Psychosocial Aspects of Gestational Grief in Women Undergoing Infertility Treatment: A Systematic Review of Qualitative and Quantitative Evidence

Women undergoing assisted reproduction treatment without being able to become pregnant, and experiencing pregnancy loss after assisted reproduction, are triggering factors for prolonged grief and mourning. This review aims to investigate the psychosocial aspects of gestational grief among women who have undergone infertility treatment. We searched the databases of MEDLINE/PubMed, EMBASE, CINAHL, Scopus, ScienceDirect, and Lilacs for works published up to 5 March 2021. The outcomes analyzed were negative and positive psychosocial responses to gestational grief among women suffering from infertility and undergoing assisted human reproduction treatment. Eleven studies were included, which yielded 316 women experiencing infertility who were undergoing treatment. The most frequently reported negative psychosocial manifestations of grief response were depression (6/11, 54.5%), despair or loss of hope/guilt/anger (5/11, 45.5%), anxiety (4/11, 36.4%), frustration (3/11, 27.3%), and anguish/shock/suicidal thoughts/isolation (2/11, 18.2%). Positive psychosocial manifestations included the hope of becoming pregnant (4/6, 66.6%) and acceptance of infertility after attempting infertility treatment (2/6, 33.3%). We identified several negative and positive psychosocial responses to gestational grief in women experiencing infertility. Psychological support before, during, and after assisted human reproduction treatment is crucial for the management of psychosocial aspects that characterize the grief process of women experiencing infertility who become pregnant and who lose their pregnancy. Our results may help raise awareness of the area of grief among infertile women and promote policy development for the mental health of bereaved women.

Legal Parentage “By Design”: Reimagining Birth Certificates in Aotearoa New Zealand

<p>This thesis highlights two significant flaws in birth certification and legal parentage regimes in Aotearoa New Zealand that negatively impact children conceived and raised in an array of diverse family structures. First, birth certificates currently reflect a child’s legal parentage, excluding any reference to a child’s genetic or gestational origins. This thesis draws on social constructionist conceptions of the self and narrative identity theory, alongside Māori understandings of aspects of whakapapa, to demonstrate that birth certificates should incorporate more information about a child’s origins, and that a failure to do so can have negative consequences for a child’s identity development. To rectify these informational deficits, this thesis argues for the reform of birth certification in Aotearoa New Zealand. It demonstrates the nature and potential of these reforms through the creation of a prototype birth certificate for all children that incorporates their genetic, gestational, and legal parentage. Second, this thesis claims that the current model of legal parentage, which permits a child to have a maximum of two legally recognised parents at any given time, does not reflect the lives of children who are intentionally brought into the world and raised by more than two individuals. Rather, it embodies historic understandings of legal parentage that privilege traditional heterosexual western forms of reproduction, and fails to account for the realities of assisted human reproduction and modern-day family formation. Expanding the operation of legal parentage to incorporate all of a child’s parental figures (and including them on the child’s birth certificate from the outset) would provide greater legal protection for children born into multi-parent families, in line with that currently enjoyed by children with one or two legal parents. Therefore, this thesis develops an intentional model of legal parentage accommodating more than two legal parents where a child is conceived by assisted human reproduction in specified circumstances. Reimagining birth certificates and legal parentage as proposed in this thesis would better reflect the social and narrative realities of identity formation, especially for children, whereby who they become is greatly shaped by the individuals in their lives and their experiences in the world. It would also better meet our obligations under the United Nations Convention of the Rights of the Child, as well as possibly affording greater respect to Māori conceptions of identity, which is of fundamental importance given the classification of whakapapa as a taonga guaranteed protection under Te Tiriti o Waitangi. The expansion of legal parentage beyond the two-parent paradigm would also provide greater legal protection to children in Aotearoa New Zealand, arguably making this area of family law consistent with a legal framework that is otherwise well attuned to recognising the diversity and complexity of family relationships.</p>

Legal Parentage “By Design”: Reimagining Birth Certificates in Aotearoa New Zealand

<p>This thesis highlights two significant flaws in birth certification and legal parentage regimes in Aotearoa New Zealand that negatively impact children conceived and raised in an array of diverse family structures. First, birth certificates currently reflect a child’s legal parentage, excluding any reference to a child’s genetic or gestational origins. This thesis draws on social constructionist conceptions of the self and narrative identity theory, alongside Māori understandings of aspects of whakapapa, to demonstrate that birth certificates should incorporate more information about a child’s origins, and that a failure to do so can have negative consequences for a child’s identity development. To rectify these informational deficits, this thesis argues for the reform of birth certification in Aotearoa New Zealand. It demonstrates the nature and potential of these reforms through the creation of a prototype birth certificate for all children that incorporates their genetic, gestational, and legal parentage. Second, this thesis claims that the current model of legal parentage, which permits a child to have a maximum of two legally recognised parents at any given time, does not reflect the lives of children who are intentionally brought into the world and raised by more than two individuals. Rather, it embodies historic understandings of legal parentage that privilege traditional heterosexual western forms of reproduction, and fails to account for the realities of assisted human reproduction and modern-day family formation. Expanding the operation of legal parentage to incorporate all of a child’s parental figures (and including them on the child’s birth certificate from the outset) would provide greater legal protection for children born into multi-parent families, in line with that currently enjoyed by children with one or two legal parents. Therefore, this thesis develops an intentional model of legal parentage accommodating more than two legal parents where a child is conceived by assisted human reproduction in specified circumstances. Reimagining birth certificates and legal parentage as proposed in this thesis would better reflect the social and narrative realities of identity formation, especially for children, whereby who they become is greatly shaped by the individuals in their lives and their experiences in the world. It would also better meet our obligations under the United Nations Convention of the Rights of the Child, as well as possibly affording greater respect to Māori conceptions of identity, which is of fundamental importance given the classification of whakapapa as a taonga guaranteed protection under Te Tiriti o Waitangi. The expansion of legal parentage beyond the two-parent paradigm would also provide greater legal protection to children in Aotearoa New Zealand, arguably making this area of family law consistent with a legal framework that is otherwise well attuned to recognising the diversity and complexity of family relationships.</p>

O DIREITO SUCESSÓRIO DOS FILHOS HAVIDOS POR INSEMINAÇÃO ARTIFICIAL HOMÓLOGA PÓS-MORTEM

The present work aims to analyze whether the children conceived after the death of the parent by homologous fertilization have the right to inheritance, seeking to conceptualize the institutes of inheritance law and artificial insemination, analyzing the constitutional principles and the sources of law, so that find the best answer on the topic. The article will be divided into 3 parts. The first will try to explain the succession law (master of the law that regulates the transfer of assets, rights and obligations to the heir after the death of an individual) in the light of Brazilian legislation, explaining the existing Types of Succession. The second part of this article will address Assisted Human Reproduction, pointing out the different conceptions of the concept of family that has undergone significant modification over time. In addition, the second part will also deal with Artificial Insemination, which is an assisted reproduction treatment that expands the possibilities of fertilization of the egg, as well as its divisions. It also points out the principles of Brazilian law applicable to assisted human reproduction. The last part of this work will analyze post mortem artificial insemination and the effects on inheritance law based on legislation, doctrine and principles applicable to the subject, pointing out the three doctrinal currents that emerged with the aim of filling this legislative vacuum. This research is categorized as explanatory, as it aims to identify the factors that determine and contribute to the succession of the post mortem inseminated child, the procedure used in this study will be the bibliographic research.

Single-embryo transfer: a key strategy to reduce the risk for multiple pregnancy in assisted human reproduction

In the early days of assisted reproductive technology (ART), the main target was achieving gestation. Success rates were low, and multiple embryo transfers became common practice, with multiple pregnancies being 20 times higher than in natural conception. Multiple pregnancy is associated with a higher risk of complications for the mother and the baby than a singleton pregnancy. Added to healthcare costs, multiple pregnancy also involves other costs and psychosocial risks, with a high social and health costs. At present, success rates of assisted human reproduction (AHR) have improved dramatically, partially due to advances in laboratory techniques such as culture of blastocyst-stage embryos and vitrification. Additionally, there is a wide range of counseling, health and economic policies that have demonstrated being effective in increasing single-embryo transfer (SET) practices and reducing multiple pregnancies, which ensures satisfactory success rates. Therefore, single-embryo transfer emerges as the approach of choice for AHR to result in a full-term healthy newborn.

Social representation of reproductive biotechnologies among nurses working in sexual and reproductive health

ABSTRACT Objectives: to compare the social representations of reproductive biotechnologies among sexual and reproductive health nurses, and their links with professional practice. Methods: an analytical, comparative, qualitative research, supported by the Theory of Social Representation, carried out in May/2014-February/2015, with 32 nurses from the city of Rio de Janeiro. Semi-structured interview, analyzed by ALCESTE® software. Results: nurses not active in assisted human reproduction represent reproductive biotechnologies as unnatural methods of human reproduction, assessing the practice in this field as generalist and bureaucratic. Those who work represent as auxiliary and supporting nature for heterosexual couples, considering the innovative and specialized practice. Final considerations: each group presented specific contents and dimensions about reproductive biotechnologies. The representations are centered on moral, normative and ideological personal values, anchored in the traditional conceptions of human and family reproduction, but also collective, acquired in the professional routine, showing group identity and its distinct practices considering reproductive biotechnologies.

A small increase in CHEK1 activity leads to the arrest of the first zygotic division in human

ABSTRACTThe first mitotic division in mammalian zygotes is unique. The fertilized egg reactivates its cell cycle, and the maternal and paternal genomes start to reprogram to become totipotent. The first division is very sensitive to a range of perturbations, particularly the DNA damage, leading to the embryo’s failure to enter the first mitosis. We discovered that a point mutation in the human CHEK1 gene resulted in an Arginine 442 to Glutamine change at the C-terminus of the CHEK1 protein. CHEK1 R442Q mutation caused the zygote to arrest just before the first division. Heterozygote individuals appeared to be healthy except that the female carriers are infertile. Expressing the corresponding mouse mutant Chk1 protein in zygotes also caused arrest before the first mitosis. Treating Chk1 R442Q mouse zygotes with low concentrations of CHEK1 inhibitor enabled the embryos to overcome the cell cycle arrest and resume normal development. Our results revealed an unexpected zygote mitotic checkpoint, which is extremely sensitive to the CHEK1 kinase activity. The fine-tuning of the DNA damage checkpoint permits the arrested one-cell embryos to overcome the first mitotic block and develop into healthy animals. These findings have important implications in assisted human reproduction.