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Murtinger M, Wirleitner B, Hradecký L, Comploj G, Okhowat J, Spitzer D, Stadler J, Haidbauer R, Schuff M, Yildirim S, Soepenberg T, Eibner K, Gagsteiger F. Medical research and reproductive medicine in an ethical context: a critical commentary on the paper dealing with uterine lavage published by Munné et al. J Assist Reprod Genet 2020; 37:2691-2698. [PMID: 33025400 DOI: 10.1007/s10815-020-01954-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022] Open
Abstract
A recent study published in Human Reproduction claimed that uterine lavage offers a non-surgical, minimally invasive strategy for the recovery of human embryos from fertile women who do not want or need IVF for medical reasons but who desire preimplantation genetic testing (PGT) for embryos. To prove this hypothesis, the researchers recruited dozens of young Mexican women. The prospective oocyte donors underwent ovarian stimulation to induce the production of multiple mature oocytes. Subsequently, these women were inseminated by donor semen. A few days later, the developing embryos were collected by uterine lavage (uterine flushing) and subjected to genetic testing for aneuploidies (PGT-A). Oocyte donors with persistently elevated hCG levels, indicating the implantation of one or more embryos after uterine lavage, had to undergo uterine curettage and/or treatment with methotrexate. A critical opinion paper discussing the aforementioned study was published by De Santis and colleagues and has raised critical issues that are largely technical in nature. However, this opinion paper neglects-from our point of view-critical issues of the Mexican study regarding ethical principles and moral standards in human research. These aspects are summarized below.
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Affiliation(s)
| | | | | | | | - Jasmin Okhowat
- NEXTCLINIC IVF Zentren Prof. Zech-Bregenz, Bregenz, Austria
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Abstract
Oocyte cryopreservation, or 'egg freezing,' is the practice of preserving unfertilised oocytes for later fertilisation. This practice allows women to extend their reproductive years. In 2014, Facebook and Apple announced that they would subsidise their female employees' elective - or 'social' - use of egg freezing so that these women can more easily reconcile the demands of career and family life. This announcement engendered controversy and moral debate. Given that social egg freezing (SEF) is becoming more popular, ethical and empirical analyses are warranted. Here, I utilise content analysis to examine media messages in advertising for SEF. I conclude that many fertility clinics engage in biased advertising - i.e. they advertise the service persuasively, not informatively, emphasising indirect benefits while minimising risks and the low chance of successfully bringing a child to term. As advertising for medical services has been shown to influence the use of those services, advertising for SEF should emphasise clear and easily interpretable statistics about success rate, usage rate, cost, and risk.
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Affiliation(s)
- Christopher Barbey
- a Center for Bioethics , University of Minnesota , Minneapolis , MN , USA
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Walsh SK, Ginsburg ES, Lehmann LS, Partridge AH. Oncofertility: Fertile Ground for Conflict Between Patient Autonomy and Medical Values. Oncologist 2017; 22:860-863. [PMID: 28408620 PMCID: PMC5507640 DOI: 10.1634/theoncologist.2016-0373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/13/2016] [Indexed: 11/17/2022] Open
Abstract
Oncofertility is a unique, multidisciplinary field that serves to bridge the gap between available fertility resources and the special reproductive needs of cancer patients. Oncofertility is a growing field due to the increasing number of survivors, development of new oncologic therapies, extension of duration of therapies, and development and refinement of reproductive therapies. While the technologies and demand for services expand, clinicians need to be appropriately prepared for dealing with various clinical scenarios that may require ethical deliberation. Three real cases are presented in which the patient wishes to pursue reproductive assistance, but her decision is met with hesitance or uncertainty by her care team. Discussion of these clinical scenarios highlights ethical implications of oncofertility practice and serves to highlight the need for the establishment of multidisciplinary care teams and guidelines to support both clinicians and patients. IMPLICATIONS FOR PRACTICE The growing field of oncofertility is ripe for conflict between patient autonomy and medical values due to the nature of cancer and associated threat on an individual's health and survival, as well as the personal significance of childbearing. Cases are presented and ethical implications are discussed to further explore the inherent difficulties in oncofertility practice and guide clinicians in similar situations. Developing guidelines and establishing multidisciplinary teams to facilitate oncofertility discussions and care, as well as training of clinical team members, may improve patient safety, well-being, and satisfaction within the context of fertility decision making, care, and outcomes.
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Affiliation(s)
- Sarah K Walsh
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth S Ginsburg
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ann H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Wenderlein JM. The Cause Is Reproductive Behavior. Dtsch Arztebl Int 2015; 112:612. [PMID: 26396047 PMCID: PMC4581109 DOI: 10.3238/arztebl.2015.0612a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Angel Petropanagos
- Novel Tech Ethics (Petropanagos, Cattapan, Baylis), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynecology, University of Ottawa, and Ottawa Fertility Centre (Leader), Ottawa, Ont.
| | - Alana Cattapan
- Novel Tech Ethics (Petropanagos, Cattapan, Baylis), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynecology, University of Ottawa, and Ottawa Fertility Centre (Leader), Ottawa, Ont
| | - Françoise Baylis
- Novel Tech Ethics (Petropanagos, Cattapan, Baylis), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynecology, University of Ottawa, and Ottawa Fertility Centre (Leader), Ottawa, Ont
| | - Arthur Leader
- Novel Tech Ethics (Petropanagos, Cattapan, Baylis), Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynecology, University of Ottawa, and Ottawa Fertility Centre (Leader), Ottawa, Ont
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O'Shea L C, Mocanu E V. Stopping the Biological Clock--Who Benefits? Ir Med J 2015; 108:165-6. [PMID: 26182796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Aznar J, Tudela J. [Is it ethical to freeze oocytes to delay childbearing for employment?]. Cuad Bioet 2015; 26:141-145. [PMID: 26030020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 02/22/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Justo Aznar
- Instituto de Ciencias de la Vida de la Universidad Católica de Valencia San Vicente Mártir .C. Guillem de Castro 94, 46003, Valencia, España.
| | - Julio Tudela
- Instituto de Ciencias de la Vida de la Universidad Católica de Valencia San Vicente Mártir.C. Guillem de Castro 94, 46003, Valencia, España
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Bard JS, Penrose L. Responding to Requests for Assisted Reproductive Technology Intervention Involving Women Who Cannot Give Consent. Health Matrix Clevel 2015; 25:227-255. [PMID: 29493172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
One of the plots of the Canadian science fiction thriller Orphan Black involves a scheme to create dozens of siblings by harvesting the eggs of one woman, fertilizing them with the sperm of a single man, and implanting them for gestation in dozens of apparently willing surrogates.¹ The casualness of the procedure speaks to how comfortable we have all become with reproduction by technology. Yet there are still aspects of this process that remain outside the normative boundaries of most of our worldviews. This article considers recent advances in assisted reproductive technology (ART) that can result in a viable, fertilized embryo even when the mother is herself either permanently unconscious from a severe injury or has actually lost all brain function and therefore meets the legal criteria for brain death. It reviews these advances and applies them to four scenarios, or vignettes, that represent different concerns about the prospective mother’s intent to reproduce before losing her ability to give consent.
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Wennberg AL, Lundborg E, Zachrisson U, Nielsen S, Saldeen P, Brännström M. [Private egg bank to protect fertility against aging]. Lakartidningen 2014; 111:793-795. [PMID: 24855744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Greer DM, Styer AK, Toth TL, Kindregan CP, Romero JM. Case records of the Massachusetts General Hospital. Case 21-2010. A request for retrieval of oocytes from a 36-year-old woman with anoxic brain injury. N Engl J Med 2010; 363:276-83. [PMID: 20647203 DOI: 10.1056/nejmcpc1004360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David M Greer
- Department of Neurology, Massachusetts General Hospital, Boston, USA
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Abstract
This article describes the relatively new technology of freezing human eggs and examines whether egg freezing, specifically when it is used by healthy women as 'insurance' against age-related infertility, is a legitimate exercise of reproductive autonomy. Although egg freezing has the potential to expand women's reproductive options and thus may represent a breakthrough for reproductive autonomy, I argue that without adequate information about likely outcomes and risks, women may be choosing to freeze their eggs in a commercially exploitative context, thus undermining rather than expanding reproductive autonomy.
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Affiliation(s)
- Karey Harwood
- Department of Philosophy and Religion and Women's and Gender Studies at North Carolina State University, North Carolina 27695-8103, USA.
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Abstract
This article explores the social benefits and moral arguments in favour of women and couples freezing eggs and embryos for social reasons. Social IVF promotes equal participation by women in employment; it offers women more time to choose a partner; it provides better opportunities for the child as it allows couples more time to become financially stable; it may reduce the risk of genetic and chromosomal abnormality; it allows women and couples to have another child if circumstances change; it offers an option to women and children at risk of ovarian failure; it may increase the egg and embryo pool. There are strong arguments based on equal concern and respect for women which require that women have access to this new technology. Freezing eggs also avoids some of the moral objections associated with freezing embryos.
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