Reproductive Biomedicine and Society Online最新文献

Fertility experts have advocated addressing preventable causes of infertility and early intervention. However, awareness of risk factors is low, especially in low- and middle-income countries where the prevalence of infertility is high. To address this lack of awareness, the Fertility Awareness Tool (FertiSTAT) was adapted for use in Sudan and other low-resource countries. The aims of this study were to ascertain the need for fertility education in Sudan (Aim 1), and to gauge the acceptability and feasibility of implementing the FertiSTAT in Sudan (Aim 2), both from the patients’ perspective. Convenience sampling was used to recruit participants for semi-structured-in-depth interviews from a fertility clinic in Sudan. We collected sociodemographic information, medical and reproductive history, asked about fertility knowledge, administered the FertiSTAT and asked about the acceptability of the FertiSTAT. Thematic analysis was conducted for qualitative data. Twenty participants were included; of these, 17 were female, 13 were educated beyond secondary school, the mean age was 32.8 years, and the mean duration of infertility was 4.1 years. Ten themes emerged: of these, three themes addressed Aim 1: ‘desire for fertility information’, ‘state of fertility knowledge’ and ‘benefits of fertility education’; and seven themes addressed Aim 2: ‘specific suggestions for the tool’, ‘factors influencing the acceptability and feasibility of implementing the tool’, ‘challenges and barriers to implementation’, ‘self-disclosure’, ‘understanding of being at risk’, ‘compatibility with worldview’ and ‘cultural tailoring’. Fertility education was viewed as necessary and beneficial; however, participants thought that lack of acceptability of sensitive topics would hinder the implementation of the FertiSTAT. Acceptability and feasibility would be enhanced if challenges were addressed in a culturally sensitive manner using cultural tailoring of materials to increase compatibility with individual worldviews.

This article proposes a metaphorical approach to the meaning-making of Portuguese assisted reproductive technology (ART) beneficiaries about human embryos created in vitro, based on the analysis of 30 in-depth interviews. This article draws from an ongoing research project on expert and lay definitions of human embryos developed in vitro, both in ART and scientific research. Four metaphors were identified in patients’ utterances about the embryo’s status and attributes: embryos are possibilities of success of treatment; utilities that can be the object of ownership and dispositional control; potential offspring with whom there are family and emotional ties; and a counter-gift to science or to other beneficiaries, in response to the generosity of professionals or gamete donors. These rhetorical devices seem to ease the tensions inherent in the technical procedures of medically assisted reproduction. Examining the meaning of attributive metaphors used by patients undergoing in-vitro fertilization about their embryos in vitro is thus essential to understanding their personal experiences, so that healthcare professionals can direct their actions/interventions towards their specific needs and concerns, which are not always spoken.

Many patients with cystic fibrosis (CF) are living well into their adult years and contemplating parenthood. Previous studies have shown that there is an opportunity to improve understanding of inheritance and genetics among individuals with CF. This study explored whether a genetic counselling intervention would be associated with a change in knowledge and/or beliefs about genetics and family-building options. Adults (age ≥ 18 years) presenting to a CF clinic were approached for inclusion. Participants completed a pre-intervention survey to measure their knowledge of CF genetics, as well as perceptions and understanding of assisted reproductive technology treatments and other family-building options. Subjects then partook in a genetic counselling session. Subjects repeated the survey immediately after the session and 1–3 months later. Data analysis used one-way analysis of variance (ANOVA), repeated measures ANOVA and multiple linear regression. Thirty-five subjects [19 (54%) men and 16 (45%) women] with a mean (±standard deviation) age of 28 ± 5.64 years were enrolled in the study. Before the intervention, 61.69% ± 4.50 of knowledge-based questions were answered correctly. Immediately after the intervention, the mean score increased to 77.71% ± 3.23, but this decreased to 69.48% ± 4.02 for the third test (P < 0.05, repeated measures ANOVA). Six individuals changed their family-building preference following the genetic counselling session. A short genetic consultation was associated with a significant improvement in CF-specific genetic knowledge. However, knowledge was not retained fully for a longer time period following the consultation. Multiple discussions regarding fertility options are needed to reinforce the key concepts related to CF genetics and fertility.

This study evaluated the retrospective perceptions of egg donors regarding information communicated about immediate and long-term risks during the process of becoming an egg donor, and the alignment of that perception with their experiences and expectations of egg donation. Data were collected using an anonymous online survey. Egg donors’ demographics, perceptions of being informed about immediate complications and long-term risks, and alignment between their expectations and experiences were analysed. In total, 375 current and former egg donors participated in an online survey about their decisions and experiences. Participants ranged in age from 18 to 57 years, with a median age of 24 years at first donation for compensated donors. The majority of the participants (81%) provided eggs in the USA, and 86.1% reported being compensated beyond direct reimbursement. Overall, 66% of egg donors surveyed reported feeling that their experiences matched their expectations based upon what they had been told during the informed consent process. While most participants (64.8%) felt well informed about potential short-term risks, 55.2% did not feel well informed about potential long-term risks. The findings indicate that while the majority of egg donors felt informed about immediate complications, there are gaps in knowledge about potential long-term risks. Results from this research provide insight into how egg donors understand risks and benefits, and can be used to improve counselling and informed consent forms and processes. The findings also indicate that longitudinal research on the health and well-being of egg donors is needed in order to improve informed consent.

Infertility presents challenges to individuals and couples, particularly in Sub-Saharan Africa. This study aimed to document beliefs about childbearing/children and the psychosocial implications of infertility in individuals seeking assisted fertilization in the Ghanaian context. The study had an exploratory descriptive qualitative design. Six males and 12 females were recruited purposefully from five private fertility centres in the Greater Accra Region. Face-to-face interviews were performed. In Ghanaian society, couples and individuals with infertility who are seeking assisted fertilization consider having biological children to be important. The quest to have children was broadly centred on the associated benefits of being a parent, including societal recognition, the role of family inheritance, and support. The inability of participants to have biological children was found to have a negative effect on their psychological and social well-being. Anxiety, worry, hopelessness, stigma and suicidal ideations were some of the effects identified. It is recommended that those seeking assisted fertilization should be supported through counselling to minimize the potential negative effects of childlessness.

Infertility treatments such as in-vitro fertilization (IVF) are stressful and challenging to mental health and well-being. The use of alternative therapies adjunct to IVF treatment, such as acupuncture, is common and women hope to improve their chance of pregnancy and live birth. While many women engage in acupuncture adjunct to IVF in Australia, few qualitative studies of women’s motivations and experiences have been conducted in this field. A qualitative study was nested within a randomized controlled trial of acupuncture during IVF treatment in order to explore women’s perceptions of acupuncture, its effects in the context of IVF treatment, and how acupuncture is perceived in relation to the outcome of IVF. Fifty women randomized into both acupuncture and sham acupuncture groups were interviewed using a semi-structured format. In-depth interviews were transcribed, coded and categorized in a theoretical thematic analysis. Two primary themes emerged: ‘psychological benefit’ and ‘perceived influence of acupuncture on fertility/medical outcome’. Regardless of randomization, women in both groups described similar psychological effects suggesting that a placebo effect was present. They were not convinced that acupuncture could enhance their treatment outcome through biomedical pathways. Rather, they perceived that acupuncture or sham acupuncture gave them a psychological advantage through increased relaxation, reduced psychological stress, and enhanced well-being and self-efficacy. In conclusion, there are significant features associated with a placebo effect in acupuncture that might be exploited to provide psychological benefit for women undertaking IVF.

Preserving the option to conceive through egg freezing (oocyte cryopreservation) is surrounded by value conflicts and diverse viewpoints, particularly when non-medical or so-called ‘social’ reasons are involved. The debate is controversial and shaped by normative perceptions of the life course, including concepts regarding reproductive ageing, gender, motherhood and biomedicalization. To unravel the controversy and systematically identify the variety of viewpoints on egg freezing, a Q-methodology study was conducted in The Netherlands between December 2018 and October 2019. Thirty-four women of reproductive age participated in the study. They ranked 40 statements according to their level of agreement, and explained their ranking during follow-up interviews. Data were analysed using by-person factor analysis and interpreted using both quantitative and qualitative data. Four viewpoints, of which the fourth was bipolar, were identified: (1) cautious about egg freezing technology; (2) my body, my choice; (3) egg freezing is unnatural; and (4) have children and have them early. The distinct viewpoints illustrate different prioritizations of values and normative dimensions of biomedical innovations. By knowing more about the prevalent opinions on egg freezing and the surrounding controversy, policy makers and practitioners can make better informed decisions in terms of promoting and providing patient-centred infertility care. The findings furthermore stimulate continuing scholarly work on egg freezing and other innovations in reproductive medicine which may continue to disrupt normative standards.

Posthumous reproduction (PHR) is the process by which assisted reproductive technology is used to establish pregnancy and produce genetic offspring following the death of a parent. There are different ethical and legal approaches towards this method of reproduction around the world. This paper will study the legality of PHR and its legal consequences for the family status of a child born by this technology according to Iranian law. This research uses the descriptive-analytical method to study Iranian legislation, the opinion of jurists and jurisconsults, and case law in the area of PHR. The only statute regarding assisted reproductive technology in Iranian law – the Embryo Donation Act 2003 – and the associated regulation contain no explicit provision on PHR. The subject is therefore very controversial among Iranian jurists and jurisconsults. This issue has also been the subject of divergent court decisions. This study shows that the current legislation is insufficient to address various issues raised by PHR, and there is a need for the legislature to provide legislative clarity. Although advocates of this technique use the approval of some jurisconsults (fuqahâ) as justification for the legal recognition of PHR during the idda period in Iranian law, some concerns regarding the practice, especially the child's best interests, support prohibition or at least restriction to specific, limited cases.

To the authors’ knowledge, this is the first UK-based study to analyse the marketing of elective egg freezing (EEF) by fertility clinics. Analyses were based on the websites of the top 15 UK clinics, which together provided 87.8% of all egg freezing cycles in the UK between 2008 and 2017 inclusive. The analyses included three phases: content analysis; systematic cost analysis and comparison; and quality analysis examining the information available on egg freezing and its adherence to the guidelines of the Human Fertilisation and Embryology Authority (HFEA). The results show that clinics frame EEF according to four main themes: as a new and exciting technology; as a solution to (a modern woman’s) life circumstances; as a means to gain control, freedom and more reproductive options; and as a means to avoid the reproductive risks of ageing. This study also found that most clinics are not sufficiently clear and transparent about the ‘true’ cost of an EEF cycle, present an unbalanced view of EEF, and do not provide satisfactory data or information. Most importantly, none of the clinics adhere adequately to the HFEA guidelines regarding advertising and the provision of information. As the EEF market continues to grow, offered exclusively by private clinics, these findings require urgent attention. Clinics must improve the type and quality of EEF information on their websites such that potential patients can make informed choices, and this article provides 10 basic criteria which can be used as a checklist. It is suggested that the time may have come to grant greater economic regulatory powers to HFEA to avoid overcommercialization of the fertility industry.

Limited resources and high treatment costs are arguments often used in many public health systems in low- and middle-income countries to justify providing limited treatments for people with infertility. In this analysis, we apply a government public economic perspective to evaluate public subsidy for in-vitro fertilization (IVF) in South Africa. A fiscal model was developed that considered lifetime direct and indirect taxes paid and government transfers received by a child conceived by IVF. The model was constructed from public data sources and was adjusted for mortality, age-specific educational costs, participation in the informal economy, proportions of persons receiving social grants, and health costs. Based on current proportions of individuals receiving social grants and average payments, including education and health costs, we estimate each citizen will receive ZAR513,165 (USD35,587) in transfers over their lifetime. Based on inflated age-specific earnings, we estimate lifetime direct and indirect taxes paid per citizen of ZAR452,869 (USD31,405) and ZAR494,521 (USD34,294), respectively, which also includes adjustments for the proportions of persons participating in the informal economy. The lifetime net tax after deducting transfers was estimated to be ZAR434,225 (USD31,112) per person. Based on the average IVF investment cost needed to achieve one live birth, the fiscal return on investment (ROI) for the South African Government is 5.64. Varying the discount rate from 4% to 7%, the ROI ranged from 9.54 to 1.53, respectively. Positive economic benefits can emanate from public financing of IVF. The fiscal analytic framework described here can be a useful approach for health services to evaluate future public economic benefits.