1. the Americans
1.1. Dalia and Galal
1.1.1. immigrated to the U.S. in 1992
1.1.2. first cousins
1.1.3. Galal knew he was infertile when they got married
1.2. IVF in the U.S.
1.2.1. Paid $16,300 for one trial
1.2.2. Detail 2
1.2.3. Wanted there extra embryos destroyed not frozen
1.2.4. Used as Muslim physician for treatment
1.2.5. the treatment failed
1.3. IVF in Egypt
1.3.1. paid $2940.00 for one trial
1.3.2. the couple conceived two children through IVF
1.3.3. felt their doctor was a good Muslim and a good doctor
2. reproductive medicine and religious morality
2.1. religion dictates how IVF clinics are ran
2.1.1. reduces the numbers of technologies available
2.1.2. reduces the number of couples that will use the technology for fear of moral ramifications
2.2. Abortion
2.2.1. is illegal by non religious law
2.2.2. widely practiced by Muslim women and physicians
2.3. the importance of religion in IVF
2.3.1. reflection of IVF emergence in the 1980's
2.3.2. the 80's and 90's was a period of heightened religiosity
2.4. American religious communities
2.4.1. reproductive technologies disrupt the connection between unitive conjugal intimacy
2.4.2. reproductive technologies often introduce a third party
2.4.3. often result in a morally illicit confusion of lineage because children do not know their biological parents
2.4.4. failure to implant fertilized eggs is viewed as abortion
2.4.5. involves a dehumanization of the reproductive process
2.4.6. involves commercialization and exploitation
3. Fatwas and "Official" Islam basic guidelines
3.1. artificial insemination with the husband's semen is allowed
3.2. no 3rd party is allowed in the DNA material or carrying of the fetus
3.3. IVF can be done if the egg and sperm are from the husband and wife if the fertilized egg is transplanted to the wife
3.4. adoption is not allowed
3.5. the physician is the only qualified person to practice medically assisted contraception
3.6. sperm banks are prohibited
3.7. if a marriage comes to and end through death or divorce the wife cannot use frozen eggs
3.8. excess number of fertilized eggs can be frozen
3.9. selective abortion is allowed if the prospect of carrying the pregnancy to viability or life of the mother is in jeopardy
3.10. all forms of surrogacy are forbidden
4. Unofficial Discourses of Islam and IVF
4.1. elite couples were just as concerned; if not more about their religion than the poor women
4.2. couples that have made it to an IVF center are convinced it is G-d's will by undergoing fertility treatments
5. Discourse of Donation
5.1. religion dictates that third party donation is haram "against religion"
5.2. third party donation
5.2.1. considered a form of adultery
5.2.2. potential for incest among offspring from unknown donors
5.2.3. confused issues of kinship, descent, and inheritance
5.2.4. does not ensure continuity or purity of lneage
5.3. adoption
5.3.1. entertained less by the elite than the poor
5.3.2. can only foster children, not a true adoption
5.3.3. cannot change the child's birth certificate
5.3.4. adoption is seen as a third party donation
6. Contemplating Immoralities
6.1. many in Egypt feel the west has lost its moral compass in the pursuit of reproductive practices
6.2. fear of Western donation practices
6.3. Muslim doctors take great care in details and video proof that the DNA material used is from the couple
7. The movie star doctor
7.1. Dr. Mohamed Yehia
7.1.1. director of the ivf-et unit at Nozha International hospital
7.1.2. son of affluent, educated parents
7.1.3. was a movie star before becoming a doctor
7.1.4. co-owner of the ivf-et unit at Nozha International Hospital
7.2. Dr. Abdel-Hamid Wafik
7.2.1. distinguished pathology professor
7.2.2. runs the lab and keeps the books for the ivf-et unit
7.2.3. co-owner of the ivf-et unit at Nozha International Hospita
7.3. the ivf unit
7.3.1. only employs one female assistant to field patient questions
7.3.2. the busiest in Egypt
7.3.3. 35% success rate per trial
8. Private providers and the NRT "epidemic"
8.1. there are 40 ivf centers in Egypt; more than any other Middle eastern country
8.2. number of the clinics offer low quality service
8.3. lack of formal mechanism for regulating assisted reproduction
8.4. four major problems of unfettered reliance on private health sectors in the third world country
8.4.1. adverse forms of completion
8.4.2. lack of forms of competion
8.4.3. private medical services are distributed in favor to the elites
8.4.4. under-privileging of private sector activity at the expense of the public health sector
9. Private IVF providers of Egypt
9.1. Egyptian IVF-ET center located in Maadi
9.1.1. oldest and best known
9.1.2. opened on March 21st 1986
9.1.3. Drs. Gamal I. Serour, Mohammed Aboulghar and Ragaa Mansour
9.2. Nile Badrawi Hospital Center for Medically Assisted Conception
9.2.1. opened in the 1990s
9.2.2. Drs. Salah Zaki, and Ashraf Hakam
9.2.3. special relationship with a foreign consultant Dr. Hosam Abdulla who practices in England
10. Quality of care: patients' perspectives
10.1. the doctors are very busy
10.2. Egyptian biomedicine is characterized by "medical paternalism"
10.3. treat the elite patients better than the poor
10.4. make negative trust calculations based on three factors
10.4.1. perceived greed of the physician
10.4.2. perceived dishonesty
10.4.3. perceived lack of religiosity
10.5. non-specialized OB/Gyns hold onto infertile patients too long
10.5.1. patients are caught in the middle of the competition between non-specialized and specialized providers
10.5.2. non specialized providers gave patients years of diagnostic procedures and failed treatment
10.5.3. non specialized providers gave surgery that only made the situation worse
10.6. patients had four sets of complaints about the IVF doctors
10.6.1. dishonest inflation of success rates
10.6.2. crass demands for money
10.6.3. authoritarian styles of patient care
10.6.4. insensitive and cruel demeanor when giving poor prognosis
11. Quality of care: physicians' perspectives
11.1. listed 6 major industry-wide problems
11.1.1. clinic maldistribution
11.1.2. dependency upon western experts and materials
11.1.3. costs and shortages of equipment and supplies
11.1.4. problems of local infrastructure
11.1.5. local shortages of qualified staff
11.1.6. lack of a nationwide regulatory system
11.2. Egyptian biomedicine was heavily influenced by the British colonial medical system
11.2.1. direct incursion of the West into the local IVF scene has been a blessing and curse
11.2.2. outside help places the Egyptian staff as "second class"
11.2.3. few European consultants reside permanently in Egypt
11.2.4. must purchase costly equipment and supplies from Western manufacturers