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[In assisted reproduction technology there is not systemic age limitation].

The age limit imposed upon women who which to undergo ART is unfair. Of course success rates decrease strongly for women over 40, and women must be informed of it. But if the ovarian reserve of these women is normal, and if they answer correctly to ovarian stimulation, there is no good reason to refuse them ART.

Adult↗

Forensic considerations of surrogacy -- an overview.

In the past two decades, there has been a spectacular change in the field of reproductive technologies. Reproductive sciences have come in with techniques such as donor insemination; in vitro fertilization and embryo transfer methods, which have completely revolutionized the reproductive environment. These techniques have given hope to many infertile couples, who wish to have a child of their own. With the oncoming of surrogacy agreements, concepts of fatherhood and motherhood have been subject to much controversy. Motherhood was never under much scrutiny as it was rightly thought that childbirth was the natural and conclusive fact establishing it, though paternity was at times a controversial concept burdening legislators to provide for suitable tests. Medical sciences have now compartmentalized motherhood into the genetic, gestational and the social mother leading to a clash of interests. This paper reviews some medicolegal, ethical and social aspects of surrogacy.

Altruism↗

Education and the new technologies in reproduction.

Since 1978 technologies applied to human reproductive biology have resulted in totally new ways of making families. Traditionally education has presented science as a value-free body of absolute knowledge, neatly divided into discrete disciplines. This has resulted in a fragmented approach to the teaching of human reproduction. Many students are leaving school today confused and ignorant about contraception and their own fertility. How will education deal with new methods of controlling and promoting human fertility and family planning? Should the curriculum include: the scientific details of the technologies; the nature and known causes of infertility; the recent legislation designed to limit these technologies; the implications for the family as the fundamental social unit? If so, where in the curriculum, and taught by whom? This paper critically examines these possibilities with particular focus on the confused role of genetics in defining parents and families, both in the literature and in recent Victorian legislation designed to regulate new reproductive technologies. A more precise definition of the concept of 'mother' which acknowledges all three components, genetic, birth and social is suggested for inclusion in a broader curriculum about human reproduction, preferably within science education.

Australia↗

[Psychological condition of children from pregnancies after assisted reproduction in the third year of life].

OBJECTIVE: To analyse psychological development of children born after assisted reproductive technology. DESIGN: Psychological analysis of the child's development related to the technology of assisted reproduction, length of pregnancy and multiple birth was performed and compared with the control group. SETTING: Institute for the Care of Mother and Child, Prague. METHODS: Out of the total number of 123 children born after assisted reproductive technology during the 1st half of the year 1998 in the Center ISCARE IVF, psychological development was evaluated in 109 children (88.6%). Ninety four children from this sample were assessed using mental, motor and behavior scales of the Bayley Scales of Infant Development II. RESULTS: Mental and motor development of infants born after intracytoplasmatic injection (ICSI) and after in-vitro-fertilisation (IVF) was not significantly different. Fullterm singletons born after assisted reproductive technology did not differ from control fullterm children. There was a developmental delay in both fullterm and preterm children from multiple pregnancies in comparison to control children. No child had serious impairment of psychic functions (developmental index <50). There were no significant differences in behavior records between children born after assisted reproductive technology and control children, but some parents had problems in educational care of their children born after assisted reproductive technology. CONCLUSION: From children born after assisted reproductive technology, those from multiple pregnancies may be at risk for later psychological development. The occurrence of educational problems in assisted reproductive families indicates a need of accessible professional care in this field.

Adult↗

Evaluating technologies in reproductive health: case studies of a consumer protection approach.

OBJECTIVE: A consumer-protection assessment and action program aimed at improving reproductive health technologies is reviewed. METHODS: Evaluations employed both literature review, synthesis, market analysis and laboratory testing for conformity to standards of a wide range of products which affect reproductive health on the Brazilian market 1995-1997. Anti-infective gynecological products, ampicillins, condoms, pregnancy tests, hormonal contraceptives, infant formulas, selected teratogens, bromocriptine and prostaglandins were studied. Actions include dissemination in periodicals and the mass media, consumer education, pressure for regulation, negotiations with manufacturers and legal action. RESULTS: The program was effective in improving the supply and regulation of some, but not all products studied. Impact on health and utilization are unknown. CONCLUSION: A significant proportion of products studied are unsafe, ineffective or of sub-standard quality. A combination of careful scientific work, strong links between scientists and social movements, dissemination and legal action, can effectively improve the quality of products which affect reproductive health.

Brazil↗

The end of motherhood as we have known it.

The new reproductive technologies have dramatic social implications, undermining previous biological assumptions about the relationships between mothers and fathers and children within families. Insofar as we may now distinguish between genetic motherhood, gestational motherhood, and social motherhood, three different women may participate in the decision to produce a child. Who is its "real" mother? Given the complicated interpenetration of nature and technology within reproductive situations today, we need to develop new social accounts of what it means to create a family. We require new narratives that highlight the wondrous kinship possibilities afforded by the new reproductive technologies while at the same time articulating the responsibilities of parenthood within new familial groupings.

Cloning, Organism↗

Reproductive laboratory technology: an alternative career.

OBJECTIVES: Define the job description for reproductive laboratory technologist (RLT); describe the RLT laboratory setting; identify education level and certification of the respondents; establish level of job satisfaction and job security; determine if certification and position affect performance and job satisfaction; compare RLT job with any previous clinical laboratory position; and document education and training important for the position. SURVEY INSTRUMENT: A questionnaire was developed with questions targeted to answer objectives. SURVEY POPULATION: The questionnaire was mailed to a random sample of 300 non-physician members from the Reproductive Biology Professional Group and the Reproductive Laboratory Technology Group from membership lists provided by the American Society for Reproductive Medicine. STUDY POPULATION: 81 survey respondents. RESULTS: RLTs are mostly college-educated, certified and non-certified laboratory professionals, trained on the job for specialty work in andrology and assisted reproductive technology (ART). Position, but not certification, correlate with job performance and job satisfaction. Respondents describe the position of RLT as stressful, but very interesting, exciting, fulfilling, and secure. Respondents with previous clinical laboratory experience rated level of job satisfaction higher for the reproductive laboratory. The CLS curriculum is an excellent background for RLT. CONCLUSIONS: RLT is an exciting career alternative for CLSs. Newly formed laws and regulations, and the demand for more stringent regulation, will continue to increase the demand for certified CLSs for this position. Formal education and certification requirements are anticipated for RLT. The specialty is being incorporated in CLS training programs.

Career Choice↗

Frequency of a monochorionic pair in multiple gestations: relationship to mode of conception.

OBJECTIVE: To determine whether the mode of conception affects the frequency of monochorionicity in multiple gestations. METHODS: Our study population consisted of all women with multiple gestations who had a first-trimester sonogram at our institution between May 1998 and April 2000. The frequency of monochorionicity in pregnancies conceived naturally was compared with the frequency in pregnancies achieved via any form of assisted reproductive technology and among the different types of assisted reproductive technology. RESULTS: Our study consisted of 464 multiple gestations comprising 332 twin, 113 triplet, 16 quadruplet, and 3 quintuplet pregnancies. The higher the fetal number, the more likely the pregnancy resulted from assisted reproductive technology (72.6% of twins, 84.1% of triplets, 92.8% of quadruplets, and 100% of quintuplets; P < .05, Fisher exact test). Monochorionic pairs were found more commonly in naturally conceived pregnancies than in those resulting from assisted reproductive technology (28.2% versus 5.4%; P < .000001, chi2 test). The frequency of monochorionic pairs after in vitro fertilization with blastocyst transfer on day 5 (10.5%) was double the frequency from in vitro fertilization with cleavage stage transfer on day 3 (4.9%), but the difference was not statistically significant (P = .24, Fisher exact test). CONCLUSIONS: Monochorionic pairs are relatively common in naturally conceived twins and in higher-order multiple gestations with more than 3 fetuses arising from assisted reproductive technology, but they are uncommon in twins and triplets arising from assisted reproductive technology There is a trend toward a higher frequency of monochorionic pairs after day 5 blastocyst transfer than day 3 transfer, but a larger study population is needed to confirm this finding.

Chorion↗

Reproduction trends and the emergence of moral panic.

Are we witnessing a moral panic or a moral evaluation in the responses to the new reproductive technologies? Locating women in reproductive technology is a particularly powerful way into a discussion of values and consequences, intended or unintended. Twelve areas are isolated for discussion beginning with issues of definition and location: What is reproductive and genetic engineering? and How does human reproduction fit into bio-technological developments generally? Next issues are raised about how the new developments are being shaped ideologically and how they are being promoted by the state. A series of legal issues affecting women, men, children, embryos and fetuses follow. The focus then shifts to the way women are ideologically constructed: Why is there an assumption that woman = mother, and mother = heterosexual married or stable cohabiting woman?--and socially controlled: Why assume technological change in human reproductive processes means the basic subordination of women to men will not alter? The usefulness of the new technologies in relieving involuntary childlessness is then queried which leads on to a questioning of whether these developments are qualitatively different from other technologies used in human reproduction. Futuristic concerns such as the importance of the male pregnancy and the social consequences of fully medicalising human reproduction are raised. The last area to be considered is protest by women and suggested alternative approaches to increase the social visibility and recognition of the needs and interest of women in the current and potential use of the new medical and scientific developments.

Female↗