"One for Sorrow, Two for Joy?": American embryo transfer guideline recommendations, practices and outcomes for gestational surrogate patients

In January 2016, Melissa Cook, a California gestational surrogate experiencing a multiple birth pregnancy following the in vitro fertilization (IVF) transfer of three embryos comprised of donor eggs and sperm provided by the intended father went to the media when the intended father requested that she undergo a fetal reduction because twins were less expensive to raise than triplets. Much of the legal interest in this case to date has centered on the enforceability of surrogacy contracts. However, the Cook case also raises troubling issues about fertility treatment practices involving gestational surrogates, twin preference, and third-party reproduction medical decision-making. This paper focuses on multipleembryo transfers in the context of U.S. surrogacy arrangements. Offering an original analysis of data obtained from the U.S. national assisted reproduction registry, it examines single- and multiple-embryo transfer trends over an eleven-year period (2003 to 2014). Findings reveal that recommended guidelines were followed in less than 42% of cases in 2014. The paper argues that ensuring equitable medical treatment for all recipients of IVF requires the adoption of treatment guidelines tailored to, and offering protections for, specific patient groups, and that, once in place, guidelines must be robustly implemente

Anangu oral health: the status of the indigenous populatin of the Anangu Pitjantjatjara lands

The definitive version is available at www.blackwell-synergy.comObjective: To describe oral health in the Anangu Pitjantjatjaraku lands in South Australia and to compare with earlier surveys and national data. Design: Descriptive. Setting: Data were collected at the time of dental care service provision, according to World Health Organization protocols, at the request of the Nganampa Health Council on optical mark reader forms. Participants: There were 356 Anangu adults and 317 children surveyed. Results: The mean number of teeth affected by dental caries in the deciduous dentition in young children, aged 5–6 years, was double (mean 3.20) that of the overall Australian child population aged 5–6 years (mean 1.44). In contrast to the decline in deciduous caries in Australian children generally, Anangu children aged 5–9 years had a 42% increase in the mean number of teeth affected since 1987. Adults experienced low levels of dental caries, but severe periodontal disease was more prevalent among diabetics (79%) compared with-non-diabetics (13.8%). Tooth loss was found more frequently among adults with diabetes (mean 5.51) than non-diabetics (mean 1.53). Conclusions: Oral health promotion strategies, in association with general health strategies, need to be developed to improve oral health in this remote Aboriginal population. What this paper adds: Recent studies have shown that oral health of Indigenous children is worsening, but there has been little documentation of the changing oral health status of Indigenous adults. This study notes the deterioration of oral health in both children and adults since 1987/88. The relationship between glycaemic control, periodontal diseases and tooth loss in Indigenous adult populations needs to be further investigated.Colin Endean, Kaye Roberts-Thomson, Simon Woole