Hot Topics: Reproductive Medicine

Blog Posts (40)

October 22, 2014

The Ethics of Sperm Freezing for Teenage Boys

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">A few weeks ago, I attended the </span><a style="line-height: 19.0400009155273px;" href="http://oncofertility.northwestern.edu/2014-Conference">annual Oncofertility Consortium conference</a><span style="line-height: 19.0400009155273px;"> where Dr. Angel Petropanagos and I presented our poster “Teen Boys and Fertility Preservation: An Ethical Analysis.”</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">The vast majority of discussions about fertility preservation (FP), particularly FP for “social” (aka nonmedical) reasons, are focused on women in part because FP for women raises more ethical issues.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">For instance, egg freezing carries more health risks and is generally less effective than sperm freezing. Furthermore, whereas sperm freezing has been an established method of FP for decades, it was only two years ago that the American Society for Reproductive Medicine lifted the experimental label from egg freezing.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Yet, even established technologies can raise ethical concerns when used in vulnerable groups, such as children. Our research project examines the ethical issues FP raises when used by teenage boys.</span><span style="line-height: 19.0400009155273px;">  </span><span style="line-height: 19.0400009155273px;">In order to undergo sperm freezing, males must produce a sperm sample and this is usually done through masturbation. However, discussions about masturbation can be embarrassing and difficult for adolescent males (as well as for healthcare providers), particularly if they have never masturbated or never masturbated and achieved an ejaculation. Some parents and healthcare providers place a high value on preserving patients’ future option of genetic reproduction, but FP discussions with teen males can be especially challenging due to the sensitive and private nature of sexuality and reproduction. </span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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 <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
September 24, 2014

How does the history of contraceptive responsibility shape current contraceptive coverage conversations?

<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">One of the more controversial parts of the Affordable Care Act (ACA) is the mandate that insurance companies cover contraception. As seen in the Hobby Lobby case, the argument is often boiled down to two conflicting sides: women who want the right to receive contraception without a co-payment and employers don’t want to provide contraception due to their religious convictions. Men’s right to receive contraception without a co-payment is missing from the ACA and the larger debate about the right to contraception. I wonder, however, how this public discussion would be different today if there were more types of male contraceptives and men were expected to assume more responsibility for contraception. </span></p> <p style="line-height: 19.0400009155273px;">It is worth noting that women’s association with contraceptive responsibility is a relatively recent phenomenon. Before the “contraceptive revolution” of the 1950s and 1960s, which lead to the development of hormonal and long-acting contraceptives, notably the pill, men actively participated in many forms of contraception. One reason for this is that contraceptive use was tied to the act of sex itself or to the timing of sex; therefore men had to be involved. All of the available contraceptives were used during sex, such as condoms, diaphragms, sponges, and withdrawal; immediately following sex, like douches; or were related to the timing of sex, as in the case of the rhythm method. </p> <p style="line-height: 19.0400009155273px;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">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 <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
August 18, 2014

Viagra Versus the Pill

<p>Given the continuing controversy surrounding insurance coverage for female contraceptives, I want to point out another drug that also targets sexuality and reproduction yet does not generate the nearly same degree of controversy. In fact, insurance companies began covering it immediately upon approval by the FDA with no fanfare. I’m referring to erectile dysfunction drugs. The public’s different responses to female contraceptives and male sexuality medications have been discussed in academic circles as well as in the media. Here I want to present some feminist perspectives on this topic. </p> <p>Some feminists argue that part of the reason we understand and treat pregnancy and impotence differently is because we have different standards for women's and men's health, which result from the traditional gender norms at play in our society. We (as a society) expect women to adhere to norms of chastity (e.g. fall on the “virgin” side of the virgin/whore dichotomy by not having sex until marriage) and one way we do this is by limiting their access to sexual and reproductive health care. In contrast, because our notions of masculinity are tied into sexual prowess, we are more receptive to providing health care for men who are not able to maintain an erection. </p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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 <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20.399999618530273px;"> </span></p>
July 28, 2014

Remote Control Birth Control

<p>The goal of the <a href="http://www.gatesfoundation.org/What-We-Do/Global-Development/Family-Planning">Bill &amp; Miranda Gates Foundation Family Planning program</a> is “to bring access to high-quality contraceptive information, services, and supplies to an additional 120 million women and girls in the poorest countries by 2020 without coercion or discrimination, with the longer-term goal of universal access to voluntary family planning.”  This is an extremely important endeavor and I'm glad that this program is devoting so many resources to achieving its goal. </p> <p>MicroCHIPS, a company based in Lexington Massachusetts, is one of the companies/organizations working with the Bill &amp; Melinda Gates Foundation Family Planning program. They are <a href="http://www.cnet.com/news/remote-controlled-chip-implant-could-be-the-future-of-contraceptives/">developing a contraceptive chip</a> that can be implanted under a women's skin. The chip, just 20 x 20 x 7 millimetres, would deliver daily dose hormones and could last up to 16 years. The chip will be controlled by remote control so that if a woman decides she wants to become pregnant, she can deactivate the chip. When she wants to resume contraceptive use, she can reactivate the chip.</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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 <a style="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
June 15, 2014

Insurance Coverage for Oncofertility: Concerns about Socioeconomic Disparities

<p>In a recent <a href="/BioethicsBlog/post.cfm/the-importance-of-assisted-reproductive-technologies-for-women-in-developing-countries">blog</a>, I asserted that assisted reproductive technology (ART) should be a higher priority for the global South because of the severe health, social, and economic effects infertility can have on women there. The most common response to this claim is that resources should first be devoted to treating and preventing life-threatening conditions, such as malaria and HIV/AIDS, rather than conditions that are perceived as merely social and/or psychological. The same response is often used when people suggest that ART should receive higher priority in the global North. Whereas many global North countries provide national health coverage for ART, the US does not. However, there has been movement toward coverage for ART in the US in the last couple of decades and currently 14 states require health insurance companies to cover ART (though there is a wide range of what is covered and under what circumstances). Unfortunately, oncofertility (fertility preservation for cancer patients) is <a href="http://oncofertility.northwestern.edu/sites/default/files/uploadedfilecontent/basco_et_al._2010.pdf">not covered in any of these state laws</a>.</p> <p>While I understand the argument that limited healthcare resources should be dedicated to the most "pressing" conditions, it is also important to recognize the potential side effects of choosing not to provide coverage for oncofertility and other types of ART. One concern with the lack of coverage for ART is that it reinforces socioeconomic inequalities. The <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955265/">primary users of ART</a> are white, educated, middle- and upper-class not because this group is the most likely to be infertile, but because they are the most likely to be able to afford the high cost of ART out-of-pocket expenses. Cancer patients from lower socioeconomic backgrounds are unlikely to have the large amount of disposable funds (the <a href="http://www.asrm.org/detail.aspx?id=3023">average cost for one cycle of IVF</a> is around $12,400) for fertility preservation treatment. While “traditional” infertility patients can save their money over a period of time in order to be able to afford ART, cancer patients need to preserve their fertility before their cancer treatment commences and thus they need to be able to immediately provide the cash for fertility preservation treatment in order for it to occur. </p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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 <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
May 28, 2014

Placentas: Food for Thought.

<p class="MsoNormal"><span style="font-family: Calibri, sans-serif; color: #536c71;"><span style="font-size: 15px; line-height: normal;">Imagine you or your partner want to take your placenta home after birth. You feel that the placenta is part of your (partner’s) body and you should be allowed to take it home.  Maybe to eat it: <a href="http://www.theguardian.com/lifeandstyle/2014/apr/30/i-ate-wifes-placenta-smoothie-taco-afterbirth">‘I ate my wife's placenta raw in a smoothie and cooked in a taco’</a> (Guardian 30 April 2014) or to bury it for cultural reasons, as protection of the <a href="http://articles.latimes.com/2013/dec/31/nation/la-na-oregon-placenta-20140101">soul and the newborn</a> (LA times 31 December 2013). In <a href="http://articles.latimes.com/2013/dec/31/nation/la-na-oregon-placenta-20140101">Oregon </a>you are legally allowed to take it home. In some hospitals elsewhere, you are <a href="http://www.parents.com/pregnancy/my-body/pregnancy-health/take-placenta-home/">not</a>. Imagine that due to circumstances, you end up in a hospital that prohibits you from obtaining the placenta. What’s next?</span></span></p> <p class="MsoNormal"><span style="font-family: Calibri, sans-serif; color: #536c71;"><span style="font-size: 15px; line-height: normal;">Requests to take placentas home after birth are increasing. Human <a href="http://en.wikipedia.org/wiki/Human_placentophagy">placentophagy </a>is on the rise. Kim Kardashian spoke about it in her soap series not too long ago.  Newspapers are full of stories about placentas, <a href="http://www.nytimes.com/2014/05/22/health/study-sees-bigger-role-for-placenta-in-newborns-health.html?ref=health&amp;_r=2">their use and ability</a>, and significant amounts of websites discuss the pros and cons of bringing placentas home. Different sources report on the alleged benefits of eating your placenta and <a href="http://www.sciencebasedmedicine.org/eating-placentas-cannibalism-recycling-or-health-food/">other reasons</a> to take it home. The public exposure to this ‘appetite’, its context and the rise in requests, raise concerns about prohibitive practices. Prohibitive policies are likely to come under increased scrutiny. My question in this context: What about eating placentas, what about policies prohibiting this?</span></span></p> <p class="MsoNormal"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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 <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
May 22, 2014

Frozen Embryos: A Modern Fairy Tale

by Craig Klugman, Ph.D.

Girl meets boy. Girl and boy fall in love (or at least into like and lust). Girl receives cancer diagnosis.…

April 21, 2014

Understanding Abortion

<p class="MsoNormal">Abortion is a contentious issue and one that gets a lot of attention by politicians and in the media. These debates on the ethics of abortion often take place on the abstract, theoretical level and fail to account for the empirical information on who seeks out abortions and why (all of the information presented here comes from the Guttmacher Institute).</p> <p class="MsoNormal">Half of all pregnancies in the United States are an intended. 40% of these unintended pregnancies end in abortion and 22% of intended pregnancies also end in abortion. Over half of all women had been using some form of contraception during the month in which they became pregnant. However, many of these women (or their partners) were incorrectly or inconsistently using contraception.  Just under half of women who had an unintentional pregnancy were not using contraception for one of the following reasons: 33% perceived themselves to be at low risk for pregnancy, 32% had concerns about contraceptive methods, 26% had unexpected sex, and 1% had been forced to have sex.</p> <p class="MsoNormal"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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 <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
March 19, 2014

The importance of assisted reproductive technologies for women in “developing” countries

<p>While assisted reproductive technologies (ART) are common in most “developed” countries (the global North), in the global South (“developing” countries), ART is generally not available for a variety of reasons, most of which center around money. These resource-poor countries typically lack both qualified health-care professionals and facilities necessary for ART. Although some countries do have ART centers, the cost of ART is prohibitive for all but the extremely wealthy. Indeed, infertility is usually seen as a treatable problem only for the upper class primarily because the poor cannot afford basic health care let alone expensive treatment like ART. The fact that the majority of people in the global South cannot afford basic health care, which is typically seen as the top priority in health-care allocation, is another reason why ART are not readily available in the global South. Most public and private health-care funding goes toward primary care and not treatments that are often seen as elective and cosmetic, like ART.</p> <p>Yet, infertility can be considered a health problem according to the World Health Organization's broad definition of health – “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Infertility in the global South can have severe and interrelated social, economic, and health-related consequences for women. This is still the case when the woman is physiologically fertile but her partner has male factor infertility; she is the one who is generally blamed for the couple’s inability to have a biological child.</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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 <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
March 4, 2014

Tampering With Evolution? "Three Parent Embryos"

by Maurice Bernstein, MD

Babies are born with  a progressive neurometabolic disorder with a general onset in infancy or childhood, often after a viral infection, but can also occur in teens and adults. …

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Published Articles (20)

American Journal of Bioethics: Volume 14 Issue 7 - Jul 2014

Therapeutic, Prophylactic, Untoward, and Contraceptive Effects of Combined Oral Contraceptives: Catholic Teaching, Natural Law, and the Principle of Double Effect When Deciding to Prescribe and Use Murray Joseph Casey & Todd A. Salzman

American Journal of Bioethics: Volume 14 Issue 5 - May 2014

Transnational Gestational Surrogacy: Does It Have to Be Exploitative? Jeffrey Kirby

American Journal of Bioethics: Volume 13 Issue 10 - Oct 2013

Gender Eugenics? The Ethics of PGD for Intersex Conditions Robert Sparrow

American Journal of Bioethics: Volume 13 Issue 10 - Oct 2013

Critically Appraising Prenatal Genetic Diagnosis to Prevent Disorders of Sexual Development: An Opportunity Missed Laurence B. McCullough

American Journal of Bioethics: Volume 13 Issue 5 - May 2013

The Right to Know Your Genetic Parents: From Open-Identity Gamete Donation to Routine Paternity Testing An Ravelingien & Guido Pennings

American Journal of Bioethics: Volume 13 Issue 3 - Mar 2013

Expanding Access to Testicular Tissue Cryopreservation: An Analysis by Analogy Tuua Ruutiainen, Steve Miller, Arthur Caplan & Jill P. Ginsberg

American Journal of Bioethics: Volume 12 Issue 7 - Jul 2012

On the Cutting Edge: Ethical Responsiveness to Cesarean Rates Sylvia Burrow

American Journal of Bioethics: Volume 12 Issue 7 - Jul 2012

Ethical Dilemma of Mandated Contraception in Pharmaceutical Research at Catholic Medical Institutions Murray Joseph Casey

American Journal of Bioethics: Volume 12 Issue 7 - Jul 2012

The Professional Responsibility Model of Respect for Autonomy in Decision Making About Cesarean Delivery Frank A. Chervenak & Laurence B. McCullough

American Journal of Bioethics: Volume 12 Issue 6 - Jun 2012

Preserving the Right to Future Children: An Ethical Case Analysis Gwendolyn P. Quinn, Daniel K. Stearsman, Lisa Campo-Engelstein & Devin Murphy

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News (653)

October 6, 2014 1:11 pm

Mother of world's first baby born after womb transplant says risk paid off

For the world’s first baby born to a woman with a transplanted womb – a medical first – only a victorious name would do.

September 25, 2014 7:24 pm

El Salvador abortion ban is torture, kills women: Amnesty

El Salvador’s total ban on abortion is killing women and girls, forcing them to undergo dangerous backstreet abortions and landing them in jail, rights group Amnesty International said on Thursday.

September 22, 2014 1:56 pm

UK opens first clinic for child victims of female genital mutilation

Britain’s first specialist clinic for child victims of female genital mutilation (FGM) opened in London on Monday as part of a push to eradicate the illegal ritual in the country.

September 15, 2014 5:12 pm

A New Study Supports Female Athletes Unfairly Excluded From Sport

I’ve had the pleasure of having a few pieces published on in Slate, in particular in Outward. None have had as much response, good and bad, as my rant against the current International Olympic Committee policy that bans women with high natural testosterone levels from competing in women’s events.

August 21, 2014 3:20 pm

California bill would let birth certificates reflect same-sex parents

Birth certificates in California would be changed to more accurately reflect families in which parents are of the same gender under a bill passed by the legislature on Wednesday.

August 20, 2014 4:21 pm

California lawmakers pass bill banning inmate sterilizations

California lawmakers sent a bill to ban sterilization surgeries on inmates in California prisons to Governor Jerry Brown on Tuesday, after media reports and a later audit showed officials failed to follow the state’s rules for obtaining consent for the procedure known as tubal ligation from incarcerated women.

August 18, 2014 1:44 pm

New York City council speaker reveals HPV diagnosis to raise awareness

The speaker of the New York City Council, Melissa Mark-Viverito, announced at the weekend that she has a “high-risk” form of HPV to try to raise awareness about the common but often stigmatized sexually transmitted infection.

August 15, 2014 3:31 pm

Thailand stops US and Australian couples leaving with surrogate babies: advocate

U.S. and Australian couples attempting to leave Thailand with babies born by surrogate mothers have been stopped at the airport and prevented from leaving the country in recent days, an Australian surrogacy advocate said on Friday.

August 14, 2014 12:23 pm

Pot-Smoking Mom Fights to Breastfeed. What Are the Risks?

A new mom in Portland, Ore., said she was barred from breastfeeding her premature newborn because she is a regular user of medical marijuana. “They’re refusing to allow me to breastfeed,” Crystal Cain told local news station KATU, referring to officials at Oregon Health Science University.

August 6, 2014 1:56 pm

France passes sweeping gender equality law

France has passed a sweeping gender equality law that eases current restrictions on abortion, encourages paternity leave and promotes gender parity at home and in the workplace.

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