Desire For Offspring Research Articles

Inhibin B and antiMüllerian hormone as surrogate markers of fertility in male and female Crohn's disease patients: a case-control study.

Several studies suggest that women with Crohn disease (CD) have reduced fertility due to decreased ovarian reserve, among other causes. On the other hand, male CD patients could have difficulties conceiving. The present study aimed to test the effect of CD on both male and female fertility potential, Sertoli cell function and ovarian reserve, assessed by inhibin-B (IB) plus IB:FSH ratio (IFR) and antiMüllerian hormone (AMH), respectively. Sexual dysfunction (SD) was studied as secondary endpoint. We performed a cross-sectional, case-control study. Serum IB levels plus IFR were measured in 58 men with CD and compared to 25 age-matched healthy controls (HC). Serum AMH levels were measured in 50 women with CD and in 30 HC matched by age. SD was assessed by means of the International Index of Erectile Function (IIFE-15) in males and the Index of Female Sexual Function (IFSF) in women. A total of 108 CD patients and 55 HC were included. IB serum levels were significantly lower in CD men than in HC (177 ± 58 vs. 234 ± 75 pg./mL, p = 0.001). IFR was also decreased in CD patients compared to HC (58.27 ± 59.5 vs. 91.35 ± 60.04, p = 0.014). Women with CD > 30 years had lower serum AMH levels compared to HC (1.15 ± 0.74 vs. 2.14 ± 1.68 ng/mL, p = 0.033). In addition, CD women >30 years presented a serum AMH < 2 ng/mL more frequently than HC (90% vs. 40%, p = 0.004). The prevalence of SD was significantly higher among both male and female CD patients compared to HC, without association to fertility potential. Age was the only predictor of low ovarian reserve. Testicular Sertoli cell function assessed through serum IB levels and IFR is decreased in CD male patients compared to HC, regardless of age. Age > 30 years is the single independent predictor of reduced ovarian reserve in women with CD. These results should be confirmed in further studies in order to properly counsel patients with CD and desire for offspring.

Surgical Treatment for Early Cervical Cancer in the HPV Era: State of the Art.

Cervical cancer (CC) is the fourth most common cancer among women worldwide. The aim of this study is to focus on the state of the art of CC prevention, early diagnosis, and treatment and, within the latter, the role of surgery in the various stages of the disease with a focus on the impact of the LACC study (Laparoscopic Approach to Cervical Cancer trial) on the scientific debate and clinical practice. We have discussed the controversial application of minimally invasive surgery (MIS) for tumors < 2 cm and the possibility of fertility-sparing surgery on young women desirous of pregnancy. This analysis provides support for surgeons in the choice of better management, including patients with a desire for offspring and the need for sentinel node biopsy (SNB) rather than pelvic lymphadenectomy for tumors < 4 cm, and without suspicious lymph nodes' involvement on imaging. Vaccines and early diagnosis of pre-cancerous lesions are the most effective public health tool to tackle cervical cancer worldwide.

Adolescents living with HIV, complex needs and resilience in Blantyre, Malawi

BackgroundAdolescents living with HIV (ALHIV) in Malawi experience multiple challenges associated with their illness and various social, environmental, economic and cultural factors. In exploring their various medical concerns and social vulnerabilities, we consider the role of multiple services in creating a pathway for resilience.MethodsMultiple methods and case studies allowed for triangulation of evidence and provided a holistic understanding of resilience among adolescents with complex needs. The research methods included: (1) a survey to identify examples of young people with complex needs, (2) qualitative interviews and field notes to further explore these needs, (3) patient files and health passports to identify clinical challenges, and (4) ecomapping exercises to personalize cases and identify resilience-enabling resources and supports. We present four case studies to highlight the complex experiences and access to services of ALHIV, and to illustrate their growing power and decision-making capacity over time.ResultsAdversity experienced by ALHIV varied by gender, family situation, years of schooling, and use of teen-clubs for support. The two female adolescents emphasised their need to be accepted and how this impacted sexuality and reproduction. The two males illustrated how ideas of masculinity influenced their sexual practice and involvement with health services and the correctional justice system. Multiple risks (alcohol use, sexual activities) and complex needs (belonging, having a purpose in life/productive activities, autonomy, desire for offspring) influence pathways to resilience. ALHIV were able to strengthen their own wellbeing by resisting negative behaviours and peer pressure and caregiver interactions through ‘strategic silence’.ConclusionALHIV experienced self-transformation as a result of taking ART, with fewer severe episodes of illness and distressing skin conditions. Continuous engagement at the teen-club clinic transformed both productive activities and social relationships among ALHIV as they set life goals, gained a sense of empowerment, requested SRH services, and formed intimate relationships. These transformative opportunities allowed them to learn ways of minimizing risk of reinfection and violence, and of navigating health worker–caregiver–adolescent interactions.

Strange (and incompatible) bedfellows: The relationship between the National Health Act and the regulations relating to artificial fertilisation of persons, and its impact on individuals engaged in assisted reproduction

Individuals are increasingly having recourse to assisted or artificial reproduction in order to realise their desire for offspring. This field is currently regulated by the National Health Act No. 61 of 2003 (NHA, or the Act) and the regulations relating to artificial fertilisation of persons, which form the framework legislation for assisted reproduction. Individuals having recourse to assisted reproductive technologies are therefore forced to engage with this legislation in one way or another. The challenge posed by the current legislative framework is that both the Act and the regulations are unclear and confusing. One could even go so far as to say that they are incompatible in some respects. Matters are further complicated when the Act and the regulations have to be applied alongside legislation such as the Children’s Act No. 38 of 2005. The result is that legislation that is intended to provide legal certainty and clarity has the opposite result. This article considers the Act, its regulations and legislation that has bearing on assisted forms of reproduction. The aim of this analysis is to identify flaws and to provide suggestions for remedying potential defects, in order to produce legislation that not only creates legal certainty, but that is up to date and on par with advances in science and technology.

WHEN A RELATIONSHIP HAS REACHED ITS EXPIRATION DATE, DOES THE SAME APPLY TO THE EMBRYOS UNDER SOUTH AFRICAN LAW?

Individuals are more frequently having recourse to assisted reproductive technologies (ART) to realize their desire for offspring. Where they do so, they may choose to fertilize their gametes and implant the resultant embryos immediately, or they may choose to freeze their embryos for later use. The latter option brings with it greater potential for legal disputes as relationships terminate, parties change their minds, and disagreements arise regarding the fate of frozen embryos. This article, therefore, examines the South African legal framework for addressing disputes involving frozen embryos. The aim is to assess whether the current legal framework is adequate, and whether lessons can be learnt from other jurisdictions faced with similar legal disputes.

Self‐transcendence as a psychological parenthood motive: When mortality salience increases the desire for non‐biological children

AbstractReminders of existential threat increase people's desire for offspring. In line with terror management theory, we explain these effects by the motivation to transcend the self via offspring that complements biological accounts of reproduction motivation under threat. Accordingly, Study 1 shows that mortality salience increases self‐transcendence motivation but not other parenthood motivations. Furthermore, mortality salience increased willingness to adopt children (Study 2) or a 14‐year‐old child (Study 3) only for those participants who were told that the personality of children is the product of nurture (and thus determined by their parent's self). In addition, mortality salience increased general willingness to adopt, irrespective of whether nurture or genetic influence was made salient in Study 3, where participants imagined being unable to have biological offspring. We discuss how these findings contribute to explaining increased reproduction intentions under existential threat and processes of terror management.

Making ‘bad’ deaths ‘good’: the kinship consequences of posthumous conception

Recent developments in assisted reproduction mean that a child may now be born long after its father’s demise. Acts of posthumous conception raise a host of complex ethical and social issues. The article draws attention to these by means of an analysis of the medical, legal, and political commentaries generated by the case of Diane Blood in her dispute with the Human Fertilisation and Embryology Authority, which had prevented her from using her deceased husband’s sperm to become pregnant. Analysis of this and similar cases reveals that the desire for offspring following the death of a husband or partner has significant consequences for notions of marriage, paternity, memoriam, and inheritance .The article identifies as an underlying theme in acts of posthumous conception an attempt to ameliorate the grief of a widow, a family, and the wider society by making ‘bad’ deaths to some extent ‘good’. To achieve this transformation the meaning of sperm within reproductive transactions is subject to radical reinterpretations which simultaneously commodotize and sacralize human gametes.