Transition à la Parentalité et Fonctionnement Conjugal chez les Couples Infertiles en Tunisie

Objectif.-Evaluer l’impact de l’adoption sur le fonctionnement conjugal des couples infertiles. Méthode.-L’échantillon est composé de 146 participants hétérosexuels (73 couples) répartis en un groupe avec enfant adoptif (GAEA) composé de 30 couples infertiles vivant une parentalité adoptive et deux groupes contrôles ; le groupe avec enfant biologique (GAEB) composé de 30 couples fertiles ayant accès à la parentalité biologique et le groupe sans enfant (GSE) qui comprend 13 couples infertiles sans enfants. Résultats : Le GAEA semble éviter moins la proximité que les deux groupes contrôles et apparaît plus anxieux face à l’abandon uniquement par rapport au GAEB. Il utilise significativement plus la communication mutuelle mais uniquement par rapport au GSE et rapporte davantage des comportements de "Demande-Retrait" par rapport aux deux groupes témoins. De plus, Il est plus satisfait sur le plan conjugal que les deux groupes contrôles. Conclusion: L’étude offre une meilleure compréhension des changements au sein des couples infertiles devenant parents par voie d’adoption et ouvre plusieurs pistes d’investigation. The aim of this study is to assess the impact of adoption on the marital functioning of infertile couples. The sample is composed of 146 heterosexual participants (73 couples) divided into a group with adopted children (GWAC) made up of 30 infertile couples living in adoptive parenthood and two control groups; the group with biological child (GWBC) made up of 30 fertile couples with access to biological parenthood and the childless group (GWC) which includes 13 infertile couples without children. The GWAC seems to avoid proximity less than the two control groups and appears more anxious about abandonment only in relation to the GWBC. He used mutual communication significantly more but only in relation to the GWC and reported more "Request-Withdrawal" behaviors compared to the two control groups. In addition, he is more marital satisfaction than the two control groups. The study offers a better understanding of the changes in infertile couples becoming parents by adoption and opens several tracks of investigation.

Endocrine Follow-Up of Men with Non-Obstructive Azoospermia Following Testicular Sperm Extraction

Testicular sperm extraction (TESE) is a surgical procedure which, combined with intracytoplasmic sperm injection, constitutes the main treatment for achieving biological parenthood for patients with infertility due to non-obstructive azoospermia (NOA). Although it is effective, TESE procedures might cause structural testicular damage leading to Leydig cell dysfunction and, consequently, temporary or even permanent hypogonadism with long-term health consequences. To a lesser extent, the same complications have been reported for microdissection TESE, which is considered less invasive. The resulting hypogonadism is more profound and of longer duration in patients with Klinefelter syndrome compared with other NOA causes. Most studies on serum follicle-stimulating hormone and luteinizing hormone concentrations negatively correlate with total testosterone concentrations, which depends on the underlying histology. As hypogonadism is usually temporary, and a watchful waiting approach for about 12 months postoperative is suggested. In cases where replacement therapy with testosterone is indicated, temporary discontinuation of treatment may promote the expected recovery of testosterone secretion and revise the decision for long-term treatment.

The path toward ectogenesis: looking beyond the technical challenges

Background Breakthroughs in animal studies make the topic of human application of ectogenesis for medical and non-medical purposes more relevant than ever before. While current data do not yet demonstrate a reasonable expectation of clinical benefit soon, several groups are investigating the feasibility of artificial uteri for extracorporeal human gestation. Main text This paper offers the first comprehensive and up to date discussion of the most important pros and cons of human ectogenesis in light of clinical application, along with an examination of crucial ethical (and legal) issues that continued research into, and the clinical translation of, ectogenesis gives rise to. The expected benefits include advancing prenatal medicine, improving neonatal intensive care, and providing a novel pathway towards biological parenthood. This comes with important future challenges. Prior to human application, important questions have to be considered concerning translational research, experimental use of human fetuses and appropriate safety testing. Key questions are identified regarding risks to ectogenesis’ subjects, and the physical impact on the pregnant person when transfer from the uterus to the artificial womb is required. Critical issues concerning proportionality have to be considered, also in terms of equity of access, relative to the envisaged application of ectogenesis. The advent of ectogenesis also comes with crucial issues surrounding abortion, extended fetal viability and moral status of the fetus. Conclusions The development of human ectogenesis will have numerous implications for clinical practice. Prior to human testing, close consideration should be given to whether (and how) ectogenesis can be introduced as a continuation of existing neonatal care, with due attention to both safety risks to the fetus and pressures on pregnant persons to undergo experimental and/or invasive procedures. Equally important is the societal debate about the acceptable applications of ectogenesis and how access to these usages should be prioritized. It should be anticipated that clinical availability of ectogenesis, possibly first as a way to save extremely premature fetuses, may spark demand for non-medical purposes, like avoiding physical and social burdens of pregnancy.

Can preoperative parameters predict successful sperm retrieval and live birth in couples undergoing testicular sperm extraction and intracytoplasmic sperm injection for azoospermia?

Background We aimed to determine if the success of TESE and live-birth following TESE-ICSI can be predicted from readily available preoperative parameters for couples with azoospermia. Our methodology was as follows, this was a cohort study of couples who attended the fertility service (from 2009-2019) at an NHS hospital in whom the male partner was diagnosed with azoospermia and required conventional TESE with multiple biopsies to obtain sperm. Of 414 men included, 223 had successful TESE and of those 178 have used sperm in ICSI cycle(s). Predictive models were developed using logistic regression. We assessed model performance by internally validated concordance statistics and calibration plots. Successful sperm retrieval was defined as the presence of motile sperm which survived the freeze-thaw process and live-birth defined as delivery after 34 weeks of gestation. Results Successful TESE was associated with higher male age and lower FSH. The TESE model discriminated well with a c statistic of 0.81 (0.77-0.85). Live-birth was associated with lower maternal age, earlier ICSI cycle, and lower testicular volume. The live-birth model also discriminated well with a c statistic of 0.70 (0.64-0.76). Conclusions These results support the pragmatic counselling of couples diagnosed with azoospermia about the chances of success of the TESE procedure and of biological parenthood prior to surgical intervention. The models help to discriminate between men who have a high or low chance of successful TESE and couples who have a higher chance of achieving a live-birth after successful TESE. This will allow couples to make a better assessment of the balance of risk versus benefit prior to commitment to surgical interventions.

A qualitative study examining transgender people’s attitudes towards having a child to whom they are genetically related and pursuing fertility treatments in Greece

Background Advances in biomedical technologies permit transgender individuals not only to achieve gender transition but also to experience parenthood. Little is known about this topic in Greece, which, although a traditionally conservative country, is changing at the legal level towards a greater recognition of transgender people’s rights. This study aimed to investigate transgender people’s attitudes towards having a child to whom they are genetically related and pursuing fertility treatments in Greece. Methods This is a prospective qualitative study conducted with adult individuals who identified as transgender men or transgender women between April 2019 and March 2020. Individual in-depth qualitative interviews were conducted with 12 participants. The interviews were carried out in person and were digitally recorded and transcribed verbatim. We performed a thematic analysis of the data. Results The thematic data analysis resulted in the identification of themes that represent key barriers to pursuing fertility preservation or the use of assisted reproductive technology. Six major themes were clearly present in the findings (lack of adequate information and counseling, worsening gender dysphoria, increased discrimination against transgender people due to the rise of extreme far-right populism, low parental self-efficacy, high costs, and a less-than-perfect legal framework). Moreover, diverse cases were examined, and minor themes, such as the symbolic value of the uterus and pregnancy, the relationship between the type of gender transition and willingness to pursue fertility treatments, and transgender people’s adherence to heteronormative patterns in the context of reproduction, were identified. Various reasons for transgender people’s differing degrees of desire for parenthood were identified. Conclusion Our findings demonstrated contextual factors as well as factors related to transgender people themselves as barriers to pursuing transgender parenthood. Most aspects of our findings are consistent with those of previous research. However, some aspects of our findings (regarding aggressive behaviors and economic instability) are specific to the context of Greece, which is characterized by the rise of extreme far-right populism due to the decade-long Greek economic crisis and a deeply conservative traditionalist background. In that regard, the participants highlighted the (perceived as) less-than-perfect Greek legislation on transgender people’s rights as a barrier to transgender (biological) parenthood.

Confirmation of Paternity despite Three Genetic Incompatibilities at Chromosome 2

DNA testing in cases of disputed paternity is a routine analysis carried out in genetic laboratories. The purpose of the test is to demonstrate similarities and differences in analyzed genetic markers between the alleged father, mother, and a child. The existence of differences in the examined loci between the child and the presumed father may indicate the exclusion of biological parenthood. However, another reason for such differences is genetic mutations, including chromosome aberrations and genome mutations. The presented results relate to genetic analyses carried out on three persons for the purposes of disputed paternity testing. A deviation from inheritance based on Mendel’s Law was found in 7 out of 53 STR-type loci examined. All polymorphic loci that ruled out the paternity of the alleged father were located on chromosome 2. Additional analysis of 32 insertion–deletion markers (DIPplex, Qiagen) and sequencing of 94 polymorphic positions of the single nucleotide polymorphism (SNP) type (Illumina, ForenSeq) did not exclude the defendant’s biological paternity. A sequence analysis of STR alleles and their flanking regions confirmed the hypothesis that the alleles on chromosome 2 of the child may originate only from the mother. The results of the tests did not allow exclusion of the paternity of the alleged father, but are an example of uniparental maternal disomy, which is briefly described in the literature.

Stories of creation

This article discusses the Norwegian media debate on surrogacy from 2010–2013. The debate was initiated by the ‘Volden-case’ where a Norwegian woman who had travelled to India to have surrogate twins could not return to Norway because the Norwegian authorities refused to give the children passports. At that time in 2010, surrogacy was not explicitly regulated by the existing Norwegian Biotechnology Act. According to the Norwegian Child and Parents Act of 1982, the woman who physically gives birth is the mother of the child. It soon became clear that, because this case existed in regulatory limbo, it required a legislative solution. At the time there was an intense and heated media debate. This was resolved when a temporary law was passed in 2013, pending a more permanent Biotechnology Act. During the process of revising the new Biotechnology Act in 2017–2018, we anticipated a continuation of the intense debate that occurred earlier. Surprisingly, this did not happen. In this article we aim to explain why. By analyzing the original 2010–2013 media debate using Hajer’s concepts of ‘discourse coalitions’ and ‘storylines’ (Hajer 2003), we identified three discourse coalitions which gathered around three storylines: the ‘storyline of biological parenthood’, the ‘storyline of equality’ and the ‘storyline on human trafficking’. The analysis demonstrated that the ‘storyline on human trafficking’ gained strength during the 2010–2013 debate, ultimately becoming hegemonic at the end of this period. Surprisingly, the other two discourse coalitions did not appear much in the media debate prior to the new law. This article discusses the lack of these discourse coalitions and concludes that the hegemonic nature of the ‘storyline on human trafficking’ may explain why the new Biotechnology Act did not spark heated debate.