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Fente BM, Asgedom YS, Asmare ZA, Kebede TN, Damtew BS, Workneh TW, Beyene MA, Seifu BL. Knowledge of fertility period among reproductive age women in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey. Contracept Reprod Med 2024; 9:27. [PMID: 38790022 PMCID: PMC11127376 DOI: 10.1186/s40834-024-00287-7] [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: 03/22/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Knowledge of the fertility period aids women in refraining and engaging in sexual intercourse to avoid and to get pregnant, respectively. The effect of community-level factors on knowledge of the fertility period was not yet known in Kenya. Therefore, we aimed to investigate the community- and individual-level determinants of knowledge of fertility period among women of childbearing age in Kenya. METHODS The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 16,901 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data. RESULTS The overall prevalence of knowledge of the fertility period among Kenyan women was 38.1% (95%CI = 37.3, 38.9). Women's age, women's education status, heard FP, contraceptive use, media exposure, and distance from health facility significant individual factors while place of residence, and community-level education, were all of factors were found to be strongly associated with knowledge of fertility period. CONCLUSION As per the findings of our study, Knowledge of the fertility period among reproductive women was low in Kenya. In the era of increasing refusal of hormone-based family planning, fertility-awareness-based family planning methods may be an option. Promoting the correct fertility period through education and media outreach may be helpful strategies for enhancing fertility decision-making.
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Affiliation(s)
- Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tirusew Nigussie Kebede
- Department of Midwifery, School of Nursing and Midwifery Asrat Woldeyes Health Science campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Beyene Sisay Damtew
- Department of Midwifery, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Tadesu Wondu Workneh
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muluken Adamu Beyene
- Department of Midwifery, College of Health Sciences, Assosa University, Assosa, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Semera, Ethiopia
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Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion. Fertil Steril 2022; 117:713-719. [PMID: 35105445 DOI: 10.1016/j.fertnstert.2021.12.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/04/2022]
Abstract
This opinion addresses the ethics of providing fertility treatment to women at elevated risk from fertility treatment or pregnancy. It is ethically appropriate for providers to treat women who are at elevated risk provided that the women are carefully assessed, that specialists in their medical condition are consulted as appropriate, and that they are fully informed about the risks, benefits, and alternatives, which may include oocyte or embryo donation, use of a gestational surrogate, declining fertility treatment, and adoption. Providers also may conclude that the medical risks of fertility treatment for a given patient are too high, in which case it is ethical for them for them to decline to provide treatment. Such determinations must be made in a medically objective and unbiased manner, and patients must be fully informed of the decision and its rationale. Counseling for these women should incorporate the most current knowledge available, with cognizance of the woman's personal determinants in relation to her reproductive desires. In this way, both the physician and the patient will optimize decision making in an ethically sound, patient-supportive context. This document replaces the document of the same name, last published in 2016 (Fertil Steri 2016;106:1319-23).
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Daar J. Physician autonomy or discrimination: the risks and limits of saying "no". Fertil Steril 2021; 115:263-267. [PMID: 33579519 DOI: 10.1016/j.fertnstert.2020.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
Respect for patient autonomy is a critical concept in the training of all physicians. Most physicians will make clinical recommendations on a daily basis that reflect a marriage of evidence-based medical fact and the deeply felt aspirations and boundaries that patients share with them. While most physicians are well versed and comfortable managing issues of patient autonomy, many are less confident about ethical and legal guidelines for expressing their own autonomy in clinical decision-making. This paper will review the legal landscape surrounding the patient-physician relationship with a focus on when and how physicians can exercise their personal and professional autonomy in their clinical practice.
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Affiliation(s)
- Judith Daar
- Chase College of Law, Northern Kentucky University, Highland Heights, Kentucky
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Access to fertility treatment irrespective of marital status, sexual orientation, or gender identity: an Ethics Committee opinion. Fertil Steril 2021; 116:326-330. [PMID: 33906744 DOI: 10.1016/j.fertnstert.2021.03.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
This statement explores the implications of reproduction by single individuals and unmarried couples and pertains to diverse sexuality and gender (DSG) or cisgender heterosexual persons. The statement concludes that individuals and couples should have access to fertility services irrespective of marital status, sexual orientation, or gender identity. This document replaces the previous version of this document entitled "Access to fertility treatment by gays, lesbians, and unmarried persons: a committee opinion", published in December 2013 (Fertil Steril 2013;100:1524-7).
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Affiliation(s)
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- American Society for Reproductive Medicine, Birmingham, Alabama
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Postmenopausal Pregnancy in the Era of Assisted Reproductive Technologies. Obstet Gynecol 2020; 136:154-160. [PMID: 32541283 DOI: 10.1097/aog.0000000000003877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Assisted reproductive technologies allow women to achieve pregnancy at ages beyond the limits of their natural reproductive lifespans. As women seek pregnancy later in life, physicians are challenged with balancing their professional autonomy against patient autonomy. Increased parental age increases risk to mother and fetus. Legal aspects of postmenopausal women desiring fertility services will vary by location. Ethically, the principles of beneficence, nonmaleficence, and justice become important factors in a physician's evaluation process. This article aims to highlight current guidelines for postmenopausal women desiring fertility services and address medical, legal, and ethical concerns that may arise when assessing these patients.
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Hemalal S, Yee S, Ross L, Loutfy M, Librach C. Same-sex male couples and single men having children using assisted reproductive technology: a quantitative analysis. Reprod Biomed Online 2020; 42:1033-1047. [PMID: 33593703 DOI: 10.1016/j.rbmo.2020.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/24/2020] [Accepted: 08/24/2020] [Indexed: 01/19/2023]
Abstract
RESEARCH QUESTION How do same-sex male couples (SSMC) and single men perceive their experience of using assisted reproductive technology (ART) in Canada; what factors contribute to their experience and the decisions made throughout the ART process? DESIGN This cross-sectional study used an anonymous online survey to gather exploratory data (between August 2018 and August 2019) about participant experience and decision-making considerations, for SSMC and single men internationally who had undergone ART in Canada. The survey was accessed by 145 individuals; 98 participants were included in the final analysis. Statistical Package for the Social Sciences (SPSS) was used for quantitative analysis. RESULTS Four out of five participants had a positive overall experience of using ART in Canada. Having the social support of knowing others who had previously pursued ART, and needing to work with multiple egg donors, were found to affect overall experience significantly. Agencies were the most common way for intended parents to connect with third parties. Major factors men considered when choosing an egg donor included medical history, physical attributes, personality and temperament, ethnicity, and education; they tended to select gestational surrogates who had similar lifestyle values to themselves. Most coupled survey respondents created embryos using each partner's spermatozoa (73.6%). CONCLUSIONS This exploratory study expands on limited knowledge of the current topic, identifying key areas for future research. Most SSMC and single men, domestic and internationally, had a positive experience pursuing ART in Canada to have children. Research on the experiences of SSMC and single men and decision-making considerations should continue.
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Affiliation(s)
- Shilini Hemalal
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto Ontario M5G1N8, Canada; Institute of Medical Sciences, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto Ontario M5S 1A8, Canada
| | - Samantha Yee
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto Ontario M5G1N8, Canada
| | - Lori Ross
- Institute of Medical Sciences, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto Ontario M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto Ontario M5T 1R8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto Ontario M5T 3M6, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto Ontario M5T 1R8, Canada
| | - Mona Loutfy
- Department of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto Ontario M5S 1A8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto Ontario M5T 3M6, Canada; Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto Ontario M5G 1N8, Canada; Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto Ontario M4N 3M5, Canada
| | - Clifford Librach
- Create Fertility Centre, 790 Bay Street, Suite 1100, Toronto Ontario M5G1N8, Canada; Institute of Medical Sciences, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto Ontario M5S 1A8, Canada; Department of Obstetrics and Gynecology, University of Toronto, 123 Edward Street, Suite 1200, Toronto Ontario M5G 1E2, Canada; Department of Physiology, University of Toronto, 27 King's College Circle, Toronto Ontario M5S 3K1, Canada; Department of Gynecology, Women's College Hospital, 76 Grenville Street, Toronto Ontario M5G 1N8, Canada.
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Zweifel JE, Woodward JT, Rebar RW, Sauer MV. Is it time to establish age restrictions in ART? J Assist Reprod Genet 2019; 37:257-262. [PMID: 31848898 DOI: 10.1007/s10815-019-01649-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022] Open
Abstract
Providers specializing in reproductive medicine are treating increasing numbers of women pursuing parenthood in their 40s, 50s, and beyond. The rise in later-life parenting can be linked to factors ranging from the advent of assisted reproductive technologies and donor oocytes to the highly publicized pregnancies of older celebrities. We explore the medical and psychosocial implications of this trend for both older parents and their children. We also discuss ethical arguments regarding older parents' access to fertility care, existing professional guidelines, and both public and provider opinions about setting age limits for fertility treatment. Finally, we share preliminary considerations of whether age policies should be established, applied to men as well as women, and standardized or considered on a case-by-case basis.
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Affiliation(s)
- Julianne E Zweifel
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 2365 Deming Way, Middleton, WI, 53562, USA.
| | - Julia T Woodward
- Department of Psychiatry & Behavioral Sciences, Department of Obstetrics & Gynecology, Duke University Health System, Durham, USA
| | - Robert W Rebar
- Department of Obstetrics and Gynecology, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, MI, USA
| | - Mark V Sauer
- Department of Obstetrics, Gynecology & Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
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Zemyarska MS. Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it? JOURNAL OF MEDICAL ETHICS 2019; 45:346-350. [PMID: 30745435 DOI: 10.1136/medethics-2018-104983] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/25/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
In vitro fertilisation (IVF) 'add-ons' are therapeutic or diagnostic tools developed in an endeavour to improve the success rate of infertility treatment. However, there is no conclusive evidence that these interventions are a beneficial or effective adjunct of assisted reproductive technologies. Additionally, IVF add-ons are often implemented in clinical practice before their safety can be thoroughly ascertained. Yet, patients continue to request and pay large sums for such additional IVF tools. Hence, this essay set out to examine if it is ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it. In order to determine what is ethical-namely, morally good and righteous, the question was considered in relation to three key values of medical ethics-autonomy, beneficence and non-maleficence. It was determined that providing IVF add-ons might be morally acceptable in specific circumstances, if true informed consent can be given, there is a potential of cost-effective physiological or psychological benefit and the risk of harm is minimal, particularly with regard to the unborn child.
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Legal principles and seminal legal cases in oocyte donation. Fertil Steril 2018; 110:1209-1215. [PMID: 30503107 DOI: 10.1016/j.fertnstert.2018.08.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 11/20/2022]
Abstract
Oocyte donation has played an increasingly important role in assisted reproductive technologies since the early 1980s. Over the past 30 years, unique legal standards have evolved to address issues in the oocyte donation procedure itself as well as the disputes over issues, such as parentage, that inevitably arise with new technologies, particularly for individuals seeking to build nontraditional families. This essay will explore oocyte donation's legal aspects as well as seminal law concerning the procedure, including statutory law (uniform and model provisions and enacted state laws) and selected judicial opinions concerning surrogacy and parentage, testing of oocyte donors, mix-ups of donated oocytes, and donor compensation.
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Bruno B, Arora KS. Uterus Transplantation: Response to Open Peer Commentaries on the Ethics of Using Deceased Versus Living Donors. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:W6-W8. [PMID: 30235090 PMCID: PMC6294994 DOI: 10.1080/15265161.2018.1502836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Rogers A. Allocating Uterus Transplants-Who Gets to Be a Gestational Mother? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:38-39. [PMID: 30040575 DOI: 10.1080/15265161.2018.1478025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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