Discordant views of experts and laypersons on the adoption of new fertility technology.

BACKGROUND: Healthcare costs are increased by the adoption of novel technologies before solid evidence on efficacy and risks. Oocyte cryopreservation for preserving fertility raises special ethical challenges. We compared opinions of professionals for assisted reproductive technology (ART), bioethicists, medical students and the general population toward the questions: do you support access to oocyte cryopreservation to preserve fertility for personal reasons and who should bear the costs? METHODS: The surveys conducted for this study were carried out in Israel included the following: (1) survey of 21 ART unit directors; (2) interviews with 23 bioethics experts; (3) survey of 196 medical students from 2 universities; (4) random digit-dial population-based survey of the public (N=600). RESULTS: Nearly 80% of ART and bioethics experts and 56% of students thought that oocyte cryopreservation should be allowed even for personal reasons. While expressing concerns about social consequences, bioethicists emphasized individuals' rights. In contrast, among the public, only 40% supported the use of this technology for personal reasons (ranging from 24% among Ultra-orthodox Jews and Arabs, to 51% among seculars or with academic education). Of note, 15% were undecided (vs. <2% among students, P<0.001). Most experts suggested private financing of the procedure for personal reasons, whereas the public preferred national or private insurance coverage. CONCLUSIONS: Nonexperts present a greater level of ambivalence than experts toward the use of a novel fertility technology for nonmedical reasons. Experts' preferences and interests may facilitate adoption of novel technologies with yet unclear effectiveness and safety, potentially contributing to increased healthcare costs.

[Oocytes cryopreservation: in which circumstances? Who should pay? Approaches amongst attending IVF physicians and researchers in the field of bioethics and health regulation].

BACKGROUND: In recent years there have been significant advances in the process of oocyte cryopreservation. Advanced techniques including vitrification have seen increasing success rates of fertilization. These successes warrant renewed public consideration and debate on several issues: In what circumstances? Who should pay? How should the process be regulated? STUDY QUESTION: Our goals were to examine the approach to oocyte cryopreservation amongst attending in-vitro fertilization (IVF) physicians and amongst researchers in the field of bioethics and health regulation. METHODS: Questionnaires regarding egg freezing were given to physicians heading IVF departments in Israel, and to bioethics researchers / health care administrators. RESULTS: Among the two groups questioned, there is strong support (80%) for the freezing of oocytes for personal circumstances, which may not be purely medical. Despite this support, there appears to be a difference in reasoning for this support. While most physicians see no reason to inhibit using the technology, bioethicists attend to the conflict between personal liberties and potentially troubling ethical consequences on society when utilizing these technologies. There is an additional discrepancy between the groups concerning regulation. Physicians prefer regulation by administrative means, while bioethicists would prefer regulation by Laws. CONCLUSIONS: Despite widespread support of oocyte cryopreservation for personal reasons among the two groups questioned, their views arise from different rationales. implementation of egg freezing technologies requires careful interdisciplinary discussion in order to consider the various medical, ethical, and sociological factors that these technologies will incur.

Primiparity: a traditional intrapartum obstetric risk reconfirmed.

BACKGROUND: Intrapartum risk is based mainly on obstetric history, which is lacking in primiparous women. OBJECTIVES: To ascertain whether the traditional known risk of primiparity is an independent variable for both maternal and neonatal outcome. METHODS: All women admitted to labor during March-April 2002 were canvassed for eligibility to participate in the study based on an obstetric risk scoring system developed and validated for our population. During the study period, 1473 women presented for delivery. Of these, 298 (20%) were eligible according to the exclusion criteria as "low risk" parturients: 135 (45%) were primiparous and 163 (55%) were multiparous (2-5 births). RESULTS: After correction for significant confounding factors, primiparity was revealed as an independent significant risk factor for instrumental delivery (odds ratio 15.5, 95%confidence interval 1.88-125) and for early postpartum hemorrhage (OR 5.6, 95%CI 1.9-16.6). CONCLUSIONS: This study highlights early postpartum hemorrhage as a significant risk for primiparous women, independent of mode of delivery, and also confirms previous reports of maternal complications requiring transfer from birth centers/home deliveries to tertiary centers.

[Can we improve the content and quality of information delivered prior to amniocentesis?].

INTRODUCTION: Amniocentesis is a procedure often used for pregnant women, as an important tool to identify chromosomal abnormalities, trisomy 21 being the main one. Amniocentesis may involve certain possible complications, the most prevalent is miscarriage. In order to make an informed decision, a woman must understand some statistical information regarding the risks and benefits of management options. OBJECTIVES: The objective of this work was to examine women's understanding of risks and benefits before amniocentesis and the effect of an educational intervention on this understanding. METHODS: Women applying for amniocentesis at Hadassah Ein-Kerem clinics were handed a questionnaire. The questionnaire examined several aspects of knowledge relevant to an informed decision about the amniocentesis. An intervention was designed to improve women's understanding before amniocentesis: an information handout was sent home to 48 women who had signed up for amniocentesis. The level of knowledge was compared between women who did and did not receive the information handout. RESULTS: There was no difference in the level of general understanding between the two groups. When the level of understanding was broken down to its specific components, it became apparent that the only improvement achieved was concerning the risk of miscarriage from the amniocentesis. CONCLUSIONS: Information delivered before amniocentesis is challenging and further research is needed in order to develop educational material that would improve women's understanding of risks and benefits of the procedure.