Vouloir un enfant et de pas parvenir à en concevoir peut constituer pour le couple qui consulte en centre de procréation médicalement assistée (PMA) une véritable épreuve assimilable à une crise de vie voire même à un deuil, celui notamment de la fertilité naturelle. Selon que l'on soit une femme ou un homme, le vécu peut différer. La prise en charge en centre de PMA peut s'accompagner de sentiments ambivalents. Le couple peut débuter les tentatives avec beaucoup d'espoir puis, lorsqu'ils ne sont pas satisfaits, passer par des phases plus négatives. Des tensions peuvent apparaître dans la relation de couple, affectant la communication et le vécu individuel. Certaines études se sont intéressées au vécu de ceux qui consultaient en centre de PMA mais rares sont finalement celles qui, en France, ont sondé leur projet d'enfant de façon précise par le biais de questionnaires. Il en est de même pour leur vécu corporel qui semble souvent délaissé malgré l'impact que peuvent représenter l'infertilité et les traitements associés sur l'identité et l'image du corps, notamment, sur la satisfaction corporelle. Ce travail a donc eu pour objectif d'étudier de façon exploratoire le projet d'enfant ainsi que le vécu corporel des couples consultant en centre de PMA au moyen d'outils complets et récemment soumis à validation. Les individus (N=102, moyenne d'âge=36 ans) ont été rencontrés dans trois centres de PMA (Hôpital Jean Verdier de Bondy, Hôpital Bèclère de Clamart et Hôpital Pellegrin de Bordeaux) et invités à remplir les questionnaires qui leur ont été fournis. Certains couples ont aussi été observés et écoutés lors de leur entretien avec le psychologue de la structure afin de compléter les résultats issus des questionnaires. Ces résultats ont été comparés avec ceux du groupe témoin. Les résultats de cette étude suggèrent qu'il existe des différences de vécu en fonction du genre mais aussi entre le groupe clinique et le groupe contrôle. On note, par exemple, que les individus consultant en centre de PMA sont plus satisfaits de leur apparence corporelle que la population témoin, ce qui va à l'encontre des résultats attendus. Cette étude exploratoire a soulevé de nombreuses questions et montre l'intérêt qu'il y a à s'intéresser au vécu corporel et au projet d'enfant des couples consultant en centre de PMA. Elle offre des perspectives non seulement cliniques mais aussi préventives ainsi que pour des recherches futures en ce qui concerne la problématique infertile. / To will a child without success to get it is a difficult step for couple who consult in Medically Assisted Procreation (MAP) center. This step can be comparable to crisis, or even bereavement, notably the natural fertility mourning. As we are a woman or a man, the personal experience can be different. Ambivalent feelings can come along the coverage of couple in MAP center. Couple can start attempt with lot of hope then, when they are not satisfied, go through negative one. Tensions can appear in the couple relationship, affecting communication and personal experience. Some studies were interested on personal experience of those who consult on MAP center, but French studies assessing child project through questionnaire are scarce. Studies of body dissatisfaction of these peoples are often unaccounted-for despite the involvement of infertility and associated treatment on identity and body dissatisfaction. This work aimed to study, in an exploratory way, child project and physical personal experience of couple consulting in MAP center, through comprehensive and validated tools. Subjects (N=102, M age=36 y.o.) have been chosen in 3 MAP centers (Hospital Jean Verdier at Bondy, Hospital Bèclère at Clamart and Hospital Pellegrin at Bordeaux) and were invited to fill out questionnaires. To complete questionnaires results, some couples have been observed during interview with the psychologist from the hospital. These results have been compared with those from the control group. Results suggest there is a different personal experience according to the gender but also between control group and clinical one. Notably, couples consulting in AMP center are more satisfied of their body appearance than the control group, which is in opposite of expected results. This exploratory study raised numerous questions and shows the interest to study physical personal experience and the child project of couple consulting in AMP center. It gives clinical and precautionary measure prospects as well as future research on infertile problems.

The presence of pathogens in semen can compromise the outcome of assisted reproductive treatment, together with the possibility of the female partner or offspring becoming infected. This is cause for concern, especially in South Africa with a high prevalence of HIV-1. Most of these infected individuals are in their reproductive years with the desire to have their own genetically related children. Therefore, assisted reproductive treatment with effective risk reduction procedures, such as semen processing for the elimination of these pathogens is crucial. However, during sperm preparation by standard discontinuous density gradient centrifugation, the supernatant is aspirated to allow access to the purified sperm pellet. Pathogens from the upper layers can adhere to the inside surface of the test tube and flow down to re-infect the purified sperm sample. The use of a centrifuge tube insert may prevent the re-contamination of sperm samples after discontinuous density gradient centrifugation. Furthermore, seminal pathogens can bind specifically or non-specifically to spermatozoa, rendering semen decontamination procedures ineffective. Serine proteases, such as trypsin, have been demonstrated to effectively inactivate viruses and to break pathogen-sperm bonds. However, the addition of a protease to density gradient layers during semen processing could have a negative impact on sperm parameters. This research was therefore aimed towards the determination of: i) The effect of semen processing with trypsin and trypsin inhibitor on sperm parameters. ii) The prevalence of various bacteria in semen samples from men attending the Reproductive and Endocrine Unit at Steve Biko Academic Hospital. iii) The effectiveness of semen processing by discontinuous density gradient centrifugation with a centrifuge tube insert, for the elimination of some of the most prevalent bacteria, white blood cells and in vivo derived HIV-1. Evaluation of sperm parameters after semen processing indicated that trypsin and trypsin inhibitor did not have an impact on sperm mitochondrial membrane potential, vitality, motility and zona binding potential, or acrosin activity, respectively. Seminal bacteria were highly prevalent in patients wishing to participate in the Unit’s assisted reproductive program, with 49.5% of semen samples presenting with positive bacterial cultures. Semen processing by means of discontinuous density gradient centrifugation with the tube insert, eliminated significantly more in vitro derived (spiked) bacteria and white blood cells from semen compared to processing without the insert. Furthermore, the semen decontamination procedure was effective in removing HIV-1 RNA from 100% of samples and proviral DNA from 98.1% of semen samples from HIV-1 sero-positive patients. The effectiveness of discontinuous density gradient centrifugation for the elimination of seminal pathogens could, therefore, be improved by the addition of trypsin to the upper density layer, without supplementing the bottom layer with trypsin inhibitor. Additionally, semen decontamination efficiency could also be improved by the prevention of re-contamination of processed sperm samples by the utilization of a tube insert during discontinuous density gradient centrifugation. / Thesis (PhD)--University of Pretoria, 2014. / gm2014 / Obstetrics and Gynaecology / unrestricted