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Anne Steiner is interested in infertility, in vitro fertilization (IVF), reproductive aging, hysteroscopy, amenorrhea (absent menses), biomarkers of ovarian aging, and reproductive potential. (Keywords: Amenorrhea, biomarkers, fertility, hysteroscopy, in vitro fertilization, infertility, ovarian aging, reproductive aging)
David Rubinow is interested in reproductive endocrine-related mood disorders. (Keywords: Endocrinology, mood disorders in women, reproductive health)
Steve Young is interested in the molecular biology of implantation and reproductive failure. (Keywords: Embryo implantation, infertility, molecular biology)
Awards: PhD
Study modes: Full-time, Part-time
Funding opportunities
Programme website: Reproductive Health
Join us online on 25 September to learn more about Scotland, the city of Edinburgh and postgraduate study at the University.
Find out more and register
The Centre for Reproductive Health ( CRH ) offers PhD programmes, and a one-year full-time MSc by Research programme, which aims to introduce students to modern, up-to-date molecular and cellular biological research in the field of:
You will study in a stimulating, challenging and vibrant research atmosphere, at the interface between basic science and clinical patient care.
Topics that can be offered include using a wide range of models and in human, studying a number of important problems associated with human reproductive health and disease in:
The MSc forms an ideal insight into a PhD. You will undertake some core teaching and two 20-week research projects, performed on a very wide range of research fields within the reproductive sciences.
The Centre for Reproductive Health is recognised internationally as a centre of excellence in research and teaching in reproductive sciences, health and medicine.
The most recent Research Assessment Exercise rated Reproductive Biology as 5*.
The CRH has arranged its research under four themes:
These theme titles illustrate some of the remarkable properties that make reproductive systems such relevant and powerful models for translational studies across a wide spectrum of human diseases and pathologies in other systems.
The CRH has close links with other internationally recognised research centres in the Institute for Regeneration and Repair (IRR) and Edinburgh BioQuarter, including:
Many student projects are organised with and between these centres, reflecting the interdisciplinary research environment, where students and trainees are regarded as the ‘lifeblood’ for the future.
The CRH has:
It utilises and links with a wide spectrum of state-of-the-art clinical imaging, genomics, proteomics, metabolomics and bioinformatics centres and core facilities.
These entry requirements are for the 2024/25 academic year and requirements for future academic years may differ. Entry requirements for the 2025/26 academic year will be published on 1 Oct 2024.
A UK 2:1 honours degree or its international equivalent.
Check whether your international qualifications meet our general entry requirements:
Regardless of your nationality or country of residence, you must demonstrate a level of English language competency at a level that will enable you to succeed in your studies.
We accept the following English language qualifications at the grades specified:
Your English language qualification must be no more than three and a half years old from the start date of the programme you are applying to study, unless you are using IELTS , TOEFL, Trinity ISE or PTE , in which case it must be no more than two years old.
We also accept an undergraduate or postgraduate degree that has been taught and assessed in English in a majority English speaking country, as defined by UK Visas and Immigration:
We also accept a degree that has been taught and assessed in English from a university on our list of approved universities in non-majority English speaking countries (non-MESC).
If you are not a national of a majority English speaking country, then your degree must be no more than five years old* at the beginning of your programme of study. (*Revised 05 March 2024 to extend degree validity to five years.)
Find out more about our language requirements:
Tuition fees.
Award | Title | Duration | Study mode | |
---|---|---|---|---|
PhD | Reproductive Health | 3 Years | Full-time | |
PhD | Reproductive Health | 6 Years | Part-time |
Featured funding.
If you live in the UK, you may be able to apply for a postgraduate loan from one of the UK’s governments.
The type and amount of financial support you are eligible for will depend on:
Programmes studied on a part-time intermittent basis are not eligible.
Search for scholarships and funding opportunities:
Select your programme and preferred start date to begin your application.
Phd reproductive health - 6 years (part-time), application deadlines.
We encourage you to apply at least one month prior to entry so that we have enough time to process your application. If you are also applying for funding or will require a visa then we strongly recommend you apply as early as possible.
You must submit two references with your application.
Before making your application, as well as meeting the minimum requirements for entry you must have agreed a research proposal with a potential supervisor from the Centre for Reproductive Health and have been successful at interview.
Further information on making a research degree application can be found on the College website:
Find out more about the general application process for postgraduate programmes:
Program Description: Reproductive science and medicine encompasses the study of endocrinology, gonad development, gametogenesis and embryogenesis, and reproductive tract biology. These areas of research influence health and disease, as they are fundamental to our understanding of fertility and infertility, contraception, infectious diseases, pregnancy, fetal origins of adult disease, and trans-generational epigenetic inheritance. In addition, reproductive science has broad general health consequences because it is well known that gonadal hormones regulate sexual, bone, cardiovascular, immune, and cognitive functions.
Northwestern University is at the forefront of reproductive research, medicine, and technology. The Center for Reproductive Science (CRS) at Northwestern University was formed in 1987 and currently consists of almost 200 faculty members and 100 trainees across basic science and clinical departments. As a group, these researchers have received millions of dollars in research funding from government agencies and private foundations - enabling significant inroads into research on reproductive hormone signaling mechanisms, reproductive tract conditions, infectious diseases, determinants of gamete quality, ex vivo integrated reproductive tract systems, and ovarian cancer.
Students in the Reproductive Science and Medicine cluster will partake in these research endeavors, can elect to partake in reproductive-focused courses, and will have full access to a wide away of programs and services offered through the CRS.
Courses: Although this cluster does not require specific coursework, we offer brand new courses focused on human reproductive health that RSM cluster members are encouraged to take. REPR_SCI 405: Female Reproductive Physiology and Endocrinology Course Director: Pamela Monahan, PhD Offered: Fall Campus: Chicago This is a lecture-based course that provides a comprehensive survey of the structure and function of the female reproductive system. Throughout the quarter, students will discuss the fundamentals of female reproductive anatomy and reproductive axis function (hypothalamus-pituitary-gonadal). Specific topics that will be covered include: female sex determination and differentiation, reproductive hormone signaling and action, the ovarian and menstrual cycles, oogenesis and folliculogenesis, pregnancy and parturition, and female reproductive technologies. Topics will be presented from molecular, cellular, and tissue perspectives and will span development, puberty, adulthood, and reproductive senescence. We will also consider perturbations to the female reproductive system that can lead to infertility, disease, or disorders. Lectures will be interactive and will consist of didactic fundamentals, deep dives into the historical literature, and examination of current and emerging topics in the field. REPR_SCI 407: Male Reproductive Physiology and Endocrinology Course Director: Pamela Monahan, PhD Offered: Fall Campus: Chicago This is a lecture-based course that provides a comprehensive survey of the structure and function of the male reproductive system. Throughout the quarter, students will discuss the fundamentals of male reproductive anatomy and reproductive axis function (hypothalamus-pituitary-gonadal). Specific topics that will be covered include: male sex determination and differentiation, reproductive hormone signaling and action, spermatogenesis, sperm capacitation and fertilization, male reproductive behavioral changes, and male reproductive technologies. Topics will be presented from molecular, cellular, and tissue perspectives and will span development, puberty, adulthood, and reproductive senescence. We will also consider perturbations to the male reproductive system that can lead to infertility, disease, or disorders. Lectures will be interactive and will consist of didactic fundamentals, deep dives into the historical literature, and examination of current and emerging topics in the field. REPR_SCI 406: Human Reproductive Development/Emerging Research in Reproductive Science and Medicine Course Director: Debu Chakravarti, PhD, and Julie Kim, PhD Offered: Winter Campus: Chicago This is a primary literature and critical thinking-based course designed to challenge students with historical, contemporary, and emerging concepts in reproductive science and medicine, particularly around the concepts of human reproductive development and ways to regulate and restore function. The ultimate goal is to provide students with the intellectual and critical thinking skills to become the next generation of leaders who will tackle research problems and fuel discoveries. Topics covered include model systems for reproductive science and medicine research, epigenetics, hormone receptor signaling, endocrine disruption for therapy and due environmental toxins, cancer stem cells, next generation sequencing, and reproductive engineering. The course is team-taught by instructors who are active researchers and leaders themselves in these research areas. Students will delve into the literature to examine how research questions are identified and how technologies are enabled or created to address them. A basic understanding of cell and molecular biology is a prerequisite for this course in addition to prior completion of REPR_SCI 405 and REPR_SCI 407. Students who have not completed REPR_SCI 405 and REPR_SCI 407 should contact Dr. Beth Sefton with the Center for Reproductive Science, [email protected] , for permission to enroll. REPR_SCI 420: Human Reproductive Health and Disease Course Director: Serdar Bulun, MD; Lia Bernardi, MD Offered: Spring Campus: Chicago This course covers human reproductive health and disease from a clinical angle – from physiology to pathology to therapeutic interventions. Aspects of both male and female reproduction are covered. The course is team-taught primarily by clinicians and physician-scientists who are experts in reproductive science and medicine and who are active in research and patient care. Topics include sexual function and dysfunction, infertility, reproductive aging, reproductive cancers, endometriosis, uterine leiomyoma, and pregnancy complications. Class sessions are interactive, and discussions focus on pathology, risk factors, diagnosis, standard of care, and the current status of research. A basic understanding of cell and molecular biology is a prerequisite for this course in addition to prior completion of REPR_SCI 405 and REPR_SCI 407. Students who have not completed REPR_SCI 405 and REPR_SCI 407 should contact Dr. Beth Sefton with the Center for Reproductive Science, [email protected] for permission to enroll.
REPR_SCI 415: Reproductive Endocrinology and Fertility Management Course Director: Maryellen Pavone, MD, MSCI Quarter: Spring Campus: Chicago This is a lecture and laboratory course that exposes students to assisted reproductive technologies (ART), embryology, and andrology. Course topics include gamete and embryo biology, assisted reproductive techniques and associated technologies, ethics, and an introduction to fertility clinic operation. Acquired techniques include sperm analysis, sperm processing for ART, intracytoplasmic sperm injection (ICSI), time-lapse morphokinetics, embryo biopsy, genetic screening gamete cryopreservation and thawing. A basic understanding of cell and molecular biology is a prerequisite for this course in addition to prior completion of REPR_SCI 405 and REPR_SCI 407. Students who have not completed REPR_SCI 405 and REPR_SCI 407 should contact Dr. Beth Sefton with the Center for Reproductive Science, [email protected] for permission to enroll. Training Opportunities:
Training Resources:
Cluster Director
A list of CRS Faculty Members may be found here: http://www.crs.northwestern.edu/people/members.html
Driskill Graduate Program (DGP) 303 East Chicago Avenue Morton 1-670 Chicago, IL 60611-3008 Phone: 312- 503-1889 Fax: 312-908-5253 Website URL: DGP Email: [email protected]
Interdisciplinary Biological Sciences (IBiS) 2205 Tech Drive Hogan 2-100 Evanston, IL 60208 Phone: 847-491-4301 Fax: 847-467-1380 Website URL: IBiS Email: [email protected]
EliScholar > Medicine > Medicine Thesis Digital Library
Starting with the Yale School of Medicine (YSM) graduating class of 2002, the Cushing/Whitney Medical Library and YSM Office of Student Research have collaborated on the Yale Medicine Thesis Digital Library (YMTDL) project, publishing the digitized full text of medical student theses on the web as a valuable byproduct of Yale student research efforts. The digital thesis deposit has been a graduation requirement since 2006. Starting in 2012, alumni of the Yale School of Medicine were invited to participate in the YMTDL project by granting scanning and hosting permission to the Cushing/Whitney Medical Library, which digitized the Library’s print copy of their thesis or dissertation. A grant from the Arcadia Fund in 2017 provided the means for digitizing over 1,000 additional theses. IF YOU ARE A MEMBER OF THE YALE COMMUNITY AND NEED ACCESS TO A THESIS RESTRICTED TO THE YALE NETWORK, PLEASE MAKE SURE YOUR VPN (VIRTUAL PRIVATE NETWORK) IS ON.
Refractory Neurogenic Cough Management: The Non-Inferiority Of Soluble Steroids To Particulate Suspensions For Superior Laryngeal Nerve Blocks , Hisham Abdou
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Behavioral Outcomes In Patients With Metopic Craniosynostosis: Relationship With Radiographic Severity , Mariana Almeida
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Radiology Education For U.s. Medical Students In 2024: A State-Of-The-Art Analysis , Ryan Bahar
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Spinal Infections: Pathophysiology, Diagnosis, Prevention, And Management , Meera Madhav Dhodapkar
Childen's Reentry To School After Psychiatric Hospitalization: A Qualitative Study , Madeline Digiovanni
Bringing Large Language Models To Ophthalmology: Domain-Specific Ontologies And Evidence Attribution , Aidan Gilson
Surgical Personalities: A Cultural History Of Early 20th Century American Plastic Surgery , Joshua Zev Glahn
Implications Of Acute Brain Injury Following Transcatheter Aortic Valve Replacement , Daniel Grubman
Latent Health Status Trajectory Modelling In Patients With Symptomatic Peripheral Artery Disease , Scott Grubman
The Human Claustrum Tracks Slow Waves During Sleep , Brett Gu
Patient Perceptions Of Machine Learning-Enabled Digital Mental Health , Clara Zhang Guo
Variables Affecting The 90-Day Overall Reimbursement Of Four Common Orthopaedic Procedures , Scott Joseph Halperin
The Evolving Landscape Of Academic Plastic Surgery: Understanding And Shaping Future Directions In Diversity, Equity, And Inclusion , Sacha C. Hauc
Association Of Vigorous Physical Activity With Psychiatric Disorders And Participation In Treatment , John L. Havlik
Long-Term Natural History Of Ush2a-Retinopathy , Michael Heyang
Clinical Decision Support For Emergency Department-Initiated Buprenorphine For Opioid Use Disorder , Wesley Holland
Applying Deep Learning To Derive Noninvasive Imaging Biomarkers For High-Risk Phenotypes Of Prostate Cancer , Sajid Hossain
The Hardships Of Healthcare Among People With Lived Experiences Of Homelessness In New Haven, Ct , Brandon James Hudik
Outcomes Of Peripheral Vascular Interventions In Patients Treated With Factor Xa Inhibitors , Joshua Joseph Huttler
Janus Kinase Inhibition In Granuloma Annulare: Two Single-Arm, Open-Label Clinical Trials , Erica Hwang
Medicaid Coverage For Undocumented Children In Connecticut: A Political History , Chinye Ijeli
Population Attributable Fraction Of Reproductive Factors In Triple Negative Breast Cancer By Race , Rachel Jaber Chehayeb
Evaluation Of Gastroesophageal Reflux And Hiatal Hernia As Risk Factors For Lobectomy Complications , Michael Kaminski
Health-Related Social Needs Before And After Critical Illness Among Medicare Beneficiaries , Tamar A. Kaminski
Effects Of Thoracic Endovascular Aortic Repair On Cardiac Function At Rest , Nabeel Kassam
Conditioned Hallucinations By Illness Stage In Individuals With First Episode Schizophrenia, Chronic Schizophrenia, And Clinical High Risk For Psychosis , Adam King
The Choroid Plexus Links Innate Immunity To Dysregulation Of Csf Homeostasis In Diverse Forms Of Hydrocephalus , Emre Kiziltug
Health Status Changes After Stenting For Stroke Prevention In Carotid Artery Stenosis , Jonathan Kluger
Rare And Undiagnosed Liver Diseases: New Insights From Genomic And Single Cell Transcriptomic Analyses , Chigoziri Konkwo
“Teen Health” Empowers Informed Contraception Decision-Making In Adolescents And Young Adults , Christina Lepore
Barriers To Mental Health Care In Us Military Veterans , Connor Lewis
Barriers To Methadone For Hiv Prevention Among People Who Inject Drugs In Kazakhstan , Amanda Rachel Liberman
Unheard Voices: The Burden Of Ischemia With No Obstructive Coronary Artery Disease In Women , Marah Maayah
Partial And Total Tonsillectomy For Pediatric Sleep-Disordered Breathing: The Role Of The Cas-15 , Jacob Garn Mabey
Association Between Insurance, Access To Care, And Outcomes For Patients With Uveal Melanoma In The United States , Victoria Anne Marks
Urinary Vegf And Cell-Free Dna As Non-Invasive Biomarkers For Diabetic Retinopathy Screening , Mitchelle Matesva
Pain Management In Facial Trauma: A Narrative Review , Hunter Mccurdy
Meningioma Relational Database Curation Using A Pacs-Integrated Tool For Collection Of Clinical And Imaging Features , Ryan Mclean
Colonoscopy Withdrawal Time And Dysplasia Detection In Patients With Inflammatory Bowel Disease , Chandler Julianne Mcmillan
Cerebral Arachnoid Cysts Are Radiographic Harbingers Of Epigenetics Defects In Neurodevelopment , Kedous Mekbib
Regulation And Payment Of New Medical Technologies , Osman Waseem Moneer
Permanent Pacemaker Implantation After Tricuspid Valve Repair Surgery , Alyssa Morrison
Non-Invasive Epidermal Proteome-Based Subclassification Of Psoriasis And Eczema And Identification Of Treatment Relevant Biomarkers , Michael Murphy
Ballistic And Explosive Orthopaedic Trauma Epidemiology And Outcomes In A Global Population , Jamieson M. O'marr
Dermatologic Infectious Complications And Mimickers In Cancer Patients On Oncologic Therapy , Jolanta Pach
Distressed Community Index In Patients Undergoing Carotid Endarterectomy In Medicare-Linked Vqi Registry , Carmen Pajarillo
Preoperative Psychosocial Risk Burden Among Patients Undergoing Major Thoracic And Abdominal Surgery , Emily Park
Volumetric Assessment Of Imaging Response In The Pnoc Pediatric Glioma Clinical Trials , Divya Ramakrishnan
Racial And Sex Disparities In Adult Reconstructive Airway Surgery Outcomes: An Acs Nsqip Analysis , Tagan Rohrbaugh
A School-Based Study Of The Prevalence Of Rheumatic Heart Disease In Bali, Indonesia , Alysha Rose
Outcomes Following Hypofractionated Radiotherapy For Patients With Thoracic Tumors In Predominantly Central Locations , Alexander Sasse
Healthcare Expenditure On Atrial Fibrillation In The United States: The Medical Expenditure Panel Survey 2016-2021 , Claudia See
A Cost-Effectiveness Analysis Of Oropharyngeal Cancer Post-Treatment Surveillance Practices , Rema Shah
Machine Learning And Risk Prediction Tools In Neurosurgery: A Rapid Review , Josiah Sherman
Maternal And Donor Human Milk Support Robust Intestinal Epithelial Growth And Differentiation In A Fetal Intestinal Organoid Model , Lauren Smith
Constructing A Fetal Human Liver Atlas: Insights Into Liver Development , Zihan Su
Somatic Mutations In Aging, Paroxysmal Nocturnal Hemoglobinuria, And Myeloid Neoplasms , Tho Tran
Illness Perception And The Impact Of A Definitive Diagnosis On Women With Ischemia And No Obstructive Coronary Artery Disease: A Qualitative Study , Leslie Yingzhijie Tseng
Advances In Keratin 17 As A Cancer Biomarker: A Systematic Review , Robert Tseng
Regionalization Strategy To Optimize Inpatient Bed Utilization And Reduce Emergency Department Crowding , Ragini Luthra Vaidya
Survival Outcomes In T3 Laryngeal Cancer Based On Staging Features At Diagnosis , Vickie Jiaying Wang
Analysis Of Revertant Mosaicism And Cellular Competition In Ichthyosis With Confetti , Diana Yanez
A Hero's Journey: Experiences Using A Therapeutic Comicbook In A Children’s Psychiatric Inpatient Unit , Idil Yazgan
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Automated Detection Of Recurrent Gastrointestinal Bleeding Using Large Language Models , Neil Zheng
Vascular Risk Factor Treatment And Control For Stroke Prevention , Tianna Zhou
Radiomics: A Methodological Guide And Its Applications To Acute Ischemic Stroke , Emily Avery
Characterization Of Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors , Annika Belzer
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Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center , Gabriel BetancurVelez
Effectiveness Of Acitretin For Skin Cancer Prevention In Immunosuppressed And Non-Immunosuppressed Patients , Shaman Bhullar
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Gender disparities, maternal health.
Clinical correlates of mycoplasma genitalium in young women.
Maria Trent The primary aims of this study are to determine the rate and 12-month longitudinal clinical correlates of MG and TV infection among a sample of young pregnant women 13-29 years of age seeking reproductive health care in an urban hospital setting. The outcomes of this work will be critical for determining need for integration of MG testing in routine laboratory testing once available.
Maria Trent As documented in the US Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior, training of health providers in sexual health care is critical to addressing a broad array of the nation's sexual and reproductive health concerns. Yet rigorous trials evaluating the effects of sexual health curricula on provider behavior are rare. In sub-Saharan Africa, an environment which has the highest rates of HIV, STI, teen pregnancy, unwanted pregnancy, unsafe abortion, child marriage of girls and sexual assault of boys in the world, and where female genital cutting, wife-beating, marital rape, criminalization of homosexuality, stigmatization of Lesbian, Gay, Bisexual and Transgender (LGBT) persons, myths about masturbation leading to dysfunction, and rates of sexual dysfunction in both men and women are common, we could find no formalized training of health providers in sexual health care. Sexual health education, even of health providers, is a sensitive issue in Africa. Consequently, a rigorous study of its effects is needed, if such education is to be widely adopted. Recently, at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, we adapted a PAHO/WHO sexual health curriculum training for healthcare providers for implementation in Tanzania. Participants were 87 nursing, midwifery, and allied health science students. Pre-post evaluations show the curriculum to be highly acceptable, needed, and desired by students, feasible in implementation, and effective in improving student knowledge, attitudes, and skills in providing sexual health care to patients. The logical next step in this line of research is to conduct the first rigorous trial of a comprehensive sexual health training curriculum for health professionals in Tanzania. There are three specific aims. Aim 1 is to conduct a social ecological needs assessment of sexual health care delivery in Tanzania. To determine whether midwifery, nursing, medical, and allied health science students would benefit from one curriculum or separate curricula tailored by discipline, we will conduct focus groups (3 from each discipline). We will also conduct individual interviews with key informants to address structural and cultural issues. In Aim 2, we will further adapt our curriculum, ensure it is culturally tailored to the Tanzanian/sub-Saharan context, and pilot test it. Aim 3 is to evaluate the effectiveness of an African-based, culturally-appropriate, sexual health curriculum. We will conduct a randomized, controlled, single blinded trial of the curriculum against a waitlist control assessing effects on sexual health knowledge, attitudes, and counseling skills (n=206 students per arm; 412 in total). Hypotheses will test if the curriculum is effective, and whether it is more effective for one discipline than another. If effective, MUHAS has committed to implement the curriculum for all their health students. Given MUHAS is preeminent in health student education across Africa, the curriculum assessed in this study has high potential to be widely adopted as a new standard of training for health professionals across Africa.
Terrinieka Williams Powell Focused on those areas of Baltimore where the adolescent pregnancy rates are the highest, this study aims to understand what is currently being done in the churches of those communities to address pregnancy prevention and to identify the potentials and barriers for effective interventions.
Robert Blum, Caroline Moreau, Kristin Mmari, Saifuddin Ahmed, Lori Heise, Leah Keonig, Mengmeng Li, Mark Emerson The Global Early Adolescent Study (GEAS) seeks to understand how norms, attitudes and expectations about gender influence health outcomes and behaviors across the adolescent period. Building upon formative, mixed-methods research conducted in sixteen countries between 2014 and 2016, the GEAS has collected baseline data from over 13,000 adolescents on five continents since 2017. Additional survey topics include sexual and reproductive health, mental health, body comfort, school retention and empowerment. In four countries, the GEAS is used to evaluate the longitudinal impact of gender-transformative interventions carried out by Rutgers, Netherlands; Save the Children and the Institute of Women and Ethnic Studies. Participating GEAS sites include New Orleans, USA; Cuenca, Ecuador; Santiago, Chile; São Paolo, Brazil; Belgium; Indonesia; Shanghai, China; Kinshasa, DRC; Cape Town, South Africa; and Blantyre, Malawi. Results from the longitudinal GEAS will help to answer important questions about the formation and manifestations of gender inequality, its relationship to health and well-being and the interventions that are effective in promoting gender equality.
Current activities include efforts to improve awareness of and response to ethical issues in research and programming with adolescents living in vulnerable contexts the development of a special supplement using baseline GEAS focused on gender equality. At present, students are involved in manuscript development with partners in China, Ecuador, Bolivia and Malawi. For more information about the GEAS, including our global network of collaborators, recent reports and publications and open-access survey and training instruments, please visit the GEAS website.
Arik V. Marcell Funded by the Office of Population Affairs, to provide reproductive health services to adolescents & young adults who are uninsured, underinsured or seeking confidential services and conduct quality improvement strategies to ensure providers are delivering quality family planning and sexual and reproductive health care services.
Maria Trent This study examines the efficacy of a technology-enhanced community health nursing intervention on adherence to PID treatment recommendations and subsequent short-term sexually transmitted infection acquisition using a randomized controlled trial.
Michele Decker, Nancy Glass (School of Nursing) This initiative adapts and refines a safety planning “app” intervention for women in urban Kenya, followed by evaluation via randomized controlled trial. The app enables priority-setting for safety-related decisions and provides support and referrals to local resources. It harnesses community health volunteers (CHVs) as key lay professionals poised to play a critical role in partner violence prevention and response. With support from ideas42.
Michele Decker, Charvonne Holliday With support from the National Institute of Justice, this initiative entails formative evaluation and evaluability assessment for leading models of housing stabilization for partner violence survivors, specifically rapid rehousing and transitional housing, in partnership with House of Ruth Maryland. Following a formative phase, we monitor health, safety, and well-being indicators among IPV survivors receiving housing support over a 6-month follow-up period, and evaluate readiness to support IPV survivors among housing providers.
Michele Decker, Susan Sherman (Epi), Nancy Glass (School of Nursing) With support from the Johns Hopkins Center for AIDS Research (P30AI094189, PI Chaisson), this initiative uses a community-based participatory approach to develop and pilot test a brief violence intervention module to encourage violence-related harm reduction, provide social support related to violence victimization, and reduce related HIV risk behavior among women who trade sex or are sexually exploited.
Michele Decker, Lori Heise, Nancy Glass, Rosemary Morgan, Colleen Stuart, Toni Ungaretti, Vivian Lee This collaborative blends gender analysis with case studies and development and field testing of new indicators for gendered aspects of labor, education and health systems, in collaboration with academic and community partners.
PI: Dr. Khalil Ghanem – Co-investigator: Anne Burke This NIH-funded study investigates the impact of hormonal contraceptives on the vaginal microbiome. Use of postpartum IUDs and implants. This study evaluates outcomes in women who receive long-acting contraception in the immediate postpartum period.
Michele Decker, Rosemary Morgan, Nancy Glass This collaboration with World Health Organization applies gender analysis frameworks to non-communicable diseases via a scoping review of gender barriers to care, primarily in low and middle income countries.
Bob Blum, Caroline Moreau, Kristin Mmari, Saifuddin Ahmed, Lori Heise, Leah Keonig, Mengmeng Li, Mark Emerson The purpose of The Global Early Adolescent Study is to understand how gender norms influence sexual attitudes and relationship formation in early adolescence as well as subsequent sexual activity and contraceptive practices in older adolescence. Specifically, the study explores: 1) gender socialization in early adolescents; 2) how gender norms inform sexual and reproductive health (SRH) across adolescent years 3) how gender transformative interventions can improve SRH trajectories. The study takes place in 9 urban poor sites across 4 continents (South Africa, Malawi, DRC, Belgium, China, Indonesia, Chili, Brazil and the United States) and follows between 600 and 3000 young adolescents 10-14 years in each site over a 3 to 5 year period. This research provides empirical evidence testing gender pathways to SRH while guiding programs to overcome gender discrimination and promote women’s and girls’ wellbeing. To learn more please visit the GEAS page .
Donna Strobino, Saifuddin Ahmed, Erika Werner (Brown Univ, school of Medicine), Mahua Mandal, Laina Gagliardi, and Roxanne Beltran The aim of this project is to update the science behind WHO recommended anti-hypertensive medications in pregnancy to prevent preeclampsia and manage hypertension and to estimates the prevalence of chronic hypertension, preeclampsia and all hypertensive disorders in pregnancy using data from population- based studies worldwide and facility based studies in resource poor settings. The study also using extant data to estimate unmet need and potential demand for antihypertensive medications in pregnancy in low resource settings.
Anne Burke This is an upcoming NICHD-funded, prospective study evaluating use of a vaginal contraceptive ring in healthy women. Pharmacokinetics of oral contraceptives before and after bariatric surgery. This study compares pharmacokinetic and pharmacodynamic profiles of oral contraceptive use for women undergoing gastric bypass surgery.
Project connect baltimore.
Arik V. Marcell This is a CDC-funded program to evaluate school and community-based methods to engage males in HIV/STD testing and sexual and reproductive health care in Baltimore City by training youth-serving professionals on a web-based clinical services provider guide for male-specific clinical services (Y2CONNECT.org). If successful, this project will advance the field of male health promotion through its use of innovative approaches and technology that are easily transferable to a variety of settings and implemented at low cost
Maria Trent The study involves 350 young women 13-21years old diagnosed with PID in Baltimore and randomize them to receive CHN clinical support using a single post-PID face-to-face clinical evaluation and SMS communication support. We hypothesize that repackaging the recommended CDC-follow-up visit using a technology-enhanced community health nursing intervention (TECH-N) with integration of an evidence-based STI prevention curriculum will reduce rates of short-term repeat infection by improving adherence to PID treatment and reducing unprotected intercourse and be more cost-effective compared with outpatient standard of care (and hospitalization). To learn more, please visit the Study Record Detail page .
Advance family planning.
Duff Gillespie, Beth Fredrick Advance Family Planning (AFP) is an advocacy initiative established in 2009 at the William H. Gates Sr. Institute for Population and Reproductive Health. AFP aims to increase the financial investment and political commitment needed to ensure access to high-quality, voluntary family planning through collaborative, evidence-based advocacy aimed at working effectively with decision-makers. AFP is supported by the Bill & Melinda Gates Foundation, the David & Lucile Packard Foundation, and the William and Flora Hewlett Foundation.
Suzanne Bell, Anne Burke, Carolyn Sufrin
Results from a small study completed by Bloomberg School faculty and students found that COVID-19 potentially increased existing inequities related to abortion. The study looked at abortion service availability and care seeking experiences in the Washington, DC, Maryland, and Virginia region during the pandemic and found that financially disadvantaged groups were disproportionately negatively impacted. More information is found in the facsheet,
Caroline Moreau, Anne Burke This project aims to test a framework for monitoring quality of care for family planning among all women of reproductive age in Maryland, using computerized data found in health insurance claims and electronic health record (EHR) systems
Caroline Moreau, Suzanne Bell The PMA Abortion project aims to use the PMA platform to conduct research on Abortion in 3 geographies (Cote D’Ivoire, Nigeria, Rajasthan) to assess abortion prevalence and safety using both direct and indirect measures and to explore women’s access to care for abortion procedures.
Amy Tsui, Scott Radloff, Phil Anglewicz This project is being implemented in 13 urban sites in collaboration with research partners in Burkina Faso, DR Congo, India, Kenya, Niger and Nigeria. PMA Agile conducts quarterly surveys of health facilities and semi-annual surveys of clients to monitor change in service preparedness and quality as well as client satisfaction and their continued use of contraception.
Scott Radloff Performance Monitoring for Action or PMA for short (formerly PMA2020) is a Bill and Melinda Gates Foundation funded project, implemented in partnership with Jhpiego and a network of university and research institutions, that supports rapid-turnaround surveys to monitor progress in reproductive health indicators. The project was launched in 2013.
PMA implements cross-sectional and longitudinal surveys to fill a data gap – collecting information to understand the drivers of contraceptive use dynamics – information that is not currently measured by other large-scale surveys. While having a core family planning focus, the PMA platform can be used for data collection in other health topics. To date the platform has been used to collect data for guiding programs in abortion, adolescent sexual and reproductive health, women and girls’ empowerment, maternal and child health, nutrition, water and sanitation, menstrual hygiene management, neglected tropical diseases (schistosomiasis), sample vital registration systems, and primary health care.
The project employs a network of female resident enumerators recruited from near the selected survey clusters who are trained to use smartphones to gather survey data. The PMA platform has been deployed in 11 countries so far with plans to expand. Countries include Ghana, Democratic Republic of Congo, Ethiopia, Uganda, Burkina Faso, Niger, Nigeria, Indonesia, India, Cote d’Ivoire, and Kenya.
For more information please visit pmadata.org .
Amy Tsui, Scott Radloff, Saifuddin Ahmed The study team is assessing the predictive utility of a leading indicator, unmet need for contraception, and that of a less prominent one, future intention to use, as influencing contraceptive adoption, using data from a four-year panel follow-up of a national sample of Ugandan women.
Arik V. Marcell Funded by the Office of Population Affairs, the goal of this program is to integrate rapid HIV testing as part of Title X services and increase the proportion of clients receiving HIV test results and evaluate increased use using rapid Plan-Do-Study-Act cycles.
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1 Australasian Institute for Restorative Reproductive Medicine, Adelaide, South Australia, Australia
2 School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
3 Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
A reductive reading of Humanae vitae seeks to limit its appeal to a ban on contraception. In truth, however, it offers a vision of human sexuality and conjugal love with broad and enduring relevance. In setting forth the intrinsic complementarity and irreducibility of the unitive and procreative dimensions of the conjugal act, Paul VI has given us a hermeneutical key for assessing many contemporary ethical dilemmas in human reproductive medicine. From this perspective, this article seeks to apply the logic of Humanae vitae to several real-life scenarios confronted by medical practitioners, educators, and ethicists working in the field of fertility and reproductive health. These include a consideration of the ethics of prescribing hormonal contraceptives, the possibilities of investigating male infertility, issues of cooperation in counseling and assisting conception in same-sex relationships, the ethics pertaining to assisted reproductive technology (ART), the contested case of prenatal adoption, and the application of double-effect reasoning.
On the occasion of the fiftieth anniversary of the promulgation of Pope Paul VI’s encyclical Humanae vitae , this article seeks to defend its enduring relevance to modern-day society, through application of its reasoning to contemporary dilemmas in reproductive medicine. It considers real cases of the ethics of prescribing hormonal contraceptives, of investigating male infertility, of cooperating in counseling and assisting conception in same-sex relationships, of ART, of prenatal adoption, and the application of double-effect reasoning.
Fertility of a couple relates to the ability of a man and woman to attain a pregnancy and the woman to sustain that pregnancy. Advances in technology and medicine have delivered considerable health benefits but have also pushed the limits of ethical practice in the field of human reproduction. Corresponding to such advances have been semantic interpretations and changes in terminology, which serve both subjective scientific and moral purposes. For example, the biological definition of human conception refers to fertilization of an oocyte by a spermatozoon resulting in a zygote—the beginning of a new and distinct human life ( Miller and Pruss 2017 ). It has been argued that conception may also refer to a pregnancy “beginning with implantation of an embryo in a woman” ( Zegers-Hochschild et al. 2017, no. 403 ), promulgating an earlier and erroneous but now widespread definition that conception begins at implantation rather than fertilization ( American College of Obstetrics and Gynecology 1965 ). In the age of assisted reproductive technology (ART), one definition of “fertility” is “the capacity to establish a clinical pregnancy” ( Zegers-Hochschild et al. 2017 ). This definition allows for extracorporeal manipulation of gametes and fertilization, with conception and thus clinical pregnancy attained at subsequent implantation of the embryo in the womb. The voracity of arguments on either side of such definitions attests to the importance of fertility and bearing of offspring in our society. For the purpose of this discussion, conception is accepted as being from the formation of the zygote from two gametes and thus the inception of a distinct new life.
One of the most profound intersections of theology and reproductive medicine is found in Humanae vitae ( Paul VI 1968 ), which is regarded as the catalyst for the field of natural family planning or what is increasingly being referred to generically as the fertility awareness-based methods (FABMs). Humanae vitae has inspired the development and spread of validated and morally acceptable techniques such as the Billings ovulation method ( Billings, Corkill, and Marshell 2008 ), Creighton Model System ( Hilgers and Stanford 1998 ), Symptothermal method ( Frank-Herrmann et al. 2007 ), and the Marquette method ( Doroski 2014 ).
These FABMs of family planning are not simply a means of conforming to Paul VI’s (1968) reiteration of the Church’s prohibition of “any action which either before, at the moment of, or after sexual intercourse, is specifically intended to prevent procreation—whether as an end or as a means” (no. 14). Rather, they find their rationale in the very reasoning for which the Church deems contraceptive intercourse to be inconsistent with conjugal love.
Married love particularly reveals its true nature and nobility when we realize that it takes its origin from God, who “is love,” the Father “from whom every family in heaven and on earth is named.”…As a consequence, husband and wife, through that mutual gift of themselves, which is specific and exclusive to them alone, develop that union of two persons in which they perfect one another, cooperating with God in the generation and rearing of new lives. ( Paul VI 1968 , no. 8)
Conjugal love that is self-giving and open to life is a witness to Divine Love—a love that is never impotent or sterile, never a partial gift of Himself, but his everything. This has a particular dignity of spousal love. Contracepted intercourse, on the other hand, constitutes a muted witness to love: a situation that “does not correspond to the interior truth and to the dignity of personal communion— communion of persons ” ( John Paul II 1984 , no. 7). As St. John Paul II writes in Familiaris consortio :
When couples, by means of recourse to contraception, separate these two meanings that God the Creator has inscribed in the being of man and woman and in the dynamism of their sexual communion, they act as “arbiters” of the divine plan and they “manipulate” and degrade human sexuality—and with it themselves and their married partner—by altering its value of “total” self-giving. Thus the innate language that expresses the total reciprocal self-giving of husband and wife is overlaid, through contraception, by an objectively contradictory language, namely, that of not giving oneself totally to the other. This leads not only to a positive refusal to be open to life but also to a falsification of the inner truth of conjugal love, which is called upon to give itself in personal totality. ( John Paul II 1981 , no. 32)
The same cannot be said of FABMs. Through period abstinence and recourse to infertile periods, they preserve the truth of self-giving love. This self-sacrificial conjugal union may achieve or avoid a pregnancy, but couples who utilize FABMs “respect the inseparable connection between the unitive and procreative meanings of human sexuality, they are acting as ‘ministers’ of God’s plan and they ‘benefit from’ their sexuality according to the original dynamism of ‘total’ self-giving, without manipulation or alteration” ( John Paul II 1981 , no. 32).
From a theological perspective, marriage as a divine gift ( Paul VI 1968 , no. 8) is complete in the three goods ( Augustine 401 ), espoused by the marital act:
Processes and actions which intentionally separate these goods then become morally illicit from a theological perspective. Positively expressed, when the unitive and procreative qualities of a marriage are preserved, “the use of marriage fully retains its sense of true mutual love and its ordination to the supreme responsibility of parenthood” ( Paul VI 1968 , no. 12).
This article discusses the clinical application of these theological and bioethical principles in human reproductive medicine with illustration by several case examples. The cases and their resultant moral and ethical discussion points have been drawn from the Restorative Reproductive Ethics Seminar at the National Fertility Conference 2014 and Bioethical Issues in Reproductive Medicine session at the National Fertility Conference 2016 held in Melbourne, Australia. This case-based discussion aims to assist clinicians to understand and manage analogous clinical scenarios in the light of Humanae vitae .
Clinicians are continually faced with balancing the indications and benefits of a treatment, on the one hand, and the anticipated side effects and possible adverse reactions, on the other. That commonly used distinction has important moral and ethical significance. The treatment goal of the clinician needs to be balanced with their responsibility for ensuring that the risks are not disproportionate or overly burdensome. With respect to treatments that have unethical or immoral dimensions, the obligation of the clinician is ideally to avoid cooperation with what is evil. For the purpose of this article, “ethics” refers to a person’s distinction between what is right and what is wrong, whereas “moral” denotes reliance or consistency with accepted teaching of the Catholic Church.
Classically, philosophers and theologians reasoned that “moral acts take their species according to what is intended, and not according to what is beside the intention, since this is accidental” ( Aquinas 1274 ). A clinician is morally responsible for what they directly intend and in that respect ought not do evil. But where doing good for a patient also has side effects and risks adverse reactions, they need to be assessed beside the intention. It is wrong to deliberately choose to do harm, but harm can result as a side effect, provided it is not directly willed and it is not disproportionate.
In double-effect reasoning, conditions to be met include that (1) the action in itself from its very object must be good or at least indifferent, (2) the good effect and not the evil effect must be intended, (3) the good effect must not be produced by means of the evil effect, and (4) there must be a proportionately grave reason for permitting the evil effect ( Haas 2017 ).
Kylie is a 30-year-old woman with four healthy children who is booked towards the end of her fifth pregnancy for an elective caesarean section. She requests a bilateral salpingectomy at the time of her caesarean, citing a desire to reduce her risk of ovarian cancer.
Kylie has been made aware that opportunistic salpingectomy is currently acceptable practice for primary prevention of high-grade serous carcinoma ( Oliver Perez et al. 2015 ). In applying the principle of double effect to Kylie’s situation, primary prevention of carcinoma is a morally acceptable object (condition 1), but bilateral salpingectomy effectively renders her sterile (the double effect). Examining the proportionality of these effects (condition 4), the weight of mitigating a potential risk in which a serious pathology (ovarian cancer) is yet to have been confirmed to exist would not justify the known destruction of bodily integrity and reproductive function entailed in a bilateral salpingectomy. If, on the other hand, there was known current and serious tubal or ovarian pathology, the proportionate reason for performing a salpingectomy/oophorectomy may then be examined for sufficiency to justify performing the procedure (condition 4). Undertaking opportune tubal ligation or bilateral salpingectomy at caesarean for the purpose of contraception would not fulfill the criteria for legitimately applying the principle of double effect since the intention would be to disrupt the procreative capacity of the woman (condition 2).
Other philosophers have noted that the concept of proportionality proposed by Aquinas did not involve the concept of comparatively lesser evil or greater good nor quantification of the overall net outcome. The proportionality only required that the action responsible for causing foreseeable harm must be no more harmful than would be necessary in that particular context ( Finnis 1991 ). For Kylie, examination of the means to reducing her risk of ovarian cancer should consider which adverse and unintended consequence (destruction of bodily integrity and reproductive function) would be the least evil of those that are foreseeable and are equally available.
Regarding the bioethics of contraceptives, the use of hormonal treatment for a medical condition does not present an ethical dilemma in itself. Provided there is informed consent and a reasonable proportion of the benefits of the therapeutic treatment over the risk of adverse effects, hormonal treatment for a condition may be both warranted and recommended. Complicating hormonal medications, whether delivered orally or via a drug-eluting device, is their effect on the fertility of a woman and their capacity for both contraception and postconception termination.
Hormonal contraception is commonly presented as the oral contraceptive pill (OCP) containing a progestogen with or without an estrogen (often termed combined oral contraceptive pill [COCP] in the case of the former, denoting a combined OCP), an implanted etonogestrel-releasing device, an intrauterine contraceptive device (IUCD) containing levonorgestrel, a depot injection of medroxyprogesterone acetate, and the contraceptive vaginal ring containing etonogestrel and ethinyl estradiol. There are three mechanisms of action for hormonal contraceptive formulations and devices, including (1) suppressing ovulation, (2) changing the characteristics of the cervical mucus thus preventing or inhibiting sperm transport to the fallopian tubes, and (3) altering the maturation of the endometrium thus potentially causing any conceptus formed to be unlikely to successfully implant ( Frye 2006 ). IUCDs are also known to invoke an inflammatory response which further inhibits sperm as well as the ability of a conceptus to implant in the uterus. The third mechanism described above is a postconception effect (postconception contraception) and may be considered an induced preimplantation abortion, which is intrinsically ethically evil ( Grisez 1997d ). This loss of human life in the case of the third mechanism coming into play is likely to raise significant questions about whether the loss of life is directly willed. If considered not to be directly willed, the issue of proportionality may still be an issue. Is the loss of life disproportionate to the good that the woman is seeking to achieve? This will depend on whether there are alternatives that do not involve that loss of life. Some couples may wish to utilize such former therapeutic options while continuing to monitor for signs of fertility where possible, thus recognizing the unitive and procreative dimensions to their relationship while reducing the likelihood for potential harm.
With respect to double-effect reasoning in managing medical conditions such as heavy menstrual bleeding or severe acne, it may be considered an appropriate option to prescribe hormonal contraception if there were no other reasonably available treatments. The purpose would not be contraception but instead to treat the presenting medical condition. However, it is still important to assess the overall consequences for the patient of suppressing fertility and the other harmful effects, such as masking underlying chronic disease including polycystic ovarian syndrome (PCOS), increased risk of venous thromboembolism (VTE), stroke, and potential carcinogenic effects ( Jordan et al. 2015 , Sondheimer 2008 ).
For the case of Sarah (case 2a) who has PCOS and is not currently sexually active, the COCP may be prescribed if this is considered the best treatment in the circumstances, although other treatment may also be available ( Goodman et al. 2015 ).
If Sarah was sexually active, then the circumstances of the GP would be significantly different and his or her obligation would be to avoid cooperating in what is considered either morally or ethically evil. Considering the moral and ethical objections to the use of hormonal contraception, the level of cooperation of the GP in prescribing the COCP in such a case would need to be questioned as to whether his or her actions would be morally licit or not. Is such cooperation formal , in which the clinician willfully and intentionally shares in the wrongfulness of the agent’s act and is always wrong, such as intending the outcome of contraception as a primary goal for Sarah? Or is it material , in which the intent or contribution is good or neutral in itself, though foreseeably used to some immoral end? If the GP intends primarily for Sarah’s PCOS to be controlled, then there is material cooperation. The next distinction in this case is whether there is immediate or mediate material cooperation by the GP. Immediate material cooperation is when the object, in this case provision of hormonal contraception, is the act which is externalized by the intent to do the morally wrong act. This reduces the act to formal cooperation so is itself always morally wrong (with the exception being in the case of duress). Mediate material cooperation is characterized by not intending or undertaking the act but by providing peripheral assistance. In certain circumstances, mediate material cooperation may be regarded as being morally licit based on the principle of double effect. Mediate material cooperation may be distinguished as being proximate or remote depending on how involved or removed it is from the action ( Keenan and Kopfensteiner 1995 ). In the original case, since Sarah’s GP is aware that she is not sexually active, then prescribing the COCP is not immediate material cooperation in contraception. If, however, she was sexually active or was planning to use the prescription for contraceptive purposes, then this degree of the GP’s material cooperation would need to be reevaluated. For such mediate cooperation to be considered morally acceptable, the GP must be satisfied that by writing the directions for a hormonal contraceptive product for a sexually active woman, the GP is adequately remote from the contraceptive effect it will have in Sarah and that treatment of her PCOS is a sufficiently grave reason in proportion to the potential preimplantation abortifacient effect of the COCP and separation of the procreative and unitive aspects of sexual intercourse ( Paul VI 1968 , no. 12). One proposed guideline to assess the proportionality in such a situation would be to consider if not prescribing the COCP in order to achieve the intended noncontraceptive benefit would be considered malpractice by omission ( Grisez 1997d ). If, as likely in this case, it would not be considered malpractice, then the reason for prescribing the COCP may not be sufficiently grave to justify doing so. An alternative assessment for proportionality would be the provision or absence of medical care to restore health and prevent disease in the assessment of negligent practice. Sarah has presented with a clinical disease that requires a multidisciplinary approach to restoring her health, the provision of care (dietary and lifestyle changes, weight loss, and endometrial protection) within accepted clinical guidelines would be expected.
There are likely clinical absolute and relative contraindications to prescribing the COCP in most circumstances. Assuming the GP’s colleagues do not hold the same morals and ethics about not prescribing the COCP as the GP, if these colleagues considered it acceptable clinical practice not to prescribe the COCP in the case where Sarah was sexually active based on medical contraindications, then the recommended course of action would similarly be for the GP to refuse prescribing the COCP to Sarah in such a case ( Grisez 1997d ).
For Talisha who is taking isotretinoin (case 2b), drug manufacturer recommendations and government regulations require that she be warned about teratogenesis if she becomes pregnant while using it and for a period of time afterward. The issue is ensuring that she has taken reasonable steps to prevent pregnancy. If she is properly instructed in fertility awareness, she could be as confident as using the COCP for that purpose ( Pallone and Bergus 2009 ). That would be especially so if the couple avoided the preovulatory phases of the cycles, waiting instead for either the postovulation higher basal body temperature or the sudden change to dry or sticky cervical discharge after a pattern of wet or slippery discharge, indicating that ovulation had occurred. If she wanted to be even more certain, a urine or serum test for the ovarian hormones indicating raised progesterone levels consistent with being postovulatory could be undertaken. Timing intercourse to align with fertile and infertile periods in a woman’s cycle may be consistent with maintaining the integrity of the unitive and procreative qualities of such intercourse: there is no deliberate obstruction of the procreative process, while the act of intercourse during a nonfertile time (or abstinence otherwise) is not in itself unethical ( Paul VI 1968 , no. 16). If Talisha were to take the COCP “to be sure” of pregnancy avoidance, this would have a primary contraceptive intention so would directly be aimed at separating the unitive and procreative aspects of sexual relations ( Paul VI 1968 , no. 12).
The situation for the current GP regarding Talisha is complicated by the fact that a different GP in the practice had initially prescribed the COCP and that now Talisha is “only” requesting a repeat prescription. The issue for Talisha is that of continuity of what appears to have been GP-approved care. The current GP has a duty of care in this regard but may also exercise a conscientious objection to prescribing the COCP after considering the ethical implications of this scenario ( Medical Board of Australia 2013 ). Provided that the current GP’s conscientious objection has been disclosed to colleagues and Talisha, it may be acceptable for the GP to undertake the routine checks needed for a patient taking the COCP and update her record before communicating the request to a colleague who might then choose to write the prescription for the patient to collect later. The question of cooperation arises: whether the actions of the current GP constitute formal, immediate material, or mediate material cooperation in prescribing the COCP by this process. This does not necessarily relate to the proximity (or perceived remoteness) of the current GP to the final prescribing of the COCP for Talisha. If the intent or the goal of the current GP is for Talisha to see his colleague in order for the repeat prescription of the COCP to be written, then such action implicates the current GP formally in the resultant prescribing of the COCP. In contrast, the intention for a colleague to reassess and provide contraceptive options may itself be considered at least morally neutral. One role of the current GP is to ascertain clinical risk for medication being taken by Talisha, which is a morally good action. Subsequent acceptability of material cooperation by alerting a fellow GP of Talisha’s request after informing her of one’s personal conscientious objection may then be assessed by considering the strengths of the diverse reasons for and against sending Talisha to that colleague. Comparing the proportionality of reasons is problematic since what first must be defined is to what they are proportionate, following which the current GP’s personal judgment as to what the magnitude or impact each of these reasons has on the situation at hand, including interpersonal (doctor–patient and collegiate relationships) and vocational factors. One searching question might then be asked in such a situation: would it be reasonably preferable for the current GP to send Talisha to his colleague for the collated reasons rather than not? For material cooperation to be morally acceptable, the reasons for sending Talisha to a colleague must be proportionate to the reasons for not doing so rather than to the gravity of prescribing the COCP or how proximate the current GPs actions are to Talisha receiving a prescription for the COCP ( Grisez 1997a ).
In a not dissimilar scenario, Lesley (case 2c), who is seeking her routine repeat COCP prescription, may have her risks of adverse effects for the COCP assessed at the time of the consultation. These are not insignificant considering her blood pressure, smoking, and age which all increase the risk of stroke, heart attack, and VTE, as well as the risk of breast cancer related to her family history and effect of the COCP ( Imkampe and Bates 2012 ). There are considerable medical reasons in this case for not prescribing the COCP, as distinct from moral or ethical reasons. Referring on for a second medical opinion in this case may be considered. Mitigating the GP’s cooperation in referring for prescribing of the COCP would be making the GP’s moral beliefs/conscientious objection known and giving witness to the values espoused in Humanae vitae by not personally prescribing the COCP.
Infertility may result from female factors, male factors, and combined factors. Although much emphasis on infertility investigation and management is directed to the woman, male investigation is also necessary to ascertain the presence of specific male infertility and to direct further investigation for the woman.
The Johnsons present as a couple to your service, having tried to achieve a pregnancy for the last 3 years. They are both healthy and have no pre-existing medical or surgical conditions of note. Jill is ovulating well, and she is comfortable with the consideration of a diagnostic laparoscopy.
Prior to undertaking invasive investigation of his wife, John should have a seminal fluid analysis performed. Three possible ways of collecting his semen include:
The MFP method allows patients to collect a semen specimen during intercourse, providing an alternative to masturbation and thus avoiding the moral issue and a potentially degrading experience. There is evidence that semen collected during a normal act of intercourse for analysis is more viable and representative than masturbatory samples ( Zavos 1985 , Zavos et al. 1994 ). The MFP device resembles a condom and is made of a flexible, inert organic polymer, polyurethane. Pathology laboratory staff may not have protocols for handling a condom device containing semen; however, semen may be decanted by the patient from the MFP into a conventional prewarmed specimen jar. Collection via contraceptive condoms (with or without spermicide) is unacceptable due to poor sperm survival, while nonspermicidal sheath collection devices have demonstrated superior sperm survival and more accurate seminal volume measurements than other collection devices ( Schoenfeld et al. 1978 , Pradiee et al. 2016 ). The World Health Organization (2010) recommends such a preferred collection method.
In order not to separate the procreative quality from intercourse, the MFP must be perforated by a sterile needle to allow some semen to pass into the vagina. This could be said to reduce the chances, though not totally, of fertilization happening as a result of that particular act of intercourse because it involves removing sperm that might otherwise have achieved fertilization. The purposes, however, are to gather sperm for analysis in order to identify treatable causes and also to prevent invasive and potentially unnecessary diagnostic procedures/treatment on the woman if the man is identified as infertile. The overall aim is to aid in procreation.
Use of the MFP does not exclude the possibility of the act of intercourse being fecund nor to intentionally separate the procreative and unitive qualities of the union. It could be argued that double-effect reasoning applies to both the perforated and nonperforated MFP, since the intent is to obtain a sample only, not to remove the semen from the act. That makes the act different from the use of a contraceptive condom which aims to prevent all mixing of bodily fluids and is specifically intended to prevent procreation ( Paul VI 1968 , no. 14).
Huhner’s test is not routine and is offered by only a few pathologists. The collection process involves cervical sampling of semen and cervical mucus shortly after intercourse which should be undertaken within the fertile window when cervical mucus is present. As well as sperm counts and motility, it can be used to assess interaction of sperm with the cervical mucus. Similar to the MFP, Huhner’s test does not intentionally separate the procreative and unitive qualities of intercourse. However, it is intrusive and may be uncomfortable for the woman, has only a poor to fair reproducibility of results, is prone to unrepresentative sampling, and overall does not present useful results ( Hilgers 2004 ).
The masturbatory sperm sample has become the standard collection method to gather data on sperm counts, motility, and some gross abnormalities. The moral issue of masturbation for this purpose is disputed by moral theologians. It has been argued that masturbation for the purpose of sperm collection and analysis would be permissible since deliberate stimulation of the genital organs is not done in order to derive sexual pleasure. The prevailing counterargument, however, is that the object of the act is still sexual pleasure in order to achieve orgasm for the intended consequence that the ejaculate can be collected for analysis. It is often undertaken with pornographic material and imaging, opposing the promotion of chastity noted in Humanae vitae ( Paul VI 1968 , no. 22), is described as being both awkward and embarrassing for the male ( FertilityAuthority.com 2018 ) and may actually deter a male from providing a seminal fluid sample for analysis.
It is legitimate for a doctor to provide advice and treatment in order to restore reproductive health as part of infertility therapies. Optimal fertility health and awareness requires knowledge of the physiological signs of fertility taught by the various agencies for FABM. Restoration of fertility may involve hormonal supplementation, surgical treatment of endometriosis, ovarian drilling, and mechanisms to enhance ovulation. Providing fertility awareness education does present certain goods such as fostering mutual respect and cooperation within couples and pointing toward the undeniable reality of sexual difference and complementarity. Fertility awareness allows individuals and couples to take responsibility for their fertility, bringing with it an awareness of their bodies, sensitive to symptoms of health and disease.
Should a woman wish to use her fertility awareness knowledge to conceive a child in a manner that is opposed to the clinician’s intention in providing that knowledge, the nature of cooperation should be questioned: is it formal or material, immediate or mediate, proximal or remote? Broadly speaking, fertility awareness education may be provided by the clinician without entering into any potentially wrongful end for which it may be used. In the absence of formal cooperation, the level of cooperation would be material, mediate, and sufficiently remote to remove a clinician from sharing in the wrongfulness of any act of the agent which might follow ( Grisez 1997e ).
If a woman is known to be ovulating adequately, the intent of procedural fertility management (such as ovulation induction) is aimed toward conceiving a pregnancy rather than restoring fertility and may thus be deemed as formal cooperation with the woman. Hence, further consideration of her individual circumstances is warranted to ascertain the balance of risk versus benefit of treatment as well as natural law principles regarding the morality of intercourse within a couple’s relationship ( Paul VI 1968 , no. 11).
Elvira, a 34-year-old social worker, informs you that she and Toni, her same-sex partner, have decided to have a child by donor insemination. She asks you to assist her with ovulation induction to improve her chance of conception.
Humanae vitae details the regulation of birth in the context of sacramental marriage. Current definitions of marriage have diversified with a nonsignificant emphasis on elements of a permanent relationship being demonstrated between two or more people, such as cohabiting or conceiving children. In addition to “church marriages,” “legal marriages” now include same-sex unions, de facto relationships, and polygamous unions. It is often not possible for a clinician to determine whether a couple is sacramentally married or whether there are elements within their marriage that may nullify the validity of it, for example, existence of a prenuptial agreement or history of civil divorce. Other arguments for providing restorative reproductive treatment for couples not sacramentally married include the couple demonstrating an openness to procreation and the supreme gift of a child, consideration of that child’s rearing and education, and conditioned social perspectives negating the need for marriage such as the individual’s own family environment growing up, perceptions around the need for sexual and cohabiting experience prior to getting married, and the avoidance of an extravagant/expensive wedding ceremony. Consideration should be given to the diminished degree of culpability for the objective state of nonsacramental marriage ( peccatum ) as being contrary to the moral law ( Paul VI 1968 , no. 9) in this context.
A child of a same-sex relationship will always have come from outside the relationship and be a stepchild of one or other of the partners. Clinicians need to consider whether their aid will lead to the existence of a child who will potentially be deprived of a relationship with his or her biological father or mother as he or she grows up and to what extent the child’s rights to know, to have access to, and be nurtured by his or her parents will be denied.
A legal issue would arise in managing Elvira who is requesting ovulation induction to assist conception while she is in a same-sex relationship. In many jurisdictions in Australia, there is legislation that prohibits discrimination based on age, disability, political belief or activity, race, religious belief or activity, sex, and sexual orientation, for example, the Victorian Equal Opportunity Act 2010 and the Charter of Human Rights and Responsibilities Act 2006 in Victoria, Australia. Other specific legislation may govern artificial reproductive treatment procedures, including artificial insemination, such as the Victorian Assisted Reproductive Technology Act 2008 which requires that “persons seeking to undergo treatment procedures must not be discriminated against on the basis of their sexual orientation, marital status, race, or religion.” Withholding such treatment from Elvira based on her sexual orientation may thus be unlawful. Significant ramifications of unlawful activity may include legal proceeding and loss of professional registration and, hence, livelihood, which may influence assessment of the moral validity of any mediate material cooperation in providing ovulation induction. In some jurisdictions, there is recourse to freedom-of-conscience principles, such as the Medical Board of Australia (2013) Code of Conduct, which permits clinicians to not provide or directly participate in treatments to which the clinician conscientiously objects. Such conscientious refusal should not obstruct patient access to treatments that are legal. Clinicians must also be aware that in certain other circumstances, they are required to cooperate against their conscientious beliefs due to legal requirements, such as by the Victorian Abortion Law Reform Act 2008 and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Code of Good Ethical Practice ( 2015 ).
In dealing with the complexities of providing fertility treatment for same-sex couples, similar principles apply as in other circumstances described herein: that formal and immediate material cooperation are morally unacceptable and that material cooperation may be licit if the clinician is sufficiently remote from and that there are proportional reasons for permitting and facilitating the immoral outcome. Legal requirements around conscientious objection and on-referring may need to be considered. In addition, consideration of clinical factors may influence treatment decisions, for example, ovulation induction may not be required if a woman is ovulating and may be contraindicated medically, with the possibility of superovulation and high-order multiple pregnancy ensuing.
According to Dignitas personae , technical interventions into the procreative process should respect three essential goods: (1) the right to life and physical integrity of the embryo from the moment of conception, (2) the right to become a father or mother only through one’s spouse in marriage, and (3) that procreation should be “the fruit of the conjugal act specific to the love between spouses” ( Congregation for the Doctrine of the Faith 2008 , no. 12). It follows that any intervention that facilitates the conjugal act in reaching its end is permitted, but any action that substitutes the conjugal act is to be excluded ( Congregation for the Doctrine of the Faith 1987 , II.B.7; 2008, no. 12).
19-year-old Melanie and 20-year-old Chris present for lessons in natural family planning to avoid pregnancy. They are sexually active and unmarried. Six years later Melanie and Chris marry and are keen to start a family, hoping to have many children. After three years of trying to conceive they present for assistance in conceiving. Melanie wants to investigate any potential underlying problems, but Chris reports he is getting impatient and wants to undertake IVF because he feels it will help them have children faster.
In reproductive technologies that replace the conjugal act, such as IVF as requested by Chris, the child originates from the act of the technologist, in which the relationship between technologist and child is one of producer and product: an unequal relationship of dominance in which the embryo is subject to objectification and quality control. In contrast, ordinary sexual reproduction involves an act of intercourse in which the child comes into being usually as an extension of the parents’ love and thus as an equal third party to their love. While ARTs intentionally stand over the newly conceived life, the child that results from the conjugal act is not directly intended but comes to be on the occasion of the act ( Rhonheimer 2010 ). He or she is rightly received as a gift, not as an artifact of making subject to conditional acceptance.
Furthermore, another gravely immoral aspect of IVF relates to the production of embryos that are in excess of that required for transfer back into the woman’s uterus. There are parallels with postfertilization “contraception” (procured preimplantation abortion) due to the reduced moral status given to the “preimplantation” embryo Kischer 1997 ). Despite clear evidence and concordance of opinion that the life of a distinct human being begins with formation of the zygote ( Hall 1983 ), the diminished moral status of these early human beings is demonstrated by the common practices of keeping them in stasis (frozen for storage), discarding as biological waste, or being used for scientific experimentation at an arbitrary postfertilization age. Such ethical problems are not peripheral to the process of IVF but are inherent to processes that paradoxically claim to be at the service of life: processes that do not respect the inviolable dignity of the human embryo and are perfused by a eugenic mentality ( John Paul II 1995 , no. 14). Individual IVF providers and technicians, while undoubtedly well intentioned, cannot make themselves immune from formal cooperation in these evils.
The use of GIFT is sometimes proposed as an ethically valid alternative to IVF, although it is the subject of some contention ( Doerfler 2000 ). GIFT involves the transfer of gametes into the fallopian tube and thus before fertilization had commenced. It has been proposed that a single ovum transfer past a blockage in the female reproductive system followed by sexual intercourse may be in itself a legitimate means of assisting a couple to conceive a child within the dignity of the conjugal act ( Tonti-Filippini 1990 ). Transfer of sperm past a blockage in the epididymis in order for the following act of intercourse to have a higher chance of conception may be similarly acceptable. This recognizes that the technical assistance provided above helps the unitive act of sexual intercourse to achieve its procreative goal and is not a substitute for the act itself.
On this principle, there is debate about the causal relationship between the act of intercourse and conceiving a pregnancy and that of the technician’s actions and conceiving a pregnancy. If GIFT is undertaken using a perforated condom in order not to render the act of intercourse infertile, it is the semen remaining in the condom that is used for GIFT. In other words, sperm incidental to the fertile element of intercourse is used in generation of a new life, which parallels that aspect of IVF ( Grisez 1997c ). This separation of the unitive act from the procreative end, and thus causal relationship of intercourse, is further evidenced by the direct relationship of the generative act undertaken by the GIFT technician in bringing the sperm and ovum together. This process would seem to displace the act of intercourse as the direct cause of the origin of the new life being created. The Church has currently not pronounced on GIFT, leaving it to the couple as to whether the process being undertaken is a displacement or instead a legitimate assistance to the unitive act of intercourse.
The fate of “spare” or abandoned embryos created through IVF 1 constitutes another moral dilemma. The Catholic Church has rejected using these embryos for research or for the treatment of disease because that would involve treating the embryos as mere “biological material” and result in their destruction. It also asserts that proposals to thaw such embryos without reactivating them and then using them for research, as if they were normal cadavers, would be unacceptable ( Congregation for the Doctrine of the Faith 2008 , no. 19).
Veronica is a 45-year-old mother of two IVF children who recently became a Catholic convert. She has been recently widowed and is in poor health herself with ischemic heart disease. Veronica has 11 embryos remaining in an IVF program and has a friend who is infertile and single who would like to have some of the embryos transferred to her uterus.
Another option involves making these embryos available for infertile couples. The case of Veronica, who wishes to donate her spare embryos to an infertile friend as a form of prenatal or “embryo adoption” (case 6), is praiseworthy with regard to the intention of respecting and defending human life ( Lee 1990 ) by saving the embryos from intentional demise and for presenting a treatment option for an infertile woman. The Catholic Church has not taken an authoritative stance on prenatal adoption. Nevertheless, it holds that there are various problems not dissimilar to those described for artificial heterologous procreation and surrogate motherhood ( Congregation for the Doctrine of the Faith 2008 , no. 19). Among the other reasons mentioned in the preceding section, IVF itself is considered ethically unacceptable because it breaches the unity of marriage, which means reciprocal respect for the right within marriage to become a father or mother only together with the other spouse ( Congregation for the Doctrine of the Faith 2008 , no. 16). The Church further recognizes that the countless numbers of abandoned embryos represent a situation of injustice that cannot be resolved.
While utilizing “spare” embryos to treat infertility is deemed unacceptable, a different proposal involves married couples who already have a family, making a home for these abandoned children through “prenatal adoption” or “heterologous embryo transfer” (HET). This option has divided pro-life ethicists. Some have argued that this matter is quite different from surrogacy because the issues arise after the embryos have been produced. They acknowledge that although it was wrong to have produced an embryo by IVF and to have subjected them to a state of suspended animation, the end or intended outcome of prenatal adoption is good because it rescues the embryos from that state. Given also that the chosen means (thawing, rehydrating, and transferring an embryo from freezer to uterus) is good, this process may be considered morally acceptable. Other arguments are that procreation is not involved because the child already exists and transfer to a uterus is akin to a woman volunteering to nurse a foundling at her breast and that the embryo is in a similar situation to a foundling awaiting adoption. Since prenatal adoption is primarily concerned with the welfare of the baby, it is deemed not to contradict the Church’s teaching on surrogacy, which requires that a child must be conceived, born, and nurtured by his or her natural parents ( Grisez 1997b ).
Opponents of HET argue that embryo transfer is intrinsically different from adoption. The transfer of the embryo into the woman’s uterus makes her pregnant, and being pregnant means becoming a mother. Pregnancy is, in itself, a union between mother and child. The child is essentially of her , not only located within her but bound essentially, vitally, to her. She is literally home to the child in the sense of a dynamic dependency and interrelationship in which they share an intimate biological and spiritual connectedness. The problem is that she becomes a mother separately from the conjugal act and independently of her husband, and this is deemed to be inconsistent with respect for her dignity, with the sacredness of marriage, and the exclusive commitment given in marriage to her union with her husband ( Paul VI 1968 , nos. 8, 9). Some go so far as to suggest that the woman’s consent to become pregnant in this way is an unchaste act and violates that couple’s reproductive integrity. What is meant to be a result of a marital act—pregnancy—is now the result of a merely technical procedure, while the sanctity of marriage means that the woman laying herself open to an impregnating intromission is a vital part of the self-giving involved in her part of the marriage act ( Geach 1997 ). Her body, which has been united to her husband in marriage, and forms one flesh with him, “for a time, becomes the home of a child that bears no relationship to him, that is from outside their union. It is in this sense that heterologous embryo transfer may be an infidelity to the marriage” ( Tonti-Filippini 2003 , no. 120). There is also concern for the alienation of the woman’s husband through prenatal adoption ( Corby 2013 ). He takes no part in her becoming pregnant. She becomes a mother outside of her marriage and in that way thus breaches the commitment of the exclusive gift of herself to her husband ( Paul VI 1968 , no. 9).
Paul VI’s encyclical has been called “prophetic” in light of its prediction of a dismantling of human sexuality and rupture of relationships—a lowering of sexual standards, an increase in infidelity, an objectification of women as mere instruments for the satisfaction of the desires of men—that is wrought by an intentional disruption of the unitive and procreative aspects of conjugal love ( Paul VI 1968 , no. 17; Smith 1993 ). However, as demonstrated by this discussion of the ethics of reproduction, Humanae vitae may be considered equally prophetic and timeless in its application to many contemporary bioethical issues, unknown in 1968, that today demand an adequate response. In setting forth the intrinsic complementarity and irreducibility of the unitive and procreative dimensions of the conjugal act, the encyclical provides a hermeneutic through which such cases can be properly and faithfully assessed. Thus, being so much more than a reiteration of the Church’s determination of the illicitness of contraception, Humanae vitae , in its vision of human sexuality, offers us a sound foundation on which to construct a reasoned and faithful response to the ethical challenges of our day.
The authors are also grateful to Rev. Dr. Paschal Corby and the other ethicists, clinicians, and educators who contributed to development of the bioethical cases and their discussions at the National Fertility Conferences in 2014 and 2016: Dr. Ray Campbell, Rev. Dr. John Fleming, Very Rev. Dr. Gerald Gleeson, Edwina Gotz, Dr. Brendan Miller, Prof. John Ozolins, Dr. Gregory Pike, Dr. Elvis Šeman, and Assoc. Prof. Bernadette Tobin.
Joseph V. Turner , MBBS, PhD, is a founding director of the Australasian Institute for Restorative Reproductive Medicine (AIRRM) and a clinical academic at the School of Rural Medicine, University of New England; Faculty of Medicine, University of Queensland; and School of Medicine, University of New South Wales, Australia. He is a general practitioner obstetrician and rural generalist. AIRRM’s e-mail address is ua.gro.mrria@ofni .
Lucas A. McLindon , MBBS, is a founding director of AIRRM and a clinical academic in the Faculty of Medicine, University of Queensland. He is a qualified specialist obstetrician and gynecologist, general practitioner, and natural family planning medical consultant.
1. Women participating in in vitro fertilization (IVF) must undergo a surgical procedure. To minimize the associated risks with multiple procedures, women’s ovaries are overstimulated to increase production from one to two ova to ten to thirty ova per cycle which are then available for harvest. Ova are very fragile, and storage is problematic. Embryos are much more robust, so the practice is to fertilize all the available ova that are harvested. The reserve of embryos thus created enables several attempts to achieve pregnancy to then be made from the one surgical procedure to harvest the ova. Furthermore, the issue with success rate of the embryo transfer procedure is also given as a reason for creating a reserve supply ( Lee et al. 2016 ). Often, couples on IVF programs still have “spare” embryos in storage when they “complete” their families or decide for other reasons not to continue. As a result, there are in the order of millions of human embryos worldwide which are left in storage, used for research, or otherwise discarded ( Embryo Adoption Awareness Center 2018 ; Fuscaldo and Savulescu 2005 ).
Authors’ Note: This article is dedicated to the memory of professor Nicholas Tonti-Filippini ( Fisher 2015 ) whose vision brought together the three leading fertility awareness providers in Australia: Billings Life, FertilityCare Australasia, and the Australian Council of Natural Family Planning, at the inaugural National Fertility Conference in Melbourne, 2014. Nicholas coordinated the first bioethics session and wrote many of the ethical analyses. The concepts and analyses presented herein do not necessarily represent the views held by those acknowledged in contributing to the development of this article.
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
Registration is open for the 2024 ASRM Scientific Congress & Expo
Date: August 28, 2024
Author: ASRM
Join "Fertility and Sterility On Air" for insights from the ANXSREI conference on unexplained infertility, IVF, and expert debates. Listen now at ASRM.org.
The California General Assembly approved a bill mandating most private health insurance plans to provide coverage for In Vitro Fertilization (IVF).
A summary of federal and state legislation, and highlighting advocacy and outreach efforts of our members.
On August 21 - 24, 2024, REI and Andrology Fellows convened in Park City, Utah, to gain valuable insights, learn from leaders in the field, and network with other fellows.
Here’s a peek at this month’s issues from our family of journals! As an ASRM Member, you can access all of our journals.
Meet Anthony N. Imudia, MD, a board certified OB/GYN and REI specialist who earned his undergraduate and medical school degree from Latina University in Panama City, Panama.
ANZSREI 2024 debate: Should unexplained infertility go straight to IVF? Experts discuss pros, cons, and alternative treatments. No clear consensus reached.
Celebrate National Patient Advocacy Day by boosting civic engagement! Order your free Vot-ER badge to help patients register to vote and promote healthy communities.
The AUA, in collaboration with the American Society for Reproductive Medicine (ASRM), has released the 2024 amendment to the Male Infertility Guideline.
Topics include: a review of studies of menstrual fluid, changing our language regarding progestin protocols, and nanoscale motion tracing of spermatozoa.
Fertility and Sterility Global Journal Club from Brazil
It is with great pleasure that the American Society for Reproductive Medicine (ASRM) acknowledges and thanks the following people for their new membership in the Society.
Articles this month include: predicting ART complications, laser assisted hatching on vitrified blastocysts, predictive models of miscarriage and more.
Fertility & Sterility se enorgullece de traer un Journal Club Global en Español en vivo desde Cancún, Mexico
The CFAS/ASRM Business in Medicine: A Leadership and Management Summit took place on July 19-20, 2024, at the picturesque Rimrock Resort Hotel in Banff, Alberta.
Dr. Albert Béla Janko, Life member of ASRM, passed away on July 15, 2024, at the age of 90.
ASRM observed World IVF Day, the day marking the birth of the world’s first IVF baby in 1978, by continuing its advocacy for improvements in IVF policy.
Meet Salu Ribeiro, MS, TS(ABB), ALS/ELS(AAB), CLSp(RB), Senior Embryologist at the University of California, San Francisco.
Dr. Gvakharia is passionate about helping young colleagues advance in the field of clinical embryology and andrology.
July: what's new from the fertility and sterility family of journals, journal club global: oral progestin for ovulation suppression during ivf.
Live broadcast from the 2024 Midwest Reproductive Symposium International in Chicago, IL
Biomarkers for sperm improvement post-varicocele repair, minimal stimulation side effects, GnRH antagonist for heavy menstrual bleeding with fibroids.
ASRM) is pleased to announce our partnership with Vot-ER, a grassroots organization dedicated to driving civic engagement among healthcare professionals.
June issue Seminal Contribution: a randomized controlled trial studying the use of progestins for ovulation supression in predicted high responders.
Covering articles on embryo transfer, PIEZO-ICSI, pregnancy outcomes, oocyte maturity, estradiol levels, and ovarian carcinoma and more!
The American Society for Reproductive Medicine is proud to endorse the HOPE with Fertility Services Act (HR 8821).
The 2024 SRS-SREI Surgical Boot Camp took place at the Cleveland Clinic in Cleveland, OH, from May 30 to June 1, 2024.
An ASRM member since 2000, Dr. Lynch has served as a Chair on the SART Electronic Communications Committee from 2018 to the present.
An ASRM member for 8 years, Dr. Vij currently serves as program director for Cleveland Clinic’s Male Infertility and Andrology Fellowship.
ASRM is disappointed that a filibuster prevented the passage of the Right to IVF Act.
We are thrilled that a unanimous Supreme Court has rejected the ideologically driven lower court decisions on access to mifepristone
It would increase access to IVF treatments for all Americans, including active-duty service members, veterans, and federal employees.
Topics include: counseling on pregnancy complications in PCOS patients, sorting early spermatocytes from testicular biopsies, and more.
An ASRM member since 2017, Dr. Nannan Thirumavalavan is a fellowship-trained and board certified urologist in Cleveland, Ohio.
ASRM mourns the death of Dr. Songqing Li, who passed away on May 22, 2024.
Topics this month include Iatrogenic and demographic determinants of the national plural birth increase, outcomes between ICSI and IVF with PGT-A.
The documents lay out the clinical IVF process, summarize oversight of IVF in the U.S., and explain how lawmakers can support access to IVF.
Dr. Julia Conant joined ASRM to access the Mental Health Professional Group and the consultation, training and support offered.
Elizabeth Lee sees ASRM as the guiding light of high-quality clinical fertility practice as well as a consistent voice advocating for reproductive rights.
Dr. Kathryn Go finds ASRM’s role is to provide a community for professionals, clinical and allied, in the field of reproductive medicine.
Are you an ASRM member looking to sharpen your advocacy skills? The Office of Public Affairs has an exciting opportunity for you!
Join ASPIRE 2024 for a Journal Club Global on PGT-A and IVF. Learn from top experts discussing recent clinical trial data and pregnancy outcomes
ASRM and CFAS have teamed up to offer much-requested business education for clinicians and REI office staff!
Asrm reacts to cruz/britt oped.
We are pleased to see Senators Cruz and Britt express their interest in protecting access to IVF.
Topics include: IVF in film, a rat model of fallopian tube torsion, comparing letrozole regimens for PCOS, and a review of chronic endometritis.
In the realm of reproductive medicine, the significance of mental health cannot be overstated.
Build Connections, Skills, and a Brighter Future for Reproductive Health!
ASRM has filed an amicus curiae (friend of the court) brief in the case of Antoun v Antoun , which is pending before the Texas Supreme Court.
Topics this month include the use of ICSI, fertility treatments among reproductive-aged women after cancer, and more.
Designed for ASRM members passionate about making a real impact, PRIMED offers a one-of-a-kind opportunity to become trailblazers.
An ASRM member for 12 years, Alison Bartolucci, PhD has served on the SART Executive Council and as the SRBT representative.
An ASRM member for over 13 years, Dr. Mak has a unique perspective on health care, as she has trained as an Ob Gyn resident in both the UK and USA.
A new public opinion poll reveals strong support for improved access to In Vitro Fertilization (IVF).
In honor of National Infertility Awareness Week (NIAW), we have rounded up some of our resources on infertility.
National Infertility Awareness Week Action Round-Up
Next week is National Infertility Awareness Week, a federally recognized health observance founded to increase awareness of infertility.
Jessie Losch, ASRM Government Affairs Manager, updates ASRM Today on the advocacy efforts underway post the Alabama Supreme Court decision.
In 2022, the number of babies born from IVF increased from 89,208 in 2021 to 91,771 in 2022. This means that 2.5% of births in the US are a result of ART.
Un panel de expertos discutirá dos artículos recientes de Fertility and Sterility que estudian la infertilidad y el síndrome de ovario poliquístico.
Topics include: melatonin and implantation (4:38), whole-genome screening of embryos, and bioengineering assisted reproductive technology.
Fertility & Sterility on Air brings you the highlights from the 2024 Annual Meeting of the Pacific Coast Reproductive Society.
Meet Aileen Portugal, MD, graduated from the University of California San Diego with a degree in biochemistry and worked as a researcher for several years.
Meet Nicole Ulrich, MD, who attended Tulane University and then trained in Obstetrics/Gynecology at the Ochsner Clinic Foundation.
Meet Rachel Whynott, MD, FACOG, a double board-certified reproductive endocrinology and infertility subspecialist.
Meet Elizabeth Lee, RN, an ASRM member since 2016 and Employee #2 at Wellnest Fertility’s Clinical Operations.
Meet Ann Marie Luft, a recent rejoining member of ASRM and a fertility nurse and fertility consultant.
Meet Julie Bindeman, Psy-D, an ASRM member for eleven years, a graduate of George Washington University, and the co-owner of Integrative Therapy.
With over 30 years’ experience, Britt Carlsson, PhD has a strong knowledge of the global fertility markets.
Infertility treatments can be financially burdensome, often without insurance coverage, making understanding the cost effectiveness of PGT-A crucial.
Morgan Baker, RN, is a registered nurse from Springville Utah, who has a passion for providing high-quality patient care.
Meet Valerie L. Baker, MD, Director of the Division of REI and the Telinde-Wallach Professor of Gynecology and Obstetrics at Johns Hopkins.
ASRM is sad to hear of the death of Dr. Gary M. Horowitz, MD
In the United States, approximately 21% of adults report some form of tobacco use, although 18% report marijuana use.
Planned oocyte cryopreservation is an ethically permissible procedure that may help individuals avoid future infertility.
CREST is seeking applications for the 2024-2025 class of Scholars.
Journal club global: the future of rei fellowship training: debating opportunities and threats.
This exciting collaboration discusses the controversy and future directions for the field of Reproductive Endocrinology and Infertility medicine.
Listen to this interview featuring Dr. Jeremy Applebaum, who recently published "Impact of coronavirus disease 2019 vaccination on live birth rates after IVF"
ASRM has had a long history of working with Springer Nature to promote and elevate the Journal of Assisted Reproduction and Genetics (JARG).
Meet Sarah Holley, PhD, Health Sciences Assistant Clinical Professor in the Department of Psychiatry and Behavioral Sciences at UCSF and Professor of Psychology at SFSU.
It is with a heavy heart that we announce the passing of Dr. Jan Friberg, MD, PhD.
ASRM shared with the Senate Judiciary Committee the dangers to reproductive medicine nearly two years after the Dobbs decision.
ASRM is proud to announce six 2024 Pilot & Exploratory Grant Cycle awardees to receive funding through the ASRM Research Institute.
The impact of treating SCH on fertility, obstetric outcomes, and offspring neurocognitive development is debated in the literature.
Topics this month include the impact of COVID-19 vaccination on live birth rates after IVF, the "freeze-all" strategy in women with adenomyosis, and more.
Meet Zaraq Khan, MBBS, MCR, FACOG, a double board certified OBGYN and Reproductive Endocrinology & Infertility specialist.
Topics this month include: fluoroscopic-guided hysteroscopic tubal cannulation, follicular-fluid phthalates and ovarian reserve, and more.
ASRM is already pushing for legislation in Congress and the states to protect IVF. It requires resources to analyze and advocate for or against these bills.
We are pleased that the legislation passed into law by the Alabama General Assembly will at least allow our members in the state to care for their patients.
Protecting access to IVF care is expected to be a major theme of the State of the Union on Thursday.
Romaine Belle Bayless, MD, age 78, of Woodbury, MN, passed away following a courageous 4-year battle with pancreatic cancer.
On Friday, March 1, the appellees in this case filed a request for rehearing with the Alabama Supreme Court.
As the situation in Alabama following LePage v Mobile Infirmary, Inc. continues to quickly evolve, we want to ensure you stay apprised of ASRM’s efforts.
Clinicians should encourage disclosure between intimate partners but should maintain confidentiality where there is no harm to the partner and/or offspring.
Telemedicine has the potential to increase access to and decrease the cost of care.
Legally Speaking™ on presenting facts and reflecting on the impact and potential implications of legal developments in ART.
Two of the studies cited by Texas Judge in his ruling suspending federal approval of abortion pill mifepristone were retracted on February 5, 2024.
Dr. Luis Blasco, a pioneer in infertility treatment and a professor emeritus died peacefully on October 23, 2023.
Ovarian hyperstimulation syndrome is a serious complication associated with assisted reproductive technology.
Reach your potential as a reproductive health professional and join the community advancing reproductive medicine with your ASRM membership.
All memberships come with online access to Fertility and Sterility , F&S Science , F&S Reviews , F&S Reports, and the Journal of Assisted Reproduction and Genetics .
Individuals joining or renewing membership in ASRM that reside in low or low-middle income countries (as defined by the World Bank) now receive a discount on ASRM membership!
Continue your education. Grow professional relationships. Enhance patient care. Collaborate. Innovate through scientific discovery. Advocate for access to care.
It is with great pleasure that the American Society for Reproductive Medicine (ASRM) acknowledges and thanks the following people for their new membership in the Society.
ASRM Affiiliated Societies are made up of professionals who have special training and expertise in specific areas of reproductive medicine.
ASRM Professional Groups allow members to network and collaborate with other professionals who have an interest in the field of reproductive medicine.
ASRM Special Interest Groups provide programming and leadership to physicians and health professionals who have a special interest in a particular area of reproductive medicine.
ASRM Members can find contact information for other members by visiting ASRM Connect , the new community hub for ASRM membership.
View the ASRM Academy Course Catalog
Panel discussions on topics to enhance your knowledge of all facets of reproductive medicine
View the specially crafted certificate courses and training modules available from ASRM Academy
The ASRM Family of Podcasts were developed with both health professionals and the layman in mind
The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.
Get the EDGE on embryo identification! EDGE allows you to compare your grading of embryos against embryologists in the US and around the world.
Reproductive Medicine International is a newly launched journal which elaborates author benefits along with reliable copy rights policy. All articles published in the journal will be subjected to peer review process. It encourages authors to publish their experimental and theoretical results in as much detailed as possible.
The Journal covers various topics of erectile dysfunction, infertility, menopause, sexual health and reproductive technologies, reproductive health, male and female sexual function, sexual disorders, STDs, genito-urinary disorders, reproductive system, sexual behavior, obstetrics, reproductive endocrinology, urinary tract infections, sexually transmitted diseases, male infertility, sexual pains, etc.
Title: Reproductive Medicine International
ISSN: 2643-4555
Editor-in-chief: Sezgin Gunes
NLM title abbreviation: Reprod Med Int
ISO abbreviation: Reprod Med Int
Other titles: RMI
Category: Reproductive Medicine
DOI: 10.23937/2643-4555
Peer review: Double blind
Review speed: 3 weeks
Fast-track review: 10 days
Publication format (s): Electronic and print
Publication policy: Open Access; COPE guide
Publication type(s): Periodicals
Publisher: ClinMed International Library
Country of publication: USA
Language: English
Contact email: [email protected]
Open Access
Iin Fadhilah Utami Tammasse and Fachrul Tamrin Article Type: Review Article | First Published: 2023/11/17 | |
Open Access
Zümrüt Bilgin and Tuğba Yılmaz Esencan Article Type: Original Research | First Published: December 14, 2022 | |
Open Access
Zümrüt Bilgin, PhD, RN and Kevser Burcu Çalık, MD Article Type: Original Article | First Published: December 01, 2022 | |
Open Access
Xuan Trang Thi Pham, M.D, Anh Dinh Bao Vuong M.D, Lan Ngoc Vuong M.D, Ph.D and Phuc Nhon Nguyen M.D Article Type: Original Article | First Published: September 12, 2022 | |
Open Access
Ariam Woldu, Ghidey Gebreyohannes, Lidia Ghirmai and Eyasu H. Tesfamariam Article Type: Original Research Article | First Published: August 29, 2022 | |
Open Access
Amala Sunder, MRCPI(OBG), Bessy Varghese, MBBS, DGO, Noora Bahzad, MD and Basma Darwish, MD Article Type: Case Report | First Published: August 26, 2021 | |
Open Access
Gitanjali Kumari, Vaishali Taralekar, Aniket Kakade, Jyoti Rathi and Naval Dudum Article Type: Case Report | First Published: July 30, 2021 | |
Open Access
Reyhan ERKAYA and Kıymet YESİLÇİÇEK ÇALIK Article Type: Orginal Research | First Published: July 19, 2021 | |
Open Access
Fazele Heydarian Moghadam, Mojgan Tansaz, Soheila Aminimoghaddam, Homa Hajimehdipoor and Hamed Hosseini Article Type: Review Article | First Published: March 08, 2021 | |
Open Access
Sema Yuksekdag, Aysun Firat, Abdullah Yildiz and Ethem Unal Article Type: Original Research | First Published: February 03, 2020 | |
Open Access
Ali Ghanbari, Telka Noormohamadi, Pegah Mirzapur and Mohammad Rasool Khazaei Article Type: Original Article | First Published: May 25, 2019 | |
Open Access
Teresa Wiesak, PhD, Robert Milewski, PhD, Kerri King, BSc, Andrew Atkinson, MD and Allen Morgan, MD Article Type: Review Article | First Published: March 28, 2019 | |
Open Access
Tong Carmen, Chin Hsuan, Lim Yvonne, Gerard Leong and Lim Yeong Phang Article Type: Case Report | First Published: February 23, 2019 | |
Open Access
Anita Lobo, Prema D'cunha and Blany Lobo Article Type: Research Article | First Published: December 19, 2018 | |
Open Access
Rifat Taner Aksoy, Mehmet Cinar, Aytekin Tokmak, Enis Ozkaya, Ali Irfan Guzel and Nafiye Yilmaz Article Type: Original Article | First Published: September 27, 2018 | |
Open Access
Ellen Casey, Travis Anderson, Laurie Wideman, Frances F Shofer and Sandra J Shultz Article Type: Original Research | First Published: August 25, 2018 | |
Open Access
M Angeles Martos, Virginia Engels, Beatriz Bueno, Angel Salcedo, Tirso Perez-Medina and Luis San-Frutos Article Type: Research Article | First Published: July 26, 2018 | |
Open Access
Baquedano L, Sanchez Borrego R, Abad P, Jurado AR, Manubens M and Mendoza N Article Type: Review Article | First Published: June 30, 2018 | |
Open Access
Mohamed Nabih EL-Gharib Article Type: Short Communication | First Published: June 25, 2018 | |
Open Access
Monica S Chung, Laurice Bou Nemer and Bruce R Carr Article Type: Mini Review | First Published: June 06, 2018 | |
Open Access
Shahar Kol and Ofer Fainaru Article Type: Case Report | First Published: May 30, 2018 |
Articles published.
All articles are fully peer reviewed, free to access and can be downloaded from our ClinMed archive.
Clinical Medical Image Library: 93.51
International Journal of Critical Care and Emergency Medicine: 92.83
International Journal of Sports and Exercise Medicine: 91.84
International Journal of Womens Health and Wellness: 91.79
Journal of Musculoskeletal Disorders and Treatment: 91.73
Journal of Geriatric Medicine and Gerontology: 91.55
Journal of Infectious Diseases and Epidemiology: 91.55
Clinical Medical Reviews and Case Reports: 91.40
International Archives of Nursing and Health Care: 90.87
International Journal of Ophthalmology and Clinical Research: 90.80
International Archives of Urology and Complications: 90.73
Journal of Clinical Nephrology and Renal Care: 90.33
Journal of Family Medicine and Disease Prevention: 89.99
Journal of Clinical Gastroenterology and Treatment: 89.54
Journal of Dermatology Research and Therapy: 89.34
International Journal of Clinical Cardiology: 89.24
International Journal of Radiology and Imaging Technology: 88.88
Obstetrics and Gynaecology Cases - Reviews: 88.42
International Journal of Blood Research and Disorders: 88.22
International Journal of Diabetes and Clinical Research: 87.97
International Journal of Clinical Cardiology ISSN: 2378-2951 | ICV: 89.24 | |
Obstetrics and Gynaecology Cases - Reviews ISSN: 2377-9004 | ICV: 88.42 | |
Journal of Hypertension and Management ISSN: 2474-3690 | ICV: 87.69 | |
International Journal of Diabetes and Clinical Research ISSN: 2377-3634 | ICV: 87.97 | |
Journal of Infectious Diseases and Epidemiology ISSN: 2474-3658 | ICV: 91.55 |
IMAGES
VIDEO
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This Special Issue aims to focus on some hot issues in reproductive medicine and to re-evaluate infertility etiology, the available clinical-therapeutic strategies (including ART), and decision-making algorithms in the light of the most recent evidence.
As my thesis supervisor, Dr. Amanda Vandyk co-authored this monograph and played an influential role in the thesis design, including the data analysis. Amanda was a key advisor throughout the development of this thesis and substantially contributed to the final document. 2. Wendy Peterson RN, PhD
An innovative interdisciplinary journal which explores human reproductive health - from STIs to reproductive epidemiology - to advance universal access to sexual and reproductive health care.
G.D.A. reports research sponsorship from Abbott, personal fees from Abbott and LabCorp, a financial interest in Advanced Reproductive Care, committee membership of the FIGO Committee on Reproductive Medicine, International Committee for Monitoring Assisted Reproductive Technologies, International Federation of Fertility Societies and World ...
Learn how to develop a thesis for Reproductive Endocrinology and Infertility fellowship with a case study of low oxygen tension for human embryo culture.
Reproductive pathologies are often challenging to diagnose and properly treat, which increases the risk of comorbidity development. Moreover, a long-standing lack of research into reproductive health and disease means that the acute and chronic healthcare burden caused by reproductive pathologies is likely to continue increasing.
Artificial intelligence (AI) has experienced rapid growth over the past few years, moving from the experimental to the implementation phase in various fields, including medicine. Advances in learning algorithms and theories, the availability of large ...
Fellows in Reproductive Endocrinology and Infertility training are expected to complete 18 months of clinical, basic, or epidemiological research. The goal of this research is not only to provide the basis for the thesis section of the oral board exam but also to spark interest in reproductive medicine research and to provide the next generation of physician-scientists with a foundational ...
Reproductive health impacts on all strands of society. Most journals covering this topic have limited scope focussing on either pregnancy or reproductive medicine, clinical or bench-based research. Our aim is to provide a journal presenting cutting-edge research and authoritative reviews, broad in scope in all aspects of reproductive biomedicine.
Fellows in Reproductive Endocrinology and Infertility training are expected to complete 18 months of clinical, basic, or epidemiological research. The goal of this research is not only to provide the basis for the thesis section of the oral board exam but also to spark interest in reproductive medic …
Background In-country research capacity is key to creating improvements in local implementation of health programs and can help prioritize health issues in a landscape of limited funding. Research prioritization has shown to be particularly useful to help answer strategic and programmatic issues in health care, including sexual and reproductive health (SRH). The purpose of this paper is to ...
Bram Sengers (SoE), Rohan Lewis (Medicine). Project description. This project will use computational modelling in combination with 3D multiscale multimodal imaging to improve our understanding of placental evolution, in close collaboration between Engineering and Medicine. Read more.
List of dissertations / theses on the topic 'Reproductive health'. Scholarly publications with full text pdf download. Related research topic ideas.
Obstetrics and Gynecology International is an open access journal that publishes articles related to obstetrics, maternal-fetal medicine, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, and sexual medicine.
School of Medicine > Department of Obstetrics and Gynecology > Division: Reproductive Endocrinology and Infertility. Anne Steiner is interested in infertility, in vitro fertilization (IVF), reproductive aging, hysteroscopy, amenorrhea (absent menses), biomarkers of ovarian aging, and reproductive potential. (Keywords: Amenorrhea, biomarkers ...
The Centre for Reproductive Health (CRH) offers PhD programmes, and a one-year full-time MSc by Research programme, which aims to introduce students to modern, up-to-date molecular and cellular biological research in the field of: reproductive sciences. reproductive health. reproductive medicine. You will study in a stimulating, challenging and ...
Background: Reproductive health is an important health topic. There are many challenges in reproductive health and it is necessary to train experts to manage them. The aim of this study was to define the tasks of Master of Science (MSc) graduates in reproductive health through comprehensive needs assessment to establish the course.
Reproductive science and medicine encompasses the study of endocrinology, gonad development, gametogenesis and embryogenesis, and reproductive tract biology. These areas of research influence health and disease, as they are fundamental to our understanding of fertility and infertility, contraception, infectious diseases, pregnancy, fetal origins of adult disease, and trans-generational ...
The digital thesis deposit has been a graduation requirement since 2006. Starting in 2012, alumni of the Yale School of Medicine were invited to participate in the YMTDL project by granting scanning and hosting permission to the Cushing/Whitney Medical Library, which digitized the Library's print copy of their thesis or dissertation.
Additional survey topics include sexual and reproductive health, mental health, body comfort, school retention and empowerment. In four countries, the GEAS is used to evaluate the longitudinal impact of gender-transformative interventions carried out by Rutgers, Netherlands; Save the Children and the Institute of Women and Ethnic Studies.
The cases and their resultant moral and ethical discussion points have been drawn from the Restorative Reproductive Ethics Seminar at the National Fertility Conference 2014 and Bioethical Issues in Reproductive Medicine session at the National Fertility Conference 2016 held in Melbourne, Australia.
One of modern healthcare's most controversial areas, reproductive medicine is an emerging discipline that fosters hugely divergent opinions on topics such as laboratory techniques, clinical ...
Legally Speaking is a column highlighting recent court decisions affecting the assisted reproductive technologies and the families they create, written by Susan L. Crockin, J.D. and guest authors who offer unique perspectives and expertise on significant legal topics.
Reproductive Medicine International is an open access and peer-reviewed journal committed to promote the best standards of scientific discoveries and knowledge in the field of sexual medicine and reproductive disorders and management. Reproductive Medicine International acts a best source of information for the researchers, reproductive health ...