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Towards less confusing terminology in reproductive medicine: a counter proposal.

Less confusing terminology in reproductive medicine was the goal of a recent proposal the basis of which was to drop the term 'infertility' and replace it with a description. It also contained a prognostic grading system. The present article, arguing against most of these proposals, should not be regarded as nihilism but as constructive criticism to attain more clarity and common understanding. A counter proposal is suggested and includes retention of the term 'infertility', disposal of the terms 'subfertility' and 'sterility' with practical suggestions of when difficulties in conceiving should be investigated and treated.

Communication↗

The role of law in reproductive medicine: a new approach.

It is a common feature of debates on the regulation of reproductive medicine to find law portrayed as a crude form of intervention consisting in the imposition of inflexible rules on doctors and medical researchers. This paper argues that this view must be replaced by a more accurate assessment of the law's potential role in the regulation of reproductive medicine. From an analysis of the White Paper on human fertilisation and embryology, and in particular the proposed Statutory Licensing Authority, the author contends that far from being an inflexible method of regulation law can foster discussion and compromise.

Contracts↗

Reproductive medicine: the ethical issues in the twenty-first century.

Reproductive medicine has developed to such an extent that numerous moral questions arise about the boundaries of applications of new reproductive technology. It is possible to imagine a future in which 'designer babies' are created and in which cloning, sex selection and male pregnancy become the instruments of individual desire or social policy. In this article, the concept of 'natural' is explored but rejected as an insufficient moral criterion for deciding these complex questions. A case is made for the criterion of welfare of the child and for the concept of the child as gift rather than product.

Bioethics↗

Future directions: anti-hormones in reproductive medicine.

Anti-hormones are important in reproductive medicine because they are useful tools that teach us about the normal physiological actions of hormones. They also provide effective therapies to control or treat a variety of pathogenic processes. We expect that the future repertoire of anti-hormones will include the paracrine and autocrine regulators of specific cell functions, in addition to the endocrine systems described here. The availability of recombinant DNA expression systems for an ever larger portion of the human genome will surely accelerate the development of novel anti-hormones.

Hormone Antagonists↗

Quality of reporting of test accuracy studies in reproductive medicine: impact of the Standards for Reporting of Diagnostic Accuracy (STARD) initiative.

OBJECTIVE: To evaluate the extent to which test accuracy studies published in two leading reproductive medicine journals in the years 1999 and 2004 adhered to the Standards for Reporting of Diagnostic Accuracy (STARD) initiative parameters, and to explore whether the introduction of the STARD statement has led to an improved quality of reporting. DESIGN: Structured literature search. Articles that reported on the diagnostic performance of a test in comparison with a reference standard were eligible for inclusion. For each article we scored how well the 25 items of the STARD checklist were reported. These items deal with the study question, study participants, study design, test methods, reference standard, statistical methods, reporting of results, and conclusions. We calculated the total number of reported STARD items per article, summary scores for each STARD item, and the average number of reported STARD items per publication year. SETTING: Not applicable. PATIENT(S): Not applicable. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Quality of reporting. RESULT(S): We found 24 studies reporting on test accuracy in reproductive medicine in 1999 and 27 studies in 2004. The mean number of reported STARD items for articles published in 1999 was 12.1 +/- 3.3 (range 6.5-20) and 12.4 +/- 3.2 (range 7-17.5) in 2004, after publication of the STARD statement. Overall, less than half of the studies reported adequately on 50% or more of the STARD items. The reporting of individual items showed a wide variation. There was no significant improvement in mean number of reported items for the articles published after the introduction of the STARD statement. CONCLUSION(S): Authors of test accuracy studies in the two leading fertility journals poorly report the design, conduct, methodology, and statistical analysis of their study. Strict adherence to the STARD guidelines should be encouraged.

Clinical Trials as Topic↗

Gene therapy and reproductive medicine.

OBJECTIVE: To review the literature on the principles of gene therapy and its potential application in reproductive medicine. DESIGN: Literature review. SETTING: Gene therapy involves transfer of genetic material to target cells using a delivery system, or vector. Attention has primarily focused on viral vectors. Significant problems remain to be overcome including low efficacy of gene transfer, the transient expression of some vectors, safety issues with modified adenoviruses and retroviruses, and ethical concerns. If these issues can be resolved, gene therapy will be applicable to an increasing spectrum of single and multiple gene disorders, as the Human Genome Project data are analyzed, and the genetic component of human disease becomes better understood. Gynecologic gene therapy has advanced to human clinical trials for ovarian carcinoma, and shows potential for the treatment of uterine leiomyomata. Obstetric applications of gene therapy, including fetal gene therapy, remain more distant goals. CONCLUSION(S): Concerns about the safety of human gene therapy research are being actively addressed, and remarkable progress in improving DNA transfer has been made. The first treatment success for a genetic disease (severe combined immunodeficiency disease) has been achieved, and ongoing research efforts will eventually yield clinical applications in many spheres of reproductive medicine.

Adenoviridae↗

[Regulation of reproductive medicine in North America or the Wild West of Medicine (Part I)].

The objective of this work is to offer a general introduction of the legal regulation of the Reproductive Medicine that is practiced in the United States of America. In the United States, besides the Federal Administration, there are also fifty state juridical instances who have competence in Assisted Reproduction subjects. The first section studies the limits of the Right to Reproduction. The American Constitution, interpreted by the Supreme Court, has been useful to establish the limits. Then, will be analyzed the reasons that have been taken by the legislator to adopt a permission with regard to issues appeared by the Medicine of the Fertility. Once studied the general context of the regulation of the Procreation Technology, it is exposed the state legislation and jurisprudence about the matter, and it is also made a review to the most relevant doctrine opinions of the american jurist in relation to Assistance to Reproduction. The cultural and juridical answers that these new clinic methods have used to control, improve or limit the reproduction capacity of human beings are almost as interesting as the Reproductive Technology. Contrary to what happens in Europe, where the legislator has firmly establish the regulation of the Reproductive Medicine since the late 80's, in North-America the lack of regulation has caused a free market where all kind of treatments of fertility are offered, just up to the point that an American author has called the sector "wild west of the Medicine".

Human Rights↗

[The application of quality control system in reproductive medicine center].

Uniform standards are required for evaluating the quality of reproductive medicine center engaged in vitro-fertilization and embryo transfer. Clinic pregnancy rates in common use are not in evaluation focus. More internationalized standard methods should be used to assess the quality of IVF center.

Embryo Transfer↗

Towards less confusing terminology in reproductive medicine: a proposal.

The use of the term 'infertility' and related terms in reproductive medicine is reviewed. Current terminology is found to be ambiguous, confusing, and misleading. We recommend that the fertility investigation report of a couple should consist of statements concerning description, diagnosis, and prognosis. The description concerns the duration of nonpregnancy before consulting the clinician. A system for prognostic grading is proposed. The fertility investigation report forms the basis for further action, including the possibility of waiting with treatment in case of almost normal or only slightly reduced fertility. The use of the terms 'infertility', 'subfertility', and 'fecundity' is not necessary, and it is recommended to avoid them.

Humans↗

Towards less confusing terminology in reproductive medicine: a proposal.

The use of the term "infertility" and related terms in reproductive medicine is reviewed. Current terminology is found to be ambiguous, confusing and misleading. We recommend that the fertility investigation report of a couple should consist of statements concerning description, diagnosis and prognosis. The description concerns the duration of non-pregnancy before consulting the clinician. A system for prognostic grading is proposed. The fertility investigation report forms the basis for further action, including the possibility of waiting with treatment in case of almost normal or only slightly reduced fertility. The use of the terms infertility, subfertility and fecundity is not necessary, and it is recommended to avoid them.

Humans↗

Is addressing the needs of its membership an easy task for the American Society for Reproductive Medicine?

The survey conducted by the American Society for Reproductive Medicine (ASRM) aimed to increase our understanding of the practices and opinions of ASRM members and to assist in decision making for the benefit of the society. Despite some limitations, this is the first step for ASRM to understand better its members, on whom its existence depends and whom it should serve.

Attitude of Health Personnel↗

[Responsibility of the physician in reproductive medicine].

The article explores the responsibility of the physician in reproductive medicine as a therapist of the couple and the child. It is based on the understanding of responsibility as a term with six relations. The article emphasizes that responsibility can only be ascribed to the physician with regard to the structure of the physicians acting.

Ethics, Medical↗

Reproductive medicine in the second half of the 20th century.

This communication reviews the most important achievements of human reproductive medicine during the last 50 years. The progress in this discipline has been so profound and unexpected that it has raised ethical questions of a fundamental character. Over the last 50 years of this century, new insight into reproductive processes enabled the following development: hormonal contraception, gonadotropin-releasing hormone (GnRH) and its agonistic and antagonistic analogues, prostaglandins: induction of labor and conquering dysmenorrhea, selective estrogen receptor modulators (SERM), assisted reproductive technologies (ART), and recombinant DNA technology and cloning. Currently, safe and effective contraceptive methods are available. Control of the world population growth is not a medical issue anymore: it is a political and social problem. Governments, and national and ideological leaders must share the responsibility for creating a social and economic milieu that facilitates women's education, provides access to birth control methods, and motivates the population to limit its own growth. At the same time, society must foster traditional family and moral values Vis a Vis sex. (Fig. 6, Ref. 22.)

Female↗

Medical education with the Internet: a pilot training programme in reproductive medicine.

Following a detailed information technology survey in the South West Deanery, an Internet educational programme in reproductive medicine was constructed, delivered and assessed. The course followed a problem-based approach using case studies, using an education website and electronic mail (e-mail) to communicate between trainees and trainers. Independent evaluation revealed a high level of satisfaction for both trainees and trainers with an increase in trainees' confidence to deal with patients following the course. This study suggests that the Internet may be used effectively to deliver postgraduate medical education, if the training programme is designed appropriately to computer infrastructure and the computer literacy of the users.

Education, Distance↗