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Aktoz F, Loreti S, Darici E, Leunens L, Tournaye H, De Munck N, Blockeel C, Roelens C, Mackens S. IVF with reception of oocytes from partner in lesbian couples: a systematic review and SWOT analysis. Reprod Biomed Online 2024; 48:103411. [PMID: 37925228 DOI: 10.1016/j.rbmo.2023.103411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 11/06/2023]
Abstract
The growing utilization of assisted reproductive technology (ART) by the LGBTQ+ community, especially among lesbian couples, challenges societal norms and promotes inclusivity. The reception of oocytes from partner (ROPA) technique enables both female partners to have a biological connection to their child. A systematic review was conducted of the literature on ROPA IVF to provide the latest data and a SWOT analysis was subsequently performed to understand the strengths, weaknesses, opportunities and threats associated with ROPA IVF. Publications from 2000 to 2023 with relevant keywords were reviewed and 16 records were included. Five studies provided clinical information on couples who used ROPA IVF. ROPA IVF provides a unique opportunity for a biological connection between the child and both female partners and addresses concerns related to oocyte donation and anonymity. Weaknesses include limited cost-effectiveness data and unresolved practical implications. Opportunities lie in involving both partners in parenthood, advancing ART success rates and mitigating risks. Threats encompass increased pregnancy complications, ethical concerns, insufficient safety data, legal or cultural barriers, and emotional stress. In conclusion, ROPA IVF offers a promising solution for lesbian couples seeking to create a family in which both partners want to establish a biological connection with their child.
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Affiliation(s)
- Fatih Aktoz
- Women's Health Center, American Hospital, Istanbul, Turkey.
| | - Sara Loreti
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ezgi Darici
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lize Leunens
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman Tournaye
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Neelke De Munck
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christophe Blockeel
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline Roelens
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Shari Mackens
- Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Brandão P, Monseur B, Melo P, Gonçalves-Henriques M, Ceschin N, Reis-Soares S, Sousa-Santos R, Bellver J. Shared IVF among female couples: clinical outcomes of the Reception of Oocytes from the Partner (ROPA) method. Reprod Biomed Online 2023; 47:103284. [PMID: 37542844 DOI: 10.1016/j.rbmo.2023.103284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/13/2023] [Accepted: 07/05/2023] [Indexed: 08/07/2023]
Abstract
RESEARCH QUESTION What is the population undergoing the ROPA (Reception of Oocytes from Partner) method and what are the outcomes of the technique? DESIGN Case series of all ROPA treatments carried out between 2011 and 2020 in 18 fertility clinics in Spain. Demographic characteristics, cycle features, laboratory and clinical outcomes, and the intentions regarding the disposition of surplus embryos were analysed. RESULTS Donor patients were on average 3.5 years younger than recipients (P = 0.001). No significant differences were found in body mass index or anti-Müllerian hormone. In 13% of cases, fertility issues were found: poor ovarian reserve (6.8%); endometriosis (2.9%); and polycystic ovary syndrome (2.2%). Including cases of advanced age (38 years old or older), more than one-half of couples (53.6%) had some condition that could affect fertility. Mean number of mature oocytes per cycle was 10 (+/- 5.7), and fertilization rate was 74.5% (+/- 18.8). Mean number of viable embryos was 3.2 (+/- 1.5). Surplus embryos were cryopreserved in 50.4% of cycles. Outcomes after embryo transfers from ROPA, and subsequent frozen cycles were as follows: positive pregnancy test (61.0%), clinical pregnancy (54.1%) and miscarriage rate (16.1%). Other outcomes were live birth rate per embryo transfer (44.7%); multiple pregnancy rate (5.4%); per cumulative ROPA cycle (48.6%); and per couple (61.6%). CONCLUSION The outcomes of the ROPA method are reassuring. About one-half of the ROPA cycles resulted in a live birth and one-quarter of the cycles had surplus embryos after achieving a live birth. Main neonatal outcomes were also reassuring.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Ginemed Porto, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | | | | | - Nathan Ceschin
- Department of Reproductive Medicine, Feliccità Fertility Institute, Curitiba, Paraná, Brazil
| | | | - Ricardo Sousa-Santos
- Faculty of Medicine, University of Porto, Porto, Portugal; Medically Assisted Reproduction Centre, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - José Bellver
- Department of Reproductive Medicine, IVIRMA Valencia, Valencia, Spain; IVI Foundation, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain
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Yao H, Yang J, Lo IPY. Lesbian couples’ childbearing experiences using assisted reproductive technology: A netnography study. Midwifery 2023; 121:103656. [PMID: 37019000 DOI: 10.1016/j.midw.2023.103656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE This study aimed to explore how Chinese lesbian couples perceived having children through assisted reproductive technology (ART) and its impact on their experiences of family formation. DESIGN This study adopted netnography to investigate online forum data created by self-identified lesbian couples in relation to assisted reproduction. Summative content analysis was used to analyse data. FINDINGS Based on data analysis, A luan B huai, in which a lesbian conceives a child using her partner's egg, was seen as the best way to establish a family because it created a sense of symbolic connectedness with the child for both of them. Moreover, lesbian couples also indicated the crucial role that having children plays in maintaining family harmony, despite their opposition to heterosexual family traditions. With the stratification of reproductive tourism, certain groups of lesbians for instance, those with limited social and cultural capital- might be at a disadvantage in the global setting of reproductive tourism. CONCLUSIONS AND IMPLICATIONS Lesbian couples valued the benefits of ART in assisting them to achieve their childbearing goals and build a family. Healthcare providers should take the initiative to enhance fertility care by addressing the concerns and unique challenges faced by lesbian populations.
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Affiliation(s)
- Hong Yao
- School of Ethnology and Sociology, Minzu University of China, Beijing, China
| | - Jieyi Yang
- School of Ethnology and Sociology, Minzu University of China, Beijing, China
| | - Iris Po Yee Lo
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
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Brandão P, Ceschin N. Lesbian shared IVF: the ROPA method: a systematic review. Porto Biomed J 2023; 8:e202. [PMID: 37152625 PMCID: PMC10158901 DOI: 10.1097/j.pbj.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/09/2023] [Indexed: 05/09/2023] Open
Abstract
The ROPA (Reception of Oocytes from PArtner) method, also known as lesbian shared IVF (in vitro fertilization), is an assisted reproduction technique for female couples, in which one of the women provides the oocytes (genetic mother) and the other receives the embryo and gestates (gestational mother). As a double parented method, it is the only way lesbian women may biologically share motherhood. This is a narrative review of data concerning ROPA published in PubMed, Scopus, and Cochrane Library. A total of 35 articles were included, 10 about motivations for undergoing ROPA, 13 about ethics or legislation, 4 about motherhood, and 8 studies reporting clinical outcomes. Despite being used for more than a decade, there is a paucity of data regarding this technique in scientific literature. Most women choose this technique to share biological motherhood, but medical issues may also justify its use. Many ethical and legal issues are still to be solved. Despite the small number of studies, data regarding the outcomes of this technique and the resulting motherhood are reassuring.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, Valencia, Spain
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Corresponding author. Address: Plaza de la Policia Local 3, 46015, Valencia, Spain, E-mail address:
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Goldberg AE, Allen KR. "I'm Not Just the Nonbiological Parent": Encountering, Strategizing, and Resisting Asymmetry and Invalidation in Genetic/ Gestational Parent Status Among LGBTQ Parents. JOURNAL OF FAMILY NURSING 2022; 28:381-395. [PMID: 36221248 DOI: 10.1177/10748407221123062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) families have expanded our understanding of who counts as family, to include legal as well as chosen ties. Yet, nonbiological parents in LGBTQ families are vulnerable to invalidation and erasure in social institutions, including health care, legal, and educational settings, where genetic and gestational linkages are privileged. The current study was guided by a queer phenomenological perspective to examine how LGBTQ parents experience and respond to dominant norms related to family relatedness and membership and thus queer the family. This mixed-methods study sampled 250 LGBTQ parents (including cisgender women and trans/nonbinary participants) to examine the question: In what ways does genetic asymmetry matter for families? The qualitative and quantitative analyses yielded three primary findings that revealed experiences of erasure and discrimination, as well as proactive strategies and active resistance used to counteract these difficulties. Themes were organized by (a) encountering marginalization and invalidation: health care, schools, and beyond; (b) strategic actions and discursive practices toward parental equality; and (c) confronting and resisting the need for legal, symbolic, and parenting strategies. This study documents ways in which nonbiological LGBTQ parents, in particular, embrace and resist societal norms for biological connectedness. Implications for nursing professionals include our finding that reproductive and perinatal contexts were particular sites of invalidation, necessitating education about the range of queer, nonbiological, and trans/nonbinary parents so that all parents are included in professional health care encounters.
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Zheng H. Shared Motherhood or Free Surrogacy?: Risks and Vulnerabilities in a Chinese Lesbian's Family-Making. JOURNAL OF HOMOSEXUALITY 2022; 69:1881-1907. [PMID: 34080961 DOI: 10.1080/00918369.2021.1923281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Lesbian motherhood is an emerging practice among Chinese lesbian couples. Although this form of family-making might be appealing to Chinese lesbians who cannot legally marry their partners, lesbian mothers are subject to substantial risks and challenges arising from the lack of recognition by Chinese authorities and other family members. This study focuses on an anonymous lesbian's confession about her motherhood. It conducts a case analysis to investigate the incompatibility between transnational reproductive services and national household regulations and Marriage Law. This study analyses the persistence of patriarchy in a lesbian family, which suppresses women's agency both corporeally and in family roles. Through this analysis, this paper intends to explore lesbian mothers' vulnerabilities as they face a continuum of patriarchal exploitation in the absence of legal and social recognition. It also questions the radical challenge that lesbian motherhood is often assumed to make to male dominance and gendered norms.
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Affiliation(s)
- Hao Zheng
- School of Humanities and Social Sciences, Faculty of Arts and Education, Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Geelong, Australia
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Diego D, Medline A, Shandley LM, Kawwass JF, Hipp HS. Donor sperm recipients: fertility treatments, trends, and pregnancy outcomes. J Assist Reprod Genet 2022; 39:2303-2310. [PMID: 36089627 PMCID: PMC9464617 DOI: 10.1007/s10815-022-02616-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To report fertility treatment use and outcomes among patients who use donor sperm for intrauterine insemination (IUI), in vitro fertilization (IVF), and reciprocal IVF (co-IVF). Methods This is a retrospective review of patients who used donor sperm at an urban, southeastern academic reproductive center between 2014 and 2020. Results Among the 374 patients presenting for care, 88 (23.5%) were single, 188 (50.3%) were in a same-sex female partnership, and 98 (26.2%) had a male partner with a diagnosis of male factor infertility. Most patients did not have infertility (73.2%). A total of 1106 cycles were completed, of which there were 931 IUI cycles, 146 traditional IVF cycles, and 31 co-IVF cycles. Live birth rates per cycle were 11% in IUI, 42% in IVF, and 61% in co-IVF. Of all resulting pregnancies, hypertensive disorders were most commonly experienced (18.0%), followed by preterm delivery (15.3%), neonatal complications (9.5%), gestational diabetes (4.8%), and fetal growth restriction (4.8%). Of the 198 infants born, fifteen (8.3%) required admission to the neonatal intensive care unit and three (1.7%) demised. Pregnancy and neonatal complications were more likely to occur in older patients and patients with elevated body mass index. Conclusion The use of donor sperm for fertility treatment is increasing. These data show reassuring live birth rates; however, they also highlight the risks of subsequent pregnancy complications. With the expansion of fertility treatment options for patients, these data assist provider counseling of patients regarding anticipated cycle success rates and possible pregnancy complications.
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Affiliation(s)
- Daniela Diego
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA.
| | | | - Lisa M Shandley
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, GA, USA
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, GA, USA
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory Reproductive Center, Atlanta, GA, USA
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Brandão P, Ceschin N, Cruz F, Sousa-Santos R, Reis-Soares S, Bellver J. Similar reproductive outcomes between lesbian-shared IVF (ROPA) and IVF with autologous oocytes. J Assist Reprod Genet 2022; 39:2061-2067. [PMID: 35819575 PMCID: PMC9474973 DOI: 10.1007/s10815-022-02560-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare reproductive outcomes of the ROPA method (reception of oocytes from partner) to IVF with autologous oocytes. To study the impact of the absence of a genetic link between the embryo and its recipient in reproductive outcomes. METHODS Retrospective multicentric cohort study performed from January 2011 to December 2020 in 18 fertility clinics in Spain. A total of 99 ROPA (73 couples) and 2929 non-ROPA cycles (2334 couples or single patients) of women younger than 38 years old with no known female fertility disorder were included. Clinical outcomes were compared between both groups and included positive pregnancy test, clinical pregnancy, miscarriage, ectopic pregnancy, pre-term birth, live birth, weeks of gestation at birth, and newborn weight at birth. RESULTS No differences were found between groups in clinical outcomes. The total clinical pregnancy rates per embryo transfer were 57% and 50.2% (p = 0.15) and the live-birth rates were 46.1% and 40.9% (p = 0.14) for the ROPA and non-ROPA groups, respectively. When adjusted to age and BMI of donors and recipients, there were also no differences in live-birth rates between both groups. The cumulative live-birth rate per ROPA cycle was 73.7% and the cumulative live-birth rate per couple was 78.3%. CONCLUSION Clinical outcomes following the ROPA method and IVF with autologous oocytes were found to be similar. These findings suggest no impact of the absence of genetic ties between the embryo and the uterus on reproductive treatments' outcomes. Data regarding the outcomes of the ROPA method are reassuring.
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Affiliation(s)
- Pedro Brandão
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain.
- Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | - Fábio Cruz
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
- IVI Foundation, Valencia, Spain
| | | | | | - José Bellver
- IVI-RMA Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain
- Faculty of Medicine and Odontology, Valencia, Spain
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Brandão P, Ceschin N, Gómez VH. The Pathway of Female Couples in a Fertility Clinic. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:660-666. [PMID: 35668678 PMCID: PMC9948101 DOI: 10.1055/s-0042-1744444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present study aims to describe the main characteristics of female couples resorting to a fertility clinic, to understand whether these patients have clear previous plans concerning procreation and how they end up completing their family planning, and to briefly describe the main outcomes of the recepción de ovocitos de pareja (ROPA, in the Spanish acronym: in English, reception of partner's oocytes) method. METHODS This is a descriptive retrospective study of the pathway and outcomes of female couples in a fertility clinic during a 2-year period. RESULTS A total of 129 couples were treated. Only one third of the couples had no condition potentially affecting fertility or advanced age. Most couples were decided to undergo artificial insemination or in vitro fertilization and the majority kept their plans, as opposed to 38% of the couples who decided to the ROPA method (lesbian shared in vitro fertilization) who changed plans. Live birth rates per treatment (including frozen embryo transfers) for artificial insemination, 58% for in vitro fertilization, 80% for treatments with donated oocytes or embryos, and 79% for ROPA. Four in five couples achieved live births. CONCLUSION The present study highlights the importance of a thorough medical workup in same-sex couples resorting to assisted reproduction. Despite the higher-than-expected rates of fertility disorders, the outcomes were good. Most couples end up in a single parented method. Furthermore, the results of the ROPA method are reassuring.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, IVIRMA Global Valencia, Valencia, Spain.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nathan Ceschin
- Department of Reproductive Medicine, Feliccità Instituto de Fertilidade, Curitiba, PR, Brazil
| | - Victor Hugo Gómez
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, IVIRMA Global Valencia, Valencia, Spain
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Raja NS, Russell CB, Moravek MB. Assisted reproductive technology: considerations for the nonheterosexual population and single parents. Fertil Steril 2022; 118:47-53. [DOI: 10.1016/j.fertnstert.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022]
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Keukens A, van Wely M, van der Meulen C, Mochtar MH. Pre-eclampsia in pregnancies resulting from oocyte donation, natural conception or IVF: a systematic review and meta-analysis. Hum Reprod 2021; 37:586-599. [PMID: 34931678 DOI: 10.1093/humrep/deab267] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/01/2021] [Indexed: 12/31/2022] Open
Abstract
STUDY QUESTION What is the prevalence of pre-eclampsia (PE) in pregnancies after oocyte donation (OD) compared to natural conception (NC) and to IVF with autologous oocytes (AO)? SUMMARY ANSWER Overall the prevalence of PE after OD was 4-5 times higher than after NC and 2-3 times higher than after IVF with AO. WHAT IS KNOWN ALREADY The indication for OD is expanding to lesbian women requesting shared lesbian motherhood. Previous reviews have shown that the risk of PE is higher in pregnancies after OD than after NC and after IVF with AO. Classification on the severity of PE is lacking as is the relationship with known risk factors such as maternal age and multiple gestations. Furthermore the actual prevalence of PE in pregnancies resulting from OD is not known. STUDY DESIGN, SIZE, DURATION A systematic review and meta-analysis was conducted. A literature search was performed using the following databases: PubMed, EMBASE and CINAHL, OpenGrey and Greynet from January 1980 through July 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS We included retrospective and prospective cohort studies. The study population consisted of pregnancies after OD and NC or IVF and data had to be available about prevalence of PE. We compared the risk of (severe) PE in OD versus NC and IVF pregnancies, subgrouped by plurality and maternal age. We calculated individual and pooled odds ratios (OR) and prevalence estimates with 95% CI using a random effect model, while heterogeneity was assessed by the I2. MAIN RESULTS AND THE ROLE OF CHANCE In total, 27 studies comprising of 7089 OD pregnancies, 1 139 540 NC pregnancies and 72 742 IVF pregnancies were available for analysis. The risks of PE and severe PE was increased in OD pregnancies compared to NC pregnancies (pooled OR of all subgroups: 5.09, 95% CI: 4.29-6.04; I2 = 19% and OR: 7.42, 95% CI: 4.64-11.88; I2 = 49%, respectively). This suggests that compared to a PE risk of 2.9% with NC, the risk with OD was between 11.5% and 15.4%. Compared to a severe PE risk of 0.5% with NC, the risk with OD was between 2.3% and 5.6%. The pooled adjusted OR for PE was 3.24 (95% 2.74-3.83) for OD versus NC pregnancies. The risks of PE and severe PE were also increased in OD pregnancies compared to IVF pregnancies (pooled OR of all subgroups: 2.97, 95% CI: 2.49-3.53; I2 = 51% and OR: 2.97, 95% CI: 2.15-4.11; I2 = 0%, respectively). This suggests that compared to a PE risk of 5.9% with IVF, the risk with OD was between 13.5% and 18.0%. Compared to a severe PE risk of 3.3% with IVF, the risk with OD was between 6.8% and 12.2%. The pooled adjusted OR for PE was 2.67 (95% 2.28-3.13) for OD versus IVF. The pooled prevalence of PE in singleton pregnancies after OD was 10.7% (95% CI 6.6-15.5) compared to 2.0% (95% CI 1.0-3.1) after NC and 4.1% (95% CI 2.7-5.6) after IVF. The prevalence in multiple pregnancies was 27.8% (95% CI 23.6-32.2) after OD, 7.5% (95% CI 7.2-7.8) after NC and 9.7% (95% CI 6.2-13.9) after IVF. LIMITATIONS, REASONS FOR CAUTION The precise definition of PE is still a matter of debate. The different criteria could have affected the prevalence estimate. WIDER IMPLICATIONS OF THE FINDINGS Nearly one in six women will suffer PE after OD. Although it is uncertain whether these risks are consistent for lesbian couples undergoing shared motherhood, we feel that women who can conceive naturally could be advised to reconsider. In women with primary ovarian insufficiency, we feel that factors that may increase risk of PE ever further, such as double embryo transfer, should be avoided whenever possible. STUDY FUNDING/COMPETING INTEREST(S) No funding or competing interests. REGISTRATION NUMBER CRD42020166899.
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Affiliation(s)
- A Keukens
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Wely
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C van der Meulen
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M H Mochtar
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Mascarenhas S, Suff N, Shennan A. Concurrent reciprocal IVF and risk of pre-eclampsia. J OBSTET GYNAECOL 2021; 42:1549-1550. [PMID: 34907816 DOI: 10.1080/01443615.2021.1971177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sophie Mascarenhas
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Natalie Suff
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
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Downing J, Everett B, Snowden JM. Differences in Perinatal Outcomes of Birthing People in Same-Sex and Different-Sex Marriages. Am J Epidemiol 2021; 190:2350-2359. [PMID: 34010958 DOI: 10.1093/aje/kwab148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/30/2022] Open
Abstract
It is unknown whether people in same-sex relationships who give birth have different perinatal outcomes than people in different-sex relationships, despite differences in risk factors such as use of assisted reproductive technologies, obesity, smoking, and poor mental health. Marriage equality has established birth certificates as a promising new source of population-based data on births to same-sex married parents. We used birth certificate data from Massachusetts for 201,873 singletons born to married parents from 2012 to 2016. We estimated the associations of several birth outcomes with having a birth parent in a same-sex marriage using propensity score-matched and -unmatched samples. We also tested whether these associations were modified by the use of assisted reproductive technologies. People in same-sex marriages who gave birth had perinatal outcomes related to decreased fetal growth and preterm birth that were similar to those of their peers in different-sex marriages. Use of assisted reproductive technology was associated with decreased fetal growth and increased risk of preterm birth for infants with different-sex parents but not for infants with same-sex parents. More research is needed across other states and to understand why use of assisted reproductive technology is not a risk factor for poor birth outcomes for those in same-sex marriages.
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Anaman-Torgbor JA, Jonathan JWA, Asare L, Osarfo B, Attivor R, Bonsu A, Fialor EAE, Tarkang EE. Experiences of women undergoing assisted reproductive technology in Ghana: A qualitative analysis of their experiences. PLoS One 2021; 16:e0255957. [PMID: 34379703 PMCID: PMC8357082 DOI: 10.1371/journal.pone.0255957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/27/2021] [Indexed: 12/04/2022] Open
Abstract
Objective The study aimed to explore the experiences of women undergoing Assisted Reproductive Technologies namely; Invitro Fertilization and Intracytoplasmic Sperm Injection at the Finney Hospital and Fertility Centre, New Bortianor, Ghana. Method A qualitative research design was employed to analyse and describe the experiences of the women seeking Assisted Reproductive Technologies. A total of 32 women were invited to take part in the interview, 15 of them accepted the invitation. However, saturation was reached before all interviews had been complete. Results Three themes emerged from the study: the women’s experiences, challenges and the roles and contributions of significant others. The women were anxious, stressed-up, exhausted and financially burdened. Spouses and health professionals played significant roles by providing social, emotional and financial support for these women. Significant others such as spouses and close relatives were supportive and provided encouragement to the women. Conclusion The experiences of women undergoing Assisted Reproductive Technologies are multi-dimensional. Thus, psychosocial interventions as part of ART services with health insurance cover may be client-centered and more appropriate for these group of women.
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Affiliation(s)
- Judith A. Anaman-Torgbor
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Justice Wiston Amstrong Jonathan
- Department of Basic Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Ho, Volta Region, Ghana
- * E-mail:
| | - Lily Asare
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Bernice Osarfo
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Rita Attivor
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Afia Bonsu
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Elizabeth A. E. Fialor
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Elvis E. Tarkang
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Volta Region, Ghana
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Núñez A, García D, Giménez-Bonafé P, Vassena R, Rodríguez A. Reproductive Outcomes in Lesbian Couples Undergoing Reception of Oocytes from Partner Versus Autologous In Vitro Fertilization/Intracytoplasmic Sperm Injection. LGBT Health 2021; 8:367-371. [PMID: 34061679 DOI: 10.1089/lgbt.2020.0282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study aimed to compare reproductive outcomes after Reception of Oocytes from Partner (ROPA; also called reciprocal in vitro fertilization) with those after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) with autologous oocytes, in lesbian couples. Methods: This was a retrospective matched cohort study of couples performing a first cycle of either ROPA (n = 60) or autologous IVF/ICSI (n = 120) between February 2012 and May 2018. Couples were matched 1:2 by age of the oocyte provider, day of embryo transfer (ET), and number of embryos transferred. Pregnancy and live birth rates after the first ET and cumulative results after all subsequent ETs performed until June 2019 were evaluated. Results: Reproductive outcomes were significantly better after ROPA at first ET: biochemical pregnancy 70.0% versus 47.5% (p = 0.004), clinical pregnancy 60.0% versus 40.0% (p = 0.011), ongoing pregnancy 60.0% versus 36.7% (p = 0.003), and live birth 57.1% versus 29.8% (p = 0.001). After adjusting for age, body mass index, and number of mature oocytes, we still observed a significant improvement across all outcomes in ROPA (live birth rate odds ratio [OR]: 3.05, 95% confidence interval [CI] 1.42-6.57). Cumulative pregnancy and live birth rates were also higher after ROPA (live birth 66.1% vs. 43.4% [p = 0.005]). The adjusted analysis result for cumulative live birth was OR: 2.51, 95% CI: 1.14-5.54. Conclusion: When medically indicated, ROPA can potentially improve reproductive outcomes for lesbian couples through the possibility of selecting the best combination between two oocyte providers and two gestational mothers, provided that both women wish to participate in the pregnancy plan.
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Affiliation(s)
- Anna Núñez
- Clínica Eugin, Research Department, Barcelona, Spain.,Physiology Unit, Department of Physiological Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona - UB, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Pepita Giménez-Bonafé
- Physiology Unit, Department of Physiological Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona - UB, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rita Vassena
- Clínica Eugin, Research Department, Barcelona, Spain
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McInerney A, Creaner M, Nixon E. The Motherhood Experiences of Non-Birth Mothers in Same-Sex Parent Families. PSYCHOLOGY OF WOMEN QUARTERLY 2021. [DOI: 10.1177/03616843211003072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this qualitative study, we explored the experiences of non-birth mothers whose child(ren) were planned and conceived within their same-sex relationship. We conducted semi-structured, face-to-face interviews with 14 participants in Ireland. We transcribed the interviews verbatim and analyzed the data using interpretative phenomenological analysis. Our findings comprised three superordinate themes: A Question of Recognition, An Insecure Connection, and Carving Your Own Way and related subordinate themes. Motherhood experiences were characterized by resilience and vulnerability in parenting their children without legal parental rights and within a heteronormative society that privileged biological motherhood. The dynamic relationship between seeking connection and seeking legitimacy that is at the heart of the participants’ experiences of motherhood is highlighted. Participants encountered challenges to their maternal legitimacy within their families and communities and in their interactions with legal and social institutions. Participants described using various strategies to reinforce their parental identity. Despite the challenges, participants were engaged in constructing satisfying parenting roles. The findings highlight the importance of legitimizing the parental identity of non-birth mothers. Therapists should be sensitive to the additional marginalization of non-birth mothers in same-sex parent families. Validating their vulnerability and their resilience in the face of obstacles may enhance their coping resources. Online slides for instructors who want to use this article for teaching are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/10.1177/03616843211003072
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Affiliation(s)
- Anna McInerney
- School of Psychology, Trinity College Dublin, The University of Dublin, Ireland
| | - Mary Creaner
- School of Psychology, Trinity College Dublin, The University of Dublin, Ireland
| | - Elizabeth Nixon
- School of Psychology, Trinity College Dublin, The University of Dublin, Ireland
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Carone N, Bos HMW, Shenkman G, Tasker F. Editorial: LGBTQ Parents and Their Children During the Family Life Cycle. Front Psychol 2021; 12:643647. [PMID: 33679568 PMCID: PMC7930207 DOI: 10.3389/fpsyg.2021.643647] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/26/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nicola Carone
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Henny M. W. Bos
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Geva Shenkman
- Interdisciplinary Center Herzliya (IDC), Hertzlya, Israel
| | - Fiona Tasker
- Department of Psychological Sciences, School of Science, Birkbeck University of London, London, United Kingdom
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Álvarez-Díaz JA. Embryo donation among Latin-Americans who have attended assisted reproduction techniques: a first empirical approach. JBRA Assist Reprod 2021; 25:81-89. [PMID: 32870624 PMCID: PMC7863107 DOI: 10.5935/1518-0557.20200055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: To determine whether Latin Americans who have undergone assisted reproduction techniques would donate embryos. Methods: This is a multinational cross-sectional study, involving 602 patients. We invited the Latin American Network of Assisted Reproduction centers. Those who accepted received the instrument distributed among the patients who agreed by signing the informed consent form. In total, 261 men and 341 women participated from seven countries. Results: Patients would donate their embryos as follows: treatment with embryonic stem cells (73.6%), heterosexual couples (63.8%), Assisted Reproduction Techniques (ART) research (57%), scientific or basic research (55.3%), research with embryonic stem cells (55.2%), premenopausal women (53.8%), single women (45.1%), people with disabilities (25.4%), lesbians (25.3%), menopausal women (25.2%), lesbian couples (24.6%), gay couples (19.6%), senile women (15.1%). Conclusions: The results favor embryos donation for research purposes, and a little less for clinical purposes, contrary to what was thought in qualitative studies conducted among Latin American populations.
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Behjati Ardakani Z, Navabakhsh M, Tremayne S, Akhondi MM, Ranjbar F, Mohseni Tabrizi A. The Impact of Third Party Reproduction on Family and Kinship. J Reprod Infertil 2021; 22:3-15. [PMID: 33680880 PMCID: PMC7903672 DOI: 10.18502/jri.v22i1.4990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
The development of in vitro fertilization (IVF) in the UK, in 1978, proved a major breakthrough in the process of human reproduction, which had remained constant in human history. The impact of IVF and the ensuing assisted reproductive technologies (ARTs) has not been limited in revolutionizing the "natural" practice of biological reproduction, but has reached out to and affected almost every institution in society. Family and kinship, as the social expression of reproduction and the institutions which are the most transparently structured realm of human life are those most profoundly affected by ARTs. Although literature on the implications of ARTs is in general abundant, this article presents new insights on their impact on family and kinship in Iran, which remains a unique case in the Muslim world. It explores the particular way ARTs, especially third-party donation, have been endorsed and practiced in Iran, and their consequences for the family, the infertile individuals, and their position vis-à-vis their kin and social group. The conclusion points to the lack of clarity concerning the initial rulings by the Islamic jurists, who allowed the practice of ARTs, and which has led to a number of unintended consequences regarding the legal, religious, cultural, and ethical issues, affecting the family, its structure and the relationship between the kin group. These consequences range, inter alia, from the question of the anonymity of third-party donor, to the permissibility of gamete donation between blood relatives, and to the absence of enforceable legislation.
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Affiliation(s)
| | - Mehrdad Navabakhsh
- Faculty of Humanistic and Social Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Soraya Tremayne
- Fertility and Reproductive Studies Group (FRSG), Institute of Social and Cultural Anthropology, Oxford, UK
| | - Mohammad Mehdi Akhondi
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Fahimeh Ranjbar
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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20
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van Bentem K, Lashley L, van der Hoorn ML. Significance of specialised preconception counselling in oocyte donation pregnancy with prior history of postpartum eclampsia. BMJ Case Rep 2020; 13:13/11/e235582. [PMID: 33148572 DOI: 10.1136/bcr-2020-235582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A well-known complication in oocyte donation (OD) pregnancy is preeclampsia. Here, we present a 31-year-old woman, pregnant after OD. She conceived by the reception of the oocyte from her partner (ROPA) and sperm from a sperm donor. She developed preeclampsia with severe features, necessitating caesarean delivery at 29 weeks' gestation due to deterioration of her clinical condition. Admission at the intensive care unit postpartum was necessary, because of recurrent postpartum eclampsia and administration of high dose magnesium sulphate for convulsion prophylaxis. This case illustrates the importance of preconception counselling for patients who are considering to conceive by OD and double gamete donation. In this specific case an alternative way to conceive was available. However, ROPA was preferred as part of shared lesbian motherhood. The risk of complications in the subsequent pregnancy has led to an alternative decision to accomplish a second pregnancy.
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Affiliation(s)
- Kim van Bentem
- Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Lashley
- Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
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21
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Dempsey D, Power J, Kelly F. A perfect storm of intervention? Lesbian and cisgender queer women conceiving through Australian fertility clinics. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1810636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Deborah Dempsey
- Department of Social Sciences, Swinburne University, Melbourne, Australia
| | - Jennifer Power
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Fiona Kelly
- School of Law, La Trobe University, Melbourne, Australia
- School of Law and Centre for Health, Law and Society, La Trobe University, Melbourne, Australia
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Guntram L, Zeiler K. The Ethics of the Societal Entrenchment-approach and the case of live uterus transplantation-IVF. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:557-571. [PMID: 31102175 PMCID: PMC6842335 DOI: 10.1007/s11019-019-09891-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
In 2014, the first child in the world was born after live uterus transplantation and IVF (UTx-IVF). Before and after this event, ethical aspects of UTx-IVF have been discussed in the medical and bioethical debate as well as, with varying intensity, in Swedish media and political fora. This article examines what comes to be identified as important ethical problems and solutions in the media debate of UTx-IVF in Sweden, showing specifically how problems, target groups, goals, benefits, risks and stakes are delineated and positioned. It also demonstrates how specific assumptions, norms and values are expressed and used to underpin specific positions within this debate, and how certain subjects, desires and risks become shrouded or simply omitted from it. This approach-which we label the Ethics of the Societal Entrenchment-approach, inspired by Koch and Stemerding (1994)-allows us to discuss how the identification of something as the problem helps to shape what gets to be described as a solution, and how specific solutions provide frameworks within which problems can be stated and emphasised. We also offer a critical discussion of whether some of these articulations and formations should be seen as ethically troubling, and if so, why.
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Affiliation(s)
- Lisa Guntram
- Department of Thematic Studies – Technology and Social Change, Linköping University, 581 83 Linköping, Sweden
| | - Kristin Zeiler
- Department of Thematic Studies – Technology and Social Change, Linköping University, 581 83 Linköping, Sweden
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23
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Nazem TG, Chang S, Lee JA, Briton-Jones C, Copperman AB, McAvey B. Understanding the Reproductive Experience and Pregnancy Outcomes of Lesbian Women Undergoing Donor Intrauterine Insemination. LGBT Health 2019; 6:62-67. [PMID: 30848719 DOI: 10.1089/lgbt.2018.0151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The study purpose was to evaluate the reproductive experience, specifically cycle characteristics and treatment outcomes, of lesbian women. In addition, we aimed to determine whether there are differences in pregnancy outcomes when comparing lesbian women undergoing ovulation induction (OI) versus natural cycles with donor intrauterine insemination (IUI), as well as lesbian and heterosexual women undergoing the same assisted reproductive technology treatment. METHODS This was a retrospective cohort study including women who underwent an IUI with cryopreserved sperm between 2006 and 2018. The primary outcome of interest was clinical pregnancy (CP) rate. RESULTS A total of 216 lesbian women (451 natural cycles and 441 OI cycles) and 584 heterosexual women (1177 natural cycles and 1238 OI cycles) were included in the study. Thirty percent of lesbian women had a hysterosalpingogram as part of their initial workup. Approximately 40% of lesbian women who underwent OI/IUI had previously undergone at least one natural cycle/IUI. There was no significant difference in CP rate when comparing lesbian women and heterosexual women undergoing natural or OI/IUI, or when comparing lesbian women who underwent natural versus OI/IUI cycles. However, there was a significantly higher multiple gestation rate among lesbian women undergoing OI compared with those undergoing natural cycles (11.8% vs. 0%, p = 0.01). CONCLUSION This large study showed that while pregnancy outcomes were similar between groups, the multiple gestation rate was higher in lesbian women undergoing OI compared with lesbian women undergoing natural cycles.
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Affiliation(s)
- Taraneh Gharib Nazem
- 1 Reproductive Medicine Associates of New York, New York, New York.,2 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sydney Chang
- 1 Reproductive Medicine Associates of New York, New York, New York.,2 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph A Lee
- 1 Reproductive Medicine Associates of New York, New York, New York
| | | | - Alan B Copperman
- 1 Reproductive Medicine Associates of New York, New York, New York.,2 Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Beth McAvey
- 1 Reproductive Medicine Associates of New York, New York, New York.,3 Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai West, New York, New York
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24
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Cavaliere G, Palacios-González C. Lesbian motherhood and mitochondrial replacement techniques: reproductive freedom and genetic kinship. JOURNAL OF MEDICAL ETHICS 2018; 44:835-842. [PMID: 29491042 PMCID: PMC6288697 DOI: 10.1136/medethics-2017-104450] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 01/12/2018] [Accepted: 02/05/2018] [Indexed: 05/17/2023]
Abstract
In this paper, we argue that lesbian couples who wish to have children who are genetically related to both of them should be allowed access to mitochondrial replacement techniques (MRTs). First, we provide a brief explanation of mitochondrial diseases and MRTs. We then present the reasons why MRTs are not, by nature, therapeutic. The upshot of the view that MRTs are non-therapeutic techniques is that their therapeutic potential cannot be invoked for restricting their use only to those cases where a mitochondrial DNA disease could be 'cured'. We then argue that a positive case for MRTs is justified by an appeal to reproductive freedom, and that the criteria to access these techniques should hence be extended to include lesbian couples who wish to share genetic parenthood. Finally, we consider a potential objection to our argument: that the desire to have genetically related kin is not a morally sufficient reason to allow lesbian couples to access MRTs.
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Affiliation(s)
- Giulia Cavaliere
- Department of Global Health and Social Medicine, King’s College London, London, UK
| | - César Palacios-González
- Centre of Medical Law and Ethics, The Dickson Poon School of Law, King’s College London, London, UK
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25
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Greene MZ, Hughes TL, Sommers MS, Hanlon A, Meghani SH. Association of Pregnancy History and Cervical Cancer Screening in a Community Sample of Sexual Minority Women. J Womens Health (Larchmt) 2018; 28:526-534. [PMID: 30118364 DOI: 10.1089/jwh.2018.6960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sexual minority women (SMW) face barriers to healthcare that may result in lower utilization of cervical cancer screening. Previous experiences with the healthcare system-specifically reproductive health-related encounters-have the potential to affect future use of screening services. This study aimed to examine the association between pregnancy history and cervical cancer screening in a diverse sample of SMW. Anderson's Behavioral Model of Health Services Use guided the selection of variables included in the study. METHODS We performed a secondary analysis of cross-sectional data from the third wave of the Chicago Health and Life Experiences of Women (CHLEW) Study, a longitudinal study of SMW in the Midwestern United States. We performed multivariable logistic regression to address the study aims, restricting the sample to women ages 21-45 (n = 430). RESULTS Reporting a previous pregnancy was consistently positively associated with past-year Pap testing. In the multivariable model, bisexual identity and disclosing one's sexual orientation to healthcare providers were also positively associated with past-year Pap test. CONCLUSIONS This analysis provides preliminary evidence that SMW who have been pregnant are more likely to receive Pap testing and that multiple sociodemographic factors are likely to impact screening in this population. Clinicians should screen all patients with a cervix for cervical cancer and should encourage screening for all SMW. Future studies should prioritize longitudinal analyses to examine the temporality of reproductive history and healthcare seeking, focus on where SMW seek care, and understand how intersecting components of identity may shape the healthcare utilization of this population.
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Affiliation(s)
- Madelyne Z Greene
- 1 Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Tonda L Hughes
- 2 School of Nursing, Columbia University, New York, New York
| | - Marilyn S Sommers
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
| | - Alexandra Hanlon
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
| | - Salimah H Meghani
- 3 School of Nursing, University of Pennsylvania, Philadephia, Pennsylvania
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Klitzman R. How Infertility Patients and Providers View and Confront Religious and Spiritual Issues. JOURNAL OF RELIGION AND HEALTH 2018; 57:223-239. [PMID: 29189982 DOI: 10.1007/s10943-017-0528-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Questions arise concerning whether and how religion affects infertility treatment decisions. Thirty-seven infertility providers and patients were interviewed. Patients confront religious, spiritual, and metaphysical issues coping with treatment failures and religious opposition from clergy and others. Religion can provide meaning and support, but poses questions and objections that patients may try to avoid or negotiate-e.g., concealing treatment or changing clergy. Differences exist within and between religions. Whether and how much providers discuss these issues with patients varies. These data, the first to examine several key aspects of how infertility providers and patients confront religious/spiritual issues, have important implications for practice, research, guidelines, and education.
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Affiliation(s)
- Robert Klitzman
- Columbia University, 1051 Riverside Drive; Mail Unit #15, New York, NY, 10032, USA.
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Shared motherhood IVF: high delivery rates in a large study of treatments for lesbian couples using partner-donated eggs. Reprod Biomed Online 2018; 36:130-136. [DOI: 10.1016/j.rbmo.2017.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/13/2017] [Accepted: 11/17/2017] [Indexed: 11/19/2022]
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Di Nucci E. IVF, same-sex couples and the value of biological ties. JOURNAL OF MEDICAL ETHICS 2016; 42:784-787. [PMID: 27613798 DOI: 10.1136/medethics-2015-103257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 06/08/2016] [Accepted: 08/11/2016] [Indexed: 06/06/2023]
Abstract
Ought parents, in general, to value being biologically tied to their children? Is it important, in particular, that both parents be biologically tied to their children? I will address these fundamental questions by looking at a fairly new practice within IVF treatments, so-called IVF-with-ROPA (Reception of Oocytes from Partner), which allows lesbian couples to 'share motherhood', with one partner providing the eggs while the other becomes pregnant. I believe that IVF-with-ROPA is, just like other IVF treatments, morally permissible, but here I argue that the increased biological ties which IVF-with-ROPA allows for do not have any particular value beside the satisfaction of a legitimate wish, because there is no intrinsic value in a biological tie between parents and children; further, I argue that equality within parental projects cannot be achieved by redistributing biological ties.
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Carpinello OJ, Jacob MC, Nulsen J, Benadiva C. Utilization of fertility treatment and reproductive choices by lesbian couples. Fertil Steril 2016; 106:1709-1713.e4. [PMID: 27666567 DOI: 10.1016/j.fertnstert.2016.08.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/20/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe intentions and outcomes of lesbian couples requesting reproductive assistance; and report number of cycles needed to achieve a live birth. DESIGN Retrospective chart review. SETTING University-based fertility center. PATIENT(S) A total of 306 lesbian couples who sought reproductive assistance between 2004 and 2015. INTERVENTION(S) Intrauterine insemination or IVF using donor sperm. MAIN OUTCOME MEASURE(S) Mean age, relationship status, family size, preconception goals, conception attempts, number of cycles to achieve a live birth. RESULT(S) Preconception plans were available for 233 couples: 76.4% planned for one partner to conceive and carry (single partner conception); 23.6% planned for both partners to eventually conceive and carry (dual partner conception). Of 306 couples who presented, 85.1% attempted single partner conception, and 68% of these achieved a live birth. Dual partner conception was attempted by 14.9% of couples, and 88.9% achieved a live birth. Of those who conceived with IUI, a mean (±SD) of 3 ± 1.1 cycles were completed. Of those who conceived with IVF, a mean of 6 ± 1.4 IUI and 1.7 ± 0.3 IVF cycles were completed. CONCLUSION(S) Lesbian couples may improve their likelihood of a live birth if both partners attempt conception. Further studies are needed to understand why one-fifth of patients did not pursue treatment.
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Affiliation(s)
- Olivia J Carpinello
- Department of Obstetrics and Gynecology, UConn Health, Farmington, Connecticut
| | - Mary Casey Jacob
- Department of Obstetrics and Gynecology, UConn Health, Farmington, Connecticut; Department of Psychiatry, UConn Health, Farmington, Connecticut; The Center for Advanced Reproductive Services, Farmington, Connecticut
| | - John Nulsen
- Department of Obstetrics and Gynecology, UConn Health, Farmington, Connecticut; The Center for Advanced Reproductive Services, Farmington, Connecticut
| | - Claudio Benadiva
- Department of Obstetrics and Gynecology, UConn Health, Farmington, Connecticut; The Center for Advanced Reproductive Services, Farmington, Connecticut.
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Perceived importance of childbearing and attitudes toward assisted reproductive technology among Chinese lesbians in Hong Kong: implications for psychological well-being. Fertil Steril 2016; 106:1221-1229. [PMID: 27473352 DOI: 10.1016/j.fertnstert.2016.06.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/08/2016] [Accepted: 06/27/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the perceived importance of childbearing and attitudes toward assisted reproductive technology (ART) among Chinese lesbians and the impact on their psychological well-being. DESIGN Survey-based study using a 39-item questionnaire. SETTING Not applicable. PATIENT(S) A total of 438 Chinese lesbians between the ages of 18 and 35 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Perceived importance of childbearing; attitudes toward ART; and levels of anxiety and depression. RESULT(S) Perceived importance of childbearing to Chinese lesbians was negatively associated with age (r = -0.23), relationship length (r = -0.18), and full-time employment (F = 4.29). Compared to heterosexual childless women, Chinese lesbians thought childbearing was significantly less important (3.30 vs. 6.00 on a 1-10 scale, t = 14.6). Most lesbian respondents (92%) supported legalizing same-sex couples' access to ART, although less than half (41%) wanted to use it themselves to have children. Among lesbians who thought childbearing was important to their parents or their partners, not wanting ART was associated with higher anxiety levels. CONCLUSION(S) This is the first quantitative study of childbearing attitudes of lesbians in Asia. The data suggest that Chinese lesbians in the study who perceived childbearing as important to their parents or to their partners but did not want to seek ART reported higher anxiety levels. This study helps raise health care professionals' awareness of Chinese lesbians' attitudes toward childbearing as well as calls for a better delivery system of fertility and mental health services to address the psychological burden of Chinese lesbians in relation to reproductive issues.
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Pennings G. Having a child together in lesbian families: combining gestation and genetics. JOURNAL OF MEDICAL ETHICS 2016; 42:253-255. [PMID: 26545709 DOI: 10.1136/medethics-2015-103007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/21/2015] [Indexed: 06/05/2023]
Abstract
The increasing acceptance of lesbian couples in medically assisted reproduction has led to new, unusual requests. This paper discusses the request for egg transfer from one partner to the other. In the first part, different analogies (egg donation, embryo donation, surrogacy and mitochondrial replacement) are made in order to find out whether one of these can help us determine whether this procedure is acceptable. It is shown that there are major difficulties with all analogies. In the second part, two balances are developed between the medical risks and costs of in vitro fertilisation (IVF) and intrauterine insemination on the one hand and the medical risks of IVF and the psychosocial benefits on the other hand. The final conclusion is that the disadvantages of the procedure can be compensated by the psychosocial advantages and thus can be accepted.
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Effects and outcomes of third-party reproduction: parents. Fertil Steril 2015; 104:520-4. [DOI: 10.1016/j.fertnstert.2015.07.1128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/03/2015] [Accepted: 07/09/2015] [Indexed: 11/20/2022]
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Yeshua A, Lee JA, Witkin G, Copperman AB. Female Couples Undergoing IVF with Partner Eggs (Co-IVF): Pathways to Parenthood. LGBT Health 2015; 2:135-9. [DOI: 10.1089/lgbt.2014.0126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arielle Yeshua
- Reproductive Medicine Associates of New York, New York, New York
| | - Joseph A. Lee
- Reproductive Medicine Associates of New York, New York, New York
| | - Georgia Witkin
- Reproductive Medicine Associates of New York, New York, New York
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York
| | - Alan B. Copperman
- Reproductive Medicine Associates of New York, New York, New York
- Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York
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Raes I, Van Parys H, Provoost V, Buysse A, De Sutter P, Pennings G. Parental (in)equality and the genetic link in lesbian families. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2014.947473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zeiler K, Malmquist A. Lesbian shared biological motherhood: the ethics of IVF with reception of oocytes from partner. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2014; 17:347-355. [PMID: 24395218 DOI: 10.1007/s11019-013-9538-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In vitro fertilization (IVF) with reception of oocytes from partners (ROPA) allows lesbian mothers to share biological motherhood. The gestational mother receives an egg from her partner who becomes the genetic mother. This article examines the ethics of IVF with ROPA with a focus on the welfare of the woman and the resulting child, on whether ROPA qualifies as a "legitimate" medical therapy that falls within the goals of medicine, and on the meaning and value attributed to a biologically shared bond between parents and child. We also contrast IVF with ROPA with egg donor IVF for heterosexual couples and intrafamilial live uterus transplantation with IVF, and show how Swedish legislation makes certain ways of sharing biological bonds out of place. In Sweden, IVF with ROPA is illegal, egg donor IVF for heterosexual couples is allowed and practiced as is sperm donor IVF for lesbians, and live uterus transplantation is performed within a research project (though not allowed in regular health care). But is ROPA really ethically more problematic than these other cases? The article argues that IVF with ROPA gives rise to fewer ethical questions than does live uterus transplantation with IVF and, in some cases, egg donor IVF.
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Affiliation(s)
- Kristin Zeiler
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden,
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De Wert G, Dondorp W, Shenfield F, Barri P, Devroey P, Diedrich K, Tarlatzis B, Provoost V, Pennings G. ESHRE Task Force on Ethics and Law 23: medically assisted reproduction in singles, lesbian and gay couples, and transsexual people†. Hum Reprod 2014; 29:1859-65. [PMID: 25052011 DOI: 10.1093/humrep/deu183] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This Task Force document discusses ethical issues arising with requests for medically assisted reproduction from people in what may be called 'non-standard' situations and relationships. The document stresses that categorically denying access to any of these groups cannot be reconciled with a human rights perspective. If there are concerns about the implications of assisted reproduction on the wellbeing of any of the persons involved, including the future child, a surrogate mother or the applicants themselves, these concerns have to be considered in the light of the available scientific evidence. When doing so it is important to avoid the use of double standards. More research is needed into the psychosocial implications of raising children in non-standard situations, especially with regard to single women, male homosexual couples and transsexual people.
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Affiliation(s)
- G De Wert
- Department of Health, Ethics & Society, Research Institutes CAPHRI and GROW, Maastricht University, PO Box 616, MD 6200 Maastricht, The Netherlands
| | - W Dondorp
- Department of Health, Ethics & Society, Research Institutes CAPHRI and GROW, Maastricht University, PO Box 616, MD 6200 Maastricht, The Netherlands
| | - F Shenfield
- Reproductive Medicine Unit, Obstetric Hospital, University College Hospital, Huntley Street, London WC1 6AU, UK
| | - P Barri
- Servei de Medicina de la Reproducció, Departament d'Obstetricia, Universitari Dexeus, Ginecologia i Reproducció, Barcelona, Spain
| | - P Devroey
- Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium
| | - K Diedrich
- Department of Obstetrics and Gynaecology, University of Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - B Tarlatzis
- Infertility and IVF Center, Department of OB/Gyn, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Provoost
- Department of Philosophy, University of Ghent, Blandijnberg 2, Gent 9000, Belgium
| | - G Pennings
- Department of Philosophy, University of Ghent, Blandijnberg 2, Gent 9000, Belgium
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Wojnar DM, Katzenmeyer A. Experiences of preconception, pregnancy, and new motherhood for lesbian nonbiological mothers. J Obstet Gynecol Neonatal Nurs 2013; 43:50-60. [PMID: 24354595 DOI: 10.1111/1552-6909.12270] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the experiences of preconception, pregnancy, and new motherhood from the perspective of lesbian nonbiological mothers. DESIGN Descriptive phenomenology. SETTING A private room at the study site and participants' homes. PARTICIPANTS Twenty-four self-identified lesbian nonbiological mothers in a committed relationship and whose partner gave birth within the past 2 years participated. All of the participants were from urban or suburban areas in the Pacific Northwest. METHODS Women participated in semistructured in person interviews that were audio recorded and transcribed verbatim for analysis. Coliazzi's method guided the process. RESULTS An overarching theme of "feeling different" permeated the experiences of preconception, pregnancy, and new motherhood for the participants. The women's narratives revealed seven themes that illustrated their experiences: (a) Launching pregnancy: A roller coaster ride; (b) Having legal and biological concerns: Biology prevails; (c) There is a little person in there: Dealing with pregnancy issues; (d) Losing relationships over pregnancy: The elephant in the room; (e) Feeling incomplete as a mother; (f) Carving a unique role: There are very few of us out there; and (g) Sadness and regret: Nonbiological mothers get the postpartum blues, too. CONCLUSIONS The experience of preconception, pregnancy, and new motherhood for nonbiological lesbian mothers is complicated by the lack of biological and legal substantiation to the infant, few role models, and limited social support. Nurses and health care providers cognizant of these issues can play an important role in facilitating a positive transition to motherhood for this population.
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