Twin pregnancy, fetal reduction and the 'all or nothing problem’

Multiple Pregnancy ◽

In Vitro Fertilisation ◽

Singleton Pregnancy ◽

Fetal Reduction ◽

Health Related

Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin pregnancy. I argue that in the case of a twin pregnancy, there are two intuitively plausible claims: (1) abortion is morally permissible, and (2) it is morally wrong to abort just one of the fetuses. But since we should choose morally permissible acts rather than impermissible ones, the two claims lead to another highly implausible claim: the woman ought to abort both fetuses rather than only one. Yet, this does not seem right. A plausible moral theory cannot advocate such a pro-death view. Or can it? I suggest ways to solve this problem and draw implications for each solution.

May I have your uterus? The contribution of considering complexities preceding live uterus transplantation

Medical Humanities ◽

10.1136/medhum-2020-011864 ◽

2021 ◽

pp. medhum-2020-011864

Author(s):

Lisa Guntram

Keyword(s):

Medical Humanities ◽

In Vitro Fertilisation ◽

Medical Innovation ◽

Uterus Transplantation ◽

Ethical Debate ◽

Care And Support ◽

Different Dimensions

Uterus transplantation combined with in vitro fertilisation (IVF) (henceforth called UTx-IVF) as a treatment for infertility caused by an absence or malfunction of the uterus is advancing. About 50 transplantations have been conducted worldwide and at least 14 children have been born—9 of them by women taking part in a Swedish research project on UTx-IVF. The Swedish research protocol initially stated that the potential recipient must ‘have her own donor’ who is preferably related to the recipient. But what does it mean to ask someone for a uterus? What challenges does this question instigate? And what norms may it enact? In this article, I explore how 10 women—who have considered, and sometimes pursued, UTx-IVF—describe their experiences of searching for a donor. I aim to show how an analysis of such accounts can help us unpack some of the specific relational and gendered dimensions of UTx-IVF and by doing so enrich discussions of risks, benefits, care and support in UTx-IVF. Drawing on research in social sciences and medical humanities that has demonstrated how assisted reproductive technologies and organ donation can provoke social and familial conundrums, with respect to such topics as embodiment and identity, I present three patterns that describe different dimensions of the interviewees’ quest for a uterus donor. I discuss the negotiations that took place, how expectations unfolded and how entanglements were managed as the interviewees considered asking someone for a donation. Such an examination, I suggest, contributes to make care and support more attuned to the experiences and entanglements that UTx-IVF entails for those pursuing it. This will become increasingly important if (or when) UTx-IVF becomes part of general healthcare. To conclude, I problematise responsibilities and relational challenges in medical innovation, and in this way provide insights into how the ethical debate over UTx-IVF can broaden its scope.

Rare occurrence of Tetralogy of Fallot in dizygotic twins conceived via in vitro fertilisation

Cardiology in the Young ◽

10.1017/s1047951119002439 ◽

2019 ◽

Vol 29 (12) ◽

pp. 1541-1542

Author(s):

Jason W. Greenberg ◽

Chetana Reddy ◽

Charles B. Huddleston

Keyword(s):

Tetralogy Of Fallot ◽

In Vitro Fertilisation ◽

Rare Occurrence ◽

Dizygotic Twins

AbstractAn increased incidence of CHD has been noted in twin gestations and in infants conceived using assisted reproductive technologies. However, CHD in these populations remains understudied and the mechanisms underlying these phenomena remain unclear. We present the case of twins conceived via in vitro fertilisation both with Tetralogy of Fallot and additional cardiac and extracardiac malformations.

Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it?

Journal of Medical Ethics ◽

10.1136/medethics-2018-104983 ◽

2019 ◽

Vol 45 (5) ◽

pp. 346-350 ◽

Cited By ~ 4

Author(s):

Mila Stefanova Zemyarska

Keyword(s):

Cost Effective ◽

Conclusive Evidence ◽

Diagnostic Tools ◽

In Vitro Fertilisation ◽

Unborn Child ◽

Effective Adjunct ◽

Psychological Benefit

In vitro fertilisation (IVF) ‘add-ons’ are therapeutic or diagnostic tools developed in an endeavour to improve the success rate of infertility treatment. However, there is no conclusive evidence that these interventions are a beneficial or effective adjunct of assisted reproductive technologies. Additionally, IVF add-ons are often implemented in clinical practice before their safety can be thoroughly ascertained. Yet, patients continue to request and pay large sums for such additional IVF tools. Hence, this essay set out to examine if it is ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it. In order to determine what is ethical—namely, morally good and righteous, the question was considered in relation to three key values of medical ethics—autonomy, beneficence and non-maleficence. It was determined that providing IVF add-ons might be morally acceptable in specific circumstances, if true informed consent can be given, there is a potential of cost-effective physiological or psychological benefit and the risk of harm is minimal, particularly with regard to the unborn child.

Foreword: A perspective on the role of emerging technologies for the propagation of companion animals, non-domestic and endangered species

Reproduction Fertility and Development ◽

10.1071/rd07091 ◽

2007 ◽

Vol 19 (6) ◽

pp. iii ◽

Cited By ~ 1

Author(s):

Monique C. J. Paris ◽

Gabriela F. Mastromonaco ◽

Damien B. B. P. Paris ◽

Rebecca L. Krisher

Keyword(s):

Endangered Species ◽

Emerging Technologies ◽

Companion Animals ◽

Reproductive Physiology ◽

In Vitro Fertilisation ◽

Genetic Management ◽

The Status

Assisted reproductive technologies (ART) have been used successfully in humans, domestic and laboratory species for many years. In contrast, our limited knowledge of basic reproductive physiology has restricted the application of ART in companion animal, non-domestic and endangered species (CANDES). Although there are numerous benefits, and in some cases a necessity, for applying ART for the reproductive and genetic management of CANDES, the challenges encountered with even the most basic procedures have limited the rate of progress. In this foreword we discuss the status of conventional ART, such as artificial insemination and in vitro fertilisation, as well as their benefits and inherent difficulties when applied to CANDES. It is upon these techniques, and ultimately our knowledge of basic reproductive physiology, that the success of emerging technologies, such as those described in this special issue, are dependent for success.

Infertility and the excruciating pursuit of motherhood

Indian Journal of Medical Ethics ◽

10.20529/ijme.2021.057 ◽

2021 ◽

pp. 01-02

Author(s):

Urmila G

Keyword(s):

Intracytoplasmic Sperm Injection ◽

Intrauterine Insemination ◽

Infertility Treatment ◽

In Vitro Fertilisation ◽

Natural Conception ◽

Graphic Description

What’s a Lemon Squeezer Doing in My Vagina? is a memoir of Rohini S Rajagopal’s excruciating five-year long fight with infertility and her journey to motherhood. After several failed attempts at natural conception and many negative home pregnancy tests, the author and her husband Ranjith visit a fertility centre in Bangalore. Rajagopal delivers a graphic description of the physical and emotional unpleasantness of her infertility treatment and also gives a vivid account of her experiences with the assisted reproductive technologies (ARTs) such as the intrauterine insemination (IUIs), in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Intrauterine Insemination (IUI) is facilitated by directly injecting a man’s sperm into the woman’s uterus around the time the eggs emerge from the ovaries.

Lesioni cutanee stellate e simmetriche in un gemello “rimasto solo”

Medico e Bambino ◽

10.53126/meb403783 ◽

2021 ◽

Vol 40 (6) ◽

pp. 383-385

Author(s):

Claudia Sciarrotta ◽

Gregorio Serra ◽

Mandy Schierz ◽

Giovanni Corsello

Keyword(s):

Twin Pregnancy ◽

Multiple Pregnancy ◽

Intrauterine Death ◽

Second Trimester ◽

Aplasia Cutis Congenita ◽

Multiple Gestations ◽

Vanishing Twin Syndrome ◽

Twin Pregnancies

The incidence of multiple pregnancy has increased, particularly because of the advances in assisted reproductive technologies. Multiple gestations are high risk pregnancies, especially the monochorionic ones. Two/thirds of initially twin pregnancies result in singles at birth, a condition defined as vanishing twin syndrome. The intrauterine death of one of the twins can cause direct fetal damage to the surviving one on several levels. The paper describes the case of a child born from twin pregnancy that was interrupted for one of the co-twins at early second trimester of gestation who presented with aplasia cutis congenita.

Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) ◽

Hearing function in twins from spontaneous and induced pregnancy

10.21508/1027-4065-2019-64-5-49-54 ◽

2019 ◽

Vol 64 (5) ◽

pp. 49-54

Author(s):

I. V. Rakhmanova ◽

L. G. Sichinava ◽

S. Yu. Lebedeva

Keyword(s):

Otoacoustic Emissions ◽

Multiple Pregnancy ◽

High Risk Group ◽

Multiple Pregnancies ◽

Auditory Function ◽

Vitro Fertilization ◽

Distortion Product

In recent years, an increase in the frequency of multiple pregnancies has been observed worldwide, which is primarily associated with the widespread use of assisted reproductive technology for the treatment of infertility. Pregnancy resulting from in vitro fertilization is a high-risk group. In the world scientific literature there are practically no works on the study of auditory function in children from multiple pregnancy. As for the studies of the auditory function of children from multiple pregnancies, such works are practically absent in the literature. The article presents the results of an audiological examination of 204 children from twins, 94 of which were born as a result of using assisted reproductive technologies, and 110 from a spontaneous multiple pregnancy. According to an audiological survey using the method of otoacoustic emission at the frequency of product distortion in the expected period of labor, we have proven that the conception method (spontaneous or induced) does not affect the maturation of the auditory function in children from twins: registration of the distortion product otoacoustic emissions (DPOAE) test is 56,1 and 54,4% of cases, respectively. The auditory function of each child from one twin must be considered individually.

Children born with assisted technology: a focus on parents’ reproductive health

Consilium Medicum ◽

10.26442/20751753.2021.7.200900 ◽

2021 ◽

pp. 539-543

Author(s):

Daria A. Kinsht ◽

◽

Mariia K. Soboleva ◽

Keyword(s):

Reproductive Health ◽

Medical Center ◽

Newborn Infants ◽

Uterine Cavity ◽

Perinatal Outcomes ◽

Singleton Pregnancy ◽

Vitro Fertilization

Aim. To assess the main indicators of the initial reproductive health of parents, somatic health of the mother and their impact on the health of children born with singleton pregnancy ART. Materials and methods. The study included all newborn infants from singleton ART who were born at the Avicenna Medical Center (Novosibirsk) over the period 2006–2017 (n=409) and their parents (n=818). All stages of overcoming infertility (from the moment the parents go to the clinic to the birth of children) are considered in the context of one center, in a relatively homogeneous social group, with ensuring continuity at all stages. The average experience of infertility in couples was 7.2±0.2 years. The groups were formed depending on the type of infertility and the method of assisted reproductive technologies (ART) used: 205 children were born using in vitro fertilization (IVF), 204 children were born using the method of Intracytoplasm Sperm Injection (ICSI). The method of IVF and transfer of embryos into the uterine cavity is more often used in women with tuboperitoneal, endocrine types of infertility (premature ovarian failure syndrome), as well as in infertility associated with endometriosis. More serious reproductive problems (severe forms of male infertility, a combination of several types of infertility) in most cases lead to the use of more serious technological methods of ART, in particular, the addition of IVF and embryo transfer by the ICSI method. The reasons underlying infertility in most cases lead not only to the choice of the ART method, but also determine the characteristics of the course of pregnancy and the development of the intrauterine fetus. Pregnancy in the IVF group is significantly more often complicated by the threat of termination and premature birth, while ICSI pregnancy more often leads to impaired development of the intrauterine fetus. Conclusion. Features of medical support of women during the preparation for ART and, of course, during pregnancy, with a comprehensive, interdisciplinary correction of expected complications in each of the groups, will improve the perinatal outcomes of induced pregnancy and will contribute to the birth of healthy offspring.

A STATISTICAL ANALYSIS OF OBSTETRIC AND PERINATAL COMPLICATIONS IN SINGLETON AND MULTIPLE PREGNANCIES ONCE ASSISTED REPRODUCTIVE TECHNOLOGIES ARE USED

Wiadomości Lekarskie ◽

10.36740/wlek202104120 ◽

2021 ◽

Vol 74 (4) ◽

pp. 915-922

Author(s):

Tamara H. Romanenko ◽

Olha M. Sulimenko ◽

Svitlana O. Ovcharenko

Keyword(s):

Statistical Analysis ◽

Multiple Pregnancy ◽

Maternity Hospital ◽

Placental Insufficiency ◽

Perinatal Complications ◽

Singleton Pregnancy ◽

Comparative Statistical Analysis ◽

In Pregnancy

The aim: To carry out a comparative statistical analysis of obstetric and perinatal complications in singleton and multiple pregnancies once assisted reproductive technologies (ART) are applied according to the records taken from archival materials (maternity and delivery records) and identify the clinical features of multiple pregnancy. Materials and methods: Over the period of 2017-2019, 522 women gave birth in LELEKA Maternity Hospital LLC after using assisted reproductive technologies and 331 women among them were followed-up in the women’s health center of LELEKA maternity hospital. Among these women (522) with singleton pregnancy 445 women gave birth, while in multiple pregnancy – 77. The statistical analysis of 150 maternity and delivery records was carried out. All pregnant women were divided into two groups: group 1 – 75 women having singleton pregnancy after ART; group 2 – 75 women having multiple pregnancy after ART. Women getting pregnant after ART, or in vitro fertilization (IVF) and five-day frozen embryo transfer to be exact, turned out to be the selection criterion for a comparative statistical analysis. Mathematical methods for research were used as O.P. Mintser (2013) suggested. The reliability of the digit cancellation test was calculated using the Fisher’s exact test and Student’s T-test. Graphs were designed using Microsoft Excel. Results: The complications of early multiple pregnancy were the following: anemia (47.8% as opposed to 22.9%, p<0.01), placental insufficiency (43.3% in contrast to 22.9%, p<0.01), threatened abortion (41.8% in contrast to 28.6%, p<0.01). The complications in late pregnancy are as follows: preeclampsia (52.7% as opposed to 20.6%, p <0.01), intrauterine growth restriction (20.0% as opposed to 7.4%, p <0.01), anemia in pregnancy (76.4% in contrast to 32.4%, p<0.01), placental insufficiency (47.3% in contrast to 22.1%, p<0.05). Conclusions: Multiple pregnancy is a high risk for anemia in pregnancy, preeclampsia, placental insufficiency, early intrauterine growth restriction and fetal distress in pregnancy and labor. It predetermines the high level of a caesarean section. Therefore, further research aimed at prediction and prevention of obstetric and perinatal complications in multiple pregnancy after ART is currently topical.