Medical and socio-cultural aspects of infertility in the Middle East

³ Correspondence address: E-mail: giserour{at}thewayout.net The Middle East (ME), an area rich in history and traditionwith >300 million population, includes 18 heterogeneous countriesconcerning resources, income per capita, available healthcareservices, population density, growth rate, birth rate, totalfertility rate and life expectancy. There is a high prevalenceof infertility in the ME because of post-partum infection, unsafeabortion, iatrogenic tubal and pelvic infertility, tuberculosis,schistosomiasis and high incidence of male factor infertility.It is argued that in the ME, the solution to the problem ofinfertility is its prevention, and population control shouldtake precedence over infertility treatment. However, for a successfulfamily planning program and adoption of small family norms,couples should be reassured that they will be helped to achievepregnancy should they decide so. Prevention and treatment ofinfertility are of particular significance in ME because a womansocial status, her dignity and self-esteem are closely relatedto her ability to have children. Also there is gender sufferingof infertility in the ME. One of the stumbling blocks to acceptanceof assisted reproductive technology (ART) as a line of treatmentof infertility was the unacceptability to the main religiousgroups of the involvement of a third party in the act of procreation.Practices of ART in the ME have many common features and littledifferences. A mechanism had to be found to provide low-costART to the needy.     

Repairing Broken Rules: Care-Seeking Narratives for Menstrual Problems in Rural Mali

Narratives play an important role in the organization of therapeutic action in rural Mali. This article provides structural and interpretive analyses of a young, French-speaking Dogon woman's accounts of her efforts to manage her menstrual bleeding and threatened infertility. Through her personal narratives she creates social arenas to recruit support, negotiate changes in her family relationships, and enhance her standing as a member of the community. Beginning with the accounts of her fear and helplessness, the narrator integrates past events into her unfolding present and achieves a meaningful resolution of her problem. Her narratives weave together encounters with family members, friends, and healers to describe a therapeutic itinerary that acquires significance as a transformative experience, [narrative, therapeutic action, medical pluralism, menstruation, Dogon, Mali]     

Experiencing infertility--social work dilemmas in child adoption procedures

The research deals with experiencing infertility and its consequences in the adoption of a child and focuses on infertile couples that have wished to adopt a child and joined a program preparing them to be foster parents. The results show that most of the infertile couples experience infertility very much as being different from couples with children as well as having to cope with the feelings of deep emotional loss resulting from the inability to reproduce biologically. There is therefore the question whether these facts should be taken into account by the profession (i.e. social workers) when dealing with child adoption as, according to most of the respondents of our survey, the process of coming to terms with infertility and its consequences is an important factor in establishing healthy family relationships and the child's identity within the adoptive family. We concluded from the results of the research that the infertile couples preparation program for adopting a child carried out by the Society of Adoptive Families "Deteljica", is a comprehensive autopoietic social workers' answer to the needs of participants for a successful adoption of a child, as it makes it possible to supply these future adoptive parents with the requisite information and experience and provides support to the entire family upon accepting a child in its midst, while its fundamental attribute is offering help to couples in overcoming the traumas resulting from their infertility.     

"He won't be my son": Middle Eastern Muslim men's discourses of adoption and gamete donation

In the Sunni Muslim world, religious mandates prohibit both adoption and gamete donation as solutions to infertility, including in the aftermath of in vitro fertilization (IVF) failures. However, both of these options are now available in two Middle Eastern countries with significant Shi'ite Muslim populations (Iran and Lebanon). On the basis of fieldwork in multisectarian Lebanon, I examine in this article attitudes toward both adoption and gamete donation among childless Muslim men who are undertaking IVF with their wives. No matter the religious sect, most Muslim men in Lebanon continue to resist both adoption and gamete donation, arguing that such a child "won't be my son". However, against all odds, some Muslim men are considering and undertaking these alternatives to family formation as ways to preserve their loving marriages, satisfy their fatherhood desires, and challenge religious dictates, which they view as out of step with new developments in science and technology. Thus, in this article I examine the complicated intersections of religion, technology, marriage, and parenthood in a part of the world that is both poorly understood and negatively stereotyped, particularly in the aftermath of September 11, 2001.     

Embracing precarity across species: Muslim ethics and care for stray dogs in Russia

Drawing on ethnographic fieldwork in Saint Petersburg between 2015 and 2016, this article puts work on postsocialist precarity in conversation with scholarship on piety and interspecies care in Muslim contexts to explore how Aliya, a low-income Slavic convert to Islam, responded to social and economic hardships by tending to stray dogs. In doing so, she did not turn away, turn inwards, or turn political in the conventional sense of the word. Instead, she engaged in what I term ‘embracing precarity’, which I define as a response to uncertainty, grounded in Islamic spirituality, ethics, and care. By embracing canine tactility – often in departure from cultural norms concerning stray dogs in Islam and at the risk of deepening her own vulnerability – Aliya embarked on a path towards God with nonhuman others. The emergent relatedness between her and the dogs illustrates how striving for an ethical Muslim life amid uncertainty may open one up to experimentation, improvisation, and becoming with precarious others in a pursuit of a relationship with God and a favourable afterlife.     

A veil (hijab) as a public symbol of a Muslim woman modern identity

In this article the author explains the social role of Muslim woman in a postmodern society through a public symbol of her identity--the veil. The article's thesis is that the Muslim women's manifestation of their Islamic denomination through veiling and wearing appropriate clothes (in the case of men through growing beards and wearing clothes considered appropriate for them) signifies an expression of a new, Islamic shaped identity. This is a postmodern identity based on modernity rather than a fundamental reaction to modernity. The veil, a public symbol of Muslim identity, is often given a different meaning by its observers than the person actually wearing it. Therefore, the intention of this article is to analyze the elements of a particular, postmodern identity that a Muslim woman's veil, as a public symbol, represents.     

Pursuing conception: a physician's experience with in-vitro fertilization.

Infertility is a common problem. Approximately one in seven North American couples will experience it, either by being unable to conceive after a year of trying or by experiencing recurrent miscarriages. A family physician outlines her experiences when being treated for infertility by in-vitro fertilization and embryo transfer.     

LH responses to single doses of exogenous GnRH by social Mashona mole-rats: a continuum of socially induced infertility in the family Bathyergidae.

The Mashona mole-rat, Cryptomys darlingi, exhibits an extreme reproductive division of labour. Reproduction in the colony is restricted to a single breeding pair. The non-reproductive male and female colony members are restrained from sexual activity by being familiar and related to one another and the reproductive animals. Circulating basal concentrations of luteinizing hormone (LH) as well as LH levels measured in response to a single exogenous gonadotropin releasing hormone (GnRH) challenge are not significantly different between the reproductive and non-reproductive groups of either sex. Socially induced infertility in both non-reproductive males and females does not result from a reduced pituitary secretion of LH or decreased sensitivity to hypothalamic GnRH, but rather appears to result from an inhibition of reproductive behaviour in these obligate outbreeders. The African mole-rats exhibit a continuum of socially induced infertility with differing social species inhabiting regions of varying degrees of aridity. In this continuum a transition from a predominantly behavioural repression in a social mesic-adapted species through to complete physiological suppression lacking incest avoidance in an arid-adapted eusocial species occurs in this endemic African family of rodents.     

Sometimes Similar,Sometimes Dangerously Different: Exploring Resonance,Laminations and Subject-Formation in South India

This paper explores the ways in which particular individuals or groups are cast as problematically other at certain times by exploring the relationship between empathy and antipathy – identified as products of ‘resonance’, or a certain kind of responsiveness to embodied encounters with others and also to concerns, ideas and discourses that originate locally or from elsewhere. Consequent effects on subject-formation and affordances of social possibilities are explored through an intensive focus on one Muslim man. The notion of a ‘laminated subjectivity’ is presented and elucidated. The paper draws on ethnography conducted in a Tamil town and is set against the backdrop of Hindu–Muslim relations in India.     

Tracking microdeletions of the AZF region in a patrilineal line of infertile men

Male infertility is considered to be a difficult-to-treat condition because it is not a single entity, but rather reflects a variety of different pathologic conditions, thus making it difficult to use a single treatment strategy. Structural alterations in the Y chromosome have been the principal factor responsible for male infertility. We examined 26 family members of 13 patients with male infertility who showed deletions in the AZF region. In family 1, the father and a brother did not show microdeletions. However, a son showed a microdeletion in AZFa (sY84) and an azoospermic sperm analysis, but another son had a microdeletion in AZFa (sY84) and AZFb (sY127) and a normal sperm analysis. The father of family 2, with severe oligozoospermia, had a microdeletion in the AZFa region (sY84) and his son, conceived by intracytoplasmic sperm injection, also showed the same microdeletion. In the other families, only the men with an altered sperm analysis had a microdeletion. It is possible that in family 1, the father and brother who did not show microdeletions in this study, could have microdeletions in regions upstream or downstream of the one analyzed. The treatment with intracytoplasmic sperm injection can result in vertical transmission of microdeletions of the AZF region and can also cause the expansion of a de novo mutation. This finding reinforces the necessity of an investigation of microdeletions of the Y chromosome in individuals who are candidates for assisted reproduction, as well as genetic counciling and follow-up.     

Understanding the Social Meaning of Infertility and Childbearing: A Qualitative Study of the Perception of Childbearing and Childlessness in Northern Ghana

Background

Infertility is a major medical condition that affects many married couples in sub-Saharan African and as such associated with several social meanings. This study therefore explored community''s perception of childbearing and childlessness in Northern Ghana using the Upper West Region as a case study.

Methods

The study was exploratory and qualitative using in-depth and key informant interviews and focus group discussions. Fifteen marriage unions with infertility (childless), forty-five couples with children, and eight key informants were purposively sampled and interviewed using a semi-structured interview guides. Three focus group discussions were also carried out, one for childless women, one for women with children and one with men with children. The data collected were transcribed, coded, arranged, and analyzed for categories and themes and finally triangulated.

Results

The study revealed that infertility was caused by both social and biological factors. Socially couples could become infertile through supernatural causes such as bewitchment, and disobediences of social norms. Abortion, masturbation and use of contraceptives were also identified as causes of infertility. Most childless couples seek treatment from spiritualist, traditional healers and hospital. These sources of treatment are used simultaneously.

Conclusion

Childbearing is highly valued in the community and Childlessness is highly engendered, and stigmatised in this community with manifold social consequences. In such a community therefore, the concept of reproductive choice must encompass policies that make it possible for couples to aspire to have the number of children they wish.     

Developments in stem cell research and therapeutic cloning: Islamic ethical positions, a review

Stem cell research is very promising. The use of human embryos has been confronted with objections based on ethical and religious positions. The recent production of reprogrammed adult (induced pluripotent) cells does not - in the opinion of scientists - reduce the need to continue human embryonic stem cell research. So the debate continues. Islam always encouraged scientific research, particularly research directed toward finding cures for human disease. Based on the expectation of potential benefits, Islamic teachings permit and support human embryonic stem cell research. The majority of Muslim scholars also support therapeutic cloning. This permissibility is conditional on the use of supernumerary early pre-embryos which are obtained during infertility treatment in vitro fertilization (IVF) clinics. The early pre-embryos are considered in Islamic jurisprudence as worthy of respect but do not have the full sanctity offered to the embryo after implantation in the uterus and especially after ensoulment. In this paper the Islamic positions regarding human embryonic stem cell research and therapeutic cloning are reviewed in some detail, whereas positions in other religious traditions are mentioned only briefly. The status of human embryonic stem cell research and therapeutic cloning in different countries, including the USA and especially in Muslim countries, is discussed.     

Genetic counselling (results of ten years experience). IV. Attitude of persons seeking counselling and reliability of the counsel (author's transl)

The authors, from their personal experience arising from 766 consultations, show that the percentages of marriages or procreations in subjects themselves suffering from a disorder, or with affected relatives, are independent of the risk estimated for their offspring. The procreation rate in couples with affected children is lower in high risk cases and depends also on the family composition. It appears that this procreation is voluntary in the great majority of cases because there were very few terminations of pregnancy among the couples seen before procreation. The estimated risks correspond to the risks observed but the authors insist that there is a relatively high proportion (4.4 per cent) of children born with a disorder different from that which motivated the consultation.     

体外受精-胚胎移植女性患者焦虑状况的影响因素分析及对妊娠结局的影响

摘要 目的：探讨体外受精-胚胎移植（IVF-ET）女性患者焦虑状况的影响因素及对妊娠结局的影响。方法：选择2019年3月~2021年4月期间南京鼓楼医院生殖医学科收治的192例IVF-ET女性患者。采用焦虑自评量表（SAS）评估所有患者焦虑状况。收集患者的临床资料,单因素及多因素Logistic回归分析IVF-ET女性患者焦虑的影响因素。观察不同焦虑状况患者的妊娠结局。结果：192例IVF-ET女性患者中,有37例（19.27%）患者出现焦虑状况。其中轻度焦虑15例（40.54%）、中度焦虑10例（27.03%）、重度焦虑12例（32.43%）。单因素分析结果显示,IVF-ET女性患者是否焦虑与家庭月收入、辅助生殖技术治疗失败史、文化程度、职业、不孕年限、年龄、社会支持、不孕类型、不孕原因有关（P<0.05）。多因素Logistic回归分析结果显示：不孕类型为原发不孕、不孕原因为女方因素、年龄>34岁、家庭月收入<3000元、文化程度为高中或中专及以下是导致IVF-ET女性患者发生焦虑的危险因素（P<0.05）。无焦虑患者优胚例数、2PN受精例数、获卵例数、临床妊娠例数占比均高于焦虑患者（P<0.05）。结论：IVF-ET女性患者较易产生焦虑情绪,其焦虑状况受不孕类型、不孕原因、年龄、家庭月收入、文化程度影响,且焦虑状况还会影响患者的妊娠结局,临床工作中应对存在上述影响因素的患者进行积极心理疏导。     

Muslim Youth in Canadian Schools: Education and the Politics of Religious Identity

This article provides an ethnographic analysis of the schooling experiences of Muslim youth in Canada who are committed to maintaining an Islamic lifestyle despite the pressures of conformity to the dominant culture. Little attention has been paid to how religious identity intersects with other forms of social difference, such as race and gender in the schooling experiences of minoritized youth. Using a case study often Muslim students and parents, this article demonstrates how Muslim students were able to negotiate and maintain their religious identities within secular public schools. The participants' narratives address the challenges of peer pressure, racism, and Islamophobia. Their stories reveal how Muslim students are located at the nexus of social difference based on their race, gender, and religious identity. The discussion further explores the dynamics through which these youth were able to negotiate the continuity of their Islamic identity and practices within schools despite the challenges that they faced. Building upon existing theories of identity maintenance and construction, this research demonstrates how the interplay of the core factors of ambivalence, role performance, and interaction and isolation are implicated in the way Muslim students negotiate the politics of religious identity in their schooling experiences.     

Aquaporins and (in)fertility: More than just water transport

Aquaporins (AQPs) are a family of channel proteins that facilitate the transport of water and small solutes across biological membranes. They are widely distributed throughout the organism, having a number of key functions, some of them unexpected, both in health and disease. Among the various diseases in which AQPs are involved, infertility has been overlooked. According to the World Health Organization (WHO) infertility is a global public health problem with one third of the couples suffering from subfertility or even infertility due to male or female factors alone or combined. Thus, there is an urgent need to unveil the molecular mechanisms that control gametes production, maturation and fertilization-related events, to more specifically determine infertility causes. In addition, as more couples seek for fertility treatment through assisted reproductive technologies (ART), it is pivotal to understand how these techniques can be improved. AQPs are heterogeneously expressed throughout the male and female reproductive tracts, highlighting a possible regulatory role for these proteins in conception. In fact, their function, far beyond water transport, highlights potential intervention points to enhance ART. In this review we discuss AQPs distribution and structural organization, functions, and modulation throughout the male and female reproductive tracts and their relevance to the reproductive success. We also highlight the most recent advances and research trends regarding how the different AQPs are involved and regulated in specific mechanisms underlying (in)fertility. Finally, we discuss the involvement of AQPs in ART-related processes and how their handling can lead to improvement of infertility treatment.     

L'AMP chez les blessés médullaires: indication et résultats

Spinal cord-injured men with ejaculation disorders can have children by means of Assisted Reproduction Techniques (ART). The possibilities of procreation of couples in which the man is praplegic or tetraplegic, have been improved over the this last decade by progress in the treatment of ejaculation disorders and the development of new ART techniques such as ICSI. Sperm quality is usually impaired in these patients. The indications for ART in spinal cord-injured patients are similar to those of other forms of male infertility. According to WHO recommendations, sperm preparation must be performed together with morphological study of spermatozoa to select the most appropriate ART technique, giving preference to so-called “simple” ART techniques, such as Intra-Uterine Insemination (IUI). Small studies have been conducted and showed that the clinical pregnancy rate per cycle was comparable to that observed in non-neurological patients. Autopreservation of sperm must be rapidly programmed to avoid repreated electrostimulation techniques and as a security measure before performing ART. A multicenter study should be conducted to pool data from all French centres.     

Ritual Efflorescences in a Sri Lankan Muslim community: The interplay of local,national and pan‐Islamic identities

This article examines the interplay of local, national, and international historical and contemporary processes as manifested in a Sri Lankan Muslim village festival. The author shows that the festival is a product of the historical isolation of the village and its attempt to establish a distinct Muslim social identity. In contemporary Sri Lanka a separate Muslim identity is no longer in doubt and the festival has become a focal event for competing and, potentially, mutually exclusive social identities as exemplified by Sufism, Sri Lankan nationalism, and pan‐Islamic fundamentalism.     

Muslims in the 2001 Census of England and Wales: Gender and economic disadvantage

The article presents new data for the Muslim population of Britain from the 2001 Census. It uses the cross tabulations of ethnicity by religion to back-project the growth of the Muslim population from 21,000 in 1951 to 1.6 millions in 2001. It examines the social, economic, demographic and geographic characteristics of the population. Although Muslims are often represented as a homogenous group, there are considerable internal differences, so that the characteristics of the population as a whole do not apply to all groups within. The 2001 Census shows that two-thirds of British Muslims are ethnically Pakistani, Indian and Bangladeshi, but one-third comes from diverse European, African, North African, Middle Eastern and other Asian sources. Nevertheless, Muslim gender roles emerge as a critical differentiator of socio-economic vulnerability. Taken as a whole, the Muslim population is young and rapidly growing; its socio-economic profile is depressed, marked by the exceptionally low participation rate of women in the formal labour market, and by high concentration in areas of multiple deprivation.     

Anonymity and Informed Consent in Artificial Procreation

The practice of informed consent in biomedicine is so widely spread that it must be considered the most important principle within bioethics, and the most universally appealed to within recent legislation. There seems to be a consensus as to its value in research on autonomous persons, but also a problem concerning its application when dealing with people having a serious mental, social or even physical disability.
Within the field of artificial procreation there are even more problems. Informed written consent is often demanded from anonymous donors of gametes in order to ensure their consent to the legal and moral consequences of their anonymity. The child resulting from the artificial procreation, on the contrary, cannot consent to, nor be informed before being conceived, of the secrecy laid on the identity of its genetic parents. Some countries resolve this problem by allowing the children, when they reach their majority, to obtain some information pertaining to the health or the identity of their genetic parents.
This presents ethical problems. It can be argued that the anonymity of the parents chiefly affects the children, so that an agreement on this point among parents, doctors and others must be regarded as invalid. The paper will argue that a law ensuring the complete anonymity of the parents is disregarding the informed consent and the interests of the children resulting from artificial procreation, and is thus doing more damage to society than good.