

are

likely

to

arise

in

response

to

this

variant

of

globalization

The

pace

of

change

evident

in

the

production

of

assisted

reproductive

technologies

themselves

as

highlighted

on

the

recent

Nova

special

called

Ways

to

Make

a

Baby

as

well

as

the

rapid

spread

of

these

technologies

into

far

reaches

of

the

non-Western

world

is

indeed

striking

Thus

as

one

science

and

technology

studies

scholar

David

Hess

-LRB-

-RRB-

rightly

observes

Anthropology

brings

to

these

discussions

a

reminder

that

the

cultural

construction

of

science

is

a

global

phenomenon

and

that

the

ongoing

dialogue

of

technoculture

often

takes

its

most

interesting

turns

in

areas

of

the

world

outside

the

developed

West

-LRB-

-RRB-

Notes

To

overcome

the

difficulties

of

raising

a

biologically

unrelated

donor

child

some

Shi'ite

physicians

in

Lebanon

are

arguing

for

a

variety

of

novel

solutions

including

inheritance

through

gifts

and

bequests

institutions

of

rida

-LRB-

milk

kinship

-RRB-

whereby

the

mother

of

a

donor

child

becomes

related

to

it

through

breastfeeding

and

the

notion

of

legal

guardianship

of

foster

children

-LRB-

Clarke

-RRB-

I

am

deeply

grateful

to

Soraya

Tremayne

who

fresh

from

fieldwork

in

Iran

has

engaged

in

a

lively

e-mail

discussion

with

me

and

has

provided

invaluable

information

on

the

practices

of

IVF

and

gamete

donation

in

Iran

since

I

have

tried

to

represent

her

findings

as

accurately

as

possible

in

this

paper

In

Iran

I

want

to

thank

Mohammad

Jalal

Abassi-Shavazi

Mohamad

Mehdi

Akhondi

and

Pegah

Ebadi

for

so

generously

inviting

and

hosting

me

at

the

Avesina

Research

Center

and

University

of

Tehran

conference

on

embryo

and

gamete

donation

In

Lebanon

anonymous

sperm

donation

using

frozen

sperm

from

overseas

sperm

banks

or

fresh

sperm

samples

from

mostly

medical

and

graduate

students

is

quietly

practiced

at

IVF

clinics

One

of

my

azoospermic

Lebanese

male

informants

produced

a

donor

child

in

this

way

and

several

others

both

Muslim

and

Christian

had

also

made

the

decision

to

use

donor

sperm

In

Iran

women

commonly

bring

their

sisters

as

potential

egg

donors

But

this

is

not

allowed

as

Islam

is

explicitly

against

the

marriage

of

one

man

to

two

living

sisters

Apparently

men

also

bring

their

brothers

as

potential

sperm

donors

in

Iran

According

to

Tremayne

she

observed

one

case

where

the

husband

did

so

without

his

wife

's

knowledge

the

wife

believed

that

she

was

receiving

her

husband

's

sperm

instead

of

that

of

her

brother-in-law

Some

leading

members

of

the

Lebanese

medical

community

are

pushing

for

a

law

that

bans

all

forms

of

third-party

donation

in

the

country

However

this

law

has

yet

to

be

debated

in

the

Lebanese

parliament

and

is

unlikely

to

pass

according

to

some

sources

in vitro fertilization
gamete donation
islam
medical anthropology
middle east