Hot Topics: Reproductive Medicine

Blog Posts (36)

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. …

February 26, 2014

Intersextion: Germany Allows Parents to Choose “No Sex” on Birth Certificate

by Craig Klugman, Ph.D.

In Jeffrey Eugenides Pulitzer-Prize winning novel Middlesex, readers are introduced to a protagonist, Cal Stephanides, who is male with female traits.…

February 23, 2014

Who Causes Fetal Harm and Who Is Blamed?

<p>There is a cultural perception that women are very likely to cause fetal harm, reflected in limitations on women’s participation in clinical trials and certain jobs, public service announcements telling women not to drink alcohol while pregnant, and extensive media coverage of ‘‘crack babies.’’ The long history of the medical realm treating women’s bodies as weak, permeable, and inherently diseased contributes to the worry that women’s bodies will ‘‘infect’’ fetuses. Men’s bodies, in contrast, are as seen as stable, bound, and healthy; therefore, they are not a risk to fetuses. However, this belief is scientifically inaccurate. Men’s behaviors and characteristics can cause paternal-fetal harm. For instance, paternal smoking and drinking can result in an increased chance of birth defects and low birth weight. Paternal use of illegal drugs (such as cocaine, hashish, opium, and heroin) can also lead to fetal health problems because of abnormal sperm. Additionally, older paternal age has been associated with a higher risk of children with autism, Down syndrome, and schizophrenia.  </p> <p>Despite these scientific facts, there is little public and academic discussion of men and fetal harm, which implies that men do not (or cannot) cause such harm. The cultural narrative that men are not causally or ethically responsible for fetal harm has been reified in law, policy, medicine, and the media.  Even the language we use to discuss reproduction and childcare minimizes the role men play in reproduction. The verb “to father” is synonymous with ‘‘to sire’’ and refers to impregnating a woman, that is, the one time event of fertilization. In contrast, “to mother” refers to constant caregiving and nurturing. </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>
January 21, 2014

Building the Better Baby

by Craig Klugman, Ph.D.

In the 1997 film GATTACA, a couple anxious to have a child sit down with their doctor.…

January 17, 2014

Wombmates in Wisconsin

by Craig Klugman, Ph.D.

Women of Wisconsin better make some room as they are about to have some visitors: Their  in-laws may come to spend time in their uterus.…

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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 (641)

July 22, 2014 3:23 pm

Pregnancy doesn’t drive women doctors out of surgical training

A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

July 15, 2014 2:39 pm

China approves DNA-sequencing devices to detect genetic defects in unborn babies

The mainland has lifted the controversial ban on medical diagnostic products that can help detect birth defects in unborn children.

July 10, 2014 4:03 pm

The Brave New World of Three-Parent I.V.F.

A microscopic image that shows a genome being removed from a donor egg. 1. Manipulation pipette. 2. Donor egg. 3. Holding pipette. 4. Zona pellucida (encircling the egg). 5. Location of the oocyte genome (or nuclear DNA) before removal.

July 8, 2014 5:15 pm

U.S. Democrats aim to turn contraception into campaign drive

U.S. Democrats hope to turn their legal setback on Obamacare and contraception into a winning autumn campaign issue by pushing legislation requiring employers to include birth control in healthcare coverage.

July 1, 2014 1:35 pm

Doctors Are Examining Your Genitals for No Reason

In total, gynecological screenings cost the U.S. $2.6 billion every year. And yet, a new study published in the Annals of Internal Medicine reports that there is no established medical justification for the annual procedure.

May 21, 2014 3:10 pm

High cholesterol levels may make it harder to get pregnant

Couples may have a harder time becoming pregnant if both the man and woman have high cholesterol levels, a new study suggests.

May 2, 2014 3:29 pm

“Drastic, unnecessary and irreversible medical interventions” imposed upon some female athletes

Four female athletes were required to undergo “partial clitorectomies” and gonadectomies (removal of gonads) as a result of the current gender-policing polices of major sports governing bodies.

May 1, 2014 1:11 pm

Criminalizing harmful substance abuse during pregnancy: Is there a problem with that?

Tennessee this week became the first state to explicitly criminalize substance abuse during pregnancy, if it harmfully affects the child.

March 24, 2014 6:38 pm

Cardiff University thyroid IQ theory 'could help children'

Children at risk of developing a low IQ could be helped by genetic screening, Cardiff University researchers say.

March 20, 2014 1:43 pm

My Neighborhood Makes It Easier to Get Pregnant Than To Go To College

‘You should get pregnant,’ a friend told me. ‘Girl, the government will take care of you, trust me.’

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