This study examines social constructions of infertility in Malawi. The literature on infertility consists of epidemiological studies, describing patterns of infertility in terms of its incidence, causes and health seeking behaviour; studies of the psychological correlates of infertility; and ethnographic studies which describe experiences, perceptions and management of infertility within specific socio-cultural contexts. In addition, some studies discuss social aspects of medical practice in relation to infertility. Overall, studies of infertility in developing countries emphasize its many serious psychological and social consequences, usually attributed to cultural norms mandating parenthood. There appear to be several lacunae in the literature: men with fertility problems are rarely included, an in-depth examination of practitioners’ views is missing, and no qualitative study has been conducted on infertility in Malawi, which has a considerable secondary infertility rate. Furthermore, although ethnographic studies highlight the interpersonal (related to others’ judgements), normative (related to ideas about what ‘ought’ to be) and moral (related to ideas about what is good or bad) issues involved in infertility, no study has investigated how these issues are managed in situ, in verbal interactions. However, it has been argued that ‘talk’ is a prime site for the management of issues such as blaming and deflecting responsibility. Hence, this study addresses several gaps in the literature. It focuses on Malawi, and includes a wide range of participants: women and men with a fertility problem, significant others, indigenous and (Malawian and expatriate) biomedical practitioners. Semi-structured interviews with 63 participants were recorded and transcribed, and translations were obtained of interviews in which interpreters were used. For the analysis, I used discourse analysis (DA), informed by conversation analysis (CA). This analytic approach, novel in infertility studies, examines the interpersonal functions of statements in interactions, such as blaming or justifying. Use of DA and CA has led to novel insights into how respondents construct infertility, its causes, solutions (sought and offered), and consequences, and how they thereby manage interpersonal, normative, and moral issues, revolving around accountability, blame and justification, and attribution of (problematic) identity categories. For instance, I have shown how respondents construct childbearing as a cultural, normative requirement, and how this can be used to justify practices like extramarital affairs, or polygamy, as necessary solutions. In addition, identifying causes appears to be problematic for people with a fertility problem due to certain interpersonal and interactional issues, such as the idea that they are not entitled to medical knowledge. Practitioners can be seen to work up and bolster an identity of professional, competent expert in constructions of causes of infertility, and by attributing problems in helping infertility clients to external factors, including patients’ intelligence. This study has several theoretical, practical, and methodological implications, although I discuss some thorny methodological issues, especially those concerning the use of translations and the transferability of the analytic findings. A first contribution pertains to methodological debates and developments in conversation analysis, and in studies of infertility and other health issues which rely upon people’s self-reports. Second, my study contributes to theoretical developments in health psychology and health promotion. My analysis points to the relevance of social and normative considerations for engagement in ‘risky’ behaviours, such as extramarital affairs. This challenges cognition models which treat health behaviour as the outcome of individualistic decision-making processes, and see providing information as the main way of changing people’s behaviour. Therefore, a third set of implications is of a practical nature: some of the findings can contribute to health promotion, as well as to improvement of health services. For example, practitioners’ attribution of failures and (communication) problems to their patients, may prevent them from reflecting critically on, and addressing, their own contributions to problems. Overall, this thesis shows that when one wants to ‘give voice’ to people who are suffering from infertility, it is valuable to examine what they say in detail, within its interactional context, and the concerns they themselves make relevant, in their own terms.

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In the first part of study, our objective was to determine the effect of CoQ10 supplementation of culture media on preimplantation mouse and human embryo development. CoQ10 supplementation of culture media did not improve mouse or human embryo development in vitro. Since the results appeared to be negative, we decided to move on to research the effect of age on female infertility. In the second part, we investigated the effect of female age and ovarian stimulation protocols on IUI outcome in 411 infertile women. We found that the ongoing/live birth rate per cycle in women ≤ 37 years was significantly higher than in older patients. In the third section, we determined if very young age (≤25 yrs) has an impact on pregnancy outcome in women undergoing IVF-ET. Our results demonstrating lower pregnancy rates in very young patients and egg donors compared to the patients in their early thirties were surprising.

<p>We live in a society that continually reinforces the connection between femininity and maternity and for the majority of women, attempts to experience motherhood are successful. However, for others the world of motherhood is not so easy to enter. To date, research regarding the needs and life satisfaction of women who are unsuccessful in becoming mothers, is fairly limited. The purpose of this study was to explore the transitional phase women endure from potential motherhood to non-motherhood and to highlight some of the complexities underpinning infertility and its impact on the lives of women in South Africa. The main objective was to gain deeper insight into how women incorporated this experience into their lives and relationships and how they began to create a future life without their own biological children. A secondary aim of this study was to investigate whether the women viewed aspects such as age and finances as having had an effect on their decision to discontinue treatment for infertility. Feminist standpoint theory served as a theoretical framework for the study that recognized that each individual voice be heard. This study was a qualitative exploration, utilizing a short demographic questionnaire and an in-depth semi-structured interview. Five interviews were conducted with women from diverse backgrounds. These interviews were recorded / transcribed verbatim and thematic analysis of the data was conducted.</p>

Approximately 1% of women will experience menopause before the age of 40, a condition known as premature ovarian failure (POF). The goal of this thesis was to identify genetic causes of POF by examining a number of candidate factors in POF patients and control women. Carriers of FMR1 premutations (55-200 CGG repeats) are known to be at increased risk of POF. A higher prevalence of alleles between 35-54 repeats was found among POF patients (p=0.01), suggesting that risk for POF may extend outside the classic premutation range. There was no evidence for any difference in FMRI promoter methylation or gene expression between cases and controls. Allele distributions of gene polymorphisms in the androgen receptor (AR), estrogen receptor (ß, sex hormone binding globulin, and FSH receptor genes did not differ between POF patients and controls. However, haplotype at the estrogen receptor a gene, ESRI, was found to be associated with POF in a simple dominant manner (RR=9.7; 95% CI=2.6-35.6). Although the functional effect of this haplotype could not be confirmed, it may confer a more active promoter that influences risk by increasing the rate of follicular atresia. X-chromosome inactivation (XCI) skewing can indicate an abnormal X chromosome and may therefore be increased in POF patients. There was no increase in skewed XCI >90% in patients with secondary amenorrhea, however, there was a significant increase in 4 POF patients with primary amenorrhea (p=0.001). No X-chromosome abnormalities were detectable by high resolution DNA microarray, and skewed XCI may be explained by a trisomic rescue event causing reduced follicular pool. Age-related chromosome factors were assessed to determine if POF patients demonstrate an increased rate of cellular aging. With age, XCI skewing and AR methylation increase and telomere length decreases. There was no difference in skewing or methylation between patients and controls. Surprisingly telomere length was increased in POF patients (p=0.04), a finding that may be explained by abnormal estrogen exposure. Genotype at the longevity-associated APOE gene was not associated with POF. In conclusion, these findings have illuminated several new areas of research in this field and provide background for future research into POF pathogenesis.

Thesis (M.W.H.)--University of Melbourne, Faculty of Medicine, Dentistry & Health Sciences, 1998. / Typescript (photocopy). Includes bibliographical references (leaves 156-167).

Thesis (Ph.D.)--Brandeis University, The Heller School for Social Policy and Management, 2005. / Chairperson: Jon Chilingerian. Includes bibliographical references.

Thesis (M.T.S.)--Southern California College, 1995. / Includes bibliographical references (leaves 132-140).