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The introduction of assisted reproduction has led to unusual forms of procreation. This article describes the social consequences of lesbian motherhood and of families headed by single heterosexual mothers.
There is a strong argument in favour of sex selection, based on respect for procreative autonomy--the autonomy of couples to decide for themselves how to procreate, and what children to have. Objections based on possible harm to the child, the parents, or society, are not compelling, particularly in Australia.
Relations between endometriosis and infertility are complex and difficult to establish. Numerous theories have been suggested, but none of them has proved conclusive. As always in case of endometriosis, medical and surgical treatments are open to discussion. The right time for medically assisted procreation is obvious in patients with tubal obstruction but in the others it varies according to age, duration of infertility and previous treatments.
By and large, essential diabetes mellitus is thought to be 50% inherited and 50% environmental. In insulin-dependent diabetes mellitus (IDDM) there is a strong link with the HLA system with regard to the inheritance of 'susceptible' diabetic genes, especially the DR3 and DR4 alleles. In IDDM environmental factors act in a predisposed individual to initiate an immune response with resultant beta-cell damage and destruction. Non-insulin-dependent diabetes mellitus (NIDDM) has no clear HLA link, but has been shown in studies of twins to have a stronger genetic basis than IDDM. In NIDDM environmental factors (race, ethnicity, diet, obesity) have an important influence on the clinical expression of the disease and the severity of complications in a genetically predisposed individual. The non-insulin-dependent diabetes of the young (NIDDY) variant and the phenomenon of chlorpropamide-primed alcohol-induced flushing both underline the heterogeneity of NIDDM. Because of the heterogeneous nature and multifactorial inheritance pattern of diabetes mellitus, accurate genetic counselling is not possible as yet. However, data to date suggest that it is unwise to advise prospective parents not to procreate, since the overall risk of the development of clinical diabetes mellitus is extremely low.
Multiple pregnancies do raise the extraordinary problem of their frequency: conceptions of this type have taken on epidemic proportions as a result of the growth of infertility treatment. The study details the obstetric management, neonatal outcome, and follow-up data of women who were delivered of twins, triplets and more. The management of multiple pregnancies includes early diagnosis, meticulous follow-up, and early decrease of maternal activity. Data on the prognosis of triplet pregnancies are of particular importance when the option of selective termination is considered. The most common complication is preterm labor. The prematurity rate is 50% in twin, 95% in triplet and 100% in multiple pregnancy of higher order. The perinatal mortality was 20 to 80 per 1,000 in twins and 40 to 250 per 1,000 in triplets. During last years, a number of changes took place: introduction of medically assisted procreation, early diagnosis via ultrasound scans, considerable increase in the number of cesarean sections in the case of multiple pregnancies, improved prognosis for premature and growth retarded newborns.
The laboratory investigation of male fertility is based on semen examinations and allows assessment of all events occurring between the onset of spermatogenesis and ejaculation. The sperm count and semen cytology remain the first-line examinations, but can be completed by more specific examinations allowing assessment of spermatozoan functions involved in passage along the female genital tract and penetration of the oocyte. However, apart from azoospermia, there is no absolute criterion beyond which semen can be considered to be infertile. The results must be interpreted by taking into account all these examinations which can provide element concerning the aetiology of infertility, helping to guide subsequent treatment. When the use of various in vivo treatments has failed, patients may require medically-assisted procreation (MAP) techniques. The type of MAP chosen will depend on the characteristics of the semen and the functional capacities of the spermatozoa.
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Heterotopic pregnancy is a rare event combining intra and extra uterine pregnancies. We report 3 cases observed in patients aged 32, 32 and 31 years consulting for pelvic pain and metrorragia with amenorrhea of 6 to 7 weeks. Treatment was conservative in 2 cases and radical for the third patient. The frequency of this association has been increased since the development of medical procreation technique and the increased of ectopic pregnancy. The foetomaternal prognosis will be improved by an early diagnosis.
The author analysed hazardous effects of exposure to ethylene oxide among hospital personnel involved in sterilization of medical instruments and equipment. Toxicity of ethylene oxide was discussed, including its sensitizing, neurotoxic, mutagenic and carcinogenic effects as well as its influence on procreation. Hazardous effect of high, transient concentrations of ethylene oxide occurring in certain sterilization processes was highlighted. Preventive methods for reducing exposure to ethylene oxide hospitals were proposed.
Thanks to a serological survey carried out in Dakar from January to November 1993 among 353 procreative women, immune cover regarding toxoplasmosis was assessed using ELISA methodology: 40.2% of the surveyed population had antibodies of toxoplasmosis. No evidence of age, pregnancy, number of previous pregnancies was noted in antitoxoplasmosis antibodies prevalence. The seroconversion risk seems to be low even when it has existed during pregnancy. Contamination occurred during childhood. Some sanitary education should be provided to the procreative population in order to achieve a better compliance with basic hygiene regulations during pregnancy.
The typical symptoms of recurrent winter depression include lowered mood, lethargy, hypersomnia, social withdrawal, decreased libido, increased appetite and weight gain. Mild hypomania often occurs in spring and summer. It is argued that this pattern of attenuated hibernation constituted an adaptive evolutionary mechanism which enhanced the likelihood of reproductive success, most notably for females, among populations living at temperate latitudes. Women were more likely to become pregnant in the summer and thus to give birth at a time of year when their babies had a higher chance of survival. Winter depression symptoms also promoted healthier pregnancies and gave rise to enhanced female-male pair-bonding which improved the survival chances of both mothers and babies. Hypomania in spring and summer also served to increase the likelihood of procreation at the optimal time of year. In the modern era, it is probable that recurrent winter depression is becoming a reproductive disadvantage.
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PURPOSE/OBJECTIVES: To review the current medical technologies available to protect the reproductive potential of adult males undergoing sterilizing cancer treatments; to describe the attributes and limitations of these technologies and how oncology nurses can access them for the patient; and to discuss psychosocial elements, including the legal considerations of oncology nurses who counsel patients. DATA SOURCES: Quantitative data from personal clinical records; personal clinical experience; published articles, abstracts, and books identified by bibliographic data base searches; and consultation with lawyers. DATA SYNTHESIS: Cancer treatment can have severe and adverse long-term iatrogenic effects on male fertility. Medical technologies that protect male reproduction potential from sterilizing procedures have progressed from unreliable to clinically practical over a period of 20 years. The present clinical means for preserving the potential reproductive capacity of men at risk is cryopreservation of sperm before treatment begins, followed by assisted reproductive technology when pregnancy is desired. Medical, legal, and religious issues relevant to counseling are involved. CONCLUSIONS: Current reproductive technology provides realistic hope for future procreation by men facing sterilizing cancer treatment. IMPLICATIONS FOR NURSING PRACTICE: Nursing intervention primarily involves providing patient counseling and arranging patient access to cryopreservation facilities. Oncology nurses can assist men making these types of reproductive decisions by assessing their medical and psychological need for information and by counseling them in regard to human sexuality, the fertility risk of oncologic therapy, the availability of reproductive interventions, and the social ramifications of using stored semen.
In a retrospective study (1985-1989) based on data from the Centre for Reproductive Medicine in Brussels, a total of 23 ectopic pregnancies (2.24%) occurred after 3800 embryo, zygote or gamete transfers. This number was low compared with the data published elsewhere. Tubal damage was a major risk factor towards developing an ectopic pregnancy after in-vitro fertilization and embryo transfer. The number of ectopic pregnancies after the association of clomiphene citrate and human menopausal gonadotrophin (HMG) was significantly higher in patients with tubal (7.8%) and non-tubal indications (2.1%) compared with those stimulated with gonadotrophin-releasing hormone (GnRH) and HMG (2.18% and 0.84%, respectively). The number of replaced embryos was not associated with the rate of ectopic pregnancy and neither did transfer technique (intra-uterine or intra-Fallopian transfer) influence the ectopic pregnancy rate.
In spring 1992 the Austrian Parliament has enacted a new law dealing with reproductive medicine. The 'Act on medically assisted conception' contains provisions which totally prohibit particular methods of assisted fertilization (such as embryo or egg donation). The main goal of the act, however, is to regulate procreative medicine and to amend the Austrian General Civil Code: the parents-to-be are now considered to have the legal rights and responsibilities of biological parents in any case.
Results of an inquiry in adults patients (18-53 years of age) coming from three centers (1 in Rouen & 2 in Paris), 213 questionnaires were sent. 105 answers were received. Scholar achievement: only secondary cycle in 6%, Secondary cycle + professional course in 22% and tertiary cycle in 44%. No scholar ship in 2%, 26% were still ongoing studies. Professions: 18% are unemployed (24%), Secretary jobs: 10%, Health professions (altogether): 18%, Teachers: 8%, Clerks: 7%, Executive jobs: 8% and Miscellaneous jobs: 5%. 3% have an handicapped status. The small height was a career obstacle in 29%. Affective life. Age of first sexual intercourse was 19-22 years. 17 are or were married and 15% are living in couple. But 58% have not any sexual life whatsoever. These women are divided on the ways to cure the sterility. Few among the oldest have attempted adoption or medically assisted procreation, with each time low rate of success. 26% have psychological disturbances which were serious in 6% mainly due to depression.
Treatment and survival of reproductive-age patients with chemotherapy raises the question of possible effects on procreative ability. An attempt has been made to establish an animal model system. The anticancer agents nitrogen mustard and procarbazine caused decreased fertility in mice of both sexes and induced meiotic chromosomal abnormalities, at least in the male. Progeny of treated mice showed similar meiotic chromosomal changes. The possibility of similar effects in human beings receiving chemotherapy must be considered.
In Asia, the lesbian and gay rights movements are clearly dominated by activists, who tend to think in terms of a binary opposition (homo- vs hetero-) and clear-cut categories. Based on "Western patterns," the approach is practical, the arguments based on minority rights. "Coming out" is often perceived as a "white model" bringing more problems than real freedom. On the contrary, "Asian values" put the emphasis on family and social harmony, often in contradiction to what is pictured as "lesbian and gay rights." Homophobia follows very subtle ways in Asian countries. Asian gays have to negotiate their freedom, lifestyle and identities in an atmosphere of heterosexism, and not the endemic violent homophobia prevalent in many western countries. In Asia, one's identity relates to one's position in the group and sexuality plays a relatively insignificant role in its cultural construction. That Asian gays often marry and have children shows the elasticity their sexual identity encompasses. Fluidity of sexuality does not really match the Western approach in terms of essentialist categories that have a right to exist. Most Asian societies can be thought of as "tolerant" as long as homosexuality remains invisible. Procreative sexuality can be seen as a social duty, and heterosexual marriage is often not considered incompatible with a "homosexual life." The development of the Internet has even facilitated the encounters while allowing secrecy. Unfortunately, the traditional figures of transgender and transvestites have often been separated from the gay liberation movement.