Beyond pathology: women's lived experiences of melancholy and mourning in infertility treatment.

Throughout history, melancholy and mourning are predominantly understood within the tradition of psychopathology. Herein, melancholy is perceived as an ailing response to significant loss, and mourning as a healing experience. By taking the philosophies of Freud, Ricoeur and Kristeva together with relevant social scientific research as a theoretical framework and by drawing on women's accounts of melancholy and mourning in infertility treatment, we offer an exploration of melancholy and mourning beyond this pathological ailing/healing logic. We do so by asking what it means for women to actually live with melancholy and mourning in infertility treatment. In answering this question, we show that women in infertility treatment may have different kinds of melancholic longings: they desire their lost time as a pregnant woman, lost love life and lost future. Within these longings, women derive their sense of self predominantly from their lost past: they understand themselves as the mothers or lovers they once were or could have been. We further reveal that some of these women attempt to escape this dwelling of identity and mourn their losses by (re)narrating their pasts or through performing rituals. While these results show how melancholy and mourning are coshaped in relation to these women's embodied, temporal, sociocultural and material lived context, they also give insight into how melancholy and mourning may be understood beyond infertility treatment. We reveal how the binary dynamic between melancholy and mourning is inherently ambiguous: melancholy instigates a joyous painfulness, something that is or is not overcome through the agonising exertion of mourning. We show, moreover, that underlying this melancholy/mourning dynamic is a pressing and uncontrollable reality of not being able to make (sufficient) sense of oneself. At the end of this work, then, we argue that it follows out of these conclusions' urgency to have context-sensitive compassionate patience with those who live with melancholy and mourning.

Disability rights, reproductive technology, and parenthood: unrealised opportunities.

The common attitude towards parents with disabilities is suspicious. Whereas usually, people are expected to become parents as part of a natural-social life course, disability and parenthood are conceived as contradicting terms. This is due to negative perceptions regarding the parenting capacity of people with disabilities, and lack of adequate state support for children upbringing. Disability Rights theories portray different approaches, aiming to promote equality, considering the unique life experiences of parents with disabilities. They acknowledge the discrimination that takes place whenever accommodations are denied, and they bring a universal point of view to light. Through the case of Ora Mor-Yosef, a woman with a severe physical disability who initiated the birth of a baby girl, with no genetic connection to her, the article wishes to demonstrate the potential contribution of reproductive technology, combined with legal parenthood developments, and disability studies theories, to the advancement of parenting rights and opportunities for persons with disabilities. Regrettably, Ora's case did not serve as a platform for such promotion. "Social disability obstacles", suspicion, and negative attitudes that still prevail regarding parents with disabilities, have led both the government authorities and the courts to deny Ora's attempt to accommodate reproductive technological processes and become a mother.

Do traditional sheep breeders perform conscious selection? An example from a participatory breeding program of Morada Nova sheep.

The implementation of sustainable breeding programs requires genetic breeding strategies that are appropriate for the reality production systems. It is also essential that the choice of animal selection criteria be based on breeders' knowledge and objectives. This work is an ethno-zootechnical study of the Morada Nova sheep breed and its crossbreeds. The goals of this study were to register and analyze indigenous breeders' knowledge and practices regarding animal selection criteria and to generate technical information to support a participatory breeding program of the breed. This study was conducted in the Morada Nova municipality in the state of Ceará, Brazil. Semi-structured interviews were evaluated using two groups of individuals, purebred Morada Nova sheep breeders (RMN, n = 13) and breeders of Morada Nova crossbreeds (MMN, n = 48). Interview questions were used to identify local selection criteria adopted by each group in the choice of animals for breeding. Data from the interviews were submitted to frequency distribution analysis and the Shapiro-Wilk test to verify their distribution. Later, the Kruskal-Wallis test was used to compare the two groups of farmers based on that information, in addition to multivariate statistical analysis and evaluation of Smith salience index. Breeders in the RMN group used selection criteria related to breed standards, such as pelage color. In contrast, breeders of the MMN group used criteria related to productivity, such as body conformation and milk production. Breeders should be engaged in the development of breeding programs, and it is important to consider their preferences and objectives when evaluating breeding animals.

Donor Conception and "Passing," or; Why Australian Parents of Donor-Conceived Children Want Donors Who Look Like Them.

This article explores the processes through which Australian recipients select unknown donors for use in assisted reproductive technologies and speculates on how those processes may affect the future life of the donor-conceived person. I will suggest that trust is an integral part of the exchange between donors, recipients, and gamete agencies in donor conception and heavily informs concepts of relatedness, race, ethnicity, kinship, class, and visibility. The decision to be transparent (or not) about a child's genetic parentage affects recipient parents' choices of donor, about who is allowed to "know" children's genetic backgrounds, and how important it is to be able to "pass" as an unassisted conception. In this way, recipients must trust the process, institutions, and individuals involved in their treatment, as well as place trust in the future they imagine for their child. The current market for donor gametes reproduces normative conceptions of the nuclear family, kinship, and relatedness by facilitating "matching" donors to recipients by phenotype and cultural affinities. Recipient parents who choose not to prioritize "matching," and actively disclose the process of children's conceptions, may embark on a project of queering heteronormative family structures and place great trust in both their own children and changing social attitudes to reduce stigma and generate acceptance for non-traditional families.

Obligatory Effort [Hishtadlut] as an Explanatory Model: A Critique of Reproductive Choice and Control.

Studies on reproductive technologies often examine women's reproductive lives in terms of choice and control. Drawing on 48 accounts of procreative experiences of religiously devout Jewish women in Israel and the US, we examine their attitudes, understandings and experiences of pregnancy, reproductive technologies and prenatal testing. We suggest that the concept of hishtadlut-"obligatory effort"-works as an explanatory model that organizes Haredi women's reproductive careers and their negotiations of reproductive technologies. As an elastic category with negotiable and dynamic boundaries, hishtadlut gives ultra-orthodox Jewish women room for effort without the assumption of control; it allows them to exercise discretion in relation to medical issues without framing their efforts in terms of individual choice. Haredi women hold themselves responsible for making their obligatory effort and not for pregnancy outcomes. We suggest that an alternative paradigm to autonomous choice and control emerges from cosmological orders where reproductive duties constitute "obligatory choices."

The Subrogacy Trap

En el presente nos dedicamos a analizar el tema de la “maternidad subrogada” y los avatares para las dos partes involucradas en el marco de una relación que se regula mediante la firma de un contrato comercial. La acción nos deja abierta la posibilidad de cuestionar el impacto de la Maternidad Subrogada sobre la función materna, el deseo materno, partiendo de la premisa de que la llamada Industria de la Fertilidad cuenta con un poder capaz de instituir un nuevo tipo de subjetividad al interior de la misma, desdoblándola al someter a los cuerpos deseantes a la lógica impuesta desde el mercado a través de su agente: el consumidor...

In this paper, we address the issue of the "Surrogate Motherhood", by analyzing the film "The Subrogacy Trap". Using it as "empirical evidence" we analyze the complexity of the phenomenon and its impact on the two parties involved in a context that is that of a relationship regulated by the signing of a commercial contract: the "contracting parents", and the "surrogate mother". The action of the film opens up to us the possibility of questioning the impact of this particular practice on key human symbolic institutions, like the "maternal function", and the "maternal desire", but also over the bodies, the material and symbolic body of a person. We based our conclusions on the premise that the so called "Fertility Industry " has the power to impact directly on them by establishing new kinds of subjectivities inside these symbolic institutions. Also, this same power tends to subdue the desiring bodies, transforming them into commodities, with the help of coercive technologies/tools, imposed from a logic that answers that of the global political-economy of our time, through his main agent: the consumer.

Aspectos psicológicos de mulheres que se submeteram às tecnologias de reprodução assistida

A infertilidade configura-se como um problema universal, porém mais pronunciado em países em desenvolvimento. Segundo dados da Organização Mundial da Saúde, estima-se no século XXI, uma percentagem de infertilidade de 8 a 12%. Neste sentido, o presente trabalho tem por objetivo analisar nas mulheres, os aspectos psicológicos que estão presentes no processo de reprodução assistida. O método utilizado teve um delineamento qualitativo de caráter interpretativo. Foram avaliadas 11 mulheres na faixa etária de 20 a 41 anos, que estavam pela primeira vez participando do processo de reprodução assistida. Estas mulheres foram encaminhadas pelo serviço de reprodução assistida do Hospital Fêmina. O instrumento utilizado foi uma entrevista semiestruturada, que foi gravada e posteriormente transcrita e a análise de dados foi realizada através do procedimento de análise de conteúdo de Bardin(2003). Este estudo constatou que a relação das mulheres entrevistadas apresenta uma relação com características da pré-genitalidade com suas próprias mães, sendo que estas demonstram um discurso que representa um pensamento de pouca subjetividade psíquica. A representação paterna dá-se com características falhas, que não cumprem o papel interditor da relação mãe-bebê. As fantasias mais frequentes encontradas foram de incapacidade de ser mãe, bem como a de ter problemas orgânicos além de psicológicos. A representação de filho se deu de uma forma idealizada, sendo que as vezes vem cumprir o papel de desejo de filho e em poucos casos o desejo de constituir família

Infertility as a psychological problem.

Recently there has been enormous progress in couple infertility treatment and diagnostics. Some couples cannot conceive despite the fact that there seems to be no objective somatic or immunologic reasons. In such situations gynaecologists are helpless and couples may be overwhelmed by a sense of defeat and hopelessness. Thus, consulting a psychologist or therapist on how to cope better with the problem may be a good solution. The objective of the following paper is to discuss the dilemmas of couples undergoing infertility treatment, related psychological problems, and to determine the need for psychological and therapeutic support. The study demonstrates numerous infertility causes and concludes that there is no universal method of dealing with them. Very frequently psychological and somatic problems overlap. Psychological causes are often the primary factors, but sometimes they are secondary derivatives of the therapeutic process. A wide scope of factors must be considered to attempt psychological analysis of patients treated for infertility including the influence of the family and relations within, reaction to the diagnosis and suggested treatment, the influence of religion on the treatment, the evaluation of the relations in the family of procreation, sexual life assessment, the sense of a woman's self-esteem and self-acceptance. Basing on empirical analysis it was concluded that all women treated for infertility want to create a full family. They have problems in coping with emotional liability during treatment and a sense of fear and failure. Understanding the psychological mechanisms observed in patients treated for infertility might help to diagnose the causes of their problems with facing the new, extremely difficult situation.

Os embriões congelados: da falta ao excesso / Frozen embryos: from lack to excess

O objetivo do artigo é abordar aquilo que as novas tecnologias reprodutivas - com a separação por elas operada entre sexo e reprodução - trazem de inédito para o campo da filiação. Para isso, em primeiro lugar, serão diferenciadas, as montagens de filiação propostas por essas tecnologias das soluções encontradas em algumas sociedades tradicionais para contornar o problema da esterilidade. Será sustentado que, diferentemente das últimas, que se baseiam em uniões legitimadas pelo social, as primeiras se fundamentam na ficção da existência do ato sexual fecundo. Em seguida, serão analisados alguns aspectos da relação entre mercado, sexualidade e reprodução no contexto das chamadas "reproduções artificiais", e mais particularmente naquele das questões referentes ao congelamento dos chamados "embriões excedentes". Para isso, será, em primeiro lugar, apresentado o elo entre as evoluções sociais no campo da família e da sexualidade e os avanços científicos no campo da reprodução, e, em segundo lugar, descrito o processo pelo qual passa um casal durante o tratamento para infertilidade. Enfim, se buscará compreender a circulação destes embriões à luz da noção de "potlatch" analisada por Marcel Mauss, Georges Bataille e Jacques Lacan. Aqui, se destacará a presença, no próprio seio da lógica mercantil e do domínio/controle daquilo que se produz, de uma outra lógica: aquela que gira em torno do desperdício de um excedente.

The aim of this article is to approach what the new reproductive technologies - along with the separation operated by them between sex and reproduction - are bringing as novelty to the field of filiation. To this purpose, the filiation assemblies proposed by these technologies will be firstly distinguished from the solutions found in certain traditional societies to resolve the problem of sterility. It will be maintained that while the latter are based on legitimate unions from the social, the former ones are based on the fiction of the fecund sexual intercourse. Next, some aspects of the relationships between the market, sexuality and reproduction in the context of the so called "artificial reproductions" will be analyzed, more specifically in that aspect of the issues related to the freezing of the called "exceeding embryos". So, in first place, the link among the social evolutions in the field of family and sexuality and the scientific advances in the field of reproduction will be presented, and secondly, the process by which a couple goes through during the treatment for infertility will be described. Finally, we will try to understand the circulation of these embryos in the light of the notion of "potlatch" analyzed by Marcel Mauss, Georges Bataille and Jacques Lacan. Here, the presence of another logic, in the midst of the commercial logic and of the domain/control of that which is produced, will be highlighted: the logic that circles around the waste of an excess.

Persons and their parts: new reproductive technologies and risks of commodification.

This paper explores one aspect of the social implications of new reproductive technologies, namely, the impact such technologies have on our understandings of family structures and our expectations of children. In particular it considers whether the possibilities afforded by such technologies result in a more contractual and commodified understanding of children. To do this the paper outlines the possibilities afforded by NRTs and their commodificatory tendencies; second, it explores the commodification debate using the somewhat parallel example of commodification of organs; and third, in light of these debates the link between the commodification of body parts and persons is addressed. It will argue that there is a prime facie connection between body parts and persons and thus, although needing to be balanced with other ethically relevant factors, commodification remains an issue of ethical concern. Accordingly we should only be supporting potentially commodifying practices when there are ethically pressing reasons to do so (such as in organ transplantation). Moreover given this link between body part and persons we should attempt to lessen commodifying attitudes and thus should resist the increasing use of practices which regard children as having choose-able parts.

Reprodução e biopolítica: infertilidades e práticas de saúde em um serviço público no Rio de Janeiro / Reproduction and biopolitic: infertilities and health practices in a public in Rio de Janeiro

Apesar de a reprodução assistida possibilitar transformações importantes na parentalidade e nas relações familiares, suas tecnologias têm sido mais frequentemente usadas para reiterar o modelo tradicional de reprodução biológica e social. Este estudo qualitativo, de cunho exploratório, analisou quais normas estariam presentes nas práticas de saúde relativas à dificuldade de engravidar e o que poderia ser revelado a partir destas práticas. Foram observadas interações entre profissionais e pacientes atendidos em um serviço público de reprodução humana no Rio de Janeiro. A discussão dos diagnósticos de infertilidade e de risco, duas importantes estratégias biopolíticas usadas como critério de elegibilidade para o acesso às novas tecnologias reprodutivas, revelou como algumas práticas de saúde reiteram normas de gênero e de reprodução social. Atrelados à condição socioeconômica de seus usuários, estes diagnósticos tendem a agravar exclusões e desigualdades no exercício dos direitos reprodutivos no país. A análise da atenção médica possibilitou conhecer em parte o difícil cotidiano não apenas de homens e mulheres, que por anos persistem em seus desejos por filhos, mas também de profissionais que enfrentam antigas barreiras políticas, econômicas e burocráticas do serviço público de saúde. Este estudo corrobora a visão de que o serviço representa um avanço em termos de direitos sexuais e reprodutivos, apesar de ainda ser longo o caminho para o acesso igualitário e equânime às tecnologias reprodutivas pelo sistema único de saúde brasileiro (SUS).

Exploring the discourse between genetic counselors and Orthodox Jewish community members related to reproductive genetic technology.

OBJECTIVE: Genetic technology is complex, relatively new and involves sensitive issues pertaining to personhood and reproduction. While ethno cultural barriers to genetic care are well documented, little attention has been devoted to understanding religious beliefs pertaining to genetic services. This study evaluated the discourse between genetic counselors and Orthodox Jewish community members' perceptions of reproductive genetic technology. METHODS: A cross section of the Orthodox Jewish community was sampled through purposeful and snowball recruitment for in-depth interviews with key informants. RESULTS: Genetic counselors felt apprehensive about serving the Orthodox Jewish population and were unaware of social norms, religious and cultural practices unique to this population. Similarly, Orthodox Jewish consumers exhibited major misgivings about genetic testing. Importantly, stereotypic expectations by both counselors and consumers exacerbated existing communication difficulties. CONCLUSION: Cultural differences and poor communication between genetic counselors and Orthodox Jewish community members impeded the ability of the Orthodox Jewish community to utilize genetic services. PRACTICE IMPLICATIONS: This work illuminates complex issues pertaining to medical encounters between providers and patients with ideological, social and cultural differences. In particular, issues of access to care and transcultural competence in serving religious minority groups, such as Orthodox Jews are presented. On the whole, this group is largely unrecognized in the minority health literature in spite of barriers and challenges that they face. Findings of this study may have application to other cloistered and highly observant religious groups when dealing with reproductive technology and other populations with diverse values, beliefs and behaviors pertaining to reproductive health.

The perceived personal control (PPC) questionnaire as an outcome of genetic counseling: reliability and validity of the instrument.

The perceived personal control (PPC) questionnaire was developed by Berkenstadt and colleagues as an outcome measure for the evaluation of the process of genetic counseling. The present study aimed to further assess the psychometric properties of a Dutch version of the instrument. Data were used from two samples. A reproductive genetic counseling sample (n = 140), which included pregnant and non-pregnant women, and a cancer genetic counseling sample (n = 181), also consisting of women only. Counselees completed questionnaires before and following their first consultation. Besides the PPC these questionnaires addressed counselees' degree of concern, risk perception and satisfaction with the consultation. The following psychometric properties were assessed: acceptability, internal consistency, dimensionality, and validity. The instrument was well accepted as indicated by few missing items. The internal consistency was good for the total PPC (Cronbach's alpha: 0.79-0.81), reasonable for the original subscales of 'decisional' and 'behavioral control' (>0.60), but unacceptable for the subscale of 'cognitive control' (<0.60). The original three-factor solution was not confirmed; a one-factor solution proved most stable. Significant differences between pre- and post-counseling PPC scores support the PPC's construct validity. Concurrent validity was confirmed by positive associations with counselees' satisfaction although non-significant (concern) and unexpected (risk perception) results were also found. When used as a one-dimensional scale, the PPC has its value as an outcome measure in research addressing genetic counseling. However, the instrument's validity needs to be further assessed.

The effect of women's occupational psychologic stress on outcome of fertility treatments.

OBJECTIVE: The objective of this study was to examine the possible association between women's occupational stress and outcome of fertility treatments. METHODS: A prospective cohort study was performed, including a consecutive group of 75 working women with a female fertility problem attending fertility clinics between the years 1999 and 2000. A structured questionnaire measuring burnout, job strain, and job satisfaction was used. Workload was assessed by number of working hours and shift work. RESULTS: Women who perceived their job as more demanding were less likely to conceive (relative risk [RR], 0.6; 95% confidence interval [CI] = 0.42-0.96). Actual workload, measured by full-time versus part-time job, was found among women who conceived to be significantly associated with less likelihood to successfully complete a pregnancy (RR, 0.3; 95% CI = 0.11-0.96). CONCLUSIONS: An inverse association was found between perceived higher workload and conceiving. The likelihood to deliver after fertility treatment was associated with less working hours.

An Islamic perspective on human genetic and reproductive technologies.

Modern advances in human genetic and reproductive technologies are among the recent developments disturbing the balance between the spiritual and the material components of life. This paper gives an Islamic perspective on some of these advances, including abortion, in vitro fertilization, genetic engineering, cloning and stem cell research.