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Chen J. Gendering the beginning of life: Taiwanese gay fathers' navigation of preimplantation genetic diagnosis-assisted sex selection in transnational third-party reproduction. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:907-925. [PMID: 38149776 DOI: 10.1111/1467-9566.13747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/07/2023] [Indexed: 12/28/2023]
Abstract
Preimplantation genetic diagnosis (PGD) has been used not only to avoid genetic diseases and increase conception success rates but also to perform non-medical sex selection, particularly in the surging cross-border reproductive care (CBRC). In the context of commercialised biomedicine, assisted reproductive technologies, such as lifestyle sex selection, have been tailored to meet intended parents' preferences. However, there is a lack of analysis on how individuals' reproductive decisions on PGD-assisted sex selection were shaped within the sociocultural norms and CBRC. This article explores Taiwanese gay fathers' navigations on sex selection while seeking third-party reproduction overseas because of local legal constraints. Drawing on in-depth interviews with 53 gay fathers (to-be), I analysed how 'individual preferences' were dynamically shaped by local sociocultural norms and embedded within transnational settings of routinising PGD in chosen repro-destinations. The findings showed that gay fathers mobilised strategic discourses on non-medical sex selection from both the local and the global to negotiate their decisions in coherence with their LGBTQ+ identity and their role as sons carrying familial responsibility to procreate male heirs. This article proposed a nuanced understanding of gay fathers' reproductive practices of 'gendering the beginning of life' through PGD-assisted sex selection.
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Affiliation(s)
- Jung Chen
- Department of Sociology, University of Cambridge, Free School Lane, Cambridge, UK
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2
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Kolk M, Jebari K. Sex Selection for Daughters: Demographic Consequences of Female-Biased Sex Ratios. POPULATION RESEARCH AND POLICY REVIEW 2022. [DOI: 10.1007/s11113-022-09710-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AbstractModern fertility techniques allow parents to carry out preimplantation sex selection. Sex selection for non-medical purposes is legal in many high-income countries, and social norms toward assisted reproductive technology are increasingly permissive and may plausibly become increasingly prevalent in the near future. We explore possible outcomes of widely observed daughter preferences in many high-income countries and explore the demographic consequences of the adoption of sex selection for daughters. While concerns over son preference have been widely discussed, sex selection that favors female children is a more likely outcome in high-income countries. If sex selection is adopted, it may bias the sex ratio in a given population. Male-biased populations are likely to experience slower population growth, which limits the long-term viability of corresponding cultural norms. Conversely, female-biased populations are likely to experience faster population growth. Cultural norms that promote female-biased sex ratios are as a consequence therefore also self-reinforcing. In this study, we explore the demographic consequences of a female-biased sex ratio for population growth and population age structure. We also discuss the technology and parental preferences that may give rise to such a scenario.
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3
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Ezeome IV, Akintola SO, Jegede AS, Ezeome ER. Perception of Key Ethical Issues in Assisted Reproductive Technology (ART) by Providers and Clients in Nigeria. Int J Womens Health 2021; 13:1033-1052. [PMID: 34764702 PMCID: PMC8572738 DOI: 10.2147/ijwh.s331917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE In the past decade, developments in the field of Assisted Reproductive Technology (ART) have intensified the hopes and the desires of infertile people to overcome infertility, resulting in an increasing demand for such services worldwide. However, as developments in ART have evolved rapidly, so have ethical, social, and political controversies surrounding many aspects arisen. It is known that societal ethics is dependent on the values and culture of a given group. We sought to explore how practitioners and clients in Nigeria perceive some Key ethical issues surrounding ART. MATERIALS AND METHODS This was an explorative descriptive study involving in-depth interview of three ART providers and eight female ART clients, all domiciled in Southeastern Nigeria. Sampling was by purposive and snowballing techniques for providers and clients, respectively. Ethical approval was obtained from University of Ibadan/University College Hospital and University of Nigeria Teaching Hospital Research Ethics Committees. Responses were grouped into themes for ease of discussion. RESULTS Providers and clients were in support of sex selection for family balancing, and multiple embryo transfers. They also perceive that the health of the woman should be the factor considered and not biological age for service provision. However, views differed on marital status as an access factor. Participants were in support of legally binding regulations to guide practice. CONCLUSION A culturally sensitive national regulation is recommended to guide practice in this vital area of reproduction.
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Affiliation(s)
- Ijeoma V Ezeome
- Department of Obstetrics & Gynecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
- Department of Bioethics, Faculty of Multidisciplinary Studies and Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
| | - Simisola O Akintola
- Department of Bioethics, Faculty of Multidisciplinary Studies and Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
- Department of Business and Private Law, Faculty of Law, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ayodele S Jegede
- Department of Bioethics, Faculty of Multidisciplinary Studies and Faculty of Clinical Sciences, University of Ibadan, Ibadan, Nigeria
- Department of Sociology, Faculty of the Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Emmanuel R Ezeome
- Department of Surgery, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
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Xafis V, Schaefer GO, Labude MK, Zhu Y, Holm S, Foo RSY, Lai PS, Chadwick R. Germline genome modification through novel political, ethical, and social lenses. PLoS Genet 2021; 17:e1009741. [PMID: 34499641 PMCID: PMC8428543 DOI: 10.1371/journal.pgen.1009741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Much has been written about gene modifying technologies (GMTs), with a particularly strong focus on human germline genome editing (HGGE) sparked by its unprecedented clinical research application in 2018, shocking the scientific community. This paper applies political, ethical, and social lenses to aspects of HGGE to uncover previously underexplored considerations that are important to reflect on in global discussions. By exploring 4 areas-(1) just distribution of HGGE benefits through a realist lens; (2) HGGE through a national interest lens; (3) "broad societal consensus" through a structural injustice lens; and (4) HGGE through a scientific trustworthiness lens-a broader perspective is offered, which ultimately aims to enrich further debates and inform well-considered solutions for developments in this field. The application of these lenses also brings to light the fact that all discussions about scientific developments involve a conscious or unconscious application of a lens that shapes the direction of our thinking.
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Affiliation(s)
- Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - G. Owen Schaefer
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Markus K. Labude
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yujia Zhu
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Soren Holm
- Centre for Social Ethics and Policy, Department of Law, School of Social Sciences, University of Manchester, Manchester, United Kingdom
- Center for Medical Ethics, HELSAM, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Roger Sik-Yin Foo
- Cardiovascular Research Institute, National University Health Systems, Centre for Translational Medicine, Singapore, Singapore
- Genome Institute of Singapore, Singapore, Singapore
| | - Poh San Lai
- Genome Institute of Singapore, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ruth Chadwick
- School of Social Sciences, Cardiff University, Cardiff, United Kingdom
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5
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Bhatia R. Figuring India and China in the Constitution of Globally Stratified Sex Selection. Asian Bioeth Rev 2021; 13:23-37. [PMID: 33717345 DOI: 10.1007/s41649-020-00160-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022] Open
Abstract
The advent of techniques of sex selection that rely on assisted reproduction led to a questioning of whether sex selection should be deemed always and everywhere unethical. While China and India are normally associated with condemned practices, they are also implicated in processes that constitute globally stratified sex selection inclusive of its more valued form, often referred to as family balancing. Through an application of Ong and Collier's concept of global assemblage, I demonstrate how family balancing, which has taken on a "global form," is tied to an "assemblage" of factors related to the anti-natal, population control contexts that have been pervasive in Asia. Three simultaneously occurring processes since the mid-1990s constituted stratified sex selection: the surfacing of China and India as figurative counter examples in deliberations of ethics on new techniques; active (inter)national surveillance of sex ratios as well as denunciation and criminalization of sex selective abortion in China and India; and the role of China and India in neoliberalizing population control and developing globalized markets in reproduction. Accounting for globally stratified sex selection requires a more robust interpretation of ethics that rethinks disciplinary approaches just as much as relativist ones in which respect for individual autonomy tends to overtake all other concerns.
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Affiliation(s)
- Rajani Bhatia
- Department of Women's, Gender & Sexuality Studies, University at Albany, State University of New York, Albany, NY USA
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6
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Changing Fertility Landscapes: Exploring the Reproductive Routes and Choices of Fertility Patients from China for Assisted Reproduction in Russia. Asian Bioeth Rev 2021; 13:7-22. [PMID: 33456546 PMCID: PMC7797492 DOI: 10.1007/s41649-020-00156-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/17/2020] [Accepted: 11/19/2020] [Indexed: 11/11/2022] Open
Abstract
Global reproductive landscapes and with them cross-border routes are rapidly changing. This paper examines the reproductive routes and choices of fertility travellers from China to Russia as reported by medical professionals and fertility service providers. Providing new empirical data, it raises new ethical questions on the facilitation of cross-border reproductive travel and the commercialisation of reproductive treatment. The relaxation of the one-child policy in 2014 in China, the increasing demand for ART exceeding the capacity of national fertility clinics and the difficulty of accessing treatment with donor eggs concomitant with a growing economic power of the upper–middle class are shaping the ART industry in Asia in new ways. A new development is Chinese citizens increasingly seeking ART treatment in Russia, which has a long-standing practice of ART governed by a liberal legislation. Furthermore, as China prohibits the export of gametes, Chinese fertility travellers rely on acquiring donor gametes once starting treatment abroad. Clinicians in Russia report three strategies amongst their Chinese patients: One group is using donor eggs of women of Asian appearance living in Russia or is hiring women of resembling appearance from third-party countries to donate their eggs in Russia to create resemblance in their offspring. Another group is buying white donor gametes to create Eurasian mixed children and thus ‘enhance’ their offspring. Providing novel empirical data, this article informs ethical deliberation and raises imminent questions for further research in this understudied geographic region and on cross-border reproductive treatment.
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Inhorn MC. Reprint: Where has the quest for conception taken us? Lessons from anthropology and sociology. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 11:110-121. [PMID: 34136666 PMCID: PMC8178439 DOI: 10.1016/j.rbms.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/04/2020] [Accepted: 04/20/2020] [Indexed: 05/10/2023]
Abstract
Louise Brown, the world's first test-tube baby, was born more than 40 years ago in England. For Louise Brown's infertile mother, Lesley, in-vitro fertilization (IVF) was the 'hope technology' which allowed her to overcome her tubal infertility after 9 years of heart-breaking involuntary childlessness. Since then, IVF has travelled to diverse global locations, where millions of individuals and couples have embarked on technologically assisted 'quests for conception'. After 40 years of IVF, where has the quest for conception taken us? This article outlines seven major global trajectories - namely, that the quest for conception has become more: (i) technological, because of a profusion of IVF-based innovations; (ii) masculine, because of men's eager uptake of intracytoplasmic sperm injection, their own 'masculine hope technology'; (iii) stratified, due to persistent race- and class-based barriers in IVF access; (iv) transnational, as infertile and other involuntarily childless people search across borders to overcome restrictions in their home countries; (v) selective, as IVF-based reprogenetic technologies eliminate genetic disease while exacerbating sex selection; (vi) moral, as religious sensibilities both accommodate and curtail the possibilities and outcomes of assisted reproductive technology (ART); and (vii) extended, as new cryopreservation technologies prolong the reproductive lifespan and extend reproduction to the transgender community. The article concludes with thoughts on where future quests for conception might take us, and why IVF and other reproductive technologies are 'good to think with' in both the anthropology and sociology of reproduction.
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Bhatia R. Doing and undoing nation through ART: a Franco-American comparison. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 11:65-72. [PMID: 33305028 PMCID: PMC7710507 DOI: 10.1016/j.rbms.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/20/2020] [Accepted: 09/03/2020] [Indexed: 06/12/2023]
Abstract
This article explores a Franco-American comparison of assisted reproductive technology (ART), specifically as it relates to sex selection and cross-border reproduction. As a basis for comparison, the nation can materialize in the form of state structure just as much as in cultural-economic assemblages or ideologies that breach geopolitical boundaries. By juxtaposing many contrasts between the French and US contexts - departure versus destination country, highly regulated versus deregulated governance, medical versus social applications, and access (or lack thereof) via public versus private health insurance sectors - it may be difficult to imagine how these extremes occupy a common continuum of globalized market channels. I suggest that invisible or semi-visible reproductive practices along with ART governance provide an avenue to stake out or protect the 'French' way of being and doing ART just as much as they make the 'American' way simultaneously elusive and easy to appropriate. Ultimately, both the French and American approaches to ART collude in the institutionalization of globalized markets. Through the case of cross-border and (sex) selective ART, it is possible to see how both the French and the Americans are involved in the undoing and doing of nation via ART as global assemblage.
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9
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Forbidden medically assisted sex selection in Sunni Muslims: a qualitative study. Reprod Biomed Online 2020; 41:534-542. [DOI: 10.1016/j.rbmo.2020.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/07/2020] [Accepted: 05/27/2020] [Indexed: 11/21/2022]
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Bracewell-Milnes T, Saso S, Jones B, Cato S, Parikh R, Thum MY, Johnson M, Almeida P, Norman-Taylor J, Nikolaou D. A systematic review exploring the patient decision-making factors and attitudes towards pre-implantation genetic testing for aneuploidy and gender selection. Acta Obstet Gynecol Scand 2020; 100:17-29. [PMID: 32862440 DOI: 10.1111/aogs.13973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pre-implantation genetic testing for aneuploidy (PGT-A) is in high demand worldwide, with ongoing debate among medical societies as to which patient groups it should be offered. The psychological aspects for patients regarding its use, lag behind the genomic technological advances, leaving couples with limited decision-making support. The development of this technology also leads to the possibility for its utilization in gender selection. Despite the controversy surrounding these issues, very few studies have investigated the psychological aspects of patients using PGT-A. MATERIAL AND METHODS This systematic review provides an up-to-date analysis of the psychosocial aspects surrounding PGT for aneuploidy and sex selection, as well as decision-making factors. A systematic search of English peer-reviewed journals of three computerized databases were undertaken following PRISMA guidelines. The qualitative data were extracted using thematic analysis. PROSPERO Registration number: CRD42019126439. RESULTS The main outcome measures were patients' motivations, decision-making factors, attitudes and experiences surrounding the use of PGT for aneuploidy and sex selection. Ten studies were included, four for PGT-A and six for sex selection. Attitudes towards PGT-A were positive, with the main motivating factors being decreasing miscarriage rate, reducing the risk of termination of pregnancy and reducing the time to pregnancy. Consistently raised concerns regarding PGT-A were the financial burden and moral beliefs. The vast majority of patients felt sufficiently knowledgeable to make the decision; however, studies did reveal that a minority mis-interpreted certain potential benefits of PGT-A. Studies investigating PGT for sex selection predominantly reported the main motivation was to achieve gender balance within the family dynamic, with most studies finding no difference between couples using PGT for gender selection to have male or female offspring. CONCLUSIONS Although this systematic review was limited by the small number of studies investigating this topic, a significant minority of patients appeared to misunderstand certain benefits and limitations of PGT-A. Fertility clinics must ensure they provide adequate counseling to all patients using PGT-A. With the use of PGT-A on the rise globally, there is a need to develop decision support tools for couples who have an increasing number of genetic testing options becoming available to them.
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Affiliation(s)
| | - Srdjan Saso
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Benjamin Jones
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Hammersmith Hospital Campus, London, UK
| | | | - Riya Parikh
- Biomedical Sciences, St George's, University of London, London, UK
| | | | - Mark Johnson
- Division of Surgery and Cancer, Institute of Reproductive & Developmental Biology, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Paula Almeida
- Assisted Conception Unit, Chelsea and Westminster Hospital, London, UK
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11
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Inhorn MC. Where has the quest for conception taken us? Lessons from anthropology and sociology. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2020; 10:46-57. [PMID: 32760816 PMCID: PMC7393315 DOI: 10.1016/j.rbms.2020.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/04/2020] [Accepted: 04/20/2020] [Indexed: 05/29/2023]
Abstract
Louise Brown, the world's first test-tube baby, was born more than 40 years ago in England. For Louise Brown's infertile mother, Lesley, in-vitro fertilization (IVF) was the 'hope technology' which allowed her to overcome her tubal infertility after 9 years of heart-breaking involuntary childlessness. Since then, IVF has travelled to diverse global locations, where millions of individuals and couples have embarked on technologically assisted 'quests for conception'. After 40 years of IVF, where has the quest for conception taken us? This article outlines seven major global trajectories - namely, that the quest for conception has become more: (i) technological, because of a profusion of IVF-based innovations; (ii) masculine, because of men's eager uptake of intracytoplasmic sperm injection, their own 'masculine hope technology'; (iii) stratified, due to persistent race- and class-based barriers in IVF access; (iv) transnational, as infertile and other involuntarily childless people search across borders to overcome restrictions in their home countries; (v) selective, as IVF-based reprogenetic technologies eliminate genetic disease while exacerbating sex selection; (vi) moral, as religious sensibilities both accommodate and curtail the possibilities and outcomes of assisted reproductive technology (ART); and (vii) extended, as new cryopreservation technologies prolong the reproductive lifespan and extend reproduction to the transgender community. The article concludes with thoughts on where future quests for conception might take us, and why IVF and other reproductive technologies are 'good to think with' in both the anthropology and sociology of reproduction.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, New Haven, CT, USA
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12
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Hibino Y. Non-commercial Surrogacy in Thailand: Ethical, Legal, and Social Implications in Local and Global Contexts. Asian Bioeth Rev 2020; 12:135-147. [PMID: 33717334 DOI: 10.1007/s41649-020-00126-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022] Open
Abstract
In this paper, the ethical, legal, and social implications of Thailand's surrogacy regulations from both domestic and global perspectives are explored. Surrogacy tourism in Thailand has expanded since India strengthened its visa regulations in 2012. In 2015, in the wake of a major scandal surrounding the abandonment of a surrogate child by its foreign intended parents, a law prohibiting the practice of surrogacy for commercial purposes was enacted. Consequently, a complete ban on surrogacy tourism was imposed. However, some Thai physicians and surrogate mothers cross into neighboring countries to provide foreign clients with the commercial surrogacy services that are forbidden in Thailand. Under this legislation, the needs of Thai couples who are unable to conceive are accommodated by legally accessible, non-commercial surrogacy services; however, there is currently no provision in place aimed at protecting the rights and interests of surrogate mothers and children. It is widely believed that the abolition of surrogacy tourism, an industry that give rise to several major scandals, and legal access to surrogacy by Thai couples were the Thai government's primary goal in implementing this legislation.
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Affiliation(s)
- Yuri Hibino
- Department of Medical Science, Environmental and Preventive Medicine, Kanazawa University, Kanazawa City, Japan
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Ginoza MEC, Isasi R. Regulating Preimplantation Genetic Testing across the World: A Comparison of International Policy and Ethical Perspectives. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036681. [PMID: 31506325 DOI: 10.1101/cshperspect.a036681] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Preimplantation genetic testing (PGT) is a reproductive technology that, in the course of in vitro fertilization (IVF), allows prospective parents to select their future offspring based on genetic characteristics. PGT could be seen as an exercise of reproductive liberty, thus potentially raising significant socioethical and legal controversy. In this review, we examine-from a comparative perspective-variations in policy approaches to the regulation of PGT. We draw on a sample of 19 countries (Australia, Austria, Belgium, Brazil, Canada, China, France, Germany, India, Israel, Italy, Japan, Mexico, Netherlands, Singapore, South Korea, Switzerland, United Kingdom, and the United States) to provide a global landscape of the spectrum of policy and legislative approaches (e.g., restrictive to permissive, public vs. private models). We also explore central socioethical and policy issues and contentious applications, including permissibility criteria (e.g., medical necessity), nonmedical sex selection, and reproductive tourism. Finally, we further outline genetic counseling requirements across policy approaches.
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Affiliation(s)
| | - Rosario Isasi
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
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Abstract
Several cultures in the world traditionally favor the birth of sons over that of daughters. This preference drives various forms of discrimination against female births ultimately reflected in demographic imbalances. Over the last decades, modern reproductive technology has made prenatal diagnosis widely accessible to parents. In certain Asian and Eastern European countries, this has led to skewed sex ratio at birth (SRB) as a result of sex-selective abortions. After reviewing motivations and circumstances associated to prenatal sex selection, our paper analyzes global trends in sex imbalances at birth as well as their parity, regional and socio-economic differentials. We focus our attention on the experience of Azerbaijan, India, and South Korea as instances of three distinct SRB trajectories. Finally, we discuss scenarios concerning the future of these sex imbalances and the implications of a consistent number of "missing women" for affected societies.
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Whittaker A, Inhorn MC, Shenfield F. Globalised quests for assisted conception: Reproductive travel for infertility and involuntary childlessness. Glob Public Health 2019; 14:1669-1688. [PMID: 31204900 DOI: 10.1080/17441692.2019.1627479] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The global movement of people across international borders to undergo assisted reproductive treatment is common, although there is little accurate data. In this article, we synthesise findings from our own empirical research on reproductive travel in addition to a review of clinical, ethical, legal, and regulatory complexities from studies on reproductive travel since 2010. Motivations for travel include legal and religious prohibitions; resource considerations; lack of access to gametes and reproductive assistors; quality and safety concerns; and personal preferences. Higher risks to mothers and children are associated with multiple embryo transfer and subsequent multiple and higher order pregnancies and the average older age of women undertaking reproductive travel. The potential exploitation of other women as providers of oocytes or surrogacy services, the lack of equity in access to assisted reproduction and the ambiguous legal status of children conceived from international reproductive travel are important ethical considerations. A range of significant legal issues remain given variable and limited international regulation. Scholarship on this trade necessarily engages with issues of power and gender, social inequities, global capitalism and the private decision-making of individuals seeking to form families. Research gaps remain given recent changes in the organisation, demands and destinations of the trade.
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Affiliation(s)
- Andrea Whittaker
- School of Social Sciences, Faculty of Arts, Monash University , Melbourne , Australia
| | - Marcia C Inhorn
- Anthropology and International Affairs, Council on Middle East Studies, The MacMillan Center, Yale University , New Haven , CT , USA
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Olesen AP, Mohd Nor SN, Amin L, Che Ngah A. Public Perceptions of Ethical, Legal and Social Implications of Pre-implantation Genetic Diagnosis (PGD) in Malaysia. SCIENCE AND ENGINEERING ETHICS 2017; 23:1563-1580. [PMID: 27995446 DOI: 10.1007/s11948-016-9857-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
Pre-implantation genetic diagnosis (PGD) became well known in Malaysia after the birth of the first Malaysian 'designer baby', Yau Tak in 2004. Two years later, the Malaysian Medical Council implemented the first and only regulation on the use of Pre-implantation Genetic Diagnosis in this country. The birth of Yau Tak triggered a public outcry because PGD was used for non-medical sex selection thus, raising concerns about PGD and its implications for the society. This study aims to explore participants' perceptions of the future implications of PGD for the Malaysian society. We conducted in-depth interviews with 21 participants over a period of one year, using a semi-structured questionnaire. Findings reveal that responses varied substantially among the participants; there was a broad acceptance as well as rejection of PGD. Contentious ethical, legal and social issues of PGD were raised during the discussions, including intolerance to and discrimination against people with genetic disabilities; societal pressure and the 'slippery slope' of PGD were raised during the discussions. This study also highlights participants' legal standpoint, and major issues regarding PGD in relation to the accuracy of diagnosis. At the social policy level, considerations are given to access as well as the impact of this technology on families, women and physicians. Given these different perceptions of the use of PGD, and its implications and conflicts, policies and regulations of the use of PGD have to be dealt with on a case-by-case basis while taking into consideration of the risk-benefit balance, since its application will impact the lives of so many people in the society.
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Affiliation(s)
- Angelina P Olesen
- Pusat Citra UKM, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia.
| | - Siti Nurani Mohd Nor
- Faculty of Science (Department of Science and Technology), University of Malaya, 50460, Kuala Lumpur, Malaysia
| | - Latifah Amin
- Pusat Citra UKM, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia
| | - Anisah Che Ngah
- Faculty of Law, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia
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Weinberger S, Nakar S, Greenbaum D. They Chose … Poorly 1 : A Novel Cause of Action to Discourage Detrimental Genetic Selection. AMERICAN JOURNAL OF LAW & MEDICINE 2017; 43:107-137. [PMID: 29086608 DOI: 10.1177/0098858817707986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | | | - Dov Greenbaum
- Dov Greenbaum, JD, PhD is the Founder and Director of the Zvi Meitar Institute for Legal Implications of Emerging Technologies, Radzyner Law School, Interdisciplinary Center Herzliya, Israel. Dov is also an Associate Professor of Molecular Biophysics and Biochemistry (adjunct) at Yale University, New Haven, CT, USA
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Mise à jour technique : Diagnostic et dépistage génétiques préimplantatoires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S629-S645. [PMID: 28063571 DOI: 10.1016/j.jogc.2016.09.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Genome editing allows for the versatile genetic modification of somatic cells, germ cells and embryos. In particular, CRISPR/Cas9 is worldwide used in biomedical research. Although the first report on Cas9-mediated gene modification in human embryos focused on the prevention of a genetic disease in offspring, it raised profound ethical and social concerns over the safety of subsequent generations and the potential misuse of genome editing for human enhancement. The present article considers germ line genome editing approaches from various clinical and ethical viewpoints and explores its objectives. The risks and benefits of the following three likely objectives are assessed: the prevention of monogenic diseases, personalized assisted reproductive technology (ART) and genetic enhancement. Although genetic enhancement should be avoided, the international regulatory landscape suggests the inevitability of this misuse at ART centers. Under these circumstances, possible regulatory responses and the potential roles of public dialogue are discussed.
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Abstract
This review analyzes the emerging literature on reproductive tourism through a metaphorical “reproscope,” focusing largely on cross-border egg donation and surrogacy as the prime areas of contemporary anthropological investigation. While acknowledging that reproductive travel is not new, this article recognizes that there has been an increased volume of such travel over the past couple of decades. It provides an overview of the major areas of anthropological investigation into these transnational phenomena, globalization, stratification, exploitation, race, nationalism, religion, biopower, and bioethics. I propose that these areas of investigation may provide key indications about the preoccupations of anthropology today. Namely, what kind of discipline does anthropology imagine itself to be?
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Affiliation(s)
- Michal Rachel Nahman
- Department of Health and Social Sciences, University of the West of England, Bristol, Frenchay Campus, Bristol, BS16 1QY, United Kingdom
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Dahdouh EM, Balayla J, Audibert F, Wilson RD, Audibert F, Brock JA, Campagnolo C, Carroll J, Chong K, Gagnon A, Johnson JA, MacDonald W, Okun N, Pastuck M, Vallée-Pouliot K. Technical Update: Preimplantation Genetic Diagnosis and Screening. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:451-63. [PMID: 26168107 DOI: 10.1016/s1701-2163(15)30261-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To update and review the techniques and indications of preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). OPTIONS Discussion about the genetic and technical aspects of preimplantation reproductive techniques, particularly those using new cytogenetic technologies and embryo-stage biopsy. OUTCOMES Clinical outcomes of reproductive techniques following the use of PGD and PGS are included. This update does not discuss in detail the adverse outcomes that have been recorded in association with assisted reproductive technologies. EVIDENCE Published literature was retrieved through searches of The Cochrane Library and Medline in April 2014 using appropriate controlled vocabulary (aneuploidy, blastocyst/physiology, genetic diseases, preimplantation diagnosis/methods, fertilization in vitro) and key words (e.g., preimplantation genetic diagnosis, preimplantation genetic screening, comprehensive chromosome screening, aCGH, SNP microarray, qPCR, and embryo selection). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies published from 1990 to April 2014. There were no language restrictions. Searches were updated on a regular basis and incorporated in the update to January 2015. Additional publications were identified from the bibliographies of retrieved articles. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. (Table 1) BENEFITS, HARMS, AND COSTS: This update will educate readers about new preimplantation genetic concepts, directions, and technologies. The major harms and costs identified are those of assisted reproductive technologies. SUMMARY Preimplantation genetic diagnosis is an alternative to prenatal diagnosis for the detection of genetic disorders in couples at risk of transmitting a genetic condition to their offspring. Preimplantation genetic screening is being proposed to improve the effectiveness of in vitro fertilization by screening for embryonic aneuploidy. Though FISH-based PGS showed adverse effects on IVF success, emerging evidence from new studies using comprehensive chromosome screening technology appears promising. Recommendations 1. Before preimplantation genetic diagnosis is performed, genetic counselling must be provided by a certified genetic counsellor to ensure that patients fully understand the risk of having an affected child, the impact of the disease on an affected child, and the benefits and limitations of all available options for preimplantation and prenatal diagnosis. (III-A) 2. Couples should be informed that preimplantation genetic diagnosis can reduce the risk of conceiving a child with a genetic abnormality carried by one or both parents if that abnormality can be identified with tests performed on a single cell or on multiple trophectoderm cells. (II-2B) 3. Invasive prenatal or postnatal testing to confirm the results of preimplantation genetic diagnosis is encouraged because the methods used for preimplantation genetic diagnosis have technical limitations that include the possibility of a false result. (II-2B) 4. Trophectoderm biopsy has no measurable impact on embryo development, as opposed to blastomere biopsy. Therefore, whenever possible, trophectoderm biopsy should be the method of choice in embryo biopsy and should be performed by experienced hands. (I-B) 5. Preimplantation genetic diagnosis of single-gene disorders should ideally be performed with multiplex polymerase chain reaction coupled with trophectoderm biopsy whenever available. (II-2B) 6. The use of comprehensive chromosome screening technology coupled with trophectoderm biopsy in preimplantation genetic diagnosis in couples carrying chromosomal translocations is recommended because it is associated with favourable clinical outcomes. (II-2B) 7. Before preimplantation genetic screening is performed, thorough education and counselling must be provided by a certified genetic counsellor to ensure that patients fully understand the limitations of the technique, the risk of error, and the ongoing debate on whether preimplantation genetic screening is necessary to improve live birth rates with in vitro fertilization. (III-A) 8. Preimplantation genetic screening using fluorescence in situ hybridization technology on day-3 embryo biopsy is associated with decreased live birth rates and therefore should not be performed with in vitro fertilization. (I-E) 9. Preimplantation genetic screening using comprehensive chromosome screening technology on blastocyst biopsy, increases implantation rates and improves embryo selection in IVF cycles in patients with a good prognosis. (I-B).
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Shefer T, Kruger LM, Schepers Y. Media debates and 'ethical publicity' on social sex selection through preimplantation genetic diagnosis (PGD) technology in Australia. CULTURE, HEALTH & SEXUALITY 2015; 17:962-976. [PMID: 25803702 PMCID: PMC4706020 DOI: 10.1080/13691058.2015.1018947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 07/19/2015] [Indexed: 06/04/2023]
Abstract
This paper offers a critical discourse analysis of media debate over social sex selection in the Australian media from 2008 to 2014. This period coincides with a review of the National Health and Medical Research Council's Ethical Guidelines on the Use of Assisted Reproductive Technology in Clinical Practice and Research (2007), which underlie the regulation of assisted reproductive clinics and practice in Australia. I examine the discussion of the ethics of pre-implatation genetic diagnosis (PGD) within the media as 'ethical publicity' to the lay public. Sex selection through PGD is both exemplary of and interconnected with a range of debates in Australia about the legitimacy of certain reproductive choices and the extent to which procreative liberties should be restricted. Major themes emerging from media reports on PGD sex selection in Australia are described. These include: the spectre of science out of control; ramifications for the contestation over the public funding of abortion in Australia; private choices versus public authorities regulating reproduction; and the ethics of travelling overseas for the technology. It is concluded that within Australia, the issue of PGD sex selection is framed in terms of questions of individual freedom against the principle of sex discrimination - a principle enshrined in legislation - and a commitment to publically-funded medical care.
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Affiliation(s)
- Tamara Shefer
- Faculty of Arts, Women's and Gender Studies, University of the Western Cape, Cape Town, South Africa
| | - Lou-Marie Kruger
- Psychology Department, Stellenbosch University, Matieland, South Africa
| | - Yeshe Schepers
- Psychology Department, Stellenbosch University, Matieland, South Africa
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Winkelman WD, Missmer SA, Myers D, Ginsburg ES. Public perspectives on the use of preimplantation genetic diagnosis. J Assist Reprod Genet 2015; 32:665-75. [PMID: 25758988 DOI: 10.1007/s10815-015-0456-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To study the perspectives of the United States population towards the use of preimplantation genetic diagnosis (PGD) in various clinical scenarios. METHODS Online cross-sectional population based questionnaire of a nationally representative sample according to age, gender, race/ethnicity, income, education and religion. RESULTS A total of 1006 completed the questionnaire with an overall response rate of 94%. A majority supported PGD for diseases fatal early in life or those causing lifelong disability (72.9 and 66.7%, respectively); only 48.0% supported PGD for diseases that manifest late in life. Respondents were more supportive of PGD for genetic diseases if they were aware of PGD prior to the survey (OR = 1.64; CI = 1.13-2.39). However, a small proportion were in favor of genetically-based trait selection: 21.1% supported PGD for sex selection, 14.6% for physical traits and 18.9% for personality traits. Compared to women, men were nearly two- to three-fold more supportive of PGD for sex selection (OR = 1.65; CI = 1.20-2.78), physical traits (OR = 2.38; CI = 1.60-3.48) and personality traits (OR = 2.31; CI = .64-3.26). Compared to Caucasians, Asians (OR = 3.87; CI = 1.71-8.78) and African Americans (OR = 1.61; CI = 1.04-2.74) were more supportive of PGD for sex selection. CONCLUSIONS In a nationally representative sample, a majority supported PGD to identify early onset diseases. We noted significant variation in opinions by sex, race, and education. There was more support among those with prior knowledge of PGD suggesting that education about PGD may foster favorable opinions. This study identifies public knowledge and attitudes that may be used to shape future research hypotheses and clinical policies.
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Affiliation(s)
- William D Winkelman
- Department of Obstetrics, Gynecology and Reproductive Medicine, University of California San Francisco, 505 Parnassus Ave., M1483, Box 0132, San Francisco, CA, 94143, USA,
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Allyse M, Michie M, Mozersky J, Rapp R. Cherchez la Femme: Reproductive CRISPR and Women's Choices. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2015; 15:47-9. [PMID: 26632363 DOI: 10.1080/15265161.2015.1103808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
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Couture V, Drouin R, Tan SL, Moutquin JM, Bouffard C. Cross-border reprogenetic services. Clin Genet 2014; 87:1-10. [PMID: 24798608 DOI: 10.1111/cge.12418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/27/2014] [Accepted: 04/29/2014] [Indexed: 12/19/2022]
Abstract
The purpose of this review is to synthesize the current knowledge on the international movement of patients and biopsied embryo cells for pre-implantation genetic diagnosis and its different applications. Thus far, few attempts have been made to identify the specific nature of this phenomenon called 'cross-border reprogenetic services'. There is scattered evidence, both empirical and speculative, suggesting that these services raise major issues in terms of service provision, risks for patients and the children-to-come, the legal liabilities of physicians, as well as social justice. To compile this evidence, this review uses the narrative overview protocol combined with thematic analysis. Five major themes have emerged from the literature at the conjunction of cross-border treatments and reprogenetics: 'scope', 'scale', 'motivations', 'concerns', and 'governance'. Similar themes have already been observed in the case of other medical tourism activities, but this review highlights their singularity with reprogenetic services. It emphasizes the diagnostic and autologous feature of reprogenetics, the constant risk of misdiagnosis, the restriction on certain tests for medically controversial conditions, and the uncertain accessibility of genetic counseling in cross-border settings.
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Affiliation(s)
- V Couture
- Laboratory of Transdisciplinary Research in Genetics, Medicines and Social Sciences, Division of Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Inhorn MC, Patrizio P. Procreative tourism: debating the meaning of cross-border reproductive care in the 21st century. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.12.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Farra C, Nassar A, Arawi T, Ashkar H, Monsef C, Awwad J. The utilization of pre-implantation genetic testing in the absence of governance: a real-time experience. Clin Genet 2013; 86:177-80. [DOI: 10.1111/cge.12250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Farra
- Human Genetics Unit, Department of Pathology and Laboratory Medicine
| | - A. Nassar
- Department of Obstetrics and Gynecology
| | - T. Arawi
- Salim El-Hoss Bioethics and Professionalism Program; American University of Beirut Faculty of Medicine; Beirut Lebanon
| | - H. Ashkar
- Human Genetics Unit, Department of Pathology and Laboratory Medicine
| | - C. Monsef
- Human Genetics Unit, Department of Pathology and Laboratory Medicine
| | - J. Awwad
- Department of Obstetrics and Gynecology
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Culley L, Hudson N, Blyth E, Norton W, Pacey A, Rapport F. ‘What are you going to do, confiscate their passports?’ Professional perspectives on cross-border reproductive travel. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2012.762084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Greco E, Fabozzi G, Ruberti A, Zavaglia D, Giulia Minasi M. Preimplantation genetic diagnosis and the biopsy technique: Important considerations. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/arsci.2013.12002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Inhorn MC, Shrivastav P, Patrizio P. Assisted Reproductive Technologies and Fertility “Tourism”: Examples from Global Dubai and the Ivy League. Med Anthropol 2012; 31:249-65. [DOI: 10.1080/01459740.2011.596495] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Inhorn MC, Gürtin ZB. Cross-border reproductive care: a future research agenda. Reprod Biomed Online 2011; 23:665-76. [DOI: 10.1016/j.rbmo.2011.08.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 08/05/2011] [Indexed: 11/26/2022]
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Storrow RF. Assisted reproduction on treacherous terrain: the legal hazards of cross-border reproductive travel. Reprod Biomed Online 2011; 23:538-45. [DOI: 10.1016/j.rbmo.2011.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 06/09/2011] [Accepted: 07/06/2011] [Indexed: 10/18/2022]
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Extraterritoriality for cross-border reproductive care: should states act against citizens travelling abroad for illegal infertility treatment? Reprod Biomed Online 2011; 23:546-54. [DOI: 10.1016/j.rbmo.2011.07.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 05/26/2011] [Accepted: 07/14/2011] [Indexed: 11/17/2022]
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