IVF

Obesity is associated with a reduction in fertility treatment success and increased risks to mother and child. Therefore guidelines of the Royal Australian and New Zealand College of Obstetricians and  Gynaecologists (RANZCOG) suggest that a body mass index exceeding 35 kg/m2 should be an absolute contraindication to assisted fertility treatment such as in vitro fertilisation IVF. In this paper we challenge
the ethical and scientific basis for such a ban. Livebirth rates for severely
obese women are reduced by up to 30%, but this result is still far better than that observed for many older women who are allowed access to IVF. This prohibition is particularly unjust when IVF is the only treatment capable of producing a pregnancy, such as bilateral tubal blockage or severe male factor infertility. Furthermore, the absolute magnitude of risks to mother or child is relatively small, and while a woman has a right to be educated about these risks, she alone should be allowed to make a decision on proceeding with treatment. We do not prohibit adults from
engaging in dangerous sports, nor do we force parents to vaccinate their children, despite the risks. Similarly, we should not prohibit obese women from becoming parents because of increased risk to themselves or their child. Finally, prohibiting obese women’s access to IVF to prevent potential harms such as ‘fetal programing’ is questionable, especially when compared to that child never being born at all. As such, we believe the RANZCOG ban on severely obese women’s access to assisted reproductive treatment is unwarranted and should be revised.

There is a growing global demand for human eggs for the treatment of sub-fertile women and for stem cell-related research. This demand provokes concerns for the women providing the eggs, including their possible exploitation, whether they should be paid, whether they can give properly informed consent and whether their eggs and bodies are becoming commodified. However, few of the debates have benefitted from insights from the women themselves. We address this gap in knowledge by reporting on a study investigating women's views and experiences of a scheme in which they can volunteer, in their capacity as fertility patients, to 'share' their eggs with researchers and receive a reduction in in vitro fertilisation fees. We focus our discussion on the question of exploitation, a concept central to many sociological and ethical interests. In brief, our analysis suggests that while interviewees acknowledge the potential of this scheme to be exploitative, they argue that this...

Background: The use of embryos in embryonic stem cell research (ESCR) has elicited ethical controversies as
it entails the destruction of 5-day old human embryos to harvest stem cells.
Objective: To explore the ethical positions of Islam, Buddhism, Hinduism, and Catholicism concerning the use
of (1) left-over embryos from in vitro fertilization (IVF) also known as ‘surplus’ embryos and (2) ‘research embryos’
which are created by scientists to conduct research using embryonic stem cells.
Methods: The opinions of religious leaders of Buddhist, Hindu, and Catholic faiths in Malaysia pertaining to
ESCR were examined via in-depth, semi-structured interviews while Islamic responses are collected from local
writings related to the derivation of fatwa on this issue. Participants’ responses on the ethics of human stem cell
research are presented as a reflection of various scriptural texts of these four religions. These are presented and
supported with the help of international bioethics literature and focus on the use of ‘surplus’ embryos and
‘research’ embryos.
Results: Islamic ethics deviate from Hindu and Buddhist teachings regarding saving of research embryos that
have been created specifically for research and are considered as human lives only after 120 days fertilization.
Hindu and Buddhists also underscore the sanctity of human life, but give priority to the alleviation of suffering
in living adult humans. They generally encourage ESCR. Research is a knowledge-seeking endeavor considered
noble by Islam. This is also a concept within Hindu and Buddhist philosophy; in particular, when potentially
beneficial research goals are the basis. Catholicism also emphasizes sanctity of human life, but stresses also
the inviolability of embryos from the moment of conception.
Conclusion: Embryonic stem cell research is permissible and encouraged according to Hindu and Buddhist
perspectives in view of the potential benefits of such research to society, with some reservations. This is similar
to Islamic views on the ethics of ESCR. However, Catholicism differs from all the other three religions; it appears
to discourage research in this field because of the likely violation of a sacred principle in Catholic teachings.

The best book for those perplexed by the philosophical and ethical conundrums of genetics in the 21st century. (CHOICE)

McGee develops a very powerful line of reasoning about genetic enhancement. (The Philadelphia Inquirer)

He combines a rich body of clinical material with informed pragmatic critique. (Mary Briody Mahowald, University of Chicago)

A pioneering, landmark work in pragmatic bioethics. (John J. Stuhr, Head of the Department of Philosophy, Penn State University)

This captivating book offers balanced new insights for individual decisions and for public policy. (John Lachs, Centennial Professor of Philosophy, Vanderbilt University)

A welcome alternative to work that force fits the issues either to scholarly abstractions or to myths of popular culture. (Caroline Whitbeck, Ethics Center for Engineering & Science, MIT)

A provocative account of this emerging, cutting-edge issue that will greatly profit future commentators and policymakers. (John Robertson, School of Law, University of Texas)

A useful road map as we enter the complex territory of genetic medicine in the 21st century. (James M. Wilson, director, Institute for Human Gene Therapy, University of Pennsylvania)

A remarkably well-informed and sensitive exploration of the opportunities and challenges presented by the new science of genetics. (Jonathan D. Moreno, State University of New York, Brooklyn)

Extremely readable and provocative . . . succeeds at something that few scholars in Bioethics have even attempted: to speak in ordinary language and in a conversational voice about the nest of subtle issues that entangle new advances in human genetics. (Eric Juengst, Ph.D. Center for Biomedical Ethics, School of Medicine)

McGee is one of the most energetic and inquisitive writers in the emerging 'next generation' of bioethicists . . . His work is interesting, important, and has the kind of self-reflective courage we need to face these issues squarely. (Margaret P. Battin, University of Utah)

McGee's application of the pragmatic method to issues in bioethics is both timely and effective. McGee's excellent final chapters will give students of all levels a perspective that cannot be found in other books of the kind. (Teaching Philosophy)

McGee's book breathes all the virtues of a pioneering work. it puts the issue of human genetic engineering in a fresh perspective, draws the attention to many valuable points, and raises a number of important questions. (Cornelis de Waal, Newsletter of the Society for the Advancement of American Philosophy Newsletter Of The Society For The Advancement Of American)

McGee's well-written and intriguing new book adds little to the content . . . .he does offer a unique and much needed practical approach to the critical analysis of the relevant issues. (Timothy Caulfield, Universtiy of Alberta Phil Review, Vol. Xvii N0.. 4-6 Aug.-Dec. 97)

McGee's book is an excellent introduction to the issues and he provides especially good treatments of the nature/nurture debate and the relationship between genetics and allocation decisions. Many will find his views provocative. His work is breezy and fun to read. (L.M.P. Ethics, Jan. 1998)

So where do ordinary folk, faced with a life-or-death decision, get some useful information? This book might be a good starting ground. (Beverly Kelley, California Lutheran University Sunday, June 29, 1997)

The philosophical tradition of American pragmatism has had a fresh life in recent years. In McGee's hands it is richer, more suggestive . . . Not everyone will find The Perfect Baby acceptable, but McGee will give the opponents reason to pause. Weneed that kind of initiative, and McGee's book will provoke some useful, much needed debate. (Daniel Callahan, The Hastings Center)

Finally— a good book about genetics— that makes these fascinating issues understandable to the families who need to know. (N. P. R.'S Voices In The Family)

. . . useful to just about everyone who must grapple with the new genetics. (The Washington Times)

The book is appropriately directed to a diverse audience and makes refreshing use of plain language to address relevant issues present in the choices we must now make in everyday life. (Bruce C. Trafnell, Genetic Therapy, Inc. Dept. of Virology Nature Medicine, Vol. 3 No. 6)

Eugenic selection of embryos is now possible by employing in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD). While PGD is currently being employed for the purposes of detecting chromosomal abnormalities or inherited genetic abnormalities, it could in principle be used to test any genetic trait such as hair colour or eye colour. Genetic research is rapidly progressing into the genetic basis of complex traits like intelligence and a gene has been identified for criminal behaviour in one family. Once the decision to have IVF is made, PGD has few`costs' to couples, and people would be more inclined to use it to select less serious medical traits, such as a lower risk of developing Alzheimer Disease, or even for non-medical traits. PGD has already been used to select embryos of a desired gender in the absence of any history of sex-linked genetic disease. I will argue that: (1) some non-disease genes affect the likelihood of us leading the best life; (2) we have a reason to use information which is available about such genes in our reproductive decision-making; (3) couples should select embryos or fetuses which are most likely to have the best life, based on available genetic information, including information about non-disease genes. I will also argue that we should allow selection for non-disease genes even if this maintains or increases social inequality. I will focus on genes for intelligence and sex selection. I will defend a principle which I call Procreative Beneficence: couples (or single reproducers) should select the child, of the possible children they could have, who is expected to have the best life, or at least as good a life as the others, based on the relevant, available information.

Taming egg donors is a multi-sited ethnography of the egg donation industry in Spain. It elaborates the politics of decision-making, information, risk perception, labour, and selection that operate in the Spanish context. In this thesis, I delineate the multilevel processes in place to ultimately achieve the stabilisation of bodies and eggs for their entry into the global bio-market circuits. Based on ethnographic fieldwork in Barcelona, I draw on the point of view and experience of both egg donors and clinicians. This polyvocal approach reveals the needs, struggles, and expectations of the participants involved and how they are orchestrated to produce the egg donation bioeconomy. The main argument of this thesis is that egg donation is a fragile process that needs careful methods of containment to effectively work. It is fragile in the sense that the process can fail at any point: the donor might not follow the rules properly; the drugs might not generate the expected effect; the risks cannot always be contained; the extracted eggs might not be mature enough; or the children born might not meet the expected health standards. I argue that these methods for containing women, which I describe as a process of taming, operate both at the structural level — where institutional discourses, socio-economic factors, and regulations converge — and at the micro level of clinical practices — through the building of particular relationships between clinicians, donors, and their bodies. First, I argue that the rationalities of becoming an egg donor are intimately linked with the precarious Spanish labour market, which makes egg donation an activity that is very similar to having a job for young women. Second, I show how the combination of the legal framework of egg donation as altruistic and anonymous and the information delivery practices in fertility clinics produce particular sociotechnical imaginaries among egg donors that ultimately prevent debates on reproductive justice. Third, I contend that fertility clinics have taming methods in place to assure that egg donors will make it until the end of the process. These techniques happen at the level of the selection and management of donors and attempt to contain behavioural problems and bodily misbalances. Fourth, I describe how clinics precariously attempt to stabilise donors’ genetic and ethnoracial pasts in objectifiable categories, a process that reveals key aspects of how health and race operate in the fertility industry. Finally, I contend that all these efforts reveal clinicians’ imaginaries, struggles, and anxieties in relation to the perceived stressful job of dealing with egg donors. Their uneasy presence in fertility clinics is highlighted by the sociotechnical imaginaries of clinicians about future of assisted reproduction, in which egg donors are expected to ‘disappear’ thanks to forthcoming technoscientific innovations. Through these arguments, thus, I analyse how the Spanish egg donation industry is orchestrated to contain women’s imaginaries, bodies, biographies, and eggs so that they can be converted and travel across the global bio-market circuits. In doing so, this dissertation contributes to scholarship on tissue economies, reproductive labour, sociotechnical imaginaries, and Spanish extractive industries.

In 2001, a study made the startling discovery that in tests 46% of subjects were unable to separate the placebo effect from established antidepressants from the US Food and Drug Administration (FDA) database (Laughren 2001). This is a qualitative study of the role of the placebo effect on 11 couples after a consultation with a predictive medical astrologer led to conception and the birth of a healthy baby. The astrologer advised them on the optimum times for in-vitro fertilisation (IVF) treatment. How did astrology work from the participants’ point of view? Does a positive or negative predisposition to astrology affect the success of the outcome? Can the effectiveness of astrology give new insight into the placebo effect? How could this be tested and measured in a statistical study?

The genetics revolution that will transform our healthcare, the way we make babies, the nature of the babies we make, and ultimately our evolution as a species has already begun. It will arrive far sooner than most of us think and will transform our lives and the world around us in ways we can hardly imagine - and we aren't ready. If you have a sense that the genetics revolution is important but recognize you need to know more about what’s happening, what’s at stake, what this means for you, and what you should be doing now to prepare.

Could this be the most important book of our generation?

Postmortem sperm retrieval (PMSR) is a procedure to procure sperm from a man who has been dead for a short period of time, or a man who has been declared dead by neurological criteria and is being kept alive artificially. Requests for PMSR are typically made by widows with the intention of using the sperm for artificial insemination in the future, but this is not always the case. This article examines requests for postmortem sperm retrieval from parents and family members. I will first overview the legal landscape and policies regarding PMSR internationally. Next, I will provide two clinical cases of requests for postmortem sperm retrieval from parents and family members which occurred at a major medical center in California, USA. I will then analyze the salient ethical features with particular emphasis on  California laws and Israel posthumous grandparenthood policies. Requests for postmortem sperm retrieval from parents, which will not necessarily result in posthumous grandparenthood, will become more frequent. This is a compelling reason for major hospitals to draft policies. I conclude with policy suggestions for this rarified request, which I believe will become routine in the future.

Enfanter, à n’importe quel prix ? L’histoire de l’insémination artificielle et de sa condamnation par l’Église catholique permet d’éclairer le débat actuel sur l’ouverture de l’assistance médicale à la procréation aux femmes seules et aux couples de femmes homosexuelles.

One of the most striking aspects of assisted reproductive technologies (ARTs) has been their rapid globalization, leading to the birth of more than five million “miracle babies” (Franklin, 2012) around the world. This global spread, however, has involved sophisticated processes of “localization” (Inhorn and Van Balen, 2002), generating myriad permutations regarding the regulation, practice and reception of ARTs in different contexts. Indeed, the different incarnations of this “global form” (Knecht et al., 2012) have been the subject of a growing body of scholarship, in which social scientists, using mostly ethnographic methods, have sought to describe and analyse IVF practice, its socio-cultural impact and the experience of IVF patients in specific contexts (see Inhorn and Birenbaum-Carmeli, 2008). This thesis is in conversation with and a contribution to the work of these scholars.

Based on several periods of fieldwork in Turkey between April 2006 and December 2009, including archival analysis, clinical ethnography, “expert” interviews and semi-structured interviews with 50 women/couples undergoing IVF treatment, I provide an account of the experiences of Turkish IVF patients. This thesis illustrates the ways in which childlessness, infertility and IVF treatment are understood and constructed by Turkish men and women, as well as their reactions to and feelings surrounding these experiences.

The thesis is divided into two parts. In the first, I establish the context for my findings. Starting with a review of key ART ethnographies, I outline the important themes and findings to emerge from this literature. Then, I move to a detailed discussion of my methodology, explaining and accounting for key research decisions, elucidating the main challenges and acknowledging the important considerations that must be borne in mind when assessing this study. The section concludes with a broad contextualisation of contemporary Turkey and the role of ARTs – in particular the local particularities surrounding the regulation, organisation and representation of tüp bebek. This discussion, with references to my previously published work, draws the broad parameters within which IVF patients’ own narratives and experiences are situated.
In the second part, comprised of four chapters, I report on the data from my clinical ethnography, focusing predominantly on patient interviews. Following a roughly chronological structure, each of the chapters addresses a different aspect of women/couples’ experiences, although many themes resonate throughout the chapters. Chapter 4 describes the social and familial consequences of involuntary childlessness and how couples seek to negotiate these. Chapter 5 follows couples’ journeys to the IVF clinic through their retrospective accounts of the medicalisation of infertility. Chapter 6 focuses on the IVF cycle and the unexpected challenges that couples must navigate. Chapter 7 begins where treatment “ends”, relating women/couple’s nuanced encounters with uncertainty and their heartfelt attempts to conceive the future. Through these four chapters, I show how what begins as a straightforward expectation or assumed norm of parenthood is transformed for these couples, who must employ not only ARTs, but also creativity, imagination and perseverance in the art of making babies.

Surrogacy and In Vitro Fertilization (IVF) is a process by which an egg is fertilized by sperm outside the body in Vitro (‘in glass’), and then implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy.
This is still a new concept in the Kenyan Society especially concerning existing laws thereof. We’ll look at the current laws, including possible developments and improvements while also discussing the disadvantages and issues of lack of proper surrogacy law in Kenya. The fact that the legal and ethical framework is too insufficient to regulate surrogacy arrangements in Kenya, places the practice in a vulnerable state where corrupt and manipulative activities can contaminate it. Gaps in the legal framework cause ambiguity and uncertainty, making it hard to regulate the practice of surrogacy in Kenya. This leaves only the option of personal and unsystematic interpretation and determinations made in the court of law.
It is vital that proper legal framework is produced to protect the rights and intentions of the parties that are victimized as well end the increasing occurrences of corruption this issue has caused. While assessing the current practices of surrogacy in Kenya, we’ll also focus on other countries; which we shall look into so as to borrow similar policies to improve our own, the laws or frameworks of the same, and how to apply them so as to fit our particular society and existing provisions.

The mitochondria of the oocyte are a prominent source of energy metabolism as well as mitochondrial DNA that will later populate the cells of the offspring. Recent discoveries provided new insight into the physiology of the mitochondria and its unique genetics. The concept of heteroplasmy defined as the presence of more than one type of mitochondrial genome, is gaining increasing recognition as an important contributor to several complex morbidities, age-related reproductive dysfunction and aging. Understanding the changes caused by pathogenic mutations as well as identifying defects occurring during reproductive aging will enhance our knowledge of the role of mitochondria as organelles in germ cell biology. In this review, we summarize the current state of knowledge about the role of mitochondria in embryo and fetal development.

This peer-reviewed paper can be cited in APA style:  Kirkman, L. (2010). The Good Sense about Surrogacy.Viewpoint (2), 20-24.

"There are many ways to form a family, including surrogacy. Children and parents in families formed through surrogacy do well. The main risk to surrogacy families is stigma; discrimination through negative social attitudes to diversity. Political and community leaders can influence attitudes by showing acceptance of, and respect for, diversity. The majority of surrogate mothers are psychologically well adjusted and comfortable with their choice. Recommendations for public policy and legislation include: permitting altruistic but not commercial surrogacy; no restriction on the couple status or sexuality of the commissioning person(s) and; having details available to the child which are to be kept in a central register.
Keywords: surrogacy; surrogate mothers; family diversity; stigma; public policy.
"

Recurrent implantation failure (RIF) is the name of a clinical condition coined following the widespread use of in-vitro
fertilization (IVF), which has allowed compartmentalization of several different fertility treatments. Its definition is
dynamic and depends on the population of patients studied, as well as the type and quality of clinical practice. In this
review we survey the tools which are currently used in order to improve treatment outcome in patients with recurrent implantation
failure. Some of these practices are more commonly or firmly established than others, however the beneficial
contribution of most of these tools to improve reproductive outcomes among patients with recurrent implantation failure
still lacks proper scientific validation.

Based on research about the infertility experiences of women and demand for in vitro fertilisation treatment in Turkey, I observe in this paper the rhetorical strategies employed by childless women to bring meaning to their infertility experience as well as to attain adult gender identity. I also briefly touch on men’s experiences of infertility. I argue that the prevalent references to the almightiness of God do not only indicate religious beliefs. Through the instrumental use of religious discourse, these references can be considered the rhetoric of religious belief.

L’Italia detiene uno dei tassi di natalità più bassi al mondo e infertilità e sterilità stanno diventando realtà sempre più diffuse. Dopo diversi tentativi infruttuosi, alcuni aspiranti genitori intraprendono la strada per avere un figlio attraverso la procreazione assistita: un percorso che richiede tempo, pazienza, denaro, e che non è privo di difficoltà e insidie.
Nel contesto italiano la situazione è aggravata dal fatto che non poter avere figli è un tabù di cui non si discute apertamente e coloro che ricorrono alla procreazione assistita spesso lo fanno di nascosto. L’Italia ha, inoltre, una delle leggi più restrittive in materia (la cosiddetta “Legge 40”) e la Chiesa cattolica condanna apertamente questi trattamenti. In un’epoca in cui quasi tutto è considerato possibile, avere figli non è sempre facile, ovvio e “naturale,” come potrebbe sembrare, e la sterilità sta diventando una vera e propria piaga sociale. Tuttavia, è indicativo che nell’editoria e – spesso in forma anonima – su blog e forum, la questione abbia iniziato a essere discussa. Questi sono sintomi di un problema che esiste e sta finalmente cominciando a emergere e a essere affrontato.
Nel mio contributo prenderò in considerazione due romanzi contemporanei italiani, pubblicati dopo l’entrata in vigore della “Legge 40” – Confessioni di una aspirante madre di Lisa Corva (2005) e Le difettose di Eleonora Mazzoni (2012) – che raccontano la ricerca, a tratti disperata e ossessiva, della maternità attraverso la procreazione assistita. Le vicende legate al sogno di gravidanza delle protagoniste e le conseguenze derivanti dal fallimento delle tecniche di fecondazione in vitro saranno approfondite con l’ausilio di studi effettuati nell’ambito delle scienze sociali, tra cui quelli di Gayle Letherby, James H. Monach, Karen Throsby e Silvia Vegetti Finzi, nel tentativo di indagare il desiderio di maternità delle protagoniste dei romanzi, il percorso di rinegoziazione della “normalità” e la loro ridefinizione di identità femminile.

STUDY QUESTION: After controlled ovarian stimulation (COS) and IUI, is it clinically feasible to recover in vivo conceived and matured human blastocysts by uterine lavage from fertile women for preimplantation genetic testing for aneuploidy (PGT-A) and compare their PGT-A and Gardner scale morphology scores with paired blastocysts from IVF control cycles? SUMMARY ANSWER: In a consecutive series of 134 COS cycles using gonadotrophin stimulation followed by IUI, uterine lavage recovered 136 embryos in 42% (56/134) of study cycles, with comparable in vivo and in vitro euploidy rates but better morphology in in vivo embryos. WHAT IS KNOWN ALREADY: In vivo developed embryos studied in animal models possess different characteristics compared to in vitro developed embryos of similar species. Such comparative studies between in vivo and in vitro human embryos have not been reported owing to lack of a reliable method to recover human embryos. STUDY DESIGN, SIZE, DURATION: We performed a single-site, prospective controlled trial in women (n = 81) to evaluate the safety, efficacy and feasibility of a novel uterine lavage catheter and fluid recovery device. All lavages were performed in a private facility with a specialized fertility unit, from August 2017 to June 2018. Subjects were followed for 30 days post-lavage to monitor for clinical outcomes and delayed complications. In 20 lavage subjects, a single IVF cycle (control group) with the same ovarian stimulation protocol was performed for a comparison of in vivo to in vitro blastocysts. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Women were stimulated with gonadotrophins for COS. The ovulation trigger was given when there were at least two dominant follicles ≥18 mm, followed by IUI of sperm. Uterine lavage occurred 4-6 days after the IUI. A subset of 20 women had a lavage cycle procedure followed by an IVF cycle (control IVF group). Recovered embryos were characterized morphologically, underwent trophectoderm (TE) biopsy, vitrified and stored in liquid nitrogen. Biopsies were analyzed using the next-generation sequencing technique. After lavage, GnRH antagonist injections were administered to induce menstruation.

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This study was conducted to assess the post thaw quality of Kundhi buffalo semen diluted in tris based diluents. After collection the ejaculates were pooled and checked for color, volume, pH, mass activity, progressive linear motility% (PLM), and intactness of cell membrane. The semen qualifying these tests was divided into four aliquots A, B, C and D, diluted with tris based diluents; the last three diluents containing sugar types glucose, fructose and lactose respectively. Aliquot A was without sugar and severed as control. These were frozen, stored for 24 hrs, thawed and incubated at 35 0 C for 5 hrs. The incubated semen aliquots were examined for PLM and membrane integrity of sperm cells with phase-contrast microscopy and HOST procedures. It was observed that all the ejaculates were creamy white in color. The mean (±SEM) volume, mass activity, sperm concentration, PLM, and intactness of cell membrane were 1.70 (±0.09) ml, 3.22 (±0.074), 1.58 (±0.136) x 10 9 /ml, 64.53 (±0.757) %...

Introduction: To study the impact of biosimilars in assisted reproductive treatments, we performed a review of the literature. Biosimilars are a bioequivalent chemical drug referred to the original. Their production is strongly requested in order to reduce drug cost and reduce health economic impact on national health system. In assisted reproductive treatments different gonadotropin biosimilars are being produced.Areas covered: For this reason, we performed a review of the literature on follitropin alfa Gonal-F biosimilar, Ovaleap and Bemfola, to assess their cost efficacy in national health system. Cost effective (CE) analysis and incremental cost-effectiveness ratio (ICER) were used as parameters for biosimilar impact evaluation in the national health system economy. In particular, they had only slight impact on cost reduction of recombinant follitropin alfa products in Europe.Expert opinion: considering cost-effective analysis, Gonal-F remains the first choice for national health systems. However, well-designed powered methods are strongly needed to assess biosimilars cost-effectiveness.

In Deutschland begeben sich immer mehr Paare mit unerfülltem Kinderwunsch in medizinische Behandlung. In einer ethnographischen Fallstudie untersucht Charlotte Ullrich auf Grundlage von teilnehmender Beobachtung, qualitativen Interviews und Dokumenten die Behandlungspraxis einer reproduktions- und einer alternativmedizinischen Klinik – und zeichnet nach, wie der Kinderwunsch im Therapieverlauf in ein medizinisches Problem transformiert wird.
Dimensionen der Analyse sind: Positionierungen und Strategien des medizinischen Personals und der Paare, organisatorische Abläufe und der Einsatz von Technik. Gleichzeitig wird aufgezeigt, wie Tendenzen der Medikalisierung in den gesellschaftlichen Kontext und die Lebenswelt der Paare eingebettet sind.