thesis topics in reproductive medicine

Information

• Author Services

Initiatives

You are accessing a machine-readable page. In order to be human-readable, please install an RSS reader.

All articles published by MDPI are made immediately available worldwide under an open access license. No special permission is required to reuse all or part of the article published by MDPI, including figures and tables. For articles published under an open access Creative Common CC BY license, any part of the article may be reused without permission provided that the original article is clearly cited. For more information, please refer to https://www.mdpi.com/openaccess .

Feature papers represent the most advanced research with significant potential for high impact in the field. A Feature Paper should be a substantial original Article that involves several techniques or approaches, provides an outlook for future research directions and describes possible research applications.

Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive positive feedback from the reviewers.

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

Original Submission Date Received: .

• Active Journals
• Find a Journal
• Proceedings Series
• For Authors
• For Reviewers
• For Editors
• For Librarians
• For Publishers
• For Societies
• For Conference Organizers
• Open Access Policy
• Institutional Open Access Program
• Special Issues Guidelines
• Editorial Process
• Research and Publication Ethics
• Article Processing Charges
• Testimonials
• Preprints.org
• SciProfiles
• Encyclopedia

Journal Menu

• Aims & Scope
• Editorial Board
• Reviewer Board
• Topical Advisory Panel
• Instructions for Authors
• Special Issues
• Sections & Collections
• Article Processing Charge
• Indexing & Archiving
• Editor’s Choice Articles
• Most Cited & Viewed
• Journal Statistics
• Journal History
• Journal Awards
• Society Collaborations
• Conferences
• Editorial Office

Journal Browser

• arrow_forward_ios Forthcoming issue arrow_forward_ios Current issue
• Vol. 13 (2024)
• Vol. 12 (2023)
• Vol. 11 (2022)
• Vol. 10 (2021)
• Vol. 9 (2020)
• Vol. 8 (2019)
• Vol. 7 (2018)
• Vol. 6 (2017)
• Vol. 5 (2016)
• Vol. 4 (2015)
• Vol. 3 (2014)
• Vol. 2 (2013)
• Vol. 1 (2012)

Find support for a specific problem in the support section of our website.

Please let us know what you think of our products and services.

Visit our dedicated information section to learn more about MDPI.

Hot Topics in Reproductive Medicine Research

• Print Special Issue Flyer

Special Issue Editors

Special issue information, benefits of publishing in a special issue.

• Published Papers

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section " Reproductive Medicine & Andrology ".

Deadline for manuscript submissions: closed (15 November 2023) | Viewed by 67727

Share This Special Issue

Dear Colleagues,

Infertility affects approximately 10–15% of couples of reproductive age worldwide. Several factors contribute to its increasing trend in Western countries. Unfortunately, the etiology of infertility remains elusive in a high proportion of patients and therefore the treatments are poorly effective.

Additionally, the results of assisted reproductive techniques (ARTs) show evident limitations even using pre-implantation genetic diagnosis for aneuploidies, prolonged embryo cultures, selection of embryos, etc. Furthermore, there are concerns about obstetric, neonatal, and adult health risks of the children obtained by ART. The endometrium and the placenta certainly deserve more attention. Despite the growing trend in the use of ART, very frequent conditions, such as inflammation of the male genital tract and varicocele, female diseases such as polycystic ovarian syndrome and endometriosis, and their treatments cannot be underestimated.

Another important aspect is the selection of embryos to be used for embryo transfer after ART. Considering the multifactorial aspects involved in reproduction, new approaches are being studied to select the “best” ones in terms of reproductive success. These include the use of artificial intelligence.

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.

Prof. Dr. Aldo E. Calogero Prof. Dr. Claudio Manna Guest Editors

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website . Once you are registered, click here to go to the submission form . Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• assisted reproduction
• preimplantation genetic tests for aneuploidies
• infertility
• male infertility
• obstetric outcome
• polycystic ovarian syndrome
• endometrium
• endometriosis
• Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
• Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
• Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
• External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
• e-Book format: Special Issues with more than 10 articles can be published as dedicated e-books, ensuring wide and rapid dissemination.

Further information on MDPI's Special Issue polices can be found here .

Published Papers (17 papers)

Jump to: Review , Other

Jump to: Research , Other

Jump to: Research , Review

Further Information

Mdpi initiatives, follow mdpi.

Subscribe to receive issue release notifications and newsletters from MDPI journals

• Search Menu
• Sign in through your institution
• Advance articles
• Mini-reviews
• ESHRE Pages
• Editor's Choice
• Supplements
• Author Guidelines
• Submission Site
• Reasons to Publish
• Open Access
• Advertising and Corporate Services
• Advertising
• Reprints and ePrints
• Sponsored Supplements
• Branded Books
• Journals Career Network
• About Human Reproduction
• About the European Society of Human Reproduction and Embryology
• Editorial Board
• Self-Archiving Policy
• Dispatch Dates
• Contact ESHRE
• Journals on Oxford Academic
• Books on Oxford Academic

Article Contents

Introduction, materials and methods, supplementary data, acknowledgments.

• < Previous

Top 10 priorities for future infertility research: an international consensus development study †   ‡

Members of the Priority Setting Partnership for Infertility are listed in the  Appendix.

• Article contents
• Figures & tables
• Supplementary Data

J M N Duffy, G D Adamson, E Benson, S Bhattacharya, S Bhattacharya, M Bofill, K Brian, B Collura, C Curtis, J L H Evers, R G Farquharson, A Fincham, S Franik, L C Giudice, E Glanville, M Hickey, A W Horne, M L Hull, N P Johnson, V Jordan, Y Khalaf, J M L Knijnenburg, R S Legro, S Lensen, J MacKenzie, D Mavrelos, B W Mol, D E Morbeck, H Nagels, E H Y Ng, C Niederberger, A S Otter, L Puscasiu, S Rautakallio-Hokkanen, L Sadler, I Sarris, M Showell, J Stewart, A Strandell, C Strawbridge, A Vail, M van Wely, M Vercoe, N L Vuong, A Y Wang, R Wang, J Wilkinson, K Wong, T Y Wong, C M Farquhar, Priority Setting Partnership for Infertility , Top 10 priorities for future infertility research: an international consensus development study  , Human Reproduction , Volume 35, Issue 12, December 2020, Pages 2715–2724, https://doi.org/10.1093/humrep/deaa242

• Permissions Icon Permissions

Can the priorities for future research in infertility be identified?

The top 10 research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction and ethics, access and organization of care for people with fertility problems were identified.

Many fundamental questions regarding the prevention, management and consequences of infertility remain unanswered. This is a barrier to improving the care received by those people with fertility problems.

Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for each of the categories male infertility, female and unexplained infertility, medically assisted reproduction and ethics, access and organization of care.

Healthcare professionals, people with fertility problems and others (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance.

The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions. A rationalized list of 231 confirmed research uncertainties was entered into an interim prioritization survey completed by 317 respondents from 43 countries. The top 10 research priorities for each of the four categories male infertility, female and unexplained infertility (including age-related infertility, ovarian cysts, uterine cavity abnormalities and tubal factor infertility), medically assisted reproduction (including ovarian stimulation, IUI and IVF) and ethics, access and organization of care were identified during a consensus development meeting involving 41 participants from 11 countries. These research priorities were diverse and seek answers to questions regarding prevention, treatment and the longer-term impact of infertility. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research and population science.

We used consensus development methods, which have inherent limitations, including the representativeness of the participant sample, methodological decisions informed by professional judgment and arbitrary consensus definitions.

We anticipate that identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems and others, will help research funding organizations and researchers to develop their future research agenda.

The study was funded by the Auckland Medical Research Foundation, Catalyst Fund, Royal Society of New Zealand and Maurice and Phyllis Paykel Trust. 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 Endometriosis Research Foundation, and research sponsorship of the International Committee for Monitoring Assisted Reproductive Technologies from Abbott and Ferring. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and editor for the Cochrane Gynaecology and Fertility Group. J.L.H.E. reports being the Editor Emeritus of Human Reproduction . A.W.H. reports research sponsorship from the Chief Scientist’s Office, Ferring, Medical Research Council, National Institute for Health Research and Wellbeing of Women and consultancy fees from AbbVie, Ferring, Nordic Pharma and Roche Diagnostics. M.L.H. reports grants from Merck, grants from Myovant, grants from Bayer, outside the submitted work and ownership in Embrace Fertility, a private fertility company. N.P.J. reports research sponsorship from AbbVie and Myovant Sciences and consultancy fees from Guerbet, Myovant Sciences, Roche Diagnostics and Vifor Pharma. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from AbbVie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. E.H.Y.N. reports research sponsorship from Merck. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology , research sponsorship from Ferring and retains a financial interest in NexHand. J.S. reports being employed by a National Health Service fertility clinic, consultancy fees from Merck for educational events, sponsorship to attend a fertility conference from Ferring and being a clinical subeditor of Human Fertility . A.S. reports consultancy fees from Guerbet. J.W. reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. A.V. reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and the journal Reproduction . His employing institution has received payment from Human Fertilisation and Embryology Authority for his advice on review of research evidence to inform their ‘traffic light’ system for infertility treatment ‘add-ons’. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the present work. All authors have completed the disclosure form.

The ultimate aim of infertility research is to improve clinical practice and optimize the chances of people with fertility problems achieving parenthood. For this to be possible, research needs to address questions that are pertinent to people with infertility, be conducted using appropriate methods, and be reported in a comprehensive, transparent and accessible manner ( Duffy et al. , 2017 ). The first step in research production is to identify appropriate questions. Traditionally, research funding organizations and researchers have identified, refined and prioritized their own research agenda. It is unlikely that such prioritization has used formal consensus methods, engaged wider stakeholders, including people with fertility problems, and was independent of commercial interests. There has been modest improvement in some countries, including the Netherlands, the UK and the USA, which has emphasized the importance of including patients and the public in developing research priorities ( Graham et al. , 2020 ).

Sir Iain Chalmers, founder of the Cochrane Collaboration, has advocated for research priorities to be jointly identified by healthcare professionals, patients and communities ( Chalmers and Glasziou, 2009 ). He established the James Lind Alliance, which brings together healthcare professionals, patients and others, in priority setting partnerships. Using formal consensus methods, each priority setting partnership engages in an open and transparent process to identify and prioritize unanswered research questions, known as research uncertainties, in a particular area of health care ( James Lind Alliance, 2018 ). The expectation is that prioritized research uncertainties will establish the future research agenda of funding organizations and researchers. As a result, it is hoped that the gap will close between what research is needed and what research is pursued ( Wilkinson et al. , 2019a ).

An international collaboration has brought healthcare professionals, people with fertility problems and others together within a Priority Setting Partnership for Infertility to develop future research priorities for male infertility, female and unexplained infertility, medically assisted reproduction and ethics, access and organization of care.

An international multidisciplinary steering group, including healthcare professionals, people with fertility problems and researchers, was established to provide a diverse range of perspectives to inform key methodological decisions. The steering group was convened during the development of the study protocol, before the launch of the initial survey and interim prioritization survey, and before the consensus development meeting. A systematic review of registered, progressing and completed priority setting research settings was completed to assist with the planning and delivery of the study ( Graham et al. , 2020 ).

Research uncertainties related to infertility associated with endometriosis, miscarriage and polycystic ovary syndrome were not considered because of other current or completed research prioritization initiatives ( Horne et al. , 2017 ; Prior et al. , 2017 ).

Research priorities were developed in a three-stage process using consensus methods advocated by the James Lind Alliance (2018) . Potential research uncertainties were gathered through an online survey of healthcare professionals, people with fertility problems and others. Healthcare professionals, including embryologists, fertility specialists and gynecologists, were recruited through the British Fertility Society, Core Outcomes in Women’s Health (CROWN) initiative, Cochrane Gynaecology and Fertility Group, Fertility and Sterility Forum, Reproductive Medicine Clinical Study Group and Royal College of Obstetricians and Gynecologists. People with fertility problems were recruited through Fertility Europe, an umbrella organization of more than 20 European patient organizations, including Fertility Network UK and Freya, Fertility New Zealand, RESOLVE: The National Infertility Association, and the Women’s Voices Involvement Panel hosted by the Royal College of Obstetricians and Gynecologists. Other people could register to participate, including healthcare funders, healthcare regulators and researchers. Recruitment was supported by an active social media campaign. Potential participants received an explanatory video abstract, a plain-language summary and survey instructions. Before completing the survey, participants provided demographic details, including age, gender and geographical location, and information pertaining to their professional or personal experience of infertility. Participants were invited to suggest up to five research questions related to infertility that they considered unanswered.

After the survey had closed, the survey responses were examined in detail within an iterative process. Individual responses were reviewed by at least two members of the steering group. Responses were excluded if they included questions that did not fit the scope of the study, were not answerable by research, related to a specific person or situation or were ambiguous. Incomplete responses were also excluded. The remaining responses were formatted into appropriate research questions.

In addition, research recommendations were identified from a systematic review of clinical practice guidelines and Cochrane systematic reviews. Clinical practice guidelines relevant to infertility were identified by searching bibliographical databases, including Embase, International Guideline Library and MEDLINE, from 2007 to July 2017. Research recommendations were extracted verbatim from clinical practice guidelines. Using a data extraction tool available to the Cochrane Gynaecology and Fertility Group, research recommendations were extracted from individual Cochrane reviews evaluating potential fertility treatments. Research recommendations from clinical practice guidelines and Cochrane systematic reviews were reviewed by two members of the steering group and formatted into appropriate research questions. Differences in opinion were resolved by discussion with the steering group.

The long list of potential research questions was organized by allocating individual research questions in four categories: male infertility; female and unexplained infertility, including age-related infertility, ovarian cysts, uterine cavity abnormalities and tubal factor infertility; medically assisted reproduction including ovarian stimulation, IUI and IVF; and ethics, access and organization of care. These categories were identified in consultation with the steering group. Duplicate research questions were removed. Research questions were checked against the published research evidence, including clinical practice guidelines, Cochrane systematic reviews and randomized trials, and those questions considered to be already answered were removed.

The long list of confirmed research uncertainties was entered into an interim prioritization survey. Initial survey participants were invited to participate in the survey. In addition, healthcare professionals, people with fertility problems and others were recruited using the same methods as the initial survey. Before completing the survey, participants provided demographic details, including age, gender and geographical location, and information pertaining to their professional or personal experience of infertility. Participants were invited to select the research uncertainties they considered most important. After the survey had closed, questions were ranked based on the frequency they had been chosen by participants.

The top 15 research uncertainties in each category were discussed during a consensus development meeting (data are presented in the Supplementary Table S1 ). A formal consensus development method, the modified nominal group technique, was used to identify the top 10 research uncertainties for each category ( James Lind Alliance, 2018 ). Healthcare professionals, people with fertility problems and others who had completed the initial or interim prioritization survey were invited to participate. The modified nominal group technique does not depend on statistical power. In consultation with the steering group, the aim was to recruit between 15 and 30 participants, as this number has yielded sufficient results and assured validity in other settings ( Murphy et al. , 1998 ).

Before the consensus development meeting, participants provided demographic details, including age, gender and geographical location, and information pertaining to their professional or personal experience of infertility. Following an introductory session, participants were assigned to one of two groups, each with a facilitator, to discuss the ranking of prioritized research uncertainties. The assignments were pre-specified to ensure a mixture of healthcare professionals, people with fertility problems and others. The groups were provided with a set of cards with an individual research uncertainty printed on each. Each participant was asked to contribute their opinions on the research uncertainties they felt most and least strongly about. Following this initial discussion, participants were invited to discuss the ordering of the research uncertainties. By the end of the session, the research uncertainties were placed in ranked order. The rankings from the two groups were aggregated into a single ranking order and presented to the entire group. Participants were invited to discuss the ordering of the research uncertainties. By the end of the discussion, the research uncertainties were placed in a final ranked order.

The National Research Ethics Service, UK, advised the study did not require formal review.

The initial survey was completed by 179 healthcare professionals (46%), 153 people with fertility problems (39%) and 56 others (14%), from 40 countries ( Table I ). Four hundred and twenty-three responses were submitted ( Fig. 1 ). Following review, 136 responses (32%) were excluded. Clinical practice guidelines relevant to infertility were identified by searching bibliographical databases; the search strategy identified 3680 records. After excluding 731 duplicate records, 2949 titles and abstracts were screened. Thirty-two potentially relevant clinical practice guidelines were evaluated. Fourteen clinical practice guidelines met the inclusion criteria, including two guidelines related to infertility in general ( Loh et al. , 2014 ; National Institute for Health and Care Excellence, 2017 ), five guidelines related to male infertility (American Urological Association, 2010; Jarvi et al. , 2010 ; Jungwirth et al. , 2018 ), five guidelines related to uterine anomalies ( Kroon et al. , 2011 ; American Association of Gynecologic Laparoscopists, 2012 ; Carranza-Mamane et al. , 2015 ; Practice Committee of the American Society for Reproductive Medicine, 2016 a, 2017 ) and two guidelines related to medically assisted reproduction ( Practice Committee of the American Society for Reproductive Medicine, 2016b ; Penzias et al. , 2017 ). Thirteen research recommendations were extracted from the clinical practice guidelines. The Cochrane Gynaecology and Fertility Group provided research recommendations from 162 Cochrane systematic reviews. Two hundred and twenty-three potential research questions were extracted from these research recommendations. A long list of 533 potential research uncertainties was reviewed, 241 duplicate research uncertainties were removed and 51 research uncertainties which had been answered by research were also removed.

Overview of the process of identifying research uncertainties .

Characteristics of the participants in a survey to identify the priorities for future infertility research.

A rationalized list of 231 confirmed research uncertainties was developed, which included 34 research uncertainties related to male infertility, 48 research uncertainties related to female and unexplained infertility, 101 research uncertainties related to medically assisted reproduction and 48 research uncertainties related to ethics, access and organization of care. These confirmed research uncertainties were entered into an interim prioritization survey, which was completed by 143 healthcare professionals, 119 people with fertility problems and 55 others, from 43 countries.

Nineteen healthcare professionals, 14 people with personal experience of infertility and 8 others, from 11 countries, participated in the consensus development meeting. The modified nominal group technique was used to prioritize the top 10 research uncertainties for male infertility, female and unexplained infertility, medically assisted reproduction and ethics, access and organization of care. Fifteen highly prioritized research uncertainties for each category were discussed during the consensus development meeting ( Supplementary Table SI ). The 15 highly prioritized research uncertainties were initially discussed by two separate groups and at the end of the discussion, they ranked the research uncertainties. The first-round ranking is presented in Supplementary Table SI . The rankings from the two groups were aggregated into a single ranking order and discussed by the entire group ( Supplementary Table SI ). Participants were encouraged to discuss and finalize the rank order of the research priorities. The top 10 research priorities are presented in Fig. 2 .

The top 10 priorities for future infertility research in each of the four categories .

The Priority Setting Partnership for infertility has brought together healthcare professionals, people with fertility problems and others to identify the top 10 research priorities for future infertility research. These research priorities are diverse and seek answers to questions regarding prevention, treatment and the longer-term impact, as well as wider contextual issues related to access and public health policy. They highlight the importance of pursuing research which has often been overlooked, including addressing the emotional and psychological impact of infertility, improving access to fertility treatment, particularly in lower resource settings, and securing appropriate regulation. Addressing these priorities will require diverse research methodologies, including laboratory-based science, qualitative and quantitative research and population science.

Strengths and limitations

The James Lind Alliance (2018) has published guidance to inform the design of research priority setting studies. This study has followed this guidance to ensure the research priorities were developed using a clear and transparent process using formal consensus development methods. The study design, development and delivery were also informed by a systematic review of research priority setting studies relevant to women’s health ( Graham et al. , 2020 ). With 388 respondents from 40 countries participating in the initial survey, 317 respondents from 43 countries participating in the interim prioritization survey, and 41 participants from 11 countries included in the consensus development meeting, the global participation achieved in this study should secure the generalizability of the results within an international context. The study included people with fertility problems and they were able to suggest potential research uncertainties during the initial survey, share their views regarding the importance of research uncertainties during the interim prioritization survey and participate fully in the consensus development meeting which prioritized the final research priorities.

This consensus study is not without limitations. Consideration should be given to the representativeness of the study’s participants. For example, when considering the initial survey, there was a higher response from participants who identified as living in Europe (115 participants; 30%). To participate in the initial survey and interim prioritization survey, English proficiency and literacy, a computer and internet access were required. We appreciate that limitations in the representativeness of the sample could impact upon the research uncertainties suggested and prioritized. There is uncertainty regarding the optimal consensus development method to prioritize research uncertainties, and methodological research is required to evaluate different approaches to priority setting and the use of different consensus methods. Further contextual information, including the number of people the research priority impacts upon, the feasibility of answering the research priority, and the resources required to address the research uncertainty could have assisted participants to prioritize research uncertainties. Future methodological research should evaluate the use of contextual information in research priority studies.

Reflections on the research priorities

Reproductive medical care for men has lagged behind that for women. Setting impactful and tractable priorities for male reproduction is consequently a critically important task. For diagnosis, the variation in morphology is extraordinary and counting sperm is challenging, severely limiting our ability to make predictions of male reproductive potential from the standard semen analysis, and begging the question: are there other, better tests of sperm? We need to explore how overall health affects male fertility and whether treating other diseases improves it. Because a man does not live in a vacuum, we need to understand how the environment affects male reproduction. When considering the treatment of male infertility, men often ask what they can do to improve their fertility, and well-conducted studies into diet and nutraceuticals are essential. The endocrine system drives the making of sperm and further evidence is required to understand if hormonal therapy could improve the production of sperm and improve live birth rates.

The priorities for unexplained infertility seek answers to several challenging and long-standing questions, including the prevention of age-related infertility and exploring the role of fibroids, polyps, intrauterine adhesions and uterine septa in unexplained infertility. It is also surprising that it remains unclear what the first-line treatment is for couples with unexplained infertility, IVF or IUI, and the timing of the superior treatment for that couple.

When considering medically assisted reproduction, new large prospective cohorts that consider all variables and use advance methodology will be required to address casual relationships related to implantation failure. Similar complexity will exist when studying oocyte yield and quality over subsequent IVF cycles, even though similar stimulation protocols have been used. The three research priorities concerning the effectiveness of IVF are seeking to identify optimal ovarian stimulation protocols in poor responders, sperm selection techniques and embryo selection. These contrast with the research priorities which explore if, when, and how IUI should be used. To answer these effectiveness questions, well-designed randomized controlled trials will be required ( Wilkinson et al. , 2019b ). The psychological impact of fertility treatment is brought into sharper focus with research priorities related to the emotional and psychological impact of repeated fertility treatment failure and in children following gamete donation. Strong involvement of patient representatives, psychologists and behavioral scientists will be required to establish the appropriate qualitative and quantitative studies to address these important priorities.

The research priorities for ethics, access and organization of care broadly fall into two overarching themes: access and infertility as a public health issue. When considering access, cost is a major barrier to appropriate care, which is reflected in the research priorities aiming to explore interventions to reduce the cost of fertility treatment and increase the availability of fertility treatment in lower-resources settings. Turning to infertility as a public health issue, prevention of infertility should be a key priority for public health initiatives. We need to determine the minimum standard of care that people with fertility problems should expect, especially if we are seeking reimbursements for this care.

Wider context

A prioritized list of research uncertainties, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems and others, should help funding organizations and researchers to set their future research agenda. The selected list of research uncertainties should serve to focus a discussion regarding the allocation of limited resources.

Many of the research priorities will require national and international collaboration. Several countries, including China, the Netherlands, the UK and the USA, have developed national networks to undertake infertility research ( Devall et al. , 2020 ). Further development of national infrastructure is required. Collaboration should spread beyond national boundaries and develop within an international context. It is hoped the development of a prioritized research agenda could be an important enabler to deepen international collaboration. Development of generic infrastructure could help foster collaboration, including the use of minimum data sets, known as core outcome sets, low-cost data repositories and standardized approaches to the reporting of research. A core outcome set has recently been developed for future infertility trials ( Duffy et al. , 2018 ). Over 400 healthcare professionals, researchers and patients, from 40 countries, have used formal consensus development methods to identify a core outcome set for infertility ( Duffy et al. , 2020a ). Consensus definitions have also been agreed for individual core outcomes ( Duffy et al. , 2020b ). It is hoped the core outcome set will provide generic tools to collect outcomes during research, provide concise guidance regarding statistical analysis and standardize the approach to research reporting ( Duffy et al. , 2019 ).

Research priorities identified in this study correspond with research priorities identified by the Priority Setting Partnership for Miscarriage, including determining the emotional and psychological impact of miscarriage, investigating the modifiable risk factors which cause miscarriage and identifying specific comorbidities which cause miscarriage ( Prior et al. , 2017 ). Other similarities exist when considering the research uncertainties prioritized by the Priority Setting Partnership for Endometriosis and International Polycystic Ovary Syndrome Network ( Horne et al. , 2017 ).

Answering the prioritized research questions would represent a significant step forward for our specialty. The steering group recognizes the important role of research which stems from the intellectual curiosity of individuals, fundamental research which does not have an immediate clinical application and research which is funded by special interest groups raising funding for the topic of their particular interest. A blended research strategy should offer the optimal pathway to improving clinical care and patient outcomes.

Perhaps the most important part of this process has been the strengthening of relationships between partner organizations, healthcare professionals and people with lived experience of infertility. The prioritized list of uncertainties that require research should help funding organizations and researchers to set their future research agenda. Our approach should ensure that future research has the necessary reach and relevance to inform clinical practice and to improve patient outcomes.

Supplementary data are available at Human Reproduction online.

We would like to thank the initial survey, interim prioritization survey and consensus development meeting participants, and colleagues at the Cochrane Gynaecology and Fertility Group, University of Auckland, New Zealand.

Authors’ roles

Study concept and design: J.M.N.D., S.B., B.C., C.C., J.L.H.E., R.G.F., S.F., L.C.G., A.W.H., N.P.J., Y.K., J.M.L.K., R.S.L., S.L., B.W.M., H.N., E.H.Y.N., C.N., A.S.O., L.P., S.R.H., M.S., J.S., A.S., C.S., A.V., M.v.W., M.A.V., N.L.V., A.Y.W., R.W., J.W. and C.M.F. Acquisition of data: J.M.N.D., S.B., K.B., C.B., C.C., J.L.H.E., R.G.F., A.F., S.F., L.C.G., A.W.H., N.P.J., Y.K., J.M.L.K., R.S.L., S.L., B.W.M., E.H.Y.N., C.N., A.S.O., L.P., S.R.H., M.S., J.S., A.S., C.S., A.V., M.v.W., M.A.V., N.L.V., A.Y.W., R.W., J.W. and C.M.F. Analysis and interpretation of data: J.M.D., G.D.A., E.B., S.B., S.B., M.B., K.B., B.C., C.C., J.L.H.E., R.G.F., A.F., S.F., L.C.G., E.G., M.H., A.W.H., M.L.H., N.P.J., V.J., Y.K., J.M.L.K., R.S.L., S.L., J.M., D.M., B.W.M., D.E.M., H.N., E.H.Y.N., C.N., A.S.O., L.P., S.R.H., L.S., I.S., M.S., J.S., A.S., C.S., A.V., M.v.W., M.V., N.L.V., A.Y.W., R.W., J.W., K.W., T.W. and C.M.F. Drafting of the manuscript: J.M.D., B.C., S.L., H.N., C.N., M.S., M.v.W., M.V., R.W., J.W. and C.M.F. Critical revision of the manuscript for important intellectual content: G.D.A., E.B., S.B., S.B., M.B., B.K., C.C., J.L.H.E., R.G.F., A.F., S.F., L.C.G., E.G., M.H., A.W.H., M.L.H., N.P.J., V.J., Y.K., J.M.L.K., R.S.L., J.M., M.M., D.M., B.W.M., D.M., E.H.Y.N., A.S.O., L.P., S.R.H., L.S., I.S., J.S., A.S., C.S., A.V., N.L.V., A.Y.W., K.W. and T.W. Statistical analysis: J.M.D., J.W. and A.V. Study supervision: C.M.F.

This research was funded by the Catalyst Fund, Royal Society of New Zealand, Auckland Medical Research Foundation and Maurice and Phyllis Paykel Trust. The funders had no role in the design and conduct of the study, the collection, management, analysis or interpretation of data or manuscript preparation. B.W.M. is supported by a National Health and Medical Research Council Practitioner Fellowship (GNT1082548). Siladitya Bhattacharya was supported by the Auckland Foundation Seelye Travelling Fellowship.

Conflict of interest

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 Endometriosis Research Foundation, and research sponsorship of the International Committee for Monitoring Assisted Reproductive Technologies from Abbott and Ferring. Siladitya Bhattacharya reports being the Editor-in-Chief of Human Reproduction Open and editor for the Cochrane Gynaecology and Fertility Group. J.H.L.E. reports being the Editor Emeritus of Human Reproduction . A.W.H. reports research sponsorship from the Chief Scientist’s Office, Ferring, Medical Research Council, National Institute for Health Research and Wellbeing of Women and consultancy fees from AbbVie, Ferring, Nordic Pharma and Roche Diagnostics. M.L.H. reports grants from Merck, grants from Myovant, grants from Bayer, outside the submitted work and ownership in Embrace Fertility, a private fertility company. N.P.J. reports research sponsorship from AbbVie and Myovant Sciences and consultancy fees from Guerbet, Myovant Sciences, Roche Diagnostics and Vifor Pharma. J.M.L.K. reports research sponsorship from Ferring and Theramex. R.S.L. reports consultancy fees from AbbVie, Bayer, Ferring, Fractyl, Insud Pharma and Kindex and research sponsorship from Guerbet and Hass Avocado Board. B.W.M. reports consultancy fees from Guerbet, iGenomix, Merck, Merck KGaA and ObsEva. E.H.Y.N. reports research sponsorship from Merck. C.N. reports being the Co Editor-in-Chief of Fertility and Sterility and Section Editor of the Journal of Urology , research sponsorship from Ferring and retains a financial interest in NexHand. J.S. reports being employed by a National Health Service fertility clinic, consultancy fees from Merck for educational events, sponsorship to attend a fertility conference from Ferring and being a clinical subeditor of Human Fertility . A.S. reports consultancy fees from Guerbet. J.W. reports being a statistical editor for the Cochrane Gynaecology and Fertility Group. A.V. reports that he is a Statistical Editor of the Cochrane Gynaecology & Fertility Review Group and the journal Reproduction . His employing institution has received payment from Human Fertilisation and Embryology Authority for his advice on review of research evidence to inform their ‘traffic light’ system for infertility treatment ‘add-ons’. N.L.V. reports consultancy and conference fees from Ferring, Merck and Merck Sharp and Dohme. The remaining authors declare no competing interests in relation to the present work. All authors have completed the disclosure form.

Priority Setting Partnership for Infertility

Dr Hisham AlAhwany, University of Nottingham, UK; Ofra Balaban, CHEN: Patient Fertility Association, Israel; Faith Barton, UK; Dr Yusuf Beebeejaun, King’s Fertility, Fetal Medicine Research Institute, UK; Professor Jacky Boivin, Cardiff University, UK; Professor Jan J. A. Bosteels, Imelda Hospital, Belgium; Professor Carlos Calhaz-Jorge, Faculdade de Medicina da Universidade de Lisboa, Portugal; Dr Arianna D’Angelo, Wales Fertility Institute, UK; Dr Leona F. Dann, Health Quality and Safety Commission, New Zealand; Professor Christopher J. De Jonge, University of Minnesota Medical Center, United States; Elyce du Mez, University of Auckland, New Zealand; Professor Rui A. Ferriani, University of Sao Paulo, Brazil; Dr Marie-Odile Gerval, Chelsea and Westminster Hospital NHS Foundation Trust, UK; Lynda J. Gingel, UK; Dr Ellen M. Greenblatt, Mount Sinai Fertility, University of Toronto, Toronto; Professor Geraldine Hartshorne, University of Warwick, UK; Charlie Helliwell, New Zealand; Charlotte Helliwell, New Zealand; Lynda J. Hughes, The Fertility Clinic, London Health Sciences Centre, Canada; Dr Junyoung Jo, Conmaul Hospital of Korean Medicine, Republic of Korea; Jelena Jovanović, Serbia; Professor Ludwig Kiesel, University of Münster, Germany; Dr Chumnan Kietpeerakool, Khon Kaen University, Thailand; Dr Elena Kostova, Cochrane Gynaecology and Fertility, New Zealand; Professor Tansu Kucuk, Acibadem Maslak Hospital, Turkey; Rajesh Kumar, National Foundation for the Deaf, New Zealand; Robyn L. Lawrence, The Liggins Institute, The University of Auckland, New Zealand; Nicole Lee, Canada; Katy E. Lindemann, UK; Professor Olabisi M. Loto, Obafemi Awolowo University, Nigeria; Associate Professor Peter J. Lutjen, Monash University, Australia; Michelle MacKinven, Fertility New Zealand; New Zealand; Dr Mariano Mascarenhas, Leeds Teaching Hospital NHS Trust, UK; Helen McLaughlin, Endometriosis UK, UK; David J. Mills, UK; Dr Selma M. Mourad, Isala Hospital Zwolle, The Netherlands; Linh K. Nguyen, Vietnam; Professor Robert J. Norman, Robinson Research Institute, University of Adelaide, Adelaide; Maja Olic, NGO Counselling Center for In Vitro Fertilisation, Serbia; Kristine L. Overfield, NISIG: National Infertility Support and Information Group, Ireland; Maria Parker-Harris, UK; David G. Ramos, Spain; Aleksandra Rendulic, Serbia; Sjoerd Repping, Amsterdam University Medical Centres, The Netherlands; Professor Roberta Rizzo, University of Ferrara, Italy; Professor Pietro Salacone, Italy; Catherine H. Saunders, The Dartmouth Institute for Health Policy and Clinical Practice, USA; Dr Rinku Sengupta, UK; Dr Ioannis A. Sfontouris, Eugonia: Assisted Reproduction Unit, Greece; Natalie R. Silverman, The Fertility Podcast, UK; Dr Helen L. Torrance, University Medical Center Utrecht, The Netherlands; Dr Eleonora P. Uphoff, UK; Dr Sarah A. Wakeman, Fertility Associates, New Zealand; Professor Tewes Wischmann, Heidelberg University, Germany; Dr Bryan J. Woodward, UK; and Mohamed A. Youssef, Cairo University, Egypt.

This article has not been externally peer reviewed.

This article has been published simultaneously in Fertility and Sterility.

American Association of Gynecologic Laparoscopists . Practice guidelines for the diagnosis and management of submucous leiomyomas . J Minim Invasive Gynecol   2012 ; 19 : 152 – 171 .

American Urological Association. The Management of Obstructive Azoospermia . Linthicum, MD: American Urological Association , 2010 .

Carranza-Mamane B Havelock J Hemmings R Cheung A Sierra S Carranza-Mamane B Case A Cathie D Graham J Havelock J  et al.    The management of uterine fibroids in women with otherwise unexplained infertility . J Obstet Gynaecol Can   2015 ; 37 : 277 – 285 .

Google Scholar

Chalmers I Glasziou P.   Avoidable waste in the production and reporting of research evidence . Lancet   2009 ; 374 : 86 – 89 .

Devall AJ Out JH Mol BWJ Duffy JMN Collura B Dyer S.   Coordination and planning of clinical research on a national and global level . Fertil Steril   2020 ; 113 : 1100 – 1106 .

Duffy JMN AlAhwany H Bhattacharya S Collura B Curtis C Evers JLH Farquharson RG Franik S Giudice LC Khalaf Y  et al.    Developing a core outcome set for future infertility research: an international consensus development study . Hum Reprod   2020 a; 35 : 2725–2734.

Duffy JMN Bhattacharya S Bhattacharya S Bofill M Collura B Curtis C Evers JLH Giudice LC Farquharson RG Franik S  et al.    Standardizing definitions for the infertility core outcome set: an international consensus development study . Hum Reprod   2020 b; 35 :2735–2745.

Duffy JMN Bhattacharya S Curtis C Evers JLH Farquharson RG Franik S Khalaf Y Legro RS Lensen S Mol BW , COMMIT: Core Outcomes Measures for Infertility Trials  et al.    A protocol developing, disseminating and implementing a core outcome set for infertility . Hum Reprod Open   2018 ; 2018 : hoy007 .

Duffy JMN Bhattacharya S Herman M Mol B Vail A Wilkinson J Farquhar C , the Cochrane Gynaecology and Fertility Group . Reducing research waste in benign gynaecology and fertility research . BJOG: Int J Obstet Gy   2017 ; 124 : 366 – 369 .

Duffy JMN Ziebland S von Dadelszen P McManus RJ.   Tackling poorly selected, collected, and reported outcomes in obstetrics and gynecology research . Am J Obstet Gynecol   2019 ; 220 : 71.e71 – 71.e74 .

Graham L Illingworth B Showell M Vercoe M Crosbie E Gingel L Farquhar C Horne A Prior M Stephenson J  et al.    Research priority setting in women’s health: a systematic review . BJOG: Int J Obstet Gy   2020 ; 127 : 694 – 700 .

Horne AW Saunders PTK Abokhrais IM Hogg L.   Top ten endometriosis research priorities in the UK and Ireland . Lancet   2017 ; 389 : 2191 – 2192 .

James Lind Alliance . The James Lind Alliance Guidebook . Southampton, UK : National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre , 2018 .

Google Preview

Jarvi K Lo K Fischer A Grantmyre J Zini A Chow V Mak VC.   Guideline the workup of azoospermic males . Can Urol Assoc J   2010 ; 4 : 163 – 167 .

Jungwirth A Diemer T Kopa Z Krausz C Minhas S Tournaye H.   EAU Guidelines on Male Infertility . Arnhem, The Netherlands : European Association of Urology , 2018 .

Kroon B Johnson N Chapman M Yazdani A Hart R , on behalf of the Australasian CREI Consensus Expert Panel on Trial evidence (ACCEPT) group. Fibroids in infertility–consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence) . Aust N Z J Obstet Gynaecol   2011 ; 51 : 289 – 295 .

Loh SF Agarwal R Chan JK Chia SJ Cho LW Lim LH Lau MSK Loh SKE Hendricks MS Nair S  et al.    Academy of Medicine-Ministry of Health Clinical Practice Guidelines: assessment and management of infertility at primary healthcare level . Singapore Med J   2014 ; 55 – 58 ; quiz 66.

Murphy MK Black NA Lamping DL McKee CM Sanderson CF Askham J Marteau T.   Consensus development methods, and their use in clinical guideline development . Health Technol Assess   1998 ; 2 : 1 – 88 , i-iv,

National Institute for Health and Care Excellence . Fertility Problems: Assessment and Treatment . London, UK : National Institute for Health and Care Excellence , 2017

Penzias A Bendikson K Butts S Coutifaris C Falcone T Fossum G Gitlin S Gracia C Hansen K La Barbera A  et al.    Performing the embryo transfer: a guideline . Fertil Steril   2017 ; 107 : 882 – 896 .

Practice Committee of the American Society for Reproductive Medicine . Uterine septum: a guideline . Fertil Steril   2016 a; 106 : 530 – 540 .

Practice Committee of the American Society for Reproductive Medicine . Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline . Fertil Steril   2016 b; 106 : 1634 – 1647 .

Practice Committee of the American Society for Reproductive Medicine . Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline . Fertil Steril   2017 ; 108 : 416 – 425 .

Prior M Bagness C Brewin J Coomarasamy A Easthope L Hepworth-Jones B Hinshaw K O'Toole E Orford J Regan L  et al.    Priorities for research in miscarriage: a priority setting partnership between people affected by miscarriage and professionals following the James Lind Alliance methodology . BMJ Open   2017 ; 7 : e016571 .

Wilkinson J Bhattacharya S Duffy JMN Kamath MS Marjoribanks J Repping S Vail A Wely M Farquhar CM.   Reproductive medicine: still more ART than science?   BJOG: Int J Obstet Gy   2019 a; 126 : 138 – 141 .

Wilkinson J Brison DR Duffy JMN Farquhar CM Lensen S Mastenbroek S van Wely M Vail A.   Don’t abandon RCTs in IVF. We don’t even understand them . Hum Reprod   2019 b; 34 : 2093 – 2098 .

Author notes

Members of the Priority Setting Partnership for Infertility are listed in the   Appendix .

Email alerts

Companion article.

• Standardizing definitions and reporting guidelines for the infertility core outcome set: an international consensus development study †   ‡

Citing articles via

• Recommend to your Library

Affiliations

• Online ISSN 1460-2350
• Copyright © 2024 European Society of Human Reproduction and Embryology
• About Oxford Academic
• Publish journals with us
• University press partners
• What we publish
• New features  
• Open access
• Institutional account management
• Rights and permissions
• Get help with access
• Accessibility
• Media enquiries
• Oxford University Press
• Oxford Languages
• University of Oxford

Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide

• Copyright © 2024 Oxford University Press
• Cookie settings
• Cookie policy
• Privacy policy
• Legal notice

This Feature Is Available To Subscribers Only

Sign In or Create an Account

This PDF is available to Subscribers Only

For full access to this pdf, sign in to an existing account, or purchase an annual subscription.

On developing a thesis for Reproductive Endocrinology and Infertility fellowship: a case study of ultra-low (2%) oxygen tension for extended culture of human embryos

• Fellow's Forum
• Published: 04 February 2017
• Volume 34 , pages 303–308, ( 2017 )

Cite this article

• Daniel J. Kaser 1 , 2  

466 Accesses

4 Citations

Explore all metrics

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 experience in research design and implementation. Incoming fellows often have varying degrees of training in research methodology and, likewise, different career goals. Ideally, selection of a thesis topic and mentor should be geared toward defining an “answerable” question and building a practical skill set for future investigation. This contribution to the JARG Young Investigator’s Forum revisits the steps of the scientific method through the lens of one recently graduated fellow and his project aimed to test the hypothesis that “sequential oxygen exposure (5% from days 1 to 3, then 2% from days 3 to 5) improves blastocyst yield and quality compared to continuous exposure to 5% oxygen among human preimplantation embryos.”

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime

Price includes VAT (Russian Federation)

Instant access to the full article PDF.

Rent this article via DeepDyve

Institutional subscriptions

Similar content being viewed by others

Oxygen tension in embryo culture: does a shift to 2% o 2 in extended culture represent the most physiologic system.

Effect of Group Embryo Culture under Low-Oxygen Tension in Benchtop Incubators on Human Embryo Culture: Prospective, Randomized, Controlled Trial

In Vitro Fertilization Research is Translational Research

Toomer GJ. Review: Ibn al-Haythams Weg zur Physik. Isis. 1964;55(4):463–5.

Article   Google Scholar  

Kaser DJ, Bogale B, Sarda V, Farland LV, Racowsky C. Randomized controlled trial of low (5%) vs. ultra-low (2%) oxygen tension for in vitro development of human embryos. Fertil Steril. 2016;106(3):e4.

Davis OC, Nakamura J. A proposed model for an optimal mentoring environment for medical residents. Acad Med. 2010;85(6):1060–6.

Article   PubMed   Google Scholar  

Yedwab GA. The temperature, pH and partial pressure of oxygen in the cervix and uterus of women and uterus of rats during the cycle. Fertil Steril. 1976;27(3):304–9.

Article   CAS   PubMed   Google Scholar  

Ottosen LDM, Hindkjaer J, Husth M, Petersen DE, Kirk J, Ingerslev HJ. Observations on intrauterine oxygen tension measured by fibre-optic microsensors. Reprod Biomed Online. 2006;13(3):380–5.

Fischer B, Bavister BD. Oxygen tension in the oviduct and uterus of rhesus monkeys, hamsters and rabbits. J Reprod Fertil. 1993;99(2):673–9.

Rodesch F, Simon P, Donner C, Jauniaux E. Oxygen measurements in endometrial and trophoblastic tissues during early pregnancy. Obstet Gynecol. 1992;80(2):283–5.

CAS   PubMed   Google Scholar  

Burton GJ, Jauniaux E, Watson A. Maternal arterial connections to the placental intervillous space during the first trimester of human pregnancy: the Boyd Collection revisited. Am J Obstet Gynecol. 1999;181(3):718–24.

Croxatto HB, Ortiz ME, Diaz S, Hess R, Balmaceda J, Croxatto HD. Studies on the duration of egg transport by the human oviduct. II. Ovum location at various intervals following luteinizing hormone peak. Am J Obstet Gynecol. 1978;132:629–34.

Avendano S, Croxatto HD, Pereda J, Croxatto HB. A seven-cell human egg recovered from the oviduct. Fertil Steril. 1975;26(12):1167–72.

Hertig AT, Rock J, Adams EC, Mulligan WJ. On the preimplantation stages of the human ovum: a description of four normal and four abnormal specimens ranging from the second to the fifth day of development. Contrib Embryol. 1954;35:199–221.

Google Scholar  

Diaz S, Ortiz ME, Croxatto HB. Studies on the duration of ovum transport by the human oviduct. III. Time interval between the lutinizing hormone peak and recovery of ova by transcervical flushing of the uterus in normal women. Am J Obstet Gyncol. 1980;137(1):116–21.

Article   CAS   Google Scholar  

Mastroianni Jr L, Jones R. oxygen tension within the rabbit fallopian tube. J Reprod Fertil. 1965;9:99–102.

Nastri CO, Nobrega BN, Teixeira DM, Amorim J, Diniz LM, Barbosa MW, et al. Low versus atmospheric oxygen tension for embryo culture in assisted reproduction: a systematic review and meta-anlaysis. Fertil Steril. 2016;106(1):95–104.

Annas GJ. Resurrection of a stem-cell funding barrier: Dickey-Wicker in court. N Engl J Med. 2010;363(18):1687–9.

Ledford H. Keeping the lights on. Nature. 2014;515:326–9.

Download references

Author information

Authors and affiliations.

Reproductive Medicine Associates of New Jersey, 140 Allen Road, Basking Ridge, NJ, 07920, USA

Daniel J. Kaser

Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Daniel J. Kaser .

Rights and permissions

Reprints and permissions

About this article

Kaser, D.J. On developing a thesis for Reproductive Endocrinology and Infertility fellowship: a case study of ultra-low (2%) oxygen tension for extended culture of human embryos. J Assist Reprod Genet 34 , 303–308 (2017). https://doi.org/10.1007/s10815-017-0887-5

Download citation

Received : 22 January 2017

Accepted : 26 January 2017

Published : 04 February 2017

Issue Date : March 2017

DOI : https://doi.org/10.1007/s10815-017-0887-5

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Embryo development
• In vitro fertilization
• Oxygen tension
• Fellowship training
• Medical education
• Find a journal
• Publish with us
• Track your research

• Frontiers in Physiology
• Clinical and Translational Physiology
• Research Topics

Reproductive Health

Total Downloads

Total Views and Downloads

About this Research Topic

Reproductive health is crucial to successful conception, pregnancy and delivery. It is also a key determinant of wellbeing in adulthood. The cellular and molecular mechanisms underlying the physiological processes involved in male and female reproduction are poorly understood with rates of infertility, ...

Important Note : All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Topic Editors

Topic coordinators, recent articles, submission deadlines.

Submission closed.

Participating Journals

Total views.

• Demographics

No records found

total views article views downloads topic views

Top countries

Top referring sites, about frontiers research topics.

With their unique mixes of varied contributions from Original Research to Review Articles, Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area! Find out more on how to host your own Frontiers Research Topic or contribute to one as an author.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

On developing a thesis for Reproductive Endocrinology and Infertility fellowship: a case study of ultra-low (2%) oxygen tension for extended culture of human embryos

Affiliations.

• 1 Reproductive Medicine Associates of New Jersey, 140 Allen Road, Basking Ridge, NJ, 07920, USA. [email protected].
• 2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA. [email protected].
• PMID: 28161857
• PMCID: PMC5360692
• DOI: 10.1007/s10815-017-0887-5

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 experience in research design and implementation. Incoming fellows often have varying degrees of training in research methodology and, likewise, different career goals. Ideally, selection of a thesis topic and mentor should be geared toward defining an "answerable" question and building a practical skill set for future investigation. This contribution to the JARG Young Investigator's Forum revisits the steps of the scientific method through the lens of one recently graduated fellow and his project aimed to test the hypothesis that "sequential oxygen exposure (5% from days 1 to 3, then 2% from days 3 to 5) improves blastocyst yield and quality compared to continuous exposure to 5% oxygen among human preimplantation embryos."

Keywords: Blastocyst; Embryo development; Fellowship training; In vitro fertilization; Medical education; Oxygen tension.

PubMed Disclaimer

• Using stem cell oxygen physiology to optimize blastocyst culture while minimizing hypoxic stress. Bolnick A, Awonuga AO, Yang Y, Abdulhasan M, Xie Y, Zhou S, Puscheck EE, Rappolee DA. Bolnick A, et al. J Assist Reprod Genet. 2017 Oct;34(10):1251-1259. doi: 10.1007/s10815-017-0971-x. Epub 2017 Jun 24. J Assist Reprod Genet. 2017. PMID: 28647787 Free PMC article.

Similar articles

• Embryo transfer training in fellowship: national and institutional data. McQueen DB, Robins JC, Yeh C, Zhang JX, Feinberg EC. McQueen DB, et al. Fertil Steril. 2020 Nov;114(5):1006-1013. doi: 10.1016/j.fertnstert.2020.06.004. Epub 2020 Sep 2. Fertil Steril. 2020. PMID: 32888679
• Outcomes of embryo transfers performed by Reproductive Endocrinology and Infertility fellows vs. faculty: an 11-year retrospective review. Miller CM, Weaver AL, Zhao Y, Babayev SN. Miller CM, et al. Fertil Steril. 2022 Jan;117(1):115-122. doi: 10.1016/j.fertnstert.2021.08.044. Epub 2021 Sep 20. Fertil Steril. 2022. PMID: 34548164
• Efficacy of intrauterine inseminations as a training modality for performing embryo transfer in reproductive endocrinology and infertility fellowship programs. Shah DK, Missmer SA, Correia KF, Racowsky C, Ginsburg E. Shah DK, et al. Fertil Steril. 2013 Aug;100(2):386-91. doi: 10.1016/j.fertnstert.2013.03.035. Epub 2013 Apr 16. Fertil Steril. 2013. PMID: 23602318
• Reproductive endocrinology and infertility fellowships: is the 'reproductive endocrinology' portion obsolete? Omurtag K, Lebovic DI. Omurtag K, et al. Curr Opin Obstet Gynecol. 2015 Aug;27(4):271-5. doi: 10.1097/GCO.0000000000000190. Curr Opin Obstet Gynecol. 2015. PMID: 26107784 Review.
• Essential learning tools for continuing medical education for physicians, geneticists, nurses, allied health professionals, mental health professionals, business administration professionals, and reproductive endocrinology and infertility (REI) fellows: the Midwest Reproductive Symposium International. Collins GG, Jeelani R, Beltsos A, Kearns WG. Collins GG, et al. J Assist Reprod Genet. 2018 Apr;35(4):547-549. doi: 10.1007/s10815-018-1182-9. Epub 2018 Apr 20. J Assist Reprod Genet. 2018. PMID: 29679181 Free PMC article. Review.
• Ultralow Oxygen Tension (2%) Is Beneficial for Blastocyst Formation of In Vitro Human Low-Quality Embryo Culture. Li M, Xue X, Shi J. Li M, et al. Biomed Res Int. 2022 Jun 1;2022:9603185. doi: 10.1155/2022/9603185. eCollection 2022. Biomed Res Int. 2022. PMID: 35692587 Free PMC article.
• Reformatting the reproductive tract to accommodate the needs of human ARTs. Albertini DF. Albertini DF. J Assist Reprod Genet. 2017 Mar;34(3):301-302. doi: 10.1007/s10815-017-0894-6. J Assist Reprod Genet. 2017. PMID: 28247099 Free PMC article. No abstract available.
• Toomer GJ. Review: Ibn al-Haythams Weg zur Physik. Isis. 1964;55(4):463–465. doi: 10.1086/349914. - DOI
• Kaser DJ, Bogale B, Sarda V, Farland LV, Racowsky C. Randomized controlled trial of low (5%) vs. ultra-low (2%) oxygen tension for in vitro development of human embryos. Fertil Steril. 2016;106(3):e4. doi: 10.1016/j.fertnstert.2016.07.016. - DOI - PubMed
• Davis OC, Nakamura J. A proposed model for an optimal mentoring environment for medical residents. Acad Med. 2010;85(6):1060–1066. doi: 10.1097/ACM.0b013e3181dc4aab. - DOI - PubMed
• Yedwab GA. The temperature, pH and partial pressure of oxygen in the cervix and uterus of women and uterus of rats during the cycle. Fertil Steril. 1976;27(3):304–309. doi: 10.1016/S0015-0282(16)41722-X. - DOI - PubMed
• Ottosen LDM, Hindkjaer J, Husth M, Petersen DE, Kirk J, Ingerslev HJ. Observations on intrauterine oxygen tension measured by fibre-optic microsensors. Reprod Biomed Online. 2006;13(3):380–385. doi: 10.1016/S1472-6483(10)61443-5. - DOI - PubMed

Publication types

• Search in MeSH

Related information

• PubChem Compound (MeSH Keyword)

LinkOut - more resources

Full text sources.

• Europe PubMed Central
• PubMed Central

Other Literature Sources

• scite Smart Citations
• Genetic Alliance
• MedlinePlus Health Information
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

• Open access
• Published: 05 March 2018

Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions

• Moazzam Ali   ORCID: orcid.org/0000-0001-6949-8976 1 ,
• Madeline Farron 1 ,
• Leopold Ouedraogo 2 ,
• Ramez Khairi Mahaini 3 ,
• Kelsey Miller 1 &
• Rita Kabra 1  

Reproductive Health volume  15 , Article number:  39 ( 2018 ) Cite this article

13k Accesses

14 Citations

13 Altmetric

Metrics details

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 present the results of a priority setting exercise that brought together researchers and program managers from the WHO Africa and Eastern Mediterranean regions to identify key SRH issues.

In June 2015, researchers and program managers from the WHO Africa and Eastern Mediterranean regions met for a three-day meeting to discuss strategies to strengthen research capacity in the regions. A prioritization exercise was carried out to identify key priority areas for research in SRH. The process included five criteria: answerability, effectiveness, deliverability and acceptability, potential impact of the intervention/program to improve reproductive, maternal and newborn health substantially, and equity.

The six main priorities identified include: creation and investment in multipurpose prevention technologies, addressing adolescent violence and early pregnancy (especially in the context of early marriage), improved maternal and newborn emergency care, increased evaluation and improvement of adolescent health interventions including contraception, further focus on family planning uptake and barriers, and improving care for mothers and children during childbirth.

The setting of priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. The key elements identified in this exercise provides guidance for decision makers to focus action on identified research priorities and goals. Prioritization and identifying/acting on research gaps can have great impact across multiple sectors in the regions for improved reproductive, maternal and children health.

Research capacity building in health fields is important specially in low and middle-income countries (LMICs). According to the World Health Report 2013 it can strengthen health systems and can help move countries towards universal health coverage [ 1 ]. Despite the large body of scientific research, protocols and strategic models to address health problems, there is an increased need for better implementation methods in order to make an impact on health outcomes. Through increased research capacity building, implementation of existing strategies and scaling up interventions may find more success as local researchers bring local knowledge and much needed perspective to these endeavors. Research capacity can also improve health system development, inform more effective policy and lead to better governance in individual countries [ 2 ].

Research capacity building on the African continent has particularly great potential as Africa has the greatest burden of disease and the lowest-density of healthcare professionals in the world [ 3 ]. Shortages of researchers, faculty members, infrastructure, and a dearth of career opportunities for upcoming researchers in Africa to build up a critical mass of scientists to prioritize and carry out policy relevant research exists [ 3 ]. Moreover, multiple factors act as barriers and issues to the health system, hindering the ability of effective health care to be delivered in these contexts. One of the largest complications is that numerous, diverse issues have been identified as health care priorities in the region, which has led to a competition for resources [ 4 ]. This lack of a coherent message is exacerbated by a lack of political will, infrastructural inadequacies, and logistical weaknesses [ 4 ] thereby paralyzing action.

Research priority setting is acknowledged to be a key function of national health research systems and is perceived to be an important process in terms of ensuring the alignment of research funding with national evidence needs [ 5 ]. It is usually done at different hierarchical levels of the health research system (national, institutional, departmental, or at a program level). Ideally health policy and systems research priorities would emerge through priority setting processes. However priority setting for health research is often not performed well or not performed at all [ 6 ]. Priorities need to be reviewed and updated periodically. Through prioritization, SRH could be given more attention, research, and action providing a great benefit to individuals in Africa.

Research prioritization is one of the key nodal points in the research cycle, which includes research planning, research priority setting, strategies and implementation of research priorities, research utilization, research monitoring and evaluation (part of the research information system) and overall research management. The final aim of research prioritization is how “balanced research can support and complement the health system to achieve the national goals for health.” With research prioritization, a forward-looking research system can be firmly established [ 7 ].

Research can play a critical role in the response to global health challenges. But when resources are limited, guidelines are needed to assist decisions on defining the priorities for health research investments [ 8 ]. Setting priorities for health research is essential to maximize the impact of investments, which is especially relevant in resource-poor environments [ 9 , 10 , 11 ].

In June 2015, the WHO/HRP’s Regional Committee meeting for the African and Eastern Mediterranean regions on research capacity strengthening in Sexual and Reproductive Health and Rights (SRH) met in Nairobi, Kenya. The three-day meeting was attended by 38 participants, including 17 women, who represented the research partners of the HRP, the collaborating centers of the WHO, the country offices of WHO, the regional offices of the WHO, the long-term institutional development grantees, and the staff from headquarters in Geneva. The main purpose of this meeting was to discuss the issues related to research capacity strengthening and the future research priorities in sexual and reproductive health and rights in the area and for the WHO.

The meeting was dedicated to discussing the challenges and the lessons learned regarding research capacity strengthening in the regions. This discussion included the emerging research priorities in the two regions. The research prioritization session was mainly dedicated to aid countries in prioritizing their research goals and to identify the main SRH research priorities for the African and Eastern Mediterranean Regions.

The discussion focused on regional experiences on research implementation plans and strategies for strengthening research capacity in SRH, identification of potential barriers and challenges inherent in these proposed plans. The challenges included lack of adequate funding, inadequate capacity to support research, regional brain drain in LMICs, poor communication within the WHO, understaffing, inadequate involvement of policy makers, and poor dissemination and use of research results.

The main objective of this paper is to present the findings of the exercise in identifying an actionable, prioritized research agenda on sexual and reproductive health in the WHO African and Eastern Mediterranean Regions.

Priorities for research on SRH were identified in three main stages in our exercise. In the first stage, the group of researchers, program managers, and other stakeholders from the African and Eastern Mediterranean regions were provided with an overview on various prioritization techniques. The framework of prioritization was presented which included five criteria: answerability (likelihood that research question can be answered ethically), effectiveness (likelihood that the new knowledge would lead to an effective intervention or program), deliverability and acceptability (likelihood that the intervention or program would be deliverable and affordable), potential impact (likelihood that the intervention or program could improve maternal and newborn health substantially), and equity (likelihood that the intervention or program will reach the most vulnerable groups).

Following the discussion of these criteria for prioritization, participants were divided into groups for the prioritization activity. In the second stage, a broad list of sample topics within sexual and reproductive health and maternal and child health were offered as jumping off point. Each group using the prioritization criteria came up with five priorities after deliberation and discussion that were then presented to the entire group. In the third and final stage, the three groups’ priorities were discussed in the large group and a consensus was reached on the six main priorities presented below by attendees.

The aim of this exercise was to create a comprehensive set of broad goals with actionable priorities to combat the problems identified in SRH as recognized by the participating members. The goals were identified to be broad, focusing more on overarching trends of need in the region and in the field of sexual and reproductive health in general. The participants were able to identify main goals that addressed these broad trends and needs in the region.

Three main high-level goals were identified for both of the regions: quality of care, contraception, and adolescent health.

The first two goals relate to sexual education and contraception. The first goal emphasizes early adolescent sexuality education in out of school, and the delay of sexual activity for all adolescents. The second goal is the development of contraception services, including post-partum and post-abortion services. This second goal also aims to address barriers to contraceptive methods, including long-acting reversible contraceptives (LARCs) and emergency contraception.

The third goal is the development of quality of care in three areas: childbirth, general sexual and reproductive services, and disrespect or abuse in childbirth. This also includes improving Emergency Obstetric Care, covering multiple topics, including blood practices, organization of services, assisted vacuum delivery, and unsafe abortion practices.

Priorities and actions from the goals identified

In addition to developing the above broad goals, the team also created a list of priorities for future SRH research. The list of priorities was extensive and comprehensive for sexual and reproductive health research in the region. While all the priorities are important and will play a major role in the future of sexual and reproductive health research in the region, the top six research priorities are given increased attention based on their effectiveness to improve sexual and reproductive health in the regions.

The below mentioned six priority areas were highlighted and selected by the meeting participants as the most pressing and prioritized aspects of sexual and reproductive health to be addressed in the near future. The priorities are written in no particular order and carry equal weight.

The first priority area is the creation and investment in multipurpose prevention technologies. This is especially relevant in the context of condoms and their unique place in sexual and reproductive health. Condoms are one of the major prevention techniques for two pressing issues in SRH: family planning and HIV/AIDS prevention. Because condoms are used in both contexts they are the only examples of a multipurpose sexual health technology. While this is a new field, there is potential in expanding research in this area to create more technologies that can address multiple issues and move toward a more comprehensive sexual and reproductive health product market.

The second priority area is addressing adolescent violence and preventing early pregnancy using contraception, particularly in the context of early marriage . Adolescent violence includes sexual violence, physical violence, and psychological violence. Early marriage greatly affects SRH as girls have an earlier sexual debut, give birth to more children, have higher mortality and morbidity rates (with pregnancy being the leading cause of death for women 15-19), have higher infant and child mortality rates, have an increased risk of experiencing partner violence, and affects educational opportunities for the girl [ 12 ]. The participants wanted to prioritize girls aged 10-14 years old and increase access to services to delay marriage, first births, and violence for women in or out of relationships.

The third priority is to increase the quality of care and safety associated with maternal and newborn emergency care in the region, and more specifically a focus on blood products and the organization of maternal services . Blood services and products are a priority for multiple health outcomes. Practices for blood transmission and safety in pregnancy are a concern, particularly when it comes to minimizing transmission of blood-borne illness and viruses (particularly HIV and hepatitis) from mother to child. The standards and practices surrounding the quality and safety of blood in hospitals and health care facilities need to be examined and improved including: examination and improvement of the systems surrounding acquisition of blood, storage of blood, transport of blood and proper documentation and data analysis of all blood product-related health care practices.

The fourth priority is to evaluate and improve adolescent health interventions in and out of schools in the region. This is to include the promotion and utilization of comprehensive sexual education and the human rights based approach for students and youth in general. This will include a curriculum that uses a comprehensive sex education program, and will emphasize information on menstruation, menstrual hygiene, puberty and access to contraception as key aspects to delivering the best health care to adolescents. Menstrual care and hygiene is specifically important for adolescent girls leading to overall increased health and dignity, as promoted by the current ELRHA toolkit [ 11 ].

The fifth priority is to focus on family planning uptake, methods used, and engagement. It was recognized that it was essential to ensure access to and availability of effective contraceptive methods to all. Participants advocated for increased usage and also identified many of the barriers to FP with possible solutions. Mixed method use and additional contraception options are needed (including lactational amenorrhea and IUDs). Access to emergency contraception was acknowledged as a priority as well as post-partum and post-abortion family planning counseling. Finally, participants felt male involvement should be emphasized in the regions and discussed ways to engage men.

The sixth priority identified focuses improvement of the services, practices and quality of care for both mother and newborn during child birth . This includes promotion of companionship in birthing services. This companionship support will encompass both the presence of fully trained community health workers in the pre-natal and birthing processes, as well as encourage the full support and participation of fathers in both the prenatal stage and at the time of delivery. The trained health workers will be able to support pregnant women, provide respectful care as well as properly refer women to hospital care, as well as provide prenatal support and counselling. Organization and standardization of childbirth care facilities were also prioritized in order to provide improved care, service, and safety to clients. This relates to other priorities identified such as elimination of obstetric fistulas and management of postpartum hemorrhages.

Other priorities identified included increased attention to cervical cancer including treatment and prevention with the HPV vaccination, need of more reliable data and studies regarding STI prevalence in the populations for the regions.

Additional priorities included general commitments to increasing quality of care, access, and increased impact evaluation to identify and implement best practices for SRH. Participants identified task-shifting as a possible solution. Participants prioritized the need to improve the access to reproductive health services for women with disabilities in the region. Finally, there was a priority established to address and combat violence against women in all forms and in all populations.

In the past two decades since the ICPD’s Cairo consensus, research has helped to define what works and at what cost to improve sexual and reproductive health. However, the remaining gaps in our knowledge and understanding are substantial, and impede greater progress and success. Conducting prioritization exercises will assist the regions and countries to understand (i) the full spectrum of research investment options, (ii) the potential risks and benefits that can result from investments in different research options, and (iii) the likelihood of achieving reductions in the persisting burden of maternal and child health morbidity and mortality. Increasingly, there is a need for national governments, public-private partnerships, private sector and other funding agencies to set priorities in health research investments in a fair and transparent way.

There are many approaches to health research prioritization. The identification of common themes for good practice fulfils the need for guidance on this varied and intricate process. The opportunity allowed participants to thoroughly think about the role of SRH in their own health systems and how they would prioritize and improve research capacity building and move forward with possible evidence-based policy solutions or interventions addressing the identified priorities. By identifying goals and priorities, governments may realize the importance of developing research capacity in their own countries in order to produce more relevant solutions and improved implementation in country. The prioritization exercise may also be applied to other health issues in countries since there are competing health issues and limited funding.

Governments should invest in prioritizing research in their own countries and follow through with their goals by increasing focus on sexual and reproductive health issues in their own countries, which can only be developed and implemented with strong research capacity. There should also be additional in-country research on the six priorities mentioned. With this research on these prioritized areas, additional context-specific implementation strategies can be developed and a new, expanded research culture may flourish in the regions. The setting of research priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. It is important to realize that these results represent a regional discussion of the issues in sexual and reproductive health. They should be interpreted carefully when applied at the country levels because of the differences in needs and context of individual countries.

In conclusion, respective governments must seriously invest in research capacity in order to create a critical mass of researchers in country who can do prioritization and help create impactful and useful policy for the local context. Prioritization is key to taking action in the face of limited funding. Investing in this cadre of researchers will lead to more successful implementation compared with foreign researchers providing implementation advice, as local researchers know their communities and countries best. This is particularly important in the realm of sexual and reproductive health as it has been underserved. With prioritization and research capacity, governments make headway on improving quality, care, and health of their citizens.

The prioritization exercise helped identify concrete issues for action and implementation. Hopefully, more attention and funding can be shifted towards this useful and often neglected element of research development. Further research is needed to determine how best to evaluate success of priority setting at country and regional levels.

Abbreviations

Human reproduction program

International Conference on Population and Development

Intra uterine device

Long-acting reversible contraceptives

Low and middle-income countries

Sexual and reproductive health

Sexually transmitted infections

World Health Organization

Sewankambo N, Tumwine JK, Tomson G, Obua C, Bwanga F, Waiswa P, et al. Enabling dynamic partnerships through joint degrees between low- and high-income countries for capacity development in global health research: experience from the Karolinska Institutet/Makerere University partnership. PLoS Med. 2015;12(2):e1001784.

Article   PubMed   PubMed Central   Google Scholar  

Beran D, Byass P, Gbakima A, Kahn K, Sankoh O, Tollman S, et al. Research capacity building-obligations for global health partners. Lancet Glob Health. 2017;5(6):e567–e8.

Article   PubMed   Google Scholar  

Davies J, Mullan Z. Research capacity in Africa--will the sun rise again? Lancet Glob Health. 2016;4(5):e287.

Whitworth J, Sewankambo NK, Snewin VA. Improving implementation: building research capacity in maternal, neonatal, and child health in Africa. PLoS Med. 2010;7(7):e1000299.

Yvo Nuyens. Setting priorities for health research: lessons from low- and middle-income countries. Bull World Health Organ. 2007;85(4):319–21. https://doi.org/10.2471/BLT.06.032375 .

Organization WH. World report on knowledge for better health: strengthening health systems. Geneva: World Health Organization; 2004.

Google Scholar  

Tomlinson M, Chopra M, Sanders D, Bradshaw D, Hendricks M, Greenfield D, et al. Setting priorities in child health research investments for South Africa. PLoS Med. 2007;4(8):1293–8.

Article   Google Scholar  

Viergever RF. Health research prioritization at WHO: an overview of methodology and high level analysis of WHO led health research priority setting exercises. Geneva: World Health Organization; 2010.

Kok M, de Souza DK. Young voices demand health research goals. Lancet. 2010;375(9724):1416–7.

The Bamako call to action: research for health . Editorial. The Lancet. 2008;372(9653):1855. https://doi.org/10.1016/S0140-6736(08)61789-4 .

ELRHA. Building a Cross-Sectoral Toolkit and Research Foundation for the Intergration of Menstral Hygiene Management into Emergency Response. Available from: http://www.elrha.org/map-location/irc-menstrual-hygiene-call2/ . Accessed 22 Feb 2018.

Walker JA. Early marriage in Africa—trends, harmful effects and interventions. Afr J Reprod Health. 2012;16(2):231–40.

PubMed   Google Scholar  

Download references

Acknowledgements

The authors would like to extend thanks to all participant researchers and colleagues at WHO offices, who kindly took time to participate in the exercise and shared the information.

The WHO/HRP’s Regional Committee meeting for the African and Eastern Mediterranean regions on research capacity strengthening in Sexual and Reproductive Health and Rights was funded by: (i) the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization.

Availability of data and materials

The exercise for research prioritization was carried out during a WHO regional meeting for Africa and Eastern Mediterranean. The data was analysed and report was prepared in Geneva, Switzerland. The WHO regional meeting report and data can be shared, if needed.

This report contains the collective views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the World Health Organization.

Author information

Authors and affiliations.

Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

Moazzam Ali, Madeline Farron, Kelsey Miller & Rita Kabra

Reproductive and Women’s Health, Africa Region, World Health Organization, Brazzaville, Democratic Republic of the Congo

Leopold Ouedraogo

Women’s Reproductive Health, Eastern Mediterranean Region, World Health Organization, Cairo, Egypt

Ramez Khairi Mahaini

You can also search for this author in PubMed   Google Scholar

Contributions

MA conceptualized the manuscript. KM, MF, MA drafted an initial version and LO, RKM, RK provided technical inputs and edits. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Moazzam Ali .

Ethics declarations

Ethics approval and consent to participate.

Approval were obtained from the meeting participants to publish the results of the discussions and collective agreements on the research priorities in Africa and Eastern Mediterranean regions.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Ali, M., Farron, M., Ouedraogo, L. et al. Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions. Reprod Health 15 , 39 (2018). https://doi.org/10.1186/s12978-018-0484-9

Download citation

Received : 14 November 2017

Accepted : 20 February 2018

Published : 05 March 2018

DOI : https://doi.org/10.1186/s12978-018-0484-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Research priority
• Maternal health
• Contraception
• Eastern Mediterranean

Reproductive Health

ISSN: 1742-4755

• General enquiries: [email protected]

We have 3 reproductive medicine PhD Projects, Programmes & Scholarships

All disciplines

All locations

Institution

All Institutions

All PhD Types

All Funding

reproductive medicine PhD Projects, Programmes & Scholarships

Msc by research: understanding the beginning of life: the role of non- canonical ubiquitylation in early embryonic development, phd research project.

PhD Research Projects are advertised opportunities to examine a pre-defined topic or answer a stated research question. Some projects may also provide scope for you to propose your own ideas and approaches.

Self-Funded PhD Students Only

This project does not have funding attached. You will need to have your own means of paying fees and living costs and / or seek separate funding from student finance, charities or trusts.

Nitrate supplementation in pregnancy: maternal, fetal and offspring outcomes

Exploration of menstrual disorders (part of the elemi womens health program).

FindAPhD. Copyright 2005-2024 All rights reserved.

Unknown    ( change )

Have you got time to answer some quick questions about PhD study?

Select your nearest city

You haven’t completed your profile yet. To get the most out of FindAPhD, finish your profile and receive these benefits:

• Monthly chance to win one of ten £10 Amazon vouchers ; winners will be notified every month.*
• The latest PhD projects delivered straight to your inbox
• Access to our £6,000 scholarship competition
• Weekly newsletter with funding opportunities, research proposal tips and much more
• Early access to our physical and virtual postgraduate study fairs

Or begin browsing FindAPhD.com

or begin browsing FindAPhD.com

*Offer only available for the duration of your active subscription, and subject to change. You MUST claim your prize within 72 hours, if not we will redraw.

Do you want hassle-free information and advice?

Create your FindAPhD account and sign up to our newsletter:

• Find out about funding opportunities and application tips
• Receive weekly advice, student stories and the latest PhD news
• Hear about our upcoming study fairs
• Save your favourite projects, track enquiries and get personalised subject updates

Create your account

Looking to list your PhD opportunities? Log in here .

Filtering Results

• Bibliography
• More Referencing guides Blog Automated transliteration Relevant bibliographies by topics
• Automated transliteration
• Relevant bibliographies by topics
• Referencing guides

Research Topic: Reproductive Endocrinology

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, fertility, hysteroscopy, in vitro fertilization, infertility, ovarian aging, reproductive aging)

School of Medicine > Department of Psychiatry > Division: None

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)

• Schools & departments

Reproductive Health PhD

Awards: PhD

Study modes: Full-time, Part-time

Funding opportunities

Programme website: Reproductive Health

Introduction to Postgraduate Study at the University of Edinburgh

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

Research profile

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 vibrant research atmosphere, at the interface between basic science and clinical patient care.

Research topics

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 uterus during the menstrual cycle and throughout pregnancy and labour
• the fetus and neonate
• fetal programming resulting in increased risk of chronic disease in adulthood

MSc by Research

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.

• Read more about the Masters by Research in 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*.

Research themes

The CRH has arranged its research under four themes:

• Theme 1: Gonadal function - Including prenatal gonad and germ cell development; spermatogenesis; oocyte maturation and competence; and fertility preservation.
• Theme 2: Sexual health - Including stillbirth and preterm birth; and in-utero programming
• Theme 3: Pregnancy and early life - Including stillbirth and preterm birth; and in-utero programming
• Theme 4: Menstrual health - Including pelvic pain and heavy menstrual bleeding; endometriosis, adenomyosis and fibroids; and reproductive cancer

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.

Training and support

The CRH has close links with other internationally recognised research centres in the Institute for Regeneration and Repair (IRR) and Edinburgh BioQuarter, including:

• the Clinical Department of Obstetrics and Gynaecology
• the Simpson’s Centre for Reproductive Health
• other research centres on the same Edinburgh Royal Infirmary site and elsewhere within Edinburgh

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:

• well-equipped, high-quality research laboratories
• excellent imaging and histological facilities
• an on-site biological research facility

It utilises and links with a wide spectrum of state-of-the-art clinical imaging, genomics, proteomics, metabolomics and bioinformatics centres and core facilities.

Entry requirements

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.

International qualifications

Check whether your international qualifications meet our general entry requirements:

• Entry requirements by country
• English language 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.

English language tests

We accept the following English language qualifications at the grades specified:

• IELTS Academic: total 6.5 with at least 6.0 in each component. We do not accept IELTS One Skill Retake to meet our English language requirements.
• TOEFL-iBT (including Home Edition): total 92 with at least 20 in each component. We do not accept TOEFL MyBest Score to meet our English language requirements.
• C1 Advanced ( CAE ) / C2 Proficiency ( CPE ): total 176 with at least 169 in each component.
• Trinity ISE : ISE II with distinctions in all four components.
• PTE Academic: total 62 with at least 59 in each component.

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.

Degrees taught and assessed in English

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:

• UKVI list of majority English speaking countries

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).

• Approved universities in 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:

Fees and costs

Tuition fees.

Scholarships and funding

Featured funding.

• College of Medicine & Veterinary Medicine funding opportunities
• Research scholarships for international students
• Principal's Career Development PhD Scholarships

UK government postgraduate loans

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:

• your programme
• the duration of your studies
• your residency status

Programmes studied on a part-time intermittent basis are not eligible.

• UK government and other external funding

Other funding opportunities

Search for scholarships and funding opportunities:

• Search for funding

Further information

• IRR Postgraduate Team
• Phone: +44 (0)131 651 8100
• Contact: [email protected]
• Centre for Reproductive Health
• Institute for Regeneration and Repair
• 5 Little France Drive
• Little France
• Programme: Reproductive Health
• School: Edinburgh Medical School: Clinical Sciences
• College: Medicine & Veterinary Medicine

Select your programme and preferred start date to begin your application.

PhD Reproductive Health - 3 Years (Full-time)

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.

• How to apply

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:

• How to apply for a research degree

Find out more about the general application process for postgraduate programmes:

• [How to apply] ( https://www.ed.ac.uk/studying/postgraduate/applying )

PhD Studies in Life and Biomedical Sciences

• Prospective Students
• Current Students
• Quick Links

Research Clusters

• Biotechnology Systems and Synthetic Biology
• Cancer Biology
• Cell and Molecular Biology
• Chemical Biology and Drug Discovery
• Developmental Systems and Stem Cell Biology
• Genetics and Genomics
• Immunology and Microbial Sciences
• Reproductive Science
• Structural Biology and Biophysics

Reproductive Science and Medicine

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:

• Reproductive Research Updates. Each week for over 30 years, the Center for Reproductive Science has hosted Reproductive Research Updates - a forum in which CRS trainees present their research to Northwestern scientists across the Evanston and Chicago campuses as well as the Stanley Manne Children’s Research Institute.
• Translational Lectures in Reproductive Science. The CRS sponsors the Translational Lectures in Reproductive Science (LRS) seminar series. This seminar series takes place seasonally and includes lectures by luminaries in the field of reproductive science and medicine. These seminars are open to the broader Northwestern community and interested members of the public. Our named lectures include: Erwin Goldberg Lecture in Male Reproduction, Neena B. Schwartz Memorial Lectureship in Reproductive Science, Danielle Maatouk Memorial Lectureship, and the CRS Alumni Lecture. View the upcoming schedule on Planit Purple. To participate in the program or to suggest a speaker, please contact the Executive CRS Director.
• Career Catalysts. The Center for Reproductive Science Career Catalyst Series is a monthly seminar that will provide trainees with a mix of professional development workshops, networking, and outreach activities. The series is aimed at preparing students for success, from industry or government careers, to workshops in PubMed and preparing manuscripts for publication. The Career Catalysts will take place in the CRS Collaborative Suite (645 N. Michigan Ave., Suite 630). Light refreshments will be provided.
• The Reproductive Science and Medicine Summit. This annual event showcases reproductive science and medicine research conducted at Northwestern and surrounding Chicago area institutions. An organizing committee composed of CRS trainees is central to the success of this event. The Summit includes distinguished internal and external speakers, and trainee oral and poster presentations.  Trainee and travel awards for this event have been funded through the Constance Campbell Memorial Fund since 1989.
• The Illinois Symposium on Reproductive Science (ISRS).  This annual regional meeting offers a unique opportunity for graduate students, post-doctoral fellows, and clinical fellows in the reproductive sciences to plan a meeting and present their research to their peers and senior scientists from across Illinois.  The meeting is hosted by a rotation of Illinois universities including Northwestern, UIUC, UIC, and Southern Illinois University (SIU). The goals of ISRS are to celebrate our strong research and educational heritage, to foster the exchange of scientific information in the reproductive sciences, to facilitate the training and career development of future reproductive scientists, and to leverage our collective institutional strengths to maintain Illinois in a preeminent nationwide position in this critical research field.

Training Resources:

• Career Hub. Do you need advice or help with: Your CV? An abstract? A manuscript? A proposal? A presentation? Your job search? A job application? A job interview? If so, come to the CRS Career Hub! Beth Sefton, PhD, will hold office hours every Tuesday from 11am-noon and is willing to help in whatever way you may need. These meetings can take place either by phone, video-conference, or in person. Contact Beth Sefton to reserve a date and time.
• Constance Campbell Memorial Research Awards. The Constance Campbell Memorial Fund supports oral and poster research awards which are granted at our annual Reproductive Science and Medicine Summit to the top trainee presentations.
• Constance Campbell Memorial Travel Awards. The Constance Campbell Memorial Fund supports Travel Awards which trainees may apply for. Applications for the travel awards are open twice a year (fall, spring). This award allows for trainees to travel to national and international professional scientific meetings to present their research to the broader scientific community.

Cluster Director

• Teresa K. Woodruff , PhD, Dean, The Graduate School, Associate Provost for Graduate Education, Thomas J. Watkins Professor of Obstetrics & Gynecology, Director, Center for Reproductive Science

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]

• Dissertations & Theses
• Collections

EliScholar > Medicine > Medicine Thesis Digital Library

Yale 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.

Theses/Dissertations from 2024 2024

Refractory Neurogenic Cough Management: The Non-Inferiority Of Soluble Steroids To Particulate Suspensions For Superior Laryngeal Nerve Blocks , Hisham Abdou

Percutaneous Management Of Pelvic Fluid Collections: A 10-Year Series , Chidumebi Alim

Behavioral Outcomes In Patients With Metopic Craniosynostosis: Relationship With Radiographic Severity , Mariana Almeida

Ventilator Weaning Parameters Revisited: A Traditional Analysis And A Test Of Artificial Intelligence To Predict Successful Extubation , John James Andrews

Developing Precision Genome Editors: Peptide Nucleic Acids Modulate Crispr Cas9 To Treat Autosomal Dominant Disease , Jem Atillasoy

Radiology Education For U.s. Medical Students In 2024: A State-Of-The-Art Analysis , Ryan Bahar

Out-Of-Pocket Spending On Medications For Diabetes In The United States , Baylee Bakkila

Imaging Markers Of Microstructural Development In Neonatal Brains And The Impact Of Postnatal Pathologies , Pratheek Sai Bobba

A Needs Assessment For Rural Health Education In United States Medical Schools , Kailey Carlson

Racial Disparities In Behavioral Crisis Care: Investigating Restraint Patterns In Emergency Departments , Erika Chang-Sing

Social Determinants Of Health & Barriers To Care In Diabetic Retinopathy Patients Lost To Follow-Up , Thomas Chang

Association Between Fine Particulate Matter And Eczema: A Cross-Sectional Study Of The All Of Us Research Program And The Center For Air, Climate, And Energy Solutions , Gloria Chen

Predictors Of Adverse Outcomes Following Surgical Intervention For Cervical Spondylotic Myelopathy , Samuel Craft

Genetic Contributions To Thoracic Aortic Disease , Ellelan Arega Degife

Actigraphy And Symptom Changes With A Social Rhythm Intervention In Young Persons With Mood Disorders , Gabriela De Queiroz Campos

Incidence Of Pathologic Nodal Disease In Clinically Node Negative, Microinvasive/t1a Breast Cancers , Pranammya Dey

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

Prevalence Of Metabolic Comorbidities And Viral Infections In Monoclonal Gammopathy , Mansen Yu

Automated Detection Of Recurrent Gastrointestinal Bleeding Using Large Language Models , Neil Zheng

Vascular Risk Factor Treatment And Control For Stroke Prevention , Tianna Zhou

Theses/Dissertations from 2023 2023

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

An Investigation Of Novel Point Of Care 1-Tesla Mri Of Infants’ Brains In The Neonatal Icu , Elisa Rachel Berson

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

Adherence To Tumor Board Recommendations In Patients With Hepatocellular Carcinoma , Yueming Cao

Clinical Trials Related To The Spine & Shoulder/elbow: Rates, Predictors, & Reasons For Termination , Dennis Louis Caruana

Improving Delivery Of Immunomodulator Mpla With Biodegradable Nanoparticles , Jungsoo Chang

Sex Differences In Patients With Deep Vein Thrombosis , Shin Mei Chan

Incorporating Genomic Analysis In The Clinical Practice Of Hepatology , David Hun Chung

Emergency Medicine Resident Perceptions Of A Medical Wilderness Adventure Race (medwar) , Lake Crawford

Surgical Outcomes Following Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis , Wyatt Benajmin David

Representing Cells As Sentences Enables Natural Language Processing For Single Cell Transcriptomics , Rahul M. Dhodapkar

Life Vs. Liberty And The Pursuit Of Happiness: Short-Term Involuntary Commitment Laws In All 50 US States , Sofia Dibich

Healthcare Disparities In Preoperative Risk Management For Total Joint Arthroplasty , Chloe Connolly Dlott

Toll-Like Receptors 2/4 Directly Co-Stimulate Arginase-1 Induction Critical For Macrophage-Mediated Renal Tubule Regeneration , Natnael Beyene Doilicho

Associations Of Atopic Dermatitis With Neuropsychiatric Comorbidities , Ryan Fan

International Academic Partnerships In Orthopaedic Surgery , Michael Jesse Flores

Young Adults With Adhd And Their Involvement In Online Communities: A Qualitative Study , Callie Marie Ginapp

Becoming A Doctor, Becoming A Monster: Medical Socialization And Desensitization In Nazi Germany And 21st Century USA , SimoneElise Stern Hasselmo

Comparative Efficacy Of Pharmacological Interventions For Borderline Personality Disorder: A Network Meta-Analysis , Olivia Dixon Herrington

Page 1 of 32

Advanced Search

• Notify me via email or RSS
• Disciplines
• Researcher Profiles
• Author Help

Copyright, Publishing and Open Access

• Terms & Conditions
• Open Access at Yale
• Yale University Library
• Yale Law School Repository

Home | About | FAQ | My Account | Accessibility Statement

Privacy Copyright

• Biochemistry and Molecular Biology
• Biostatistics
• Environmental Health and Engineering
• Epidemiology
• Health Policy and Management
• Health, Behavior and Society
• International Health
• Mental Health
• Molecular Microbiology and Immunology
• Population, Family and Reproductive Health
• Program Finder
• Admissions Services
• Course Directory
• Academic Calendar
• Hybrid Campus
• Lecture Series
• Convocation
• Strategy and Development
• Implementation and Impact
• Integrity and Oversight
• In the School
• In the Field
• In Baltimore
• Resources for Practitioners
• Articles & News Releases
• In The News
• Statements & Announcements
• At a Glance
• Student Life
• Strategic Priorities
• Inclusion, Diversity, Anti-Racism, and Equity (IDARE)
• What is Public Health?
• Research and Practice
• Inclusion, Diversity, Anti-Racism and Equity (IDARE)
• Job Openings
• Alumni Employment
• Courses by Areas of Interest
• Introduction
• Project Development
• Implementation
• Dissemination
• Tools and Templates
• Publications
• CAHMI - Child and Adolescent Health Measurement Initiative
• COVID-19 Policies and Childhood Obesity Study
• Childcare Wellness Practices & Policies Project
• Evaluation of COVID-19 School Meals Response
• Maryland Wellness Policies and Practices Project (MWPPP)
• Wellness Champions for Change
• Healthiest Maryland Schools
• Project SELECT
• Tools and Resources
• For Families
• Volunteer and Employment
• Master's Students
• PhD Students
• News and Events
• Make a Gift
• Adolescent Sexual and Reproductive Health

Gender Based Violence

Gender disparities, maternal health.

• Men’s Sexual and Reproductive Health
• Pregnancy prevention: Family Planning/Unintended pregnancy and Abortion

Adolescent Sexual and Reproductive 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.

Evaluation of Sexual Health Curriculum for Health Students in Tanzania

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.

Faith-based Adolescents Involved in Total Health

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.

The Global Early Adolescent Study

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.

Harriet Lane Clinic’s Title X Program

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.

Technology Enchanced Community Health Nursing to Reduce Recurrent STIs after PID

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.

Community-partnered technology for partner violence prevention and response: MyPlanKenya

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.

Continuum of Shelter and Housing Models for Victims of Intimate Partner Violence

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.

Developing and Piloting A Gender-Based Violence Intervention Module to Reduce HIV Risk among Female Sex Workers (FSWs)

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.

Collaborative for Gender Equity and Empowerment in Education, Health and Labor Systems

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.

Duration of Hormonal Contraceptive Use: Immune Responses & Vaginal Microbiota

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.

Gender barriers to non-communicable disease prevention, treatment and management

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 .

Antihypertensive Medication in Pregnancy: An Update from the 2011 WHO Recommendations for Prevention and Treatment of Preeclampsia and Eclampsia

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.

Contraceptive Efficacy of a Novel Vaginal Ring

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.

Men's Sexual and Reproductive Health

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

Technology Enchanced Community Health Nursing Study

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 .

Pregnancy Prevention: Family Planning/Unintended Pregnancy and Abortion

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.

Evidence of COVID-19’s Potential Impact on Inequities in Abortion Access

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,  

FP quality metrics in Maryland

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

Measuring the incidence and safety of Abortion

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.

PMA Agile: Monitoring family planning service delivery and use at the subnational level

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.

Performance Monitoring in Action

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 .

The predictive utility of unmet need and intentions to use contraception in Uganda

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.

Quality improvement to integrate HIV testing in the Harriet Lane Clinic’s Title X Program

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.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• v.85(4); 2018 Nov

Bioethical and Moral Perspectives in Human Reproductive Medicine

Joseph v. turner.

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

Lucas A. McLindon

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.

Introduction

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:

• Fides : the faithfulness, intimacy, and companionship shared by the married couple,
• Proles : the fruit of children and family, and
• Sacramentum : the sacramental/covenant nature, its transcendent aspect, and indissolubility in the eyes of men and God ( Paul VI 1968 , no. 9).

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 .

Double-Effect Reasoning

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 ).

Case 1: Moral Decision-Making during Caesarean

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.

Hormonal Contraception

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.

Clinical Perspectives on the OCP

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 ).

Case 2: Prescribing the OCP

• Sarah, a seventeen-year-old woman, presents concerned that she has not had a period for the last eight months, coinciding with a significant weight gain of twenty-five kilogram. Her usual general practitioner (GP) had diagnosed her with PCOS and suggested a script for the COCP. She is not sexually active presently but has been in the past. Sarah wants a regular period and does see contraception as an added advantage should she require it.
• Talisha, a twenty-three-year-old beauty therapy student, presents for a repeat script for her Yaz (ethinyloestradiol/drospirenone). She is currently on Roaccutane (isotretinoin) as prescribed six months ago by her dermatologist for severe acne. After being prescribed Roaccutane, she elected to see a fertility awareness practitioner to monitor her cycle in order to avoid becoming pregnant. Two months later, she saw her GP colleague who recommended against FABMs for contraception and instead supplied her with the initial COCP prescription.
• Lesley, a forty-nine-year-old corporate lawyer, just wants a repeat script for her Levlen ED (ethinyloestradiol/levonorgestrel) which she has been on for fifteen years without any concerns. She does not have a regular partner but is sexually active. A cursory review of her health file shows a blood pressure of 160/110 at last COCP script visit twelve months ago, she is a smoker and has a maternal history of breast cancer at age forty-five.

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.

Male Fertility Investigation

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.

Case 3: Male Fertility Investigation

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:

• using a specially manufactured polyurethane device similar to a condom called a “Male-FactorPak” (MFP), in which the semen is collected within a normal act of intercourse;
• a Huhner’s test in which the doctor performs a procedure much like a Pap smear to collect the semen from the cervix after sexual intercourse;
• production of a masturbatory sample: either undertaking this at the pathology laboratory or delivering after producing the sample elsewhere.

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.

Fertility Awareness and Assisting Conception

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).

Case 4: Ovulation Induction in a Same-Sex Relationship

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.

ART: In Vitro Fertilization (IVF) and Gamete Intrafallopian Transfer (GIFT)

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).

Case 5: ART

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.

Prenatal Adoption of IVF Embryos

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).

Case 6: “Spare” IVF Embryo Adoption

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).

Concluding Remarks

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.

Acknowledgments

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.

Biographical Notes

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.

• American College of Obstetrics and Gynecology. 1965. “ Terminology Bulletin No. 1: Terms Used in Reference to the Fetus .” Terminology Bulletin . American College of Obstetrics and Gynecology: Chicago, IL. [ Google Scholar ]
• Aquinas T. 1274. Summa Theologiae , Vol. II-II , Question 64, Article 8. [ Google Scholar ]
• Augustine. 401. “ On the Good of Marriage .” New Advent . http://www.newadvent.org/fathers/1309.htm .
• Billings E. L., Corkill M., Marshell M. 2008. “ The Cultural Value of Natural Family Planning .” Paper presented at International Congress on the 40th Anniversary of Humanae Vitae , Pontifical Lateran University, Vatican City. [ Google Scholar ]
• Congregation for the Doctrine of the Faith. 1987. Donum vitae ( The Gift of Life: Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day ). Vatican City: The Holy See. [ Google Scholar ]
• Congregation for the Doctrine of the Faith. 2008. Dignitas personae ( On Certain Bioethical Questions ) . Vatican City: The Holy See. [ Google Scholar ]
• Corby P. M. 2013. “ Estranged Fathers: The Alienation of Men in Heterologous Embryo Transfer .” National Catholic Bioethics Quarterly 13 , no. 2 : 287–97. [ Google Scholar ]
• Doerfler J. F. 2000. “ Assisting or Replacing the Conjugal Act: Criteria for a Moral Evaluation of Reproductive Technologies .” The Linacre Quarterly 67 , no. 3 : 22–66. [ Google Scholar ]
• Doroski D. M. 2014. “ How Humanae Vitae Has Advanced Reproductive Health .” The Linacre Quarterly 81 , no. 3 : 286–94. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Embryo Adoption Awareness Center. 2018. “ Embryo Adoption .” https://www.embryoadoption.org .
• FertilityAuthority.com. 2018. “ Collecting a Semen Sample .” Progyny http://www.fertilityauthority.com/articles/collecting-semen-sample .
• Finnis J. 1991. “Challenge and Response” In Moral Absolutes , edited by Finnis John, 84–106. Washington, DC: The Catholic University of America Press. [ Google Scholar ]
• Fisher A. 2015. “ Nicholas Tonti-Filippini .” The Linacre Quarterly 82 , no. 2 : 97–98. [ Google Scholar ]
• Frank-Herrmann P., Heil J., Gnoth C., Toledo E., Baur S., Pyper C., Jenetzky E., Strowitzki T., Freundl G. 2007. “ The Effectiveness of a Fertility Awareness Based Method to Avoid Pregnancy in Relation to a Couple’s Sexual Behaviour during the Fertile Time: A Prospective Longitudinal Study .” Human Reproduction 22 , no. 5 : 1310–19. [ PubMed ] [ Google Scholar ]
• Frye C. A. 2006. “ An Overview of Oral Contraceptives: Mechanism of Action and Clinical Use .” Neurology 66 , no. 6 Suppl. 3 : S29–36. [ PubMed ] [ Google Scholar ]
• Fuscaldo G., Savulescu J. 2005. “ Spare Embryos: 3000 Reasons to Rethink the Significance of Genetic Relatedness .” Reproductive BioMedicine Online 10 , no. 2 : 164–68. [ PubMed ] [ Google Scholar ]
• Geach M. 1997. “ Are There Any Circumstances in Which It Would Be Morally Admirable for a Woman to Seek to Have an Orphan Embryo Implanted in Her Womb? ” Paper presented at International Conference to celebrate the Twentieth Anniversary of the Foundation of the Linacre Centre, London, UK. [ Google Scholar ]
• Goodman N. F., Cobin R. H., Futterweit W., Glueck J. S., Legro R. S., Carmina E. 2015. “ American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome—Part 2 .” Endocrine Practice 21 , no. 12 : 1415–26. [ PubMed ] [ Google Scholar ]
• Grisez G. 1997. a. “Appendix 2: Formal and Material Cooperation in Others’ Wrongdoing” In The Way of the Lord Jesus , vol. 3 , Difficult Moral Questions, 871–97. Quincy, IL: Franciscan Press; http://www.twotlj.org/G-3-A-2.html . [ Google Scholar ]
• Grisez G. 1997. b. “Question 51: Should a Woman Try to Bear Her Dead Sister’s Frozen Embryo?” In The Way of the Lord Jesus , vol. 3 , Difficult Moral Questions , 239–44. Quincy, IL: Franciscan Press; http://www.twotlj.org/G-3-51.html . [ Google Scholar ]
• Grisez G. 1997. c. “Question 52: May an Infertile Married Couple Try Tubal Ovum Transfer with Sperm? In The Way of the Lord Jesus , vol. 3 , Difficult Moral Questions . Quincy, IL: Franciscan Press; http://www.twotlj.org/G-3-52.html . [ Google Scholar ]
• Grisez G. 1997. d. “Question 67: May a Physician Prescribe Contraceptives?” In The Way of the Lord Jesus , vol. 3 , Difficult Moral Questions . Quincy, IL: Franciscan Press; http://www.twotlj.org/G-3-67.html . [ Google Scholar ]
• Grisez G. 1997. e. “Question 69: May a Physician Help Unmarried Couples Achieve Pregnancy?” In The Way of the Lord Jesus , vol. 3 , Difficult Moral Questions Quincy, IL: Franciscan Press; http://www.twotlj.org/G-3-69.html . [ Google Scholar ]
• Haas J. M. 2017. “ Moral Theological Analysis of Direct versus Indirect Abortion .” The Linacre Quarterly 84 , no. 3 : 248–60. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hall T. 1983. “ Human Life Begins: Integrated Senate Report .” The Linacre Quarterly 50 , no. 3 : 253–61. [ PubMed ] [ Google Scholar ]
• Hilgers T. W. 2004. “Evaluating and Treating Male Infertility” In The Medical Surgical Practice of NaProTECHNOLOGY , edited by Hilgers T. W., 635–642 Omaha, NE: Pope Paul VI Institute Press. [ Google Scholar ]
• Hilgers T. W., Stanford J. B. 1998. “ Creighton Model NaProEducation Technology for Avoiding Pregnancy. Use Effectiveness .” Journal of Reproductive Medicine 43 , no. 6 : 495–502. [ PubMed ] [ Google Scholar ]
• Imkampe A. K., Bates T. 2012. “ Correlation of Age at Oral Contraceptive Pill Start with Age at Breast Cancer Diagnosis .” The Breast Journal 18 , no. 1 : 35–40. [ PubMed ] [ Google Scholar ]
• John Paul Pope., II 1981. Familiaris consortio . Vatican City: Holy See. [ Google Scholar ]
• John Paul Pope., II 1984. General Audience of 22 August . Vatican City: Holy See. [ Google Scholar ]
• John Paul Pope., II 1995. Evangelium vitae . Vatican City: Holy See. [ Google Scholar ]
• Jordan S. J., Wilson L. F., Nagle C. M., Green A. C., Olsen C. M., Bain C. J., Pandeya N., Whiteman D. C., Webb P. M. 2015. “ Cancers in Australia in 2010 Attributable to and Prevented by the Use of Combined Oral Contraceptives .” Australian and New Zealand Journal of Public Health 39 , no. 5 : 441–45. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Keenan J. F., Kopfensteiner T. R. 1995. “ The Principle of Cooperation. Theologians Explain Material and Formal Cooperation .” Health Program 76 , no. 3 : 23–27. [ PubMed ] [ Google Scholar ]
• Kischer C. W. 1997. “ The Big Lie in Human Embryology: The Case of the Preembryo .” The Linacre Quarterly 64 , no. 4 : 53–61. [ PubMed ] [ Google Scholar ]
• Lee A. M., Connell M. T., Csokmay J. M., Styer A. K. 2016. “ Elective Single Embryo Transfer the Power of One .” Contraception and Reproductive Medicine 1 :11. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lee P. 1990. “ Personhood, the Moral Standing of the Unborn, and Abortion .” The Linacre Quarterly 57 , no. 2 : 80–89. [ PubMed ] [ Google Scholar ]
• Medical Board of Australia. 2013. Good Medical Practice: A Code of Conduct for Doctors in Australia . Australian Health Practitioner Regulation Agency: Melbourne, Australia. [ Google Scholar ]
• Miller C., Pruss A. 2017. “ Human Organisms Begin to Exist at Fertilization .” Bioethics 31 , no. 7 : 534–42. [ PubMed ] [ Google Scholar ]
• Oliver Perez M. R., Magrina J., Garcia A. T., Jimenez Lopez J. S. 2015. “ Prophylactic Salpingectomy and Prophylactic Salpingoophorectomy for Adnexal High-Grade Serous Epithelial Carcinoma: A Reappraisal .” Surgical Oncology 24 , no. 4 : 335–44. [ PubMed ] [ Google Scholar ]
• Pallone S. R., Bergus G. R. 2009. “ Fertility Awareness-Based Methods: Another Option for Family Planning .” Journal of the American Board of Family Medicine 22 , no. 2 : 147–57. [ PubMed ] [ Google Scholar ]
• Paul VI, Pope. 1968. Humanae vitae ( On the Regulation of Birth ). Vatican City: The Holy See. [ Google Scholar ]
• Pradiee J., O’Brien E., Esteso M. C., Castano C., Toledano-Diaz A., Lopez-Sebastian A., Santiago-Moreno J. 2016. “ Spermiotoxicity of Commercial Condoms Made from Polyurethane, Polyisoprene and Latex, Using Domestic Ruminants as an Experimental Animal Model .” Andrologia 48 , no. 4 : 475–80. [ PubMed ] [ Google Scholar ]
• Royal Australian and New Zealand College of Obstetricians and Gynaecologists. 2015. The RANZCOG Code of Ethical Practice . Royal Australian and New Zealand College of Obstetricians and Gynaecologists: Melbourne, Australia. [ Google Scholar ]
• Rhonheimer M. 2010. “The Instrumentalization of Human Life” In Ethics of Procreation and the Defense of Human Life: Contraception, Artificial Fertilization and Abortion , edited by Murphy Jr. W. F., 153–78. Washington, DC: The Catholic University of America Press. [ Google Scholar ]
• Schoenfeld C., Amelar R. D., Dubin L., Skwerers R. G. 1978. “ Evaluation of a New Silastic Seminal Fluid Collection Device .” Fertility and Sterility 30 , no. 3 : 319–21. [ PubMed ] [ Google Scholar ]
• Smith J. E. 1993. “Paul VI as Prophet” In Why Humanae Vitae Was Right: A Reader , edited by Smith J. E., 519–31. San Francisco: Ignatius Press. [ Google Scholar ]
• Sondheimer S. J. 2008. “ Oral Contraceptives: Mechanism of Action, Dosing, Safety, and Efficacy .” Cutis 81 , no. 1 Suppl. : 19–22. [ PubMed ] [ Google Scholar ]
• Tonti-Filippini N. 1990. “Donum Vitae” and Gamete Intra-Fallopian Tube Transfer . The Linacre Quarterly 57 , no. 2 : 68–79. [ PubMed ] [ Google Scholar ]
• Tonti-Filippini N. 2003. “ The Embryo Rescue Debate: Impregnating Women, Ectogenesis, and Restoration from Suspended Animation .” National Catholic Bioethics Quarterly 3 , no. 1 : 111–37. [ PubMed ] [ Google Scholar ]
• World Health Organization. 2010. WHO Laboratory Manual for the Examination and Processing of Human Semen , 5th ed Geneva, Switzerland: WHO Press. [ Google Scholar ]
• Zavos P. M. 1985. “ Characteristics of Human Ejaculates Collected via Masturbation and a New Silastic Seminal Fluid Collection Device .” Fertility and Sterility 43 , no. 3 : 491–92. [ PubMed ] [ Google Scholar ]
• Zavos P. M., Kofinas G. D., Sofikitis N. V., Zarmakoupis P. N., Miyagawa I. 1994. “ Differences in Seminal Parameters in Specimens Collected via Intercourse and Incomplete Intercourse (Coitus Interruptus) .” Fertility and Sterility 61 , no. 6 : 1174–76. [ PubMed ] [ Google Scholar ]
• Zegers-Hochschild F., Adamson G. D., Dyer S., Racowsky C., de Mouzon J., Sokol R., Rienzi L., Sunde A., Schmidt L., Cooke I. D., Simpson J. L., van der Poel S. 2017. “ The International Glossary on Infertility and Fertility Care, 2017 .” Fertility and Sterility 108 , no. 3 : 393–406. [ PubMed ] [ Google Scholar ]

Registration is open for the 2024 ASRM Scientific Congress & Expo

• Related Sites
• For Patients
• Career Center
• Member Groups

The SREI and SMRU Fellows Symposia: A Look Back

Date: August 28, 2024

Author: ASRM

The 2024 SREI Fellows Symposium

The First SMRU Fellows Symposium

Latest News

• Resident and Fellow Education

Fertility and Sterility On Air - ANZSREI 2024 Journal Club Global: "Should Unexplained infertility Go Straight to IVF?"

Join "Fertility and Sterility On Air" for insights from the ANXSREI conference on unexplained infertility, IVF, and expert debates. Listen now at ASRM.org.

Trump Calls for IVF Coverage, California Legislature Sends IVF Mandate Bill to Governor

The California General Assembly approved a bill mandating most private health insurance plans to provide coverage for In Vitro Fertilization (IVF). 

Advocacy in Action: August 2024

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.

August: What's New from the Fertility and Sterility Family of Journals

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.

ASRM Member Spotlight: Anthony M. Imudia, MD

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.

Journal Club Global from ANZSREI 2024: Debate Unexplained infertility; Straight to IVF?

ANZSREI 2024 debate: Should unexplained infertility go straight to IVF? Experts discuss pros, cons, and alternative treatments. No clear consensus reached.

Get Vot-ER Ready This National Patient Advocacy Day!

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.

AUA Releases Male Infertility Guideline Amendment

The AUA, in collaboration with the American Society for Reproductive Medicine (ASRM), has released the 2024 amendment to the Male Infertility Guideline.

Fertility and Sterility On Air - Unplugged: August 2024

Topics include: a review of studies of menstrual fluid, changing our language regarding progestin protocols, and nanoscale motion tracing of spermatozoa.

Journal Club Global: Falha de implantação: realidade ou ilusão estatística?

Fertility and Sterility Global Journal Club from Brazil

Welcome New ASRM Members!

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. 

Fertility and Sterility On Air - TOC: July 2024

Articles this month include: predicting ART complications, laser assisted hatching on vitrified blastocysts, predictive models of miscarriage and more.

Journal Club Global en Espanol: Actualizacion sobre el síndrome de ovario poliquístico

Fertility & Sterility se enorgullece de traer un Journal Club Global en Español en vivo desde Cancún, Mexico

Event Recap: CFAS/ASRM Business in Medicine 2024: A Leadership and Management Summit

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. 

Albert B. Janko, MD

Dr. Albert Béla Janko, Life member of ASRM, passed away on July 15, 2024, at the age of 90.

ASRM marks World IVF Day by doing what we do best – advocating for access to reproductive health care by calling for a House floor vote on the Right to IVF Act

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.

ASRM Member Spotlight: Salu Ribeiro, MS, TS(ABB), ALS/ELS(AAB), CLSp(RB)

Meet Salu Ribeiro, MS, TS(ABB), ALS/ELS(AAB), CLSp(RB), Senior Embryologist at the University of California, San Francisco.

ASRM Member Spotlight: Marina Gvakharia, MD, PhD, HCLD/ELD(ABB), CLS(CA), MT(ABOR)

Dr. Gvakharia is passionate about helping young colleagues advance in the field of clinical embryology and andrology.

Advocacy in Action: July 2024

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

Fertility and Sterility On Air - Unplugged: July 2024

Biomarkers for sperm improvement post-varicocele repair, minimal stimulation side effects, GnRH antagonist for heavy menstrual bleeding with fibroids.

Order your FREE Vot-ER badge to encourage patients and colleagues to vote!

ASRM) is pleased to announce our partnership with Vot-ER, a grassroots organization dedicated to driving civic engagement among healthcare professionals.

Fertility and Sterility On Air - Seminal Article: Ernest Ng and Zhi Chen

June issue Seminal Contribution: a randomized controlled trial studying the use of progestins for ovulation supression in predicted high responders. 

Fertility and Sterility On Air - TOC: June 2024

Covering articles on embryo transfer, PIEZO-ICSI, pregnancy outcomes, oocyte maturity, estradiol levels, and ovarian carcinoma and more!

ASRM announces support for HOPE with Fertility Services Act

The American Society for Reproductive Medicine is proud to endorse the HOPE with Fertility Services Act (HR 8821).

What's New from the Fertility and Sterility Family of Journals

2024 SRS-SREI Surgical Boot Camp: A Recap

The 2024 SRS-SREI Surgical Boot Camp took place at the Cleveland Clinic in Cleveland, OH, from May 30 to June 1, 2024.

Advocacy in Action: June 2024

ASRM Member Spotlight: Kelly Lynch, MD

An ASRM member since 2000, Dr. Lynch has served as a Chair on the  SART Electronic Communications Committee from 2018 to the present.

ASRM Member Spotlight: Sarah C. Vij, MD

An ASRM member for 8 years, Dr. Vij currently serves as program director for Cleveland Clinic’s Male Infertility and Andrology Fellowship.

ASRM Responds to Senate Vote on IVF Bill

ASRM is disappointed that a filibuster prevented the passage of the Right to IVF Act.

ASRM Responds to Supreme Court Ruling on Mifepristone

We are thrilled that a unanimous Supreme Court has rejected the ideologically driven lower court decisions on access to mifepristone

ASRM Calls for Passage of Family Building Bill

It would increase access to IVF treatments for all Americans, including active-duty service members, veterans, and federal employees.

Fertility and Sterility On Air - Unplugged: May 2024

Topics include: counseling on pregnancy complications in PCOS patients, sorting early spermatocytes from testicular biopsies, and more.

ASRM Member Spotlight: Nannan Thirumavalavan, MD

An ASRM member since 2017, Dr. Nannan Thirumavalavan is a fellowship-trained and board certified urologist in Cleveland, Ohio.

Songqing Li, PhD

ASRM mourns the death of Dr. Songqing Li, who passed away on May 22, 2024. 

Fertility and Sterility On Air - TOC: May 2024

Topics this month include Iatrogenic and demographic determinants of the national plural birth increase, outcomes between ICSI and IVF with PGT-A.

ASRM publishes IVF one-pagers for media use

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. 

ASRM Member Spotlight: Julia Conant, PsyD

Dr. Julia Conant joined ASRM to access the Mental Health Professional Group and the consultation, training and support offered.

ASRM Member Spotlight: Elizabeth L. Lee, BSc, RN

Elizabeth Lee sees ASRM as the guiding light of high-quality clinical fertility practice as well as a consistent voice advocating for reproductive rights.  

ASRM Member Spotlight: Kathryn J. Go, PhD, HCLD (ABB)

Dr. Kathryn Go  finds ASRM’s role is to provide a community for professionals, clinical and allied, in the field of reproductive medicine.

ASRM Action Alert Challenge

Are you an ASRM member looking to sharpen your advocacy skills? The Office of Public Affairs has an exciting opportunity for you!

Journal Club Global: Recent clinical trials in Fertility and Sterility from the Asia Pacific region

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

Register Now for CFAS/ASRM Business in Medicine: A Leadership and Management Summit

ASRM and CFAS have teamed up to offer much-requested business education for clinicians and REI office staff!

Advocacy in Action: May 2024

Asrm reacts to cruz/britt oped.

We are pleased to see Senators Cruz and Britt express their interest in protecting access to IVF.

Fertility and Sterility On Air - Unplugged: April 2024

Topics include: IVF in film, a rat model of fallopian tube torsion, comparing letrozole regimens for PCOS, and a review of chronic endometritis.

Mental Health Awareness Month: Mental Health Provider Appreciation

In the realm of reproductive medicine, the significance of mental health cannot be overstated. 

ASRM Needs You

Build Connections, Skills, and a Brighter Future for Reproductive Health!

ASRM Files Amicus Brief in Texas Embryo Case

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. 

Fertility and Sterility On Air - TOC: April 2024

Topics this month include the use of ICSI, fertility treatments among reproductive-aged women after cancer, and more.

Advocacy in Action: April 2024

Get to Know the Members of the 2024 PRIMED Scholars Cohort

Designed for ASRM members passionate about making a real impact, PRIMED offers a one-of-a-kind opportunity to become trailblazers.

Meet Alison Bartolucci, PhD

An ASRM member for 12 years, Alison Bartolucci, PhD has served on the SART Executive Council and as the SRBT representative.

ASRM Member Spotlight: Winifred Mak, MD, PhD

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.

Survey shows strong support for increased access to fertility treatments

A new public opinion poll reveals strong support for improved access to In Vitro Fertilization (IVF). 

Infertility Awareness

In honor of National Infertility Awareness Week (NIAW), we have rounded up some of our resources on infertility.

Leave Your Mark! NIAW April 21-27

National Infertility Awareness Week Action Round-Up

National Infertility Awareness Week 2024: Leave Your Mark

Next week is National Infertility Awareness Week, a federally recognized health observance founded to increase awareness of infertility.

ASRM Today: ASRM Policy Matters: Post-Alabama IVF decision advocacy roundup with Jessie Losch

Jessie Losch, ASRM Government Affairs Manager, updates ASRM Today on the advocacy efforts underway post the Alabama Supreme Court decision.

IVF-assisted pregnancies constitute 2.5% of all births in 2022

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.

Journal Club Global en Español: Avances recientes en el tratamiento del síndrome de ovario poliquístico e Infertilidad

Un panel de expertos discutirá dos artículos recientes de Fertility and Sterility que estudian la infertilidad y el síndrome de ovario poliquístico.

Fertility and Sterility On Air - Unplugged: March 2024

Topics include: melatonin and implantation (4:38), whole-genome screening of embryos, and bioengineering assisted reproductive technology.

Fertility and Sterility On Air - Live from PCRS 2024

Fertility & Sterility on Air brings you the highlights from the 2024 Annual Meeting of the Pacific Coast Reproductive Society.

Aileen Portugal, MD, St. Louis, MO

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.

Nicole Ulrich, MD, New Orleans, LA

Meet Nicole Ulrich, MD, who attended Tulane University and then trained in Obstetrics/Gynecology at the Ochsner Clinic Foundation.

INTRODUCING THE 2024 PRIMED SCHOLARS COHORT

Meet Rachel Whynott, MD, FACOG, a double board-certified reproductive endocrinology and infertility subspecialist.

Elizabeth Lee, RN, Gilbert, AZ

Meet Elizabeth Lee, RN, an ASRM member since 2016 and Employee #2 at Wellnest Fertility’s Clinical Operations.

Ann Marie Luft, RN, Lake Mary, FL

Meet Ann Marie Luft, a recent rejoining member of ASRM and a fertility nurse and fertility consultant.

Julie Bindeman, Psy-D, Rockville, MD

Meet Julie Bindeman, Psy-D, an ASRM member for eleven years, a graduate of George Washington University, and the co-owner of Integrative Therapy.

Inger Britt Carlsson, PhD, Orange, CA

With over 30 years’ experience, Britt Carlsson, PhD has a strong knowledge of the global fertility markets.

Journal Club Global: Cost effectiveness analyses of PGT-A

Infertility treatments can be financially burdensome, often without insurance coverage, making understanding the cost effectiveness of PGT-A crucial.

Morgan Baker, RN, Pleasant Grove, UT

Morgan Baker, RN,  is a registered nurse from Springville Utah, who has a passion for providing high-quality patient care.

Valerie Lynn Baker, MD, Lutherville Timonium, MD

Meet Valerie L. Baker, MD, Director of the Division of REI and the Telinde-Wallach Professor of Gynecology and Obstetrics at Johns Hopkins.

Gary M. Horowitz, MD

ASRM is sad to hear of the death of Dr. Gary M. Horowitz, MD

Tobacco or marijuana use and infertility: a committee opinion (2023)

In the United States, approximately 21% of adults report some form of tobacco use, although 18% report marijuana use.

Planned oocyte cryopreservation to preserve future reproductive potential: an Ethics Committee opinion (2023)

Planned oocyte cryopreservation is an ethically permissible procedure that may help individuals avoid future infertility.

CREST Scholars Program - Applications Open

CREST is seeking applications for the 2024-2025 class of Scholars.

Advocacy in Action: March 2024

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.

Fertility and Sterility On Air - Seminal Article: Dr. Jeremy Applebaum

Listen to this interview featuring Dr. Jeremy Applebaum, who recently published "Impact of coronavirus disease 2019 vaccination on live birth rates after IVF"

Important Message from ASRM Regarding JARG

ASRM has had a long history of working with Springer Nature to promote and elevate the Journal of Assisted Reproduction and Genetics (JARG).

ASRM Member Spotlight: Sarah Holley, PhD

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. 

Jan Friberg, MD, PhD

It is with a heavy heart that we announce the passing of Dr. Jan Friberg, MD, PhD. 

ASRM provides testimony to Senate Judiciary Committee on threats facing IVF

ASRM shared with the Senate Judiciary Committee the dangers to reproductive medicine nearly two years after the Dobbs decision.

Announcing Six Pilot & Exploratory Grant Cycle Awardees

ASRM is proud to announce six 2024 Pilot & Exploratory Grant Cycle awardees to receive funding through the ASRM Research Institute.

Journal Club Global: Infertility and Subclinical Hypothyroidism

The impact of treating SCH on fertility, obstetric outcomes, and offspring neurocognitive development is debated in the literature.

Fertility and Sterility On Air - TOC: March 2024

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.

ASRM Member Spotlight: Zaraq Khan, MBBS, MCR, FACOG

Meet Zaraq Khan, MBBS, MCR, FACOG, a double board certified OBGYN and Reproductive Endocrinology & Infertility specialist.

Fertility and Sterility On Air - Unplugged: February 2024

Topics this month include: fluoroscopic-guided hysteroscopic tubal cannulation, follicular-fluid phthalates and ovarian reserve, and more.

A Message from the Office of Public Affairs

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.

ASRM reacts to Alabama legislation

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.

IVF at the SOTU: Fertility care expected to be major focus at State of the Union

Protecting access to IVF care is expected to be a major theme of the State of the Union on Thursday.

Romaine B. Bayless, MD

Romaine Belle Bayless, MD, age 78, of Woodbury, MN, passed away following a courageous 4-year battle with pancreatic cancer.

ASRM Files Request for Rehearing with Alabama Supreme Court

On Friday, March 1, the appellees in this case filed a request for rehearing with the Alabama Supreme Court.

Update on ASRM's Efforts to Protect IVF

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.

Ethical obligations in fertility treatment when intimate partners withhold information from each other: an Ethics Committee opinion (2024)

Clinicians should encourage disclosure between intimate partners but should maintain confidentiality where there is no harm to the partner and/or offspring.

Ethical considerations for telemedical delivery of fertility care: an Ethics Committee opinion (2024)

Telemedicine has the potential to increase access to and decrease the cost of care.

Alabama Supreme Court Rules Frozen Embryos are “Unborn Children” and admonishes IVF’s “Wild West” treatment

Legally Speaking™ on presenting facts and reflecting on the impact and potential implications of  legal developments in ART.

February 19, 2024 Updates

Two of the studies cited by Texas Judge in his ruling suspending federal approval of abortion pill mifepristone were retracted on February 5, 2024.

Luis Blasco, MD

Dr. Luis Blasco, a pioneer in infertility treatment and a professor emeritus died peacefully on October 23, 2023. 

Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023)

Ovarian hyperstimulation syndrome is a serious complication associated with assisted reproductive technology.

ASRM Membership

Benefits of Membership

Reach your potential as a reproductive health professional and join the community advancing reproductive medicine with your ASRM membership.

ASRM Membership Dues

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 .

Discounted Membership

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 Affiliated Societies

ASRM Affiiliated Societies are made up of professionals who have special training and expertise in specific areas of reproductive medicine.

ASRM Professional Groups

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

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.

Membership Directory

ASRM Members can find contact information for other members by visiting ASRM Connect , the new community hub for ASRM membership.

ASRM Academy

Find A Course

View the ASRM Academy Course Catalog

Educational Webinars

Panel discussions on topics to enhance your knowledge of all facets of reproductive medicine

Certificate Courses and Training Modules

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

ASRM MAC Tool 2021

The ASRM Müllerian Anomaly Classification 2021 (MAC2021) includes cervical and vaginal anomalies and standardize terminology within an interactive tool format.

ASRM EDGE Tool

Get the EDGE on embryo identification! EDGE allows you to compare your grading of embryos against embryologists in the US and around the world.

More News from ASRM

Press Releases/Bulletins

Legally Speaking

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.

Journal Information

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]

Articles Search by   Keyword   |   Journal title   |   Author name   |   DOI

Editor-in-chief

ClinMed Archive

Articles published.

All articles are fully peer reviewed, free to access and can be downloaded from our ClinMed archive.

Contact our editorial office

ClinMed Journals Index Copernicus Values

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