The pros and cons of genetic testing for breast and ovarian cancer risk.

Nearly 10% of breast and ovarian cancers develop as a direct consequence of an inherited flaw in the genes BRCA1 and BRCA2. The protein products of these genes suppress the development of cancer, in part by repairing damage in other genes. Women who inherit a nonfunctioning copy of either BRCA1 or BRCA2 therefore have a significantly elevated lifetime risk of breast cancer, especially at an early age. Identification of hereditary breast and ovarian cancer susceptibility allows optimized medical management of an individual's increased risk of breast and ovarian cancer. Significantly, testing may also identify women in "high-risk" families who did not themselves inherit cancer susceptibility, allowing them to avoid unnecessary medical intervention. Choosing to be tested for breast and ovarian cancer risk is a complicated task, however. It takes into account concerns about insurance liability, family dynamics, and an individual's psychological needs. From the limited research, evidence suggests that for individuals in high-risk families it is more beneficial to know than not to know one's genetic status. Education and counseling may improve public perception about genetic testing for breast cancer.

Characteristics and attitudes of parents of children born with the use of assisted reproductive technology.

OBJECTIVE: To explore the medical issues, attitudes, concerns, and choices that parents have about their children born with the use of assisted reproductive technology (ART). DESIGN: Retrospective and prospective survey. SETTING: An academic medical center and a private practice. PATIENT(S): Participants who conceived and were delivered of infants in two ART programs. INTERVENTION(S): A total of 373 patients were mailed an anonymous survey, a consent form, and the Parent Child Relationship Inventory. The rate of response was approximately 49% for clinic A and 33% for clinic B. MAIN OUTCOME MEASURE(S): Pregnancy outcomes and attitudes about parenting. RESULT(S): Respondents' major concerns during pregnancy revolved around miscarriage and the infant's health; complications occurred in 38.9% of first pregnancies. Parents believed that their children were more appreciated, that their children were not emotionally different, that ART did not create ongoing medical or emotional problems, and they were not overprotective as parents. Gender differences were statistically significant on attitudinal variables. CONCLUSION(S): Parents had concerns about pregnancy. Overall, men and women felt positive about ART and their parenting. The ART experience is associated with complex choices, attitudes, and emotions.

Predicting anonymous egg donor satisfaction: a preliminary study.

Our aim was to assess the psychologic characteristics and postdonation satisfaction of anonymous oocyte donors. Twenty-five consecutive anonymous oocyte donors completed psychologic tests before donation and satisfaction ratings following completion of the egg donation cycle. The average donor was 27 years old, married, and employed outside the home. All predonation scores on the psychologic measures were within the normal range. However, 24% of donors reported a history of sexual assault, and 40% described having had some type of reproductive loss. Although monetary compensation for donation was provided, altruism was reported as the most salient motivating factor. Following oocyte donation, 80% of women stated that they would be willing to donate again. Postdonation satisfaction was high. A significant negative correlation was found between predonation financial motivation and postdonation satisfaction (r = -.48, p < 0.01) and between predonation ambivalence and postdonation satisfaction (r = -.84, p < 0.0001). Donors with high levels of predonation financial motivation or ambivalence should be carefully screened and counseled before oocyte donation to ensure satisfactory psychologic outcome.

Gestational carrier pregnancy.

OBJECTIVE: To evaluate the results of a gestational carrier program in terms of pregnancy rates in fresh and cryopreserved cycles. DESIGN: Retrospective analysis. SETTING: Private IVF program. PATIENT(S): Women with uterine or medical reasons for unsuccessful gestation. INTERVENTION(S): In vitro fertilization of oocytes with fresh or cryopreserved ET to gestational carriers. MAIN OUTCOME MEASURE(S): Pregnancy rates and deliveries. RESULT(S): A PR of 56.3% and a cycle rate of 30.8% was achieved in each patient <40 years of age in 117 cycles of fresh or cryopreserved ET. There were no pregnancies for nine patients >40 years of age in 27 cycles. CONCLUSION(S): Carrier gestation offers a satisfactory solution to childlessness caused by uterine or major medical factors.

Factors related to preferences in gamete donor sources.

OBJECTIVE: To survey fertile and infertile individuals concerning attitudes about donor insemination and ovum donation and to analyze whether gender, experience with infertility, and religion influences: [1] preference for choosing gamete donor over adoption or child-free living; [2] choice of selecting a known or anonymous donor; or [3] choice of disclosure or nondisclosure to any offspring. DESIGN: Patients in an infertility clinic and obstetrics and gynecology practice were asked to complete surveys. PARTICIPANTS: Three hundred nineteen individuals who completed surveys. MAIN OUTCOME MEASURES: A 14-item questionnaire (created for this study) with a demographic information section. RESULTS: No gender differences were observed for preference to use donor gametes, to adopt, or to live child free within the infertility group. In the obstetrics and gynecology group, men preferred adoption more than women and were less likely to use a donor. Choice of whether to use a donor, which donor source, and whether to disclose the use of a donor was influenced by gender, experience with infertility, and religion. CONCLUSIONS: Gender, experience with infertility, and religion influence an individual's choice in family building options as well as what information will be shared with the child. There is a wider acceptance of using known donor sources than has heretofore been seen and these options should be explored.

Characteristics of participants in a gestational carrier program.

Genetic parents and gestational carriers in our gestational carrier program were evaluated by psychodiagnostic interview and by the Minnesota Multiphasic Personality Interview-2 (MMPI-2), a widely used objective psychological test, to identify psychopathology and describe personality characteristics. Overall, participants exhibited no overt psychopathology. Personality differences were found between gestational carriers and genetic mothers and genetic fathers and mothers. Clinical interviews revealed that gestational carriers tended to be the dominant partner in the relationship, were motivated by a wish to help an infertile couple, enjoyed being pregnant, showed narcissistic needs, and expressed a wish for secondary financial gain. The majority of gestational carriers stated that they had considered becoming a traditional surrogate but felt they could not surrender a child that was genetically theirs. These results indicate that there is not any predisposing psychopathology which attracts participants to the gestational carrier program.

Creating brave new families with advanced reproductive technologies.

The advanced reproductive technologies such as in vitro fertilization, gamete intrafallopian transfer, and donor gametes have created "brave new families," which can no longer be described by traditional definitions based on genetics and gestation. Understanding the particular stresses and issues that these families face can be particularly helpful to the clinician working with these couples and their children. The potential long-term effects also are explored.

Therapeutic considerations in prescribing for elderly patients.

A review of some of the problems which occur in prescribing for the elderly is presented. Three quarters of the population over 75 years of age are taking some form of medication, and 12.4% of admissions to Departments of Geriatric Medicine are admitted at least in part because of some adverse reaction to their drug treatment. The presentation of drugs, drug compliance, the absorption, metabolism and elimination of drugs, related to the effects of ageing and disease in old age are discussed, and used to argue that the elderly present special problems in therapeutics, and that pharmacokinetic and pharmacodynamic studies should be carried out specifically in the elderly on all drugs.

Single-dose pharmacokinetic study of 900 mg fenbufen in the elderly.

A single oral dose of fenbufen 900 mg was administered to 12 elderly volunteers, average age 81 years. The plasma levels of fenbufen and its major metabolites were measured at intervals over 72 hours following dosing. Results were compared with previously obtained data from young healthy volunteers. No significant differences were seen, after corrections from body weight, between the two groups for fenbufen and 2 of its metabolites. The mean serum levels in the elderly of biphenylacetic acid were significantly higher at 36 hours and 48 hours than the means at these times in the young group. This was not thought to be clinically significant. The terminal half lives for fenbufen and its major metabolites were not significantly prolonged compared with young volunteers.