Reproductive Future Research Articles

O-234 Indication for fertility preservation in patients with endometriosis

Abstract Endometriosis is a complex gynecological condition that not only causes debilitating symptoms but also significantly impacts fertility. As the disease affects approximately 10% of women of reproductive age, addressing fertility preservation strategies becomes paramount. The conventional treatments for endometriosis, such as medical therapy and surgery, often fail to fully address its adverse effects on ovarian reserve and reproductive potential. Consequently, there is a growing interest in exploring fertility preservation options, particularly oocyte cryopreservation (OOC), for endometriosis patients. Despite the prevalence and impact of endometriosis on fertility, comprehensive data and guidelines specifically tailored to fertility preservation in this population remain scarce. The available evidence suggests that endometriosis, particularly when it involves ovarian endometriomas, is associated with a significant reduction in ovarian reserve, as indicated by lower levels of anti-Müllerian hormone (AMH). Surgical interventions, often necessary for managing endometriosis-related complications, can further compromise ovarian function and diminish fertility prospects. However, recent studies have shed light on the potential benefits of OOC in preserving fertility for endometriosis patients. OOC offers a minimally invasive approach with no impact on ovarian reserve compared to other fertility preservation techniques. Despite the lack of randomized controlled trials, our retrospective data have demonstrated promising outcomes, with a notable number needed to treat (NNT) of 16 for one successful pregnancy. This underscores the significance of discussing and considering OOC as part of the treatment plan for endometriosis patients, especially those at risk of ovarian compromise due to the disease or its management. The decision to pursue fertility preservation through OOC should be made on a case-by-case basis, taking into account various factors such as disease severity, patient age, ovarian reserve, and treatment history. French guidelines recommend considering OOC for endometriosis patients with bilateral ovarian endometriomas larger than 3 cm or those with endometriomas on a single ovary. Initiating fertility preservation discussions early, preferably before surgical intervention, allows patients to make informed decisions regarding their reproductive future. It is crucial to acknowledge the challenges and uncertainties associated with fertility preservation in endometriosis patients. Socio-economic factors, patient preferences, and the lack of clear criteria for selecting candidates for OOC pose significant hurdles. Furthermore, the effectiveness and cost-effectiveness of OOC in this population warrant further investigation. In addition to OOC, alternative fertility preservation options, such as ovarian tissue preservation, could be considered, particularly in cases where ovarian stimulation is not feasible or declined by the patient. However, data on the efficacy and safety of ovarian tissue preservation specifically in endometriosis patients are limited, highlighting the need for further research in this area. In conclusion, fertility preservation, particularly through OOC, holds promise for mitigating the adverse effects of endometriosis on ovarian function and fertility. While uncertainties persist, integrating fertility preservation discussions into the comprehensive management of endometriosis is essential. This ensures that patients are empowered to make informed decisions about their reproductive health and maximizes their chances of achieving desired fertility outcomes despite the challenges posed by endometriosis.

Semen cryopreservation for an oncological reason: a retrospective study

Research questionHow do cancer type and treatment affect semen quality before and after treatment, and what effect does it have in their clinical management of infertility? Also, what is the rate of patients using cryopreserved semen samples after treatment? DesignPatients who cryopreserved spermatozoa for oncological reasons between 2000 and 2022 in IVI clinics in Spain were retrospectively reviewed. Semen parameters were analysed before and after treatment, and utilization and destruction rates were calculated. Total motile sperm count (TMSC) was used for assisted reproductive technology (ART) counselling. ResultsA total of 724 patients cryopreserved their semen during the study period. The semen parameters of the cancer patients' semen before and after treatment were heterogeneous, with significant differences between cancer type and semen parameters. The utilization rate was relatively low (0.4%), whereas the destruction rate was 23.1%. ConclusionCancer and antineoplastic treatment affect everyone differently. Therefore, sperm cryopreservation should be offered to all patients before starting treatment to ensure their reproductive future. Furthermore, in addition to considering the semen parameters defined by the World Health Organization, it is important to use TMSC in the diagnosis of men to choose appropriate ART according to type of cancer.

Filling the Gaps in Oncofertility Care by Addressing Challenges Faced by Patients and Providers.

With enhanced technology and upcoming treatment strategies in the cancer field, the survival rates of patients have increased. We have now reached a stage in the treatment of cancer where we not only address the disease but also address complications that arise due to the disease and the side effects that present in the post-survival population due to its treatment. One of the primary consequences after oncotherapy is infertility, which is a major reason for distress for patients' post-survival, as they are afraid they may be deemed as less desirable, be rejected by their existing partner, or cannot grapple with the fact that they cannot have children of their own. This can be avoided by the implementation of proper oncofertility practices. The subject of oncofertility involves interactions between experts in the domains of cancer diagnosis, therapy, fertility preservation, and reproductive health. It attempts to investigate and broaden the possibilities for cancer survivors' reproductive future in order to suit their needs according to their ethical religious and sociocultural beliefs. However, these practices are often not implemented effectively due to ineffective doctor-patient communication, lack of knowledge, or partial knowledge of clinicians themselves regarding fertility care. This leads to a feeling of insecurity among clinicians hence resulting in them not referring patients. Lack of awareness among doctors of different oncofertility procedures available especially for patient groups like women and younger patients, hence leading to reduced referral in these groups. Improper coordination across health departments, patient ignorance regarding procedures, financial instability especially in acountrywitha lower sociodemographic indexlike India, and neglect or less importance given to the related ethical, social, and legal issues. In this article, we cover the effects of cancer and cancer treatment on fertility, the options available to adult and pediatric cancer patients to preserve their fertility like oocyte/ovarian tissue cryopreservation in females and sperm cryopreservation in males,techniques undergoing experimental studies that could be implemented in the future like spermatogonial stem culture and transplantation of testicular tissue, the obstacles that we face that hinder the proper implementation of such practices and what measures can we take to overcome these obstacles to improve patient care and be better healthcare providers.

Freezing Low Numbers of Sperm

Azoospermia, a condition defined by a complete lack of sperm in the ejaculate, presents a significant reproductive challenge for many infertile men worldwide. In recent years, Microsurgical Sperm Extraction (Micro-TESE) has emerged as an innovative surgical technique, allowing clinicians to retrieve viable sperm directly from the testicular tissues of patients diagnosed with this condition. A crucial aspect of optimizing the reproductive potential of the extracted sperm lies in the subsequent preservation techniques employed. This study delves deep into one such technique, sperm vitrification. As opposed to the traditional slow freezing methods, vitrification offers a rapid-cooling approach that effectively sidesteps the formation of potentially damaging ice crystals, thereby maintaining the structural and functional integrity of the sperm. The survival rates of sperm post-thawing, when subjected to vitrification, have been found to be commendably high, with figures often exceeding 60%. This is a promising statistic, particularly when dealing with minuscule sperm quantities as retrieved in Micro-TESE. However, the importance of sperm freezing transcends azoospermic scenarios. A broader and crucial indication for sperm freezing is fertility preservation, particularly poignant for cancer patients on the brink of undergoing treatments like chemotherapy or radiation, which could jeopardize their reproductive future. For these individuals, the opportunity to freeze their sperm offers a chance to father biological offspring post-recovery. By allowing multiple in vitro fertilization (IVF) attempts without necessitating recurrent surgical interventions, sperm cryopreservation, especially using vitrification, amplifies the chances of achieving biological parenthood. This is pivotal for both azoospermic individuals and cancer patients, safeguarding their dreams of family amidst medical adversities. In conclusion, the efficacy of vitrification, especially in the context of limited sperm counts, has the potential to reshape the landscape of male infertility treatments, offering a glimmer of hope for numerous affected individuals and their partners.

Somatic rights and medical law: issues of protecting dignity and autonomy

It is noted that somatic rights, which define human rights to the inviolability of the physical body and medical autonomy, are gaining increasing importance in the modern world. The protection and enforcement of these rights are becoming urgent challenges because they determine the way in which health care is provided and received.
 It has been established that somatic rights are defined as human rights to the inviolability of the physical body and the right to control it. These rights include the right to privacy of medical information, the right to freely choose medical procedures, as well as the right to confidentiality and protection from any form of medical discrimination. Somatic rights are an important aspect of general human rights and ensure that individuals can make their own decisions about their physical health and medical procedures.
 It is emphasized that medical law recognizes the right of a person to freedom of choice of medical procedures and treatment, as well as the right to refuse medical intervention. This is related to a person's right to control his physical body and make decisions about it. It also provides protection against any form of medical discrimination based on gender, age, race, religion or other characteristics, which contributes to the observance of the principle of equal opportunities and respect for somatic rights in all areas of medical practice.
 It is emphasized that reproductive rights include the right to freely choose the number of children, intervals between births, as well as the right to access information and services related to reproductive health. They allow a person to make decisions about their reproductive future according to their own values and beliefs. Medical law includes norms and principles that regulate medical practice, relationships between medical professionals and patients, and also ensure compliance with ethical standards in the medical field.

The Reproductive Future: “Space Babies” in Chinese Posters 1950s–1980s

Abstract This paper focuses on the visual depiction of children venturing into space in China during the late 20th century. I investigate how children are portrayed in Chinese posters and their space exploration themes by comparing them with similar art forms in the Soviet Union and the United States during the 1950s–1980s. Moreover, the study examines how these posters both shaped and reflected the political, social, and gender discourses of the period and served as means of reinforcing the reproductive future while interacting with Chinese historical myths. The study also considers the motivations for including chubby babies in Chinese posters, noting that this primarily resulted from Chinese moral beliefs. By historicizing the meaning-making process behind the “space babies” in Chinese posters, I argue that the depiction of children venturing into space helped in two distinct ways. First, it helped shift traditional immortality ideology into new forms of living and delimit the Chinese’s vision of the reproductive future: a desire to create better futures for our children/humanity by participating in politics. Furthermore, these visualizations apply the form of children as citizens to represent the mother country’s wishes while reflecting the corresponding Chinese national policy and fear of anthropic population expansion.

O-080 An umbrella review of meta-analyses regarding the incidence of female specific malignancies following fertility treatment

Abstract Study question To investigate the validity of the association between the development of female specific malignancies, including ovarian, endometrial, breast and cervical cancer following fertility treatment. Summary answer There is a statistically significant increase in the incidence of ovarian cancer and borderline ovarian tumours associated with fertility treatment. What is known already Approximately 1.3 million IVF cycles have been performed since 1991. The association between fertility treatment (FT) and female-specific cancers however, remains contentious, largely due to the conflicting outcomes published in various meta-analyses. Study design, size, duration A thorough literature search of the Cochrane Database of Systematic Review, EMBASE, Google Scholar and Pubmed was carried out to identify relevant systematic reviews and meta-analyses, from inception up until April 2022. Participants/materials, setting, methods The inclusion criteria included original studies stating the incidence of cancer in FT and control groups (non-FT). The principal outcome of interest was the incidence of cancer (breast, endometrial, cervical, and ovarian) in FT and non-FT groups. The effect estimates, Hazard Ratios and Odds Ratios (OR) were extracted, or calculated de novo. The strength of evidence and extent of potential biases were summarised. Main results and the role of chance In total, 3129 publications were identified, and 11 meta-analytical reviews were included. This umbrella review synthesised 324 meta-analyses, including data from over 20 million patients. The incidence of ovarian cancer (OR 1·21;95% CI 1·00-1·45) and BOTs (OR 1.87;95%CI 1·18-2.97) was higher in the FT compared to non-FT group. The meta-analyses related to ovarian cancer was statistically significant (p < 0.05), using a random-effects model. There was no significant association demonstrated between FT and the incidence of cervical, breast or endometrial cancer. Limitations, reasons for caution Although it has been demonstrated that exposure to fertility treatment does significantly increase the risk of ovarian cancer and BOTs, further studies are required in order to draw accurate conclusions. Wider implications of the findings Understanding the potential long-term sequelae of FT is fundamental to guide counselling and enable individuals to make informed decisions about their reproductive future. Clinicians should engage in appropriate patient selection, with those deemed to be at a higher risk, selected for more personalised fertility treatment and careful preventative follow-up. Trial registration number NA

A Survey of Medical Professionals on the Level of Sexual Competence and Reproductive Health in Teenagers

The article analyzes data from a survey conducted with 34 medical professionals in the field of sexual and reproductive health regarding their opinion and observation of the level of competence in this area in adolescent patients who sought medical care. The results are summarized in seven tables and three diagrams. The analysis of the results indicates that the most significant, from a medical point of view, are the personal deficits related to the lack of adequate information among patients regarding: the role of contraception and protective means for preventing unwanted pregnancy and avoiding sexually transmitted diseases; the provoking of risky behavior by the use of psychoactive substances; underestimating the role of prevention for the individual's general and sexual health, etc. The low level of knowledge, skills and competencies of adolescent patients in this aspect necessitates the search for more effective approaches, methods and means to involve adolescents in understanding and evaluating the importance of this issue for their health and for ensuring a satisfying sexual and reproductive future.

Laparoscopic Uterovaginal Anastomosis for Cervical Agenesia and Upper Vagina

<h3>Study Objective</h3> Cervical agenesis and the upper third of the vagina is a Müllerian malformation, which presents alterations in the patient's quality of life, with primary amenorrhea, dysmenorrhea, for which treatment was initiated for laparoscopic uterovaginal anastomosis. <h3>Design</h3> Report of a case, followed up 6 months after the surgical event. <h3>Setting</h3> This is a female patient undergoing operative laparoscopy, after performing a neovagina. In the laparoscopy operating room, assisted vaginally. <h3>Patients or Participants</h3> A 21-year-old female patient with primary amenorrhea. <h3>Interventions</h3> Uterovaginal anastomosis was performed. <h3>Measurements and Main Results</h3> Post-surgical surveillance was maintained to assess clinical improvement of pelvic pain, she presented menstruation the first three months in follow-up with oral contraceptives based on ethinylestradiol/levonogestrel, and after three months the treatment was suspended, the silastic uterine catheter, and the patient continued to present cyclical menses. <h3>Conclusion</h3> Vaginal-assisted laparoscopic uterovaginal anastomosis is a technique with satisfactory results for patients with C4 and V4 Müllerian malformations, to improve quality of life and reproductive future.

Associations of Reproductive Health Concerns, Health-Related Quality of Life, and Stress Among Adolescents and Young Adults with Chronic Illness.

Adolescents and young adults (AYA) living with chronic illness are as sexually active and interested in having children as healthy peers. Few studies have examined the intersection of managing chronic illness and concerns about realizing reproductive goals, including fertility, pregnancy, childbirth, and parenting. Even less is understood regarding how these concerns might be associated with psychological distress. This study examines associations between the reproductive health concerns (RHC) and health-related stress of AYA patients living with chronic conditions including rheumatologic, cardiac, pulmonology, gastrointestinal disorders, and solid organ transplant. A total of 140 patients aged 15 to 20 years (68% female; 81% Hispanic/Latinx) recruited from a transition program located at a safety-net pediatric institution completed surveys examining multiple dimensions of RHC and health-related quality of life (life satisfaction, illness burden, and illness-related anxiety) and condition-related stress. Exploratory factor analyses of RHC variables yielded 3 factors used in regression analyses to identify convergent validity of RHC factors with health-related mental health measures. Three RHC factor loadings emerged: concern about availability to raise children (timing/future), impact of condition/medication on fertility and childbearing (pregnancy/fertility), and impact of condition on motivation to have children (motivation/decision-making). Positive associations were found between all RHC factors and illness-related anxiety; condition-related stress was associated with motivation/decision-making. RHC, health-related anxiety, and stress can impede healthy sexual and reproductive health and development of AYA living with chronic conditions. Providers' proactive exploration of patients' concerns about their reproductive future can offer critical support as they navigate the unique existential challenges of early adulthood.

O-220 Automation and the future of fertility care: An ethical analysis of empowerment-oriented innovation

Abstract Study question What do the anticipated ethical benefits of automation oriented innovations in assisted reproductive technology teach us about the future of ethical assessments of fertility services? Summary answer Benefits like democratization and empowerment to justify disruptive innovation in the fertility field may obscure more fundamental ethical concerns about justice, self-surveillance and reproductive/parenthood ideals. What is known already It is believed that combining robotic components and artificial intelligence may yield an automated ‘lab in a box’ that reduces costs of gamete selection, fertilization, embryo development and genetic testing. Earlier references to ‘fertility labs in a box’ focused on functionality in traditional laboratory setups. Present-day rhetoric instead emphasizes the assumedly democratizing potential, aimed at transforming the fertility sector from reactively treating infertility to proactively managing fertility. Accordingly, the idea is to go after the ‘bigger market’ of preventive management of fertility, to allegedly empower people to reproduce at a time that is most convenient. Study design, size, duration A literature study was performed to inventory how future visions of automated, low-cost and anticipatory fertility management are gaining momentum, not only as marketing efforts of private companies, but also in academic literature among medical professionals and researchers. It was observed how these aspirations are justified with reference to moral values like empowerment and equality. This was critically evaluated against the backdrop of ethical arguments, indicating that beyond apparent benefits there are weighty moral questions. Participants/materials, setting, methods Literature study, conceptual analysis, normative analysis. Main results and the role of chance The anticipated ethical benefits of automated ‘fertility labs in a box’ are couched with high hopes about affordable and democratic fertility services and about empowering individuals to become managers of their own reproductive future. The ethical value of these benefits may seem to resonate with the importance of reproductive autonomy and just access. Yet, it is debatable whether these reproductive technological innovations that are promoted under the flag of empowerment, reproductive autonomy and accessibility will actually have a beneficial impact in terms of these values. It may be questioned how empowering it is to provoke demand for an unproven service that is supposed to vouch for reproductive goals that individuals may, or may not have later in life. More fundamentally, by fixating on the narrow way in which central ethical values like equality, autonomy and empowerment are employed to justify revenue-driven steps towards an automated fertility lab of the future, other crucial questions might be hedged. As will be shown during this presentation, careful ethical analysis can expose that more fundamental questions should be asked about economic constellations, self-surveillance, and fundamental matters pertaining to what ought to be valued, rather than what is valued or desired about human reproduction. Limitations, reasons for caution This is an agenda-setting analysis, and so it is not meant to serve as an exhaustive discussion of these moral concerns. While automated fertility labs are a speculative matter indeed, these perspectives are nonetheless gaining momentum, not only as commercial rhetoric, but also in scientific literature. Wider implications of the findings These findings instigate reflection about (bio)ethical analysis by accentuating the importance of contextual and global elements that may propel or restrain individuals’ reproductive options. This analysis also connects with earlier forms of ‘disruptive innovation’ rhetoric related to egg freezing enterprises as a way to transform infertility treatment into fertility management. Trial registration number N/A

Hijras, Lovers, Brothers: Surviving Sex and Poverty in Rural India by Vaibhav Saria

Reviewed by: Hijras, Lovers, Brothers: Surviving Sex and Poverty in Rural India by Vaibhav Saria Nikhil Pandhi Vaibhav Saria. Hijras, Lovers, Brothers: Surviving Sex and Poverty in Rural India. New York: Fordham University Press, 2021. 268 pp. In an early, instructive ethnographic vignette, anthropologist Vaibhav Saria, who is living with a community of hijras (commonly referred to as a "third gender" in India), describes a conversation with an interlocutor who has just returned from conducting sex work along a local highway in eastern India. Nandita, a poor hijra, ecstatically shows off a used condom and proclaims she "finally ate Saajan" (8). Amid peals of laughter and jubilation, Nandita empties the contents of the condom into her mouth, momentarily consuming her lover's semen before spitting it back into the condom. The hijra swallows and spits her lover's semen repeatedly, declaring, "I want his smell in my mouth, so that I can smell him every time I breathe. It's like perfume…" (8). Attuned to such intimate, intricate scenes of pleasure and desire, alongside the wider sensorium of affective labors and longings, Saria's ethnography skillfully traces the textures and tapestries that make "the fullness of hijra lives in India" (1). Drawing on 24 months of living and traveling with hijras between 2008 and 2019—including 16 continuous months of fieldwork in Bhadrak and Kalahandi, two of eastern India's poorest districts—Saria traces fraught webs of kinship, sexual fields of fantasy and fucking, libidinal attachments and gendered labors, as well as everyday struggles and quotidian pleasures. The author grounds his vital analysis in a decolonial critique of global public health, which both singles out hijras as biopolitical mascots for spreading information about safe sex and casts hijras' own quests for survival and sexual desire as stigma-ridden, dangerous, and incommensurable with the normative goals of global health practice. [End Page 697] Replete with ethnographic rigor as well as creative engagements with South Asian social and literary theory, Saria's analysis disrupts Euro-American theories of kinship, queerness, and the psyche by foregrounding hijra's stories and bodies, which deepen decolonial understandings of "living and dying in the contemporary world" (3). Chapter 1 explores how hijras' affective labors of laughing, flirting, and fucking are crucial means to sustain shifting moral modes of normative kinship. Hijras' open invitations to men to fornicate in fields and marketplaces dramatize the everyday anxieties of heteropatriarchy and poverty, allowing for masculinities and domesticities to be (re)inscribed as well as (re)imagined through wild sex. Hijras provide their lovers with sex to "enjoy the pleasures of betrayal afforded by the temporary suspension of the moral" (27), relieving them from "the deceptively comforting shelter of domesticity" (61). The hijra engages in the "drama of seduction" (30), wilfully knowing that by "opting out" (21) of a reproductive future, she can never really set up a house with a man. Hijras are haunted by fantasies of unborn children, yet sex becomes an "instance of sexual pedagogy between a hijra and lover" (30). The hijra teaches her man sexually to calibrate his relationships precisely so that he can return "more fortified to meet the demands of domesticity" (61). In Saria's sensitive analysis, this "care afforded by the erotic relationships of hijras" (55) makes life more "bearable in the world" (56). Chapter 2 analyzes how hijras move through webs of domestic relations burdened by the normative demands of fertility and futurity. Far from being socially abandoned, hijras remain tied to their families in ways that sustain fraternal intimacy yet allow for the contradictions of internecine disputes and familial disruptions—e.g., feuds over property among sons and brothers—to be absorbed without annihilating the scaffolding of kinship. Saria intriguingly notes that for families, "the presence of a hijra sibling was not seen as a breach of nature so much as a breach of structure" (64). Hijra lives and the brokerage they provide to sustain "everyday domestic existence" (84) become central to the kinship calibrations that brothers, daughters, sisters, and mothers must make as they negotiate patriarchal futures for the family. Beyond the familial, the love and lust that hijras receive from their sexual pleasures "dilates" (88) the violent hold...

Juvenile nulliparous uterine prolapse in an unmarried 17-year-old adolescent

In a peripheral health camp, a 17-year-old juvenile nullipara who presented with the history of something coming out per vagina was clinically diagnosed as third-degree pelvic organ prolapse (POP) Stage III, acknowledged as a rarity concerning patient wellbeing and reproductive future.

The development of adolescent agency and implications for reproductive choice among girls in Zambia

BackgroundA substantial proportion of adolescent girls in Zambia lack the ability to decide their reproductive future. We examined the role of agency in early and unwanted adolescent childbearing. MethodsUsing latent transition analysis, we characterized a multi-dimensional profile of adolescent agency annually over a four-year period. We investigated the influence of early life access to resources and time-varying predictors (school retention, violence, early marriage and unwanted/mistimed pregnancy and childbearing) on agency profile membership as well as transitions in agency status over time. ResultsFour agency profiles were identified, with differences by age cohort (10–14 years vs. 15–19 years). Three profiles identified in both age cohorts were: Low-moderate agency, Self-assured gender conformers, and High agency. Unique to younger girls was the Gender conscious, low belief in abilities status, while among older girls was the Self-assured selective gender conscious status. While younger girls were likely to transition to the highest agency status over time, high agency membership declined among older girls. Early life resources were associated with augmented agency while exposure to negative events, particularly early marriage, were associated with detraction from high agency status. Girls who expressed high self-efficacy but gender-conforming values were most at risk of early marriage and unwanted/mistimed pregnancy while High agency girls were at comparatively low risk. ConclusionsResults show agency is dynamic but less mutable with increasing age. Early adolescent strategies which address inequitable gender norms and limit early marriage, may guard against losses to agency which contribute to unwanted fertility outcomes.

Solar-powered slugs have a bright reproductive future

Solar-powered slugs have a bright reproductive future

The 4B movement: envisioning a feminist future with/in a non-reproductive future in Korea

ABSTRACT Recently, in Korea, young feminists launched the 4B (4非) movement: bihon, bichulsan, biyeonae, bisekseu, meaning the refusal of (heterosexual) marriage, childbirth, romance, and sexual relationships. The 4B movement encompasses not only criticisms of the pro-natalist turn in state policy and protests against it, but also various forms of self-help discussions and practices that are explicitly oriented towards women’s individual futures. In this article, we explore how the 4B movement has given young feminists the opportunity to envision the future that they had been discouraged from imagining. Presenting a lived critique of contemporary Korea, these feminists ask how young women are led to imagine their current, single life as a temporary state, as consumer capitalism and the patriarchal state together place these young non-married women in an economically vulnerable position. They see this as achieved by endorsing ‘feminine’ desires and a presentist lifestyle, as well as excluding non-married women from opportunities in the job market and state-sponsored benefits in welfare services. We argue that the 4B movement and its discourses on the future and self-help could offer these women one possible way to envision a feminist future as individuals without being part of the state’s reproductive future.

Outcomes following medical termination versus prolonged pregnancy in women with severe preeclampsia before 26 weeks.

ObjectiveTo compare maternal complications and describe neonatal outcomes in women with severe preeclampsia at ≤ 26+0 weeks in two countries with different management policies: expectant management (Brazil) versus termination of pregnancy (France).MethodsWe conducted a retrospective comparative study by reviewing the medical records of women with severe preeclampsia at ≤ 26+0 weeks, from January 2010 to June 2018, in two centers: Hospital das Clínicas da Faculdade de Medicina, in Sao Paulo, Brazil (where medical abortion is forbidden in this indication) and Hôpital Antoine-Béclère, Clamart, France (where medical termination is accepted). We collected information on maternal characteristics, laboratory tests, maternal complications and fetal and newborn characteristics. We used Student’s t-test and the Mann-Whitney U nonparametric test to compare quantitative variables, and Chi-square test or Fisher's exact test to evaluate the associations between the qualitative variables.ResultsThere was no between-group difference in maternal complications during hospitalization (p = 0.846). In Brazil, the rate of cesarean section was 66.7%, and 20% of patients had vertical incision. The rate of spontaneous fetal death was 35.6% and among the live-born infants 26.6% were discharged from hospital. In France, one patient had a cesarean section with vertical incision.ConclusionWhen comparing termination of pregnancy to expectant management in severe preeclampsia before 26 weeks, maternal complications were equivalent but maternal reproductive future might have been compromised in 20% of cases due to a higher risk of uterine rupture in subsequent pregnancies for patients having classic cesarean (vertical incision). 26.6% of children survived the neonatal period when pregnancy was pursued, however we lack information on their long-term follow-up.

A View from the past into our collective future: the oncofertility consortium vision statement.

PurposeToday, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium.MethodsThe Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process.ResultsThis interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity.ConclusionThe goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future.

Prevalence of Repeat Cesarean Section in a Tertiary Care Hospital.

Cesarean section is the surgical delivery of a baby through an incision made in the mother's abdomen and uterus. Repeat cesarean section has recently increased, partly because of concern about increased risk of uterine rupture in women attempting vaginal birth after cesarean delivery. Among the women who underwent cesarean section in their first delivery, 80-96% had a second surgical delivery. Therefore, the present study aimed to describe the prevalence of repeat cesarean section among Nepali women presented at Kathmandu Medical College and Teaching Hospital who had a previous cesarean section. This was a descriptive cross-sectional study conducted in Kathmandu Medical College and Teaching Hospital from 1st of February to 31st of May 2020. Ethical approval was taken from the Institutional Review Committee of the Kathmandu Medical College. Convenient sampling was done. All pregnant patients between gestational ages of 37-40 weeks with previous cesarean section admitted for safe confinement were included in the study. Among the 104 women, who had prior cesarean section, 99 (95.19%) had second cesarean section and 5 (4.81%) had vaginal birth after cesarean. The most common indication for the first cesarean section was fetal distress 31 (29.81%) while the indication for the second cesarean section among previously cesarean section women was cephalo pelvic disproportion 39 (39.40%). The proportion of cesarean section in both first and subsequent delivery is quite high. This high rate may compromise the reproductive future of the women who underwent consecutive cesarean section with possible consequent complications.

Gamete preservation: knowledge, concerns and intentions of Israeli and Danish students regarding egg and sperm freezing

Research questionWhat do Danish and Israeli students of both sexes know about age in relation to fertility and gamete preservation, and what are their concerns and intentions for the future in this regard? DesignA cross-sectional comparative study of male and female Danish and Israeli students was conducted between November 2018 and April 2019. A total of 1010 students, 508 from Denmark and 502 from Israel, completed questionnaires assessing knowledge, perceptions and intentions regarding gamete preservation. ResultsMore than 70% of both genders in Israel thought that women start experiencing fertility decline at age 35 and up. A total of 60% of Danish women and 51% of Danish men chose 29–34 as the time where fertility decline starts. Some 95% of Danish students chose 20–29 as the best age for egg freezing, while the corresponding number in Israel was 85%, regardless of gender. In total, 51% of Israeli women said they are extremely or very worried about future infertility, compared with 31% of Danish women, 26% of Israeli men and 12% of Danish men. Regarding preservation intentions, no gender differences were found. Some 3% of Israeli students said they would consider gamete preservation, as compared with 14% of Danish students. ConclusionsThese findings suggest a widespread worry among Danish and Israeli women about their future fertility. Danish students report more awareness of age-related fertility decline. Unique to this study is the inclusion of male students. The preliminary findings reveal that men are less worried about their reproductive future.