title: Assisted reproduction: what factors interfere in the professional's decisions? Are single women an issue?
abstract: BACKGROUND
  With the development of medical technology, many countries around the world have been implementing ethical guidelines and laws regarding Medically Assisted Reproduction (MAR). A physician's reproductive decisions are not solely based on technical criteria but are also influenced by society values. Therefore, the aim of this study was to analyze the factors prioritized by MAR professionals when deciding on whether to accept to perform assisted reproduction and to show any existing cultural differences.
  
  
  METHODS
  Cross-sectional study involving 224 healthcare professionals working with assisted reproduction in Brazil, Italy, Germany and Greece. Instrument used for data collection: a questionnaire, followed by the description of four special MAR cases (a single woman, a lesbian couple, an HIV discordant couple and gender selection) which included case-specific questions regarding the professionals' decision on whether to perform the requested procedure as well as the following factors: socio-demographic variables, moral and legal values as well as the technical aspects which influence decision-making.
  
  
  RESULTS
  Only the case involving a single woman who wishes to have a child (without the intention of having a partner in the future) demonstrated significant differences. Therefore, the study was driven towards the results of this case specifically. The analyses we performed demonstrated that professionals holding a Master's Degree, those younger in age, female professionals, those having worked for less time in reproduction, those in private clinics and Brazilian health professionals all had a greater tendency to perform the procedure in that case. A multivariate analysis demonstrated that the reasons for the professional's decision to perform the procedure were the woman's right to gestate and the duty of MAR professionals to help her. The professionals who decided not to perform the procedure identified the woman's marital status and the child's right to a father as the reason to withhold treatment.
  
  
  CONCLUSIONS
  The study indicates differences among countries in the evaluation of the single woman case. It also discloses the undervaluation of bioethics committees and the need for a greater participation of healthcare professionals in debates on assisted reproduction laws.
authors.affiliation: Post-Graduate Program in Medicine, Assisted Reproduction Service, Gynecology and Obstetrics Department, Hospital de Clínicas de Porto Alegre 90035-903, Porto Alegre, Brazil. szachia@hcpa.ufrgs.br
authors.forename: Suzana
authors.initials: S
authors.lastname: Záchia
authors.forename: Daniela
authors.initials: D
authors.lastname: Knauth
authors.forename: José R
authors.initials: JR
authors.lastname: Goldim
authors.forename: Juliana R
authors.initials: JR
authors.lastname: Chachamovich
authors.forename: Eduardo
authors.initials: E
authors.lastname: Chachamovich
authors.forename: Ana H
authors.initials: AH
authors.lastname: Paz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Felberbaum
authors.forename: PierGiorgio
authors.initials: P
authors.lastname: Crosignani
authors.forename: Basil C
authors.initials: BC
authors.lastname: Tarlatzis
authors.forename: Eduardo P
authors.initials: EP
authors.lastname: Passos
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001695:Biology / Q000941:ethics; D001938:Brazil; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D003657:Decision Making / Q000941:ethics*; D005260:Female; D005858:Germany; D006115:Greece; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D018452:Homosexuality, Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000941:ethics*; D027724:Reproductive Techniques, Assisted / Q000941:ethics*; D012743:Sex Preselection; D012847:Single Person