Reproductive Biomedicine and Society Online最新文献

Endometriosis is a chronic gynaecological condition which has been referred to as the ‘missed disease’ due to its unclear aetiology and inconsistencies in its diagnosis and management. Unlike other long-term conditions such as diabetes and asthma, endometriosis has remained largely ignored in government policy and research funding globally. Drawing on scholarship from the growing field of ‘ignorance studies’, this paper considers how ambiguity around endometriosis is part of a wider constellation of discursive, material and political factors which enrol certain forms of knowledge whilst silencing, ignoring or marginalizing other forms of knowledge. It uses concepts of ‘undone science’ and ‘wilful ignorance’ to explore how an absence of knowledge on endometriosis is a result of structural, cultural and political processes and forces which privilege certain voices and communities. This paper suggests that the association of endometriosis with historically specific constructions of menstruation and women’s pain has informed contemporary imaginaries around the condition, including ideas about women being somehow accountable for their own illnesses. Applying an ignorance lens demonstrates how the legacy of invisibility of endometriosis shapes its place in the present political and social arena, and is reflective of a process of undone science. The paper concludes by arguing that the social and political significance of endometriosis as a chronic, life-limiting condition which affects millions of women globally continues to need attention, illumination and critique.

Conceptualizations of the ‘biological clock’ in popular imaginary in the USA centre on the temporal limits of fertility, with assisted reproductive technology (ART) an increasingly proposed answer to these constraints (at least in the public imaginary). In this study, I analyse how surrogates in the USA understand their own bioavailability for others’ reproductive needs in the commercial ART market vis-à-vis their own reproductive trajectories. Based on interview data with gestational surrogates, I propose a new concept of the ‘ART clock’ to capture how time shapes the experiences of reproductive workers in the US fertility clinic. My findings point to four important ART time-related issues: (i) women desiring to extend their own ‘biological clocks’ via surrogacy; (ii) significant time being needed to achieve and sustain third-party pregnancy; (iii) women extending their total reproductive time via repeat surrogacy ‘journeys’; and (iv) temporal constraints to surrogacy reproduction regarding time of year, the day-to-day time effort, the number of surrogacy journeys, the total number of pregnancies, and surrogates’ age and the ages of their children. Each of these aspects point to important ways that reproductive desire and time shape the labour of reproductive workers, highlighting temporal constraints to assisted reproduction and limits to ART as a solution to delayed reproduction and the biological clock.

Given the controversial nature of research into in-vitro gametogenesis (IVG), this study set out to investigate the current attitudes towards IVG in the general Belgian population in order to anticipate potential future barriers and misunderstandings. A questionnaire was developed and incorporated into a web-based online survey and sent out to Belgians aged ≥ 18 years in September 2018 until a representative sample (by age, gender and region) of 1000 participants was reached. Respondents expressed an overall positive attitude towards IVG and its possible future applications, with the exception of the use of IVG in postmenopausal women. They were ambivalent about the importance of genetic parenthood and about the necessary experiments on animals and embryos to bring IVG to the clinic. While the willingness to accept greater risks for IVG than for other assisted reproductive technology treatments was low (17.5%), the use of spare in-vitro fertilization embryos to study those risks was acceptable for 55.8% of participants; embryo creation was acceptable for 38.1%; and experiments on mice and monkeys were acceptable for 45.3% and 30.4%, respectively. Finally, 85.6% of participants agreed that the Belgian Government should strictly regulate IVG. In conclusion, preclinical research into IVG and other reproductive technologies elicits a great diversity of attitudes towards the importance of genetic parenthood and the acceptability of embryo and animal research. There is a need for public dialogue on these topics.

The coronavirus disease 2019 (COVID-19) pandemic resulted in unprecedented measures across all health services around the globe, including the large-scale cessation of assisted reproductive technology treatment in Europe as clinics closed, causing disruption and delay to the fertility treatment of thousands of patients in the UK alone. This research explores how patients were impacted by the delay and disruption, and their feelings, concerns and reactions. A mixed-methods, anonymous, online questionnaire, live between 19 May and 30 June 2020, was used to target all fertility patients aged >18 years whose treatment had been impacted by COVID-19. In total, 709 people began the questionnaire and 501 completed it in the time available (70.7% completion rate). Patients reported feeling ‘powerless/helpless’ (78.3%), ‘frustrated’ (59.3%) and ‘anxious’ (54.7%) in response to the closure of fertility clinics. The majority were ‘very concerned’ about time passing and not knowing when they could start treatment again (79.0%), and the length of waiting lists when clinics reopened (70.9%). While 76.8% of respondents had some concerns around contracting COVID-19, 42.9% were ‘not at all concerned’ about undergoing in-vitro fertilization treatment during a pandemic. Variables such as funding source, duration of infertility, previous experience of fertility treatment, treatment stage and the presence of children were correlated with significant intragroup differences in the types of concerns reported. The large majority (72.7%) of respondents stated their eagerness to start treatment as soon as possible, and 9.4% said that they had already resumed treatment; only 6.0% of respondents wanted to wait due to concerns related to COVID-19.

This paper draws upon data from an online survey with closed- and open-ended questions completed by 168 identity-release sperm donors who had all donated in the UK between 2010 and 2016. Paying particular attention to the qualitative data obtained from the donors’ responses to the open-ended questions, this paper explores the sperm donors’ thoughts and feelings about being an identity-release donor and about future information exchange and contact with offspring conceived with their gametes. It shows that the majority of donors regarded identity-release donation as their preferred method of donation, supported the removal of anonymity, did not have concerns about being an identity-release donor and indeed saw positives for both the donor-conceived offspring and themselves. However, it also highlights that the donors’ thoughts and feelings about being an identity-release sperm donor, how they saw themselves in relation to the individual conceived with their donation, and their preferences for information exchange and contact, varied greatly. The paper explores how identity-release donation is surrounding by many unknowns and consequentially sperm donors struggle to conceptualize what it means to be an identity-release sperm donor. As well as adding to the literature on donor conception, relatedness and kinship, by giving voice to sperm donors’ own views and experience of the identity-release regulatory context, and their thoughts and feelings about future information exchange, this paper will help policy makers and clinicians prepare for the imminent time when donor-conceived individuals in the UK can start requesting their donor’s identity.

In Tunisia, medication abortion has been available in government reproductive and sexual health clinics since the early 2000s. Since its introduction, it has rapidly replaced the surgical method, and between 75% and 80% of abortions in the public sector were performed using the pharmacological protocol in 2016. In this article, I intend to discuss the various forms of ignorance about medication abortion that exist in Tunisia among several categories of actors in relation to the legal, medical and religious domains. I explore how the existing ‘varieties of ignorance’ are related to the specific political, social and economic positions of the involved actors, the dominant gender regime, specific institutional policies and economic interests. I also investigate how some forms of ignorance are wilfully produced by institutions and individuals, whereas others are the result of positionality or organizational features. I first describe when and how medication abortion was introduced in Tunisia and the forms of resistance it elicited; later, I examine the production of ignorance about this technology after the revolution of 2011. I mainly consider practices and discourses of health professionals, but also those of women seeking abortion care in the public sector, and those of the activists of a Tunisian non-governmental organization operating in the domain of women’s health and rights.