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Global perspectives on reproductive medicine
Published in David J Cahill, Practical Patient Management in Reproductive Medicine, 2019
These rights inevitably cause tensions and difficulty when practicing assisted conception. There are minor differences between the national churches as to what is acceptable in this area, but the overarching Orthodox Church position is (16): It does not approve assisted reproduction as the solution to infertility (preferring couples to seek less invasive or intrusive methods).It does not approve of spare leftover embryos.It does not approve of multiple embryos being transferred if that will lead to selective reduction of some of the fetuses.Greek and Russian churches are publicly flexible on the use of IVF when it is used between a man and a woman within a marriage.
Multifetal pregnancies: Considerations in couples with a genetic problem
Published in Elisabeth Hildt, Dietmar Mieth, In Vitro Fertilisation in the 1990s, 2018
This deliberate production of multifetal pregnancies and subsequent selective reduction is ethically hard to justify. That is why several F/F-clinics decided to limit the embryo-transfer to two. In these special cases of parental chromosomal anomaly preimplantation diagnosis might be a possible way to improve the situation. Balancing risks and benefits, this possibility might result in the least harm and the most benefit to the persons involved.
Abortion and pre-natal harm
Published in Marc Stauch, Kay Wheat, Text, Cases and Materials on Medical Law and Ethics, 2018
As we saw above, in Chapter 7, certain forms of fertility treatment, IVF or (more often) the use of super-ovulatory drugs, may result in a multiple pregnancy in which the woman carries more foetuses than can safely be brought to term. The term ‘selective reduction’ refers to the practice, in such a pregnancy, of deliberately terminating the lives of some of the foetuses in order to improve the survival chances of those that remain. Andrew Grubb has discussed the legal problems posed by the practice as follows: In the light of these uncertainties, when Parliament came to amend the Abortion Act in 1990 a new s 5(2) was introduced specifically to deal with the practice: It is apparent that the effect of this provision is that selective reduction will be lawful either to protect the health or life of the pregnant woman (in which case the foetus(es) for destruction may be randomly chosen) or to terminate the life of a particular foetus on the s 1(1)(d) ground of foetal handicap.
Hypertensive disorders of pregnancy after multifetal pregnancy reduction: a systematic review and meta-analysis
Published in Hypertension in Pregnancy, 2023
Petra M. van Baar, Jeske M. Bij de Weg, Eibert A. ten Hove, Linda J. Schoonmade, Lidewij van de Mheen, Eva Pajkrt, Christianne J.M. de Groot, Marjon A. de Boer
Two reviewers (PB and JW) independently screened all potentially relevant titles and abstracts for eligibility using Rayyan (27). Studies were included if they met the following criteria: (i) prospective or retrospective studies; (ii) reporting on MFPR from triplets to twins or MFPR from higher-order multifetal pregnancy to twins compared to ongoing (i.e., non-reduced) triplets and/or twins; (ii) featuring HDP (including GH and PE) as an outcome measure. The exclusion criteria were as follows: (i) review articles, case reports, congress abstracts, and letters; (ii) MFPR to singletons; (iii) studies comparing different types of reduction techniques; (iv) studies comparing early versus late reduction; (v) more than 20% of case group (after MFPR) consisting of spontaneous reduction or selective reduction (i.e., reduction for fetal anomaly or complications related to a monochorionic pregnancy (e.g., twin to twin transfusion syndrome (TTTS), twin anemia polycythemia Sequence (TAPS), selective intra uterine growth restriction (sIUGR)); (vi) outcome data published in other language than English. No restrictions regarding chorionicity were made since chorionicity does not appear to substantially influence maternal outcomes (28), except for those with complications related to monochorionic pregnancies. Full texts were obtained if studies appeared to meet the inclusion criteria or in case of uncertainty. All reasons for exclusion were recorded. Reviewing authors were not blinded to the journal titles, study authors, or institutions. Reference and citation lists of the included studies were scanned to ensure literature saturation. Disagreements regarding study selection were resolved by consulting a third author (MB).
Ivabradine, the hyperpolarization-activated cyclic nucleotide-gated channel blocker, elicits relaxation of the human corpus cavernosum: a potential option for erectile dysfunction treatment
Published in The Aging Male, 2020
Serap Gur, Laith Alzweri, Didem Yilmaz-Oral, Ecem Kaya-Sezginer, Asim B. Abdel-Mageed, Suresh C. Sikka, Wayne J. G. Hellstrom
The selective reduction of HR with oral ivabradine is safe and efficient [7–9]. In different animal models, ivabradine contributed to heart failure prevention, and reduced HR and blood pressure by affecting the neuroendocrine stress response and aldosterone levels [10–12]. Reduced androgen levels, metabolic syndrome, and other factors may be considered a risk factor for age-related erectile dysfunction (ED) [13,14]. Thus, behind HR reduction, the additional beneficial cardiac, metabolic, and hormonal effects of ivabradine seem suitable for the management of ED in the aging male.
Fetal anemia in monochorionic twins: a review on diagnosis, management, and outcome
Published in Expert Review of Hematology, 2023
L.S.A. Tollenaar, F. Slaghekke, J.M. Middeldorp, E. Lopriore
Antenatal management options for TAPS include expectant management, prenatal delivery, intrauterine transfusion (IUT) with or without a partial exchange transfusion (PET), fetoscopic laser surgery, or selective reduction. With expectant management, no intrauterine treatment is performed, but the twins are closely monitored with MCA-PSV measurements. Expectant management is usually opted in mild or stable cases of TAPS. Preterm delivery can be a choice when intrauterine treatment is not feasible and when prolonging the TAPS pregnancy is expected to be more detrimental to the health of the twins than the consequences of prematurity. With an IUT, the TAPS donor will be provided with red blood cells to temporarily correct fetal anemia. In case of severe polycythemia in the recipient twin, an IUT in the donor can be combined with a PET in the recipient to reduce the hyperviscosity/polycythemia. During a PET, 5–10 ml of the recipient’s blood will be removed slowly and will be preplaced with saline, repeatedly. IUT (with PET) is not a definitive treatment, and only a temporary solution and therefore reintervention might be required. Fetoscopic laser surgery is the only treatment option that tackles the cause of TAPS. Laser surgery is an endoscopic intrauterine procedure during which the tiny anastomoses are identified and then coagulated. Selective reduction can be considered in severe cases of TAPS, when there are structural anomalies, or when other treatment options are infeasible, and is aimed at sacrificing one twin in order to increase the chances for healthy survival in the cotwin. The best treatment option for TAPS is still under investigation. We are currently performing an international multicenter randomized controlled trial (TAPS trial), comparing laser surgery to standard treatment (IUT/(±PET), expectant management, preterm delivery) (anonymized) (Clincialtrials.org number NCT04432168)