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Topic: Reproductive Medicine
June 29, 2015 | Posted By Lisa Campo-Engelstein, PhD
Apple recently announced that they will update their health app, HealthKit, to include reproductive health. Many were critical of the original app because although it can track a wide range of health indicators, such as BMI, sleep, sodium intake, number of falls, etc., it neglected reproductive health. Specifically, it is problematic that the app includes some obscure health indicators, like selenium intake, but not menstrual cycle, which affects half of the population. While there are other apps that are specifically geared toward women's reproductive health, it is troubling that an iPhone app that comes standard with the phone would exclude something so central to women's health as menstruation. Some believe that the omission of reproductive health from HealthKit is due to the fact that the tech world, including Apple, is dominated by men.  

The new the updated app is a huge improvement because it includes a variety of reproductive health indicators like menstruation, basal body temperature, and spotting. The broad range of reproductive health indicators helps women keep track of their reproductive health in general and specifically for women looking to prevent pregnancy and for women looking to achieve pregnancy. This is an important addition because too often reproductive health is overlooked or not considered part of "real" healthcare. The addition of the reproductive health category in HealthKit technology not only acknowledges the reproductive health issues specific to many women, but also normalizes them.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

May 19, 2015 | Posted By Lisa Campo-Engelstein, PhD

In my last blog, I discussed some of the problems with the definition of infertility, including that it is based mainly on women's bodies, which implies that men are less likely or not likely to be infertile, and it is based on heterosexual activity, which implies that single individuals and/or individuals in the LGBTQ community cannot experience infertility. I also distinguished between physiological infertility (i.e. infertility due to a biological condition such as low sperm count or blocked tubes) and social infertility (i.e. situational infertility, such as whether one has a partner and if so, if that partner is fertile and together one and one’s partner have the “right” parts to reproduce biologically). In this blog, I want to reflect more on that it means to be infertile and how the role social desire (i.e. the social desire to have biological children) plays in diagnosing this condition.

Imagine two women with the same exact circumstances: they are both 30 years old, in long term heterosexual relationships, and have been having unprotected sex regularly for the last 3 years. The only difference is that one woman, Jessica, wants to have biological children, while the other woman, Katie does not. Should they both be classified as infertile? How does their desire to have or not have biological children shape their medical diagnosis? Should their partners be labeled as infertile too? Does it matter whether Jessica and Katie are physiologically or socially infertile in classifying them as infertile? Does their partners’ interest in having biological children or lack thereof factor into determining if Jessica and Katie are infertile?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.  

April 20, 2015 | Posted By Lisa Campo-Engelstein, PhD
The concept of infertility seems relatively straightforward, yet there are many myths, confusions, and disagreements regarding who counts as being infertile. According to the World Health Organization (WHO), infertility is "a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”Like many definitions of infertility, this one is based on a woman's body since she is the one who experiences pregnancy. However, this definition may make it more difficult to understand and recognize male factor infertility.Indeed, defining infertility based solely on a woman's ability to achieve pregnancy reinforces the myth that women are more likely to be infertile than men. In reality, women and men are equally likely to be infertile. The National Institutes of Health (NIH) definition of infertility is more inclusive: “the inability of a woman or man to conceive a child or the inability of a woman to carry a pregnancy to term.”

Another concerned with the WHO definition of infertility is that it is based on being in a heterosexual relationship.According to this definition and many others like it, people can only be considered infertile if they engage in "regular unprotected sexual intercourse." This definition does not explicitly state that this it is referring to heterosexual intercourse, which is problematic. Given the narrow scope of this definition, how then should we diagnose infertility in lesbian and gay couples and heterosexual individuals who are singleand not engaging in regular unprotected sexual intercourse.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

March 18, 2015 | Posted By Lisa Campo-Engelstein, PhD

The story about the UK passing a law to allowa reproductive technology called mitochondrial donation, what has been informally known as three person or three parent embryos, recently dominated the news.Part of the reason this story received so much attention is because the idea of a child with more than two biological parents sounds really scary, even Frankensteinish.While new medical technologies often raise ethical concerns, it is imperative to understand the science behind these technologies in order to accurately assess the likelihood and degree of potential harms caused by these technologies. In the case of three parent embryos, once we understand the science, this technology is not as threatening as it may initially appear.

The UK will only allow mitochondrial donations in cases where women could pass along mitochondrial diseases to their children. There are various types of mitochondrial diseases, which affect approximately one in 8,500 people and can lead to serious and fatal conditions. The mitochondria are located in the cytoplasm of the cell and serve as the cell powerhouses. Mitochondria have their own set of DNA with the 37 genes and a mitochondrial disease occurs when there is a mutation in the mitochondrial DNA. Mitochondrial donation allows women who are at risk for passing along mitochondrial diseases to the children to avoid doing so by using the mitochondria of a donor. There are two ways this can be done. In the first way, known asmaternal spindle transfer technique, the nucleus from the donor egg is removed and replaced with the nucleus from the intended mother's egg. The resultant eggwill carry the nucleus with all the genetic information from the intended mother, but will also contain the healthy mitochondrial DNA from the donor egg.The second way, known as pronuclear transfer, removes the nucleus from a donor embryo and replaces it with the nucleus of an embryo that contains the genetic material from intended mother and father. Here again,the resultant embryo contains the genetic material from the intended parents, but avoids inheriting mitochondrial diseases because donor mitochondria is used. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

February 17, 2015 | Posted By Lisa Campo-Engelstein, PhD
In recognizing the health-related and financial benefits of preventive reproductive health services, the Affordable Care Act (ACA) has included them (namely contraception and preconception care) as part of standard care and without co-payment. While the inclusion of women’s reproductive health care in the ACA is a milestone for women’s health, children’s health, and reproductive health overall, it is troubling that the ACA does not seem to make any mention of men’s reproductive health

Men's reproductive health is not only missing from policy, also from everyday practice. Whereas women know to see a gynecologist for their reproductive health and can easily do, men are often unsure of where to turn for the reproductive health needs. Most men have never heard of the field of andrology, which is devoted to men's reproductive health, and this field is so small and fragmented that it may be difficult for a man to find a nearby andrologist. Some men seek out urologists for their reproductive health, but many urologists are not trained in all areas of men's reproductive health. Men may also talk to their primary care physician about their reproductive health needs, but many of these physicians are not very familiar with men's reproductive health since it is barely covered in medical school. Family planning centers tend to focus on treating women and some family planning providers have even been known to be hostile toward men. The lack of healthcare providers trained to treat in men’s sexual and reproductive health contributed to American Board of Obstetrics and Gynecology recent statement that condoned OBGYNs treating certain areas of men’s sexual and reproductive health.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

January 23, 2015 | Posted By Lisa Campo-Engelstein, PhD

Although life-saving, cancer treatments (e.g. radiation, chemotherapy, and surgery) can also lead to infertility in both women and men. Established reproductive technologies for women and men like gamete freezing and embryo freezing allow cancer patients to preserve their fertility in case they want to become biological parents in the future. 

Unfortunately, patients are frequently not adequately informed and sometimes not informed at all about fertility preservation. Some oncologists don’t consider fertility preservation to be an important issue, as they are more focused on saving the patients’ lives and see fertility preservation as a secondary consideration. Research has shown that even when oncologists refer their patients for fertility preservation they often do so based on social factors (they are more likely to refer wealthy, white, heterosexual, married patients) rather than purely on medical indications. Even when health care providers discuss fertility preservation with patients, many patients say that once they heard the word “cancer” as a diagnosis, they didn’t absorb much else from their initial conversation with their provider. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

January 16, 2015 | Posted By Jane Jankowski, DPS, LMSW

The release of Cuban spy Gerardo Hernandez as part of a prisoner swap made headlines last month not only for the diplomatic implications for Cuba-US relations, but also for the questions surrounding assisted reproductive services for incarcerated persons. According to a brief report from NPR, Hernandez’s spouse wanted to have a child with her incarcerated husband and sought support from a sympathetic US senator to facilitate this expression of reproductive liberty. While this case includes an added layer of intrigue because of the impressive barriers that were overcome to secure the means and support for artificial insemination, the question of how we ought to consider the use of assisted reproductive technology for couples who wish to bear children despite one parent serving a life sentence.

While some children may be conceived where prisoners are permitted conjugal visits, Mr. Hernandez was in a federal prison where it is reported that such visits are not allowed. The only means for reproduction would be via assisted technology such as artificial insemination, a now basic intervention. What about other families who wish to raise children but without the connections or possibility for release? Is it ethical to support such endeavors when one parent will be able to contribute gametes and an occasional visit in a prison setting without freedom to participate in rearing the child? This is not such an easily answered question.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

January 6, 2015 | Posted By Lisa Campo-Engelstein, PhD

Many professions require state or federal licensure, including hairdressers, teachers, accountants, and physicians. The main reason we have professional licensure is to protect the clients who seek out the services of these professionals. Licenses require that professionals meet a minimum standard of knowledge and skills to certify competence in their field. Even some leisure activities require licensure, especially those that are considered potentially dangerous, such as scuba diving and hunting. 

Some have suggested that parents should also be licensed as a way of protecting their children by ensuring that have a base minimum skill set and knowledge about good parenting. The typical response to this suggestion is an emphatic no. Why is our knee jerk reaction to the idea of licensing parents to be horrified when we aren't bothered by licenses for professional and leisure activities, some of which also involve placing the lives of others in their hands (e.g. a physician) or require developing a deeper connection between people (e.g. a teacher)? How and why is parenthood different from these other activities? 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

November 20, 2014 | Posted By Lisa Campo-Engelstein, PhD

In the last couple of years, the media has reported women undergoing uterus transplantations. Just last month, the media reported that the first baby was born from a transplanted uterus. While the woman’s identity remains unknown, she is a 36 year old Swedish woman who was born with ovaries, but not a uterus. She and her partner underwent IVF to produce embryos that could then be transferred into the transplanted uterus. This donor is a friend of hers who is 61 years old and had experienced menopause seven years beforehand. The quality of a woman’s uterus does not diminish over time, so she is able to successfully carry a pregnancy event postmenopausally (it is the quality and quantity of her eggs that leads to infertility and eventually menopause).  Both the woman and the baby are doing fine, according to media reports. However, the baby was born prematurely at 32 weeks because the women developed preeclampsia and the fetal heart rate became abnormal. It is not clear from the media reports whether the development of preeclampsia was related to the uterus transplantation.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

November 17, 2014 | Posted By Wayne Shelton, PhD

Let me emphatically state at the outset of this short blog: I have always thought the elective termination of pregnancy (ETOL) was a serious moral issue. As I have taught students over the years on this topic, to fully appreciate the moral conflict around abortion (or any other moral conflict) one must be willing to put oneself in the middle of two important value positions. In other words, one must be willing to hold and take seriously in one’s mind simultaneously two opposing thoughts or value positions in order to weigh them fairly.  

Though I don’t think that a fetus is a person with a personal or social identity, it is biologically human—and that alone is a relevant piece of moral information. The fetus has a unique genetic code and has the potential to grow to full term into a new baby and eventually grow into a child, adolescent, and adult human being. Because a fetus has the potential to become a full-fledged member of the human community, all things equal, we should not destroy it. But rarely in human life are all things equal.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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