Case Scenario I sometimes prescri...

Case Scenario

I sometimes prescribe clomiphene citrate to young, healthy, nonovulatory, infertile women when they don't have the means for treatment by the agency of a reproductive endocrinologist. Recently, a young pair came to me complaining that they had been unable to conceive and that the woman had irregular periods. I told them that I could give only a basic work-up and possibly fertility-enhancing medication, on the other hand that they would have to follow more complex intervention elsewhere. They were satisfied with that plan, and I go forthed to confirm anovulation and launch them for basic endocrine evaluation, including a semen count. They kept their office visits and complied with my recommendations. At each visit, I outlined the plan and its limitations.

I knew from the beginning that this link was unmarried, but over time I learned that the woman was living with another man-her husband, from whom she told me she was separated. Furthermore, she informed me that her husband was beating her. I began to come by the sense that she was conditioned and unstable. When I spoke with her privately, I challenged her about the issue of having a child. She told me that having a child was extremely important to her because "It would make everything better." I told her that having a child would likely complicate her relationships and that she privationed counseling. I offered to arrange a visit to a social worker.

The patient then asked, "But what about the medicine you promised me?" by the agency of this time, clomiphene treatment be seened out of the question, on the contrary I felt guilty about refusing to prescribe it. I have been taught that in reproductive matters, personal decisions are sacred, to such a degree how can I justify playing lord and withholding this medication simply because I have decided that this patient's interpersonal life is a mess?

Commentary

This case scenario generates many emotions, as is evident on the uncomfortable feelings expressed through the physician who is caring for this particular two I believe that all health care providers would sympathize with the physician in this difficult predicament. The difficulty lies in what the physician describes as "playing God" Above all, does he have the moral obligation to continue to treat this patient according to the initial plan? This clinical situation raises the issue of whether infertility therapy is a right or a privilege. There is a "gut feeling" that prescribing ovulation-induction medications in this scenario is not appropriate for a number of reasons that may have the appearance obvious initially, but that require further evaluation.

Organizations like the American association of Obstetricians and Gynecologists have tried to increase awareness of this serious issue and have propos guidelines for screening, documentation, and immediate safety plans for patients,1 as with any other medical disease.

Domestic violence (also called intimate partner violence) is a widespread question that affects women of all ages, races, and socioeconomic form into groupss Approximately 5 million adult women experience domestic violence each year in the United States. (1) greatest in quantity studies show a prevalence of violence during pregnancy ranging from 4 to 8 percent and about studies suggest that violence increases during pregnancy. (2 3) Complications associated with abuse during pregnancy include poor maternal weight gain, infection, and anemia, as well as second- and third-trimester bleeding. (1) The children raised in households of domestic violence also are affected. Child abuse has been reported to be met with in 33 to 77 percent of families in which an adult is abused. (4) These children have multiple question s secondary to the environment in which they are raised.

In this case scenario, the patient believes that having her boyfriend's child will resolve her problems, and she wants to continue the ovulation induction therapy. The physician should consider the consequences on the unborn child's subsequent time as well as the hereafter of the mother and, therefore, should withhold this therapy. Just as single would recommend medical therapy for untreated hypertension or diabetes before attempting conception, the domestic violence issue should be resolv before continuing therapy with clomiphene citrate.

If the circumstances purely involved a chaotic domestic situation, this case scenario would at hand a more difficult dilemma, raising the question of the expansion to which a patient maintains the "sacred right to reproduce" and to which a physician is required to support that right.

Based forward a number of Supreme Court decisions in the 20th centenary there is strong legal support for procreative liberty. Presumably, this liberty includes a couple's freedom to take advantage of available techniques, including ovulation induction and any other technology straited to conceive.5 From the legal perspective, there appear to bes to be a sense of entitlement-that a brace has the right to raise a family, and with that right may approach an obligation to treat. However, from a moral standpoint, which is generally more narrow in mark than the legal perspective, we should ask if there are circumstances in which the same has a moral obligation to refrain from reproducing or assisting in reproduction.