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A Baby at All Costs? Exploring the Use and Provision of Unproven Adjuvant Treatments in the Context of IVF
Abstract
The year 2018 marked 40 years since the birth of Louise Brown, the first baby born as a result of pioneering in vitro fertilization (IVF) treatment. Since then, advances have seen a wide range of reproductive technologies emerge into clinical practice, including adjuvant treatments often referred to as IVF “add-ons.” However, these “optional extras” have faced growing criticism, especially when they have often come at additional financial cost to the patient and have little evidence supporting their efficacy to improve pregnancy or birth rates. Despite this, according to the latest national patient survey by the Human Fertilisation and Embryology Authority, three quarters of patients who had fertility treatment in the United Kingdom in the past two years had at least one type of treatment add-on highlighting the growing demand for these interventions. This article uses a psychosocial perspective to consider the motivations behind patient and clinician behavior along with the wider societal and economic factors that may be impacting upon the increase in the use of adjuvant treatments in fertility clinics more widely. It suggests the reasons fertility patients use unproven “optional extras” are complex, with interpersonal, psychological, and social factors intertwining to generate an increase in the use of IVF add-ons.
... Since pregnancy rates have generally plateaued following decades of improvement of ART, physicians often tend to use various add-ons or adjuvants in attempts to improve the factors relevant to implantation, even though robust evidence for these adjuvant therapies remained limited (2). Despite the criticism of unproven efficacy and additional resource consumption (3), the use of add-ons/adjuvants in ART is widespread. It is estimated that 65% of women undergoing IVF in the U.K. used one or more add-ons in 2021 (4). ...
... A national survey showed that the median number of add-ons the patients took as part of their treatment was two (5). Sometimes, the motives for using adjuvants in ART treatments go further than technical issues (3). Driven by complex motives, such as pursuing solutions to uncertainty, combinations of adjuvants that are supposed to be helpful are used in the same cycle. ...
Objective
To investigate the interaction between atosiban and growth hormone (GH) as adjuvants in frozen-thawed embryo transfer (FET) cycles
Method
A total of 11627 patients who underwent FET at Xiamen University Affiliated Chenggong Hospital between January 2018 to December 2022 were retrospectively analyzed. Among them, 482 patients received atosiban and 275 patients received GH. The interactions were estimated by comparing the odds ratio (OR) for pregnancy comparing patients with or without atosiban adjuvant in cohorts stratified according to the presence of GH use in either the overall cohort or a propensity score (PS) matched cohort. An interaction term (atosiban × GH) was introduced to a multivariate model to calculate the ratio of OR (ORR) adjusted for confounders.
Results
For all patients receiving atosiban administration, no obvious effect on pregnancy was observed in comparison with either matched or unmatched controls. However, when the patients were stratified according to GH administration, atosiban showed a significant association with clinical pregnancy in comparison with either matched or unmatched controls among patients with GH treatment with rate ratios (RR) of 1.32 (95%CI: 1.05,1.67) and 1.35 (95%CI: 1,1.82), respectively. On the other hand, however, the association was absent among patients without GH treatment. The adjusted ORRs in both matched and unmatched cohorts were 2.44 (95%CI: 1.07,5.84) and 1.95 (95%CI: 1.05, 3.49) respectively.
Conclusion
The combination use of atosiban and GH in FET cycles is potentially beneficial to the pregnancy. However, indications for the use of atosiban and GH may need further assessment.
... A holistic and collaborative approach is essential for addressing these challenges. Educational institutions, policymakers, and professional organizations must work together to develop comprehensive strategies that address the multifaceted barriers to effective hybrid CPD implementation (Aravind, 2021;Jones et al., 2021;Lowry et al., 1951;Moon et al., 2013;Nawab, 2020;Shonfeld et al., 2021). Implementing this transition may involve investing in robust digital infrastructure, designing targeted training programs to enhance digital literacy, and fostering supportive communities of practice where educators can share knowledge, collaborate, and collectively navigate the shift to hybrid CPD models. ...
Continuing professional development is essential for enhancing the quality of teaching and learning in English as a Foreign Language education. Hybrid CPD models have been a central focus in language teaching for decades, with various models and approaches proposed to enhance teacher competencies and student learning outcomes. However, the literature lacks a comprehensive review of the existing models, applications, and impacts of hybrid CPD on EFL/ESL teachers. This paper addresses this gap by providing a theoretical review of hybrid CPD models, their key characteristics, and empirical evidence on their effectiveness in improving teacher efficacy and student achievement in national contexts. This research paper presents a comprehensive analysis of the impact of hybrid CPD models, which combine face-to-face and online components, on English as a Foreign Language teacher efficacy and student outcomes in a national context. This study explores the key characteristics, goals, and applications of these hybrid CPD models, their empirical impact on teachers’ pedagogical knowledge, self-efficacy, and professional identity, and the subsequent influence on student engagement, achievement, and language proficiency. The findings of this study indicate that hybrid CPD models can significantly enhance EFL teacher competencies and improve student learning outcomes when designed and implemented effectively, considering contextual factors. Specifically, the impact of hybrid CPD models on EFL teacher efficacy and student outcomes was multifaceted. These models can foster the development of teachers’ pedagogical knowledge, self-efficacy, and professional identity, which, in turn, can lead to improved student engagement, achievement, and language proficiency. However, the effectiveness of hybrid CPD models is contingent on careful design and implementation that considers the unique contextual factors of the educational setting, such as infrastructure, access to technology, and cultural norms. When implemented thoughtfully and with attention to context, hybrid CPD models can be powerful tools for enhancing the quality of English teaching and learning quality.
... One of the major issues surrounding fertility treatment add-ons is the quality of information provided to patients. A growing body of international literature underscores the importance of providing clear information about interventions, including potential uncertainties and risks, to enable patients to make well-informed decisions about their treatment in IVF clinics Jones et al., 2021;Serdarogullari et al., 2025). Studies have shown that information on clinic websites is often incomplete or framed in ways that emphasise potential benefits without adequately addressing the limitations or risks, both in the UK Spencer et al., 2016;Van de Wiel et al., 2020) and globally (Bossi et al., 2024;Galiano et al., 2021;Lensen, Chen, et al., 2021). ...
Clinical innovation by doctors involves the development and use of interventions that have not been formally evaluated according to the usual standards of evidence-based medicine. While the distinction between research and innovation has been discussed theoretically, little is known about how doctors working in different specialty areas define and understand clinical innovation and how they distinguish it from other related practices. In order to address this gap, this qualitative interview study explored how doctors from diverse specialties defined and understood clinical innovation. Thirty-one semi-structured interviews were conducted with Australian doctors from surgery, reproductive medicine, and cancer care. While participants defined clinical innovation in similar ways, they also identified several morally and clinically salient characteristics that distinguish different types of innovation. Based on these findings, we developed a multidisciplinary governance model for clinical innovation that accounts for its diversity and complexity. This governance model offers clear guidance for determining what types of oversight are most appropriate for different types of clinical innovation. Its benefits include that it can be applied across diverse medical specialties and used alongside existing models, such as those used to identify clinical innovation.
Research question
Why are women who face poor prognoses for success in assisted reproductive technologies (ART) choosing to pursue treatments using their own eggs, despite receiving information that their chances of success are very low.
Design
Cross-sectional study based on an anonymous questionnaire distributed to women aged between 43 and 45 years, undergoing ART using their own oocytes, at six public outpatient fertility clinics and three public in-hospital IVF units in Israel between 2015 and 2016. The main outcome measure was personal estimation of chance to achieve a live birth after the current ART treatment cycle and the cumulative estimated rate after all the treatment cycles the patient intended to undergo.
Results
Response rate was 70.0%, with 91 participants of mean age 43.8 ± 0.7 years. Participants estimated their delivery rates after the next ART treatment cycle at 49.0 ± 31.8% (response rate 93.4%) and their cumulative delivery rates after all the ART treatments they would undergo at 57.7 ± 36.3% (response rate 90.1%). This is significantly higher than the predicted success rates of 5% and 15%, respectively (both P < 0.001), which are based on national register data. Nearly one-half of patients rated themselves as having a better than average chance of conception (47.3%).
Conclusion
Women do not pursue futile treatments because they lack information. Despite being informed of the low success rates of conception using ART treatments, many patients of advanced maternal age have unrealistically high expectations from ART, essentially ignoring their estimated prognosis when deciding on treatment continuation. Future work should examine the psychological reasons behind continuing futile fertility treatments.
In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts ‐ Alzheimer’s disease, neonatal surgery, cardiovascular disease prevention, cancer, addiction (use of alcohol and other drugs during pregnancy), mental health/disorders and medical education – and many tackle issues of contemporary relevance, such as an ageing population, and novel medical interventions and their sequelae. These empirical papers are complemented by a further theoretical contribution, which considers the role of ‘implicit normativity’ in masking and containing potential ethical uncertainty. By mapping themes across the collection, in this introduction we present a number of core analytical strands: (1) conceptualising uncertainty; (2) intersections of uncertainty with aspects of care; (3) managing uncertainty; and (4) structural constraints, economic austerity and uncertainty work. We reflect on the methodological and theoretical stances used to think sociologically about uncertainty in health care, and the strengths, silences and gaps we observe in the collection. We conclude by considering the implications of the insights gained for ‘synthesising certainty’ in practice and for future research in this area.
With steadily improving pregnancy and live birth rates, IVF over approximately the first two and a half decades evolved into a highly successful treatment for female and male infertility, reaching peak live birth rates by 2001-2002. Plateauing rates, thereafter, actually started declining in most regions of the world. We here report worldwide IVF live birth rates between 2004 and 2016, defined as live births per fresh IVF/ICSI cycle started, and how the introduction of certain practice add-ons in timing was associated with changes in these live birth rates. We also attempted to define how rapid worldwide 'industrialization' (transition from a private practice model to an investor-driven industry) and 'commoditization' in IVF practice (primary competitive emphasis on revenue rather than IVF outcomes) affected IVF outcomes. The data presented here are based on published regional registry data from governments and/or specialty societies, covering the USA, Canada, the UK, Australia/New Zealand (combined), Latin America (as a block) and Japan. Changes in live birth rates were associated with introduction of new IVF practices, including mild stimulation, elective single embryo transfer (eSET), PGS (now renamed preimplantation genetic testing for aneuploidy), all-freeze cycles and embryo banking. Profound negative associations were observed with mild stimulation, extended embryo culture to blastocyst and eSET in Japan, Australia/New Zealand and Canada but to milder degrees also elsewhere. Effects of 'industrialization' suggested rising utilization of add-ons ('commoditization'), increased IVF costs, reduced live birth rates and poorer patient satisfaction. Over the past decade and a half, IVF, therefore, has increasingly disappointed outcome expectations. Remarkably, neither the profession nor the public have paid attention to this development which, therefore, also has gone unexplained. It now urgently calls for evidence-based explanations.
In an era of high technology and low trust, acknowledging and coping with uncertainty is more crucial than ever. Medical uncertainty has been considered an innate feature of medicine and medical practice. An intolerance to uncertainty increases physicians' stress and the effects of burnout and may be a potential threat to patient safety. Understanding medical uncertainty and acquiring proper coping strategies has been regarded to be a core clinical competency for medical graduates and trainees. Integrating intuition and logic and creating a culture that acknowledges medical uncertainty could be suggested ways to teach medical uncertainty. In this article, the authors describe the concepts of medical uncertainty, its influences on physicians and on medical students toward medical decision making, the role of tolerance/intolerance to uncertainty, and proposed strategies to improve coping with medical uncertainty.
The history of obstetrics and gynaecology is not a tale of evidence‐based practice. Tradition, expert opinion, and the lure of new technology have frequently superseded evidence as the primary driver for clinical decision making. The proof can be found in a litany of dubious interventions which have gained widespread popularity despite an absence of high quality data attesting to their effectiveness and, in some cases, ample credible evidence demonstrating harm. As a specialty, we have relied on investigations including X‐ray pelvimetry and antenatal stress tests, subjected innumerable women to stilboestrol and thalidomide, and have performed routine episiotomy in all primigravid women 1,. It is no surprise that, in 1979, Archie Cochrane famously awarded obstetrics the ‘wooden spoon’ for being the least evidence‐based specialty. This article is protected by copyright. All rights reserved.
Modern medicine has developed an apparently unlimited array of diagnostic and therapeutic tools. Treatment options, for example for patients with hematologic malignancies, are expanding rapidly. These developments, offering a spectrum of modalities, provide a new outlook on successful treatment for many patients. However, for any individual patient, decisions as to the optimum treatment strategy remain challenging as all prognostic projections are based on statistics. The challenge lies in the identification of parameters that characterize individual patients as prospective responders or non-responders and, hence, determine the prognosis. Both physicians and patients are confronted with the uncertainty of treatment success with any strategy in a particular disease condition and with the impact of treatment outcome on overall prognosis. How certain is it that this one patient has the best prognosis with that particular intervention? How does the physician's own uncertainty affect decisions by the less well informed patient? Here we examine various aspects of uncertainty and their relevance in the process of medical decision-making as briefly illustrated by two clinical scenarios of hematologic malignancies.
We live in an era saturated with the language and imagery of hope. Patient advocacy groups, welfare groups, and organizations oriented to various humanitarian causes often make direct reference to hope in their official titles and campaign bylines: “Pink Hope,” “Giving children hope,” “Hope: Global,” “Hope: Preventing Euthanasia and Assisted Suicide,” “Hope Foundation,” and “Australia HOPE International,” to name a few. Politicians of both the left and right have sought to deploy the rhetoric of hope to announce promises of economic prosperity and their commitments to provide improved social services and to deliver better futures for all. The now-famous “Hope” poster, which represented President Barak Obama’s 2008 presidential campaign, serves as a powerful illustration of the symbolic power of the hope message, a message that Australia’s Prime Minister, Tony Abbott, also appropriated for his 2013 “Hope, Reward, and Opportunity” election poster campaign. People’s hopes readily feature within the language of advertisements (Petersen and Seear, 2011). As Raymond Williams (1980) noted, the enticement of hope is an essential part of the “magic system,” whereby efforts are made to persuade and identify consumerism as the means to personal fulfillment and happiness. It might be argued, however, that it is in relation to matters of health, illness, and healing that hope finds its fullest expression and is most forcefully addressed as a vital concern. This is not only due to the fact that the lived disruption and distress of injury and
This article discusses the new reproductive technology of egg freezing in the context of existing literature on gender, medicalization, and infertility. What is unique about this technology is its use by women who are not currently infertile but who may anticipate a future diagnosis. This circumstance gives rise to a new ontological category of “anticipated infertility.” The author draws on participant observation and a qualitative analysis of scientific, mainstream, and marketing literature to identify and compare the representation of two different candidates for egg freezing: women with cancer and healthy young women. Although both populations experience anticipated infertility, their dichotomous portrayals as appropriate candidates are demonstrative of gender norms linking women to motherhood. Egg freezing is a concise illustration of how the medicalization of women’s bodies and bodily processes masks a host of cultural anxieties about aging, illness, reproduction, and risk.
Power is an inescapable aspect of all socialrelationships, and inherently is neither goodnor evil. Doctors need power to fulfil theirprofessional obligations to multipleconstituencies including patients, thecommunity and themselves. Patients need powerto formulate their values, articulate andachieve health needs, and fulfil theirresponsibilities. However, both parties canuse or misuse power. The ethical effectivenessof a health system is maximised by empoweringdoctors and patients to develop `adult-adult'rather than `adult-child' relationships thatrespect and enable autonomy, accountability,fidelity and humanity. Even in adult-adultrelationships, conflicts and complexitiesarise. Lack of concordance between doctors andpatients can encourage paternalism but may bebest resolved through negotiated care. Afurther area of conflict involves the `doubleagency' of doctors for both patients and thecommunity. Empowerment of all players is notalways possible but is most likely where eachparty considers and acknowledges power issues.
High-quality healthcare should be effective, safe and patient-centred. How important patient-centredness is in relation to effectiveness of fertility care has never been investigated. This study aimed to determine and compare the importance of patient-centredness, relative to pregnancy rates, to patients and physicians.
A discrete choice experiment (DCE) was designed. Participants had to choose between hypothetical fertility clinics differing in following attributes: travel time; pregnancy rate (effectiveness); physicians' attitude; information on treatment; and continuity of physicians (the latter three represent patient-centredness). A total of 1378 patients and 268 physicians from eight Dutch and Belgian fertility clinics received the DCE-questionnaire. The attributes' relative importance was analysed using multinomial logistic regression. Additionally, patients' actual choice behaviour was investigated.
In total, 925 patients and 227 physicians participated. Pregnancy rates were relatively more important to physicians. Patients assigned more value to patient-centredness (P < 0.001) and were willing to trade-off a higher pregnancy rate for patient-centredness than physicians recommended them to do (P < 0.05). For example, patients considered pregnancy rates 1.5 times as important as an interested physician's attitude, whereas physicians considered this 2.4 times as important (P < 0.001). The willingness to trade-off pregnancy rate for this attitude was 9.8% for patients and 6.3% for physicians (P < 0.001). A lack of patient-centredness was the most cited non-medical reason for changing fertility clinics.
Patients and physicians put considerable value on pregnancy rates. However, physicians significantly undervalue the importance of patient-centredness to patients. Clinics aiming to optimize the quality of their services should be aware of the substantial importance their patients assign to patient-centredness.
Background
The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. The Objective was to identify patients' expectations and reasons governing the choice of complementary medicine compared with conventional primary care (CONV).
Methods
The data were derived from the PEK study (Programm Evaluation Komplementärmedizin), which was conducted in 2002–2003 with 7879 adult patients and parents of 1291 underage patients, seeking either complementary (CAM) or conventional (CONV) primary care. The study was performed as a cross-sectional survey. The respondents were asked to document their (or their children's) self-perceived health status, reasons governing their choice, and treatment expectations. Physicians were practicing conventional medicine and/or complementary methods (homeopathy, anthroposophic medicine, neural therapy, and traditional Chinese medicine). Reasons governing the choice of physician were evaluated on the basis of a three-part classification (physician-related, procedure-related, and pragmatic/other reasons)
Results and Discussion
Patients seeing CAM physicians tend to be younger and more often female. CAM patients referred to procedure-related reasons more frequently, whereas pragmatic reasons dominated among CONV patients. CAM respondents expected fewer adverse side effects compared to conventional care patients.
Conclusion
The majority of alternative medicine users appear to have chosen CAM mainly because they wish to undergo a certain procedure; additional reasons include desire for more comprehensive treatment, and expectation of fewer side-effects.
The aim of this study was to examine the unique and shared predictive power of psychological variables on reproductive physical health. Three months before fertility treatment, 97 women completed measures of dispositional optimism, trait anxiety, and coping. Information about biological response to treatment (e.g., estradiol level) was collected from medical charts after treatment. Structural equation modeling showed that measured psychological variables were all significant indicators of a single latent construct and that this construct was a better predictor of biological response to treatment than was any individual predictor. This research contributes to evidence suggesting that the health benefits of dispositional optimism are due to its shared variance with neuroticism.
Add-on treatments are the new black. They are provided (most frequently, sold) to patients undergoing in vitro fertilization on the premise that they will improve the chances of having a baby. However, the regulation of add-ons is consistently minimal, meaning that they are introduced into routine practice before they have been shown to improve the live birth rate. Debate on the adequacy of this light-touch approach rages. Defenders argue that demands for a rigorous approval process are paternalistic, as this would delay access to promising treatments. Critics respond that promising treatments may turn out to have adverse effects on patients and their offspring, contradicting the clinician's responsibility to do no harm. Some add-ons, including earlier versions of preimplantation genetic testing for aneuploidy, might even reduce the live birth rate, raising the prospect of desperate patients paying more to worsen their chances. Informed consent represents a solution in principle, but in practice there is a clear tension between impartial information and direct-to-consumer advertising. Because the effects of a treatment cannot be known until it has been robustly evaluated, we argue that strong evidence should be required before add-ons are introduced to the clinic. In the meantime, there is an imperative to identify methods for communicating the associated risks and uncertainties of add-ons to prospective patients.
Compassionate transfer is a procedure wherein in vitro-created embryos are placed in a patient's cervix, vagina or uterus at an infertile period in the menstrual cycle where they are expected to perish. Patients report that they feel this procedure is a more natural means of disposition and provides them with the opportunity to grieve the loss of a potential child. However, some have argued that the procedure is an unnecessary, and illogical, addition to fertility treatment and that it detracts resources from medical care. Here, we introduce compassionate transfer as an alternative disposition option and argue that, for certain patients, it may constitute an ethical extension of fertility care that respects patient autonomy and psychosocial health.
The promise of egg freezing for women’s fertility preservation entered feminist debate in connection with medical and commercial control over, and emancipation from, biological reproduction restrictions. In this paper we explore how women negotiate and make sense of the decision to freeze their eggs. Our analysis draws on semi-structured interviews with 16 women from the Midwest and East Coast regions of the USA who froze their eggs. Rather than freezing to balance career choices and ‘have it all’, the women in this cohort were largely ‘freezing for love’ and in the hope of having their ‘own healthy baby’. This finding extends existing feminist scholarship and challenges bioethical concerns about egg freezing by drawing on the voices of women who freeze their eggs. By viewing egg freezing as neither exclusively liberation nor oppression or financial exploitation, this study casts egg freezing as an enactment of ‘responsible’ reproductive citizenship that ‘anticipates coupledom’ and reinforces the genetic relatedness of offspring.
In Australia, the growing assisted reproductive technologies (ART) industry has recently received some public criticism. Much of this criticism centres on the concern that doctors are increasingly motivated by profit, rather than patient interests. These concerns appear to suggest that the growing business of ART generates conflicts of interest (COI) for clinicians. While media reports may be rhetorically compelling, claims that ART practice is distorted by COI must be supported by empirical evidence. This preliminary study sought to engage with people involved with the ART industry and map out their concerns related to COI in ART. A small convenience sample of eight professionals was interviewed. Here, we present the major themes uncovered, including a richer understanding of the ‘interests’ of various parties involved in Australian ART. We then propose a strategy for how this topic could be constructively explored.
Over the past decade ‘social egg freezing’ has emerged as a technology of hope that purports to empower women by enabling them to continue their careers or find the right partner without the fear of jeopardising their fertility. This technology has been promoted and celebrated by fertility companies, bioethicists, clinicians, and multi-national corporations such as Apple and Facebook. While critical questions have been raised, they tend to focus on ethical and legal issues, such as informed consent and patient autonomy. This paper uses Foucault’s notion of dispositif as analytic lens to examine the entanglement of the commercial arrangements of fertility companies, the discursive use of hope in promoting these services, and effects on professional medical care. Drawing on socio-political analyses of hope, this paper examines the potential financial conflicts of interest facing clinicians and the way discourses of hope might mask problematic financial relations and lack of evidence of effectiveness.
While studies of ‘parenting culture’ and ‘assisted reproductive technologies’ are now well-established areas of social science scholarship, so far, the potential connections between the two fields have not been significantly explored. Responding to calls for a more ‘processual’ approach to studying reproduction in order to make clearer contributions to sociological theory more broadly, we begin a dialogue between these mutually relevant bodies of literature, highlighting connections and crosscutting findings. We focus on four interlinked themes – Reflexivity, Gender, Expertise and Stratification – and promote a more holistic approach to understanding how children are conceived and cared for within the current ‘Euro-American’ reproductive landscape. By way of conclusion, we draw attention to the contemporary context of ‘anxious reproduction’ and propose directions for future research.
Modern Families brings together research on parenting and child development in new family forms including lesbian mother families, gay father families, families headed by single mothers by choice and families created by assisted reproductive technologies such as in vitro fertilisation (IVF), egg donation, sperm donation, embryo donation and surrogacy. This research is examined in the context of the issues and concerns that have been raised regarding these families. The findings not only contest popular myths and assumptions about the social and psychological consequences for children of being raised in new family forms but also challenge well-established theories of child development that are founded upon the supremacy of the traditional family. It is argued that the quality of family relationships and the wider social environment are more influential in children’s psychological development than are the number, gender, sexual orientation, or biological relatedness of their parents or the method of their conception.
During ethnographic fieldwork at a fertility clinic in Denmark, I became intrigued by emotions. In particular, I found an incidence labelled ‘psychological IVF’ theoretically provocative as it challenged my views on materializations, which I was preparing to study. This paper centres on the story of psychological IVF, and I use this narrative to consider emotions and materialization methodologically. I also ask how emotions at fertility clinics can be conceptualized to enable analysis of their materialization, change, and effects. In order to do so, I develop the term ‘emotional choreography’. This theoretical work has three aims. First, it seeks to illustrate how the story of psychological IVF offers a rich range of materializations of emotions. Secondly, this work proposes a feminist materialist conceptualization of emotions that is both non-representational and posthuman. This conceptualization draws upon Thompson's notion of ontological choreography and Barad's theory of agential realism, extending these concepts to develop the notion of emotional choreography. Finally, this paper aims to contribute to current discussions regarding (new) materialisms within feminist theory, underscoring the conceptual importance of the feminist legacy.
Hope is defined as the process of thinking about one's goals, along with the motivation to move toward (agency) and the ways to achieve (pathways) those goals. After discussing other related concepts, the scale for measuring hope is introduced, and the role of hope in the counseling process is described.
The wholesale introduction of any new procedure to medical practice requires an acceptance based on evidence-based medicine, which is primarily acquired using prospective randomized controlled trials. However, for self-funded treatments, as are the majority of IVF cycles, this has always been very difficult to achieve. Generally, new technologies are introduced and adopted by patients who have failed in previous attempts at IVF. Urging patients to enter into a prospective randomized controlled trial is problematic, especially when they are self-funding; eagerness to conceive when time is against them, and/or having undergone previously failed treatment attempts, convince most patients to fund the new technology/opportunity rather than risk falling into the control arm and repeating their previous failure(s). The UK is uniquely placed to advance IVF medicine by helping practitioners and patients gain access to vital trials through the National Health Service.
Context.—
Research both in the United States and abroad suggests that significant
numbers of people are involved with various forms of alternative medicine.
However, the reasons for such use are, at present, poorly understood.Objective.—
To investigate possible predictors of alternative health care use.Methods.—
Three primary hypotheses were tested. People seek out these alternatives
because (1) they are dissatisfied in some way with conventional treatment;
(2) they see alternative treatments as offering more personal autonomy and
control over health care decisions; and (3) the alternatives are seen as more
compatible with the patients' values, worldview, or beliefs regarding the
nature and meaning of health and illness. Additional predictor variables explored
included demographics and health status.Design.—
A written survey examining use of alternative health care, health status,
values, and attitudes toward conventional medicine. Multiple logistic regression
analyses were used in an effort to identify predictors of alternative health
care use.Setting and Participants.—
A total of 1035 individuals randomly selected from a panel who had agreed
to participate in mail surveys and who live throughout the United States.Main Outcome Measure.—
Use of alternative medicine within the previous year.Results.—
The response rate was 69%.The following variables emerged as predictors
of alternative health care use: more education (odds ratio [OR], 1.2; 95%
confidence interval [CI], 1.1-1.3); poorer health status (OR, 1.3; 95% CI,
1.1-1.5); a holistic orientation to health (OR, 1.4; 95% CI, 1.1-1.9); having
had a transformational experience that changed the person's worldview (OR,
1.8; 95% CI, 1.3-2.5); any of the following health problems: anxiety (OR,
3.1; 95% CI, 1.6-6.0); back problems (OR, 2.3; 95% CI, 1.7-3.2); chronic pain
(OR, 2.0; 95% CI, 1.1-3.5); urinary tract problems (OR, 2.2; 95% CI, 1.3-3.5);
and classification in a cultural group identifiable by their commitment to
environmentalism, commitment to feminism, and interest in spirituality and
personal growth psychology (OR, 2.0; 95% CI, 1.4-2.7). Dissatisfaction with
conventional medicine did not predict use of alternative medicine. Only 4.4%
of those surveyed reported relying primarily on alternative therapies.Conclusion.—
Along with being more educated and reporting poorer health status, the
majority of alternative medicine users appear to be doing so not so much as
a result of being dissatisfied with conventional medicine but largely because
they find these health care alternatives to be more congruent with their own
values, beliefs, and philosophical orientations toward health and life.
IN 1993 Eisenberg and colleagues1 reported
that 34% of adults in the United States used at least 1 unconventional form
of health care (defined as those practices "neither taught widely in U.S.
medical schools nor generally available in U.S. hospitals") during the previous
year. The most frequently used alternatives to conventional medicine were
relaxation techniques, chiropractic, and massage. Although educated, middle-class
white persons between the ages of 25 and 49 years were the most likely ones
to use alternative medicine, use was not confined to any particular segment
of the population. These researchers estimated that Americans made 425 million
visits to alternative health care providers in 1990, a figure that exceeded
the number of visits to allopathic primary care physicians during the same
period.
Recent studies in the United States2
and abroad3- 4 support the prevalent
use of alternative health care. For example, a 1994 survey of physicians from
a wide array of medical specialties (in Washington State, New Mexico, and
Israel) revealed that more than 60% recommended alternative therapies to their
patients at least once in the preceding year, while 38% had done so in the
previous month.2 Forty-seven percent of these
physicians also reported using alternative therapies themselves, while 23%
incorporated them into their practices.
When faced with the apparent popularity of unconventional medical practices
and the fact that people seem quite willing to pay out-of-pocket for these
services,1 the question arises: What are the
sociocultural and personal factors (health status, beliefs, attitudes, motivations)
underlying a person's decision to use alternative therapies?
At present, there is no clear or comprehensive theoretical model to
account for the increasing use of alternative forms of health care. Accordingly,
the goal of the present study was to develop some tentative explanatory models
that might account for this phenomenon.
Three theories that have been proposed to explain the use of alternative
medicine were tested:
Dissatisfaction: Patients are dissatisfied with
conventional treatment because it has been ineffective,5- 6
has produced adverse effects,6- 7
or is seen as impersonal, too technologically oriented, and/or too costly.6- 15Need for personal control: Patients seek alternative
therapies because they see them as less authoritarian16
and more empowering and as offering them more personal autonomy and control
over their health care decisions.14,16- 19Philosophical congruence: Alternative therapies
are attractive because they are seen as more compatible with patients' values,
worldview, spiritual/religious philosophy, or beliefs regarding the nature
and meaning of health and illness.19- 24
In addition to testing the validity of these 3 theoretical perspectives,
this study also sought to determine on an exploratory basis how the decision
to seek alternative therapies is affected by patients' health status and demographic
factors.
Around one million couples in Poland suffer from infertility People in reproductive age are most active Internet users. The aim of the study was to assess Internet habits of infertile patients. We checked to what extent infertile patients seek information about infertility on-line and what is their approach to the information found.
85 female patients treated for infertility for at least one year were surveyed. The anonymous questionnaire was designed by the authors of the publication. It consisted of questions related to medical history of the patients and sources of information about infertility they used. It also checked Internet activity of the patients and contained Beck's Depression Inventory (BDI). Chi-square test and Spearman's correlation test were used to evaluate the results.
The majority of patients used Internet to find information about infertility (93%); 46% of the respondent declared Internet forums to be their main source of information about it. Patients used on-line sources of information more often than stricte medical sources. Internet influenced their relation with the physician. 64% of patients verified on-line information and treatment proposed by their doctor before using them. One third of the surveyed women claimed their knowledge about infertility comes more from the Internet than the specialist who treated them. There was a positive correlation between patients who checked diagnostic or therapeutic methods proposed by their physician with depression in BDI.
Considering the great impact of Internet forums and web pages on patient approach to diagnostics and treatment of infertility there seems to be a need to create a professional Polish website and forum to provide the patients with reliable information about the disease.
In this article I draw on the data from a recently completed research project within which I was concerned with exploring the social, emotion, and medical experience of ‘infertility’ and ‘involuntary childlessness’ (predominantly women's). Here I am concerned particularly with the status and experience of non-motherhood and of motherhood achieved following ‘infertility’/‘involuntary childlessness’. I suggest that non-mothers often feel stigmatised and perceive that others view them as less than whole, pitiable and “desperate” even though they often do not feel this way themselves. Women who achieve motherhood following ‘infertility’/‘involuntary childlessness’ (particularly social rather than biological motherhood) still feel that they do not meet the ideal. All of this leads me to suggest that both non-mothers and women who achieve motherhood in an unusual way can be seen as the “other,” as “stranger.”
The reproductive body has become the site of intensive medical intervention, yet, paradoxically, women have never been more at risk of suffering the distress of infertility. Drawing on in-depth interviews with 22 infertile women, this article explores their reproductive experience from fertility postponement to assisted conception. All had used both modern contraception and in vitro fertilisation, yet none achieved the fertility they desired, when they desired it. All had structured their use of these technologies around the social practice of postponement. Modern contraception, however, while removing the sexual costs of postponement, did not resolve its reproductive dilemmas. Rather it appeared to collapse the experience of this traditionally difficult process, sustaining an illusion of reproductive control in which fertility decisions were 'put on the back burner', undiscussed and sometimes unimagined. For these women this delay then revealed the hidden cost of postponement--infertility--which, in turn, led to their pursuit of assisted conception after the age of 35, at precisely the point when its already limited efficacy begins to fail sharply. In these accounts age-related infertility emerged as a tale of two technologies: two technologies linked to each woman, and each other, through the social practice of postponement.
The objective of this study was to investigate the views of patients and experts in Germany on information provision and decision-making in assisted reproduction treatment (ART).
Standard questionnaire techniques were used for interviewing Reproductive Physicians (n= 230), Psychosocial Counsellors (n = 66) and Patients (n = 1590). Descriptive data analyses and non-parametric tests for significance were performed.
Higher scores were assigned for information on the chances for treatment success and on direct, physical risks of fertility treatment than for information on the risks and burden of multiple pregnancies and on the emotional risks and burden associated with infertility treatment. Three-quarters (74%) of the Patients (P) reported that they had experienced an overwhelming desire for a child at some point during their treatment, and half (47%) stated that they had experienced the feeling of losing control over the situation. According to 25% of the Reproductive Physicians (RP) and 47% of the Psychosocial Counsellors (PC), patients are often or very often limited in their capacity to decide when to stop the treatment.
A significant number of patients in reproductive care in Germany are not well informed on all the aspects that are relevant for treatment decision-making, are overwhelmed by their desire for a child, lose control over the situation, and are limited in their capacity to end unsuccessful treatment. Information provision should be ensured and monitored during treatment by standardized safeguards. A strategy for stopping ART and embarking on alternative ways of coping with infertility should be installed from the outset of every treatment.
Assisted reproductive technology (ART) makes babies and parents at once. Drawing on science and technology studies, feminist theory, and historical and ethnographic analyses of ART clinics, Charis Thompson explores the intertwining of biological reproduction with the personal, political, and technological meanings of reproduction. She analyzes the "ontological choreography" at ART clinics—the dynamics by which technical, scientific, kinship, gender, emotional, legal, political, financial, and other matters are coordinated—using ethnographic data to address questions usually treated in the abstract. Reproductive technologies, says Thompson, are part of the increasing tendency to turn social problems into biomedical questions and can be used as a lens through which to see the resulting changes in the relations between science and society.
After giving an account of the book's disciplinary roots in science and technology studies and in feminist scholarship on reproduction, Thompson comes to the ethnographic heart of her study. She develops her concept of ontological choreography by examining ART's normalization of "miraculous" technology (including the etiquette of technological sex); gender identity in the assigned roles of mother and father and the conservative nature of gender relations in the clinic; the naturalization of technologically assisted kinship and procreative intent; and patients' pursuit of agency through objectification and technology. Finally, Thompson explores the economies of reproductive technologies, concluding with a speculative and polemical look at the "biomedical mode of reproduction" as a predictor of future relations between science and society.
Many doctors, patients, journalists, and politicians alike do not understand what health statistics mean or draw wrong conclusions without noticing. Collective statistical illiteracy refers to the widespread inability to understand the meaning of numbers. For instance, many citizens are unaware that higher survival rates with cancer screening do not imply longer life, or that the statement that mammography screening reduces the risk of dying from breast cancer by 25% in fact means that 1 less woman out of 1,000 will die of the disease. We provide evidence that statistical illiteracy (a) is common to patients, journalists, and physicians; (b) is created by nontransparent framing of information that is sometimes an unintentional result of lack of understanding but can also be a result of intentional efforts to manipulate or persuade people; and (c) can have serious consequences for health.
The causes of statistical illiteracy should not be attributed to cognitive biases alone, but to the emotional nature of the doctor–patient relationship and conflicts of interest in the healthcare system. The classic doctor–patient relation is based on (the physician's) paternalism and (the patient's) trust in authority, which make statistical literacy seem unnecessary; so does the traditional combination of determinism (physicians who seek causes, not chances) and the illusion of certainty (patients who seek certainty when there is none). We show that information pamphlets, Web sites, leaflets distributed to doctors by the pharmaceutical industry, and even medical journals often report evidence in nontransparent forms that suggest big benefits of featured interventions and small harms. Without understanding the numbers involved, the public is susceptible to political and commercial manipulation of their anxieties and hopes, which undermines the goals of informed consent and shared decision making.
What can be done? We discuss the importance of teaching statistical thinking and transparent representations in primary and secondary education as well as in medical school. Yet this requires familiarizing children early on with the concept of probability and teaching statistical literacy as the art of solving real-world problems rather than applying formulas to toy problems about coins and dice. A major precondition for statistical literacy is transparent risk communication. We recommend using frequency statements instead of single-event probabilities, absolute risks instead of relative risks, mortality rates instead of survival rates, and natural frequencies instead of conditional probabilities. Psychological research on transparent visual and numerical forms of risk communication, as well as training of physicians in their use, is called for.
Statistical literacy is a necessary precondition for an educated citizenship in a technological democracy. Understanding risks and asking critical questions can also shape the emotional climate in a society so that hopes and anxieties are no longer as easily manipulated from outside and citizens can develop a better-informed and more relaxed attitude toward their health.
While uncertainty can never be totally eliminated from clinical practice, physicians can at least come to terms with it. In interviews with Canadian physicians in a variety of clinical settings, three sources of uncertainty affecting the allocation of medical resources were identified. Technical uncertainty arises from inadequate scientific data. Personal uncertainty arises from not knowing patients' wishes. Conceptual uncertainty arises from the problem of applying abstract criteria to concrete situations.
In this article I use literature from the medical and social sciences, as well as interviews with women and couples with fertility impairments, to argue against locating the compelling character of conceptive technology exclusively in pronatalist or patriarchal agendas. I suggest that the attraction to this technology derives not only from these broader cultural values but also from the way that the technology itself works (or does not work). Studying conceptive techniques helps illuminate why enough never seems to be enough for couples and physicians in pursuit of fertility.
Nowadays, the Internet has a tremendous impact on modern society, including healthcare practice. The study aim was to characterize current Internet use by IVF and ICSI patients and to identify their preferences regarding Internet applications in fertility care.
A total of 163 couples with fertility problems awaiting an IVF or ICSI procedure in the University Medical Centre Nijmegen, The Netherlands, was asked to complete a written questionnaire on Internet use in general, and also for fertility-related problems, preferences regarding Internet applications in fertility care and demographic characteristics.
The response rate was 82%. In total, 81% of infertile couples used the Internet. Multivariate logistic regression analysis showed ethnic background and annual family income to be significant predictors of Internet use. Some 66% of Internet users and 54% of the total study population used the Internet for fertility-related problems. The female partners were the main Internet users with regard to fertility-related issues. In terms of preferences of the study participants, the majority favoured personal medical information online.
Most infertile couples used the Internet with respect to fertility-related problems and were interested in implementation of Internet applications in fertility care. Healthcare providers should actively participate in the development and implementation of Internet applications in fertility care.
To evaluate perceived helpfulness of and reliance on infertility information and support sources and correlates of online information and support seeking among infertile women.
Cross-sectional survey.
Web site of RESOLVE: The National Infertility Association.
A total of 567 infertile women responded to an invitation.
Self-administered online questionnaire.
Sense of being informed, perceived helpfulness of online information, perceived helpfulness of online support, perceived helpfulness of infertility specialist for information, perceived helpfulness of infertility specialist for support.
The Internet is the most heavily relied-upon source, followed by books and infertility specialists. Sense of being informed was related to patient history, comfort level with doctor, doctor's encouragement of Internet use, and reliance on infertility specialists, but not related to Internet use. Perceived helpfulness of online information was negatively related to reliance on infertility specialists for information and support.
Providers should consider patients' perceptions of the Internet as an information and support source. Encouraging Internet use may help women feel comfortable talking with providers and asking questions, two major factors that contributed significantly to ratings of specialists and to these women's sense of being informed about their infertility.