Conselho Nacional de Desenvolvimento Científico e Tecnológico / Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Nesta tese foram analisadas iniciativas e ações individuais e coletivas de gestores e profissionais de dois Hospitais Público-Universitários de Saúde, que mantêm serviços de referência no atendimento às infertilidades, no Estado do Rio de Janeiro. É visada a implementação de tecnologias de reprodução assistida (RA) pelo SUS, no Estado. O estudo constou de entrevistas com profissionais de saúde destes serviços e especialistas na área que ali atuam, leitura de prontuários e pesquisa documental no Departamento de Serviço Social de um dos serviços, além de atualização bibliográfica no campo estudado. Os resultados obtidos de material primário e documental evidenciam a não priorização da reprodução assistida em políticas públicas de saúde no Brasil. No entanto, foi possível encontrar importantes iniciativas dos próprios profissionais de saúde para a ampliação da atenção em infertilidade e do acesso às tecnologias reprodutivas no Rio de Janeiro. Em geral, foram mobilizações individuais, que dependeram do empenho direto dos médicos responsáveis dos serviços. As motivações para estas ações incluíam aspectos acadêmicos, assistenciais, de direitos reprodutivos, além de interesses público-privados. A única mobilização interinstitucional, organizada inicialmente pelo Serviço Social, não conseguiu garantir o acesso à assistência integral em reprodução assistida no Rio de Janeiro. No caso da reprodução assistida, há uma forte desigualdade de base socioeconômica, já que mulheres e casais pobres são excluídos, ou quase, do acesso à IIU, Fiv e ICSI, pois não têm condições econômicas para tentar um tratamento particular, onde se encontram concentradas mais de 90% da assistência no país. Este segmento populacional não encontra recursos, nem tecnológicos, nem humanos, nos serviços públicos de saúde. Este quadro aumenta sua vulnerabilidade e reduz sua autonomia reprodutiva pela falta de acesso. / This thesis analyses initiatives and actions undertaken by managers and health professionals working in two public university hospitals that offer model health services to tackle the problem of infertility in the state of Rio de Janeiro. The aim of the study is to infer the implementation of Assisted Reproductive Technologies (ART) by the Brazilian Universal Health System (SUS) in these two different Units. The study was based on interviews with medical specialists and other health professionals; archived patient data and documental service papers, besides an update of the concerned scientific literature (critical reading). The results from our primary data (interviews) as well as patients data show non-prioritizing policies and implementation of high complexity techniques at SUS. Nevertheless, we could find relevant initiatives emerging from actions by the health staff themselves, in order to try to guarantee access to ART techniques to women and couples living in the state of Rio de Janeiro. Most of them consisted of individual mobilization, depending on direct efforts undertaken by the heads of the medical facilities in the hospital. The motivations for these actions ranged from academic interests to the aim of improving availability of treatment, the concern with reproductive rights, and what we called in this text public-private interests. We found the organization of a network initiative by health social works, but it did not achieve the integral access to treatment in the area of assisted reproduction (ART), in Rio de Janeiro. In the case of ART, there is a huge socioeconomic inequality that almost completely excludes poor women and couples from the access to IIU, Fiv and Icsi, since these techniques are present in 90% of cases in private clinics and private health sector not integrated to the SUS. So, this population that cannot count on economic resources is also excluded from technologic and human resources for ART. This lack of access aggravates their vulnerability also reducing their reproductive autonomy in decisions making.

Infertility is the inability to achieve a pregnancy. WHO classify infertility into two groups. Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after at least 1 year of unprotected intercourse. Secondary infertility describes couples who have previously been pregnant at least once, but have not been able to achieve another pregnancy. Causes of infertility include a wide range of physical as well as emotional factors. Approximately 30 - 40% of all infertility is due to a "male" factor such as retrograde ejaculation, impotence hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count. A "female" factor -- scarring from sexually transmitted disease or endometriosis, ovulation dysfunction, poor nutrition, hormone imbalance, ovarian cysts, pelvic infection, tumor or transport system abnormality from the cervix through the fallopian tubes -- is responsible for 40 - 50% of infertility in couples. The remaining 10 -30% of infertility cases may be caused by contributing factors from both partners, or no cause can be identified. This dissertation has two main goals. The first goal is to describe how a couple face up to their problems with infertility. The second goal is that this dissertation can be used as a study material for social and medical employees. This dessertation is based on a qualitative research. I used a method CAMI {--} communication through the use of computer. The observational goup were people disccusing at www.neplodnost.cz.

Apesar da acumulada experiência e tecnologia da reprodução assistida, ainda é comum a ocorrência de má resposta (MR) à estimulação ovariana (EOC). Alguns dos mecanismos que prejudicam a resposta ovariana são conhecidos, como a obesidade e a redução de reserva funcional ovariana com o avançar da idade. No entanto, também se observa má resposta à estimulação ovariana controlada em pacientes jovens e sem comprometimento dessa reserva ovariana. Apesar do desenvolvimento de marcadores para predizer a má resposta, como o hormônio folículo estimulante (FSH), o hormônio antimulleriano (AMH) ou a contagem de folículos antrais (CFA), ainda não há disponibilidade de mecanismos amplamente confiáveis para este fim. Há controvérsias quanto a qual destes preditores apresenta maior acurácia. Esta incerteza é ainda maior quando se analisa a população infértil de aparente bom prognóstico, ou seja, jovens, não obesas e com boa reserva ovariana. Predizer a má resposta neste grupo permitiria importante incremento na qualidade do tratamento destas pacientes. O objetivo deste estudo foi avaliar a acurácia dos marcadores de resposta ovariana como idade, FSH, AMH e CFA e comparar a acurácia destes entre si e combinados em uma fórmula para predizer má resposta à estimulação ovariana controlada em pacientes de bom prognóstico. Foram avaliadas 141 mulheres com idade <40 anos, FSH <10 mUI/ml e índice de massa corpórea (IMC) <30 Kg/m2,, consecutivamente submetidas à injeção intracitoplasmática de espermatozoides (ICSI), a partir de espermatozoides obtidos através de ejaculado. Destas, 45 (32%) obtiveram <3 oócitos e, portanto, tiveram má resposta ovariana. Avaliou-se a acurácia dos marcadores citados em predizer a má resposta através da área sob a curva ROC (AUC). A fórmula obteve AUC = 0.82, valor significativamente superior aos marcadores isolados (idade=0.67, CFA=0.74, AMH=0.75 e FSH=0,61). Também foram definidos os valores de corte para se obter a taxa de detecção de 50% e 80% e analisadas as taxas de verossimilhança dos marcadores. Concluiu-se que a fórmula é mais acurada em predizer má resposta ovariana à EOC do que qualquer dos marcadores isoladamente. / Age, antral follicle count (AFC), antimullerian hormone (AMH) and follicle stimulating hormone (FSH) are frequently used for the prediction of the ovarian response to controlled ovarian stimulation (COS). The objective of this study is to assess the accuracy of a formula combining all these parameters in predicting poor ovarian response (POR) to COS in good prognosis women. We included all good prognosis women submitted to COS for intracitoplasmatic sperm injection (ICSI) between n Feb-2008 and Jan-2009 who accepted to participate. We defined good prognosis as: age <40 years, basal FSH <10 mIU/ml, and body mass index (BMI) <30 Kg/m2; in which the ICSI was performed with sperm obtained by ejaculation. POR was defined as 3 oocytes retrieved or cycle cancelation before oocyte retrieval due to a poor ovarian response. We performed a linear regression to determine a formula to predict POR using age and the logarithm regression of AFC, AMH and FSH. We assessed the predictive accuracy by the area under ROC curve (AUC). Additionally, we determined the cut-off values and false positive rate (FPR) for predicting POR with a detection rate of 50% and 80%. We evaluated 141 women who were submitted to COS and oocyte retrieval; 45 (32%) had POR. The formula to predict poor ovarian response was 0.024 + 0.017*Age - 0.403*LogAFC - 0.339*LogAMH + 0.204*LogFSH. The AUC observed for the formula (0.82) was significantly higher than for the isolated markers (age = 0.67, AFC = 0.74, AMH = 0.75, FSH = 0.61). We also determined the cut-off values and false positive rates for obtaining detection rates of 50% and 80%. We conclude that the formula combining age, FSH, AMH, and AFC is more accurate in predicting POR than individual markers.

Nowadays, anonymous sperm donation is indeed a globally discussed topic: the popularity of the use of assisted reproduction technology for the purpose of conception is directly proportional to increasing infertility and technological progress. Also, the duration of its use already started to show, with the first generation of opinionated anonymous donor children growing up. The aim of my work is to analyze what are the today's Western society's current ethical and legal views on the anonymous sperm donation and its alternatives, as well as what they should be, and to demonstrate these on the example of Canada, United Kingdom and Australia. In the first two chapters, I outline the context of ethical and legal thinking about anonymous sperm donation: I analyze the concept and implications of the infertility, as well as the development and types of methods of assisted reproduction. Further, I proceed from the basis of ethical reasoning and the determination whether the right to know one's origins, implying the right to know the circumstances of one's conception, exist, and its competition with the rights of parents and donors in the third chapter, to its legal grounds. First, in the fourth chapter, I deal with legislation on the right to know one's origins and other related rights in the international...

Gamete donors are actively searched by companies dedicated to assisted reproduction in the Spanish State, and advertising is not only legal but rather common. This thesis provides an overview of the main themes that arise from the analysis of mostly visual materials used to promote ovum donation in public spaces in Barcelona, and critically links them to current debates in intersectional feminist cultural studies of technoscience, bodily theory and visual studies. Conceptual and affective tensions between characterisations of women’s bodies, reproductive function and desires are identified and brought forward in terms that imply tropes of sacralisation, reification of cells/organs/tissues, and fragmentation of the bodily reality. It is argued that egg donation advertisements use an imagery that deeply connects with practices well rooted in Western biomedical traditions when it comes to female bodies, physiology and reproductive function, and that such practices are to be understood against the backdrop of neoliberalism. The analysis supports the idea that the publicity discourse of the assisted reproduction industry in Spain actively engages in a legitimation of the desire of biological parenthood as a right, in ways that value lives conceived in different circumstances and geopolitical contexts in radically different ways, and that can be interpreted as paving the way to prosurrogacy and/or eugenic positions. Future research is encouraged and directed towards exploring issues of agency, particularly in vulnerable groups such as migrant, poor, uneducated or racialised women. Further research is needed in order to build the foundations of a feminist ethical reflection on reproductive technologies and particularly of ovum donation.

Magister Legum - LLM / In this research, I carefully and coherently examine Chapter 19 of the Children's Act 38 of 2005 as the first legislation to afford surrogate motherhood agreements legal recognition in South Africa. I argue that the application of Chapter 19 imposes a number of unwarranted limitations on several of the constitutional rights of the parties to a surrogacy agreement. In addition, I propose that Chapter 19 is not in accordance with the principal of the best interests of the child. I examine the history of surrogate motherhood in South Africa and establish that, prior to the enactment of Chapter 19, no legislation expressly afforded surrogate motherhood agreements legal recognition. Hence, prior to the enactment of Chapter 19, parties who entered surrogacy agreements could, first, not rely on the agreement to enforce contractual obligations, and secondly, the legal positions of the parties to the agreement were uncertain. Thirdly, a child born of a surrogacy agreement was seen as the child of the surrogate mother and not of the commissioning parents. / South Africa

Les nouvelles pratiques d’aide médicale à la procréation, notamment celle qu’on appelle « le don d’ovocyte » bouleverse le sens de la parentalité. Elle oblige chacun d’entre nous à expliciter ses conceptions de la vie, à énoncer ses priorités, mais elle oblige aussi la collectivité à prendre conscience d’elle-même et de ce qui peut être acceptable. Est-il moralement satisfaisant qu’une femme donne ses ovocytes pour qu’une autre ait un enfant ?En interrogeant 50 donneuses d’ovocytes, ce travail a cherché à mieux comprendre la signification d’un tel geste.La procréation par don, défie nos habitudes et nos manières de penser. Elle nous réinterroge sur notre capacité de fraternité comme réponse d’un appel de l’un pour l’autre, elle cherche à donner une juste place à ce tiers-donneur qui s’insinue (presque malgré lui) dans un arbre généalogique. Elle bouleverse notre rapport à l’enfant qui se pose comme « un ayant droit à connaître ses origines ». En définitive, ce n’est pas tant la question de l’anonymat du don qui nous importe que ce qu’il en est de l’homme, de son altérité et de ses responsabilités / Reproductive technology, in particular oocyte or egg donation, upsets the meaning of parenthood and raises questions about the circumstances surrounding those who decide to have a child by means of this technology. A woman using egg donation must come to grips with questions such as the meaning of life, and what it means to be a mother. But it also requires that society become aware of what is morally acceptable. Is it morally acceptable for the egg donor to give her eggs to anotherwoman who wants to have a child? We would like to gloss over these issues by the power of love or by the growth of the uterus, but these issues will remain in the minds of everyone and will circulate in the subconscious. The purpose of this essay is to grapple with these issues. Reproduction by gift, it challenges our habits and ways of thinking. It causes us to re-examine the companionship among two people, it creates a role for the egg donor who, almost despite herself, inserts herself into the family tree. It disrupts the relationship being the parents and the child who demands the right to know where they came from. Ultimately, the focus rests not on the anonymity of the egg donor but on the father, his otherness and his responsibility.

Syftet med den aktuella kvalitativa studien var att belysa frivilligt ensamstående föräldrars (FEF) upplevelser för att bidra till ökad förståelse och kunskap om hur det är att överväga, bli och vara FEF. Sju semistrukturerade intervjuer genomfördes och analyserades genom tematisk analys, vilket resulterade i fem huvudteman: Så upplevs FEF-skapet, Ta steget att bli FEF, Stöd från ett nätverk är viktigt som FEF, Hur FEF blir bemötta av sin omgivning och Tankar om framtiden. Mödrarna upplevde FEF-skapet som övervägande positivt och enklare än förväntat. Både för- och nackdelar nämndes och stöd från ett nätverk beskrevs vara extra viktigt. Mödrarna var medvetna om att de bryter mot kärnfamiljsnormen. Från omgivningen hade de mestadels mött positiva reaktioner men även en del negativa reaktioner och fördomar, främst rörande avsaknaden av en pappa. Mödrarna uppgav olika skäl till att bli FEF och beslutsprocessen rapporterades övervägande som enkel. Samtidigt uttrycktes viss ambivalens då FEF inte var deras förstahandsval, men ansågs mest optimalt utifrån deras förutsättningar. / The aim of this qualitative study was to make visible the experiences of single mothers by choice (SMC) with the purpose of contributing to increased understanding and knowledge of what it is like to consider, become and be a SMC. Seven semi-structured interviews were conducted and analyzed through thematic analysis, resulting in five main themes: The experience of motherhood as SMC, Making the choice to become SMC, Support from a network is important as SMC, How SMC is met by their surroundings and Thoughts on the future. The mothers perceived motherhood as SMC as mostly positive and easier than expected. Both advantages and disadvantages were mentioned and support from a network was described as especially important. The mothers were aware that they are violating the nuclear family norm. From their surroundings, they had mostly encountered positive reactions but also some negative reactions and prejudices, mainly concerning the absence of a father. The mothers stated different reasons for becoming SMC and the decision-making process was predominantly reported as simple. At the same time, some ambivalence was expressed as motherhood as SMC was not their first hand choice, but was considered the best choice based on their situation.

Human infertility is not a new phenomenon, but it is as old as humanity itself. Currently in most developed countries, the number of couples who have a problem with childbearing is growing. This is due, among other things, to the lifestyle associated with career development and postponement of parenthood. While in the past infertile couples usually had only two options to deal with their sterility - childlessness and a substitute life program, or adopting a child. Today, infertile couples have a third option and this is the treatment of infertility using assisted reproduction methods. This year, exactly forty years have elapsed since the birth of the first child by means of extracorporeal fertilization. Already then the assisted reproduction was considered a method that is ethically problematic. Numerous specialists, such as physicians, biologists, lawyers, philosophers, theologians, and others, have been involved in the quest for ethical issues. Not only there has been no solution to some problems during the whole lifetime of assisted reproduction on which most experts and the general public would agree, but with the gradual development of this treatment method new problems have arisen. Today's stage of development of artificial insemination techniques and procedures together with modern...

This master's thesis focuses on the retrospective biographical interviews with three now fertile women who as narrators retrospectively create their identities during the experience with the diagnosis and treatment of infertility. I also explored how the medical and social institution could lead to a change of identity of female infertility. This master's thesis is based on theory of Erving Goffman about patients in total institution: this theory supports the idea that total (medical) institution destroys the patient's original identity and then constructs new identity. The major result of this master's thesis found four different changes in woman's identity during the experience of infertility: identity of implicitly fertile woman and potential mother, denial of identity and the process of accepting a new identity, identity of infertile woman and patient's identity, and mother's identity. The changes of woman's identity are based on diagnostic phase. Therefore I decided to separate them into four various period in this research: pre-diagnostic, diagnostic, post-diagnostic and contra-diagnostic. I also found a difference between Goffman's theory and my results: Based on my research I concluded that the construction of identity of infertile women in the diagnostics and treatment of infertility is...