Infertility and assisted reproductive technologies (ART) is a topic garnering significant attention in India in academia and in the media, mostly because of India's substantial transnational commercial surrogacy in the last decade. Aditya Bharadwaj's Conceptions: Infertility and Procreative Technologies in India is surely a pioneering work in this area. This multi-sited ethnography based on fifteen years of fieldwork focuses on procreative technologies, their seekers, medical practitioners, and policymakers in six Indian cities. It provides a comprehensive understanding of what the author refers to as “cultural conceptions”. The work covers analyses found in ancient Hindu texts and literature, to modern media discourses on India's first “test-tube baby”, to doctor–patient interactions in the consultation rooms of in vitro fertilization (IVF) clinics. With this wealth of information, Bharadwaj argues that fertility and infertility are culturally constructed and that these concepts structure and reconcile cultural ways to understand and implement reproductive technologies.

Conceptions: Infertility and Procreative Technologies in India is organized into four sections plus an introduction and afterword. The introduction presents an overview of the anthropological debates on infertility and reproductive technologies in Western societies followed by those of non-Western societies. Ethnographies on reproductive technologies and surrogate motherhood in India have been consistently published in recent years, but Bharadwaj insists that the theoretical and critical debates are not adequate and further investigation is needed. Thus, the purpose of this book is to “add a critical Indian chapter to this expanding cultural universe of biotechnological interventions into an ever-increasing number of lives facing reproductive disruption around the globe” (pp. 24–25).

Chapters 1 and 2 consider cultural perceptions of fertility and infertility. From the Hindu perspective, fertility is quasi-sacred because it is embedded in religious and cultural norms. On the other hand, infertility is considered deviant, and infertile women (and men) are highly stigmatized. Stigma is a key word for understanding infertility in pronatalist societies, such as India, where it is understood as not just a physical disorder, but also as a threat to personhood, gender identity, and everyday life. The detailed explanations of the stigmatizing of infertility and traditional practices that aim to resolve it (such as niyoga, conception by proxy) are described in ancient texts, which explains the widespread appeal of reproductive technologies and the behaviours of childless couples in India. Chapter 3 examines the history of the first Indian IVF baby, who was born in 1986, from the perspective of the socio-medical politics surrounding the event, and Chapter 4 describes the nature of biomedicine and the public/private healthcare sector to “understand the presence of assisted conception” (p. 109) and expansion of IVF clinics, which are not regulated by the government.

Chapter 5 focuses on Bharadwaj's field data, for example interviews and conversations with treatment seekers and clinicians about treatment-seeking behaviours. The average number of years that his informants underwent treatment exceeded seven, which was most of their married lives. Regarding treatments, some of them accepted donated gametes (sperm or egg) to achieve conception. In the case of male infertility, some couples preferred to use semen from the husband's male family members, such as his father or brother, which indicates the patriarchal management of fertility. This confidential arrangement is a more accepted approach to infertility than child adoption, which is negatively perceived and reluctantly pursued because it reveals infertility. Then, Chapter 6 analyses surrogacy and the socio-political problems it creates by discussing the theoretical frameworks and structures of previous studies to describe the broad context of transnational surrogacy arrangements.

I believe that the most fascinating and, perhaps, best parts of the book are Chapters 7 and 8. Chapter 7 explains the ways that infertile people and clinicians experience, understand, and interpret infertility to “make sense” of the technologies. Treatment seekers undergo lengthy treatments with highly uncertain results that often end in disappointment and a sense of helplessness. They feel that the treatments are entirely serendipitous because of the lack of proper guidance and information that lead to conception. The anxiety, anger, and sense of betrayal they feel tends to turn them against their doctors and clinicians. Treatment seekers’ emotional stress, particularly those who want quick and secure conceptions, creates high stress for their doctors.

Then, Chapter 8 considers the low success rates and uncertainties of reproductive technologies from the perspective of cultural meaning. The doctors are in an ambiguous position regarding the failure and success of conception. The doctors are blamed for failure to conceive, but at the same time they are praised as quasi-sacred, able to perform a miracle. As Chapter 3 points out regarding India's first officially documented “test-tube baby”, Dr Indira Hinduja, a woman gynaecologist, became the symbol and representative of the whole project. She was praised by the parents as a “god”, reflecting the social tendency of hero worship in India. However, Bharadwaj carefully shows that the doctors give credit for the results to God or nature by taking the position that the success or failure of embryo transfer, which they point out is an uncertain science, is in the hands of the divine. In other words, doctors and treatment seekers share a religious and cultural perspective that helps them to make sense of the uncertainties of assisted conception (p. 239). In the afterword, these arguments are submerged, and several topics for future study, suggested by the discussions in the book, are recommended.

The striking contribution of this book is its ability to demonstrate the links between treatment seekers and doctors regarding perceptions and understandings of reproductive technologies in the context of assisted conception. The author's fieldwork is impressive and rich considering the challenges of conducting fieldwork at busy IVF clinics, and the fact that fieldwork in clinical settings has particular limitations in terms of access to informants. Readers might want more information about couples’ social and family lives to help them understand the trajectories of their quests for conception. For example, changing perceptions of parenthood during long-term treatment, and parent–child relationships including family members who contributed gametes might be good topics to further our knowledge on this subject. In addition, as Marcia Inhorn's ethnographies have demonstrated, the quest for conception and the practical means to achieve it are not limited to medical efforts; religious, family, and kinship measures are often pursued.Footnote ¹ If “medical treatment is not restricted to the ‘mechanics’ of offering and receiving treatment, but more crucially to the ways in which clinicians and infertile couples make sense of the cultural context” (p. 241), this would be true for the long journey towards conception.

I agree with the author that this insightful work is a milestone in the study of infertility in India, and I invite further research, discussion, and contributions to deepen understanding of the cultural meanings of infertility and reproductive technologies. Only a few works have attempted to comprehensively unravel the complex dimensions of infertility in India, and thus, Conceptions: Infertility and Procreative Technologies in India will be of interest not only to scholars who focus on India, but also to medical anthropologists, science and technology studies (STS), and gender studies specialists.