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PubMed1987

Power, certainty, and the fear of death.

Reproductive technology has been poorly used because both health care providers and clients unrealistically expect it to prevent all death and uncertainty. Because of this we often get the risks, side effects, and inaccurate information without benefits. Poorly used reproductive technology also deskills both providers and clients. Used realistically and controlled by women--birthing women and midwives--this technology can be of great benefit to us and our children.

Attitude to Death↗
PubMed1993

Japanese attitudes toward assisted procreation.

CONCLUSION: Based on the present results, the following points are suggested: First, there are significant attitudinal differences [in Japan] on new reproductive technologies between infertile couples and married laypersons; laypersons' attitudes were not so affirmative as those of infertile couples. Second, among the group of infertile couples, male respondents showed more affirmative attitudes toward assisted procreation than female respondents. Third, the main reason for approving of new reproductive technologies was that "it is a treatment for infertility," while the main reasoning of those who disapproved of them was that "it conflicts with the way of nature."

Attitude↗
PubMed2004

HIV and reproduction.

PURPOSE OF REVIEW: Three quarters of individuals infected with HIV are in their reproductive years and can expect an almost normal life expectancy under antiretroviral treatment. Many of them want to have a child and reproductive counselling and care can offer a sharp reduction in both sexual and vertical transmission rates. RECENT FINDINGS: Most couples with HIV are formed by an infected man and an uninfected woman; in this setting, semen washing coupled with reproductive technology can be applied to eliminate the risk of sexual transmission of the virus. Semen washing is a processing method which reduces both HIV RNA and DNA to undetectable amounts. In couples in which only the woman is infected, self-insemination might be indicated. When both partners are carrying HIV, semen washing can be used in couples with different viral strains. HIV can be vertically transmitted and the risk of infection for the infant can be decreased to approximately 1% by reducing maternal viral load, elective caesarean section and avoidance of breastfeeding. In pregnancy the efficacy of antiretroviral treatment should be balanced against the possibility of embryonic or fetal toxicity. Caesarean section, performed electively, has proven its protective efficacy, without significant maternal morbidity. Its role should now be reassessed in mothers with undetectable viral load. Breastfeeding, discouraged to avoid postnatal transmission, might be possible in the future, with antiretroviral therapy capable of suppressing viral excretion in maternal milk. SUMMARY: Semen washing, reproductive technology, antiretroviral therapy and obstetrical care can work in sequence to allow safe reproduction in couples infected with HIV.

Female↗
PubMed2006

Transmission of male infertility and intracytoplasmic sperm injection (mini-review).

The fact that genetic aetiology is responsible for approximately one third of all kinds of male sterility has led to concerns regarding the application of artificial reproductive technologies in the cases of azoospermia and severe oligozoospermia. Congenital sterility could be caused by gene mutation, quantitative or structural abnormality of sexual chromosomes or autosomes. The possibility of inherited transmission of male sterility within the context of applying artificial reproductive technologies is analysed in the article. Klinefelter's syndrome, mutation of cystic fibrosis transmembrane conductance regulator (CFTR) gene, which causes cystic fibrosis, and mutation of azoospermia factor zone (AZF) of Y-chromosome are among the most frequent genetic causes of severe oligozoospermia and azoospermia. The probability of a mutation of the CFTR gene being transmitted to the next generation is 50%. The probability of inherit transmission of Klinefelter's syndrome of mosaic karyotype could reach 70%. The probability of transmission of AZF mutation to children of male sex, generated with ICSI, is 100%. The percent of men with AZF mutation among users of ICSI centers, ranges from 3.2% to 14%. It means that at least 3.2 % of all boys conceived with ICSI will be sterile because of mutation in the AZF zone of Y-chromosome. It should be noted that genetic analysis and counselling do not always occur before the beginning of artificial fertilization cycles. Parents-to-be do not always have an opportunity to learn about the genetic risks of their unborn child and make any subsequent and responsible decisions. Among the decisions is a choice of not resorting to ART, but to live with the infertility and explore other opportunities for parenthood. Responsibility for high risk of conceiving a child with genetic anomalies rests not only with the parents, but also with all of society, including those responsible for research, technology, and legislation, in the health care profession.

Chromosome Deletion↗
PubMed2001

Transgenesis may affect farm animal welfare: a case for systematic risk assessment.

This paper considers (potentially) harmful consequences of transgenesis for farm animal welfare and examines the strategy of studying health and welfare of transgenic farm animals. Evidence is discussed showing that treatments imposed in the context of farm animal transgenesis are by no means biologically neutral and may compromise animal health and welfare. Factors posing a risk for the welfare of transgenic farm animals include integration of a transgene within an endogenous gene with possible loss of host gene function (insertional mutations), inappropriate transgene expression and exposure of the host to biologically active transgene-derived proteins, and in vitro reproductive technologies employed in the process of generating transgenic farm animals that may result in an increased incidence of difficult parturition and fetal and neonatal losses and the development of unusually large or otherwise abnormal offspring (large offspring syndrome). Critical components of a scheme for evaluating welfare of transgenic farm animals are identified, related to specific characteristics of transgenic animals and to factors that may interact with the effects of transgenesis. The feasibility of an evaluation of welfare of transgenic farm animals in practice is addressed against the background of the objectives and conditions of three successive stages in a long-term transgenic program. Concrete steps with regard to breeding and testing of transgenic farm animals are presented, considering three technologies to generate transgenic founders: microinjection, electroporation and nuclear transfer, and gene targeting including gene knockout. The proposed steps allow for unbiased estimations of the essential treatment effects, including hemi- and homozygous transgene effects as well as effects of in vitro reproductive technologies. It is suggested that the implementation of appropriate breeding and testing procedures should be accompanied by the use of a comprehensive welfare protocol, specifying which parameters to monitor, at which stages of the life of a farm animal, and in how many animals. Some prerequisites and ideas for such a protocol are given. It is anticipated that systematic research into the welfare of farm animals involved in transgenesis will facilitate the use of the safest experimental protocols as well as the selection and propagation of the healthiest animals and, thereby, enable technological progress that could be ethically justified.

Animal Welfare↗
PubMed1998

[Infertility and some of its psychosocial aspects].

The paper gives account of several psychosocial aspects of infertility. Firstly, the author deals with a fact that infertility impede the desire to produce a child and the socially created need to become a parent. The M. Hunter's model of biopsychosocial aspects of reproductive problems is used as a framework for analysing the complexity of factors which influence single person's reactions to infertility and its treatment. Secondly, the authors gives a summary of feminist critique of reproductive technologies. These technologies are widely used and accepted as a way to overcome infertility, but they create some additional problems. These problems are discussed using four types of arguments: anti-biological, anti-medical, eugenic and those considering women's reactions to reproductive technologies. All of these arguments are based on feminist publications. Thirdly, the author discusses the similarities and differences in male and female reactions to infertility. It is argued that two tendencies are observed while reactions to infertility are researched: the first is see those reactions as entirely different while the second is to see them as very similar. These controversy can be explained on the ground of different research methodology, the notion of infertile persons as a homogeneous group, the lack of proper theoretical model to contain all aspects of gender differences in reactions to infertility.

Female↗
PubMed2000

Embryo donation programs and policies in North America: survey results and implications for health and mental health professionals.

OBJECTIVE: To use survey results from Society of Assisted Reproductive Technology to describe program policies regarding embryo donation, report protocols used for the disposition of cryopreserved embryos, and discuss clarification of guidelines governing ethical and psychosocially informed embryo donation. METHOD(S): A 66-item questionnaire was sent to the 312 Society of Assisted Reproductive Technology programs, generating 108 responses. RESULT(S): Seventy-eight (72%) of 108 programs offer embryo donation. Forty (37%) have actually performed donation, with 246 cycles completed and 53 "take-home babies." Disposition agreements for donors address divorce (92%) and death (90%). Only 28% require that potential donors undergo psychologic evaluation. Ninety-five percent of programs do not compensate donors. Seventy-one percent require a complete medical and psychologic history and 10% require genetic karyotyping. Three percent limit the number of donations. Eligible recipients include married couples (100%), unmarried couples (61%), lesbian couples (55%), and single women (59%). Sixty-four percent of programs require psychologic screening. Storage limits range from 2-10 years. Forty-nine percent of programs have unclaimed embryos in storage. CONCLUSION(S): Embryo donation is more often contemplated than performed. Variability in program procedures and policies suggests that guidelines need to be clarified. The complexity of the psychosocial and ethical issues underscores the importance of a routine, comprehensive psychologic assessment.

Female↗
PubMed1999

Immature oocyte retrieval with in-vitro oocyte maturation.

Early studies of in-vitro fertilization used immature oocytes. The process evolved to retrieving metaphase II oocytes, and was eventually successful. At present, aggressive ovulation induction protocols are the mainstay of assisted reproductive technology programs, but not without increased cost, multiple gestations, morbidity, potential future risks and isolated mortalities. The ability to retrieve each month's cohort of immature oocytes transvaginally opened the door to search for a new option for infertile couples requiring assisted reproductive technology. Immature oocyte retrieval combined with in-vitro oocyte maturation eliminates the stimulation, costs and time that were required to monitor oocytes, along with the short- and long-term complications. The essential components are optimal maturation media and a synchronized endometrium in which the embryos transferred from a truncated follicular phase can implant. The process has been successful in several centers with an acceptable success rate when used in conjunction with a host uterus. Future research with maturation, culture, and endometrial synchronization may allow immature oocyte retrieval with in-vitro oocyte maturation to replace in-vitro fertilization in its present form.

Cryopreservation↗
PubMed2003

Measuring uterine depth with colpohydrosonography.

OBJECTIVE: To evaluate the accuracy of colpohydrosonography for measuring uterine depth. STUDY DESIGN: Uterine depth was assessed in 64 women being evaluated for assisted reproductive technology treatment in a high-volume private practice. After noting the cavity depth by standard transvaginal ultrasonography, a small amount of saline (10-20 mL) was instilled into the vagina, and the uterine depth was remeasured. The results were compared to the depth measured by mechanical sounding performed during a different evaluation. The sonographic measurements of uterine cavity depth were correlated with mechanical sounding. RESULTS: Colpohydrosonography correlated strongly with uterine depth as measured by mechanical sounding (r = .89), while standard vaginal ultrasound correlated less well with sounding (r = .66). There was < 5% difference between colpohydrosonography and mechanical sounding in 89% of patients, while 48% of standard vaginal ultrasounds varied from sounding by > 10%. CONCLUSION: Colpohydrosonography is a simple procedure that more accurately measures uterine cavity depth than conventional transvaginal ultrasound alone. Improved precision of cavity depth measurement could have implications for improving embryo placement during assisted reproductive technology treatment.

Adult↗
PubMed1997

Variation in the determination of follicular diameter: an inter-unit pilot study using an ultrasonic phantom.

Ultrasound operators in assisted reproductive technology units in New South Wales, Australia cooperated in a study that was conducted to assess their ability to measure fixed objects embedded in an ultrasound phantom. The results have demonstrated a large variation ranging between 10 and 25% coefficient of variation on distances between 10 and 32 mm. As ultrasonic imaging is the only component of assisted reproductive technology not currently controlled by an external quality assurance scheme, the authors suggest there may be a need to establish a programme.

Female↗
PubMed2005

Animal biotechnology: applications and economic implications in developing countries.

In most developing countries, biotechnological applications relating to livestock need to be suitable for animal owners who are resource-poor small-scale operators who own little or no land and few animals. Livestock is becoming increasingly important to economic growth in developing countries and the application of biotechnology is largely dictated by commercial considerations and socio-economic goals. Using technology to support livestock production is an integral part of viable agriculture in multi-enterprise systems. Livestock are part of a fragile ecosystem and a rich source of animal biodiversity, as local species and breeds possess genes and traits of excellence. Molecular markers are increasingly being used to identify and select the particular genes that lead to these desirable traits and it is now possible to select superior germ plasm and disseminate it using artificial insemination, embryo transfer and other assisted reproductive technologies. These technologies have been used in the genetic improvement of livestock, particularly in cattle and buffaloes, and the economic returns are significant. However, morbidity and mortality among animals produced using assisted reproductive technologies lead to high economic losses, so the principal application of animal biotechnology at present is in the production of cheap and dependable diagnostic kits and vaccines. Several obstacles limit the application of biotechnology at present: there is a lack of infrastructure and insufficient manpower, so funding is needed if resource-poor farmers are to benefit from biotechnology.

Animal Husbandry↗
PubMed1998

The changing moral landscape of human reproduction: two moments in the history of in vitro fertilization.

Ethical attitudes toward in vitro fertilization (IVF) have varied historically. This paper discusses the changes in views about the morality of human IVF by exploring the response to a pair of critical moments in the history of this reproductive technology: the announcement of the first successful IVF experiment by John Rock and Miriam Menkin in 1944 and the first successful IVF live birth of Louise Brown in 1978. By exploring public and private reactions to these two events in the context of wider social and political developments, this paper demonstrates the degree to which our notions of the morality of medical experimentation and of reproductive technologies are socially constructed and historically contingent.

England↗
PubMed2006

Deafness, genetics and dysgenics.

It has been argued by some authors that our reaction to deaf parents who choose deafness for their children ought to be compassion, not condemnation. Although I agree with the reasoning proposed I suggest that this practice could be regarded as unethical. In this article, I shall use the term "dysgenic" as a culturally imposed genetic selection not to achieve any improvement of the human person but to select genetic traits that are commonly accepted as a disabling condition by the majority of the social matrix; in short as a handicap. As in eugenics, dysgenics can be achieved in a positive and a negative way. Positive dysgenics intends to increase the overall number of people with a particular genetic trait. Marriage between deaf people or conceiving deaf children through reproductive technology are examples of positive dysgenics. Negative dysgenics can be obtained through careful prenatal or pre-implantation selection and abortion (or discarding) of normal embryos and foetuses. Only deaf children would be allowed to live. If dysgenics is seen as a programmed genetic intervention that undesirably shapes the human condition--like deliberately creating deaf or dwarf people--the professionals involved in reproductive technologies should answer the question if this should be an accepted ethical practice because the basic human right to an open future is violated.

Deafness↗
PubMed2000

Successful twin pregnancy in a dual-transplant couple resulting from in-vitro fertilization and intracytoplasmic sperm injection: case report.

There are numerous reports of successful pregnancy following liver transplantation. Little information is available regarding the incidence and management of infertility in transplant recipients, particularly the use of artificial reproductive technologies. We present a case of a successful twin pregnancy resulting from in-vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI) in a liver transplant recipient, whose partner was a renal transplant recipient with severe oligozoospermia. With careful evaluation and monitoring, and the involvement of appropriate consultants, artificial reproductive technologies can be safely used in transplant recipient couples experiencing infertility.

Adult↗
PubMed2001

Three blastocyst stage embryo transfer resulting in a quintuplet pregnancy.

High-order pregnancies are associated with high morbidity and mortality and the incidence is increased as a drastic complication of assisted reproductive technology. This case presents a high-order pregnancy achieved by transfer of three blastocyst stage embryos resulting in a quintuplet pregnancy including a monochorionic triplet. Following the selective termination of the monochorionic triplet, two healthy children were born. The mechanism of monochorionic development and its association with assisted reproductive technology are discussed.

Adult↗
PubMed1989

Application of computer technology to reproductive endocrinology.

Data manipulation and information management activities are as central to physicians as writing is to the literary profession. It is not surprising that the computer, as an information tool, has become important and accepted in many aspects of our professional lives. Computer applications can significantly help in daily patient care activities as well as serve as instruments for advancing and managing medical knowledge. Even if the rate of computer technology change slows down from its exponential increase in the last decade, useful software applications will continue at the same or faster rate since they do not now, fully utilize existing hardware features. This presents an exciting future for all information management, decision-rich professions.

Computer Systems↗
PubMed1994

Successful implementation of a regional in vitro fertilization program.

In vitro fertilization and other assisted reproductive technologies are becoming widely accepted modalities of treatment for infertile couples. Like other modern technologies, in vitro fertilization requires specially trained physicians and scientists who need specially dedicated equipment and space. In addition, patients having the procedure must undergo timely laboratory tests and sonographic evaluations for monitoring follicular maturation. To make in vitro fertilization available to patients in north central Florida, the Division of Reproductive Endocrinology and Infertility of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Gainesville established a system that utilizes local resources in three distant locations. Patients in an assisted reproductive technologies cycle are monitored at satellite locations but coordinated through the University of Florida in vitro fertilization team. Oocyte retrieval, laboratory handling of gametes and embryo transfer are performed at the Shands Teaching Hospital in Gainesville. Micromanipulation for severe male factor infertility and oocyte donation are available when needed. Preimplantation diagnosis for genetic conditions is under development. The ongoing pregnancy and delivery rate is 21% per cycle initiated from July 1, 1992, to July 3, 1993, 62% above the reported national pregnancy rate for 1991. This program may be a useful model for the development of collaborative efforts in delivering highly complex medical services to large populations.

Academic Medical Centers↗