Hot Topics: Reproductive Medicine

Blog Posts (96)

June 22, 2017

Fertility preservation for transgender individuals

The field of oncofertility emerged to preserve the fertility of cancer patients whose treatment might render them as infertile or sterile. Today, the field of fertility preservation has expanded to other patient populations whose medical treatment may affect their fertility. One such population is transgender individuals undergoing gender affirming treatments. Although research on transgender individuals is limited overall and in particular regarding issues surrounding reproduction, transgender individuals are interested in biological reproduction. Because various gender affirming treatments will permanently affect their fertility, such as hormonal treatment and surgical removal of the gonads, it is important for transgender individuals to be offered fertility preservation before they start these treatments.

There are, however, some factors that may make fertility preservation difficult or less attractive of an option for transgender individuals. Healthcare professionals offering fertility preservation should be aware of these factors so they can help mitigate them. Here I will discuss two of them.

First, undergoing fertility preservation treatment can be stressful for both transgender and cisgender people, but there are some unique challenges for transgender individuals. Individuals with gender dysphoria may find it particularly difficult to undergo procedures involving anatomy that is discordant with their identity. For example, transgender women who are asked to retrieve sperm via masturbation may find this request exacerbates their gender dysphoria and may not be possible to do. Transgender men who are asked to undergo vaginal ultrasounds may find this psychologically traumatic. In recognizing how fertility preservation treatment can be particularly difficult for transgender individuals, healthcare professionals should be prepared to find ways to alleviate these difficulties, such as by offering surgical methods of sperm retrieval for transgender women and sedating transgender men during vaginal ultrasounds.

Second, the gametes retrieved and frozen will not match the gender identity of transgender patients (i.e. a transgender woman will bank sperm and a transgender man will bank eggs). This discordance may not matter for some transgender individuals, but it could affect others. At least one older study found that having frozen discordant gametes made it difficult for some transgender individuals to move forward with their lives in their gender identity. More research is needed in this area to understand if and how this discordance affects transgender individuals today. Healthcare professionals should be aware of this potential discordance between gender identity and frozen gametes, but it should not be a reason to deny fertility preservation to transgender patients.

In addition to the two factors I have discussed here, there are other factors at play in fertility preservation for transgender individuals. Fertility preservation is becoming more common for transgender individuals undergoing gender affirming treatment and consequently healthcare professionals treating these individuals should be aware of some of the unique challenges this patient population faces. For more information on this topic, check out the “Proceedings of the Working Group Session on Fertility Preservation for Individuals with Gender and Sex Diversity.”

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.  

 

May 15, 2017

A review of Table 19: Reinforcing the dominant cultural narrative that all unintended pregnancies are wonderful and wanted

A friend and I recently watched the movie Table 19 because we were looking for a fun comedy. Unfortunately, the movie was neither fun nor funny. Indeed, the movie did not deliver on a number of fronts, which is why I do not recommend it. I want to focus on a specific plot line that this movie employed—one that is common in movies and books—and that I find problematic. In case you are interested in watching this movie despite my warnings, there are spoilers ahead.

The basic plot is that Eloise McGarry, played by Anna Kendrick, ends up sitting at the table of “rejects” at a wedding. She was originally the maid of honor to the bride, but she and the bride’s brother, Teddy, broke up after two years of dating and she was consequently demoted from the bridesmaids’ table to the “loser” table, Table 19. As the movie progresses, we find out that the reason Eloise and Teddy broke up is because of an argument surrounding an unintended pregnancy. Eloise was upset with Teddy when she told him she was pregnant because he did not immediately respond positively. Instead, he asked her what she wanted to do about the pregnancy. His lack of enthusiasm enraged her and she told him that they would be ridiculous parents, which angered him, causing him to break up with her via text message. Because this is a typical Hollywood movie, it has a happy ending with Eloise and Teddy getting back together and happily welcoming their baby into the world.

Unintended pregnancies account for almost half of all pregnancies in the United States so it is not surprising that they are used as a plot twist in many movies and books. What is problematic is that many movies and books expect both members of the heterosexual couple to respond joyfully to the news of an unintended pregnancy and there is shock and discord if this is not the response. This is precisely what happened in Table 19. While some unintended pregnancies are wanted pregnancies (perhaps they are mistimed or the couple didn’t think they could conceive but they always wanted to), many unintended pregnancies are not wanted pregnancies. Just because a couple is now pregnant does not mean that they automatically switch from not wanting to become pregnant to being thrilled that they are pregnant. The dominant cultural narrative that all pregnancies are wonderful and wanted is harmful to women, men, and couples.

Eloise and Teddy are a couple in their 20s who seem somewhat irresponsible and lacking direction. They are trying to figure out what to do with their lives individually and as a couple. Given their circumstances, it is understandable that they may not be ready for a baby. Their inability to have a mature and reasoned conversation about their unintended pregnancy further buttresses that they might not be ready for a baby. But according to the dominant cultural trope, they are supposed to be able to pull it all together in order to be an intact heterosexual couple who are excited to have a baby. While this is how the movie Table 19 ends, not all stories have happy endings and it is important to recognize that there is a diversity of responses to unintended pregnancies.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.  

 

May 8, 2017

Woolgathering: It’s a Bag, It’s a Baby, It’s an Artificial Womb!

by Craig Klugman, Ph.D.

An announcement last week took the science dream of an artificial womb one step closer to science fact: premature lambs were gestated in a biobag (technically an “extra-uterine system”).…

March 22, 2017

Texas Considers Letting Doctors Lie to Patients

by Craig Klugman, Ph.D.

The Texas Senate just passed a new bill (SB 25) that would shield doctors from a lawsuit if a baby is born with a disability even if the doctor knew of the concern and chose not to tell the parents.…

March 2, 2017

The ethics of conscientious objection: Caring for patients and supporting providers

Although conscientious objection arises in various areas of medicine, notably end-of-life issues (e.g. physician assisted death), it is ubiquitous in all aspects of reproductive medicine and women’s health care. Indeed, it is discussed extensively in the academic bioethics literature, clinical practice, healthcare law and policy (e.g. the Hobby Lobby Supreme Court case), and in the popular press. Part of the reason conscientious objection is so commonplace in reproductive medicine and women’s healthcare is because of the controversial nature of abortion and emergency contraception.

The topic of conscientious objection forces us to confront the boundaries of professional obligations and individual rights. Which should be prioritized when they conflict? The common stance of most professional medical organizations is that providers have an obligation to refer if they oppose a practice/prescription based on personal beliefs (e.g. providers should provide a referral if a patient requests an abortion and they oppose abortion due to philosophical or religious reasons), but not if they believe the practice/prescription doesn’t align with standard of care (e.g. providers don’t have to provide a referral if a patient requests antibiotics for the common cold).

The position of most medical organizations on conscious objection raises some concerns. First, there are logistical and feasibility concerns. While it may be easier to uphold providers’ conscientious objection in densely populated areas, in rural areas where there may only be one provider, thereby making it difficult to find someone to refer patients to. It is burdensome for patients to travel far away to receive medical care that they could receive locally if the provider did not have a conscientious objection.  

Second, there are concerns about violating the beliefs of individual providers. Some providers may believe that a certain medical practice/prescription, such as abortion, is so evil that even making a referral violates their religious or philosophical beliefs by making them an “accomplice” in what they see an immoral act. However, it may be difficult for patients to know where to go to receive care if they don’t have a referral. Furthermore, providers who intentionally withhold information about medically appropriate care (e.g. not mentioning that abortion is an accepted standard of care option for a woman carrying a fetus with a lethal abnormality) can be seen as violating the principles of nonmaleficence and informed consent.

Although there are some concerns with the position of most medical organizations on conscientious objection, ultimately it does its best to protect the interests of both patients and providers. One of the main goals of medicine is to care for patients according to the accepted medical standard of care. When providers have a conscience objection to a particular standard of care, they still have an obligation to their particular patients to ensure the patients receive the care that they need. Referring their patients to another provider safeguards the health of the patients while preventing the provider from having to participate in care that violates deeply held beliefs.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

January 9, 2017

Crossing the Line: When Doctors’ Beliefs Endanger Patients’ Autonomy and Health

by Craig M. Klugman, Ph.D.

In 2016 the Illinois legislature passed and Governor Bruce Rauner signed into law Public Act 099-690 (SB 1564), an amendment to the Health Care Right of Conscience Act.…

January 2, 2017

The Year in Bioethics That Was - 2016

by Craig Klugman, Ph.D.

Happy New Year. As has become a tradition at the bioethics.net blogs, the ending of one year and beginning of another is a time for reflection, for reviewing the year that has passed and planning for the year to come.…

December 28, 2016

Modern Pregnancies and (Im)Perfect Babies

by Stephanie A. Kraft, JD

The modern experience of pregnancy is distinctly “not your mother’s pregnancy”. Ever-expanding options for carrier, prenatal, and newborn screening offer today’s pregnant women countless choices when it comes to genetic testing—choices that were unheard of, even unfathomable, just a generation ago.…

December 9, 2016

Don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse? Then don’t ask


One of the first questions a newly married straight couple often gets from well-meaning friends and family is “when are you going to start trying?” For those of you who are wondering what this question is getting at, it is asking them if they are going to start to try to get pregnant. It is interesting to analyze the language used here. People typically talk about “trying” without ever specifying what they are in fact trying to do. Part of the reason for this may be because people assume the meaning is obvious from the context, such as “they’ve been trying for six months but haven’t gotten pregnant yet.” Another reason probably has to do with our societal discomfort talking about sex.

We use general and vague terms to imply that we are talking about sex, but often don’t feel comfortable out right discussing it. For example, the birth control pill is generally just referred to as “the pill.” There is still shame and stigma surrounding sex, particularly for women and sexual minorities, so it may be easier and safer for a woman to talk about being on “the pill,” even though everyone knows what she is referring to, than to overtly announce that she is using contraception.

Even though we as a society may not feel comfortable explicitly discussing sex, we still feel that it is our business. From a legal perspective, look at how carefully reproductive medicine is regulated. For instance, certain reproductive procedures (e.g. abortion and sterilization) can require waiting mandatory periods – something that is not common in other areas of nonelective medicine. In the social realm, family, friends, and even strangers feel they have the right to comment on a pregnant woman’s behavior, such as by telling her what she should and should not eat or drink.

Returning to the topic of “trying,” family, friends, and again even strangers often have no qualms about asking women about whether they are trying to conceive. This is especially the case for straight women who are recently married and women who are perceived as being near or at the end of their “biological clock.”

Asking women whether they are “trying” is problematic on many levels. First, it assumes that all women want to become pregnant with genetically related children. While this may be true for many women, it is not true for all women. There is already enough social pressure on women in our pronatalist society to have biological children so people should avoid adding to this pressure. Second, asking people if they are “trying” is just a euphemism for asking them if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, which is usually not considered an appropriate topic, especially among strangers. It is typically seen as impolite to discuss sex under certain circumstances or with certain people and discussing reproductive sex (that is, sex for which one of the purposes is reproduction) should not be treated differently.

To summarize, if you don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, then don’t ask them if they are “trying” to conceive.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

December 8, 2016

Don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse? Then don’t ask them if they are “trying” to conceive

 

One of the first questions a newly married straight couple often gets from well-meaning friends and family is “when are you going to start trying?” For those of you who are wondering what this question is getting at, it is asking them if they are going to start to try to get pregnant. It is interesting to analyze the language used here. People typically talk about “trying” without ever specifying what they are in fact trying to do. Part of the reason for this may be because people assume the meaning is obvious from the context, such as “they’ve been trying for six months but haven’t gotten pregnant yet.” Another reason probably has to do with our societal discomfort talking about sex.


We use general and vague terms to imply that we are talking about sex, but often don’t feel comfortable out right discussing it. For example, the birth control pill is generally just referred to as “the pill.” There is still shame and stigma surrounding sex, particularly for women and sexual minorities, so it may be easier and safer for a woman to talk about being on “the pill,” even though everyone knows what she is referring to, than to overtly announce that she is using contraception.


Even though we as a society may not feel comfortable explicitly discussing sex, we still feel that it is our business. From a legal perspective, look at how carefully reproductive medicine is regulated. For instance, certain reproductive procedures (e.g. abortion and sterilization) can require waiting mandatory periods – something that is not common in other areas of nonelective medicine. In the social realm, family, friends, and even strangers feel they have the right to comment on a pregnant woman’s behavior, such as by telling her what she should and should not eat or drink.


Returning to the topic of “trying,” family, friends, and again even strangers often have no qualms about asking women about whether they are trying to conceive. This is especially the case for straight women who are recently married and women who are perceived as being near or at the end of their “biological clock.”


Asking women whether they are “trying” is problematic on many levels. First, it assumes that all women want to become pregnant with genetically related children. While this may be true for many women, it is not true for all women. There is already enough social pressure on women in our pronatalist society to have biological children so people should avoid adding to this pressure. Second, asking people if they are “trying” is just a euphemism for asking them if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, which is usually not considered an appropriate topic, especially among strangers. It is typically seen as impolite to discuss sex under certain circumstances or with certain people and discussing reproductive sex (that is, sex for which one of the purposes is reproduction) should not be treated differently.


To summarize, if you don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, then don’t ask them if they are “trying” to conceive.

 

 

 The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.


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Published Articles (30)

AJOB Primary Research: Volume 8 Issue 2 - Apr 2017

Adolescent oncofertility discussions: Recommendations from a systematic literature review Dorit Barlevy, Bernice S. Elger, Tenzin Wangmo & Vardit Ravitsky

AJOB Primary Research: Volume 8 Issue 1 - Feb 2017

Morals or markets? Regulating assisted reproductive technologies as morality or economic policies in the states Erin Heidt-Forsythe

American Journal of Bioethics: Volume 17 Issue 1 - Jan 2017

A Framework for Unrestricted Prenatal Whole-Genome Sequencing: Respecting and Enhancing the Autonomy of Prospective Parents Stephanie C. Chen & David T. Wasserman

American Journal of Bioethics: Volume 17 Issue 1 - Jan 2017

Modern Pregnancies and (Im)Perfect Babies Stephanie A. Kraft

American Journal of Bioethics: Volume 16 Issue 12 - Dec 2016

Does Lack of “Genetic-Relative Family Health History” Represent a Potentially Avoidable Health Disparity for Adoptees? Thomas May, Kimberly A. Strong, Kaija L. Zusevics, Jessica Jeruzal, Michael H. Farrell, Alison LaPean Kirschner, Arthur R. Derse, James P. Evans & Harold D. Grotevant

American Journal of Bioethics: Volume 16 Issue 5 - May 2016

The Paradigm of the Paradox: Women, Pregnant Women, and the Unequal Burdens of the Zika Virus Pandemic Lisa H. Harris, Neil S. Silverman & Mary Faith Marshall

American Journal of Bioethics: Volume 16 Issue 2 - Feb 2016

Fetal Risks, Relative Risks, and Relatives' Risks Howard Minkoff & Mary Faith Marshall

American Journal of Bioethics: Volume 16 Issue 2 - Feb 2016

Restricting Choices of Childbearing Women Bela Fishbeyn

American Journal of Bioethics: Volume 15 Issue 11 - Nov 2015

Sleepwalking Into Infertility: The Need for a Public Health Approach Toward Advanced Maternal Age Marie-Eve Lemoine & Vardit Ravitsky

American Journal of Bioethics: Volume 15 Issue 2 - Feb 2015

Ritual Male Infant Circumcision and Human Rights Allan J. Jacobs & Kavita Shah Arora

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News (721)

June 20, 2017 10:54 am

Legionnaires' cases among newborns raise questions about water births (CNN)

Cases of Legionnaires’ disease have been documented at hotels, gyms and even health care facilities, but a recent report from the Centers for Disease Control and Prevention finds that even newborns are being infected — after water births.

June 15, 2017 9:00 am

A fetus needs to defend itself against foreign bodies—so how does it avoid attacking its mother? (Science)

The immune system of a fetus developing in the womb faces a quandary: It has to prepare itself to attack dangerous pathogens after birth, by distinguishing its own cells from those of invaders. But until that time, it needs to avoid attacking the mother, whose cells are also “foreign.” A new study of fetal tissue has revealed one way the developing immune system keeps itself in check: by interrupting the production of a key weapon in the body’s arsenal against invaders.

April 6, 2017 9:00 am

Proposed SC bill would define 'person' at fertilization (WISTV)

South Carolina’s Lt. Gov. Kevin Bryant is fighting for the ‘right to life’ for unborn children, starting at fertilization. He sponsored the bill as a senator along with 18 other senators who also signed on as sponsors. In a standing room only meeting on Thursday morning, there was moving testimony on the bill from those both for and against it. If passed, the act would grant the same rights to the zygote or fertilized egg, as to the adult.

January 20, 2017 9:00 am

How Science Is Helping Us Understand Gender (National Geographic)

A “neutral space” is a hard thing for a teenager to carve out: Biology has a habit of declaring itself eventually. Sometimes, though, biology can be put on hold for a while with puberty-blocking drugs that can buy time for gender-questioning children.

January 9, 2017 9:00 am

Fact-checking Congress’s fetal tissue report (Science)

They interviewed senior physicians from Planned Parenthood, who spoke bluntly about their provision of fetal tissue from legal abortions for medical research

December 23, 2016 9:00 am

Abortion Is Found to Have Little Effect on Women’s Mental Health (The New York Times)

Some states require women seeking abortions to be counseled that they might develop mental health problems. Now a new study, considered to be the most rigorous to look at the question in the United States, undermines that claim.

December 15, 2016 9:00 am

First hard look at Zika pregnancies finds nearly half result in miscarriage or birth defects (Science)

The data are the first to quantify the risks to women infected at different times during pregnancy, and they seem to confirm that they are highest early in pregnancy.

December 5, 2016 9:00 am

UK moves closer to allowing ‘three-parent’ babies (Nature)

United Kingdom may soon become the first country to explicitly permit the birth of children from embryos modified to contain three people’s DNA.

November 22, 2016 9:00 am

Missouri appeals court rules frozen pre-embryos are marital property (Jurist)

Any frozen pre-embryos, fertilized eggs that are not implanted in the uterus, are legally classified as marital property

November 2, 2016 8:00 am

Male Birth Control Injections Found Effective, But Study Cut Short Due to Side-Effects (US News)

New research published Thursday in The Journal of Clinical Endocrinology & Metabolismshows hormonal birth control injections for men could be effective. But don’t expect to see them on the market anytime soon. The study was cut short due to side effects including depression, mood changes and libido issues – in short, side effects similar to those experienced by women who take hormone-based birth control.

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