Surrogacy arrangements have become an option for many involuntarily childless couples. Although surrogacy arrangements are not regulated in Sweden, there is an implied prohibition contained in the Genetic Integrity Act which makes it impossible to facilitate such arrangements under the Swedish health care system. However, many couples go abroad to fulfill their dream of having a child. The paper discusses whether surrogate arrangements can change the view of biological / genetic motherhood. The unwritten maternity presumption makes it difficult to determine the legal parenting of children born through surrogacy arrangements, which puts the child in a lawless position. Why have surrogate arrangements become controversial? The motherhood presumption has been used as a way to mark ethical resistance to surrogate arrangements. This is evident partly from preliminary work on the presumption and the presumption and it´s definition. Arguments that are weighted heavily for the legislation are that surrogate arrangements can be harmful to women and children and that it is considered a violation of the human dignity principle. The legislator believes that a woman's body is used in such cases as a means of achieving someone else's goals. The legislator also states that it can be difficult for the birth woman to give up the child during the exchange. There are different ways to implement a surrogate arrangement and one is considered better than the other. The debate that has been made in Sweden has been that; either both forms, altruistic and commercial surrogate arrangements should be banned, or that they should only allow altruistic surrogate arrangements. Altruistic for some is considered more accepted because this form of surrogate arrangement is about a woman carrying the child without agreeing on money in exchange. In commercial surrogate arrangements, the woman carries the child in exchange for compensation, which is not considered acceptable in society. One problem that is highlighted in the paper is that there are clear differences between commissioning father and commissioning father with genetic linkage to the child in surrogate arrangements. The differences arise when the parties are to be determined as legal parents. Based on practice it appears that men's genetics are recognized to a greater extent than women by the legislature. The genetic mother becomes powerless without the consent of the genetic father. As a result of our investigation, we believe that surrogacy arrangements need regulation in Sweden. What is considered most ethically justifiable is to legalize altruistic surrogacy. When egg donation was legalized in Sweden the same discussion took place as it is today with surrogacy arrangements, whether it is ethically justifiable or not. Today egg donation is not unusual when a woman´s eggs are unusable, and we believe the future will be the same for surrogacy arrangements. Surrogacy arrangements will be normalized in society and therefore the legislation should also keep up. The view of who the child´s mother is will be expanded, and more people will be involved, if surrogacy arrangements are legalized. The child will have the opportunity for a larger network of parents and in altruistic contexts, the woman who carries the child will have a close connection without being a legal parent and guardian. / Surrogatarrangemang har blivit ett alternativ för många ofrivilligt barnlösa par när de vill bilda familj. Det är inte reglerat i Sverige och det är heller inte lagligt att utföra sådana behandlingar inom den svenska hälso-sjukvården pga. ett implicit förbud enligt genlagen. Detta medför att många par åker utomlands för att uppfylla drömmen om ett barn. Det som diskuteras i uppsatsen är huruvida surrogatarrangemang bör legaliseras i Sverige och om surrogatarrangemang kan ändra synen på biologiskt/genetiskt moderskap. Den oskrivna moderskapspresumtionen gör det svårt att fastställa det rättsliga föräldraskapet till barn födda genom surrogatarrangemang vilket sätter barnet i en rättsosäker position. Varför har surrogatarrangemang blivit kontroversiellt? Moderskapspresumtionen har använts som ett sätt att markera etiskt motstånd mot surrogatarrangemang. Detta framgår dels av förarbeten till presumtionen och den utformning som den fick år 2003. Argument som vägt tungt för lagstiftningen är att surrogatarrangemang kan vara skadligt för kvinnor och barn samt att det anses vara en kränkning mot människovärdesprincipen. Lagstiftaren menar att en kvinnokropp används i sådana fall som medel för att åstadkomma någon annans mål. Lagstiftaren framför även att det kan vara svårt för den födande kvinnan att ge upp barnet efter födseln. Det finns olika vägar att genomföra ett surrogatarrangemang och det ena anses bättre än det andra. Debatten som framförts i Sverige har handlat om att antingen bör båda formerna, altruistiskt och kommersiellt surrogatarrangemang, förbjudas eller endast tillåta altruistiskt surrogatarrangemang. Altruistiskt anses för vissa mer accepterad eftersom denna form av surrogatarrangemang handlar om att en kvinna bär barnet utan att avtala om pengar i utbyte. I kommersiella surrogatarrangemang bär kvinnan barnet i utbyte mot ersättning vilket inte är lika accepterat av samhället.  Ett problem som belyses i uppsatsen är att det uppstår tydliga skillnader mellan beställande män och beställande kvinnor med genetisk koppling till barnet i surrogatarrangemang. Skillnaderna uppstår när parterna ska fastställas som rättsliga föräldrar. Med utgång i praxis framgår det att män genetiskt erkänns i större utsträckning än kvinnor av rättstillämparen. Den genetiska modern blir maktlös utan den genetiska faderns samtycke. Resultatet av denna undersökning blev att surrogatarrangemang är i behov av reglering i Sverige. Det som anses mest etiskt försvarbart är att legalisera altruistiska surrogatarrangemang. När äggdonationer legaliserades i Sverige pågick ungefär en likadan diskussion som det idag gör kring surrogatarrangemang, huruvida det är etiskt försvarbart eller inte. Idag är äggdonationer inget ovanligt när en kvinnas ägg är obrukbara och vi anser att framtiden kommer se likadan ut för surrogatarrangemang. Surrogatarrangemang kommer normaliseras i samhället och därför bör även lagstiftningen utvecklas i takt med samhället. Synen på vem som är barnets moder kommer att utvidgas och fler personer involveras, om surrogatarrangemang legaliseras. Barnet kommer få möjlighet till ett större nätverk av föräldrar och i altruistiska sammanhang kommer kvinnan som bär barnet ha en nära anknytning utan att vara rättslig förälder och vårdnadshavare.

Treatment success in IVF-ICSI is mainly limited by female age, but differences in ovarian reserve (OR; the remaining pool of oocytes and their quality) between individuals modify treatment prerequisites among women of similar age. OR may be assessed by OR tests (ORTs). The main aims of this work were to study menstrual cycle length (MCL), basal levels of circulating gonadotrophins, antral follicle count (AFC) and serum Anti-Müllerian hormone (AMH) levels and their associations with and prognostic capacities regarding IVF-ICSI outcome in large cohorts of unselected women. Age-adjusted MCL was positively and linearly associated with pregnancy rates (PRs), live-birth rates (LBRs) and ovarian response to controlled ovarian hyperstimulation. An MCL of >34 days almost doubled the LBR compared with an MCL of <26 days. The grouped variable ‘combined FSH and LH levels’ was superior to both individual gonadotrophin levels and the LH:FSH ratio. The highest mean PR was seen in connection with a combination of FSH <6.7 U/l with LH >4.9 U/l; PRs were lowest when FSH-LH levels were opposite to this (high-low) and intermediate when FSH-LH levels were low-low or high-high. Associations with LBR and ovarian response were similar as those for PR. AFCs and serum AMH levels were positively and log-linearly associated with PR, LBR and ovarian response. Success rates levelled out above AFC 30 or AMH 5 ng/ml. Treatment outcome was superior among women with polycystic ovaries. Among the studied ORTs, logAFC and logAMH concentration correlated most strongly. After multivariate testing, entering all studied ORTs, AMH and female age remained independently associated with LBR. AMH + AFC + age predicted both poor and excessive ovarian responses with high accuracy. Adjusting for age and oocyte yield, all ORTs remained significant for LBR, implying that ORTs also capture information on oocyte quality. In conclusion, measures of OR are strongly associated with PR, LBR and ovarian response in a log-linear fashion, and partly reflect oocyte quality. The OR spectrum is continuous, from small ‘oligofollicular’ ovaries (the low extreme) to polycystic ovaries (the high extreme). Among the studied ORTs, AMH together with age provide the most powerful basal estimate for IVF/ICSI outcome.

Des facteurs masculins sont identifiés dans près de la moitié des cas d’infertilité. À ce jour, les tests évaluant la fertilité masculine demeurent peu prédictifs de la survenue d’une grossesse. Dans le but de pallier cette lacune, nous avons mis au point deux nouveaux tests mesurant l’intégrité de l’ADN et le temps de survie des spermatozoïdes. Nous avons effectué une étude prospective portant sur 42 couples infertiles suivis en fécondation in vitro (FIV). Le spermogramme a été effectué selon les critères de l’Organisation Mondiale de la Santé (OMS) et le temps de survie des spermatozoïdes exposés à un détergent cationique a été mesuré en observant la mobilité sous microscope. L’intégrité de l’ADN des spermatozoïdes a été vérifiée par la nouvelle méthode de marquage radioenzymatique et par analyse de la structure de la chromatine (SCSA). Tous les tests ont été réalisés sur la partie des échantillons de sperme non utilisée par la clinique de fertilité. Le projet a été approuvé par le comité d’éthique du Centre Hospitalier Universitaire de Montréal (CHUM) et les patients ont préalablement signé un formulaire de consentement éclairé. L’analyse des paramètres du spermogramme et de l’intégrité de l’ADN n’a montré aucune différence statistiquement significative entre les données chez les couples avec ou sans grossesse. Cependant, le taux de grossesse biochimique était statistiquement plus élevé chez les couples dont le temps de survie des spermatozoïdes était long (>250 s) comparativement à ceux dont ce temps était court (≤250 s): 66% vs 27% respectivement (p<0,05). Les taux de grossesse clinique et d’implantation étaient aussi plus élevés, mais les différences n’atteignaient pas le seuil de signification statistique. Nos résultats confirment que le spermogramme et la mesure de la fragmentation de l’ADN des spermatozoïdes ne sont pas de bons facteurs prédictifs des résultats de la FIV. Par contre, le test de survie des spermatozoïdes serait un meilleur indicateur de la possibilité d’une grossesse en FIV. L’amélioration de sa spécificité et un plus grand nombre de sujets sont nécessaires avant de proposer son application en clinique de fertilité. / Male factors are known to be involved in almost half of the couples consulting for infertility. To date, the tests for evaluating male fertility are poor predictors of pregnancy. We developed two new tests to evaluate sperm function: a sperm survival test and a new method to measure sperm DNA integrity. This prospective study was conducted on 42 infertile couples undergoing in vitro fertilization (IVF). Assessment of sperm parameters was done according to the World Health Organization (WHO) criteria, and sperm survival upon exposure to a cationic detergent was measured by observing motility under the microscope. Sperm DNA integrity was verified by our new radioenzymatic method as well as by the sperm chromatin structure analysis (SCSA) method. All testing was performed on a remainder aliquot of the semen samples. The study was approved by the ethics committee of the Centre Hospitalier Universitaire de Montréal (CHUM), and informed consent was obtained before inclusion. Neither conventional semen analysis, nor sperm DNA fragmentation showed statistically significant difference between conception and non-conception cycles. However, the biochemical pregnancy rate was statistically higher in couples where the sperm survival time was long (>250 s) compared to short (≤250 s): 66% vs. 27% respectively, (p < 0.05). The clinical pregnancy rate and implantation rate were also higher but the differences did not reach statistical significance. Our study confirms that conventional semen analysis and the assay for sperm DNA integrity are not reliable indicators of IVF outcome. In contrast, our new sperm survival test seems to be a better predictor of the pregnancy rate after IVF. Improvement of its specificity and a larger cohort of patients are necessary before proposing its regular application in IVF clinics.

No description available.

Cette thèse de psychopathologie psychanalytique est une réflexion théorico-clinique sur l'expérience d'une assistance médicale à la procréation (AMP), et plus particulièrement sur l’état psychologique des femmes infertiles en parcours de fécondation in vitro (FIV) et de don d'ovocytes. Cette recherche a pour but d'évaluer la psychopathologie de ces femmes et les éventuels remaniements psychiques qu'impose ce mode de procréation. L’hypothèse générale de cette étude soutient l’idée qu’il existe des particularités dans le fonctionnement psychique des femmes infertiles qui diffèrent selon que les femmes ont recours à une FIV ou à un don d’ovocytes. La méthodologie repose sur la base d'entretiens semi-directifs, de questionnaires et de tests projectifs (Rorschach et TAT) et l'analyse du matériel recueilli s'appuie sur la théorie psychanalytique. Les résultats montrent que ces femmes souffrent d’une blessure psychique qui est à mettre en lien avec le vécu d’une castration réelle de leur féminité dans sa valence maternelle châtrée. Les femmes infertiles se trouvent sous l’emprise de l’objet primaire et leur fonctionnement mental se caractérise par une pensée opératoire défensive. De plus, le recours à une FIV ou à un don d’ovocytes suscite des aménagements psychiques, notamment en termes de représentations maternelles, qui apparaissent spécifiques au type d’AMP. Enfin, l’AMP amène les couples à érotiser les interventions médicales conduisant notamment à un remaniement des théories sexuelles infantiles et à une reconstruction des fantasmes originaires. / This thesis psychoanalytic psychopathology is a reflection on the theoretical and clinical experience of medical assistance to procreation (MAP), and more particularly on the psychological status of infertile women in course of in vitro fertilization (IVF) and oocyte donation. This research aims to assess the psychopathology of these women and the possible psychological changes imposed by this mode of procreation. The general hypothesis of this study is as follows: there are specific aspects in the psychic functioning of infertile women, these characteristics differ between women using IVF or oocyte donation. The methodology is based on semi-directive interviews, questionnaires and projective tests (Rorschach and TAT) and analysis of collected material is based on psychoanalytic theory. The results show that these women suffer psychological injury that is to be linked with the experience of a real castration of their femininity in its valence maternal castrated. Infertile women are under the mastery of the primary object and mental functioning is characterized by a defensive operational thought. In addition, the use of IVF or oocyte donation leads to psychic adjustments, particularly in terms of maternal representations that appear specific to the type of MAP. Finally, MAP brings couples to eroticize medical interventions leading a redesign of infantile sexual theories and a reconstruction of primal fantasies.

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No. of bitstreams: 2 Tese- Érica Eugênio Lourenço Gontijo - 2016.pdf: 2253704 bytes, checksum: db396485a7f8b5e9945a2d3be4fa771b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-06-23 / Outro / INTRODUCTION: The frequency of embryo production and successful pregnancy are the main parameters used to measure the quality of human reproduction laboratories. OBJECTIVE: We compared the success in the production and quality of embryos, success rate and factors related to pregnancy in LabRep/HC/UFG before deep adjustments estrututurais, when it was classified as conventional laboratory and after adequaçãos, when it began to be classified as an ISO 5/7 laboratory and factors related to the success of fertilization. METHOD: The study was divided into two parts. The first evaluated the embryo quality and the second risk factors capable of interfering with the success of pregnancy. information of 278 cycles of women were surveyed who submitted any Assisted Human Reproduction technique during the study period. In the first analysis were surveyed: cleavage of the embryo, the result of βHCG, embryo quality and microbiological contamination of the means of embryos crops. In the second, they evaluated the size of follicles per woman, amount of aspirated oocytes, raised, inseminated and injected, ovarian stimulation scheme, maternal infections, infertility period and sperm quality. The study design was a case control. Data were entered into Epi-Info 3.3.2 and analyzed in BioEstat 5.3 program. We evaluated the relationship between the groups and the factors and the success of pregnancy the odds ratio (OR) and chi-square test (p = 0.05). RESULTS: In the first analysis it was observed that the ISO 5/7 laboratory, there were successful in the formation of embryos and the conventional O , CI - 2: 0.24, p: 0.81). 5/7 96.6% ISO laboratory embryos were generated A or B, since the conventional laboratory, 90.4% were A or B. The pregnancy success in the laboratory I O was , and conventional laboratory O CI to 2: 2,24; p: 0.13). The second correlation was found with pregnancy failure female factors: having more than 40 years (OR 6.04, CI: 1.34 to 27.08; p: 0.010), higher infertility time 97 months (OR: 4.49, CI: 1.65 to 12, .21; p: 0.00) and have endometrial thickness of less than 10mm (OR: 5.42, CI: 2.44 to 12.05; p:0.001). The male factors with correlation were: oligozoospermia (OR:3,35; IC:1,41-7,92; p:0,010) e teratozoospermia (OR:4,14; IC:1,89-9,07; p:0,010).Microbiological contamination was found in 11.06% of semen samples. CONCLUSIONS: There was no statistical difference between the results of the two laboratories, however we observed a trend of better quality embryos in ISO 5/7 laboratory. It was concluded that the patients attended the LabRep/HC/UFG, present a great heterogeneity of clinical profiles and different reproductive characteristics. It shows how a major challenge that encourages the ongoing investment in cutting edge technology and processes, as well as constant improvement of the multidisciplinary team that make up the lab. / INTRODUÇÃO: A frequência de produção de embriões e sucesso na gravidez são os principais parâmetros usados para verificar a qualidade de laboratórios de reprodução humana. OBJETIVO: Comparar o sucesso na produção e qualidade de embriões, taxa de sucesso e fatores relacionados a gravidez no LabRep/HC/UFG, antes de profundas adequações estrututurais, quando era classificado como laboratório convencional e após as adequaçãos, quando passou a ser classificado como um laboratório ISO 5/7 e os fatores relacionados ao sucesso da fertilização. MÉTODO: O desenho do estudo foi do tipo caso controle. Os dados foram inseridos no programa Epi-Info 3.3.2 ® e analisados no programa BioEstat 5.3 ®. Foram avaliadas a relação entre os grupos e dos fatores e o sucesso da gravidez pelo odds ratio (OR) e qui-quadrado (p=0,05). O estudo se deu no Laboratório de Reprodução Humana do HC/UFG Goiânia-Goiás. Foram pesquisadas informações de 278 ciclos de mulheres que submeteram a uer técnica de FIV, ICSI E IIU, como tratamento de Reprodução Humana Assistida no período do estudo. O trabalho foi dividido em três artigos para melhor compreensão dos resultados. No primeiro artigo realizou-se uma revisão bibliográfica sobre relação entre alterações bioquímicas, ambientais e microbiológicas e o sucesso da técnica de fertilização in vitro. O segundo artigo avaliou a qualidade embrionária e o terceiro, os fatores de risco com capacidade de interferir no sucesso da gestação. Na primeira análise foram pesquisadas: clivagem do embrião, resultado do βHCG, qualidade embrionária e a contaminação microbiológica dos meios de cultivos de embriões. Na segunda, foram avaliados o tamanho dos folículos por mulher, quantidade de oócitos aspirados, captados, inseminados e injetados, esquema de estimulação ovariana, infecções maternas, período de infertilidade e qualidade espermática. RESULTADOS: No primeiro trabalho científico onde comparou-se o sucesso na produção e qualidade de embriões, taxa de sucesso e contaminação microbiológica nos meios de cultura onde os embriões foram cultivados antes das adequações estrututurais, quando era classificado como laboratório convencional e após as adequaçãos, quando passou a ser classificado como um laboratório ISO 5/7, foi observado que no laboratório ISO 5/7, houve 74,1% de sucesso na formação de embriões e no convencional 67,8% (OR:1,30; IC:0,47-3,61; אּ2:0,24; p:0,81). No laboratório ISO 5/7 96,6% dos embriões gerados eram A ou B, já no laboratório convencional, 90,4% eram A ou B. O sucesso de gravidez no laboratório ISO 5/7 foi de 22,8% e no laboratório convencional de 36,2% (OR:1,9; IC: 0,81-4,52; אּ 2: 2,24; p: 0,13). No segundo trabalho científico onde avaliou-se os fatores relacionados a gravidez no LabRep/HC/UFG, foi encontrado correlação do insucesso de gravidez com os fatores femininos: ter mais de 40 anos (OR: 6,04; IC: 1,34-27,08; p:0,010), tempo de infertilidade superior a 97 meses (OR: 4,49; IC: 1,65-12,.21; p:0,001) e possuir endométrio com espessura inferior a 10mm (OR: 5,42; IC: 2,44-12,05; p:0,001). Os fatores masculinos com correlação foram: oligozoospermia (OR: 3,35; IC: 1,41-7,92; p:0,010), teratozoospermia (OR: 4,14; IC: 1,89-9,07; p:0,010). Foi encontrado contaminação microbiológica em 6.11% das amostras de sêmen. CONCLUSÕES: No primeiro trabalho científico foi possível concluir que não houve diferença estatística entre os resultados dos entre os dois laboratórios. No segundo trabalho científico concluiu-se que os fatores relacionados ao insucesso do tratamento de reprodução assistida encontrados foram: idade superior a 40 anos, tempo de infertilidade superior a 96 meses e espessura endometrial inferior a 10mm e presença de sêmen de baixa qualidade.

La procréation médicalement assistée (PMA) permet à beaucoup d’individus infertiles de concevoir un enfant qui leur est génétiquement lié. Cependant, des données scientifiques émergentes suggèrent que la PMA pourrait entraîner des risques épigénétiques pour les futurs enfants. Conformément à l'hypothèse des origines développementales de la santé et des maladies, la PMA pourrait augmenter le risque de développer des maladies à apparition tardive par des mécanismes épigénétiques, car l’hyperovulation, les méthodes de fécondation et la culture embryonnaire pourraient nuire à la reprogrammation épigénétique de l'embryon. De tels risques épigénétiques soulèvent des enjeux éthiques pour toutes les parties prenantes: les futurs parents et enfants, les professionnels de la santé, et la société. Ce mémoire se concentre sur les questions éthiques soulevées par la prise en compte de ces risques lors de l'utilisation de la PMA. Pour mettre en lumière ces enjeux, nous utilisons l’approche principiste. Nous argüons qu'une tension éthique peut émerger entre le respect de l'autonomie procréative des parents d’intention et le devoir de minimiser les risques pour les enfants potentiels. Une seconde tension éthique peut émerger entre le droit des parents d’intention de faire un choix éclairé, et la réticence que peuvent avoir les professionnels de la santé de communiquer l’information sur les risques épigénétiques de la PMA, étant donné la validité incertaine de ces informations. Nous explorons aussi le risque de conflits d’intérêts pour les cliniciens des cliniques de PMA. Nous soutenons que les parents d’intention et les professionnels de la santé ont la responsabilité partagée de promouvoir les meilleurs intérêts du futur enfant. Nous plaidons pour que plus de recherche soit faite sur les effets de la PMA sur la santé des futurs enfants, pour que soient énoncées des lignes directrices priorisant le recours à des techniques moins risquées au niveau épigénétique, et pour que d’autres lignes directrices guident les professionnels de la santé dans la communication des risques épigénétiques associés à la PMA. Enfin, nous suggérons que cette communication se fasse dans le cadre d’une approche centrée sur le patient. Nous explorons aussi l’apport d’une approche narrative pour aborder les tensions éthiques soulevées par l’approche principiste. / The use of assisted reproductive technologies (ART) allows many coping with infertility to conceive. However, an emerging body of evidence suggests that ART could carry epigenetic risks for those conceived through the use of these technologies. In accordance with the Developmental Origins of Health and Disease (DOHaD) hypothesis, ART could increase the risk of developing late-onset diseases through epigenetic mechanisms, since superovulation, fertilization methods and embryo culture could impair the embryo’s epigenetic reprogramming. Such epigenetic risks raise ethical issues for all stakeholders: prospective parents and children, health professionals, and society. This thesis focuses on ethical issues raised by the consideration of these risks when using ART. To highlight these issues, we use the principlist approach. We argue that an ethical tension can emerge between respect for the reproductive autonomy of prospective parents and the duty to minimize the risks for potential children. A second ethical tension can emerge between the parents' right to make an informed choice about the use of ART, and the reluctance of health professionals to communicate epigenetic risk given its uncertain validity. We also explore the risks of conflicts of interests for health professionals in ART clinics. We argue that prospective parents and health professionals have a shared responsibility to promote the best interests of the future child. We also argue in favor of further research on the effects of ART on the health of future children, and in favor of clinical guidelines that prioritize the use of techniques that carry less epigenetic risk and that assist health professionals in communicating the epigenetic risks associated with ART. Finally, we suggest that this communication be done within the patient-centered approach. We also explore the contribution of a narrative approach to address the ethical tensions raised by the principlist approach.

Philosophiae Doctor - PhD / The aim of this thesis is first, to evaluate various culture conditions to improve embryo development, and secondly, to analyze spent culture media for any biomarkers that may be predictive of embryo health. Single-step and sequential culture media were compared in both Planer and EmbryoScope™ incubators. Single-step media resulted in better blastocyst development compared to sequential media and the EmbryoScope™ incubation system showed slight improvements in embryo development than the Planer system. The benefits of supplementing the culture medium with either insulin or insulin-like growth factor 1 (IGF-1) or culturing in a 2% O2 environment, using two different strains of mice (hybrid and C57), as well as the suitability of these strains for quality control were compared. In insulin, hybrid embryos were slower to blastulate and had a lower blastocyst rate, whereas C57 embryos were slower to the morula and faster to blastocyst stages, and lower blastocyst rate than the controls. IGF-1 showed no difference in time-lapse morphokinetics (TLM) or blastocyst rates compared to controls in both hybrid and C57 embryos. Under 2% O2, hybrid embryos showed no significant difference in TLM up to the 8-cell stage, but slowed down afterwards, resulting in blastocysts with significantly lower cell counts than the 6% O2 group. The C57 embryos were slower to reach morula and expanded blastocyst, and had lower blastocyst rates in 2%O2 vs 6%O2. The C57 strain had significant slower overall embryo development for all time points than hybrid embryos in insulin, IGF-1 and ultra-low O2, as well as lower blastocyst rates. Measurement of growth differentiation factor 9 (GDF-9) and oxidation-reduction potential (ORP) in spent media as markers for embryo health were evaluated. Day 5 human blastocysts yielded higher pregnancy rates and GDF-9 levels in spent media compared to Day 6 blastocysts, but TLM parameters showed no impact on pregnancy outcome. In Day 6 blastocysts, the non-pregnant group showed significantly faster embryo development compared to the clinically pregnant group up to the 8-cell stage and start of blastulation. GDF-9 did not show any significant differences between non-pregnant and pregnant groups of Day 5 or Day 6 embryo transfers. ORP in spent media from good quality Day 3 embryos that developed into blastocysts were significantly higher than from those that did not, with no difference in control medium ORP. Spent media from arrested embryos showed lower ORP than their corresponding controls. Arrested embryos had slower development at syngamy, morula, blastulation and blastocyst stages. The single step medium in the EmbryoScope™ is the preferred choice for embryo culture. Insulin or IGF-1 media supplementation or 2% O2 culture did not provide any benefit to embryo development. The C57 mouse strain is more sensitive and may be better to detect changes in culture conditions, and therefore better model for quality control assays. GDF-9 values decrease from Day 5 to Day 6 which gives new insight to understanding the role of GDF-9 during embryogenesis. ORP in spent media indicate that embryos that developed into blastocysts did not contribute to ROS, but maintained ORP balance.

This thesis investigates the access to IVF-treatment for people with psychiatric disabilities who intend to carry the child themselves. It explores how the Swedish welfare state resonates around people with psychiatric disabilities wanting to become parents, and how their reproductive rights might differ from others seeking the same treatment. Therefore, different official reports from the Swedish government and documents from the National Board of Health and Welfare that deals with the legal framework and state-sanctioned guidelines for medical professionals regarding IVF has been examined in a qualitive discourse analysis. Two interviews with two medical professionals working with IVF has also been conducted. The focus has been on the psychosocial interviews every treatment-seeking individual has to go through to determine if they are fit as parents. The main body of theory consists of work surrounding feminist disability studies, crip theory, discourse analysis, repronormativity and critical studies of the welfare state. This thesis set out to investigate how the demand from the government to put the best interest of the child first when deciding over who gets access to IVF are used to resonate around if people with psychiatric disabilities can be seen as fit parents. It also seeks to understand what these state-sanctioned guidelines and the way medical professionals interacts with them can say about the reproductive politics of the Swedish welfare state regarding people with psychiatric disabilities. The general conclusion is that the welfare state has implemented tools for reproductive control over the group that has been studied (particularly women and trans people) since at least the 1930’s, and while there has been significant change, the gatekeeping practises surrounding IVF can be seen as another tool for reproductive control. It is evident that people with psychiatric disabilities have to prove themselves in order to be seen as fit parents, and it is assumed that there is a risk trying to combine their psychiatric disabilities with the best interest of the child. While there is no legal framework denying this group access to IVF outright, this thesis shows that they face challenges to gain that access that people without psychiatric disabilities does not.

This thesis analyzes how compulsory heterosexuality is present in Polish legislation on women* and trans* people’s reproductive and sexual rights. The aim of this study is to increase an understanding of how compulsory heterosexuality’s presence in legislation regarding reproductive and sexual rights can consequently affect women* and trans* people in practice. By the means of qualitative content analysis and the operationalization of compulsory heterosexuality through the lens of queer feminism, this thesis analyzes three Polish legislations on reproductive and sexual rights, namely the Constitution of Poland, the Family Planning, Human Embryo Protection and Conditions of Permissibility of Abortion Act, and the Family and Guardianship Code. Adrienne Rich’s theory of compulsory heterosexuality suggests that heterosexuality is not natural, but a violent institution enforced in society through e.g. law. This thesis found that compulsory heterosexuality was present in all three legislations, and presented itself through: erasure of women* and trans* people, denial of their sexuality, idealization of heterosexuality, rape and violence, control of their bodies, robbing of their children, punishment for being LGBTQIA+, diminishing their aspirations, restricting their self-fulfillment to parenthood and marriage, keeping them from seeking reproductive care, erasure of their traditions, objectification, and dismissive language. Possible consequences identified were: invalidation and invisibilization of queer and trans* people, increased oppression, the social norm being a negative bias against LGBTQIA+ people, criminalization of LGBTQIA+ people, more deaths at the hands of the law, more parentless children, making women* and trans* people question their body or intuition, and an increase in illegal unsafe abortions or abortion tourism.