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Biomedical subjects

R D Nachtigall

Publications and source records attributed to R D Nachtigall.

15 recordsLinked to original sources
PubMed1998

The disclosure decision: concerns and issues of parents of children conceived through donor insemination.

OBJECTIVE: The purpose of our study was to examine the disclosure decision by parents of children conceived by donor insemination. STUDY DESIGN: A qualitative component of a self-administered questionnaire mailed to 184 couples who had become parents by donor insemination encouraged respondents to volunteer their written comments, concerns, or opinions about their disclosure decision. RESULTS: A total of 70 men and 86 women submitted written comments indicating that 54% did not plan to disclose the donor insemination treatment (nondisclosers), 30% indicated they would (disclosers), and 16% remained undecided. The only significant relationship between the disclosure decision and expressed concern was with regard to confidentiality and honesty (chi2 = 99.9, p < 0.05). CONCLUSIONS: Whether parents viewed the disclosure issue as one of honesty (disclosers) or confidentiality (nondisclosers) was the major determinant in the decision of whether to tell children about their donor insemination origin. There was no association between disclosure status or gender and expressed concerns about parenting, children, or family relations.

Adult↗
PubMed1997

Stigma, disclosure, and family functioning among parents of children conceived through donor insemination.

OBJECTIVE: To examine the influence of gender, male infertility factor, and other demographic variables on stigma and whether parents tell their children that they were conceived by donor insemination (DI) and to ascertain if stigma and the disclosure decision affect parental bonding with the child or the quality of the interparental relationship. DESIGN: One hundred eighty-four San Francisco Bay Area couples who had become parents by DI were asked to complete a self-administered questionnaire. SETTING: A private infertility practice. PATIENT(S): Eighty-two men and 94 women who completed the questionnaire. MAIN OUTCOME MEASURE: A questionnaire assessing disclosure, stigma, parental bonding, and the quality of the interparental relationship. RESULT(S): Factors that increased the couple's likelihood of disclosure included younger age, azoospermia, lower stigma scores, and having more than one DI child. Fathers who scored higher on stigma reported less parental warmth and parental fostering of independence. CONCLUSION(S): Because the decision regarding disclosure of DI treatment was not linked to parental bonding with the child or to the quality of the interparental relationship, we cannot conclude that nondisclosure is harmful to family relationships or is a symptom of family problems. The husband's perceptions of stigma however, may affect the father--child relationship adversely.

Adult↗
PubMed1996

The use of intravenous immunoglobulin in recurrent pregnancy loss associated with combined alloimmune and autoimmune abnormalities.

PROBLEM: Several studies have evaluated the effect of intravenous gammaglobulin (IVIG) in women with unexplained recurrent spontaneous abortions (RSA). Data regarding the underlying immunologic abnormalities in these patients is scant. This study reports the pregnancy outcome and immunologic changes observed in a large group of women with RSA associated with well-defined alloimmune and autoimmune abnormalities treated with IVIG. METHODS: Thirty-five patients with three or more recurrent miscarriages were studied. None of the patients had identifiable alloimmune response to paternal lymphocytes. Twenty-four patients had anti-thyroid antibodies, ten patients had high levels of circulating immune complexes, and six patients had anti-cardiolipin antibodies. Five patients had Hashimoto's disease, one had immune thrombocytopenic purpura, and one had Crohn's disease. Twenty-three patients had more than one autoimmune abnormality. All patients received IVIG infusions (200-250 mg/kg) every 3 weeks during the first 8 months of pregnancy. RESULTS: Twenty-eight patients (80%) had a successful pregnancy. Decrease of the level of autoantibodies and circulating immune complexes was observed in all patients who had a successful pregnancy. Only three of these patients developed measurable alloimmune response to paternal antigens. CONCLUSIONS: This preliminary study suggests that IVIG may be of benefit to patients with recurrent pregnancy associated with combined alloimmune and autoimmune abnormalities. This benefit was seen in spite of lack of detectable correction of the alloimmune abnormality in the majority of patients.

Abortion, Habitual↗
PubMed1994

'Born to be a mother': the cultural construction of risk in infertility treatment in the U.S.

As American society has become increasingly medicalized, biomedically shaped constructions of risk have begun to dominate traditional cultural constructions. This paper examines how the quest for a pregnancy affects the construction of risk by women in infertility treatment in the United States. Findings are based on a longitudinal, qualitative study with 275 persons (132 couples and 11 women) who experienced infertility. Because women's involvement in medical treatment was greater than that of men and because they were more intent on treatment, women assumed the role of final arbiter of what was a risk, and which risks to take. Women perceived more risks than men and were more willing to take risks than men. Notions of risk changed for both women and men, however, as they proceeded through medical treatment. This research suggests that once infertility is medically designated as a disease, both patients and practitioners pursue a 'cure' through a well-delineated pattern of medical treatment, despite the risks of such treatment and independent of the likelihood of success. When medical views of risk and responsibility are teamed with women's persistence in the pursuit of a pregnancy, medical treatment may be taken to extremes. Americans consider risk-taking to be their prerogative when personal histories reflect strong cultural mandates about norms, values, rights, and responsibilities, and these in turn are interpreted as health-related by both consumers and health professionals. As a consequence, the forces that trigger medicalization are activated and medical technology is given potentially limitless scope.

Adult↗
PubMed1994

Donor insemination and human immunodeficiency virus: a risk/benefit analysis.

In 1988 the American Fertility Society revised its guidelines for the use of semen in donor insemination by stating that "the use of fresh semen for donor insemination is no longer warranted." Although the consequences of this recommendation include an approximate doubling of the patient's cost of treatment, a 50% reduction in both cycle fecundity and 3-month life-table pregnancy rates, a reduction in the number of pregnancies because of patient dropout, and an ethically troubling increase in physician income as a direct result of the diminished efficacy of treatment, an analysis of the risk of transmission of human immunodeficiency virus through donor insemination has not been presented. All available data suggest that neither safety nor efficacy need be sacrificed in the current practice of donor insemination by offering patients the choice of appropriately screened fresh or frozen sperm.

Cost-Benefit Analysis↗
PubMed1993

Secrecy: an unresolved issue in the practice of donor insemination.

There is a paucity of information on the well-being of the families created through artificial insemination with donor sperm despite its widespread availability for more than a generation. Physicians who practice donor insemination have historically supported or encouraged secrecy while observing that couples are satisfied and well adjusted after the birth of their donor insemination offspring. However, from the perspective of the child's best interests, it has been argued that accurate genealogic knowledge should be a "right" and that an ethical conflict exists if the practitioner and the couple act together to deceive the child about his or her true genetic identity. The recognition that secrecy raises difficult social, psychologic, and ethical questions while holding considerable practical and emotional appeal for the couple is a major unresolved issue in the practice of donor insemination. It is suggested that further study and evaluation of donor insemination families is needed if accurate counseling and advice are to be provided to couples considering the option of donor insemination.

Advisory Committees↗
PubMed1992

Incidence of breast cancer in a 22-year study of women receiving estrogen-progestin replacement therapy.

OBJECTIVE: To review the incidence of breast cancer in a continuous 22-year study of conjugated estrogen-medroxyprogesterone acetate hormone replacement therapy. METHODS: Eighty-four pairs of continuously hospitalized postmenopausal women who were matched for age, smoking history, and medical diagnosis were treated with estrogen-progestin hormone replacement therapy or placebo in a prospective and double-blind manner for 10 years. In the subsequent 12 years, the women were offered the choice of starting, stopping, or continuing hormone replacement therapy. RESULTS: After the initial 10 years, the incidence of breast cancer in the placebo group was 4.8%, whereas no cancers were found in the hormone replacement therapy group (P = .12). After an additional 12 years of follow-up, the overall incidence of breast cancer in the women who had never taken hormone replacement therapy was 11.5%, whereas no breast cancers had developed in the women who had ever taken hormone replacement therapy (P < .01). CONCLUSIONS: These data suggest that the 22-year administration of estrogen-progestin hormone replacement therapy did not increase the incidence of breast cancer in a small group of continuously hospitalized postmenopausal women.

Adult↗
PubMed1992

The effects of gender-specific diagnosis on men's and women's response to infertility.

OBJECTIVE: To determine if differences could be distinguished between men's and women's emotional response to infertility based on the assignment of a gender-specific diagnosis. DESIGN: Gender-specific diagnoses were examined in relation to stigma, perception of loss, role failure, and self-esteem, using structured interviews. SETTING: Tertiary clinical care in private practice settings. PARTICIPANTS: Thirty-six self-selected volunteer couples undergoing infertility treatment. MAIN OUTCOME MEASURES: Stigma, perception of loss, role failure, and lowered self-esteem emerged from content analysis of structured interview data. RESULTS: No differences were found among women in their emotional response to infertility regardless of whether a female or male infertility factor was present, whereas men with a male factor experienced more negative emotional response to infertility than men without a male factor. CONCLUSIONS: Although both women and men are affected by infertility, their emotional response is significantly influenced by a gender-specific diagnosis. Men's response to infertility closely approximates that of women if the infertility has been attributed to a male factor but differs considerably if a male factor is not found.

Emotions↗
PubMed1991

Ambiguous responsibility in the doctor-patient relationship: the case of infertility.

The effects of ambiguous responsibility in the doctor-patient relationship on persons undergoing medical treatment for infertility are examined through the negotiation process that ensues following diagnosis. Through the analysis of 79 interviews with women and men undergoing infertility treatment, it was found that: (1) diagnosis reinforced individuals' sense of responsibility for their infertility; (2) ambiguity in the doctor-patient relationship affected shifts in patients' perception of physician responsibility, and (3) patients eventually re-established responsibility for their medical treatment. The implications of ambiguous responsibility for symbolic meanings in biomedicine and the way those meanings are linked to power and authority are explored through an examination of power in patient and physician roles, clinical uncertainty, and medical competence.

Clinical Competence↗
PubMed1984

Compliance difficulties with progestin-supplemented estrogen replacement therapy.

Forty postmenopausal women were studied prospectively while undergoing estrogen replacement therapy (ERT). Eighteen women with an intact uterus were cycled with additional progestin therapy. All but three women of the estrogen-progestin group elected to discontinue therapy because of undesirable "physiologic" withdrawal bleeding. Future progestin-ERT recommendations should take these results into consideration. Wide-scale re-education of patients and physicians will be necessary if the existing recommended regimens are to be observed. Alternatively, new or different pharmacologic agents and regimens will be necessary to achieve the postulated benefits of progestin-ERT without undesirable side effects.

Aged↗
PubMed1979

Estrogen replacement therapy II: a prospective study in the relationship to carcinoma and cardiovascular and metabolic problems.

A 10-year double-blind prospective study was undertaken to evaluate the effects of estrogen replacement therapy (ERT). The sample population consisted of 84 pairs of randomly chosen postmenopausal in-patients, matched for age and diagnosis. The treatment group received high-dose conjugated estrogens, cyclically with progesterone. The controls recieved placebos. Results revealed no statistically significant difference in that incidence of thrombophlebitis, myocardial infarction (MI), or uterine cancer. There was a lower incidence of breast cancer in the treated group. Estrogen-treated patients showed a higher incidence of cholelithiasis. Those in the treated group who began the study with elevated beta/alpha lipoprotein ratios showed a reduction in that ratio over the course of the study, while the controls either maintained or increased their ratios. The low number of cases precludes drawing any real significance from the data on diseases of low frequency. The study excludes only a high incidence of complications from estrogens.

Adult↗
PubMed1979

Estrogen replacement therapy I: a 10-year prospective study in the relationship to osteoporosis.

A 10-year, double-blind prospective study was undertaken to evaluate the effects of estrogen replacement therapy. The sample population consisted of 84 pairs of randomly chosen postmenopausal patients who were matched for age and diagnosis. One half of the patients received conjugated estrogens and cyclic progesterone, while the other half received placebo. Estrogen-treated patients whose therapy started within 3 years of menopause showed improvement or no increase in osteoporosis. Control patients demonstrate an increase in their osteoporosis.

Clinical Trials as Topic↗