Claims about whether or not infertility is a disease are sometimes invoked to defend or criticize the provision of state-funded treatment for infertility. In this paper, I suggest that this strategy is problematic. By exploring infertility through key approaches to disease in the philosophy of medicine, I show that there are deep theoretical disagreements regarding what subtypes of infertility qualify as diseases. Given that infertility's disease status remains unclear, one cannot uncontroversially justify or undermine its (...) claim to medical treatment by claiming that it is or is not a disease. Instead of focusing on disease status, a preferable strategy to approach the debate about state-funded treatment is to explicitly address the specific ethical considerations raised by infertility. I show how this alternative strategy can be supported by a recent theoretical framework in the philosophy of medicine, which avoids the problems associated with the concepts of health and disease. (shrink)

I explore the role that values and interests, especially ideological interests, play in managing and balancing epistemic risks in medicine. I will focus in particular on how diseases are identified and operationalized. Before we can do biomedical research on a condition, it needs to be identified as a medical condition, and it needs to be operationalized in a way that lets us identify sufferers, measure progress, and so forth. I will argue that each time we do this, we engage in (...) epistemic risk balancing that inevitably draws upon values and interests, often including social and ideological values. My main interest here is in the conceptualization of infertility as a disease. Infertility is a rich test case for exploring the interplay between interests and epistemic risk management. There is no uncontested or standardized definition of infertility. The various definitions of it are internally ambiguous and tension-ridden, and in spectacular contradiction with one another. Many interest groups who are invested in framing infertility as a pressing problem deserving of social and medical redress are quick to insist that it is a legitimate ‘disease,’ but they cannot agree on which disease it is, what its symptoms or diagnostic markers are, or even what its basic ontology is. I suggest that there are political explanations for this epistemic mess. Indeed, I contend that there are good scientific and ethical reasons to reduce away the category of ‘infertility,’ especially understood as a scientific or medical category; I argue that we should excise the concept from our research and clinical practices. (shrink)

Infertility can be an agonizing experience, especially for women. And, much of the agony has to do with luck: with how unlucky one is in being infertile, and in how much luck is involved in determining whether one can weather the storm of infertility and perhaps have a child in the end. We argue that bad luck associated with being infertile is often bad moral luck for women. The infertile woman often blames herself or is blamed by others (...) for what is happening to her, even when she cannot control or prevent what is happening to her. She has simply had bad luck. We focus on the self-blame of infertile women and show how it stems from pro-natalism that targets women. We also argue that overall for women, regret is a better moral response to infertility than self-blame. (shrink)

This article discusses the new reproductive technology of egg freezing in the context of existing literature on gender, medicalization, and infertility. What is unique about this technology is its use by women who are not currently infertile but who may anticipate a future diagnosis. This circumstance gives rise to a new ontological category of “anticipated infertility.” The author draws on participant observation and a qualitative analysis of scientific, mainstream, and marketing literature to identify and compare the representation of (...) two different candidates for egg freezing: women with cancer and healthy young women. Although both populations experience anticipated infertility, their dichotomous portrayals as appropriate candidates are demonstrative of gender norms linking women to motherhood. Egg freezing is a concise illustration of how the medicalization of women’s bodies and bodily processes masks a host of cultural anxieties about aging, illness, reproduction, and risk. (shrink)

Using qualitative data based on interviews with 22 married infertile couples living in western New York State, we describe the ways in which husbands and wives interact in the process of constructing their infertility. The wives experienced infertility as a cataclysmic role failure. Husbands tended to see infertility as a disconcerting event but not as a tragedy. Couples tended to see infertility as a problem for wives. Frustration and lack of communication were typical consequences of the (...) confrontation of husbands' and wives' perspectives on infertility. Interactions with medical professionals tended to reinforce these consequences. These interactions between wives, husbands, and medical professionals may lead to taking wrong directions in treatment and to ignoring treatment options. Some of the problems we describe could be lessened by adopting a model of couple-centered treatment in a setting that incorporated routine counseling. (shrink)

Infertility specialists may be confronted with the ethical dilemma of whether to disclose misattributed paternity (MP). Physicians should be prepared for instances when an assumed father’s evaluation reveals a condition known for lifelong infertility, for example, congenital bilateral absence of vas deferens (CBAVD). When there is doubt regarding a patient’s comprehension of his diagnosis, physicians must consider whether further disclosure is warranted. This article describes a case of MP with ethics analysis that concludes that limited nondisclosure is most (...) consistent with a physician’s principled duties to inform, to respect patients’ autonomy, and to employ nonmaleficence (including the avoidance of psychosocial harms). (shrink)

This chapter explores current and prospective reproductive technologies and some of their likely implications for reproductive and family ethics and policymaking. The technologies discussed include uterus transplants, mitochondrial transfer, ectogenesis, the development of in vitro gametes, and solo reproduction. The chapter considers the impact of these developments on the content of concepts such as 'infertility', 'mother', or 'father'. Another layer to this process of redefinition originates in ongoing socio-cultural changes that shift the focus in parenting from the way in (...) which children have come into the world, to relationships within the family. Considering these scenarios beforehand can help to clarify some of the current challenges in defining and regulating infertility. The chapter therefore aims to raise a number of questions rather than provide answers. (shrink)

Patterns of reproductive failure described in humans and other mammals suggest that reproductive failure may in many instances be the result of adaptations evolved to suppress reproduction under temporarily harsh conditions. By suppressing reproduction under such conditions, females are able to conserve their time and energy for reproductive opportunities in which reproduction is most likely to succeed. Such adaptations have been particularly important for female mammals, given (a) the amount of time and energy that reproduction requires, and (b) the degree (...) to which reproductive conditions can vary.The existence of conscious and unconscious mechanisms to suppress reproduction under poor conditions has several implications for obstetric/gynecologic practices. Two implications are discussed with reference to biotechnological advancements in our ability to facilitate conceptions and manage problem pregnancies: (a) potential dangers of sophisticated technologies overriding natural fertility controls; and (b) the need for greater appreciation of the association between psychosocial stress and reproductive failure in the treatment of reproductive problems. Implications for elective abortion practices are discussed as well. (shrink)

Pfeiffer, Kimberley We've heard it happening more than once. A couple uses IVF to fall pregnant then later down the track they conceive naturally. Confusing, right? Aren't they supposed to be infertile? Isn't that why people request this invasive and expensive procedure in the first place? Well, a recent study shows that more than 40% of women aged between 28 and 36 years that report having a history of infertility achieved subsequent births without using any form of reproductive assistance1. (...) Which raises the question, what does it mean to be infertile? (shrink)

This article examines two questions pertaining to the extension of infertility treatment to postmenopausal women. First, what concepts and principles of infertility practice apply to assisted reproduction for the postmenopausal patient? Second, what role should these concepts play in the development of an ethical justification for extending women's reproductive lives past the menopausal boundary? The argument offered here supports their claim to infertility services on the basis of the formal principle of justice, which requires that similar cases (...) be treated similarly. The cases of many postmenopausal patients are argued to be relevantly similar to classes of patients who already receive assistance in reproduction. (shrink)

Many countries tightly ration access to publicly funded fertility treatments such as in vitro fertilisation. One basis for excluding people from access to IVF is their body mass index. In this paper, I consider a number of potential justifications for such a policy, based on claims about effectiveness and cost-efficiency, and reject these as unsupported by available evidence. I consider an alternative justification: that those whose subfertility results from avoidable behaviours for which they are responsible are less deserving of treatment. (...) I ultimately stop short of endorsing or rejecting such a justification, though highlight some reasons for thinking it is unlikely to be practicable. (shrink)

In a heart-wrenching TEDx Beacon Street talk entitled "A Journey Through Infertility: Over Terror's Edge", Camille Preston narrates her traumatic journey through infertility. Although she is now the mother of a child, Preston's characterization of infertility as "over terror's edge" and as "a journey" finds a graphic expression in Paula Knight's The Facts of Life, Emily Steinberg's Broken Eggs, and Phoebe Potts's Good Eggs. Unlike Preston, these authors do not give birth to a child; however, they authentically (...) portray the tribulations of infertility in their respective graphic memoirs. While Knight's memoir chronicles her traumatic experience of being an infertile woman in a society that... (shrink)

Infertility constitutes an essential source of stress in the individual and couple’s life. The Infertility-Related Stress Scale is of clinical interest for exploring infertility-related stress affecting the intrapersonal and interpersonal domains of infertile individuals’ lives. In the present study, the IRSS was translated into Brazilian–Portuguese, and its factor structure, reliability, and relations to sociodemographic and infertility-related characteristics and depression were examined. A sample of 553 Brazilian infertile individuals completed the Brazilian–Portuguese IRSS, and a subsample of 222 (...) participants also completed the BDI-II. A sample of 526 Italian infertile individuals was used to test for the IRSS measurement invariance across Brazil and Italy. Results of exploratory structural equation modeling indicated that a bifactor solution best represented the structure underlying the IRSS-BP. Both the general and the two specific intrapersonal and interpersonal IRSS-BP factors showed satisfactory levels of composite reliability. The bifactor ESEM solution replicated well across countries. As evidence of relations to other variables, female gender, a longer duration of infertility, and higher depression were associated with higher scores in global and domain-specific infertility-related stress. The findings offer initial evidence of validity and reliability of the IRSS-BP, which could be used by fertility clinic staff to rapidly identify patients who need support to deal with the stressful impact of infertility in the intrapersonal and interpersonal life domains, as recommended by international guidelines for routine psychosocial care in infertility settings. (shrink)

Murphy etal. (1997) showed age-standardised twinning rates for Scotland and England & Wales 195281 and subsequently increased to about 11·5 per 1000 in 1992–94. The authors conclude their paper with the words: 'perhaps 15% oftwins nationally now follow treatment and the natural twinning rate mightstill be in decline'.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies by Karey HarwoodKathryn Lilla CoxThe Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies Karey Harwood Chapel Hill, NC: University of North Carolina Press, 2007. 221pp. $22.00Karey Harwood’s The Infertility Treadmill, published in the University of North Carolina’s Studies in Social Medicine series, fills a lacuna in the (...) class='Hi'>infertility literature. Harwood takes an interdisciplinary approach examining “assisted reproductive technologies” (ART) using current scientific, philosophical, theological, and—most importantly—her own ethnographic research. By way of a thick description of women’s experiences of infertility, she draws the reader into a rich ethical conversation regarding ARTs.Harwood “seeks first and foremost to offer an interpretation of the ethical significance of the increasing use of ART by bringing a particular set of normative or evaluative lenses to bear on a particular set of descriptive data” (8). She engaged in this study because of her desire to explore the connections between decisions to use ART and such factors as paid employment, delayed childbirth, and the ongoing balancing of work and family life. Harwood gathered her descriptive data by spending a year with the Atlanta chapter of RESOLVE (The National Infertility Association): attending monthly meetings and listening to speakers and participants as well as appraising RESOLVE’s national and local literature. She also conducted nine interviews with eight women and one man. Focusing on work and family conflicts in light of questions related to gender justice and the interplay between social and communal norms theories, on the one hand, and private and individual choice, on the other, Harwood teases out the ethical complexity surrounding ARTs.After surveying philosophical and theological literature relevant to her topic, Harwood names and examines existential concerns that emerged from her observations, conversations, and interviews with RESOLVE members. Clustered thematically, these concerns include the painful isolation of infertility, the stigma attached to using ARTs, people’s moralizing, how much treatment to pursue, what is the value in trying one more thing, socioeconomic status, and emotional awareness (62–97). Throughout her discussion of these concerns, [End Page 209] Harwood reminds ethicists of the importance of personal narratives for any treatment of an ethical issue like this.Moreover, her research leads Harwood to deduce that RESOLVE helps people with meaning-making, questions of purpose, language clarification, and various options surrounding infertility and ARTs. She asserts that the infertility experience can be a transformative one for the infertile. The decision-making process regarding the use of ARTs functioned as a type of ritual—albeit “a consumeristic ritual”—that aided people in working through the grief of infertility (157). Religious institutions have not always helped the infertile in these areas. Nonetheless, Harwood’s study leads her to conclude that RESOLVE members and leaders tend to be deficient in their capacities for challenging and critically examining how individual decisions intertwine with larger social contexts.Harwood acknowledges that her methodological decision to focus on one RESOLVE chapter limited her demographics (63–64). Moreover, although for the most part balanced, Harwood’s assessment of her findings is at times partial, even bordering on advocacy. For example, she clearly seeks to make the case that ethical analyses of infertility need to be more nuanced—incorporating more personal narrative—and that RESOLVE needs to be more open to critical self-reflection, especially the critical questioning of the “treadmill of infertility” (133). In her analysis of her findings, Harwood demonstrates how personal narratives help nuance ethical analysis. Less clear is whether RESOLVE can be or wants to be more self-critical and more questioning of its own core premises. Nonetheless, these limitations do not detract from Harwood’s important insights regarding “the infertility treadmill” and the host of issues related to ARTs—including consumerism, the role of rituals, meaning-making, suffering and grief, and gender justice, among others.Those struggling with infertility or considering ARTs will find Harwood to be an empathetic dialogue partner. Others will gain a deeper understanding of infertility’s toll by reading this book. Graduate and advanced undergraduate students will benefit from Harwood’s analysis of how personal decisions have wide-ranging... (shrink)

Fiction television series are one of the few cultural expressions in which men’s infertility experiences are represented. Through a content analysis of twenty fiction series, this article describes and analyzes such representations. By drawing on Connell’s concept of hegemonic masculinity and Ricoeur’s understanding of paradoxical power structuring, four character types of infertile men are identified: (1) the virile in/fertile man, (2) the secretly non-/vasectomized man, (3) the intellectual eunuch, (4) the enslaving post-apocalyptic man. While these various dramatis persona outline (...) different ways of how infertile men relate to normative hegemonic masculinity, they all represent infertile men as diverging from shared masculine norms. This non-normativity initially excludes many represented men from hegemonic positions. Eventually, however, these men generally aspire to and succeed in reaffirming their hegemonic masculinity through coercive force towards women and other men, through instigating the precondition for any power structure – the shared will to live together as a community –, and/or by seeking and finding explicit recognition for their normativity and dominance. At the end of this paper, I will reflect on the potential harmful effect of these outlined representations of infertile men and make a plea for diversifying representations of infertile men in our culture. (shrink)

The Chief Medical Officer of Health of the United Kingdom has recommended that the 1990 Human Fertilisation and Embryology Act should be amended to allow cloning in humans for research purposes only. He also recommended that: “The transfer of an embryo created by cell nuclear replacement into the uterus of a woman (so called ‘reproductive cloning’) should remain a criminal offence” (recommendation 7, Ref. 1). This recommendation implies that nuclear replacement and cloning are the same. They are not. Nuclear transfer (...) constitutes reproductive cloning only when the individual created is genetically identical to the nuclear donor. In this paper, we describe a possible future use of nuclear transfer for the treatment of infertile individuals. The treatment yields an individual that receives approximately equal genetic contributions from each parent. We use this example to illustrate how semantic confusion might lead to plausibly moral and justifiable treatments being legally banned. In doing so, we hope to encourage a more accurate and informed use of language in science, law and politics, so that legislation is properly informed by science and achieves what it intends. BioEssays 23:359–364, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

In Turkey, as in many other countries, infertility is generally regarded as a negative phenomenon in a woman’s life and is associated with a lot of stigma by society. In other words, female infertility and having a baby using Assisted Reproductive Technologies have to be taken into consideration with respect to gender, motherhood, social factors, religion and law. Yet if a woman chooses to use ART she has to deal with the consequences of her decision, such as being (...) ostracized by society. Other types of procedures in this area, such as sperm and ova donation or surrogate motherhood, are not permitted in law. However, both before and after the development of this techonology, society has been finding its own solutions which are rarely questioned and are still performed. This article will discuss what these practices are and try to reach some pragmatic conclusions concerning female infertility, the concept of motherhood and some traditional practices in Turkey. (shrink)

Infertile women in the developing world face an additional layer of vulnerability compared to their counterparts in the developed world due to social, cultural, political, and socioeconomic factors that truly render their infertility a disability. After exploring how infertility in the developing world fits the World Health Organization’s biopsychosocial model of disability, we will argue that feminists and disability rights proponents should jointly articulate and advocate for change.

In Western countries today, a growing number of women delay motherhood until their late 30s and even 40s, as they invest time in pursuing education and career goals before starting a family. This social trend results from greater gender equality and expanded opportunities for women and is influenced by the availability of contraception and assisted reproductive technologies. However, advanced maternal age is associated with increased health risks, including infertility. While individual medical solutions such as ART and elective egg freezing (...) can promote reproductive autonomy, they entail significant risks and limitations. We thus argue that women should be better informed regarding the risks of advanced maternal age and ART, and that these individual solutions need to be supplemented by a public health approach, including policy measures that provide women with the opportunity to start a family earlier in life without sacrificing personal career goals. (shrink)

As a feminist updating of Foucauldian analysis, the article makes the point that ‘the lesbian’ was not significantly exposed or seriously interpellated by Danish official discourse until the political debate on new reproductive technologies and reprogenetics accelerated at the end of the 20th century. In the 1990s, the debate thus constructed ‘the lesbian’ not only as an ‘unnatural mother’, but also as heiress to the monstrous figure of the ‘mad scientist’ whose tampering with the embryo had stirred the political mind (...) in the previous decade. Deeply worried by developments in biotechnology, many politicians felt they should protect the embryo from this sinister scientist, and, subsequently, the innocent child from the monstrous lesbian. Hence, a majority of MPs voted for excluding lesbians and single women from access to assisted reproduction in medical clinics. (shrink)

Experimental, theoretical, psychological, and economic barriers have caused physicians to rely on biomedical treatments for infertility at the exclusion of more environmentally oriented ones (e.g., psychosocial stress therapy). An evolutionary model is described for the origin of reproductive failure, suggesting why mammals evolved to be reproductively responsive to the environment and why psychosocial stress should have an especially strong impact on fertility problems. A study of the causal role of psychosocial stress in infertility is then summarized. The paper (...) concludes with implications for future directions for the treatment of infertility and related human reproductive problems. (shrink)

In this paper we will look at the various ways in which infertility can be understood and at how need for reproductive therapies can be construed. We will do this against the background of research with artificial gametes. Having explored these questions we will attempt to establish the degree to which technologies such as AGs could expand the array of choices that people have to reproduce and/or become parents. Finally, we will examine whether and in what ways the most (...) promising developments of such technologies are likely to bring about the “end of infertility”. (shrink)

This paper explores the experiences of infertile women who occupy a liminal space in society, and argues that the fertility clinic served as a space to tolerate women's experiences of liminality. It provided not only rituals aimed at transition to pregnancy, but also a space where women's liminal experiences, which are caused by the existential chaos of infertility, could be tolerated. The British experience seemed to differ from the American one identified in the literature, where self‐management and peer group (...) support are described as strategies used by infertile women to manage infertility. The British women in this study did not appear to draw so much on self‐management or peer group support to deal with their experiences of infertility. They appeared to be isolated in their experience. The clinic thus provided a space in which recognition was given to their intensely private experiences of difference from those in the outside fertile world and allowed them to manage these socially unacceptable, culturally taboo and invisible experiences. However, because of its very limited success rate in enabling women to become pregnant, rather than facilitating the transition of status from infertile to fertile woman, the clinic also served to reinforce the liminal experiences of those women who remained infertile. Inadvertently, the clinic offered a way of being in limbo while at the same time reinforcing the liminal experiences of women. (shrink)

In this article, it is argued that it is problematic to construe the debate around the process labelled ‘surrogacy’ as a form for infertility treatment. Firstly, this way of defining what happens opens up a new form of medical desire where a growing number of people wish to have children through ‘surrogacy’. This medicalizes childlessness and creates pressure within health services to respond to the desires of an ever-growing group of patients. Secondly, this labels the woman who carries the (...) child as a ‘surrogate’ and defines her as a core element in a ‘treatment method’. This way of phrasing and defining what happens puts the woman carrying the child in an unacceptable moral position within the health system. Thirdly, by viewing the woman carrying the child as a ‘substitute’ for a mother or as a ‘temporary custodian’ ignores the unique relationship between the foetus and the pregnant woman. To keep the ethical issues in focus in the ‘surrogacy’ process, it is necessary for health professionals to always... (shrink)

Although there are important moral arguments against cloning human beings, it has been suggested that there might be exceptional cases in which cloning humans would be ethically permissible. One type of supposed exceptional case involves infertile couples who want to have children by cloning. This paper explores whether cloning would be ethically permissible in infertility cases and the separate question of whether we should have a policy allowing cloning in such cases. One caveat should be stated at the beginning, (...) however. After the cloning of a sheep in Scotland, scientists pointed out that using the same technique to clone humans would, at present, involve substantial risks of producing children with birth defects. This concern over safety gives compelling support to the view that it would be wrong to attempt human cloning now. Thus, we do not reach the debate about exceptional cases unless the issue of safety can be set aside. I ask the reader to consider the possibility that in the future humans could be cloned without a significantly elevated risk of birth defects from the cloning process itself. The remainder of this paper assumes, for sake of argument, that cloning technology has advanced to that point. Given this assumption, would cloning in the infertility cases be ethically permissible, and should it be legally permitted? (shrink)

Melanie was 29-years-old, married, and hoping to start a family when she discovered a lump in her pelvis. She was diagnosed with non-Hodgkin lymphoma. But one of her biggest fears upon learning of her diagnosis was the possibility of loosing her ability to have children. When Melanie asked her oncologist and radiation oncologist about the risk cancer treatment posed to her fertility, they told her it was small, as only one ovary would be destroyed during the radiation. Deciding to ask (...) for another opinion, she sought out a reproductive endocrinologist, who told her, contrary to what her oncologists had said, that women like her typically did have problems conceiving after radiation treatment on their pelvis. One of the hardest parts of dealing with her dual diagnosis, Melanie later recalled, was the unknown: “I didn't know if my treatment would definitely render me infertile.”. (shrink)

In this paper, we recommend expanding infertility insurance mandates to people who may become infertile because of cancer treatments. Such an expansion would ensure cancer patients can receive fertility preservation technology (FPT) prior to commencing treatment. We base our proposal for extending coverage to cancer patients on the infertility mandate in Massachusetts because it is one of the most inclusive. While we use Massachusetts as a model, our arguments and analysis of possible routes to coverage can be applied (...) to all states' seeking inclusive coverage for infertility treatment. Furthermore, our proposal can also be applied to people with other diseases who may be rendered infertile by treatment. (shrink)

BackgroundPsychological distress is common among infertility patients. Total scale scores are often used to represent the severity of anxiety, depression, or stress, which ignores important differences between specific symptoms, and relationships between symptoms. This study aimed to identify patterns of psychological distress experienced by infertility patients and to identify the most central symptoms of anxiety, depression, and stress.MethodFrom June to September 2016, 740 infertility patients were included in this cross-sectional study. Infertility patients were asked to complete (...) the Generalized Anxiety Disorder-7, Patients Health Questionnaire-9 (PHQ-9), and Fertility Problem Inventory. Network analysis was used to examine the patterns of psychological distress in infertility patients and to test the most central symptoms of anxiety, depression, and stress.ResultsRestlessness was the most central symptom in infertility patients. “Feelings of guilt” had the highest strength among PHQ-9 symptoms. “Relationship concern stress” and “sexual concern stress” had the strongest connections in the network. Stability estimation indicated that the order of node strength centrality was more stable than the order of closeness and betweenness (the CS-coefficients were 0.75, 0.13, and 0.67, respectively). In addition, network structure and global strength were invariant across gender.LimitationsThe cross-sectional design did not permit identification of causal relationships. Patients in this study were recruited from one reproductive hospital; especially, most patients had low socioeconomic status, which limits generalizability of the findings.ConclusionThis study reinforces the need to better understand the underlying causes of psychological distress in infertile patients. A more detailed investigation of the relationship between these symptoms could provide information for psychosocial interventions aimed beyond “alleviating psychological distress.” We should consider the individual psychological symptom pattern and its potential causes in infertility patients instead of assuming a consistent psychological distress structure. (shrink)

Although most studies investigated the impact of infertility and its treatment on the couple, a small body of evidence suggested that infertility care providers may experience different sources of stress related for instance to excessive workload, the complexity of the technique, and relational difficulties with patients. The current study aimed at providing further insight into the understanding of the subjective experience of infertility care providers by highlighting their feelings and emotions, personal meanings, challenges, and opportunities. Following the (...) methodological guidelines of Interpretative Phenomenological Analysis, we conducted individual semi-structured interviews with 23 members of two different fertility units. Interviews were audiotaped and transcribed verbatim. Textual analysis was then conducted to identify emerging dominant themes and subthemes. Three main themes were extracted: dealing with infertile patients and their specificities, performing assisted reproductive technology, being part of a team. These themes related to participants experiencing: difficulties in establishing an empathic connection and communicating with couples, such that women were sometimes perceived as “particular patients” and men as poorly involved in the process; difficulties in dealing with a complex procedure in which errors are not allowed, with a growing number of women aged > 40 seeking assisted reproduction, despite the risks for their health; being part of a team as a resource, although the huge amount of time spent together can involve conflicts and organizational problems. These findings suggested that patients’ overpersistence represents an important source of stress for infertility care providers. At the same time, the concept of particular or difficult patient derives from the combination of multiple factors, including providers’ own history and subjective experience. The presence of mental health professionals in fertility units is essential to help providers improve the quality of doctor-patient communication and relieve the stress related to organizational issues and conflicts. (shrink)

This article will examine current US health insurance policies for providing fertility services and Assisted Reproductive Technologies and analyze the open-ended policies of the Commonwealth of Massachusetts. This state in particular will be discussed in depth, as there are virtually no limits on infertility provision or coverage. However, tightening up Massachusetts’s health insurance policies by putting parameters on provision and coverage of Assisted Reproductive Technologies will allow the infertile to continue to access paid-for treatment while ensuring that the goal (...) of health insurance coverage—which I understand to be the provision of paid coverage to address medical conditions—is maintained. (shrink)

The aim of this article is to analyse the role of metaphors for the infertile body in the context of assisted reproduction, using conceptual metaphor theory as a framework, and to evaluate the moral significance of these metaphors. This sub-study is part of a larger study examining the biosafety practices of new biotechnologies in Latvia. In the sub-study, special attention was paid to metaphors used by assisted reproductive technology users, egg donors and experts. It can be concluded that not only (...) does the infertility experience influence the choice of metaphors, but the use of certain metaphors can also change the infertility experience. In this process the practice of infertility treatment and the meaning of the body are socially and culturally shaped. The main groups of metaphors for the infertile body discovered through interview analysis are: order/disorder, the body as a resource, the body as a container, the body as a project, and anthropomorphization of gametes. (shrink)

Background: When infertility is diagnosed, physicians have the difficult task to break bad news. Their communication skills play a central role in improving patients' coping abilities and adherence to infertility treatments. However, specific guidelines and training courses on this topic are still lacking. The aim of the present study is to provide some practical advice for improving breaking bad news in infertility diagnosis through a systematic literature review of qualitative and quantitative studies. Methods: Electronic searches were performed (...) in the MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Psychology and Behavioral Sciences Collection databases. All articles focusing on the communication of the diagnosis of infertility were included. The main findings of each included article were then summarized. Results: Literature search identified 11,838 references that were screened for eligibility. Full texts of 81 articles were retrieved, and their analysis led to the inclusion of 4 articles, which treated the theme of communication of infertility only partially. The main addressed aspects concerning the communication of the infertility diagnosis were the following: the value that patients give to healthcare professionals' communication skills; the importance of giving clear information on diagnostic procedures and treatments in order to decrease patients' anxiety; and the importance of involving both partners. Conclusions: This review pointed out that the communication of the infertility diagnosis is still underinvestigated. Specific guidelines are currently not available, but other protocols could be used. Taking into account the principal aspects of communication highlighted with this review, in this study, we suggested an adaptation of the original SPIKES protocol that could be used by healthcare professionals for the communication of the infertility status. (shrink)

Infertility is a prevalent worldwide health issue and is defined by the World Health Organization as a global health problem. Considering the importance of the psychological dimensions of infertility, various measurement tools have been used to measure the variables involved in infertility, of which the most widely used are the following: the Symptom Checklist 90, the Brief Symptom Inventory, the State-Trait Anxiety Inventory Form, and the Depression Anxiety Stress Scale. Therefore, given the problems of infertile people in (...) terms of psychological dimensions, the aim of this meta-analysis was to assess the psychological assessment score in infertility. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, we applied an online database with no time restriction. Data were gathered using a random-effect model to estimate the standard mean difference for the evaluation of the strength of association analyses. Our data demonstrated a significant higher SCL90 score, and a non-significant higher DASS score. It is essential to seek for strategies to help infertile patients overcome their infertility-related psychological problems. (shrink)

Clinical decision-making concerns the normal and the not normal and is marked by moral discourse. In the area of assisted reproduction technologies, little is known about physicians' attitudes towards their patients, and therefore one aim of this study is to enquire into infertility clinicians' perceptions of their patients. Additionally, this study seeks to establish what kinds of patients are defined by the clinicians as Others, as less appropriate candidates for infertility treatment. In this study, clinical judgements were affected (...) by the gendered nature of patients and by the supposed nature of potential mothers-to-be. The other patients and mothers-to-be were described in terms of their mental, physical and emotional status, and in terms of their lifestyle. The most inappropriate Other mothers-to-be were those who had complicated psychosocial and health problems. A second group were described as single and supposedly lonely women, and as women who were considered too career oriented. The importance of money played a primary role in determining who is supposedly a good mother. Namely, if a woman was too rich or too stingy and career oriented, or too poor, with several psychosocial problems, her capacity for maternal love was questioned. The clinicians' perceptions of the roles of technology and nature in assisted reproduction technologies are also discussed. (shrink)

IVF as lottery or investment: contesting metaphors in discourses of infertilityThis paper reports an aspect of a poststructural feminist study in which I explored the discursive formations within which women for whom in vitro fertilisation (IVF) was unsuccessful constitute themselves. In my exploration I draw on data from interviews with women who discontinued infertility treatment, print media material and infertility self‐help books. Specifically, I highlight a metaphor of lottery in discourses of infertility, arguing that it is hegemonic (...) and showing how when women are situated as gamblers, the metaphor is instrumental in polarising them into ‘winners’ or ‘losers’ in relation to the subjectivity of motherhood. I further deconstruct these subjectivities, showing how ‘winners’ are valorised and ‘losers’ are pathologised. But importantly, I show how infertile women who are not mothers resisted locating themselves as ‘losers’ in a metaphor of lottery and instead situated themselves in a contesting metaphor of investment as diligent ‘workers’ and as active agents in choosing the best employment of their bodily and monetary resources. This paper therefore amplifies the marginalised perspective of infertile women who are not mothers. (shrink)