Darbo tikslas. Išanalizuoti pagalbinių apvaisinimo būdų taikymo etines problemas pacientų požiūriu. Uždaviniai. Ištirti ir palyginti vaisingų ir nevaisingų šeimų požiūrį į pagalbinius apvaisinimo būdus; Nustatyti etines problemas, kylančias nevaisingoms šeimoms, naudojant pagalbinius apvaisinimo būdus; Įvertinti nevaisingų šeimų požiūrį į pagalbinių apvaisinimo būdų įstatyminę bazę. Tyrimo metodika. Anoniminė anketinė apklausa. Tirtos dvi respondentų grupės: nevaisingi asmenys (vaisingumo asociacijos nariai, n=93) ir vaisingi asmenys (besilaukiančios moterys, n=146). Rezultatai. Didžioji dalis respondentų yra girdėję apie pagalbinius apvaisinimo būdus ir jų taikymą. Vaisingi asmenys linkę pritarti įvairiems IVF taikymo apribojimams (amžiaus riba, IVF tik susituokusioms poroms ir pan.), vaisingumo sutrikimų turintys asmenys linkę naudotis PAB be jokių apribojimų. Nevaisingi žmonės pritaria embrionų užšaldymui, donorystei bei surogatinei motinystei, siekdami išnaudoti visus įmanomus būdus pasiekti norimo nėštumo. Nevaisingų asmenų nuomone, būtiname DA įstatyme privalo atsispindėti embrionų šaldymas, donorystė bei procedūrų kompensavimo tvarka. Išvados. 84,9 proc. visų tyrime dalyvavusių respondentų mano, kad nevaisingumas yra liga; 88,7 proc. visų respondentų yra girdėję apie pagalbinius apvaisinimo būdus. Abiejų grupių respondentai pritaria tiek in vivo, tiek in vitro procedūroms. Nevaisingos šeimos perteklinių embrionų sukūrime, jų šaldyme, spermos ar kiaušialąsčių... [toliau žr. visą tekstą] / Aim of the study. To analyse the patient‘s view of ethical issues in assisted reproductive technologies use. Objectives. To investigate and compare the fertile and infertile person‘s view of assisted reproductive technologies; To identify an ethical problems arising for infertile persons from assisted reproductive technologies use; To evaluate infertile person‘s view of assisted reproductive technologies legislative base. Methods. Anonymous questionnaire survey. Inquired two groups of respondents: infertile persons (members of Fertility Association, n=93) and fertile persons (pregnant women, n=146). Results. Most of respondents have heard about the use of assisted reproductive technologies. Fertile persons are minded to agree with various limitations of IVF use (age limit, IVF only for married couples, etc.), infertile persons prefer to use ART without any restrictions. Infertile people accept embryos cryopreservation, use of donors and surrogate motherhood, seeking to use all possibilities in order to receive pregnancy. According to infertile people opinion, new ART law is mandatory and must cover embryo cryopreservation, use of donors and reimbursement of procedures. Conclusions. 84.9 % of all respondents thinks, that infertility is a disease; 88.7 % of all respondents have heard about assisted reproductive technologies. Respondents of both groups approves in vivo and in vitro procedures. Infertile persons do not see serious ethical issues in creation of spare embryos... [to full text]

Oxidative stress contributes to inadequate in vitro maturation of porcine oocytes which leads to a failure of successful fertilization and embryo development. Therefore, the overall objective of this research was to characterize the mechanisms of oxidative stress in maturing oocytes and determine how oocytes alleviate oxidative stress with the assistance of supplemental antioxidants. A preliminary study was conducted to evaluate the effects of glutathione (GSH), N-acetyl-cysteine (NAC), and N-acetyl-cysteine-amide (NACA) supplemented to the maturation medium on intracellular GSH concentrations, nuclear maturation, fertilization success and embryo development. Antioxidants GSH, NAC and NACA (1.0 mM) were supplemented to the media during oocyte maturation. Intracellular GSH concentrations were recorded at 48 h of maturation and nuclear maturation and fertilization were analyzed 12 h after IVF. Embryo development was analyzed at 48 h and 144 h after IVF or intracytoplasmic sperm injection (ICSI). Supplementation of antioxidants had no effect on intracellular levels of GSH, nuclear maturation or fertilization traits. Blastocyst formation for NAC (35.0 ± 7.4%) and NACA (40.0 ± 7.4%) supplementation were higher (P < 0.05) than the control (20.0 ± 7.4%) and GSH supplemented (20 ± 7.4%) oocytes. The same pattern was seen for ICSI-derived embryos: blastocyst formation for NAC (22.0 ± 5.9%) and NACA (25.0 ± 4.6%) supplementation were higher (P < 0.05) than the un-supplemented (10.0 ± 6.0%) oocytes. There were no differences between NAC and NACA supplementation and there were no differences between the cleavage rates for any of the treatment groups. These results indicate that supplementing 1.0 mM of NAC or NACA to the oocyte maturation medium and the ICSI medium increased the percentage of viable embryos reaching the blastocyst stage of development, and could warrant further investigation. The next study was conducted to evaluate the effects of different concentrations of NAC supplemented to the maturation medium on embryo development. Comparisons of significant concentrations of NAC and NACA on embryo development were evaluated for nuclear maturation, fertilization success and embryo development. Concentrations of NAC (0, 0.5, 1.0, 1.5, 2.0, 2.5, 5.0 mM) were supplemented to maturing oocytes and embryo development was analyzed at 48 h and 144 h post-fertilization. There were no differences between cleavage rates for any of the treatment groups. Blastocyst formation for 1.5 mM NAC (56.5 ± 9.2%) was significantly higher (P < 0.05) than all other supplementations. There were no differences in nuclear maturation or fertilization when comparing 1.5 mM NAC and 1.5 mM NACA supplementation to the maturation media. There was no difference between cleavage rates of 1.5 NAC and 1.5 mM NACA supplementation to the maturation media. Blastocyst formation for 1.5 mM NAC (44.4 ± 4.7%) and 1.5 mM NACA (46.2 ± 3.4%) supplementation were significantly higher (P < 0.05) than the control (32.1 ± 6.2%) oocytes. These results indicate that supplementing 1.5 mM of NAC or NACA to the oocyte maturation medium increased the percentage of viable embryos reaching the blastocyst stage of development and could be used during the oxidative stress experiments. In the final study, the mechanisms of oxidative stress in maturing oocytes were studied in addition to evaluating the effects of antioxidant supplementation to the media. This study focused on superoxide dismutase (SOD), GSH peroxidase, catalase and intracellular GSH concentrations with respect to DNA fragmentation evaluated using the single cell Comet assay. Results indicate that when SOD was inhibited, the GSH peroxide levels and length of DNA migration significantly increased (P < 0.05). Catalase levels significantly decreased (P < 0.05) and intracellular GSH remained unchanged. When GSH peroxidase was inhibited, the SOD levels and catalase levels significantly decreased (P < 0.05) but the intracellular GSH and DNA migration length significantly increased (P < 0.05). The supplementation of 1.5 mM NAC and 1.5 mM NACA had multiple effects on the enzyme levels. Specifically, supplementation of 1.5 mM NAC or 1.5 mM NACA significantly decreased (P < 0.05) the length of DNA migration when other enzymes were inhibited compared to no antioxidant supplementation. These results indicate that antioxidant supplementation may alleviate the free radicals associated with oxidative stress in the maturing porcine oocyte. In conclusion, supplementing the antioxidants NAC or NACA to the oocyte maturation media does not have negative effects on IVF or embryo culture. Supplementation of NACA increases the number of oocytes reaching the blastocyst stage of development. Glutathione, SOD, catalase, and GSH peroxidase are all required to be functional during oocyte development to alleviate oxidative stress on the oocyte. Antioxidants enhance the enzyme activity during oocyte maturation and may even contribute to protecting the oocyte when enzyme activity is impaired. / Ph. D.

Thesis advisor: Stephen Pfohl / Assisted reproductive technologies have transformed the way medicine responds to infertility, as well as the ways those who go through difficulty conceiving understand their bodies and their experiences. In many capacities, however, the biomedical model is insufficient: recognition is contingent upon attempts to conceive, diagnosis is often imprecise or unexplained, and treatments strive for solutions without cures - and are frequently incapable of providing even the former. Interviews with 26 participants with current or recent histories of infertility revealed the ways they negotiate the biomedical model: 1) going beyond medical treatment in making lifestyle changes; 2) pursuing alternative treatments; 3) questioning doctors and playing active roles in determining courses of treatment; 4) using religion, spirituality, or magical thinking to develop other, non-bodily ways of controlling infertility; 5) extracting meaning from the experiences, infusing the objective idea of "disease" with subjective purpose; 6) building personal, alternate models that encompass a wide range of ways of thinking about infertility; and 7) directly challenging the scientific authority of the biomedical model, resisting the terms of treatment, or questioning the ability of medicine to offer them solutions. No participants showed pure compliance - as all included at least one of the negotiations - and none showed full resistance - as all had sought at least some medical treatments. Understanding these negotiations leads to a better concept of patient identity and the "illness" experience; it can inform policy in regards to prevention, education, and insurance mandates; and it better reveals who society permits to pursue parenthood in what ways. / Thesis (MA) — Boston College, 2009. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.

This doctoral research explores the ways in which UK law engages with embryonic processes, namely under the Human Fertilisation and Embryology Act 1990 (as amended). The research offers a fuller understanding of these elusive and evolving biological processes, and in particular, how they can, in turn, allow us to understand legal process and legal regulation more deeply. To do so, the thesis employs an anthropological concept - liminality - coined by Arnold van Gennep, which is itself concerned with revealing the dynamics of process. Liminality may be described as being concerned with the spaces in between distinct stages of human experience or with the process of transition between such stages. With this framing of liminality in mind - which is often characterised as a three-stage process of human experience - the research is divided into three parts, broadly reflecting the three parts of van Gennep's liminal schema: into, through, and out of liminality. It is argued herein that in regulating the embryo - that is, a processual liminal entity in itself - the law is regulating for uncertainty. Tracing the legal governance of the early stages of human life, from its inception to today's regulatory frameworks, the research diagnoses a 'legal gap' between the conceptual basis for regulation, and practical 'realities' of the 1990 Act (as amended). In particular, this 'gap' is typified by uncertainty surrounding embryos in vitro, and what this thesis diagnoses as 'legal stasis'. In order to situate this novel liminal analysis within existing paradigms, however, the thesis first frames embryos in vitro as 'gothic', building upon emergent analytical responses to postmodern forms of categorisation. This framing helps to articulate the nature of, and the reasons for, the above-mentioned 'legal gap'. This framing is nonetheless incomplete without a liminal lens, as it draws our attention to the dynamics of the processes occurring within this 'gap'. It is argued that considering the 'problem' in this manner enables us to move beyond conceptualisation, towards realisation. The gothic, and the liminal are thus used to critically assess legal representations of the embryo, and suggests that there are ways in which the law might better embrace the multiplicity of environments through which the embryo in vitro can travel, that is, either towards reproductive or research ends. It is argued that full recognition of these variable, relational liminal states of the embryo is important for the future of artificial reproduction and embryo research, and that this does not currently happen. In order for the law to reflect better the uncertain nature of embryonic processes, and the technologies that create them, the thesis posits a nuanced, contextual reframing of the embryo that captures the multiplicity of embryonic 'pathways' available within the 1990 Act (as amended). The overarching objective of this work is to consider a more coherent and robust intellectual defence of the ways in which we justify different treatments of in vitro embryos. It thus proposes a 'context-based approach' that embraces the variable, relational pathways already facilitated by the 1990 Act (as amended) in order to lead the embryo (and itself) into, through and out of liminality.

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No description available.

This study explored gender role conformity as a predictor of infertility-related distress and relational health in women and men undergoing treatment for infertility. Other factors that have been linked to infertility-related distress, including diagnosis type, treatment type, and insurance coverage were also explored. Study participants were comprised of 185 women and 147 men who had received a diagnosis of primary infertility and were undergoing medical treatment for infertility. Participants completed an online measure which included the following instruments: the Fertility Problem Inventory (FPI: Newton et al., 1999); the Conformity to Feminine Norms Inventory (CFNI: Mahalik et al., 2004); the Conformity to Masculine Norms Inventory (CMNI: Mahalik et al., 2003); and the Relational Health Indices (RHI: Liang et al., 2001). Findings from the study demonstrate a significant relationship between gender role conformity and infertility-related distress for both men and women. Women reported significantly greater levels of infertility-related distress than did men. Biological sex was a stronger predictor of infertility-related distress than was gender role conformity for both men and women. No significant differences in distress scores were found for individuals grouped by diagnosis type, treatment type, or insurance coverage status were detected. When the couple was used as the unit of analysis, no differences were found between couples with congruent distress scores and incongruent distress scores. Clinical implications linking the study findings with individual and couple-based interventions, as well as ideas for future research, are discussed.

Background: Due to the “flare effect” associated with the flare protocol, variation in the degree of follicular maturation during stimulation may result in differences in follicle response as compared to the luteal protocol which is based on maximal pituitary suppression and synchronization of follicular maturation. In this study, besides other methods, Anti-Mullerian Hormone (AMH), a novel marker for ovarian reserve, was used as a tool to evaluate the ovarian responsiveness to stimulation. Methods: Women undergoing IVF/ICSI treatment in the UBC IVF Program from January to December 2006 using luteal and flare protocols were retrospectively selected for a total of 40 treatment cycles, 20 cycles in each protocol matched by age, weight, and indication for IVF/ICSI. Serial serum Estradiol (E₂) levels and follicle data were obtained from the clinic chart. Follicle stimulating hormone (FSH), Luteinizing Hormone (LH), progesterone (P), androstenedione (D₄) and AMH levels were measured from aliquots of frozen serum samples. Hormone responses were evaluated by Area Under the Curve (AUC). Data were analyzed using the t-test and statistical significance was considered present at P<0.05. Results are reported as the mean ± SEM. Results: For flare versus luteal protocol, there was a significant difference in the number of total follicles (14.5 ± 1.8 vs 21.3 ± 2.3), medium follicles (3.7 ± 0.6 vs 8.4 ± 1.3), eggs retrieved (8 ± 0.8 vs 14 ± 1.4) and oocytes fertilized (4.4 ± 0.5 vs 8.4 ± 0.7), AMH AUC (62 ± 12 vs 111 ± 13), LH AUC (67 ± 21 vs 20 ± 9), FSH AUC (171 ± 59 vs 112 ± 29), respectively. Mean number of embryos transferred in both groups was similar. Number of pregnancies conceived (5 for flare and 10 for luteal protocol) was not significantly different. Although E₂ AUC in luteal protocol was higher than that in flare protocol, the difference was not statistically significant (28,339 ± 2,669 vs 26,905 ± 2,790). Differences in P and D₄ AUC between the two protocols were not statistically significant. Correlations with ovarian follicles and eggs retrieved were better for AMH than E₂. Conclusions: The luteal protocol exhibited a better ovarian response to stimulation as compared to the flare protocol. As compared to E₂, AMH had a better correlation with the number of follicles and eggs retrieved.

A questionnaire based survey was done to assess the views of fertile individuals, infertile individuals, egg donors and recipients towards gamete donation. The survey showed that fertile individuals were significantly less inclined towards the use of donated eggs in research and treatment, compared to infertile individuals. Acceptability of gamete donation was found to be very high in all groups regardless of their fertility, but the majority of individuals, whether fertile or infertile, were opposed to the use of fetal and cadaveric sources of obtaining eggs. The effect of modifications of the freeze-thaw process was investigated in the mouse model. It was seen that slight modifications of the slow freeze protocol affected survival rates and that ultrarapid freezing achieved better survival rates than slow freezing. Human oocyte cryopreservation was performed using a slow freeze-rapid thaw protocol. In total, 34.4% of oocytes survived cryopreservation and these were randomly allocated for fertilisation by conventional <I>in vitro</I> fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Resulting embryos were spread for chromosomal analysis. ICSI significantly improved the rates of normal fertilisation (43.2% versus 2.7%) compared to IVF (P<0.001). A normal diploid karyotype was achieved by ICSI. These studies show that oocyte donation is acceptable to the majority of both fertile and infertile individuals. Further research is required to improve the methods of oocyte cryopreservation. Once the techniques of cryopreservation have been established, ICSI may successfully be applied to enhance subsequent fertilisation rates.

Background: Due to the “flare effect” associated with the flare protocol, variation in the degree of follicular maturation during stimulation may result in differences in follicle response as compared to the luteal protocol which is based on maximal pituitary suppression and synchronization of follicular maturation. In this study, besides other methods, Anti-Mullerian Hormone (AMH), a novel marker for ovarian reserve, was used as a tool to evaluate the ovarian responsiveness to stimulation. Methods: Women undergoing IVF/ICSI treatment in the UBC IVF Program from January to December 2006 using luteal and flare protocols were retrospectively selected for a total of 40 treatment cycles, 20 cycles in each protocol matched by age, weight, and indication for IVF/ICSI. Serial serum Estradiol (E₂) levels and follicle data were obtained from the clinic chart. Follicle stimulating hormone (FSH), Luteinizing Hormone (LH), progesterone (P), androstenedione (D₄) and AMH levels were measured from aliquots of frozen serum samples. Hormone responses were evaluated by Area Under the Curve (AUC). Data were analyzed using the t-test and statistical significance was considered present at P<0.05. Results are reported as the mean ± SEM. Results: For flare versus luteal protocol, there was a significant difference in the number of total follicles (14.5 ± 1.8 vs 21.3 ± 2.3), medium follicles (3.7 ± 0.6 vs 8.4 ± 1.3), eggs retrieved (8 ± 0.8 vs 14 ± 1.4) and oocytes fertilized (4.4 ± 0.5 vs 8.4 ± 0.7), AMH AUC (62 ± 12 vs 111 ± 13), LH AUC (67 ± 21 vs 20 ± 9), FSH AUC (171 ± 59 vs 112 ± 29), respectively. Mean number of embryos transferred in both groups was similar. Number of pregnancies conceived (5 for flare and 10 for luteal protocol) was not significantly different. Although E₂ AUC in luteal protocol was higher than that in flare protocol, the difference was not statistically significant (28,339 ± 2,669 vs 26,905 ± 2,790). Differences in P and D₄ AUC between the two protocols were not statistically significant. Correlations with ovarian follicles and eggs retrieved were better for AMH than E₂. Conclusions: The luteal protocol exhibited a better ovarian response to stimulation as compared to the flare protocol. As compared to E₂, AMH had a better correlation with the number of follicles and eggs retrieved.