6 MONDAY, SEPTEMBER *

incapacity, embryos may curently be created with their gametes. Diagnosis and therapy may generate anecdotal data of wider interest, but creation of specific embryos for diagnosis and therapy remains lawful. 2. Disposal of Surplus Gametes and Embryos. A couple leaving an assisted reproduction program may agree that remaining gametes and embryos be available for others or research, or be destroyed. Where they disagree, competing claims arise for control. Courts have to resolve the status of embryos, and whether they are property. 3. Multiple Implantation and Pregnancy. Codes of practice limit embryos created in vitro that may be placed in viva in a single cycle, but ovarian hyperstimulation for natural insemination may produce high multipregnancy. This endangers pregnancy, birth of healthy children, and maternal welfare. Advanced technologies allow selective reduction but, where accommodated by local abortion law, may nevertheless be unacceptable to practitioners or patients. 4. Gestational (Surrogate) Motherhood. When women surrender children born from their own or other’s ova, interests in genetic, gestational and sociaVpsychologica1 motherhood diverge. Pre-conception legal agreements reduce risks of confusion and clarify birth registration, but where gestational mothers receive payments and so-called “commercial” surrogacy is unlawful, lawyers may be professionally compromised in negotiating agreements.

ss1.02.04 EMERGING ISSUES IN WOMEN’S REPRODUCTIVE RIGKI-S Anika Rahman, JD, Director, International Program, Center for Reproductive Law and Policy, New York, NY 10005

In the more than five years since the 1994 International Conference on Population and Development and the 1995 Fourth World Conference on Women, there have been significant efforts to promote women’s reproductive health and rights worldwide. While most governments have yet to translate their international commitments into domestic laws and policies, there are some instances of model government action in a variety of arenas. Moreover, non-governmental organizations (NGOs) around the world have been working on a host of women’s reproductive rights matters. Sometimes, such work has occurred in the face of considerable political opposition. The question thus arises that, given the recent prominence of reproductive rights at the international level, what has occurred in this field. The presentation will provide an overall background on key issues in reproductive rights globally, some trends in law and policy, the role of women’s NGOs and some future issues to consider. Particular attention will be paid to an emerging human rights based approach to reproductive health.

ss1.03.01 SOMATIZATION DISORDERS IN OBSTETRICS AND GYNECOLOGY .I. Bitzer, University Clinic/Women’s Hospital, Basel, Switzerland

Introduction: Somatoform disorders in Obstetrics and Gynecology are frequent symptoms. There is however yet no classification system which is especially developped for these disorders. They can be grouped according to their symptomatology like obstetrical symptoms (hypereme- sis, pain disorders during pregnancy, premature contractions, some forms of hypertensive diseases, etc.), or gynecologic symptoms (chronic pelvic pain without obvious pathology, pruritus, discharge without pathology, etc.) or reproductive endocrinology (PMS, menstrual disturbances, unexplained infertility, etc.). Another approach to classification is ICD- 10 or DSM-4, where the symptoms can be grouped into major psychiatric diseases or somatoform disorders which are then subdivided into somatization disorders, hypochondriasis, somatoform pain disorders, etc. Finally, the etiologic pathogenetic approach is based on either psychody- namic models (conflict, structure-deficit models) or cognitive behavioural models (learning theory, SORC). Methods: 65 patients presenting with somatoform disorders were examined using the above described instruments. For each patient gynecologic symptoms, descriptive classification (ICD 10) and model of symptom formation were combinded looking for patterns which would help to integrate the different levels of observation to guide clinical intervention. Results: Through this analysis we found three types of somatoform disorders. Type 1: Psychosocial factors lead to cognitive and behavioural changes which result in somatic symptoms (cognitive-processing

disorders) 35% of patients. Type 2: Psychosocial factors lead to psychoendocrine and psychovegetative dysfunctions which can be measured and quantified (functional, conversion disorders) 40% of patients. Type 3: Psychosocial factors lead to basic vulnerability of the personality resulting in chronic pathological changes (psychological factors affecting medical conditions and psychosomatoses) 25% of patients. Integration of these models into everyday’s gynecological practice will be demonstrated.

ss1.03.02 PSYCHOENDOCRINOLOGICAL DISORDERS IN GYNECOLOGY Fabio Dept. of Gynecol. Obstet. Pediat Sciences, Unit of Psychobiology of Reproduction. University of Modena & Reggio Emilia, via de1 Pozzo 71,411OO Modena, Italy

Gynecological disorders are often an expression of psychological discomfort and distress impairing daily activities, worsening self-esteem, reducing social interactions, etc. Gynecologists should face clinical problems bearing in mind the above reported interactions with psychic world. This become particularly true for disorders linked to reproductive function, that is menstrual and fertility problems. However, the operative relationships between emotions and clinical problems changes in their pathway according to the specific clinical condition, as outlined in the following examples. Psychological distress, either acute or chronic, is the main reason accounting for the occurrence of secondary amenorrhea, even in the absence of psychiatric disturbances such as eating disorders or major depressive disorder. Te interaction between stress and menstrual function has found his roots in the pathological activation of the endogenous opioid system which blunted the pulsatile release of hypothalamic LH-RH, thus inducing a reversible state of hypogonadism. Often, resumption of menstrual function occur spontaneously once subjects adapted to the stress stimulus or the stimulus disappear. In some other cases, a pharmacological approach requires a concomitant psychological support. A more complex, two-way interaction has been established between psychological distress and infertility. According to social context, couple infertility could be per se a distressing condition, therefore infertility influences psychological well-being. On the opposite, psychological discomfort reduces fertility, directly acting on the production of gametes, in both partners of the couple. A third level of the vicious cycle of stress and infertility is represented by the medically proposed solutions, i.e. assisted procreation. A significant proportion of couples were further distressed by invasive technology of baby tubes, limiting the success in term of pregnancy rate. Also in such cases, the activation of neuroendocrine circuits such as hypothalamus-pituitary-adrenal axis and portal pituitary dopaminergic system account for hormonal secretions negatively affecting gametogenesis and implantation. The cyclical recurrence of severe and transiently disabling physical, psychological and behavioural symptoms in the late luteal phase of 5- 10% of women in their 30ies is a complex, still unknown phenomenon certainly due to an “hypersensitivity to ovarian cycle”. The steroid-brain interaction is the target of our efforts in order to understand such disorder since the suppression of ovarian activity is a definite therapeutic approach. At present, however, several neuroendocrine relationships have been explored without success for a comprehensive premenstrual syndrome explanation.

ss1.03.04 MANAGEMENT OF SOMATIZATION DISORDERS IN THE GYNECOLOGICAL CONSULTATION C. Mannioni & S. Mimoun, (1) University of Milan, Milan Italy, (2) HBpital Debre, Paris, France

Although much research has been conducted regarding the psycological causes of disease, there is a lack of focus on women’s viewpoints regarding their bodies as they relate to illness. This study examines the interpretation of body self-perception and body image by women who present gynaecological complaints. Medicine allows and sustains the representation of the body like an object open to scientific investigation. Medicine reinforces the idea that the body is an object we can open and manipulate at will. Lastly, it reinforces the idea that only the physical body is involved in the recovery process. Thus, a vicious circle is created, where women ask for physiologically-based reasons for illness,