When research knowledge is unwelcome: studying the health effects of in vitro fertilization

OBJECTIVES: To illustrate the complexity of setting up evaluative research when it is perceived to threaten professional and financial interests. METHODS: A case study based on participatory observation of attempts to study the delivery and health consequences of in vitro fertilization (IVF). Two research projects were observed: one used well-baby clinic records and this project was completed; the other project aimed to use national data and record linkage to study the patterns of use of IVF, the IVF success rate, and the health effects on women and on children. This project could not be carried out as planned. The reasons for this were studied. Observations, documents and notes on discussions were analysed. RESULTS: IVF clinicians were not interested in the second project until faced with a concrete request to provide data. Tactics to avoid providing data included asking for more information on the project, transferring the request from one person to another, and arguing against the project. The arguments used and conditions set by different clinics were similar and centred around data confidentiality and authorship of the anticipated research reports. This case illustrated features that occur when health care is evaluated by non-clinicians: quarrels over mandate and ownership; and conflicts between the different research traditions of clinicians and epidemiologists. CONCLUSIONS: To facilitate evaluation by outsiders, new norms are needed and outside researchers need institutional back-up. Outside evaluation may need a determined push from health care funders and a cultural change within the clinical community itself.     

Female genital mutilation: a prospective view

There continues to be a high rate of female circumcision being practiced in Egypt. A questionnaire covering circumcision status, circumstances of circumcision procedures, and attitudes towards circumcising their daughters was given to female students in nursing secondary schools. This population was chosen as a representative sample of future mothers who also will work in a very sensitive area related to female circumcision. Results showed that all the students surveyed were circumcised. The peak ages for circumcision performance were between 10 and 12 years. About 60% of operations were performed by physicians and about 80% were done under anaesthesia at home. Rural residence was the main variable influencing the continuation of this practice in a culture in which traditions and habits are strongly respected. This points to the difficulties that face any efforts to eradicate this process.     

Psychological aspects of in vitro fertilization: a review

This paper reviews psychological research within the context of in vitro fertilization (IVF). The focus will be on psychological reactions before entering an IVF-procedure, during an IVF-treatment, and after both unsuccessful and successful IVF. The effects of psychosocial factors on the treatment outcome after IVF and interventions on conception rates will also be discussed. Undergoing an IVF-treatment is an emotional and physical burden, for both the woman and her partner. Research results suggest that couples entering an IVF-treatment program are, in general, psychologically well adjusted. Concerning reactions during the treatment, both women and men experience waiting for the outcome of the IVF-treatment and an unsuccessful IVF. as most stressful. Common reactions during IVF are anxiety and depression, while after an unsuccessful IVF, feelings of sadness, depression and anger prevail. After a successful IVF-treatment, IVF-parents experience more stress during pregnancy than 'normal fertile' parents. Mothers with children conceived by IVF express a higher quality of parent child relationship than mothers with a naturally conceived child. Research further suggests that psychosocial factors, like ineffective coping strategies, anxiety and/or depression are associated with a lower pregnancy rate following IVF-procedures. In addition, support has been found suggesting that stress reduction through relaxation training or behavioral treatment improves conception rates.     

Sex education from prospective teachers' view poses a dilemma.

A survey was conducted among 102 prospective elementary school teachers enrolled in a required school health education course in a southeastern university in the United States in an effort to determine how these teachers view the need for and their roles in providing human sexuality education. The final sample included 90 females and 6 males. 96.9% of the sample perceived their own knowledge of human sexuality as being adequate or better, but over 1/2 felt that they were not adequately prepared to deal with the subject in the classroom. 70% indicated they would teach sex education only if they were required to do so. These prospective teachers seemed to feel most uncomfortable about the possibility of having to cope with parents who might object to human sexuality education in the schools. They also expressed fear of having to deal with questions their students asked which would be embarrassing. They were equally concerned about not knowing the factual answer to a question a student asked. 50% of the respondents consider the primary purpose of sex education in the schools to be increasing knowledge of the anatomy and physiology of the reproductive system and enabling students to have their questions about sex answered in an objective and factual manner.     

Resource allocation of in vitro fertilization: a nationwide register-based cohort study

Background  

Infertility is common and in vitro fertilization (IVF) is a widely used treatment. In IVF the need increases and the effectiveness and appropriateness decrease by age. The purpose of this study was to describe allocation of resources for IVF by women's age, socioeconomic position, area of residence and treatment sector (public vs. private) and to discuss how fairly the IVF resources are allocated in Finland.     

Social and ethical aspects of in vitro fertilization.

In vitro fertilization (IVF) stands out as one of the contemporary period's most extraordinary technologies, and its social and ethical consequences among the most far reaching. Despite its uncertain effectiveness and medical consequences, IVF has contributed significantly to the medicalization of infertility and the increasingly imperative character of reproductive technology. New developments in IVF, particularly oocyte donation, have created new definitions of treatable infertility and new social needs for IVF; when the technology does not result in pregnancy or healthy babies, these developments have created profound new disappointments. IVF and the commodification of the extracorporeal embryo have also confused the social meaning and legal definition of parenthood. Ultimately the relationship between prospective parents, infertility specialists, and the embryos that they create is a highly ambiguous one. This ambiguity is likely to be a long-term characteristic of efforts to develop, use, and assess assisted reproductive technologies.     

Pricing in vitro fertilization procedures

This paper examines the economics of pricing practices at artificial reproductive clinics, which have introduced money‐back guarantees (MBGs) for in vitro fertilization. We identify incentives for clinics to offer MBGs and evaluate the impact on couples' choices and on social welfare. Introducing MBGs allows a clinic to (i) segment couples simultaneously on their relative fertility and on risk preferences; (ii) offer quantity discounts to relatively infertile couples; and (iii) offer some risk‐sharing to couples for this costly procedure, whose outcome is uncertain. Our results also show how the addition of MBGs can affect the overall social welfare. Copyright © 2009 John Wiley & Sons, Ltd.     

In vitro production of pig embryos: a point of view

Porcine embryos have become raw materials for different programmes of reproductive biotechnology and the in vitro production of embryos has some advantages over in vivo production in gene transfer programmes and for xenotransplantation. Despite this promising future, several problems limit the success of the in vitro production (IVP) of viable porcine embryos. Porcine IVP has not been fully developed because of several problems associated with different techniques, such as incomplete final maturation status after in vitro maturation, a high incidence of polyspermy after in vitro fertilization and a low development rate and poor quality of blastocysts at the end of culture. The results could be improved with studies comparing in vivo and in vitro conditions, standardization of techniques for sperm processing, testing new additives in the culture media and developing intracytoplasmic sperm injection procedures. The first objective of the present article is to summarize the main studies published on the subject. Second, we provide a guide for researchers starting work on the IVP of pig embryos, making special mention of first papers and the most recent achievements for each of the different techniques. Third, we provide suggestions for future experiments designed to improve the results of each technique.     

Children after in vitro fertilization. An overview of the literature.

This paper provides an overview of the effects of in vitro fertilization (IVF) on the children born from it. One of the main problems with IVF to date remains the high incidence of multiple pregnancies, which carry an inherent higher risk of preterm delivery and, therefore, of increased morbidity and mortality in newborns. Further, singleton pregnancies and twin pregnancies from IVF compared to control singleton or twin pregnancies appear to be at higher risk of preterm birth and low birth weight. Whether this is an effect of the procedure per se or is related to maternal factors, or a combination of both, remains to be studied. The risk of congenital malformations does not, with the available data, seem to be elevated. As of now, it remains unclear whether embryo freezing is a safe procedure. Psychomotor development of children born through IVF does not seem to be disturbed. Until further and more extensive studies are conducted, it remains unclear whether IVF poses long-term risks for the children.