Background: Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. Methods: We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the (...) impact of infertility on the quality of life of infertility patients. Results: All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one’s self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. Conclusions: The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications. (shrink)

This paper argues that uterine transplants are a potentially dangerous distraction from the development of alternative methods of providing reproductive options for women with absolute uterine factor infertility. We consider two alternatives in particular: the bioengineering of wombs using stem cells and ectogenesis. Whether biologically or mechanically engineered, these womb replacements could provide a way for women to have children, including genetically related offspring for those who would value this possibility. Most importantly, this alternative would (...) avoid the challenge of sourcing wombs for transplant, a practice that we argue would likely be exploitative and unethical. Continued research into bioengineering and ectogenesis will therefore remain morally important despite the recent development of uterine transplantation, even if the procedure reaches routine clinical application. (shrink)

Over the course of recent years, various scientific advances in the realm of reproduction have changed the reproductive landscape, enhancing women’s procreative rights and the choices available to them. Uterus transplants (UTx) are the latest of such medical innovations aimed at restoring fertility in women suffering from absolute uterine factor infertility, providing them with the possibility not only of conceiving a genetically related child but also of gestating their own pregnancies. This paper critically examines the primacy (...) of reproductive liberty in the context of uterus transplantation. It questions whether and to what extent we should respect the reproductive autonomy of a woman who chooses UTx, given the significant risks that attach to the procedure and existing concerns that UTx may perpetuate potentially troubling gendered norms surrounding pregnancy and the role of women’s bodies in reproduction, which may place undue reproductive pressures on women. (shrink)

Interest in the future, clinical implementation of uterus transplantation for uterine factor infertility was recently boosted by the demonstration of proof-of-concept for deceased uterus donation/transplantation. The ethical dimensions of living and deceased uterus transplantation are explored and addressed in the paper through their comparison to the ethical elements of an existing, legal, assisted reproduction practice in some high-income countries, i.e., gestational surrogacy. A set of six ethics lenses is used in the comparative analysis: reproductive autonomy and rights, (...) informed choice/consent, relevant critical relational theories, health equity, theoretical application of the accepted living donation standard, and comparative benefits and burdens considerations. Gestational surrogacy, as currently practiced in some high-income countries, is the assumed, theoretical base-threshold for determination of ethical acceptability in assisted reproduction practices. The analysis demonstrates that : 1) the ethical acceptability of living uterus donation/transplantation is less than that of gestational surrogacy in high-income countries, and 2) the ethical acceptability of deceased uterus donation/transplantation is roughly equivalent to that of gestational surrogacy. This leads to the conclusion that, at the present time, only one version of uterus transplantation practice, i.e., deceased uterus transplantation, should be considered ethically acceptable for possible clinical implementation in high-income countries. (shrink)

Ever since its first documented live birth in 2014, the use of uterine transplantation (UTx) for the treatment of absolute uterine factor infertility (UFI) has seen major clinical advances, which include the use of alternative surgical approaches, different donor states, and diverse patient populations. In addition to the thorough research programs that developed the technique, this accomplishment has occurred in large part following a number of ethical frameworks, such as the Montreal Criteria and the Indianapolis (...) Consensus, which paved the way to transition from experimental animal trials to human ones. To date, over 60 uterine transplants have been performed in the world, and at least 18 births have been thus far confirmed. While the procedure remains experimental, the vast knowledge and procedural experience amassed over the last 20 years of rigorous research have hinted at the next step of discovery. In particular, advancing social circumstances have prompted the question regarding the use of this technology in transgender individuals. Though the potential use of uterine transplants in the transgender population has been hypothesized, no in‐depth ethical framework has been developed towards this purpose. Herein, we explore the ethical issues revolving around the use of this technology in this patient population and provide key insights that may advance this cause. (shrink)

Being inherently different from any other lifesaving organ transplant, uterine transplantation does not aim at saving lives but supporting the possibility to generate life. Unlike the kidneys or the liver, the uterus is not specifically a vital organ. Given the non-lifesaving nature of this procedure, questions have been raised about its feasibility. The ethical dilemma revolves around whether it is worth placing two lives at risk related to surgery and immunosuppression, amongst others, to enable a woman with absolute (...) uterine factor infertility to experience the presence of an organ enabling childbirth. In the year 2000, the first uterine transplantation, albeit unsuccessful, was performed in Saudi Arabia from where it has spread to the rest of the world including Sweden, the United States and now recently India. The procedure is, however, still in the preclinical stages and several ethical, legal, social and religious concerns are yet to be addressed before it can be integrated into the clinical setting as standard of care for women with absolute uterine factor infertility. (shrink)

In recent years much research has been undertaken regarding the feasibility of the human uterine transplant as a treatment for absolute uterine factor infertility. Should it reach clinical application this procedure would allow such individuals what is often a much-desired opportunity to become not only social mothers, or genetic and social mothers but mothers in a social, genetic and gestational sense. Like many experimental transplantation procedures such as face, hand, corneal and larynx transplants, UTx as (...) a therapeutic option falls firmly into the camp of the quality of life transplant, undertaken with the aim, not to save a life, but to enrich one. However, unlike most of these novel procedures – where one would be unlikely to find a willing living donor or an ethics committee that would sanction such a donation – the organs to be transplanted in UTx are potentially available from both living and deceased donors. In this article, in the light of the recent nine-case research trial in Sweden which used uteri obtained from living donors, and the assertions on the part of a number of other research teams currently preparing trials that they will only be using deceased donors, I explore the question of whether, in the case of UTx, there exist compelling moral reasons to prefer the use of deceased donors despite the benefits that may be associated with the use of organs obtained from the living. (shrink)

Researchers have recently provided proof of concept for uterus transplantation, giving rise to a discussion about priority setting. This article analyses whether absolute uterine‐factor infertility (AUFI), the main indication for uterus transplantation, gives rise to a healthcare need and the extent to which such a need places justified claims on public funding in a needs‐based welfare system. It is argued that, regardless of the concept of health to which one subscribes, there is a healthcare need for (...) uterus transplantation in women with AUFI. The provision of alternative ways of addressing this need, such as surrogacy and adoption, reduces its severity. Hence, where such alternatives are publicly funded, uterus transplantation is unlikely to become cost‐effective. However, where surrogacy and adoption are not publicly funded, uterus transplantation should be given a similar priority level to other assisted reproductive technologies. In these circumstances, public funding for uterus transplants may well be justified, particularly in well‐funded healthcare system with relatively generous cost‐effectiveness thresholds. (shrink)

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how (...) to allocate donated organs; whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward. (shrink)

Within the ethics and science literature surrounding uterus transplantation (UTx), emphasis is often placed on the extent to which UTx might improve upon, or offer additional benefits when compared to, existing ‘treatment options’ for women with absolute uterine factor infertility, such as adoption and gestational surrogacy. Within this literature UTx is often positioned as superior to surrogacy because it can deliver things that surrogacy cannot (such as the experience of gestation). Yet, in addition to claims that (...) UTx is superior in the aforementioned sense it is also often assumed (either implicitly or explicitly) that UTx is less fraught with ethical difficulties and thus should be considered a less morally problematic option. This article seeks to examine this assumption. Given that much UTx research has been performed in Sweden, a country where surrogacy is effectively although not currently explicitly forbidden, we do this through an analysis of the arguments underpinning a 2016 Swedish white paper which considered amending existing policy such that altruistic surrogacy arrangements would be permitted. By applying the white paper’s arguments for a restrictive position on altruistic surrogacy to the case of UTx using living altruistic donors we find that such arguments, if they hold in the case of surrogacy, apply similarly to UTx. We thus suggest that, for reasons of consistency, a similar stance should be taken towards the moral and legal permissibility of these two practices. (shrink)

Uterus transplantation (UTx) is highly anticipated for the benefits that it might bring to individuals wanting to carry a pregnancy in order to reproduce who do not have a functioning uterus. The surgery—now having been performed successfully in several countries around the world—remains experimental. However, UTx is at some point expected to become a routine treatment for people without a uterus and considering themselves in need of one: women with absolute uterine factor infertility; transgender women; and (...) even cisgender men who wish to gestate. Given the unique benefits UTx offers, uteri are likely to be ‘in demand’, and such demand, we suggest, will feasibly outstrip supply. Therefore, allocation of those uteri available for transplant may become a pressing issue. In this paper, we consider one aspect of organ allocation—the preferences of donors in making a directed or conditional donation of their uterus. To what extent, in the context of uterus donation, would such donations be ethically permissible? (shrink)

Uterus transplantation is a relatively new intervention. A woman with absolute uterine factor infertility receives, by a surgical procedure, a transplanted uterus, most often by living donation. The uterus recipient may thus become pregnant and conceive her own child. As with any other medical treatment, UTx requires legitimation. The anticipated benefits must outweigh the risks of the medical intervention. The risks and benefits of UTx are by no means unequivocal and cannot be easily determined. The benefits (...) depend on the final evaluation of the suffering to be alleviated by the intervention. In the following, we will analyze the suffering addressed by UTx and discuss its normative value. First, we point out that (a) suffering is generally considered an important normative criterion in medicine as well as in the context of UTx; (b) we then describe the risks and anticipated benefits of UTx for the three persons directly concerned: the child, the donor, and the recipient; (c) we further analyze the suffering addressed by UTx. The intervention addresses a form of existential suffering. We discuss the common notion that existential suffering should be evaluated from the subjective perspective of the sufferer; (d) afterwards, we argue that in a social practice like medicine, a one‐sided evaluation stemming from the sufferer alone is not sufficient; and (e) finally, arguments from a societal perspective lead us to the conclusion that the existential suffering addressed by UTx does not possess a sufficiently strong normative value to legitimize a high‐risk, expensive procedure. (shrink)

Uterine transplantation could give women who suffer from uterine factor infertility the possibility of experiencing gestation. Much of the ethical discussion about uterine transplantation has focused on whether research on it should even be pursued, but researchers are nevertheless moving forward with several uterine transplant research protocols. Scholars should therefore already be identifying and engaging in an intimate examination of the ethical realities of offering uterine transplantation in a clinical setting. Given the potential (...) for the procedure to expand reproductive options for women, reproductive autonomy has been a primary principle underlying much of the ethical discourse about the hypothetical impact of uterine transplantation. Yet the factors that will affect whether uterine transplants promote or undermine a patients’ reproductive autonomy if the procedure is integrated into clinical practice have yet to be rigorously explored. Focusing on the clinical realities of patient autonomy, I argue that empirical data exploring prospective recipients’ motivations and their perceptions of the benefits of the procedure in the context of their lived experiences are critical to a robust analysis of the ethical dimensions of uterine transplantation. (shrink)

The field of reproductive medicine witnessed a breakthrough in September 2014 with the first successful live birth post uterine transplantation. This success represents the culmination of decades' worth of research on infertility and reproductive medicine. This subject of infertility gathers special attention in the Middle East, as childbearing is given paramount importance in the family unit. And as with any new medical advancement, Middle Eastern people look to their religious authorities for guidance. This paper describes the various (...) ethical quandaries related to uterine transplantation, from a perspective of the religious and societal factors that are unique to the Middle East, and embeds them within the conversation of its alternative solutions. (shrink)

Moving forward rapidly in the clinical research phase, uterus transplantation may be a future treatment option for women with uterine factor infertility, which accounts for three per cent of all infertility in women. This new method of treatment would allow women, who currently rely on gestational surrogacy or adoption, to gestate and birth their own genetic offspring. Since uterus transplantation carries significant risk when compared with surrogacy and adoption as well as when compared with other organ (...) transplants, it requires greater justification because its goals are quality of life, not life-saving, in their scope. It is important to address questions regarding the physical, psychosocial and ethical risks and benefits of uterus transplantation for all three parties involved—the patient, the donor and the potential child—as well as discuss the regulatory implications as research on uterus transplantations moves forward. (shrink)

Uterus transplantation is an emerging technology adding to the arsenal of treatments for infertility; specifically the only available treatment for uterine factor infertility. Ethical investigations concerning risks to uteri donors and transplant recipients have been discussed in the literature. However, missing from the discourse is the potential of uterus transplantation in other groups of genetically XY women who experience uterine factor infertility. There have been philosophical inquiries concerning uterus transplantation in genetically XY women, (...) which includes transgender women and women with complete androgen insufficiency syndrome. We discuss the potential medical steps necessary and associated risks for uterus transplantation in genetically XY women. Presently, the medical technology does not exist to make uterus transplantation a safe and effective option for genetically XY women, however this group should not be summarily excluded from participation in trials. Laboratory research is needed to better understand and reduce medical risk and widen the field to all women who face uterine factor infertility. (shrink)

The first baby has successfully been born by uterus transplantation (UTx) in the United States and the procedure is swiftly becoming a viable clinical option for patients with uterine factor infertility (UFI). This raises a practical ethical question: should health insurers finance UTx and what issues should they consider in coming to this decision? The article lays forth some of the factors that shape the decision over whether to finance UTx in the United States, including what procedures (...) must be covered, whether UTx is more like organ transplantation or infertility treatment (which are treated differently in the United States), and the benefits and alternatives of the procedure. Then, the article explores arguments around why UTx should be financed, or at least considered along with other important medical needs. The paper argues that UTx ought to be considered along with other competing claims for healthcare services. In countries that generously cover other infertility services, it may logically follow that medical services that enable gestation should be insured when the healthcare system covers services to conceive. In the United States, however, many groups have long suffered inadequate access to medical care, in the context of infertility and more broadly. U.S. healthcare may need to be made more widely equitable, before covering UTx is seen as financially or politically possible. (shrink)

The recent advances in assisted reproductive technology, such as hormonal stimulation, IVF, and intracytoplasmic sperm injection (ICSI), have made it possible to circumvent many causes of male and female factor infertility. However, uterine infertility is still considered an ‘‘unconditionally infertile’’ condition. Owing to the continued advances in organ transplantation, microvascular anastomosis techniques, and immunosuppressive medicine, the transplantation of organs is no longer restricted to the ones necessary for continued life. Quality-of-life enhancing types of transplantation, such as (...) uterine transplantation, in recent years, have also entered the clinical arena. This undoubtedly brings new hope to such women, but also creates ethical challenges. Selection of the donor, the impact on the recipient and offspring, as well as challenges to moral and social norms are issues that cannot be ignored. In the present review, the ethical issues of transplantation of the uterus will be discussed in light of recent progress in the procedure. (shrink)

The recent advances in assisted reproductive technology, such as hormonal stimulation, IVF, and intracytoplasmic sperm injection (ICSI), have made it possible to circumvent many causes of male and female factor infertility. However, uterine infertility is still considered an ‘‘unconditionally infertile’’ condition. Owing to the continued advances in organ transplantation, microvascular anastomosis techniques, and immunosuppressive medicine, the transplantation of organs is no longer restricted to the ones necessary for continued life. Quality-of-life enhancing types of transplantation, such as (...) uterine transplantation, in recent years, have also entered the clinical arena. This undoubtedly brings new hope to such women, but also creates ethical challenges. Selection of the donor, the impact on the recipient and offspring, as well as challenges to moral and social norms are issues that cannot be ignored. In the present review, the ethical issues of transplantation of the uterus will be discussed in light of recent progress in the procedure. (shrink)

The recent advances in assisted reproductive technology, such as hormonal stimulation, IVF, and intracytoplasmic sperm injection (ICSI), have made it possible to circumvent many causes of male and female factor infertility. However, uterine infertility is still considered an ‘‘unconditionally infertile’’ condition. Owing to the continued advances in organ transplantation, microvascular anastomosis techniques, and immunosuppressive medicine, the transplantation of organs is no longer restricted to the ones necessary for continued life. Quality-of-life enhancing types of transplantation, such as (...) uterine transplantation, in recent years, have also entered the clinical arena. This undoubtedly brings new hope to such women, but also creates ethical challenges. Selection of the donor, the impact on the recipient and offspring, as well as challenges to moral and social norms are issues that cannot be ignored. In the present review, the ethical issues of transplantation of the uterus will be discussed in light of recent progress in the procedure. (shrink)

We argue that strong moral objections to widespread implementation of uterine transplantation persist despite recent live births following the procedure. These objections relate not only to the serious medical risk to which live donors are currently subject but also to the strength of pronatalistic and biologistic social forces. We explore medical risk in light of various factors and treat questions relating uterine transplantation to gestational surrogacy.

The options currently available to women with uterine infertility are adoption or surrogacy. Recently the option of uterine transplantation has been explored which would allow a woman to carry her own genetically related child. Although this type of transplant raises similar ethical considerations to other types of non-life-saving organ transplantation, such as facial tissue and limb, it also raises its own very unique considerations. In this paper, some of the considerations surrounding uterine transplantation, such as informed (...) consent and an individual's rights, and potential limit to reproductive autonomy are explored. (shrink)

Infertility constitutes an essential source of stress in the individual and couple’s life. The Infertility-Related Stress Scale is of clinical interest for exploring infertility-related stress affecting the intrapersonal and interpersonal domains of infertile individuals’ lives. In the present study, the IRSS was translated into Brazilian–Portuguese, and its factor structure, reliability, and relations to sociodemographic and infertility-related characteristics and depression were examined. A sample of 553 Brazilian infertile individuals completed the Brazilian–Portuguese IRSS, and a subsample of (...) 222 participants also completed the BDI-II. A sample of 526 Italian infertile individuals was used to test for the IRSS measurement invariance across Brazil and Italy. Results of exploratory structural equation modeling indicated that a bifactor solution best represented the structure underlying the IRSS-BP. Both the general and the two specific intrapersonal and interpersonal IRSS-BP factors showed satisfactory levels of composite reliability. The bifactor ESEM solution replicated well across countries. As evidence of relations to other variables, female gender, a longer duration of infertility, and higher depression were associated with higher scores in global and domain-specific infertility-related stress. The findings offer initial evidence of validity and reliability of the IRSS-BP, which could be used by fertility clinic staff to rapidly identify patients who need support to deal with the stressful impact of infertility in the intrapersonal and interpersonal life domains, as recommended by international guidelines for routine psychosocial care in infertility settings. (shrink)

Infertile women in the developing world face an additional layer of vulnerability compared to their counterparts in the developed world due to social, cultural, political, and socioeconomic factors that truly render their infertility a disability. After exploring how infertility in the developing world fits the World Health Organization’s biopsychosocial model of disability, we will argue that feminists and disability rights proponents should jointly articulate and advocate for change.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies by Karey HarwoodKathryn Lilla CoxThe Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies Karey Harwood Chapel Hill, NC: University of North Carolina Press, 2007. 221pp. $22.00Karey Harwood’s The Infertility Treadmill, published in the University of North Carolina’s Studies in Social Medicine series, fills a lacuna in the (...) class='Hi'>infertility literature. Harwood takes an interdisciplinary approach examining “assisted reproductive technologies” (ART) using current scientific, philosophical, theological, and—most importantly—her own ethnographic research. By way of a thick description of women’s experiences of infertility, she draws the reader into a rich ethical conversation regarding ARTs.Harwood “seeks first and foremost to offer an interpretation of the ethical significance of the increasing use of ART by bringing a particular set of normative or evaluative lenses to bear on a particular set of descriptive data” (8). She engaged in this study because of her desire to explore the connections between decisions to use ART and such factors as paid employment, delayed childbirth, and the ongoing balancing of work and family life. Harwood gathered her descriptive data by spending a year with the Atlanta chapter of RESOLVE (The National Infertility Association): attending monthly meetings and listening to speakers and participants as well as appraising RESOLVE’s national and local literature. She also conducted nine interviews with eight women and one man. Focusing on work and family conflicts in light of questions related to gender justice and the interplay between social and communal norms theories, on the one hand, and private and individual choice, on the other, Harwood teases out the ethical complexity surrounding ARTs.After surveying philosophical and theological literature relevant to her topic, Harwood names and examines existential concerns that emerged from her observations, conversations, and interviews with RESOLVE members. Clustered thematically, these concerns include the painful isolation of infertility, the stigma attached to using ARTs, people’s moralizing, how much treatment to pursue, what is the value in trying one more thing, socioeconomic status, and emotional awareness (62–97). Throughout her discussion of these concerns, [End Page 209] Harwood reminds ethicists of the importance of personal narratives for any treatment of an ethical issue like this.Moreover, her research leads Harwood to deduce that RESOLVE helps people with meaning-making, questions of purpose, language clarification, and various options surrounding infertility and ARTs. She asserts that the infertility experience can be a transformative one for the infertile. The decision-making process regarding the use of ARTs functioned as a type of ritual—albeit “a consumeristic ritual”—that aided people in working through the grief of infertility (157). Religious institutions have not always helped the infertile in these areas. Nonetheless, Harwood’s study leads her to conclude that RESOLVE members and leaders tend to be deficient in their capacities for challenging and critically examining how individual decisions intertwine with larger social contexts.Harwood acknowledges that her methodological decision to focus on one RESOLVE chapter limited her demographics (63–64). Moreover, although for the most part balanced, Harwood’s assessment of her findings is at times partial, even bordering on advocacy. For example, she clearly seeks to make the case that ethical analyses of infertility need to be more nuanced—incorporating more personal narrative—and that RESOLVE needs to be more open to critical self-reflection, especially the critical questioning of the “treadmill of infertility” (133). In her analysis of her findings, Harwood demonstrates how personal narratives help nuance ethical analysis. Less clear is whether RESOLVE can be or wants to be more self-critical and more questioning of its own core premises. Nonetheless, these limitations do not detract from Harwood’s important insights regarding “the infertility treadmill” and the host of issues related to ARTs—including consumerism, the role of rituals, meaning-making, suffering and grief, and gender justice, among others.Those struggling with infertility or considering ARTs will find Harwood to be an empathetic dialogue partner. Others will gain a deeper understanding of infertility’s toll by reading this book. Graduate and advanced undergraduate students will benefit from Harwood’s analysis of how personal decisions have wide-ranging... (shrink)

In Turkey, as in many other countries, infertility is generally regarded as a negative phenomenon in a woman’s life and is associated with a lot of stigma by society. In other words, female infertility and having a baby using Assisted Reproductive Technologies have to be taken into consideration with respect to gender, motherhood, social factors, religion and law. Yet if a woman chooses to use ART she has to deal with the consequences of her decision, such as being (...) ostracized by society. Other types of procedures in this area, such as sperm and ova donation or surrogate motherhood, are not permitted in law. However, both before and after the development of this techonology, society has been finding its own solutions which are rarely questioned and are still performed. This article will discuss what these practices are and try to reach some pragmatic conclusions concerning female infertility, the concept of motherhood and some traditional practices in Turkey. (shrink)

Although most studies investigated the impact of infertility and its treatment on the couple, a small body of evidence suggested that infertility care providers may experience different sources of stress related for instance to excessive workload, the complexity of the technique, and relational difficulties with patients. The current study aimed at providing further insight into the understanding of the subjective experience of infertility care providers by highlighting their feelings and emotions, personal meanings, challenges, and opportunities. Following the (...) methodological guidelines of Interpretative Phenomenological Analysis, we conducted individual semi-structured interviews with 23 members of two different fertility units. Interviews were audiotaped and transcribed verbatim. Textual analysis was then conducted to identify emerging dominant themes and subthemes. Three main themes were extracted: dealing with infertile patients and their specificities, performing assisted reproductive technology, being part of a team. These themes related to participants experiencing: difficulties in establishing an empathic connection and communicating with couples, such that women were sometimes perceived as “particular patients” and men as poorly involved in the process; difficulties in dealing with a complex procedure in which errors are not allowed, with a growing number of women aged > 40 seeking assisted reproduction, despite the risks for their health; being part of a team as a resource, although the huge amount of time spent together can involve conflicts and organizational problems. These findings suggested that patients’ overpersistence represents an important source of stress for infertility care providers. At the same time, the concept of particular or difficult patient derives from the combination of multiple factors, including providers’ own history and subjective experience. The presence of mental health professionals in fertility units is essential to help providers improve the quality of doctor-patient communication and relieve the stress related to organizational issues and conflicts. (shrink)

In February 2016, the Cleveland Clinic initiated the first attempt at cadaveric uterine transplantation (UTx) in the United States. The transplantation was ultimately unsuccessful, but it opened doors for further research on both live and cadaveric UTx. While initial strides toward successful transplantation have been made, questions persist on the ethics of UTx: whether the uterus is a vital organ, whether we should prioritize live or cadaveric options, and how the procedure should be covered by health insurance. If we (...) agree that the goal of the medical profession is both to treat and improve quality of life, then the question of whether or not infertility is considered a disease becomes inconsequential in the discussion. As such, the medical enterprise should move forward with research in UTx. In doing so, considering the ethical implications of UTx remains essential—and we must remember to pair innovation with regulation. (shrink)

Background Changes in policies and practices related to repeat cesareans and home birth in the U.S. have been influenced by different interpretations of the risk of poor outcomes. Methods This article examines two cases—vaginal birth after cesarean (VBAC) and home birth to illustrate how an emphasis on relative over absolute risk has been used to characterize outcomes associated with these practices. The case studies will rely on reviews of the research literature and examination of data on birth trends and (...) outcomes. Results Childbirth involves some unique challenges in assessing health risks, specifically the issues of: (1) timing of risks (lowering health risk in a current birth can increase it in subsequent births); (2) the potential weighing of risks to the mother’s versus the infant’s health; (3) the fact that birth is a condition of health and many of the feared outcomes (for example, symptomatic uterine rupture) involve very low absolute risk of occurrence; and (4) a malpractice environment that seizes upon those rare poor outcomes in highly publicized lawsuits that receive widespread attention in the clinical community. In the cases of VBAC and home birth, the result has been considerable emphasis on relative risks, typically an adjusted odds ratio, with little consideration of absolute risks. Conclusion Assessments of the safety of interventions in childbirth should involve careful consideration and communication of the multiple dimensions of risk, particularly a balancing of relative and absolute risks of poor health outcomes. (shrink)

Mitochondrial replacement techniques (MRTs) usually aim to prevent the genetic transmission of maternally inherited mitochondrial diseases. Until now, only the UK and Australia have implemented specific legal regulations of MRTs. In both countries, clinical trials on these techniques are only permissible for cases with a high risk of severe mitochondrial disease in the offspring. However, these techniques can also be applied to treat infertility, especially for older women with impaired oocyte quality. In some countries without legal regulation of these (...) techniques, MRTs are already offered for this purpose. Yet, this application of MRTs has received insufficient attention in the bioethical literature so far.In this paper, I examine whether there are ethical reasons to prohibit trials on MRTs in the context of infertility when they are permitted for preventing mitochondrial disease. Allowing MRTs in one context but not the other might be justified either because their application in the context of mitochondrial disease (1) is supported by a more convincing evidence base, (2) has a higher potential benefit or (3) has a lower risk. I compare both applications of MRTs with respect to these three factors. I conclude that there is no convincing reason to prohibit clinical trials on MRTs for infertility when they are permitted in the context of mitochondrial disease. (shrink)

We discuss the case against Factorism, which is the standard assumption in quantum mechanics that the labels of the $$\otimes$$ ⊗ -factor Hilbert-spaces in direct-product Hilbert-spaces of composite physical systems of similar particles refer to particles, either directly or descriptively. We distinguish different versions of Factorism and argue for their truth or falsehood. In particular, by introducing the concepts of snapshot Hilbert-space and Schrödinger-movie, we demonstrate that there are Hilbert-spaces and $$\otimes$$ ⊗ -factorisations where the labels do refer, even (...) descriptively, to similar particles, which renders them probabilistically absolutely discernible. (shrink)

Some experts have argued that patients should routinely be told the specific magnitude and absolute probability of potential risks and benefits of screening tests. This position is motivated by the idea that framing risk information in ways that are less precise violates the ethical principle of respect for autonomy and its application in informed consent or shared decisionmaking. In this Perspective, we consider a number of problems with this view that have not been adequately addressed. The most important challenges (...) stem from the danger that patients will misunderstand the information or have irrational responses to it. Any initiative in this area should take such factors into account and should consider carefully how to apply the ethical principles of respect for autonomy and beneficence. (shrink)

The science of Kalām aims to prove the existence and attributes of Allah. For this purpose, the theologians adopted a method that turns from the sensible universe to the unseen universe. This method, named as qiyāṣ al-ğāib alā alā al-shāḥid, created a common ground in the discussions with the dissenters. Because the sensible universe is open to human perception in a way that does not allow for denial. From this point of view, the universe, which is defined as "everything other (...) than Allah" in Ashʿarite Kalām, has been discussed in terms of both structure and functioning. Based on the principles determined by the theologians, the universe is said to be composed of substance, accidents and bodies. The said entities are basically constructed in a way that is dependent on each other and on a higher will. Based on this construct, the Ashʿarite tradition preferred to explain the functioning of the universe with the theory of custom. In fact, their basic assumptions about the universe and Allah necessitated this preference. This is because they envision Allah as a fāil al- mukhtār deity with absolute will and power. Everything in the universe, except for the events or situations deemed impossible by the mind, is within His power. In this respect, the universe is described as an area of possibilities. The Ashʿarite tradition, which is based on the nonpermanent nature of accidents, insists that accidents should be recreated at every moment. This basic defense completely reveals the dependence of the universe on Allah. Built on these basic assumptions, the theory of custom uniquely explains the functioning of the universe without imposing any limitations on Allah, who has absolute will and power. This theory, which reflects the Ashʿarite tradition exactly, enables them to explain all theological issues, especially the relationship between Allah and the universe, in a consistent manner. This study aims to examine the basic principles that led the early Ashʿarite tradition to accept the theory of custom by analyzing them under several headings. For this aim, the views of the early Ashʿarite theologians have been identified through a literature review analyzed and interpreted in the context of the matter. (shrink)

The IVF ET method is a scientifically recognized infertility treat- ment method. The problem, however, is this method’s unsatisfactory efficiency. This calls for a more thorough analysis of the information available in the treat- ment process, in order to detect the factors that have an effect on the results, as well as to effectively predict result of treatment. Classical statistical methods have proven to be inadequate in this issue. Only the use of modern methods of data mining gives hope (...) for a more effective analysis of the collected data. This work provides an overview of the new methods used for the analysis of data on infertility treatment, and formulates a proposal for further directions for research into increasing the efficiency of the predicted result of the treatment process. (shrink)

It is often assumed that the reaction time of a saccade toward visual and/or auditory stimuli reflects the sensitivities of our oculomotor-orienting system to stimulus saliency. Endogenous factors, as well as stimulus-related factors, would also affect the saccadic reaction time. However, it was not clear how these factors interact and to what extent visual and auditory-targeting saccades are accounted for by common mechanisms. The present study examined the effect of, and the interaction between, stimulus saliency and audiovisual spatial congruency on (...) the SRT for visual- and for auditory-target conditions. We also analyzed pre-target pupil size to examine the relationship between saccade preparation and pupil size. Pupil size is considered to reflect arousal states coupling with locus-coeruleus activity during a cognitive task. The main findings were that the pattern of the examined effects on the SRT varied between visual- and auditory-auditory target conditions, the effect of stimulus saliency was significant for the visual-target condition, but not significant for the auditory-target condition, Pupil velocity, not absolute pupil size, was sensitive to task set, and there was a significant correlation between the pre-saccade absolute pupil size and the SRTs for the visual-target condition but not for the auditory-target condition. The discrepancy between target modalities for the effect of pupil velocity and between the absolute pupil size and pupil velocity for the correlation with SRT may imply that the pupil effect for the visual-target condition was caused by a modality-specific link between pupil size modulation and the SC rather than by the LC-NE system. These results support the idea that different threshold mechanisms in the SC may be involved in the initiation of saccades toward visual and auditory targets. (shrink)

Approx. 60–80 million couples globally are affected by the problem of infertility. The issue is important both for the couple trying to conceive and for the whole society in which the couple lives. Lifestyle, including nutrition, may have both a positive and a negative impact on the outcomes of infertility treatment. The aim of this paper is to assess the relationship between knowledge in the area of fertility diet and its actual use, and types of fertility disorders among (...) women undergoing treatment in a fertility clinic. A group of women was analyzed statistically, divided into 3 groups according to their couple’s cause of infertility – the causes of infertility were described as: the male factor, the female factor, and the idiopathic factor. The study group answered questions that comprised a fertility diet knowledge test; the frequency of consumption of particular food products in a individual groups was also analyzed. Correspondence analysis showed differences between the groups in the number of points scored in the fertility diet knowledge test, as well as in the consumption of sweets, crisps and sticks, and nuts and seeds. Women among whom the main cause of infertility was defined as the male factor scored the highest numbers of points in the fertility diet knowledge test, women with the idiopathic cause of infertility scored slightly lower numbers of points, while women whose main cause of infertility was defined as the female factor scored the lowest numbers of points. Women from couples with idiopathic infertility consumed sweets, crisps and sticks the most often, followed by women with the cause of infertility identified on their side, with the lowest frequency of consumption of sweets identified among women whose partner was infertile. Nuts and seeds were consumed the most frequently by women whose partners were infertile, followed by women with the cause of infertility identified on their side, while women with the idiopathic cause of infertility consumed nuts and seeds the least frequently. These examples show that correspondence analysis is well suited to the assessment of the influence of lifestyle on fertility; in addition, it makes it possible to recognize certain correlations that may not be observed in standard statistical tests. (shrink)

With the popularization of mobile Internet and smart terminals, mobile reading with diversity and mobility has become a hot issue in the industry and academia. This article comes up with a hypothetical model of mobile reading user acceptance behavior based on the technology acceptance model and unified theory of acceptance and use of technology and conducts an analysis of the reliability and validity of questionnaire data. Based on this, the model fitness is analyzed as well as the path hypotheses testing. (...) We find that user-perceived ease of use greatly influences perceived usefulness, and user attitude and behavioral intention are significantly impacted by perceived usefulness. The impact of social influence on user attitude toward using mobile reading is significant, but the influence of perceived payment is not obvious. The moderating effect of living habit is not obvious because the absolute value of the critical ratio is under 2.58 with a significance level of 0.01. (shrink)

Our commentary is focused on the idea that takes on its full significance whenever its relativistic nature, in the short- and long terms, is taken into account. Given the transformations brought about by application of a general model of freedom based on ecological-economic factors clearly seems to be rather untimely. We examine this idea through egocentric and ethnocentric views of the social and environmental analyses of.

The once marginal theological question of Christ’s unique status has today entered into general consciousness. Increasing friendly dialogue among religions is one factor contributing to the urgency of the question. Another is the critical nature of the question within Christian theology. This article examines a broad range of responses and calls for a foundational approach based on Karl Rahner. It shares the advantage of this approach in addressing the suggestion that the Christian religion plays a unique role in a (...) “liberation theology of religions.”. (shrink)

Due to the limited work safety resources and the poor awareness of work safety from business owners with absolute decision-making power, safety accidents frequently occur in Chinese micro and small enterprises in high-risk industries. This study identifies the influencing factors of work safety behavior from MSEs, government safety supervision departments, and work safety service agencies. Based on the theory of planned behavior, the mechanism model of work safety behavior is built from the aspects of behavior attitude, subjective norms, behavior (...) control cognition, past behaviors, and risk awareness of the enterprise. Based on the interview with nearly 600 MSEs in the east of China over 6 months, the results show that the work safety awareness of the business owner determines the work safety lever of the enterprise, and the work safety behavior of MSEs is a passive restraint behavior. Our findings provide a new perspective on the formation of MSEs’ work safety behavior in high-risk industries. (shrink)

BackgroundPrevious studies have found that the decision-making process for stored unused frozen embryos involves much emotional burden influenced by socio-cultural factors. This study aims to ascertain how Japanese patients make a decision on the fate of their frozen embryos: whether to continue storage discard or donate to research.MethodsTen Japanese women who continued storage, 5 who discarded and 16 who donated to research were recruited from our infertility clinic. Tape-recorded interviews were transcribed and analyzed for emergent themes.ResultsA model of patients’ (...) decision-making processes for the fate of frozen embryos was developed, with a common emergent theme, “coming to terms with infertility” resulting in either acceptance or postponing acceptance of their infertility. The model consisted of 5 steps: 1) the embryo-transfer moratorium was sustained, 2) the “Mottainai”- embryo and having another child were considered; 3) cost reasonability was taken into account; 4) partner’s opinion was confirmed to finally decide whether to continue or discontinue storage. Those discontinuing, then contemplated 5): the effect of donation. Great emotional conflict was expressed in the theme, steps 2, 4, and 5.ConclusionsPatients’ 5 step decision-making process for the fate of frozen embryos was profoundly affected by various Japanese cultural values and moral standards. At the end of their decision, patients used culturally inherent values and standards to come to terms with their infertility. While there is much philosophical discussion on the moral status of the embryo worldwide, this study, with actual views of patients who own them, will make a significant contribution to empirical ethics from the practical viewpoint. (shrink)

We discuss the case against Factorism, which is the standard assumption in quantum mechanics that the labels of the ⊗\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\otimes$$\end{document}-factor Hilbert-spaces in direct-product Hilbert-spaces of composite physical systems of similar particles refer to particles, either directly or descriptively. We distinguish different versions of Factorism and argue for their truth or falsehood. In particular, by introducing the concepts of snapshot Hilbert-space and Schrödinger-movie, we demonstrate that there are Hilbert-spaces and ⊗\documentclass[12pt]{minimal} \usepackage{amsmath} (...) \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\otimes$$\end{document}-factorisations where the labels do refer, even descriptively, to similar particles, which renders them probabilistically absolutely discernible. (shrink)

Um bei einer Wertung der Faktoren, die das Wachstum einer Population beeinflussen, zu einer richtigen Einsicht zu gelangen, empfiehlt es sich, nicht den relativen Wert dieser Faktoren in Bezug auf die in Rede stehende Insektenpopulation auszudrücken, sondern ihre absolute Grösse in Faktoreinheiten zum Ausdruck zu bringen — wie: Wärme in Grad Celsius, Luftfeuchtigkeit in Prozenten, Zahl der im Bevölkerungsmilieu vorgefundenen Raubinsekten oder Parasiten. Auf dieser Grundlage liessen sich Faktoren in folgender Weise aufteilen: Faktoren ersten Grades : Allgemeine Faktoren : (...) Unabhängige Faktoren : nicht mechanische Klimaeinflüsse , chemische Faktoren, Güte der Nahrung. Abhängige Faktoren : die internen Faktoren, die bei einer Zunahme der Dichtigkeit einen Rückgang des Zuwachses bewirken, mit Ausnahme des Kannibalismus, ferner die Menge der Nahrung. Selektive Faktoren : Unabhängige Faktoren : unersättliche Faktoren : mechanische Klimaeinflüsse, weitere mechanische Faktoren, Parasiten und Raubfeinde, die nicht mit töten aufhören, wenn sie gesättigt sind, insofern ihre Bevölkerungsdichte nicht durch die des fraglichen Insektes bedingt wird. ersättliche Faktoren: restliche Raubinsekten und Parasiten, insofern ihre Bevölkerungsdichte nicht durch die des fraglichen Insektes bedingt wird. Abhängige Faktoren : Kannibalismus. Wandelbare Faktoren : Raubinsekten und Parasiten, welche diesem Erfordernis entsprechen, pathogene Pilze und Bakterien. Faktoren zweiten Ranges . Faktoren des dritten Ranges .Afin d'obtenir une notion exacte de la valeur des facteurs qui influencent la croissance d'une population, il vaudra mieux ne pas exprimer ces facteurs en leur valeur relative quant à la population d'insectes en question, mais en unités de facteurs: degrés Celsius, pourcentage de l'humidité de l'air, nombre d'ennemis ou de parasites qui sont présents dans le milieu de la population. Sur cette base on pourra répartir les facteurs de la façon suivante: Facteurs du 1er ordre : Facteurs généraux : influences climatiques non mécaniques , facteurs chimiques, qualité de la nourriture. Facteurs dépendants : les facteurs internes qui font de sorte que la densité de la population diminue quand se présente une plus forte densité, en exceptant le cannibalisme, la quantité de nourriture. Facteurs selectifs ; seule une partie des individus est exposée à leur action; les animaux touchés sont mécaniquement endommagés et, dans la règle, tués. Facteurs indépendants : facteurs insatiables : des influences climatiques mécaniques, d'autres facteurs mécaniques, des parasites et des ennemis qui ne s'arrêtent pas de tuer quand ils sont rassasiés, pour autant que l'intensité de la population de l'insecte en question. facteurs rassasiables: autres ennemis et parasites pour autant que l'intensité de leur population ne se modifie pas sous l'influence de la densité de la population de l'insecte en question. Facteurs indépendants : cannibalisme. Facteurs modifiables : ennemis et parasites qui satisfont à cette exigence, champignons pathogènes, bactéries. Facteurs du 2ième ordre . Facteurs du 3iéme ordre. (shrink)

This paper analyzes the concept of language developed in Gelug School and discusses its specific features. The majority of the Buddhist schools state that language can express only the relative truth. As for the absolute truth, it can be cognized directly in the meditative state when any duality is absent, including the symbolic linguistic structures. However, the Gelug School accentuates the point that it is impossible to explain the techniques of realization of the absolute without the use of (...) language. That is why the concept of language was developed in the Gelug School, according to which not all verbal structures are obstacles to enlightenment. The followers of the Gelug School subdivide concepts into two types. The first type includes the concepts that have arisen as a result of ascribin the false qualities to the objects. The second type is deprived of the false ascribing; it is formed in the process of using the special type of philosophical discourse – prasangika, which is the factor for emerging of the “middle view”, the proper view of things. This allows the follower of prasanga to efficiently use the verbal structures for adequate cognition on the conceptual level and transition towards the direct attainment of the absolute truth, which as a result leads to gaining freedom and achieving the state of Buddha. (shrink)

The article explores the relationship between the dialogical way of existence of religion and social stability. The author argues that dialogue is becoming a way of existence of religion in societies with a high level of religious freedom. The author emphasizes constructive types of communication between religions, one of which is traditionally interreligious (interfaith) dialogue. The definition of religious dialogue as a broad communication phenomenon is considered, which, in particular, involves the interaction of not only religions with each other (interreligious, (...) interfaith dialogue), but also communication between religion and society (religious and social dialogue) on important issues of the present, and reactions to them. It is substantiated that the reluctance of a certain religious institution to engage in dialogue may be based on the theological position of the church caused by the phenomenon of «ambivalence of the sacred». Some ways to restore the dialogue of religions and overcome the conflict conditions of their interaction are proposed. In conclusion, it is noted that the «war of civilizations» launched by the Russian Federation in Ukraine brings the dialogue of religions to a new level, namely: requires a revision of certain theological theories, the formation of new theological visions; significantly actualizes the issues of justice, heroism, good and evil, the impossibility of violence, ethical problems and their reflection in theological thought; requires religions to take a civic stance, where it is no longer possible to speak of secularization in the sense of separation of religion from politics; sharpens and problematizes the attitude of religions to the national question as a result of the Russian Federation’s provoked terrorist methods of warfare, and thus the threat to humanity of genocide on a national basis; raises the issue of universal values, the humanistic paradigm and personal responsibility, which brings all religious systems too close together; meta-anthropologizes religion, absolutizes humanism as a value when a believer «goes beyond» mere existence to approach eternal truths, where the concept of «salvation» loses its narrowly individualistic characteristic. (shrink)

Many factors are thought to increase the chances of misrecognizing a word in ASR, including low frequency, nearby disfluencies, short duration, and being at the start of a turn. However, few of these factors have been formally examined. This paper analyzes a variety of lexical, prosodic, and disfluency factors to determine which are likely to increase ASR error rates. Findings include the following. (1) For disfluencies, effects depend on the type of disfluency: errors increase by up to 15% (absolute) (...) for words near fragments, but decrease by up to 7.2% (absolute) for words near repetitions. This decrease seems to be due to longer word duration. (2) For prosodic features, there are more errors for words with extreme values than words with typical values. (3) Although our results are based on output from a system with speaker adaptation, speaker differences are a major factor influencing error rates, and the effects of features such as frequency, pitch, and intensity may vary between speakers. (shrink)

This paper means to demonstrate the theoretical-and- methodological potential of a particular pattern of thought about culture. Employing an end-means and absolute value plus concept of reality approach, the continuous model of culture aims to embrace from one holistic standpoint various concepts and debates of the modern human, social, and political sciences. The paper revisits the debates of fact versus value, nature versus culture, culture versus structure, agency versus structure, and economics versus politics and offers the concepts of the (...) rule of law, state capitalism, a dialectical model of progress, and interpretative qualitative research, as well as of cultural diffusion, autonomy, alienation, and individuality. This model distinguishes between the ideal-symbolical and the instrumental functions of culture, sees culture as being sewn from universal binaries, and provides a certain understanding of the cognitive function of a value judgment, with positivism so far vague about the topic. It, too, suggests an extra method for investigating culture : the comparative literature study of culture enables social science to view literature as its potential in-depth interviewee— a case for arguing for a certain conception of interdisciplinarity as well. In addition, it predicts that cultural particularism or individuality remains an essential factor of human existence. Analyzing the issue of Eurocentrism in social science, the model finds modernity ’s concept of reality to be involved in ” methodological ” intellectualistic reductionism, characterizing it since the empiricism/ rationalism origination. Systematically confusing the universal oppositions in a Eurocentric manner, intellectualism becomes a contributing factor in unfolding post- modernity. (shrink)

Hegel believes that the immanent ascent of finite spirit and its immersion in its uncreated foundation-in absolute spirit-is a true transition and he cannot use the so-called proofs of the existence of God. Besides, he sees an advantage here in that this transition results in the ascent of the human spirit to the most concrete and true, to God in His absolute truth-to Absolute Spirit. In connection with this, Hegel emphasizes in the manuscript of his lectures on (...) the philosophy of religion that the speculative meaning of the religious idea of the immortality of the soul lies in attaining the absoluteness and infinity of self-consciousness, the fact that "the self-consciousness of the spiritual is itself an eternal, absolute factor.". (shrink)