Technology and Infertility : Clinical, Psychosocial, Legal, and Ethical Aspects

Medicine is changing at a speed never witnessed before in history. With each passing year, medical technology achieves the capacity to provide cures and improve treatments that even a short time before were difficult to con­ ceptualize and impossible to provide. Reproductive technology personifies this concept perhaps better than any other field of medicine. The 1990s have seen an explosion in endoscopic and ambulatory procedures, the application of molecular biology to clinical conditions, and the refinement of assisted reproduction to allow third parties (donors and surrogates) into the process of family building. More than ever before, comprehensive medical care requires a team approach. However, the team comprises not only medical and scientific personnel, but also mental health professionals, lawyers, and ethicists. This integrated and multidisciplinary approach to medical care will become even more necessary as medical capabilities continue to develop faster than society can respond. This book reflects such an approach. It is based on a Harvard Postgraduate Course in June 1990 entitled Infertility in the 1990s: Technological Advances and Their Psychosocial Implications that was sponsored by the Faulkner Centre for Reproductive Medicine. The first half of the course was directed by Drs. M. Seibel, A. Kiessling, and C. Richards. The second half of the course was directed by Dr. M. Seibel, J. Bernstein, R. N. and S. Levin, LICSW. Front Matter....Pages i-xv A Historical Perspective of Obstetrics and Gynecology: A Backdrop for Reproductive Technology....Pages 1-9 Medical Evaluation and Treatment of the Infertile Couple....Pages 11-38 The Laser and Infertility: Present and Future....Pages 39-49 Operative Laparoscopy: Patient Selection and Instrumentation....Pages 51-60 Operative Pelviscopy: Techniques and Results....Pages 61-66 Hysteroscopy in Infertility....Pages 67-72 Surgical Advances for Male Infertility....Pages 73-82 Epididymal Sperm in Obstructive Azoospermia for In Vitro Fertilization....Pages 83-89 Gamete Intrafallopian Transfer and Ultrasound-Guided Transcervical Fallopian Tube Canalization....Pages 91-98 Transcervical Fallopian Tube Catheterization for Diagnosis and Treatment of Female Infertility....Pages 99-107 The Natural Cycle for In Vitro Fertilization....Pages 109-113 The Natural Cycle for In Vitro Fertilization: A French Experience....Pages 115-118 Expression of Proto-Oncogenes in Mammalian Gametes and Embryos....Pages 119-133 In Vitro Coculture of Mammalian Embryos....Pages 135-164 The Intraovarian Insulinlike Growth Factor System: Basic and Clinical Implications....Pages 165-169 Medical Treatment of Ectopic Pregnancy....Pages 171-179 GnRH Agonists in the Treatment of Fibroids....Pages 181-191 GnRH Agonists in the Treatment of Endometriosis....Pages 193-201 GnRH Agonists in the Treatment of Hyperandrogenism....Pages 203-211 The Neuroendocrine Basis of Infertility....Pages 213-222 Oocyte Donation....Pages 223-233 New Animal Embryo Engineering Technology....Pages 235-261 The Role of the Embryo in Prenatal Diagnosis....Pages 263-269 Historical Perspective of the Infertile Experience....Pages 271-277 Psychological Issues in Infertility: An Historical Overview....Pages 279-287 Psychological Evaluation of the Infertile Couple....Pages 289-296 Male Infertility: The Psychologic Issues....Pages 297-301 Paradise Lost: Sexual Function and Infertility....Pages 303-311 Secondary Infertility....Pages 313-317 Coping with Pregnancy Loss: Ectopic Pregnancy, Recurrent Abortion, and Stillbirth....Pages 319-327 Implementation of Ovum Donation Technology: Start-up Decisions, Challenges, and Problems....Pages 329-336 The Long-Term Psychologic and Social Effects of Gamete Donation....Pages 337-346 Individual Psychotherapy for Infertile Patients....Pages 347-350 Management of Patients with Preexisting Psychiatric Illness....Pages 351-354 Application of Behavioral Medicine Techniques to the Treatment of Infertility....Pages 355-360 Psychotherapy with Infertile Couples....Pages 361-364 Support Groups....Pages 365-371 Psychological Experience of Medical Professionals on the IVF Team....Pages 373-380 When to Call It Quits....Pages 381-389 The Adoptee’s Search: Who Are the Real Parents of Adopted Children?....Pages 391-397 Parenting After Infertility....Pages 399-402 Public Policy and the New Technologies....Pages 403-406 The Legal Response to the New Reproductive Technologies....Pages 407-411 Diethylstilbestrol and Infertility: The Past, the Present, and the Revelance for the Future....Pages 413-423 Ethics of the New Technologies: A Discussion of Case Histories....Pages 425-438 Back Matter....Pages 439-446 The field of reproductive technology witnessed enormous advances in the 1980s which have greatly altered the diagnosis and management of infertility. This book surveys the technological advances in infertility which the clinician must understand to optimize patient care. However, the same technologies that provide new hope for infertile couples generate increasingly complicated social concerns. Therefore, the second part of this volume explores the significant psychosocial, legal, and ethical issues which surround infertility. Gynecologists, general practitioners, psychologists, psychiatrists, social workers, and nurses working with infertile couples will gain meaningful insight into the many aspects of current infertility treatment. Experts in medical law and ethics will also find this book to be fascinating reading