Degrees of Medicalization: The Case of Infertility Health-Seeking

Types of genetic determinism in direct-to-consumer genetic testing for health

Prior research has challenged genetic determinism by highlighting the complex ways lay people engage with genetics. However, most of these critiques took place prior to the availability of direct-to-consumer (DTC) genetic health testing and were based on reactions to genetic testing administered in a clinical context due to either symptoms or family history. Today, many lay people interact with genetic health information outside of medicine, and often without pre-existing symptoms or family history. This suggests the need to revisit genetic determinism in the context of this new mode of public engagement with genetic information about health. In this paper we examine how a sample of 39 people who had previously taken a DTC genetic test for health make sense of their results. We find genetic determinism is prominent, but takes on several distinct forms, including protective determinism, motivating determinism, and absolute determinism. Considering this, we argue that genetic determinism should not be treated as a singular or fixed concept and cannot be dismissed as insignificant, given its continued salience for DTC genetic test-takers. Our analysis also pays particular attention to how test-takers interpret negative results (i.e., no elevated risks detected), as this is a common outcome of DTC genetic tests but has not been a focus of prior research.

Sociocultural aspects of the medicalisation of infertility: a comparative reading of two illness narratives

This paper is a comparative reading of variations in the medicalisation of infertility caused by sociocultural aspects, in two illness narratives by patients: Elizabeth Katkin's Conceivability (2018), a story of navigating a fertility industry with polycystic ovarian syndrome and antiphospholipid syndrome in America and Rohini Rajagopal's What's a Lemon Squeezer Doing in My Vagina (2021), a discussion from India of a growing awareness of medicalisation in treatment of unexplained infertility. For this purpose, it first charts scholarship on illness narratives and medicalisation, noting a historical association. Following this, it shows how infertility, a physiological symptom of reproductive incapacity or failure to show clinical pregnancy, is generally medicalised. This paper reads the texts as showing hitherto unaddressed sociocultural aspects of infertility's medicalisation. At the same time, drawing from existing sociological and anthropological scholarship, it shows how a reading of sociocultural aspects in medicalised infertility nuances understanding of it's medicalisation. This comparative reading attends to sociocultural values and norms within the texts, including pronatalism, fetal personhood, kinship organisation, purity/pollution, individual reliance, sacred duty and so forth. It draws from scholarship on embodiment, rhetorical strategies and the language of medicine. It also shows how a patient's non-medicalised, affective history of 'deep' sickness caused by the biographical disruption of infertility is not that of a 'poor historian'. In laying out the particularisation of such sociocultural values and norms across America and India, medicalisation's migration from its origins to the margins reveals subjectivised, stratified reproduction in infertility illness narratives. This paper is part of a turn in scholarship away from understanding the medicalisation of infertility as naturalised and decontextualised.

Who can take advantage of medically assisted reproduction in Germany?

Compared with other European societies, access to medically assisted reproduction (MAR) in Germany is rather restrictive. Surprisingly little is known about the actual utilization of MAR in Germany and its social selectivity, primarily due to a lack of appropriate data. This article studies the use of MAR by drawing on 11 waves of the German Family Panel (pairfam), an annual survey that collects data on partnership and family dynamics in Germany. In estimating pooled logistic regression models that take into account whether or not MAR has been used, the following treatments were included: (i) in-vitro fertilization or micro-fertilization; (ii) intrauterine insemination; and (iii) any type of surgery performed to treat infertility. The highest odds of seeking medical help for infertility were found among married, childless couples who had a higher income, a strong desire to have children, a poor self-assessed health status, and who reported having problems conceiving a child prior to the year of the interview. Among these married couples, those with an above-average income were particularly likely to use MAR. These findings indicate that social selectivity in the uptake of MAR is based on economic resources and on the importance of marriage as the cultural ideal for a 'normal family'.

Information needs of people seeking fertility services in Canada: a mixed methods analysis

BACKGROUND

Infertility is a challenging experience associated with high levels of psychological distress. Many people seeking fertility services use the internet to obtain information about their conditions and treatments.

OBJECTIVES

This mixed-methods study aimed to describe the information-seeking experience of people seeking fertility services with respect to the fulfillment of their individually defined information needs and explore relationships between the fulfillment of information needs and psychological outcomes.

METHODS

One hundred and four participants completed a survey with close-ended and open-ended questions about their experience using an informational web-based application (app) called 'Infotility' and about their mental well-being before and after using the app. The questionnaires administered were the The Mobile Application Rating Scale (uMARS), the Fertility Quality of Life questionnaire (FertiQol), the Patient Empowerment Questionnaire (PEQ) and the General Anxiety Disorder 7-item Scale (GAD-7). Eleven participants completed in-depth qualitative interviews about their experience using the app. A thematic analysis was used to interpret qualitative results and quantitization was used to dichotomize participants into those with met information needs versus those with unmet information needs. Google Analytics was used to compare participants' reported experience with their actual use of the app.

RESULTS

The results of this study show that there is variability in the amount of information that people seeking fertility services wish to receive. Participants whose information needs were met reported improved psychological outcomes after using the app, while those with unmet needs showed no change in their psychological outcomes.

CONCLUSIONS

Our results suggest that fulfilling information needs was associated with improved psychological outcomes in people seeking fertility services. Our results also suggest that individual differences in information needs should be considered when developing health educational materials.