Index
A
Abortion, 49 , 128 , 233 , 355 nn18,22. See also Fetal reduction; Political arena
Adoption, 129 , 306
Advanced reproductive technologies. See Assisted reproductive technologies
Age-related infertility, 121 -22, 122 -24, 344 n5;
and decision making, 115 , 126 -27, 144 -46, 148 -49;
and diagnostic uncertainty, 125 ;
and egg donation, 120 , 121 , 125 -26;
and fertility drugs, 124 ;
and pressure on women, 118 -19, 294 -95;
and treatment success rates, 63 , 122 -23, 125 , 272 -73.
See also Postmenopausal pregnancies
AIDS, 100
American College of Obstetricians and Gynecologists, 48 , 89
American Gynecological and Obstetrical Society, 72 -73
American Society for Reproductive Medicine (ASRM):
on assisted reproductive technologies, 37 , 39 ;
on cancer risks, 168 ;
on cryopreservation, 131 -32;
on egg donation, 149 ;
on endometriosis, 32 ;
and Internet, 264 -65;
on micromanipulation, 94 ;
and monitoring, 41 , 43 , 225 , 226 , 229 , 353 -54n6;
on pelvic surgery, 339 n11;
and success rates, 59 ;
on unexplained fertility, 82
Anas, George, 121
Andrologists, 90 , 283
Angell, Marcia, 344 n85
Anti-abortion movement, 41 , 234
Antinori, Severino, 231 , 232
ART. See Assisted reproductive technologies
Artificial insemination, 25 -26, 98 , 227
Asch, Ricardo, 9 -10, 148 -49, 218 , 260 -61. See also Irvine clinic scandal
ASRM. See American Society for Reproductive Medicine
Assisted reproductive technologies (ART):
and age-related infertility, 122 -24, 125 -26;
conflicts within medical profession, 39 , 66 -67;
and cost concerns, 53 , 67 , 337 -38n26;
decision making, 60 -65;
experimentation, 42 , 161 ;
feminists on, 41 , 336 n3;
government research moratorium, 41 -44, 166 , 233 , 234 , 235 , 236 ;
and health insurance, 33 , 67 , 113 , 337 -38n26;
and immunologic infertility, 107 ;
incentives for, 40 ;
moderation trend, 51 -56, 155 , 337 -38n26, 347 n10;
monitoring, 40 -41, 42 -43, 113 , 226 ;
and multiple pregnancies, 46 -51;
and ovarian hyperstimulation, 33 , 36 -37, 43 -46;
risks/complications, 44 -51;
and stimulated intrauterine insemination, 80 , 83 ;
and treatment momentum, 53 ;
unproven treatments, 39 -40, 41 -42, 43 -44, 55 -56, 66 , 159 , 161 , 248 -50;
variations of, 37 -39
See also Assisted reproductive technology success rates; GnRH-a; In vitro fertilization
Assisted reproductive technology success rates, 35 , 40 , 52 , 56 -60, 356 n1;
and age-related infertility, 63 , 122 -23, 125 , 345 n14;
clinic-specific, 61 -62, 64 -65, 226 , 338 n35;
definitions of, 30 , 62 -63, 338 n37;
and egg donation, 141 ;
and moderation trend, 55 ;
and multiple pregnancies, 46 -47;
stimulated IUI, 78 -79;
and treatment expansion pattern, 35 -36
Australia, 354 n9
B
Baby-boom generation, 294 -95, 299
Basal body temperature (BBT) chart, 85 , 86 , 87 , 88 , 89
Bern, Howard, 152 -53, 179 , 346 n2
Biochemical pregnancies, 58
Birth control pill, 45 , 296 -97
Bongaarts, John, 119
Breast cancer. See Cancer risks
Brennan, Troyen, 197 -98, 351 n21
C
Caffeine, 318 , 358 n6
Canada, 230 , 233 , 292 -93, 354 n9, 355 n16
Cancer, 128 -29, 132 -33, 265 , 345 n19. See also Cancer risks
Cancer risks, 349 n35;
and clomiphene citrate, 22 , 169 , 174 ;
and ovarian hyperstimulation, 46 , 54 , 134 -35, 170
Caplan, Arthur, 121 , 166
Case reports, 309
Catholicism, 232 , 336 n1
Center for Reproductive Health (University of California at Irvine). See Irvine clinic scandal
Centers for Disease Control, 227
Cervical conization, 318
Chemotherapy, 128
Class issues, 144 , 148
Clinical pregnancies, 58 , 62 -63
Clinical significance, 313
Clinical studies, 309
Clinton administration, 9 , 67 , 234 , 238 , 240
Clomid. See Clomiphene citrate
Clomiphene citrate, 18 -23, 30 , 79 , 81 ;
and age-related infertility, 124 ;
and anti-cancer effect of, 174 ;
and fertility continuum, 25 ;
and luteal phase deficiency, 88 ;
and male factor infertility, 341 n33;
and moderation trend, 53 ;
research, 150 -51;
risks/complications, 151 , 169 , 174
Cloning, 11
Colborn, Theo, 179 , 180
College of American Pathology, 225
Conflicts within medical profession, 4 , 6 , 7 -8, 24 -25, 114 , 266 -67;
assisted reproductive technologies, 39 , 66 -67;
clomiphene citrate, 18 -20, 21 , 22 ;
cryopreservation, 131 -32;
egg donation, 136 -37, 346 n38;
fertility tests, 26 ;
fetal reduction, 50 -51;
immunotherapy, 110 -12, 343 n73;
luteal phase deficiency, 86 ;
market-driven nature of fertility intervention, 220 -21;
micro-manipulation, 94 -95;
pelvic surgery, 25 , 71 , 72 -73, 339 n11
Consumer/advocacy organizations, 3 -4, 243 , 292 , 308 , 321 , 357 n22s. See also Resolve
Contraception, 317 -18
Corporations, 5
Cost concerns, 123 -24, 182 , 219 -20, 248 -49, 263 -64, 272 , 356 n29;
assisted reproductive technologies, 53 , 67 , 337 -38n26;
fertility drugs, 193 , 242 , 356 n24;
and research, 154 , 177 -78, 252 , 263 , 346 -47n4;
and specialty rivalries, 250 , 356 n35;
stimulated intrauterine insemination, 78 , 340 n19;
and unequal access, 245 , 356 n27.
See also Health insurance; Market-driven nature of fertility intervention
Cryopreservation, 39 , 128 -33, 134 , 345 n19;
marketing, 265 -66;
monitoring, 132 , 232 , 354 n12
Cunha, Gerald, 150 , 151 , 179
D
Dalkon Shield, 335 n2
DeCherney, Alan, 129 , 195 -96, 225 , 228
Decision making, 68 -69, 261 -62, 274 -79;
and age-related infertility, 115 , 126 -27, 144 -46, 148 -49;
assisted reproductive technologies, 60 -65;
and cancer risks, 172 ;
and doctors, 189 -93, 287 -89, 282 -87, 350 -51nn5, 7, 9, 357 nn16, 18;
and health insurance, 182 ;
and health records, 290 -91;
overview, 321 -24;
and patient choice, 142 -44;
pelvic surgery, 74 ;
and risks/complications, 21 , 173 -75, 280 , 281 -82, 357 n10;
and societal changes, 149 ;
stimulated intrauterine insemination, 76 -77;
and treatment-independent pregnancy, 115 -16;
and treatment momentum, 258 -59;
and treatment options, 279 -81.
See also Information sources
Denmark, 233 , 355 n15
DES (diethylstilbestrol), 2 -4, 20 , 22 , 25 , 164 -65, 180 , 218 , 294 ;
and research, 152 , 153 , 164 -65, 348 n30, 350 n49
DES Action, 3 -4, 357 n22
Diagnoses, 63 , 182 , 274 , 290 , 322 -23. See also Diagnostic uncertainty; Unproven treatment; specific diagnoses
Diagnostic uncertainty, 26 , 18 , 69 -70, 87 -88, 115 , 125 , 157 , 192 , 347 n12;
immunologic infertility, 26 , 99 , 101 -4, 106 -7, 111 , 343 n75;
luteal phase deficiency, 89 , 341 nn38, 42;
male factor infertility, 91 , 92 , 187 , 342 n52.
See also Unexplained infertility
Diethylstilbestrol. See DES
Dioxin, 32
Discrimination, 143 -44, 231
Doctor choice, 189 -92, 282 -87, 350 -51nn5, 7;
and cost concerns, 182 ;
and geographical location, 190 , 351 n9;
and health insurance, 191 -92, 282 -83;
information sources, 321 ;
and market-driven nature of fertility intervention, 191 , 285 -86;
and research, 189 -90, 284 , 357 n18;
and training, 189 , 283 -84, 357 n16;
warning flags, 324
Doctors as information sources, 185 -87, 192 -93
Donor eggs. See Egg donation
Donor sperm. See Sperm donation
Douching, 318
Drug manufacturers:
advertising, 192 -93;
and assisted reproductive technologies, 42 ;
"educational" activities, 197 -98, 202 , 351 -52n21;
and government regulation, 194 , 199 , 352 n25;
incentives to doctors, 195 -96, 197 , 201 -2;
and menopause hormone treatments, 295 ;
and research, 200 -201, 352 nn23-25;
sales representatives, 195 , 351 n14;
and treatment expansion pattern, 199 -200
E
EAB. See Ethics Advisory Board
Egg donation, 39 ;
and age-related infertility, 120 , 121 , 125 -26;
conflicts within medical profession, 136 -37, 346 n38;
decision making, 144 ;
egg sharing programs, 127 -28, 272 , 346 n34, 357 n7;
feminist analysis, 336 n3;
marketing, 137 , 138 -41, 146 -48;
risks/complications, 135 -36, 142 , 216 , 346 n38.
See also Irvine clinic scandal
Eli Lilly and Company, 352 nn24, 25
Embryos:
ethical issues, 232 , 336 n1, 354 n12;
research on, 239 , 355 nn22.
See also Cryopreservation
Empirical treatment. See Unproven treatment
Endocrine disrupters, 179 -80
Endometrial biopsy, 87 , 88
Endometriosis, 30 -32, 73 , 75 , 348 n17;
and environmental pollutants, 32 , 350 n53;
and GnRH-a, 157 -59
Environmental pollutants, 178 -81, 358 n9, 359 n11;
and endometriosis, 32 , 350 n53;
and male factor infertility, 98 -99, 179 , 180 ;
prevention, 99 , 241 , 318 -19, 358 n9
Epidemiological studies, 309
Eshkenazi, Brenda, 358 n6
Estrogen, 21 , 22 , 152 , 159
Ethical violations, 204 , 348 n33. See also Irvine clinic scandal; Monitoring
Ethics Advisory Board (EAB), 234 -36, 237 , 238
Experimentation, 152 , 161 -62;
assisted reproductive technologies, 42 , 161 ;
cryopreservation, 131 ;
and decision making, 175 ;
and diagnostic uncertainty, 70 ;
immunotherapy, 161 ;
and marketing, 210 -11;
micromanipulation, 95 , 96 ;
and postmenopausal pregnancies, 120 -21;
and research, 163 -67, 237 , 348 nn30, 31;
and risks/complications, 165 ;
stimulated intrauterine insemination, 77 -78.
See also Research; Unproven treatment
Exploitation, 6 , 28 -30, 235 , 269 -73
F
FDA. See Food and Drug Administration
Federal Trade Commission (FTC), 226 , 227 , 353 n2
Feminism, 41 , 336 n3
Fertility and Sterility , 39 , 42 , 264 -65, 356 n29
Fertility drugs:
and age-related infertility, 124 ;
alternatives to, 172 , 349 -50n48;
cost concerns, 193 , 242 , 356 n24;
costs of, 193 , 242 ;
extent of use, 349 n39;
and male factor infertility, 79 , 341 n33;
moderation trend, 53 -54;
and postmenopausal pregnancies, 134 -35;
risks/complications, 134 -35, 167 -72;
treatment expansion pattern, 79 ;
unproven treatment, 20 , 21 , 22 -23, 43 -44, 156 -57, 176 -77.
See also Clomiphene citrate; Human menopausal gonadotropin; Ovarian hyperstimulation
Fertility intervention, 321 -24;
appropriateness of, 250 -59;
benefits of, 4 -5;
changes in, 262 -64;
as exploitation, 6 , 28 -30, 235 , 269 -73;
individual cases, 17 , 20 , 23 -24, 33 ;
momentum of, 53 , 206 -7, 258 -59, 275 -79;
no-treatment option, 183 , 341 n30;
ongoing development of, 181 -83.
See also Experimentation; Fertility intervention; Unproven treatment; specific interventions
Fertility tests, 26 , 27 -28, 30 , 86 -87, 125 ;
immunologic infertility, 101 , 213 ;
male factor infertility, 91 -92.
See also Diagnoses; Diagnostic uncertainty
Fetal reduction, 48 -51, 50 -51, 187 -88, 239 , 337 n18
Fetal tissue research, 236 , 355 nn18, 22
First National Conference on Infertility for the Patient and the Medical Team, 5
Fletcher, John C., 236
Food and Drug Administration (FDA), 18 , 335 n2, 339 n8, 352 n25, 353 n4. See also Government regulation
France, 229 -30, 231 , 354 n8
FTC. See Federal Trade Commission
G
Gag clauses, 192 , 351 n12
Gamete intrafallopian transfer (GIFT), 9 -10, 37 -38, 43 , 44 , 47 , 57 , 125 , 159 , 218 . See also Assisted reproductive technologies
Genetics, 100 , 104 -5
Genetics and IVF Institute, 128 , 130 , 132 , 265 -66
GIFT. See Gamete intrafallopian transfer
Gleicher, Norbert, 245
GnRH-a, 155 , 193 , 348 n18;
risks/complications, 135 , 157 -59, 176 -77, 199 , 348 n18;
unproven treatment, 176 , 347 n6
GnRH ovulation pump, 192
Gosden, Roger, 128
Government regulation, 41 , 252 , 324 ;
and drug manufacturers, 194 , 199 , 352 n25;
history of, 234 -40, 355 n19;
inadequacy of, 6 , 40 -41, 72 , 233 , 335 n2;
thalidomide, 348 n30;
working conditions, 359 n11.
See also Monitoring
Guillette, Louis, 181
H
Harvey, Brit, 236
Haseltine, Florence, 46 , 136
Health insurance, 124 , 182 , 242 -45, 263 , 355 n24;
and assisted reproductive technologies, 33 , 67 , 113 , 337 -38n26;
and doctor choice, 191 -92, 282 -83;
and informed consent, 192 -93, 351 n12;
international comparisons, 230 , 292 -93;
and market-driven nature of fertility intervention, 245 -46;
and moderation trend, 337 -38n26;
and monitoring, 43 , 230 , 291 , 343 n83, 357 n21;
and multiple pregnancies, 247 ;
pelvic surgery, 33 , 74 -75, 124 , 246 -47, 340 n12;
reform failure, 9 , 67 ;
and research, 112 -13, 154 , 247 , 252 ;
risks of managed care, 247 -48;
and treatment expansion pattern, 245 -46, 247 .
See also Cost concerns
Health Net, 351 n12
Healy, Bernadine, 133 -34
Herbst, Arthur, 152 , 346 n2
HFEA. See Human Fertilisation and Embryo Authority
HIV infection risk, 227 -28, 353 n4
HMG. See Human menopausal gonadotropin
HMOs. See Health insurance
Hormonal contraception, 45 , 296 -99, 317 -18
Hormone treatments:
and clomiphene citrate, 21 , 22 ;
and luteal phase deficiency, 88 ;
menopause, 295 -98, 357 n23;
risks/complications, 216 , 353 n36.
See also Fertility drugs; Ovarian hyperstimulation
Hostile cervical mucus, 26 , 79 , 176
Human Fertilisation and Embryo Authority (HFEA) (United Kingdom), 228 , 229 , 231 , 233
Human menopausal gonadotropin (hMG), 53 , 79 , 88 , 124 , 156 , 241 -42;
risks/complications, 88 , 170 , 176 , 177 .
See also Fertility drugs; Ovarian hyperstimulation
Human Reproduction , 266
I
Iatrogenic risk, 275 , 318 , 357 n10
ICSI. See Intracytoplasmic sperm injection
Immature egg removal, 232 -33, 349 -50n48
Immunologic infertility, 100 -104, 108 ;
diagnostic uncertainty, 26 , 99 , 106 -7, 111 , 343 n75.
See also Immunotherapy
Immunotherapy:
conflicts within medical profession, 110 -12, 343 n73;
marketing, 102 , 209 -10, 213 ;
and placebo effects, 108 -9;
risks/complications, 104 , 106 , 213 -16;
success rates, 106 , 343 nn73, 74;
unproven treatment, 161 , 213 -14, 343 nn81, 82
Implantation rates, 58
Infertility intervention. See Fertility intervention
Information sources, 184 -221, 263 , 279 -80;
doctors, 185 -87, 189 -93, 321 ;
drug companies, 193 -202, 351 n14, 352 nn23-25;
Internet, 264 -67;
media, 203 -5;
and openness, 254 -56;
and patient demand, 205 , 206 -7;
and research, 210 -12.
See also Decision making; Medical journal articles
Informed consent, 8 -9, 163 , 167 , 314 -16, 350 n1;
and health insurance, 192 -93, 351 n12;
inadequacy of, 4 , 7 , 166 , 187 -88.
See also Information sources
Insurance issues. See Health insurance
Intercourse timing, 82 -83, 155 -56
Internet, 264 -67, 308
Intracytoplasmic sperm injection (ICSI), 93 , 97 -98, 208 -9, 342 n47;
and health insurance, 182 ;
media coverage, 203 , 204 ;
unproven treatment, 94 , 95 , 161 .
See also Micromanipulation
Intrauterine insemination (IUI), 23 -24, 92 , 124 ;
treatment expansion pattern, 77 , 79 , 80 , 84 .
See also Stimulated intrauterine insemination
In vitro fertilization (IVF), 24 , 34 -35, 44 , 75 , 77 , 100 , 161 ;
and age-related infertility, 122 -24, 125 , 345 n14;
and endometriosis, 31 -32, 159 ;
failures, 107 , 159 , 161 , 215 ;
government research moratorium, 41 -44, 234 , 235 ;
increased use of, 31 , 33 , 37 , 52 ;
and male factor infertility, 90 -91, 92 , 98 , 342 n47;
and micromanipulation, 95 , 97 ;
moderation trend, 54 -55, 155 , 347 n10;
monitoring, 43 , 113 , 226 ;
and ovarian hyperstimulation, 33 , 36 -37, 43 -44;
procedure, 36 , 336 n1;
success rates, 47 , 52 , 57 , 123 , 270 -71, 345 n14;
unproven treatment, 249 -50.
See also Assisted reproductive technologies
Irvine clinic scandal, 9 -11, 128 , 131 , 166 , 261 , 336 n1;
and health insurance, 355 n24;
and media, 204 ;
and monitoring, 224 -25, 228 , 229 , 237 -38, 353 -54n6;
and patient demand, 206
Italy, 231 -32
IUI. See Intrauterine insemination; Stimulated intrauterine insemination
IVF. See In vitro fertilization
J
Jaffe, Robert, 19 , 22
Jones, Howard W., Jr., 66
Jonsen, Albert, 11
K
Kaiser-Permanente, 269
Keith, Louis, 47 -48, 80 , 340 nn26, 27
L
Laboratory research, 310
Lancet , 49 , 50 , 52
Laparoscopic surgery, 72 -73, 74 -75;
for endometriosis, 31 , 73 , 75 , 157 , 348 n17;
risks/complications, 44 , 75 , 339 n8;
unproven treatment, 71 , 73 , 248 -49, 339 n3.
See also Pelvic surgery
Laser surgery, 71 -75. See also Pelvic surgery
Lupron. See GnRH-a
Luteal phase deficiency, 85 -89, 341 nn38, 42
M
Male factor infertility, 90 -99, 161 , 203 ;
diagnostic uncertainty, 187 , 342 n52;
environmental factors, 179 , 180 ;
and fertility drugs, 79 , 341 n33;
and in vitro fertilization, 342 n47;
and micromanipulation, 342 n52;
and stimulated intrauterine insemination, 83 -84;
treatment success rates, 341 -42n47
Malpractice, 40
Managed care. See Health insurance
Market-driven nature of fertility intervention, 28 , 191 , 268 -69;
assisted reproductive technologies, 41 -42, 356 n1;
conflicts within medical profession, 220 -21;
and doctor choice, 191 , 285 -86, 293 ;
and health insurance, 244 , 245 -46;
and pelvic surgery, 73 , 74 -75.
See also Cost concerns; Drug manufacturers; Marketing
Marketing, 216 -17, 270 ;
and cost concerns, 263 -64;
DES, 218 ;
egg donation, 137 , 138 -41, 146 -48;
financial lures, 263 -64, 265 -66, 268 -69;
hormone treatments, 295 , 357 n23;
immunotherapy, 102 , 209 -10, 213 ;
Internet, 265 -66;
intracytoplasmic sperm injection, 208 -9;
and monitoring, 227 , 353 n2;
and research, 210 -12;
and success rates, 29 -30
Martin, Mary, 223 -24, 234 , 237 , 238 -39, 241 -42
McLachlan, John, 179 -80
Media, 203 -5
Medical conventions, 39 , 198
Medical journal articles, 187 , 308 -10, 311 -13;
anecdotal basis, 205 ;
bias in, 264 -65;
drug manufacturer influence, 197 -98, 351 -52n21.
See also Conflicts within medical profession; Research
Medline, 308
Menge, A. C., 99
Meta-analyses, 310
Micromanipulation, 39 , 92 -97, 342 n52;
conflicts within medical profession, 94 -95;
risks/complications, 94 , 95 , 96 , 173
Miscarriage, 107
Moderation trend, 51 -56, 337 -38n26;
and research, 155 , 347 n10
Monitoring, 222 -23;
assisted reproductive technologies, 40 -41, 42 -43, 113 , 226 ;
cryopreservation, 132 , 232 , 354 n12;
and decision making, 65 ;
and health insurance, 43 , 230 , 291 , 343 n83, 357 n21;
and HIV infection risk, 227 -28, 353 n4;
importance of, 228 -29, 251 -52;
international comparisons, 228 , 229 -32, 354 -55nn8, 9, 12, 14-16;
and Irvine clinic scandal, 224 -25, 228 , 229 , 237 -38, 353 -54n6;
NABER, 237 ;
pelvic surgery, 72 ;
postmenopausal pregnancies, 231 -32;
research, 166 , 167 , 212 , 237 , 253 ;
resistance to, 41 , 225 -26;
and success rates, 227 , 353 n2;
and unproven treatment, 113 -14;
voluntary, 226 -27.
See also Experimentation; Government regulation; Unproven treatment
Multiple pregnancies, 46 -47, 53 , 58 -59, 124 , 134 , 247 , 345 n24;
fetal reduction, 48 -51, 187 -88, 337 n18;
increase in, 336 -37n11, 356 n1;
and ovarian hyperstimulation, 80 , 340 n27;
risks/complications, 47 -48, 337 n13, 340 nn26, 27;
and unequal access, 356 n27
N
NABER. See National Advisory Board on Ethics in Reproduction
National Advisory Board on Ethics in Reproduction (NABER), 237
National Institutes of Health, 167 , 171 , 212 , 235 , 238 , 239
Naz, R. K., 99
New England Journal of Medicine , 154
New York Hospital—Cornell Medical Center, 269
NIH Revitalization Act (1993), 238
Nitrous oxide, 359 n11
No-treatment option, 183 , 341 n30. See also Treatment-independent pregnancy
Nulsen, J. C., 76
O
Observational studies, 309
Office for Protection from Research Risks (National Institutes of Health), 167
Office of Technology Assessment (OTA), 235 , 240 , 355 n19
Ortho Pharmaceuticals, 296
Osteoporosis, 135 , 158 , 296 -97
Ovarian cancer. See Cancer risks
Ovarian cryopreservation. See Cryopreservation
Ovarian hyperstimulation, 33 , 36 -37, 88 , 97 -98, 124 ;
and egg sharing programs, 127 -28, 272 , 346 n34, 357 n7;
hMG shortage, 241 -42;
and moderation trend, 53 , 55 ;
and multiple pregnancies, 80 , 340 n27;
research, 154 , 347 n6, 348 n14;
treatment expansion pattern, 79 , 80 , 81 , 84 , 156 , 176 , 182 ;
unproven treatment, 43 -44, 156 , 157 .
See also Risks/complications of ovarian hyperstimulation; Stimulated intrauterine insemination
Ovarian hyperstimulation syndrome, 45 , 136 , 160 -61, 186
Ovarian stimulation. See Fertility drugs; Ovarian hyperstimulation
Oversight. See Monitoring
P
PCT. See Postcoital test
Pear, Robert, 192
Pelvic inflammatory disease (PID), 317 , 318 , 358 n1
Pelvic surgery, 24 , 71 -76;
and age-related infertility, 122 -23;
conflicts within medical profession, 25 , 339 n11;
cost concerns, 123 -24;
for endometriosis, 31 , 157 , 348 n17;
health insurance, 33 , 124 , 246 -47, 340 n12;
risks/complications, 44 , 318 , 339 n8;
risks of, 44 ;
success rates, 30 , 122 -23;
unproven treatment, 248 -49, 339 n3
Pergonal. See Human menopausal gonadotropin
Pharmaceutical manufacturers. See Drug manufacturers
Physician-patient partnership: inadequacy of, 4
PID. See Pelvic inflammatory disease
Pill. See Birth control pill
Pituitary growth hormone, 348 n31
Placebo effects, 108 -9, 163
Political arena, 9 ;
ART research moratorium, 41 -44, 166 , 233 , 234 , 235 , 236 ;
and fetal reduction, 49 ;
history, 234 -40.
See also Government regulation
Postcoital test (PCT), 26 , 27
Postmenopausal pregnancies, 117 -18, 133 -35;
decision making, 143 ;
and egg donation, 135 -36;
and experimentation, 120 -21;
and monitoring, 231 -32;
and multiple pregnancies, 345 n24;
risks/complications, 137 -38, 345 -46nn22-24, 29
Premarin, 357 n23
Prenatal diagnosis, 230 -31
Prevention, 99 , 244 , 289 , 317 -20;
need for, 178 , 182 , 240 -41
Progesterone, 21 -22, 88
Prospective studies, 310
Public Citizen Research Group, 324
Q
Quigly, Martin, 40 , 43 , 143 -44
R
Radiation treatments, 128
Randomized controlled trials, 162 -64, 309 . See also Research
Reagan-Bush administrations, 9 , 41 , 49 , 166 , 235 -36, 238
Reinhardt, Uwe, 190
Research, 153 -54, 162 -64, 210 -12, 309 -10;
age-related infertility, 122 -24;
animal experimentation, 153 , 346 n3;
clinical significance of results, 151 -52, 313 , 346 n2;
and clinic success rates, 218 -19;
and cost concerns, 154 , 177 -78, 252 , 263 , 346 -47n4;
and diagnostic uncertainty, 347 n12;
and doctor choice, 189 -90, 284 , 357 n18;
doctors as information sources, 186 -87, 350 n3;
and drug manufacturers, 200 -201, 352 nn23-25;
embryos, 239 , 355 n22;
and experimentation, 163 -67, 237 , 348 nn30, 31;
fertility drugs, 150 -51, 156 , 171 ;
fertility tests, 27 -28;
fetal tissue, 236 , 355 nn18, 22;
government funding, 238 -40;
government moratorium, 41 , 166 , 233 , 234 , 235 , 236 , 355 n18;
and health insurance, 112 -13, 154 , 247 , 252 ;
intercourse timing, 155 -56;
and moderation trend, 155 , 347 n10;
monitoring, 166 , 167 , 212 , 237 , 253 ;
ovarian hyperstimulation, 154 , 347 n6, 348 n14;
stimulated intrauterine insemination, 78 -79;
treatment follow-up, 173 , 218 -19, 350 n49;
zygote intrafallopian transfer, 155 , 347 n8.
See also Medical journal articles; Monitoring; Success rates; Unproven treatment
Resolve, 5 , 10 , 202 , 225 , 243 , 270
Retrospective studies, 310
Review articles, 310
Richardson, David, 165
Risks/complications:
assisted reproductive technologies, 44 -51;
clomiphene citrate, 19 , 20 , 21 , 22 -23, 151 , 169 , 174 ;
cryopreservation, 132 -33;
and decision making, 21 , 173 -75, 274 -75, 280 , 281 -82, 357 n10;
egg donation, 135 -36, 142 , 216 , 346 n38;
and experimentation, 165 ;
fertility drugs, 134 -35, 167 -72;
GnRH-a, 135 , 157 -59, 176 -77, 199 , 348 n18;
HIV infection, 227 -28, 353 n4;
hormone treatments, 216 , 353 n36;
human menopausal gonadotropin, 88 , 170 , 176 , 177 ;
iatrogenic, 275 , 318 , 357 n10;
immunotherapy, 104 , 106 , 112 , 213 -16;
intrauterine insemination, 79 ;
managed care, 247 -48;
and media coverage, 204 ;
micromanipulation, 94 , 95 , 96 , 173 ;
multiple pregnancies, 47 -48, 337 n13, 340 nn26, 27, 345 n24;
pelvic surgery, 44 , 75 , 318 , 339 n8;
postmenopausal pregnancies, 133 -35, 137 -38, 345 -46nn22-24, 29;
stimulated intrauterine insemination, 80 ;
and woman's age, 338 n37.
See also Risks/complications of ovarian hyperstimulation
Risks/complications of ovarian hyperstimulation, 44 -46, 53 -54, 88 , 134 -35, 182 , 349 n44;
cancer, 170 ;
lower pregnancy rates, 176 , 177 ;
ovarian hyperstimulation syndrome, 136 , 160 -61, 186
S
SART. See Society for Assisted Reproductive Technologies
Sauer, Mark, 121 , 136 -37
Selective termination. See Fetal reduction
Serono Labs, 202 , 242
Serono Symposia, 5 , 10
Serophene. See Clomiphene citrate
Sexually transmitted diseases (STDs), 317
Side effects. See Risks/complications
Silicone breast implants, 344 n85
Smoking, 318 , 358 n6
Society for Assisted Reproductive Technologies (SART), 64 , 338 n35, 354 n6
Society of Reproductive Surgeons, 339 n11
Sperm count, 91 , 1779
Sperm donation, 98 , 146 , 204 , 347 n12, 348 n33
Sperm washing, 343 n73
Spontaneous pregnancy. See Treatment-independent pregnancy
STDs. See Sexually transmitted diseases
Stillman, Robert, 41 -42
Stimulated intrauterine insemination, 55 -56, 76 -81, 83 , 84 -85, 340 nn19, 22
Stress, 290
Success rates, 60 -62;
and age-related infertility, 122 -23, 272 -73;
assisted reproductive technologies, 356 n1;
calculation of, 62 -63, 338 n37;
clinic-specific, 59 , 64 -65, 226 , 338 n35;
vs. cost-effectiveness, 340 n19;
and decision making, 64 ;
definitions of, 29 -30, 58 -59, 62 -63;
and exploitation, 29 -30, 269 -73;
and follow-up research, 218 -19;
immunotherapy, 106 , 343 nn73, 74;
and infertility duration, 115 , 344 n86;
and male factor infertility, 92 , 341 -42n47;
and media, 205 ;
and monitoring, 227 , 353 n2;
and multiple pregnancies, 46 -47, 58 -59;
ovarian hyperstimulation, 177 ;
pelvic surgery, 30 , 122 -23;
SART Registry, 64 , 338 n35;
stimulated intrauterine insemination, 55 , 78 -79;
and treatment-independent pregnancy, 57 , 267 .
See also Assisted reproductive technology success rates
Superfetation. See Multiple pregnancies
Superovulation. See Ovarian hyperstimulation
Surrogacy, 39 , 336 n3
T
Taymor, Melvin, 18 , 19 , 156
Thalidomide, 348 n30
Treatment expansion pattern, 70 , 114 , 267 -68;
assisted reproductive technologies, 35 -36;
clomiphene citrate, 18 -19, 79 , 81 ;
and drug manufacturers, 199 -200;
and health insurance, 244 , 245 -46, 247 ;
intracytoplasmic sperm injection, 95 , 208 -9;
intrauterine insemination, 77 , 79 , 80 , 84 ;
micromanipulation, 93 -94;
ovarian hyperstimulation, 79 , 80 , 81 , 84 , 156 , 176 , 182 ;
and patient demand, 205 ;
pelvic surgery, 71 , 72 -75;
and risks/complications, 175 , 182 .
See also Unproven treatment
Treatment-independent pregnancy, 64 , 267 , 340 -41n28;
and assisted reproductive technologies, 35 , 57 ;
and deci-
sion making, 115 -16, 274 ;
and fertility continuum, 25 -26;
and immunologic infertility, 104 ;
and intercourse timing, 82 -83, 155 -56;
and stimulated intrauterine insemination, 78 , 81
Triplets, 49 -50, 53 . See also Multiple pregnancies
Trounson, Alan, 349 n48
Tubal embryo transfer (TET), 38 -39
Tubal surgery. See Pelvic surgery
Tucker, M. J., 90
Tuskegee syphilis studies, 165 -66
U
Ultrasound, 44
Unexplained infertility, 26 , 82 , 322 -23;
and clomiphene citrate, 19 ;
and gamete intrafallopian transfer, 57 ;
and immunologic infertility, 108 ;
and male factor infertility, 90 ;
research, 347 n12;
and stimulated intrauterine insemination, 81 ;
and stress, 290
United Kingdom, 349 n44;
monitoring, 228 , 229 , 230 , 231 , 233 , 354 -55nn12, 14
Unproven treatment, 151 -52, 268 ;
assisted reproductive technologies, 39 -40, 41 -42, 43 -44, 55 -56, 66 , 159 , 161 , 248 -50;
and cost concerns, 248 -49;
and decision making, 66 ;
DES, 4 , 165 ;
fertility drugs, 20 , 21 , 22 -23, 43 -44, 156 -57, 176 -77;
fetal reduction, 49 , 337 n18;
GnRH-a, 176 , 347 n6;
hormone treatments, 21 -22;
immunotherapy, 110 -11, 161 , 213 -14, 343 nn81, 82;
importance of changing, 114 -15;
intracytoplasmic sperm injection, 94 , 95 , 161 , 208 -9;
micromanipulation, 95 -96;
and monitoring, 113 -14;
ovarian cryopreservation, 128 -29, 130 , 265 -66;
ovarian hyperstimulation, 43 -44, 156 , 157 ;
pelvic surgery, 71 , 72 , 73 , 248 -49, 339 n3;
silicone breast implants, 344 n85;
stimulated intrauterine insemination, 55 -56, 77 -78, 81 , 83 , 84 -85, 340 n22.
See also Conflicts within medical profession; Diagnostic uncertainty; Experimentation; Treatment expansion pattern
V
Video display terminals, 319 , 358 n9
W
Whittemore, Alice, 168 , 173
Wyden, Ron, 226
Z
ZIFT. See Zygote intrafallopian transfer
Zygote intrafallopian transfer (ZIFT), 38 , 44 , 47 ;
research, 155 , 347 n8.
See also Assisted reproductive technologies
Judith Steinberg Turiel is a freelance medical writer with a doctorate in education from Harvard University. She was the research liaison for DES Action and worked with the Coalition for the Medical Rights of Women. She is the coauthor of Preventing Preterm Birth: A Parent's Guide . Photo: Ed Kirwan.