Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0011
R. Klitzman
{"title":"Choosing Doctors","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0011","url":null,"abstract":"Patients struggle with how to pick doctors, wanting success and patient-centered care but often facing difficulties assessing and weighing these qualities. Many patients feel dissatisfied and disappointed and grapple with how to gauge and weigh communication against technical skills, success rates, financial resources, and hope—whether to shop around and, if so, how much and how to decide. Providers generally receive little, if any, training on how best to address the difficult emotions, profound uncertainties, and complex statistics involved with assisted reproductive technologies. After treatment failures, many patients consult more than one physician and/or seek more holistic, patient-centered approaches, including unproven, alternative approaches.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129658306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0007
R. Klitzman
{"title":"“Family Balancing”","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0007","url":null,"abstract":"Doctors and patients confront decisions of whether to perform “positive selection”—to choose embryos for various socially desired characteristics—most commonly sex but also deafness and dwarfism. Physicians routinely screen embryos for sex not only to prevent the transmission of serious sex-associated diseases (e.g., autism) but also for “family balancing”—though differing widely in how they define this concept. University-affiliated clinics tend to consult formal external ethics committees about these issues, while free-standing private clinics do not. While many countries explicitly prohibit social sex selection, US providers regularly perform it, raising concerns about a possible “slippery slope” toward eugenics. In the near future, screening for genes associated with other non-medical “desired traits” such as blond hair and blue eyes will probably also be developed and requested. Providers and patients wrestle with whether certain types of embryo selection might restrict a child’s “open future” and ability to make key choices for him- or herself, as well as how to uphold the child’s best interests.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126455959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0017
R. Klitzman
{"title":"Choosing Education","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0017","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0017","url":null,"abstract":"Physicians in several fields, patients, families, and the public at large would benefit from more education and understanding regarding infertility and its treatment—from information about basic biology and causes of infertility to specific procedures and the ethical, legal, social, and psychological issues that can arise. Patients must comprehend myriad new facts, which can take considerable effort, struggling to grasp important aspects of statistics and genetics, including recessive genes and variants of unknown significance. Many physicians in and outside of the field of infertility also have knowledge gaps about these medical (e.g., genetic), psychological, and ethical issues and vary in how well they educate patients.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134142830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0016
R. Klitzman
{"title":"“Meant to Be?”","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0016","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0016","url":null,"abstract":"Religious and spiritual beliefs can help patients cope and/or prevent them from pursuing certain treatments. Major religions all contain myths about the creation of life—including human beings. Clergy, families, and friends may sanction certain procedures but prohibit others and vary widely, even within any one faith. Religious leaders may oppose a variety of procedures from small to large. Patients can follow or avoid such prohibitions. Patients, family, friends, and providers can misunderstand a religion’s perspectives, making incorrect assumptions and/or disagreeing about whether a particular couple is “meant” to have children. Providers may be unsure how to interact with patients’ beliefs and clergy, especially when the latter, not the patient, is making the decisions.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126566673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0015
R. Klitzman
{"title":"Choosing Supports","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0015","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0015","url":null,"abstract":"Patients struggle to cope with ethical, social, and psychological challenges in several ways, from trying to manage expectations to seeking various forms of support from family, friends, and others. Shame, stigma, and disappointment lead many patients to disclose their infertility and treatment to few, if any, family members; and consequently, they derive little support from them. Abortion or embryo screening due to a mutation, for instance, can be difficult to reveal because outsiders may be pro-life. Patients respond to perceived shortcomings of families and friends in several ways—from trying to educate these individuals or limit interactions to seeking new supports, whether from fellow patients or psychotherapists. Patients frequently seek new social supports—from formal to informal, from in person to online, and from individual psychotherapy to support groups and large organizations. Many prospective parents, who might benefit from mental health treatment, resent the cost as insurance commonly covers little, if any, of the expense. Face-to-face and online groups each offer pros and cons.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116994279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0009
R. Klitzman
{"title":"Choosing Wombs","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0009","url":null,"abstract":"Many would-be parents face quandaries about whether to pay a woman to carry their fetus in her womb as a gestational surrogate—so-called renting wombs—and, if so, what woman. Many prospective mothers cannot carry a fetus themselves due to medical reasons. Single and gay men who want a biological child have no choice but to use a surrogate. Celebrity actresses such as Sarah Jessica Parker have also hired a surrogate to avoid undergoing pregnancy themselves. The market for such surrogates grows enormously, but debates rage about it due to fears of exploiting women as surrogates. US states range considerably in whether they permit, prohibit, or limit surrogacy and in how they enforce whatever laws they have. Like all pregnant women, surrogates face potential short- and long-term risks. Many parents seek gestational surrogates abroad to save money but may face medical and legal risks regarding the pregnancy and bringing the children into the United States.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131964107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0003
R. Klitzman
{"title":"Becoming an Infertility Patient","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0003","url":null,"abstract":"For many patients, the first step in using these technologies is getting a referral to an infertility specialist, yet even that step can pose challenges. Several types of healthcare provider can serve as gatekeepers and refer patients to fertility specialists—obstetricians and gynecologists, general practitioners, oncologists, and genetic counselors. Yet these clinicians often have knowledge gaps regarding infertility and thus delay or fail to make referrals. Patients encounter financial barriers as well. Patients may postpone or not seek treatment because they fail to appreciate how much age can diminish fertility. Both doctors and patients can feel awkward discussing sexual activity, reproduction, and infertility because of stigma. Usually, infertile patients who pursue treatment first undergo tests to determine whether the infertility stems from the man, the woman, or both. Before proceeding to in vitro fertilization, women ordinarily attempt medications and intrauterine insemination but face a range of challenges and questions.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134403572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0001
R. Klitzman
{"title":"“A Take-Home Baby”","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0001","url":null,"abstract":"This introductory chapter provides an outline of the structure and themes of the book, and describes how I became interested in this topic—through both personal and professional experiences. The chapter presents a brief overview of infertility and several assisted reproductive technologies (ARTs), including new technologies (e.g., gene editing and CRISPR) and their history; recent statistics on use of these interventions in the United States and elsewhere; several relevant current policies, guidelines, and recent legal cases in the United States, Europe, and elsewhere (e.g., from the FDA, CDC, and the American Society for Reproductive Medicine [ASRM]) pertaining to sale and purchase of so-called third-party gametes (i.e., human eggs and sperm); costs and insurance coverage; ethical issues posed by ARTs (e.g., regarding eugenics); and other aspects of these treatments. The chapter also provides an overview of the qualitative methods used in the research that forms a basis of the book.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127483898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Designing BabiesPub Date : 2019-09-01DOI: 10.1093/med/9780190054472.003.0002
R. Klitzman
{"title":"“Not Part of the Parent Club”","authors":"R. Klitzman","doi":"10.1093/med/9780190054472.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780190054472.003.0002","url":null,"abstract":"Individuals and couples who wish to have children but cannot do so due to infertility or other barriers confront many stresses. Having children can give vital meaning and purpose to people’s lives. Many women race against a “biological clock”—the fact that difficulties having a healthy baby skyrocket after age 40. Hence, miscarriages and failures to conceive can feel devastating. The fact that friends of the same age are having children can heighten these strains. Men with little or no sperm often feel guilty, ashamed, and less “macho” and are uncomfortable discussing infertility, even with their doctors, hampering communication and referrals. Outsiders, including patients, parents, siblings, extended family, and friends, may fail to appreciate these travails and ask or push prospective parents about having children, unaware of these impediments. Stigma and misunderstandings regarding infertility persist.","PeriodicalId":229275,"journal":{"name":"Designing Babies","volume":"78 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126817251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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