University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 2nd Fl, Philadelphia, PA, 19104, USA.
School of Public Health, University of Montreal, Montreal, Canada.
Curr Psychiatry Rep. 2018 Aug 9;20(9):70. doi: 10.1007/s11920-018-0944-5.
This review aims to provide guidance to clinicians facing requests for assisted reproduction from women with mental illness.
The paper explores the clinical and safety aspects of initiating fertility treatment in this context, including the use of psychotropic medication and the risk of untreated psychiatric mood or psychotic disorders. It also presents the ethical considerations involved in candidate selection, including treating similar cases equitably to avoid biased decisions based solely on "gut-feelings," respect for women's reproductive autonomy, and an effort to protect patients and prospective fetuses/children from harm by employing optimal strategies regarding medication and psychosocial support. Clinicians ought to be informed regarding recent evidence related to the safety and efficacy of psychopharmacologic treatment of women during pregnancy and the post-partum. They should also carry out a thoughtful ethical analysis to ensure minimal violation of women's reproductive autonomy.
本文旨在为面临精神疾病女性提出的辅助生殖请求的临床医生提供指导。
本文探讨了在这种情况下启动生育治疗的临床和安全性方面，包括使用精神药物和未经治疗的精神情绪或精神病障碍的风险。它还提出了候选者选择中涉及的伦理考虑因素，包括公平对待类似病例，以避免仅仅基于“本能感觉”做出有偏见的决定，尊重女性的生殖自主权，并努力通过使用关于药物和社会心理支持的最佳策略来保护患者和潜在胎儿/儿童免受伤害。临床医生应该了解与怀孕期间和产后女性精神药物治疗的安全性和有效性相关的最新证据。他们还应该进行深思熟虑的伦理分析，以确保最小限度地侵犯女性的生殖自主权。
