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A closer look at reproductive technology and postmenopausal motherhood.

Although reproductive technologies have been aimed at young, infertile women, evidence suggests that postmenopausal women are also taking advantage of them. Dr. Eike-Henner Kluge asserts in an article in CMAJ (1994; 151; 353-355) that there are ethical reasons to deny older women access to these technologies. Kluge's comparison of postmenopausal women to prepubescent girls is fallacious. His assertion that older parents harm children by denying them a "normal" childhood is not supported by any empiric data. Kluge's distinction between medical intervention, in offering reproductive technologies to a woman in her reproductive years, and "improving on nature", by offering these technologies to postmenopausal a woman is spurious. Unless technologies that are expensive and minimally successful, such as in-vitro fertilization, are denied to everyone, there are no grounds for denying them to postmenopausal women.

Adolescent↗

Monitoring reproductive health in Europe--what are the best indicators of reproductive health?

Setting up goals to monitor if the goals are achieved and to compare health performance over time and between regions is part of modern health care. A key part in this process is to choose the right indicators. The indicators in reproductive health should be selected on the basis of relevance and validity. They should be simple and action oriented because monitoring for the sake of monitoring alone may do more harm than good. We invite comments from the readers of Human Reproduction on a set of indicators suggested by Reprostat.

Europe↗

Workplace policy on hazards to reproductive health.

At present, workplace policies regarding reproductive hazards are not regulated directly, and inappropriate policies are occasionally corrected by legal actions or union pressures on the employers. Further, information on reproductive hazards is incomplete; however, employees have a legal right to know available information about hazards, including reproductive hazards, that they face in the workplace. Occupational health personnel play a major role in communicating information about reproductive hazards in the workplace and in implementing company policy and complying with legislation. Regulatory and case law likely will continue to evolve as many issues related to safety from reproductive hazards in the workplace have not yet been resolved.

Ethics, Medical↗

Epidemiology of occupational reproductive hazards: methodological aspects.

Both male and female workers may be exposed to occupational agents which affect their reproductive processes. Reproductive outcomes are important in their own right, for example teratogenic effects and impaired neurological development. In addition, reproductive impairment may indicate germ cell mutation, which has far-reaching implications. Research into reproductive effects is beset with pitfalls. Applying the results of toxicological research may be suggestive, but such extrapolation is very unreliable owing to profound differences in reproductive and/or toxicological mechanisms. Epidemiological data are therefore indispensable. Optimal methods of data collection and study design, comparable with similar studies of other populations, are essential. Otherwise reliable conclusions cannot be drawn, and this is a waste of resources and of the work and cooperation of everyone who participates in the research. In considering study design, the key question is the measurement (or minimally, the accurate description) of exposures, which is more problematic than the ascertainment of reproductive outcome variables. From the viewpoint of exposures, case control studies have the same disadvantage as studies of the general population, that exposures are heterogeneous, and most specific exposures are therefore rare, even in a large study; in addition, measurement is particularly difficult in this situation. Occupationally defined populations have the corresponding advantages of relative homogeneity and availability of data, although even here numerous problems exist, which are well known. Outcomes can be assessed by means of biological or questionnaire-based methods. They are best regarded as complementary, as each has its strengths and weaknesses.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Drug-Induced↗