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Slides 2-3 Slides 4-11 The process of assisted reproductive technology (ART) is first explained through definitions, milestones in clinical embryology in the different countries are shown, as this is a rapidly developing field of medicine. The different approaches of reproductive medicine should be discussed according to the level of knowledge of the students. This part of the presentation aims to clarify the possible steps of the different techniques in order to understand ART processes. You might also ask students if they know the related success rates to point out that ART procedures provide no guarantee to get pregnant and the chance of success is largely related to the underlying cause of infertility , the age of the woman and other modifiable risk factors such as BMI. Slides 12-23 a) Before showing the slide, ask the students to imagine an infertile woman and write down 2-3 sentences expressing the feelings and thoughts of women in such a situation. Encourage them to use the first-person singular to enhance empathy. Read out a few different prepared sentences. Then, with the slide projected, try to collectively determine whether the spoken sentences can be related to the emotions presented on the slide. b) Project one of the cases! Have a willing student read out what is seen on the slide (thus, for a few minutes, stepping into the patient's role). After the volunteering student has read the text written in the first person singular, ask them to remain in the woman's role. Encourage the other students to ask questions to the "patient": How do you feel? What are you afraid of? What is your biggest problem? The student in the patient's role can freely respond. This exercise helps students gain a better understanding of the patient's cultural and personal condition within an imagined specific situation. c) Project one of the slides presenting a case and ask the students to identify in pairs, with the person sitting next to them, at least 3 elements from the text that indicate the patient's emotional or cultural state. This exercise helps students learn how to read the emotions and condition of future patients. Slide 16 a) Ask the students to turn to the person next to them and share a small event from their day, something that happened to them (e.g., "I saw a chocolate bar in the store that I used to eat a lot as a child, and I haven't seen it since"). The partner listening to the story should respond to the narrative with a single sentence that identifies the storyteller's feelings or initiates a discussion about it (e.g., "I suppose this might have evoked strong nostalgic feelings in you" or "I imagine this brought up a lot of emotions"). After the exchange, provide feedback: How did it feel to have the other person respond to your story on an emotional level? What was done well in the expression of feelings, and what could be done differently? This exercise provides concrete assistance in understanding and acknowledging another person's feelings. b) Replay one of the slides presenting cases and work together with the students to formulate sentences towards the patients that acknowledge and make explicit the difficulty of their situation. For example: "It might be challenging, Jennifer, to both lose weight and quit smoking, as it's a lot of change at once for your case." or: “It can be very disheartening that it didn't work on the third attempt, especially when you feel like you've invested so much money, time, and emotion into the process. Others feel the same way at this stage, and that's natural.” This exercise encourages students to develop empathetic communication. Slides 29-32 Slides 33-34 The process of ART was visible in the previous slides. Ask the students to work in pairs, with one of them taking on the role of an uninformed patient while the other explains the ART process to the "patient." The patient should react as expected from their role (showing confusion, asking questions, or nodding, for instance). After the exercise, the "patient" should provide feedback on how much they understood from their partner's explanation.The exercise highlights the challenges of clear communication. Ask the students to imagine themselves in the role of the male doctor in the first case described, who is not allowed to examine the woman for cultural reasons (her husband doesn't allow anyone else to see her and she also feels uncomfortable being treated by a male doctor). Have the students discuss the possible emotions the doctor might experience. Emphasize that these feelings are normal and common. Then, collectively formulate rational arguments that could help the doctor cope with these negative emotions. The exercise aims to confront the fact that doctors' feelings need to be acknowledged, and cultural barriers may not always be overcome. Slides 35-36 Ask student to think of a sci-fi film or novel in which people were created with predetermined traits (e.g. Huxley: Brave New World). Share it and consider the problems it posed in that situation! Additionally, explore their thoughts in the direction of biological questions. (These stories depict the ethical and societal consequences of human manipulation and raise the question of where the boundaries of human genetic manipulation lie. One important biological question may concern the long-term consequences of genetic manipulation on the human genome and how this can be safely achieved. Ethical questions include who can make such decisions and what principles should guide actions in the field of human genetic manipulation.) Ask students to collect provocative statements about ART. For example: "It is natural and acceptable that the accessibility of ART procedures may vary depending on ethnic and social backgrounds," or "It is acceptable to have a phase of embryo disposal in case of more fertilized eggs than necessary." Collect individually, in pairs, or as a group 3 pros and 3 cons for each statement. Slide 30 The treatment options of infertility developed rapidly in the last three centuries and they continue to advance rapidly. For this reason continuing education is key to understanding medical processes and their psychosocial impact. Be aware that the topic of infertility should always be put in personal, cultural and socioeconomic context as treatment options might be limited in a personal, cultural/social level. Accessibility/ regulations of ART also differ in the different countries. Infertility and ART are bio-psycho-social problems. Ideally, patient- doctor communication should proceed accordingly. Be aware of the unsettled ethical issues of ART and follow the rapid changes of techniques, regulations and outcome chances in this field Recommended literature: Zegers-Hochschild F, Dickens BM, Dughman-Manzur S. Human rights to in vitro fertilization. Int J Gynaecol Obstet. 2013 Oct;123(1):86-9. doi: 10.1016/j.ijgo.2013.07.001. Epub 2013 Aug 6. PMID: 23932062. Pandruvada, S., Royfman, R., Shah, T.A. et al. Lack of trusted diagnostic tools for undetermined male infertility. J Assist Reprod Genet 38, 265–276 (2021). Gelbaya, T. A., Potdar, N., Jeve, Y. B., & Nardo, L. G. (2014). Definition and Epidemiology of Unexplained Infertility. Obstetrical & Gynecological Survey, 69(2), 109–115. Kol, S. (2014). Assisted Reproductive Technology (ART). Reference Module in Biomedical Zegers-Hochschild, F., Adamson, G. D., de Mouzon, J., Ishihara, O., Mansour, R., … Nygren, K. (2009). The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009. Human Reproduction, 24(11), 2683–2687. Kamel RM. Assisted reproductive technology after the birth of Louise Brown. J Reprod Infertil. 2013 Jul;14(3):96-109. Adamson GD, Zegers-Hochschild F, Dyer S, Chambers G, de Mouzon J, Ishihara O, Kupka M, Banker M, Jwa SC, Elgindy E, Baker V. International Committee for Monitoring Assisted Reproductive Technology: World Report on Assisted Reproductive Technology, 2018 Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356. doi: 10.1371/journal.pmed.1001356. Epub 2012 Dec 18. PMID: 23271957; PMCID: PMC3525527. Mazur DJ, Lipshultz LI. Infertility in the Aging Male. Curr Urol Rep. 2018 May 17;19(7):54. doi: 10.1007/s11934-018-0802-3. PMID: 29774447.
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Teachers Guide
5. The issue of infertility in Reproductive Medicine: A Medical and (Inter)Cultural Perspective
(Advanced auf Basic umändern)
Outline the logic of your presentation so that the students can follow where you are in your train of thought! Repeatedly refer back to this logical sequence in your presentation. The slide titled 'Debated topics' illustrates the overall structure of the entire presentation, while the 'Introduction' slide articulates the differences between the medical and patient perspectives using a first-person narrative. It also draws attention to the role of the medical professional in bridging this gap. The entire structure of the presentation points in this direction: to make it explicit that communication is a fundamental part of the medical role.
The first topic is infertility. The discussion of the medical perspective on this subject occurs in two steps, first by providing definitions and then by elaborating on the causes of the phenomenon.
Understanding infertility from the patient's perspective can also be facilitated through various empathy-building exercises. Here are some ideas for student engagement:
The doctor's responsibilities include bridging the two perspectives. The slide presents the first steps of this. Here are some processing ideas we recommend below.
On the slides, to help understand the difficulties of assisted reproductive technology (ART) from the patient's perspective, we used a single, thought-provoking fact. We draw attention to the fact that a significant percentage of women experience a clinically relevant form of depression during the ART process. As a presenter, it's important to emphasize that addressing this condition is not a medical (gynecological) task; it's a interdisciplinary and societal issue, and doctors also have a responsibility to raise awareness of this problem.
The slide presents the steps of doctors' communication after building trust by acknowledging the patient's emotional and cultural state. At this stage, the doctor's responsibilities include presenting the situation in an understandable way before making a collaborative decision. The following exercises can help practice solving communication challenges.
To understand the cultural issues of ART, we have proposed some ethical and legal questions for thought-provoking. Before showing the slides, you can ask students to elaborate on some questions on their own with the help of the following exercises:
Take home messages:
Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the Foundation for the Development of the Education System. Neither the European Union nor entity providing the grant can be held responsible for them.