Reproductive Biomedicine and Society Online最新文献

In this paper, I explore the narratives on the administration of assisted reproductive technology (ART) treatments amongst ageing men and women who are past their ‘reproductive prime’. I use the phrase ‘past their reproductive prime’ with caution as ART has the capability to resurrect the desire, quest and conception of children amongst these ageing women and men. In rural agrarian Haryana in North India, ART panders to, and provides, potent narratives for perpetuation of the patrilineage for genetic continuity through the male line. The administration of ART treatments to this particular demographic is undertaken through the ‘operation’ of two particular forms of discourse: the desire for genetic perpetuity, and the pursuit of sons. In this enterprise, the aged pregnant body becomes an important trope of resurrecting childless marriages, evidenced by the secrecy surrounding the use of donated sperm, and the open rejection of adoption. Through an exploration of conceptualizations of pregnancy, age and legislation in India, I present the argument that ART supports the pursuit of genetic connectedness by resurrecting the social importance of genetic connectedness through sons and the pregnant wife. In this paper, I purposely engage with elements of the study of kinship and family in South Asia to undertake an analysis of how ART is used as part of a larger social narrative around conception and pregnancy amongst older married couples.

Most studies of the psychosocial consequences of infertility have focused on those who seek medical treatment, leaving a research gap regarding the psychosocial consequences of perceived inability to procreate in the general population. Moreover, most studies are cross-sectional and the results are thus likely affected by omitted variable bias. Inspired by aspects of the Theory of Conjunctural Action, this study analysed 10 waves of data from the German Family Panel (pairfam) for women and men using fixed effects panel regression and including time-varying control variables suggested by theory and research. This study found that both women and men experienced lower life satisfaction in years when they perceived an inability to procreate. This association was not affected by the inclusion of relevant time-varying control variables. Furthermore, the association between perceived barriers to procreation and life satisfaction was found to differ depending on life circumstances and gender. Women with partners and men without partners had lower life satisfaction when they perceived an inability to procreate compared with when they did not. Women and men who intended to have a(nother) child had lower life satisfaction when they perceived an inability to procreate compared with when they did not. The association, however, was only significant for men. Somewhat surprisingly, women who perceived an inability to procreate also had lower life satisfaction when they were not intending to have a(nother) child. This study makes an important contribution to research on the psychosocial consequences of perceived infertility, and provides insights into why some people may pursue assisted reproductive technology for family creation.

Most women and men want and expect to have children. Parental age and some health behaviours affect fertility and the chance of conception. The aim of this study was to gauge people’s parenthood aspirations and knowledge about the factors that affect their chance of achieving them. Members of an Australian probability-based online panel aged 18–45 years were invited to complete a survey with questions about parenthood goals and knowledge about factors known to affect fertility. Of the 965 eligible people, 716 (74.2%) completed the survey. Only 6% stated that they did not want biological children. Around one in 10 respondents had experienced infertility. Amongst respondents aged 35–45 years, almost one in five (18%) had experienced infertility. Overall, respondents reported high levels of confidence about their understanding of preventative measures associated with safe sex and avoiding unwanted pregnancies. However, confidence in understanding of factors affecting ability to conceive was lower. Almost one-third of respondents believed that female fertility starts to decline between the ages of 35 and 39 years, and another one-third of respondents believed that the decline starts at 40 years of age or later. One in four respondents believed that male fertility starts to decline at 50 years of age or later. Findings suggest that people of reproductive age in Australia have inadequate knowledge about the factors that affect the chance of achieving their parenthood goals. Fertility health education initiatives are needed to allow people to make informed decisions about childbearing, and reduce the risk of unfulfilled parenthood aspirations.

Like other assisted reproductive technology (ART) procedures, the cost of egg freezing (EF) is significant, presenting a potential barrier to access. Given recent technological advancements and rising demand for EF, it is timely to reassess how EF is funded. An online cross-sectional survey was conducted in Victoria, Australia and was completed by 656 female individuals. Participants were asked their views on funding for both medical and non-medical EF. The median age of participants was 28 years (interquartile range 23–37 years) and most participants were employed (44% full-time, 28% part-time, 33% students). There was very high support for public funding for medical EF (n = 574, 87%), with 302 (46%) participants indicating support for the complete funding of medical EF through the public system. Views about funding for non-medical EF were more divided; 43 (6%) participants supported full public funding, 235 (36%) supported partial public funding, 150 (23%) supported coverage through private health insurance, and 204 (31%) indicated that non-medical EF should be self-funded. If faced with the decision of what to do with surplus eggs, a high proportion of participants indicated that they would consider donation (71% to research, 59% to a known recipient, 52% to a donor programme), indicating that eggs surplus to requirements could be a potential source of donor eggs. This study provides insights that could inform policy review, and suggests revisiting whether the medical/non-medical distinction is a fair criterion to allocate funding to ART.

Metabolic risk factors such as obesity are considered major obstacles to female fertility. Chronic infertility imposes psychological and social burdens on women because infertility violates societal gender roles. Although the prevalence of obesity among women is expected to increase in the future, the relevance of metabolic status for fertility is still underestimated. However, the assessment of metabolic risk factors is highly relevant for understanding fertility disorders and improving infertility treatment. This narrative review discusses the associations of metabolic risk factors (e.g. obesity, female athlete triad, oxidative stress) with significant infertility. An electronic search was conducted for studies published between 2006 and 2020 in Cumulative Index to Nursing and Allied Health Literature, ScienceDirect, PubMed, Scopus, Google Scholar and related databases. In total, this search identified 19,309 results for polycystic ovary syndrome, 28,969 results for endometriosis, and only 1611 results for idiopathic and/or unknown infertility. For the present narrative review, 50 relevant studies were included: 19 studies were on obesity, 24 studies investigated the female athlete triad, and seven studies addressed other risk factors, including reactive oxygen species. This narrative review confirms the direct impact of obesity on female infertility, while the effect of other risk factors needs to be confirmed by large-scale population studies.

This article examines the West German controversy over Duogynon, a ‘hormone pregnancy test’ and the drug at the centre of the first major, international debate over iatrogenic birth defects in the post-thalidomide era. It recovers an asymmetrical power struggle over the uneven distribution of biomedical knowledge and ignorance (about teratogenic risk) that pitted parent-activists, whistleblowers and investigative journalists against industrialists, scientific experts and government officials. It sheds new light on the nexus of reproduction, disability, epidemiology and health activism in West Germany. In addition, it begins to recover an internationally influential discourse that, in the post-thalidomide world, seems to have resuscitated antenatal drug use as safe until proven harmful.

This commentary evaluates the contributions to this special issue through a feminist lens. It reviews the field of ignorance studies and two distinguishable areas in the field: undone science and ignorance/non-knowledge. It points to ways in which the articles in this special issue engage with the social production of ignorance. It explores feminist roots of ignorance studies, including feminist ignorance epistemologies, identifies strengths and gaps in ignorance studies, and suggests possible lines of future work.

This study examined awareness about fertility among immigrant women and non-migrants in Germany. The social relevance of infertility and fertility treatment is increasing in Western countries due to continually low overall birth rates, a high rate of childlessness, and a gap between the desired and actual numbers of children. While there is growing interest in infertility and reproductive medicine in general, previous studies have rarely included immigrant or ethnic minorities in Europe. This study investigated whether knowledge on the age-related fertility decline (ARFD) varies between migrant groups and the majority group, and the role of education. Working hypotheses were drawn from theoretical considerations on frameworks of migrant assimilation. The analysis was based on data collected in a social science pilot study on reproductive medicine, representative of the general population (‘NeWiRe’ 2014–2015). The sample included 962 women aged 18–50 years living in Germany. Approximately 81% of the sample were immigrants who originated from Turkey, Poland, the Balkan countries or countries of the (post-Soviet) Commonwealth of Independent States. While rather poor overall, knowledge on ARFD was found to be significantly lower in the migrant groups compared with the majority group. This minority-group disadvantage cannot be explained by sociodemographic or cultural variables. Future research should include minority groups in empirical studies on awareness about fertility in order to better understand the causes of this disadvantage, and the potential reproductive needs of migrants.

As scientific evidence from the UK and the USA in the 1980s was questioning the usefulness of episiotomy, the rate in France increased from 38% in 1981 to 58.4% in 1996. In 1996, the World Health Organization recommended limiting the episiotomy rate to 10%. This article aims to examine this paradox through an analysis of the French medical debate on episiotomy during the 1980s and 1990s. Drawing on an analytical corpus composed of 192 articles published in French professional journals of obstetrician-gynaecologists and midwives, it shows that the majority of these health professionals considered episiotomy to be a preventive intervention. The most influential professional organizations and experts manage to refute most of the international alerts on the limitations and side effects of episiotomy through the constant production of new justifications and competing knowledge for the procedure. In the 1980s, episiotomy was seen as a means to prevent tearing and thus avoid perineal dysfunction. Episiotomy and perineal re-education (which developed into a new health sector) were put forward as ‘the’ solution to the problem. From the mid-1990s onwards, the focus shifted from the mother to the baby as episiotomy was promoted as a way to reduce the risk of newborn mortality and morbidity. This article shows that the alerts and controversies on the assumed iatrogenic effects of biomedical technologies and practices were silenced through efficient and dynamic production of competing knowledge about their assumed benefits.

Drawing on scholarship from ignorance studies, this paper uses the case of the UK debates on mitochondrial donation (2012–2015) to emphasize the importance of deploying an analysis of ignorance that goes beyond medical and safety concerns when scrutinizing debates or campaigns around new reproductive technologies. In contrast to what happened with previous reproductive health treatments or drugs, the potential medical risks of mitochondrial donation were explicitly acknowledged and examined during its public and parliamentary discussions. However, I show, using the concepts of ‘acknowledged unknowns’ and ‘ignored knowns’, how the attention drawn to the medical risks contributed to obscuring the assessment of its economic and social impacts by silencing key knowledge regarding the limitations of mitochondrial donation in relation to the potential beneficiaries, the scope of the techniques, their alternatives and their costs. This article therefore calls for more systematic use of an integrated analytical framework of ignorance to be applied in the field of reproductive public policies, paying particular attention not only to the ways that medical risks are addressed, but also to the type of knowledge and disciplines this allows to silence or side-line in the framing and assessment of new biotechnologies.