Childbearing Capacity Research Articles

EP360 - Pitfalls in the management of transgender patients: a case report and discussion

Abstract Introduction There has been an increase in the number of transgender individuals in the population. In a clinical setting, this introduces potential patient safety issues from misidentification of biological sex, particularly in emergency scenarios. We report one such patient. Case report A 21-year-old ‘male’ patient presented with right iliac fossa pain. No surgical history was reported by the patient or GP records. Repeat medication included Testosterone gel. Bloods showed raised amylase though the clinical picture suggested appendicitis so a CT scan was done. This was reported normal but also identified normal sized uterus/ovaries! Following a sensitive discussion with the patient, ‘they’ revealed that ‘they’ were born biologically female and were on gender-affirming hormone-therapy. The patient was successfully managed conservatively. Discussion Our case report highlights the potential risks of misidentification of biological sex in an acute-abdomen scenario. Misdiagnosis is most critical - all gynaecological causes of abdominal pain (e.g. PID/ life- threatening ectopic-pregnancy) were missed. Due to the risk of ionizing radiation to unborn children, CT require the pregnancy status of patients with childbearing capacity, prior to the scan: this therefore should include transgender ‘males’ who have not undergone sex-reassignment surgery. There are also patient safety/ comfort issues with admission in single- sex wards. Conclusion It is important to identify transgender patients in order to avoid misdiagnosis and hence mismanagement. Taking detailed history including medication will help with this, as some transgender individuals may not volunteer details regarding their biological sex. Sensitive communication is vital to avoid any feeling of discrimination/stigmatisation.

YUNAN MİTOLOJiSiNDE ATAERKiL PANTEON'DA RAHiM KISKANÇLIĞININ İZLERİ

Myths provide insight both into the cultural aspects of human societies and the psychological motivations behind human actions, drives, urges, dreams and fantasies. Myths illustrate how the ancient people make sense of their existence, creation, the working of the earth, natural events and catastrophes. They also provide symbolic representations and projections of desired attainments, relations, bodies and institutions in human culture. In this sense, wishfulfillment can be considered one of the fundamental functions of myths. Important psychoanalysts such as Sigmund Freud and Carl Jung also extensively make use of myths to shed light on various aspects of cultural practices, human psyche and behavior. This paper intends to explore the traces of womb envy in Greek mythology since it is one of the fundamental feelings and desires that can be observed in the male psyche. The child-bearing capacity of women, along with the pre-oedipal mother-child relation, has always created anxiety and fear in male deities, which in fact reflect the real life experience. Gods’ desire to possess the ruling power can be seen as an attempt to overcome this fear and make up for their lack of reproductive capacity. This paper will examine the selected myths in a psychoanalytical framework with specific references to Melanie Klein’s and Karen Horney’s concepts of womb envy.

A blueprint for a new model of sexual and reproductive health care in subspecialty medicine.

A blueprint for a new model of sexual and reproductive health care in subspecialty medicine.

Transgender Men Forming Two-Father Families with Their Cisgender Male Partners: Negotiating Gendered Expectations and Self-Perceptions

This article explores the experiences of transgender men who became parents through childbirth and started families with their cisgender male partners. The study explores the transgender men’s experiences of having and raising children in this family constellation, with a specific focus on how they experience gender in their parenting role. Semi-structured interviews were conducted with three participants. The data was transcribed and analyzed with thematic analysis. Results of the analysis showed that the participants had experienced gender dysphoria before and during pregnancy, but also embraced their childbearing capacity. As transgender fathers, they found themselves expected to fulfill gendered expectations for women and mothers but sometimes appreciated access to women’s spaces. The participants had employed different strategies to protect their masculine selves, such as concealing their pregnancy and/or defending the right to be respected as transgender pregnant men. When passing as cisgender men, they experienced being praised for taking care of their children. They did not receive such praise when they were assumed to be women or known to be transgender men. The men struggled with inequality in their relationships, reflecting each partner’s assigned gender at birth. Still, they emphasized that same-gender relationships facilitated attempts to achieve equality.

Cruel Dilemmas in Contemporary Fertility Care: Problematizing America's Failure to Assure Access to Fertility Preservation for Trans Youth

Transgender youth are increasingly able to access gender-affirming healthcare. Because gender-affirming care such as hormone therapy is clinically shown to reduce gender dysphoria and ease physical and social transition, every major U.S. medical association recognizes that gender-affirming healthcare is medically necessary for the treatment of dysphoria. However, an important dimension of gender-affirming care remains under-insured and overpriced: fertility preservation (FP). Several studies indicate that hormone therapies and certain gender-affirming surgeries can have negative, long-term impacts on future fertility. Although these impacts can be mitigated through approved FP methods such as sperm cryopreservation and oocyte cryopreservation, such methods are rarely affordable for those who need them. These cost barriers largely exist because fertility care (including FP) remains excluded from most public and private insurance plans. Even though states have the regulatory authority to remedy this, only seventeen have taken steps to do so. This paper will demonstrate how the failure to provide coverage for fertility care forces young people into cruel dilemmas. Because gender-affirming care is, itself, expensive, paying additional out-of-pocket fees for FP is often not in the cards for many young people. Section I will delve into the landscape of FP coverage in the U.S. and the barriers that prevent people from accessing FP services. Section IV will then connect the lack of insurance coverage to a broader pattern of state efforts to withhold and eliminate child-bearing capacity, either directly or indirectly, from marginalized communities. Finally, Section III will offer legal and policy recommendations that could disrupt this history of reproductive oppression, and secure greater access to bodily autonomy for trans youth.

Psychological Outcome of Women with Morbidly Adherent Placenta Following Hystrectomy: Prospective Matched Case-control Study

Abstract Background Placenta accreta (Morbidly adherent placenta) is a condition in which all or part of the placenta is adherent to the uterine wall because of myometrial invasion by chorionic villi. It may occur when there is either a primary deficiency of or a secondary damage to chorionic villi or Nitabuch’s layer. Women often consider the uterus to be a sexual organ, and the controller and regulator of important physiological functions in the body, as well as the source of youth, energy, activity, and a symbol of child-bearing capacity. Aim of the work The purpose of this study is to investigate the risk of postoperative psychiatric disorders of depression, anxiety outcomes and sexual dysfunctions and self esteem disturbance in women with morbidly adherent placenta following hysterectomy. Methods The study included 120 subjects divided into 3 groups including Group A which included 40 women who underwent caesarean hysterectomy, Group B which included women who underwent lower segment caesarean section and Group C which included 40 women who underwent spontaneous vaginal delivery with inclusion and exclusion criteria. All patients who delivered from 4 to 6 months ago, will be subjected to fulfill Questionnaire after obtaining informed consent from the patients who are invited to participate in the research. Results Self-esteem was statistically signifciantly highest in cases underwent CS with no statistical significant difference between CH and VD. Anxiety was non- statistically significantly most frequent in CH and least frequent in VD. Depression was non- statistically signifciantly most frequent in CH and least frequent in VD. Severe depression was statistically signifciantly most frequent in VD and least frequent in CH. Different dysfunctions were statistically significantly highest in CH research group. Desire, Arousal, Lubrication and pain dysfunctions were statistically significantly lowest in VD group. Orgasm and Satisfaction dysfunctions were signifciantly lowest in CS group. Analyzing the current research data results and considering previous research efforts in female sexual dysfunctions in correlation to obstetric clinical scenarios reveal that the female sexual normal activity is a critical issue when affected could result in serious sequale not only affecting the female as regards self-esteem and psychiatric health status but could affect the male partner due to reduced sexual functional capacity, future research efforts are recommended to be multi-centric in fashion taking in consideration more detailed aspects particularly the male partner satisfaction from sexual activities with his female counterpart after cesarean, vaginal deliveries. Conclusion Analyzing the current research data results and considering previous research efforts in female sexual dysfunctions in correlation to obstetric clinical scenarios reveal that the female sexual normal activity is a critical issue when affected could result in serious sequale not only affecting the female as regards self-esteem and psychiatric health status but could affect the male partner due to reduced sexual functional capacity, future research efforts ere recommended to be multicentric in fashion taking in consideration more detailed aspects particularly the male partner satisfaction from sexual activities with his female counterpart after cesarean, vaginal deliveries.

Optimizing reproductive health management in lupus and Sjogren's syndrome.

People with childbearing capacity who are diagnosed with systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS) have specific and important reproductive health considerations. Recommendations from the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) provide rheumatologists and other clinicians with guidance for reproductive health management of patients with rheumatic diseases. Patient-centered reproductive health counseling can help clinicians to operationalize the EULAR and ACR guidelines and enhance patient care. Disease activity monitoring, risk factor stratification, and prescription of pregnancy-compatible medications during pregnancy help to anticipate complications and enhance pregnancy outcomes in SLE and SS. Assisted reproductive technologies are also safe among people with well-controlled disease. Safe and effective contraceptive methods are available for patients with SLE and SS, and pregnancy termination appears to be safe among these patients.

Mass media exposure and use of reversible modern contraceptives among married women in India: An analysis of the NFHS 2015-16 data.

Since the inception of the National Programme for Family Planning, messages on family planning (FP) have been promoted across India using different mass media platforms. Mass media plays an important role in disseminating important information among the masses, such as how reversible modern methods give women more reproductive choices than opting for permanent methods that limit their child-bearing capacity. Mass media can provide a continuous flow of information and motivation to deter women from discontinuing the methods they have opted for. However, very few studies have been conducted on this issue, especially using recently available data. This study particularly focuses on exposure to mass media and the use of reversible modern methods of family planning among married women in India. The data for this study was obtained from the National Family Health Survey (2015–16) on currently married women aged 15–49 years. The association of reversible modern method use with media exposure variables was examined, controlling for a set of independent variables from multiple levels—individual, district, state, and region. The findings from this study showed that television was the most important medium for disseminating information on FP among married women in India. Spatial analysis revealed that some districts in the north, parts of the northeast, and Kerala in South India lacked any television exposure. The results from the decomposition analysis showed that mass media exposure was associated with a 14% increase in the use of reversible modern methods. Results from the multilevel analyses showed that exposure to TV along with other media (AOR 1.57 95% CI 1.49–1.65) and exposure to FP messages through different media (AOR 1.22 95% CI 1.12–1.32) had a significant positive effect on the use of reversible modern methods even when various individual, district, state, and regional-level factors were controlled. The findings of this paper provide evidence supporting the use of mass media to promote and increase awareness of voluntary contraceptive use in India. An increase in mass media exposure coupled with improvement in coverage and services of the FP program can significantly increase the use of reversible modern methods in a cost-effective yet efficient manner among women in need of FP services.

Uterine Arteriovenous Malformations

Uterine arteriovenous malformations are rare but may represent a life-threatening cause of vaginal bleeding. The typical patient affected is a multiparous woman during her thirties. The origin can be congenital or acquired, with the latter being more common after uterine surgery and presenting mainly as arteriovenous fistulous connections into the myometrium supplied by uterine arteries. The correct diagnosis of uterine arteriovenous malformations requires imaging findings of tubular and tortuous structures with mixed signal from arterial and venous flows; transvaginal color-Doppler ultrasound is the initial technique applied, then integrated with contrast-enhanced magnetic resonance or computed tomography. Multiple treatment approaches are available, including conservative-medical, endovascular embolization and surgery. Transarterial embolization represents the most applied, preserving childbearing capacity with negligible procedural complications; clinical and technical success rates are elevated, up to 90%. The goal of embolization is to occlude the point of fistula or the nidus and the application of multiple embolizing agents has been reported: despite there is no clear superiority of one over the others, liquids, especially those related to the dymethil-sulfoxide family, present relevant technical advantages. Surgery is nowadays to be considered when the endovascular approach fails and in these cases hysterectomy remains the common recommendation.

Socio-Cultural Practices Harmful on Female Reproductive Health: A Case Against Female Genital Mutilation

About 115 to 130 million girls and young women have experienced FGM/C, otherwise referred to as Female Genital Mutilation/cutting and an additional three million are at risk each year. It is one of the most political areas of women’s health. The practice of FGM/C harms the physical, psychological, reproductive and sexual health of women and is a violation of women’s fundamental human rights. The federal government of Nigeria in 2015 enacted the Violence against Person’s Prohibition Act which made provisions criminalising FGM. However the VAPP Act is only applicable in the Federal Capital Territory because it is a matter provided for under the concurrent legislative list. Hence, other states of the federation are expected to pass the same law to become applicable within their states. The main objective of this study is to ascertain, the extent to which FGM is harmful to female reproductive health and ascertain the effectiveness of the VAPP Act, the Constitution and other health policies of government in the eradication of FGM. Despite the VAPP Act which criminalised the offence of FGM there is still a high level of ignorance amongst practitioners. Apart from the violation of the right against torture and the dignity of the human person the study found that there are other dangers associated with the practice varying from danger to physical health resulting from unhygienic and unskilled procedures. Other lifelong effects can result in infertility, since the procedure can limit sexuality and childbearing capacity. Keywords: Female Genital Mutilation, Reproductive Health DOI: 10.7176/JLPG/100-07 Publication date: August 31 st 2020

Decision Making and Fertility Preservation in Cancer Patients

Infertility following cancer treatment in cancer patients is consequently a source of psychosocial and emotional distress and may severely impact quality of life into survivorship [1,2]. Therefore, storing the potential or material to have biological children after cancer treatment can be of high importance to many cancer survivors and help them adjust to life after cancer therapy [3]. There are various fertility preservation (FP) techniques with the aim of saving the possibility of childbearing capacity in prepubertal and pubertal cancer patients [4]. It is important that patients are adequately supported to determine which options are best suited to their individual situation [5]. Decisions surrounding FP in children, adolescents, and adults can be difficult due to the distress of a cancer diagnosis, time constraints for decision-making, and lack of efficacy data, oncological treatment planning and preparation, and possible fertility treatment financial barriers, etc. [6,7].

Post-abortion care: Ethical and legal duties.

Women who experience complications from abortion, whether unlawful or lawful, induced or spontaneous, need immediate post-abortion care. Delay in providing care might cause women's avoidable disability, lost childbearing capacity, or death. Rendering care is not an abortion procedure nor illegal, and does not justify conscientious objection. Harm reduction strategies to reduce effects of unsafe abortion may legitimately inform women who might consider resort to abortifacient interventions of their rights to professional post-abortion care. Healthcare practitioners' refusal or failure to provide available care might constitute ethical misconduct and attract legal liability, for instance for negligence. States are responsible to ensure healthcare practitioners' and facilities' provision of post-abortion care, including both medical care and psychological support, delivered with compassion and respect for dignity, and to suppress stigmatization of patients and/or caregivers. Mandatory reporting of patients suspected of criminal abortion violates professional confidentiality. States' failures of indicated care might constitute human rights violations.

Women’s perceptions of hysterectomy and alternative surgical treatments for benign pelvic pathologies: A Literature Review

Background: The evolving landscape of new technologies offering minimally invasive options for the treatment of benign pelvic diseases present with varying effectiveness and safety profiles. This raises questions regarding how patients make treatment decisions. Patients may perceive risk or benefits of a device/treatment differently than physicians or regulators responsible for determining whether a new device can be marketed. Methods: We reviewed publications in PubMed investigating patients’ perceptions of surgical treatments for benign pelvic pathology, including perceived benefits and risks. In addition, we explored the social and cultural factors influencing these perceptions and treatment decisions. Results: We included 16 studies in our literature review. Factors which were identified to influence women’s perceptions include: symptom relief; surgical complications and recovery times; impact on periods; child-bearing capacity; femininity; sexual desire and sexual dysfunction; cosmetic effects; emotional effects and risk of cancer. Our review revealed some heterogeneity in patients’ perspectives on factors (including benefits and risks) associated with surgical treatments for benign pelvic pathology. Women’s intrinsic factors including age, race, sexuality and child-bearing status may influence how they perceive the potential effects of their surgical options and influence their treatment decision. Conclusions: It is important to understand the trade-offs patients make as they consider competing surgical treatment options. Patient preference information from future patient studies could quantify patient perspective thereby providing additional information to patients, clinicians, current and prospective device developers. In addition, it may be used by regulators in their evaluation of surgical devices for the treatment of benign pelvic disease.

“ Effect of Apamarga Kshara Pratisarana followed by Jatyadi Tail Pichu on Cervical Erosion - A Case study ”

Since evolution of life,woman has been placed on extreme worship place due to her ability of Janan. Preparation of motherhood starts with puberty & ends with menopause. In this period,woman may suffer from different gynaecological disorders affecting child bearing capacity. Cervical erosion is one of the gynaecological conditions in woman of reproductive age group. It adversely affects physiological as well as psychological health of female & even interfers with the professional life & may also cause infertility. So, it is major problem in front of gynaecologists.
 Cervical erosion is a condition, where the squamous epithelium of the ectocervix is replaced by columnar epithelium. It causes excessive mucoid discharge per vagina. Electrocauterization & cryosurgery for management of cervical erosion are based on principle of destruction of columnar epithelium to be followed by it’s healing by squamous epithelium.
 Ayurvedic classics defined use of Shodhana dravyas in treatment of Karnini Yonivyapada. Many preparations can be used for management of cervical erosion by considering factors such as parity, age & desire of patient with regard to contraception, future pregnancy etc. which are non-hormonal, non-surgical & most effective without side effects. Among these, Apamarga Kshara for destruction & Jatyadi Tail Pichu for healing was selected in the present study.

“Childless? Childfree? Neither, Just ME”: pronatalism and (m)otherhood in Paula Knight’s The Facts of Life

ABSTRACT Defining female identity primarily in terms of their childbearing capacity is prevalent across cultures. Centrality of motherhood within discursive formations of womanhood has resulted in establishing inextricable linkages between maternity and femininity. The reproductive ethic privileged by sociocultural discourses and institutions, which are impelled by the pervasive ideology of pronatalism, coerces women to procreate, reducing their identity to mere reproducing bodies. Consequently, those who are unable to reproduce due to fertility-related disorders encounter severe cultural derision and social stigmatisation. Paula Knight’s autopathography The Facts of Life is a harrowing account of the author’s struggles with infertility in a pronatal society. In a close reading of Knight’s graphic memoir, this article aims to investigate how the pluripotent space of the comics medium allows the author to arraign the ideology of pronatalism as an oppressive force that mediates her lived experience of infertility. Drawing theoretical insights from Ellen Peck, Judith Senderowitz, and Louis Althusser, among others, the essay also seeks to examine the socially constructed and gendered nature of (m)otherhood as it unfolds in Knight’s narrative.

Myomectomy over the age of forty

Purpose of investigation: The aim of this study is to evaluate the fertility results of women who had myomectomy surgery in their forties for fertility preservation. Materials and Methods: All women who had myomectomy surgery in her forties were included in the study. Phone interviews were conducted and the patients were asked whether they had any pregnancy after myomectomy. Results: During the study period, 82 women had myomectomy surgery in this hospital. Sixty-nine patients had abdominal surgery for myomectomy and they were considered as women wishing to preserve childbearing capacity. Three of them achieved three pregnancies which all ended in miscarriage. Conclusion: The treatment of fibroids in women who desire future fertility is myomectomy, but once a woman reaches the age of 35, her fertility begins to decline and the success rates of IVF treatment for women over 40 using their own oocytes are low. All the data should be discussed with the patient who will have an abdominal surgery for uterine myoma.

Ethical Implications of Obstetric Care in Hungary : Results from the Mother-Centred Pregnancy Care Survey

Background: Informed consent plays an important role in clinical decision making. It is a basis of self determination in health care. In ideal situations health care professionals inform their patients about all relevant aspects of care and alternative care options, map the value system of the patients, and adjust the information process accordingly. Objectives: Our objective was to see the frequency of selected interventions (birth induction, caesarean section, episiotomy, forced supinal position during birth, and the consent process associated to these interventions. Methods: 1,257 women (with childbearing capacity) between the age of 18 and 45 with children under the age of 5 were surveyed online. Results: Caesarian section was done without permission in 10.2% of women. Labour was inducted in 22.2% of all deliveries and it was done without permission in 25.4% . Episiotomy was done in 39.9% of women having vaginal delivery in the Sample 2 group and in 72.2% of women having vaginal delivery in the Sample 1 (representative) group. Women undergoing episiotomy were not asked for consent in 62.0% in the Sample 1 group and in 57.1% in the Sample 2 group. Freedom to choose labour position for women having vaginal birth was restricted in 65.7% in the Sample 1 group and in 46% in the Sample 2 group. Discussion and Conclusions: We have found that the right of women to informed consent and best available treatment is frequently and seriously violated in obstetric practice in Hungary in the given period. These findings should serve as an important basis for improving the quality of maternity care.

“Out of All of this Mess, I Got a Blessing”: Perceptions and Experiences of Reproduction and Motherhood in African American Women Living With HIV

HIV disproportionately impacts African American women of childbearing age residing in the southern United States. Antiretroviral therapy has increased the quantity and quality of life for people living with HIV and produced viable and safe reproduction possibilities for women living with HIV. However, little is known about reproductive decision-making processes for African American women living with HIV. The overall goal of our study was to qualitatively explore perspectives related to reproduction and motherhood in HIV-infected African American women of childbearing capacity. HIV-infected African American women of childbearing capacity in South Carolina (N=42) participated in in-depth interviews. Our respondents held positive views about pregnancy and motherhood, despite nonsupportive pregnancy messages from interpersonal influences, including health care providers. Study findings uncovered the need for programs and interventions to support women's reproductive autonomy and focus on reducing conception- and pregnancy-related transmission risks to infants and uninfected sexual partners.

Embarazo ectópico cervical tratado con metotrexato

Se presenta los casos de dos pacientes con embarazo ectópico cervical, con deseo depreservación de la fertilidad, tratados con metotrexato (MYX) en dósis única de -50 mg/m2. Se discute los hallazgos así como el tratamiento y la evolución.

Controversies in borderline ovarian tumors.

Borderline ovarian tumors (BOTs) represent about 15% to 20% of all ovarian malignancies and differ from invasive ovarian cancers (IOCs) by many characters. Historically, standard management of BOT is peritoneal washing cytology, hysterectomy, bilateral salpingo-oophorectomy, omentectomy, complete peritoneal resection of macroscopic lesions; in case of mucinous BOTs, appendectomy should be performed. Because BOTs are often diagnosed at earlier stage, in younger age women and have better prognosis, higher survival rate than IOCs, fertility-sparing surgery is one of the option to preserve childbearing capacity. The study of such conservative surgery is being released, and still controversial. After surgery, pregnancy and ovarian induction followed by in vitro fertilization are also significant issues. In surgery, laparoscopic technique can be used by a gynecologic oncology surgeon. So far postoperative chemotherapy, radiotherapy and hormone therapy are not recommended. We will discuss controversial issues of BOTs on this review and present the outline of the management of BOTs.