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      Survey of Attitudes toward Uterus Transplantation among Japanese Women of Reproductive Age: A Cross-Sectional Study

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          Abstract

          Objective

          Uterus transplantation (UTx) is a potential option for women with uterine factor infertility to have a child, but there has been no large-scale survey of the views on UTx in women of reproductive age in Japan. The present study was aimed to clarify the views of Japanese women of reproductive age on UTx for uterine factor infertility.

          Methods

          A questionnaire on UTx was conducted by an Internet research company in December 2014 as a cross-sectional study in 3,892 randomly chosen women aged 25 to 39 years old. Responses were analyzed from 3,098 subjects (mean age 32.1±4.2 years old), after exclusion of inappropriate respondents in screening.

          Results

          Of the respondents, 62.1%, 34.7% and 18.1% favored adoption, UTx and gestational surrogacy, respectively. In contrast, 7.0%, 21.9% and 63.3% opposed adoption, UTx and gestational surrogacy, respectively. In choices of candidates for UTx based on highest priority, deceased persons (33.8%) and mothers (19.0%) were favored as donors, and women with congenital absence of the uterus (54.4%) and hysterectomy due to a malignant uterine tumor (20.0%) as recipients. Regarding societal acceptance of UTx, the answer rates were 15.7% for "UTx should be permitted", 77.6% for "UTx should be permitted with discussion", and 6.7% for "UTx should not be permitted, even with discussion". Regarding personal opinions on UTx, 44.2% were in favor, 47.5% had no opinion, and 8.3% were against.

          Conclusion

          Our results suggest that many Japanese women of reproductive age feel that UTx is socially and individually acceptable, but that concerns requiring further discussion remain among these women. There was also a tendency for UTx to be viewed more favorably than gestational surrogacy.

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          Most cited references22

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          Livebirth after uterus transplantation.

          Uterus transplantation is the first available treatment for absolute uterine infertility, which is caused by absence of the uterus or the presence of a non-functional uterus. Eleven human uterus transplantation attempts have been done worldwide but no livebirth has yet been reported.
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            First clinical uterus transplantation trial: a six-month report.

            To report the 6-month results of the first clinical uterus transplantation (UTx) trial. This type of transplantation may become a treatment of absolute uterine-factor infertility (AUFI).
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              • Article: not found

              The economic impact of assisted reproductive technology: a review of selected developed countries.

              To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries. Comparative policy and economic analysis. Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia. Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity. Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an IVF cycle after government subsidization ranged from 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity. Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                20 May 2016
                2016
                : 11
                : 5
                : e0156179
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, Keio University, School of Medicine, Tokyo, Japan
                [2 ]Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
                [3 ]Department of Nursing, Keio University Hospital, Tokyo, Japan
                VU University Medical Center, NETHERLANDS
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: IK KB ES YK MO AY EN KU DA. Performed the experiments: IK. Analyzed the data: IK. Contributed reagents/materials/analysis tools: IK ES YK MO AY EN. Wrote the paper: IK.

                Article
                PONE-D-15-49630
                10.1371/journal.pone.0156179
                4874691
                27203855
                7f912803-6c13-4eb9-ba0c-ca78dceb0d49
                © 2016 Kisu et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 13 November 2015
                : 10 May 2016
                Page count
                Figures: 6, Tables: 1, Pages: 15
                Funding
                This study was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number 26713050.
                Categories
                Research Article
                Medicine and Health Sciences
                Urology
                Infertility
                Female Infertility
                People and Places
                Population Groupings
                Age Groups
                Computer and Information Sciences
                Computer Networks
                Internet
                Biology and Life Sciences
                Anatomy
                Reproductive System
                Uterus
                Medicine and Health Sciences
                Anatomy
                Reproductive System
                Uterus
                People and Places
                Geographical Locations
                Asia
                Japan
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Assisted Reproductive Technology
                Research and Analysis Methods
                Research Design
                Survey Research
                Questionnaires
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Reproductive System Procedures
                Hysterectomy
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Surgical Excision
                Hysterectomy
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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                Uncategorized

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