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Genomic technologies
Published in Wendy A. Rogers, Jackie Leach Scully, Stacy M. Carter, Vikki A. Entwistle, Catherine Mills, The Routledge Handbook of Feminist Bioethics, 2022
Genomic screening and testing programs can be used at several stages of human life. At the earliest stages, they can be used before embryo implantation in combination with reproductive technologies such as in vitro fertilization (IVF) (De Rycke et al. 2020). IVF is the most common reproductive technology. It involves several steps, including ovarian stimulation to produce multiple eggs, retrieval of the eggs from the woman’s body, mixing them with sperm to create embryos, and transferring of the embryos into the woman’s body. Before embryos are transferred, genomic screening and testing techniques are employed to identify, and usually discard, embryos that carry genomic variants associated with particular diseases or disorders, with the aim of increasing the chances of giving birth to children without the disease or disorder in question. Fertility clinics also use genomic technologies to detect embryos with aneuploidy (an abnormal number of chromosomes in a cell), in order to select unaffected embryos for transfer so as to enhance pregnancy rates.
Women and the National Health Service: the carers and the careless
Published in Ellen Lewin, Virginia Olesen, Women, Health, and Healing, 2022
This point is particularly clear in the case of medical control over reproductive technology. Perfectly healthy women are still dependent on doctors for information, advice, and sometimes even physical access to contraception (Aitken-Swan 1977; Roberts 1981: 1-17). And as we have seen, abortion in particular remains firmly in medical hands (Macintyre 1977). But doctors increasingly control not just the means to prevent pregnancy but also the conditions under which women give birth. While medical intervention has played some part in improving rates of infant and maternal mortality, its importance has often been greatly overestimated. In fact, there is a growing belief that the medicalization of childbirth in Britain now goes beyond what is necessary or desirable (Chard and Richards 1977; Kitzinger and Davis 1978; Oakley 1980). Throughout the postwar period there has been a marked trend towards hospital deliveries and the percentage of home births declined from 33 per cent in 1961 to only 2.5 per cent in 1976 (Doyal and Elston 1983). Not surprisingly, this has been accompanied by a growing medical domination of pregnancy and childbirth. Women have complained about the unnecessary and demeaning rituals involved in such births (the shaving of pubic hair and the use of enemas for instance) as well as the pervasive use of anesthetics and analgesics, the denial to women of the right to choose the position in which they will deliver, and the inflexible routines of many postnatal wards (Oakley 1981; Graham and Oakley 1981).
Adenomyomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Anshumala Shukla Kulkarni, Fouzia Hayat
Post-adenomyomectomy improvements in dysmenorrhea and hypermenorrhea vary but are recognized. The postoperative pregnancy rate also varies between 17.5% and 72.7%. However, artificial reproductive technology largely contributes to the relatively high pregnancy rate. In total, 2365 uterine adenomyomectomies have been reported from 18 facilities worldwide. Of these, 2123 procedures have been performed at 13 facilities in Japan, constituting 89.8% of the global total. Among these, 449 pregnancies have been confirmed and 363 (80.8%) resulted in deliveries, including 2 cases of stillbirths. There were 13 (3.6%) cases of uterine ruptures. An additional 11 cases of uterine rupture have been reported.
Reproductive health in adults with congenital heart disease: a review on fertility, sexual health, assisted reproductive technology and contraception
Published in Expert Review of Cardiovascular Therapy, 2023
J.A. van der Zande, G. Wander, K.P. Ramlakhan, J.W. Roos-Hesselink, M.R. Johnson
Assisted Reproductive Technology (ART), also called medically assisted reproduction, is defined as all clinical and laboratory procedures with the objective of establishing a pregnancy, including in vitro handling of both oocytes and sperm, or embryos [29]. Over the last 30 years, the use of ART has risen steeply, which can be explained by couples choosing to delay pregnancy until later life, and the greater acceptance and dissemination of these technologies [30,31]. Various studies have shown an increased risk of adverse outcomes in pregnancies conceived with ART, and it is still unclear if this risk arises from the fertility treatments themselves or the preexisting risk profile of the infertile population [31–33]. Moreover, the fertility treatments themselves can also be complicated by, for example, ovarian hyperstimulation syndrome (OHSS), bleeding, thromboembolic events, or anesthesia-related risks, resulting in acute and/or major hemodynamic shifts [34,35]. In adults with congenital heart disease, these hemodynamic shifts and other risks can lead to life-threatening situations as they may be less capable to adapt due to a compromised cardiac function.
Preimplantation genetic testing in two Danish couples affected by Peutz–Jeghers syndrome
Published in Scandinavian Journal of Gastroenterology, 2023
Anna Byrjalsen, Laura Roos, Tue Diemer, John Gásdal Karstensen, Kristine Løssl, Anne Marie Jelsig
In Denmark, patients with TPDS are offered genetic counseling in adulthood, including information on reproductive options, e.g., invasive prenatal diagnostics (PNDs) with genetic testing of a chorionic villus sampling (CVS) or amniocentesis, gamete donation, or preimplantation genetic testing for monogenic disease (PGT-M). In Denmark, PGT-M has been offered since 1999 to couples with a known and significant risk of severe genetic disease in future children (Danish law on assisted reproduction https://www.retsinformation.dk/eli/lta/2019/514) and the demand and number of PGT procedures increases. Assisted reproduction technology (ART) including controlled ovarian stimulation, oocyte retrieval, intracytoplasmic sperm injection (ICSI), in vitro culture and cleavage stage biopsy or trophectoderm (TE) biopsy from the blastocyst stage is a prerequisite for PGT. Unaffected blastocysts can then be transferred to the uterus in order to achieve pregnancy [4] (Figure 2).
The psychological impact of the COVID-19 pandemic on fertility care: a qualitative systematic review
Published in Human Fertility, 2023
Abirami Kirubarajan, Priyanka Patel, Jackie Tsang, Theebhana Prethipan, Padmaja Sreeram, Sony Sierra
The COVID-19 pandemic has disrupted the provision of health services worldwide, including delays and cancellations of elective surgeries, increased strain on hospital resources, and interruptions to ambulatory care (Lee et al., 2020). Governments have struggled with difficult health resource allocation and distribution, given the shortages in personal protective equipment as well as the necessity to decrease hospital-based spread of COVID-19 (Lee et al., 2020). Fertility care, including assisted reproductive technology such as in-vitro fertilisation cycles, has not been immune to these worldwide changes. In March 2020, the American Society of Reproductive Medicine (ASRM) as well as the Canadian Fertility and Andrology Society (CFAS) recommended the suspension of in-person fertility care, which often included halting treatment cycles that were already initiated (American Society for Reproductive Medicine (ASRM), 2020; McMohan & Goldi, 2020). In the months following, fertility providers and patients alike have adapted to new regulations regarding social distancing as well as new regulations for practice (Anifandis et al., 2020; Gleicher, 2020).