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Iliyasu Z, Galadanci HS, Zubairu AA, Amole TG, Sam-Agudu NA, Aliyu MH. Health workers' knowledge of safer conception and attitudes toward reproductive rights of HIV-infected couples in Kano, Nigeria. Int Health 2020; 11:536-544. [PMID: 31028377 DOI: 10.1093/inthealth/ihz016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/28/2019] [Accepted: 03/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The restriction of reproductive rights of HIV-positive couples in low-resource settings could be related to the attitudes and skills of health workers. We assessed health workers' knowledge of safer conception and their attitudes toward the reproductive rights of HIV-positive couples in a tertiary hospital in Nigeria. METHODS A cross-section of health workers (n=294) was interviewed using structured questionnaires. Knowledge and attitude scores were analyzed. Logistic regression was employed to generate adjusted odds ratios (AORs) for predictors of attitude. RESULTS Safer conception methods mentioned by respondents included timed unprotected intercourse with (27.9%) and without antiretroviral pre-exposure prophylaxis (37.4%), in vitro fertilization plus intracytoplasmic sperm injection (26.5%), and sperm washing and intrauterine insemination (24.8%). The majority (94.2%) of health workers acknowledged the reproductive rights of HIV-infected persons, although (64.6%) strongly felt that HIV-infected couples should have fewer children. Health workers reported always/nearly always counseling their patients on HIV transmission risks (64.1%) and safer conception (59.2% and 48.3% for females and males, respectively) (p<0.05). Among health workers, being older (30-39 vs <30 y) (AOR=1.33, 95% CI=1.13-2.47), married (AOR=2.15, 95% CI=1.17-5.58) and having a larger HIV-positive daily caseload (20-49 vs <20) (AOR=1.98, 95% CI=1.07-3.64) predicted positive attitude towards reproductive rights of HIV-affected couples. CONCLUSIONS Health workers had limited knowledge of safer conception methods, but were supportive of the reproductive rights of HIV-positive couples. Health workers in Nigeria require training to effectively counsel couples on their reproductive rights, risks and options.
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Affiliation(s)
- Zubairu Iliyasu
- Departments of Community Medicine, Bayero University, PMB 3011 Kano, Kano State, Nigeria.,Centre for Infectious Diseases Research, Bayero University, PMB 3011 Kano, Kano State, Nigeria
| | - Hadiza S Galadanci
- Departments of Obstetrics and Gynecology, Bayero University, PMB 3011 Kano, Kano State, Nigeria
| | - Ahmad A Zubairu
- Departments of Community Medicine, Bayero University, PMB 3011 Kano, Kano State, Nigeria
| | - Taiwo G Amole
- Departments of Community Medicine, Bayero University, PMB 3011 Kano, Kano State, Nigeria
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology, Maina Court, Plot 252, Abuja, Nigeria.,Institute of Human Virology, University of Maryland, 725 W Lombard St, Baltimore, MD 21201, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 725, Nashville, TN 37203, USA
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Loutfy M, Kennedy VL, Poliquin V, Dzineku F, Dean NL, Margolese S, Symington A, Money DM, Hamilton S, Conway T, Khan S, Yudin MH. No. 354-Canadian HIV Pregnancy Planning Guidelines. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:94-114. [PMID: 29274714 DOI: 10.1016/j.jogc.2017.06.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist Canadians affected by HIV with their fertility, preconception, and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible and take into account diverse and intersecting local/population needs based on the social determinants of health. INTENDED OUTCOMES EVIDENCE: Literature searches were conducted by a librarian using the Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases for published articles in English and French related to HIV and pregnancy and HIV and pregnancy planning for each section of the guidelines. The full search strategy is available upon request. VALUES The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines. BENEFITS, HARMS, AND COSTS Guideline implementation should assist the practitioner in developing an evidence-based approach for the prevention of unplanned pregnancy, preconception, fertility, and pregnancy planning counselling in the context of HIV infection. VALIDATION These guidelines have been reviewed and approved by the Infectious Disease Committee and the Executive and Council of the SOGC. SPONSOR Canadian Institutes of Health Research Grant Planning and Dissemination grant (Funding Reference # 137186), which funded a Development Team meeting in 2016. RECOMMENDATIONS
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N o 354 – Lignes directrices canadiennes en matière de planification de la grossesse en présence du VIH. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:115-137. [DOI: 10.1016/j.jogc.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Loutfy MR, Margolese S, Money DM, Gysler M, Hamilton S, Yudin MH. Lignes directrices canadiennes en matière de planification de la grossesse en présence du VIH. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S59-S78. [PMID: 28063568 DOI: 10.1016/j.jogc.2016.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kuete M, Yuan H, He Q, Tchoua Kemayou AL, Ndognjem TP, Yang F, Hu Z, Tian B, Zhao K, Zhang H, Xiong C. Sexual Practices, Fertility Intentions, and Awareness to Prevent Mother-to-Child Transmission of HIV Among Infected Pregnant Women at the Yaounde Central Hospital. Sex Med 2016; 4:e95-e103. [PMID: 27006318 PMCID: PMC5005303 DOI: 10.1016/j.esxm.2016.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 01/06/2016] [Accepted: 01/28/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction The sexual and reproductive health of people living with HIV is fundamental for their well-being. Antiretroviral therapy and reproductive technologies have significantly improved quality of life of people living with HIV in developed countries. In sub-Saharan Africa, the epicenter of HIV, the sexual practices and fertility of women infected with HIV have been understudied. Aim To assess the sexual behavior, fertility intentions, and awareness of preventing mother-to-child transmission of HIV in pregnant women with HIV-negative partners in Yaounde Central Hospital (Yaounde, Cameroon). Methods A cross-sectional survey using a semistructured, interviewer-administered questionnaire was conducted at the antenatal unit and HIV clinic in 2014. Main Outcome Measures Ninety-four pregnant women infected with HIV provided consistent information on (i) sociodemographic characteristics, (ii) sexual and fertility patterns, (iii) awareness of preventing mother-to-child transmission of HIV, and (iv) their unmet needs. Results Although sexual desire had significantly changed since their HIV diagnosis, the women were highly sexually active. Approximately 19% of women had more than one sexual partner and 40% had regular unprotected sex during the 12-month period before the interviews (P < .0001). Twenty-nine percent of women preferred intermittent sexual intercourse and inconsistent condom use to delay pregnancy, but the abortion rate remained high. Age, marital status, and education affected women's awareness of mother-to-child transmission (P < .05); and no association existed between the number of living children and future pregnancies (rs = −0.217; P = .036). Conclusion HIV-infected women living with HIV-negative partners in Cameroon expressed high sexual and fertility intentions with several unmet needs, including safer sexual practices and conception. Incorporating and supporting safe sexual educational practices and conception services in maternal care can decrease risky sexual behavior and vertical transmission.
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Affiliation(s)
- Martin Kuete
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon
| | - Hongfang Yuan
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian He
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Aude Laure Tchoua Kemayou
- Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon
| | - Tita Pale Ndognjem
- Yaounde Central Hospital, Faculty of Medicine and Biomedical Sciences, The University of Yaounde, Yaounde, Messa, Cameroon
| | - Fan Yang
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - ZhiZong Hu
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - BoZhen Tian
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kai Zhao
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - HuiPing Zhang
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - ChengLiang Xiong
- Family Planning Research Institute, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Zafer M, Horvath H, Mmeje O, van der Poel S, Semprini AE, Rutherford G, Brown J. Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis. Fertil Steril 2015; 105:645-655.e2. [PMID: 26688556 DOI: 10.1016/j.fertnstert.2015.11.028] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)-discordant couples in which the male partner is infected. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Forty single-arm open-label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen. INTERVENTION(S) Semen washing followed by IUI, IVF, or IVF/ICSI. MAIN OUTCOME MEASURE(S) PRIMARY OUTCOME HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy. RESULT(S) No HIV transmission occurred in 11,585 cycles of assisted reproduction with the use of washed semen among 3,994 women. Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women after 2,863 cycles of assisted reproduction with the use of washed semen. Studies that measured HIV transmission to infants reported no cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy with the use of washed semen. CONCLUSION(S) Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help to further reduce the spread of HIV.
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Affiliation(s)
- Maryam Zafer
- Global Health Sciences, University of California, San Francisco, California
| | - Hacsi Horvath
- Global Health Sciences, University of California, San Francisco, California
| | - Okeoma Mmeje
- Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Sheryl van der Poel
- Division of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Augusto E Semprini
- Department of Clinical Sciences "L. Sacco", University of Milan School of Medicine, Milan, Italy
| | - George Rutherford
- Global Health Sciences, University of California, San Francisco, California
| | - Joelle Brown
- Global Health Sciences, University of California, San Francisco, California; Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Epidemiology and Biostatistics and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California.
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Giles ML, Barak S, Baker G, Perna S, Tabrizi S, Greengrass V, Bourne H, Clarke GN, Peak SA, Hoy JF, Foster P, Knight RL. Outcomes from the first assisted reproduction program for HIV-serodiscordant couples in Australia. Med J Aust 2012; 195:599-601. [PMID: 22107010 DOI: 10.5694/mja11.10156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the clinical outcomes for all HIV-serodiscordant couples attending an assisted reproduction program. DESIGN, SETTING AND PARTICIPANTS Retrospective review of demographic, clinical and outcome data for all HIV-serodiscordant couples who attended an assisted reproduction program at a tertiary hospital in Melbourne, between its commencement in 2003 and June 2010. MAIN OUTCOME MEASURES Pregnancies, miscarriages, births, HIV transmission to the HIV-negative partner, semen quality and detection of HIV (HIV RNA and HIV DNA) in semen. RESULTS As of June 2010, 39 HIV-positive clients had proceeded to assisted reproduction after the initial consultation in the program. There were 162 completed cycles, with 26 pregnancies (clinical pregnancy rate per cycle, 16.2% for HIV-positive men with an HIV-negative partner, and 15.4% for HIV-positive women). Of all 222 tested semen samples, 18 (8%) had HIV RNA detected despite these men receiving antiretroviral therapy and having an undetectable HIV viral load in plasma. Sperm velocity was significantly lower in HIV-positive clients receiving combination antiretroviral therapy than in a control group of recipient-recruited sperm donors (P = 0.01); there were no other significant differences in sperm quality between the two groups. No HIV transmission to babies or HIV-negative partners occurred. CONCLUSION Our findings show detectable HIV in 8% of semen samples from men with an undetectable HIV viral load in plasma, but confirm the safety of assisted reproduction for HIV-serodiscordant couples within a program with strict protocols for HIV treatment and testing of all semen before use.
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Frainais C, Vialard F, Rougier N, Aegerther P, Damond F, Ayel JP, Yazbeck C, Hazout A, Selva J. Impact of freezing/thawing technique on sperm DNA integrity in HIV-1 patients. J Assist Reprod Genet 2010; 27:415-21. [PMID: 20496107 DOI: 10.1007/s10815-010-9417-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 04/08/2010] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION According french legislation, sperm freezing/thawing procedures are used to prevent ART contaminations in couple with HIV-1 infected men. We determined sperm nuclear fragmentation rate before and after selection and freezing/thawing in HIV-1 14 patients. METHODS Two groups of patients were studied: 20 control patients with normal sperm (group 1) and without viral infection and 20 fertile treated HIV-1 patients (group 2). DNA fragmentation was evaluated using terminal uridine nick end labeling, before and after gradient selection, and after cryopreservation and thawing procedures. RESULTS DNA fragmentation rates in fresh semen were increased in HIV patients (6.38% vs 3.39%) (p < 0.05) compared with control patients. After sperm migration, fragmentation rates were significantly lower (p < 0.0001) in the two groups compared with fresh sperm rates. After freezing/thawing, values were similar to those of fresh semen with an increased rate (p < 0.01) for HIV-1 patients, with respectively 3.40% and 5.18% rates in control and infected patients. HIV-1-infected patients treated by antiretroviral therapy showed a significant increase in sperm DNA fragmentation in fresh sperm and also after freezing/thawing procedures, but these two fragmentation rates were not significantly different. CONCLUSION So, freezing/thawing procedures do not seem to impair sperm DNA and preserve probability of conception for couples with HIV-1 infected men.
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Abstract
As life expectancy for HIV-infected persons improves, studies in sub-Saharan Africa show that a considerable proportion of HIV-positive women and men desire to have children. Integrating sexual and reproductive health care into HIV services has until now emphasized the right of women to make informed choices about their reproductive lives and the right of self-determination to reproduce, but this is often equated with avoidance of pregnancy. Here, we explore guidance and attention to safer conception for HIV-infected women and men. We find this right lacking. Current sexual and reproductive health guidelines are not proactive in supporting HIV-positive people desiring children, and are particularly silent about the fertility needs of HIV-infected men and uninfected men in discordant partnerships. Public health policymakers and providers need to engage the HIV-infected and uninfected to determine both the demand for and how best to address the need for safer conception services.
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Abstract
Many HIV-infected individuals are in relationships with HIV-uninfected partners and desire to have children. This review focuses on the issue of reproductive choices for these couples, in particular assisted reproductive technologies, and summarises the published outcome data currently available. The results thus far from assisted reproductive technologies in optimising pregnancy outcomes and reducing heterosexual and perinatal HIV transmission are promising. In the future, it is essential that there is ongoing reporting of outcome data, publication of methodology and follow-up, and reporting of adverse outcomes.
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Affiliation(s)
- Michelle Giles
- Macfarlane Burnet Institute for Medical Research and Public Health, GPO Box 2284, Melbourne, VIC 3001, Australia.
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Fineschi V, Neri M, Turillazzi E. The new Italian law on assisted reproduction technology (Law 40/2004). JOURNAL OF MEDICAL ETHICS 2005; 31:536-9. [PMID: 16131556 PMCID: PMC1734215 DOI: 10.1136/jme.2004.010231] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The Italian parliament passed the law on assisted reproduction after a heated debate. The promulgation of this law (Law 40/2004) is the end point of a long and troubled journey that has seen many bills come and go, all of which have failed. The law consists of a whole set of regulations that will have a great impact on health and on society in general. The law is against many of the technical practices of assisted reproduction; several such practices are banned. This paper outlines ethical and medicolegal issues arising in connection with the law. The law states that no more than three embryos must be created at any one time and all the embryos created must be transferred together even if the couple does not need all the embryos. Embryo cryopreservation is also forbidden, as is assisted reproductive technology (ART), which uses a third party in any way, and the screening of embryos for genetic defects.
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Affiliation(s)
- V Fineschi
- Institute of Legal Medicine, University of Foggia, Ospedali Riuniti, Via L Pinto, no 1, 71100 Foggia, Italy.
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Pitts M, Shields P. Access to infertility investigations and treatment for HIV+ people: a survey of Australian infertility clinics. Aust N Z J Public Health 2005; 28:360-2. [PMID: 15704701 DOI: 10.1111/j.1467-842x.2004.tb00444.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine the availability in Australia of investigations and treatment of infertility for people infected with HIV. METHODS The study was a questionnaire survey of all identified Australian IVF clinics undertaken in 2002. All clinics potentially offering investigations and treatments for IVF were contacted (52) and invited to return a survey concerning people infected with HIV. RESULTS Thirty-one (59.6%) clinics responded. Fourteen (45.2%) clinics had seen 24 HIV+ patients in the past 12 months. Twenty (64.5%) clinics had a policy on HIV. In nearly all clinics (n=29), an HIV+ man or woman would be offered investigations; 28 clinics indicated they would offer investigations when both partners were positive. Treatments would be offered by 26 clinics if the man was HIV+, by 23 clinics if the woman was HIV+, and by 24 clinics if both were HIV+. CONCLUSIONS Infertility treatment in Australia for HIV+ people is available. Couples will more than likely receive both investigations and treatment. There are marked differences between States and Territories in the numbers of HIV+ people reported seen at the clinics. IMPLICATIONS There is currently variable access and policies with regard to infertility treatment for HIV+ people in Australia. It is likely that demand for these services will increase.
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Affiliation(s)
- Marian Pitts
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria.
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Younglai EV, Holloway AC, Foster WG. Environmental and occupational factors affecting fertility and IVF success. Hum Reprod Update 2005; 11:43-57. [PMID: 15601728 DOI: 10.1093/humupd/dmh055] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Reproductive function has been shown to be sensitive to changes in the physical, psychosocial and chemical environments. Although reproductive effects of occupational exposure to hazardous chemicals have been well documented in the literature, the potential effects of chemical contaminants at levels representative of contemporary exposures in the general population are much less certain. Evidence for adverse effects of exposure to environmental contaminants is more conclusive among the lower animals than for humans where considerable controversy remains. In addition to potential reproductive hazards of exposure to environmental contaminants, there is also evidence for adverse reproductive effects of the physical and psychosocial environments. In this review we focus on the difficulties involved in linking exposure to putative hazardous substances in environmental and occupational settings to adverse reproductive outcomes, especially success of IVF procedures. We highlight the plausibility of adverse events through animal and cell studies and the application of these results to the interpretation of human data. We consider both the male and female partners since it is essentially their combined contributions of gametes which may be affected by chemicals, which lead to successful outcomes.
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Affiliation(s)
- Edward V Younglai
- Department of Obstetrics & Gynaecology, Reproductive Biology Division, McMaster University, Health Sciences Centre, Hamilton, Ontario, Canada.
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Spriggs M, Charles T. Should HIV discordant couples have access to assisted reproductive technologies? JOURNAL OF MEDICAL ETHICS 2003; 29:325-9. [PMID: 14662810 PMCID: PMC1733816 DOI: 10.1136/jme.29.6.325] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
In this paper we identify and evaluate arguments for and against offering assisted reproductive technologies (ART), specifically IVF, to HIV discordant couples (male partner HIV positive, female partner HIV negative). The idea of offering ART to HIV discordant couples generates concerns about safety and public health and raises questions such as: what is an acceptable level of risk to offspring and should couples who want this assistance be subject to selection criteria; should they undergo scrutiny about their suitability as parents when those who are able to conceive naturally face no such scrutiny and people with other illnesses are given access to ART? We conclude that offering ART to HIV discordant couples is likely to produce more benefit than harm and violates no ethical principles. Nevertheless, a decision to deny treatment need not constitute unjustified discrimination.
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Affiliation(s)
- M Spriggs
- Ethics Unit, Murdoch Children's Research Institute, Royal Childrens Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
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