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Shin A, Kathrins MN, Keuroghlian AS. Systemic Barriers to Fertility Preservation for Sexually and Gender Diverse Populations. LGBT Health 2024; 11:415-418. [PMID: 38557157 DOI: 10.1089/lgbt.2023.0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Fertility preservation is the process of collecting and storing oocytes, sperm, or reproductive tissue so that a person may retain their ability to have biologically related children. In instances of infertility caused by medical intervention or an underlying medical condition, this procedure is often sought by affected patient populations. U.S. Title 21 regulations have produced disparities in access, disproportionately restricting services for sexually and gender diverse subpopulations capable of producing sperm. This article examines policies contributing to these disparities, explores how these policies may translate to real-world health care delivery, and proposes policy changes that would increase equitable access to care.
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Affiliation(s)
- Andrew Shin
- Harvard Medical School, Boston, Massachusetts, USA
| | - Martin N Kathrins
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Urology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- The National LGBTQIA+ Health Education Center at The Fenway Institute, Boston, Massachusetts, USA
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Bashiri A, Cherlow Y, Kresch-Jaffe T. Surrogacy: An important pathway to parenthood. A call for international standardization. J Reprod Immunol 2024; 163:104247. [PMID: 38669789 DOI: 10.1016/j.jri.2024.104247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
This comprehensive review examines the multifaceted landscape of surrogacy, a revolutionary treatment for infertility. The study examines historical origins, shifting trends, medical considerations, psychological implications, legal complexities, international variations, and ethical dilemmas surrounding surrogacy. With the advent of assisted reproductive technology, gestational surrogacy allows intended parents a genetic connection to their child. Medical facets encompass indications for gestational surrogacy, drawing attention to maternal health risks and infertility factors. Evidence indicates that medical outcomes are comparable to conventional pregnancies, suggesting a viable reproductive solution for intended parents. Due to the complex nature of surrogacy psychological and emotional vulnerability is inevitable; yet studies underscore positive psychological well-being and satisfaction among gestational carriers (GCs), intended parents (IPs) and children. Surrogacy also has many religious dimensions, as each religion has its own perspective on the distinctive process of creating life and its outcomes, such as, the determination of the child's mother according to their beliefs. Legal considerations emerge as a fundamental aspect, with differing regulations globally. The review emphasizes the significance of comprehensive agreements to safeguard the rights and responsibilities of surrogates and IPs. The unique surrogacy laws in Israel serve as a noteworthy example, reflecting a progressive approach that provides a promising template to establish crucial international guidelines on surrogacy. The absence of international consensus necessitates attention from the global community to address key concerns, including the well-being of GCs, legal recognition for IPs, and the child's best interests, with the goal of establishing a universal standard of care in the field.
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Affiliation(s)
- Asher Bashiri
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Be'er Sheva, Israel; Faculty of Health Sciences, Ben- Gurion University of the Negev, Be'er Sheva, Israel.
| | - Yuval Cherlow
- Tzohar Rabbinical Organization Center for Jewish Ethics, Lod, Israel
| | - Talya Kresch-Jaffe
- Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Attawet J, Alsharaydeh E, Brady M. Commercial surrogacy: Landscapes of empowerment or oppression explored through integrative review. Health Care Women Int 2024:1-19. [PMID: 38252790 DOI: 10.1080/07399332.2024.2303520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
The surge in demand for surrogacy treatments, combined with regulatory loopholes, has spurred the widespread adoption of global commercial surrogacy. This phenomenon poses potential risks to all involved parties, including surrogates and children, encompassing ethical, legal, physical, and psychological concerns. Although commercial surrogacy is under discussion in various jurisdictions, some countries may reintroduce legislation on the matter. In addressing this intricate landscape, the researchers performed an integrative review of existing literature with the intention of providing guidance to researchers and policymakers. The researchers emphasized notable legal and ethical challenges linked to commercial surrogacy. Surrogates often experience disempowerment and oppression, exacerbated by the contractual nature of these arrangements, perpetuating structural inequalities. Children born through commercial surrogacy, especially internationally, risk losing cultural heritage and future benefits. Banning commercial surrogacy may drive it underground, harming surrogates. Reconsidering prohibitions without penalizing surrogates could mitigate downstream issues and safeguard them from exploitation.
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Affiliation(s)
- Jutharat Attawet
- Faculty of Health, Charles Darwin University, Sydney, New South Wales, Australia
- Charles Darwin Centre for Evidence-Based Practice: A JBI Affiliated Group, Darwin, Northern Territory, Australia
| | - Ethar Alsharaydeh
- Faculty of Health, Charles Darwin University, Sydney, New South Wales, Australia
| | - Mark Brady
- School of Law, Faculty of Arts and Society, Charles Darwin University, Casuarina, Northern Territory, Australia
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Qi Q, Gu X, Zhao Y, Chen Z, Zhou J, Chen S, Wang L. The status of surrogacy in China. Biosci Trends 2023; 17:302-309. [PMID: 37081669 DOI: 10.5582/bst.2022.01263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
China's birth rates hit a record low in 2021. The high demand for having children has spawned a massive market for surrogacy, which, however, is a dilemma in China involving a series of moral and legal issues under the current circumstances. First, special populations, including infertile patients, families who have lost their sole child, and homosexuals, wanted to have children, giving rise to surrogacy. Then, the development of and innovation in assisted reproductive technology allowed surrogacy to mature. A high return offsets a high risk, and consequently, an underground surrogacy market has emerged, causing various social issues for the Chinese Government, such as civil disputes, gender disproportion, crime, and the spread of disease. At the same time, surrogacy violates moral ethics, traditional Chinese culture, and the rights and interests of vulnerable groups.
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Affiliation(s)
- Qing Qi
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Xiaolei Gu
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Yangyang Zhao
- Clinical Base of Qingpu Traditional Medicine Hospital, the Academy of Integrative Medicine of Fudan University, Shanghai, China
| | - Ziqin Chen
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Song Chen
- College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
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Lutkiewicz K, Bieleninik Ł, Jurek P, Bidzan M. Development and validation of the attitude towards Surrogacy Scale in a polish sample. BMC Pregnancy Childbirth 2023; 23:413. [PMID: 37270565 DOI: 10.1186/s12884-023-05751-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/30/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Surrogacy is one of the options in reproductive medicine that raises a lot of ethical, legal and psychological controversy. Surveying attitudes toward surrogacy plays an important role in building awareness of this phenomenon in the society, which may help eliminate its stigma. In this study authors aimed to develop and validate a scale to assess the attitudes towards surrogacy. METHODS In this study cross-sectional design was implemented. Development process of the Attitude towards Surrogacy Scale (ATSS) included items development based on literature reviews, other existing questionnaires, confirmatory factor analysis (CFA), and reliability analysis using internal consistence coefficients. A pilot study using adult members of the public was conducted after consultation with the Expert Advisory Panel Board. The final survey, which was used in this study, consisted of 24 items, which were organized into the four subscales: general opinion on surrogacy and its social context (7 items), financing and legalizing surrogacy (8 items), the acceptance of surrogacy (4 items), and attitudes towards the intended parents and children born through surrogacy (5 items). 442 individuals participated in this study. RESULTS The final version of Attitude towards Surrogacy Scale (ATSS) consists of 15 items, grouped in three subscales. Final version of the ATSS showed that the three-factor model indicated an acceptable model fit: Chi-square = 320.46, p < 0.01, df = 87, CFI = 0.94, TLI = 0.92, RMSEA = 0.078 (90% C.I.: 0.070-0.086), SRMR = 0.040 Reliability was assessed by calculating the McDonald's omega that ranged from 0.74 for the Surrogacy ethical context subscale to 0.94 for the overall ATSS score. CONCLUSION ATSS was developed to measure general attitude toward surrogacy with satisfying psychometric properties. The analysis of socio-demographic variables with ATSS showed that the most significant predictor of the general attitude towards surrogacy, and three aspects of surrogacy was being a religious person (profess a Catholic religion or profess another religion).
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Affiliation(s)
| | - Łucja Bieleninik
- Institute of Psychology, University of Gdansk, 80-309, Gdansk, Poland
- GAMUT-The Grieg Academy Music Therapy Research Centre, NORCE Norwegian Research Centre, Bergen, Norway
| | - Paweł Jurek
- Institute of Psychology, University of Gdansk, 80-309, Gdansk, Poland
| | - Mariola Bidzan
- Institute of Psychology, University of Gdansk, 80-309, Gdansk, Poland
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Lee JY. Surrogacy: beyond the commercial/altruistic distinction. JOURNAL OF MEDICAL ETHICS 2023; 49:196-199. [PMID: 35314464 DOI: 10.1136/medethics-2021-108093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
In this article, I critique the commonly accepted distinction between commercial and altruistic surrogacy arrangements. The moral legitimacy of surrogacy, I claim, does not hinge on whether it is paid ('commercial') or unpaid ('altruistic'); rather, it is best determined by appraisal of virtue-abiding conditions constitutive of the surrogacy arrangement. I begin my article by problematising the prevailing commercial/altruistic distinction; next, I demonstrate that an assessment of the virtue-abiding or non-virtue-abiding features of a surrogacy is crucial to navigating questions about the moral legitimacy of surrogacy; in the final part, I reject other moral heuristics that might be proposed as alternatives to the commercial/altruistic dichotomy, and reiterate that a virtue-ethical framework is the most suitable way forward.
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Affiliation(s)
- J Y Lee
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Kelly HK, Geller S, Swami V, Shenkman G, Levy S, Ridge D. A relational investigation of Israeli gay fathers' experiences of surrogacy, early parenthood, and mental health in the context of the COVID-19 pandemic. PLoS One 2023; 18:e0282330. [PMID: 36827339 PMCID: PMC9956003 DOI: 10.1371/journal.pone.0282330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Perinatal distress affects approximately 10% of fathers, but little is known about how gay fathers experience the challenges surrounding childbirth and early parenting of a child. This study explored gay fathers' experiences of having a baby via transnational surrogacy, raising that baby as a gay parent, and the context of the COVID-19 pandemic. In-depth qualitative interviews were conducted with 15 Israeli men to understand their experiences of surrogacy and early parenthood, focusing on the impact on their mental health and the relational factors involved. Secondary narrative analysis revealed that fathers constructed surrogacy as a perilous quest that required strong intentionality to undertake. The first year of parenthood was conceptualised alternately as a joyful experience and/or one that challenged fathers' identities and mental health. A relational framework was applied to better conceptualise the fathers' narratives, revealing that actual connections-and the potentials for links-considerably shaped experiences of surrogacy, perinatal distress and recovery. Implications for research and policy are discussed.
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Affiliation(s)
- Hannah Kate Kelly
- School of Social Sciences, University of Westminster, London, United Kingdom
| | - Shulamit Geller
- Statistics Education Unit, The Academic College of Tel Aviv Yaffo, Tel Aviv-Yafo, Israel
| | - Viren Swami
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom,Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia
| | - Geva Shenkman
- School of Psychology, Reichman University (Interdisciplinary Center, IDC), Herzliya, Israel
| | - Sigal Levy
- Statistics Education Unit, The Academic College of Tel Aviv Yaffo, Tel Aviv-Yafo, Israel
| | - Damien Ridge
- School of Social Sciences, University of Westminster, London, United Kingdom,* E-mail:
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Brandão P, Garrido N. Commercial Surrogacy: An Overview. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2022; 44:1141-1158. [PMID: 36580941 PMCID: PMC9800153 DOI: 10.1055/s-0042-1759774] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Surrogacy is the process in which a woman carries and delivers a baby to other person or couple, known as intended parents. When carriers are paid for surrogacy, this is known as commercial surrogacy. The objective of the present work is to review the legal, ethical, social, and cultural aspects of commercial surrogacy, as well as the current panorama worldwide. METHODS This is a review of the literature published in the 21st century on commercial surrogacy. RESULTS A total of 248 articles were included as the core of the present review. The demand for surrogate treatments by women without uterus or with important uterine disorders, single men and same-sex male couples is constantly increasing worldwide. This reproductive treatment has important ethical dilemmas. In addition, legislation defers widely worldwide and is in constant change. Therefore, patients look more and more for treatments abroad, which can lead to important legal problems between countries with different laws. Commercial surrogacy is practiced in several countries, in most of which there is no specific legislation. Some countries have taken restrictive measures against this technique because of reports of exploitation of carriers. CONCLUSION Commercial surrogacy is a common practice, despite important ethical and legal dilemmas. As a consequence of diverse national legislations, patients frequently resort to international commercial surrogacy programs. As of today, there is no standard international legal context, and this practice remains largely unregulated.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad, Valencia, Spain
| | - Nicolás Garrido
- University of Valencia, Valencia, Spain
- IVI Foundation, Valencia, Spain
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Medico legal and ethical aspects of surrogacy; A case report of a tragic maternal death from Sri Lanka. J Forensic Leg Med 2022; 91:102425. [PMID: 36058108 DOI: 10.1016/j.jflm.2022.102425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/20/2022]
Abstract
A case report from Sri Lanka on surrogacy leading to a tragic maternal death; medico-legal and ethical aspects. Surrogacy, with multiple ethical and legal issues associated with it, is practised worldwide. Although regulations are not available in Sri Lanka, we report a woman who had a tragic death as a complication of surrogate pregnancy. The body of a young mother with four living children was brought for autopsy examination. According to the documents provided, there was a controversy about the deceased's identity. A woman volunteered to show a pillow trapped in her abdomen, simulating a pregnancy. By surrogacy, her husband's sperm were inseminated in this woman's uterus artificially according to a contract. She was diagnosed and managed for pregnancy-induced hypertension in the second trimester. At 36 weeks of gestation, she was admitted to the hospital in labour. On admission, she was icteric with elevated blood pressure. A cesarean section delivered a baby, and it was noted that she had an abruption of the placenta. She developed a postpartum haemorrhage following delivery, and resuscitation failed, resulting in her death. She had elevated liver enzymes and low serum proteins before death. Autopsy findings included intense icterus, congested lungs, global ischemic changes in the myocardium, pale kidneys and fatty soft yellow liver. This case discusses many unanticipated legal and ethical issues related to surrogate pregnancy, especially in a lack of regulations regarding the practice and relatively cheap medical expenses.
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Piersanti V, Consalvo F, Signore F, Del Rio A, Zaami S. Surrogacy and "Procreative Tourism". What Does the Future Hold from the Ethical and Legal Perspectives? MEDICINA (KAUNAS, LITHUANIA) 2021; 57:47. [PMID: 33429930 PMCID: PMC7827900 DOI: 10.3390/medicina57010047] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/17/2020] [Accepted: 01/05/2021] [Indexed: 01/22/2023]
Abstract
Background and objectives: To explore the ethical and legal complexities arising from the controversial issue of surrogacy, particularly in terms of how they affect fundamental rights of children and parents. Surrogacy is a form of medically-assisted procreation (MAP) in which a woman "lends" her uterus to carry out a pregnancy on behalf of a third party. There are pathological conditions, such as uterine agenesis or hysterectomy outcomes, that may prevent prospective mothers from becoming pregnant or carry a pregnancy to term; such patients may consider finding a surrogate mother. Many issues relating to surrogacy remain unresolved, with significant disagreements and controversy within the scientific community and public opinion. There are several factors called into play and multiple parties and stakeholders whose objectives and interests need to somehow be reconciled. First and foremost, the authors contend, it is essential to prioritize and uphold the rights of children born through surrogacy and heterologous MAP. Materials and methods: To draw a parallel between Italy and the rest of the world, the legislation in force in twelve European countries was analyzed, eleven of which are part of the European Union (France, Germany, Italy, Spain, Greece, Netherlands, Belgium, Denmark, Lithuania, Czech Republic and Portugal) and three non-members of the same (United Kingdom, Ukraine and Russia), as well as that of twelve non-European countries considered exemplary (United States, Canada, Australia, India, China, Thailand, Israel, Nigeria and South Africa); in particular, legislative sources and legal databases were drawn upon, in order to draw a comparison with the Italian legislation currently in force and map out the evolution of the Italian case law on the basis of the judgments issued by Italian courts, including the Constitutional and Supreme Courts and the European Court of Human Rights (ECHR); search engines such as PubMed and Google Scholar were also used, by entering the keywords "surrogacy" and "surrogate motherhood", to find scientific articles concerning assisted reproduction techniques with a close focus on surrogacy. Results: SM is a prohibited and sanctioned practice in Italy; on the other hand, it is allowed in other countries of the world, which leads Italian couples, or couples from other countries where it is banned, to often contact foreign centers in order to undertake a MAP pathway which includes surrogacy; in addition, challenges may arise from the legal status of children born through surrogacy abroad: to date, in most countries, there is no specific legislation aimed at regulating their legal registration and parental status. Conclusion: With reference to the Italian context, despite the scientific and legal evolution on the subject, a legislative intervention aimed at filling the regulatory gaps in terms of heterologous MAP and surrogacy has not yet come to fruition. Considering the possibility of "fertility tourism", i.e., traveling to countries where the practice is legal, as indeed already happens in a relatively significant number of cases, the current legislation, although integrated by the legal interpretation, does not appear to be effective in avoiding the phenomenon of procreative tourism. Moreover, to overcome some contradictions currently present between law 40 and law 194, it would be appropriate to outline an organic and exhaustive framework of rules, which should take into account the multiplicity of interests at stake, in keeping with a fair and sustainable balance when regulating such practices.
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Affiliation(s)
- Valeria Piersanti
- Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University, 00198 Rome, Italy; (V.P.); (F.C.); (S.Z.)
| | - Francesca Consalvo
- Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University, 00198 Rome, Italy; (V.P.); (F.C.); (S.Z.)
| | - Fabrizio Signore
- Obstetrics and Gynecology Department, Sant’Eugenio Hospital, 00144 Rome, Italy;
| | - Alessandro Del Rio
- Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University, 00198 Rome, Italy; (V.P.); (F.C.); (S.Z.)
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University, 00198 Rome, Italy; (V.P.); (F.C.); (S.Z.)
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Holte J, Brodin T. Are we looking under the lamp although we know the lost key is somewhere else? Or is it just about the egg? Ups J Med Sci 2020; 125:200-203. [PMID: 32423270 PMCID: PMC7720965 DOI: 10.1080/03009734.2020.1755398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Jan Holte
- Carl von Linne Kliniken, Uppsala, Sweden
- Department of Women’s and Children’s Health, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
| | - Thomas Brodin
- Carl von Linne Kliniken, Uppsala, Sweden
- Department of Women’s and Children’s Health, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden
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