A Infertilidade é, hoje, um problema real na vida de homens e mulheres. Pelo menos, 20% da população mundial está descobrindo que o filho nem sempre chega no momento planejado. Habitualmente, um casal infértil é definido como aquele que não obteve gravidez após um ano tendo relações sexuais regulares sem o uso de qualquer método contraceptivo, apesar de alguns autores estenderem esse período para dois anos. As principais causas da Infertilidade feminina estão relacionadas com a idade da paciente, com os fatores ovulatório, cervical, tubário, peritoneal e o endometrial. A Síndrome dos Ovários Policísticos não determina, necessariamente, a Infertilidade da mulher, porém é considerada como uma de suas etiologias, dado ao desequilíbrio hormonal que a acompanha. Obrigatoriamente, o tratamento de um casal infértil deverá ser realizado após uma investigação detalhada das possíveis causas da Infertilidade. As técnicas empregadas para o tratamento da Infertilidade são conhecidas como \'Reprodução Assistida\'. Apesar de existir certo reconhecimento dos fatores emocionais presentes nessa condição, as pesquisas sobre a Infertilidade que consideram os aspectos psicológicos e psicodinâmicos ainda são incipientes, principalmente no Brasil. Diante disso, a realização da presente pesquisa teve como objetivo conhecer os psicodinamismos de mulheres inférteis portadoras da Síndrome dos Ovários Policísticos, sendo operacionalizada por meio de avaliação psicológica, a qual incluiu entrevistas, técnicas objetivas e projetivas de avaliação da personalidade, a saber: Inventário de Sintomas de Stress de Lipp (ISSL) e Teste de Apercepção Temática (TAT). As entrevistas psicológicas foram analisadas por meio do método da livre inspeção do material; o ISSL, a partir das diretrizes expostas no manual; o TAT, pelo sistema interpretativo de Morval, acrescentando uma avaliação dinâmica das estórias. A amostra foi composta com quatro mulheres que apresentaram o referido quadro, sem suspeita de fator masculino envolvido na Infertilidade. A investigação sustenta-se numa abordagem qualitativa de cunho biopsicossocial, analisando os elementos conscientes e inconscientes presentes nas mulheres inférteis, bem como o seu nível de stress. A estratégia metodológica eleita foi a do estudo de caso coletivo e os resultados mostraram que as participantes vivem em ambientes familiares conflitivos, permeados pela deficiência de holding, com presença de rivalidade fraterna, dificuldades na introjeção da figura materna, sentimentos de desvalorização, rejeição, solidão, baixa autoestima, ambivalência frente à maternidade, enfrentando a Infertilidade vivida por elas como uma doença. Com isso, essas mulheres apresentaram dificuldades em seu desenvolvimento emocional, especialmente no que se refere à integração da sexualidade na personalidade e na identificação com a figura feminina, necessária para posterior estabelecimento de sua identidade sexual. / Nowadays, infertility is a real problem in women and men\'s life. At least 20% of people around the world are realizing that a child is not always born in the planned moment. Ordinary couples, that usually have active sexual life, have 25% chances of conceiving every month. After a year, 85% of the couples obtain a pregnancy. An infertile couple is defined as the one who is not able to obtain a pregnancy after trying one year without the use of any contraception - despite the fact that some authors consider a two-year period. The treatment of an infertile couple must be performed after a detailed research of the infertility reasons. Nevertheless, many general factors such as age, habits, environment and psychological factors may also have influence in the success of the infertility treatment. The techniques are known as \"Assisted Reproduction\" and have the objective of helping the nature, obtaining a good oocyte and spermatozoa quality, that should result in a healthy pregnancy and embryo. The present study aims to make a medical, psychoanalytic, psychological and social literature, investigating unconscious aspects and the psychodynamics of women with infertility caused by Polycystic Ovary Syndrome. The inquiry is supported by a qualitative boarding of biopsych- social matrix type, and regards the understanding of the desire for maternity - however it emphasazes unconscious elements found in the infertile women, as well as their level of stress. The methodological strategy was the study of a 4 infertile women collective case, with the instruments: the TAT - Thematic Apperception Test, the ISSL - Inventory of Stress Symptoms for adults with Lipp and the psychological interview. The analysis of the data was made through the interpretation of the interview, the Thematic Apperception Test and the interpretation of the ISSL.

A ultra-sonografia é essencial para a condução de casos que irão ser submetidos aos tratamentos de reprodução assistida. Apesar de inúmeras pesquisas, não se mostrou capaz de predizer o sucesso do procedimento e apenas a medida da espessura endometrial tem algum valor prognóstico. Com a introdução da ultra-sonografia tridimensional, cresceu o interesse no assunto, na esperança que a possibilidade de uma avaliação espacial mais exata dos tecidos e da vascularização pudesse melhorar nossa habilidade de predizer a resposta à estimulação ovariana ou determinar a receptividade do meio endometrial. Objetivamos nesta revisão apresentar os resultados dos trabalhos envolvendo a ultra-sonografia tridimensional e a reprodução assistida, e suas possíveis aplicações nestes procedimentos. / Ultrasonography is essential to guide the cases that will be submitted to assisted reproduction. In spite of the great amount of researchs, it is not able to predict the sucess of the treatment and only the endometrial thicknesshas some prognostic value. With the introduction of three-dimensional ultrasound, therewas a new curiosity incoming, in the expectancy that the possibility of volume assessment of tissues and its vascularization could improve our ability to determine endometrial receptivity or to predict the patient response to ovarian stimulation. In this review we intend to present the results of researchs about three-dimensional ultrasound and assisted reproduction as well as its possible clinical aplications.

This socio-legal thesis explores the highly topical and underexplored issue of the legal regulation of gay and lesbian collaborative co-parenting in England & Wales, drawing on British Columbia (Canada) as a jurisdiction where this issue has been considered in more detail. These families involve reproductive collaborations between single or partnered lesbians and gay men where a child is conceived through assisted reproduction and each of the adults remain involved in the child’s life. Collaborative co-parenting can take a variety of forms, each of which is distinguishable from gamete donation or surrogacy because each of the adults continues to exercise some sort of parental role in relation to the child. Since the adoption of the UK Human Fertilisation and Embryology Act 2008, it has been possible for two female parents to appear on a child’s birth certificate following birth and for two male parents to be registered following a court parental order. The UK parliament has not, however, gone so far as to allow more than two parents to be legally recognised. This contrasts with the approach in British Columbia, which allows three parents to be registered on the birth certificate in cases of same-sex parenting involving assisted reproduction. In both Canada and the UK, however, courts have struggled to balance the interests of those involved in these collaborative co-parenting arrangements with varying degrees of success. This thesis combines detailed, comparative doctrinal analysis with a series of case studies of collaborative co-parenting families gathered from in-depth interviews with co-parents and legal professionals in Canada and the UK. In doing this, a typology of collaborative co-parenting families is advanced. The conclusion the thesis draws from this is that gay and lesbian collaborative co-parents are not an homogenous group and the law’s adherence, in England & Wales, to a one-size-fits-all, dyadic approach to parenthood based on the intimate couple does not adequately reflect the needs of the adults in this situation nor what is in the best interests of the child. One of the key findings to emerge from this study and the typology of collaborative co-parenting it advances is that the legal framework in England & Wales risks overlooking the interests of gay men who are involved in collaborative co-parenting in its attempt to protect women-led homonuclear families, even where this is not consistent with their agreed role in the child’s life. Therefore, a central recommendation is that any reform to this area of law should move away from a prescribed dyadic parenting model as the basis for regulating parent-child relationships in collaborative co-parenting families. Instead, it should require a careful consideration of pre-conception intentions, recorded where possible in a parenting solidarity agreement.

Assisted reproductive technologies are the phenomenon of the nowadays. With respect to the growing possibilities of the medical science and its impact on lives of individuals it is very important to consider the legal regulation of assisted reproduction. The aim of the thesis is to analyse the law of assisted reproduction in the Czech Republic in wider context in three chapters. The first chapter provides the reasons why it is necessary to regulate assisted reproduction, even though the law does not and should not interfere with the natural reproduction, reflecting the power of the modern reproductive technologies and new concerns it raises. Moreover, it focuses on the issues which need to be remembered when setting the legal rules in general, including the ethical aspects and access to treatment, considering the concept of reproductive autonomy of individuals. The law of assisted reproduction in the Czech Republic is described in the second chapter, which includes the throughout analysis of the Czech law. The thesis includes the explanation of essential legal definitions as assisted reproduction and artificial insemination and summarises the legal conditions, under which the treatment by assisted reproduction technologies can be accessed including the financial issues. Moreover, surrogacy and its...

The aim of the diploma thesis is to evaluate the position of the Czech Republic in the field of health tourism, particularly assisted reproduction. The theoretical chapters include the definitions of the following topics: health tourism, organization of tourist agents and tour operators, marketing methods and the issue of assisted reproduction. In the analytic part, the offer of the Czech Republic in this field is described, the survey investigating customer behaviour of the patients as tourists is evaluated and SWOT analysis of the Czech Republic and of its offer in the field of assisted reproduction is conducted. In the last part of the thesis, a tourism product including a fertility treatment is created and some distribution channels are suggested.

The main goal of this thesis is the analysis of multiple-births in Czech Republic between the years of 1950 and 2005 including the international comparison and assess of the influence of assisted reproduction on occurrence of multiple-births. The thesis is divided into five different parts. The first part is dedicated to the analysis of fertility according to a succession of births in Czech Republic while using the indicators of total fertility, the average age of mothers in the time of childbirth and the total number of new-born babies. The second part focuses on multiple-births considering both historical and contemporary point of view and on possible risks for both the mother and the foetus. Next part describes the assisted reproduction, its history, present and commonly used methods. The fourth part is dedicated to the influence of assisted reproduction on the occurrence of multiple-births and to the analysis of multiple-births with the use of absolute and relative number of mono-births and multiple-births indicators, indicators of total fertility, masculinity index, the rate of stillborn babies and the proportion of children born outside of marriage. The last part compares the development of multiple-births within the European countries according to NIDI 1999 classification.

The subject of my thesis is to analyze the evolution of the reproductive behavior of the Czech population to assess changes over time, especially after 1989 and to analyze the success of assisted reproduction in the Czech Republic in the period 2007 to 2013. It is divided into several parts. The first theoretical part describes the change in reproductive behavior after 1989, risk factors and causes of female and male infertility, possible tratments of diagnosed infertility and various methods of assisted reproduction. Another analytical part is dedicated to the evolution of fertility and the phenomenon of childlessness of young women. Some indicators are compared with selected European countries for an overall assessment. Subsequently are analyzed in detail the most widely used methods of assisted reproduction IVF, ICSI and kryoembryotransfer and of using indicators Pregnancy rate and Take-home baby rate is assessed their effectiveness. The thesis is supplemented by own research reproductive and family behavior on a selected sample of the Czech population.

The main objective of this study is to study the juridical and constitutional profile of the right to the genetic identity of the human person in the juridical and constitutional order of the mother country, especially as a basis for the consecration, even if implicit, of this right in the 1988 Constitution as a manifestation and principle of the dignity of the human person, of the general implicit clause for the protection of all essential manifestations of human personality and of the fundamental right to life, with particular reference to the anonymity or not of the donor of genetic material in the heterologous human reproduction technique, the present research will have as problematic to investigate the heterologous human reproduction, medically assisted, specifically with respect to the fundamental right of the person who was generated by this technique to know the genetic origin (civil identity) of the donor, even if in confrontation with the right to confidentiality of male gametes donors and / or u female. We have made a brief analysis on the constitutionalisation of private law, as well as seeking to extract the most relevant lessons about the constitutional principles applicable to the institute, especially the dignity of the human being, that it is an unquestionable fundamental right to the right of personality, aiming, therefore, to harmonize the rights in question, since the right to know the biological identity is not incompatible with the affective affiliation, especially that both the search for genetic ancestry and the secrecy of the gametes donors, are protected by the Brazilian legal system. In the first chapter of the development, we highlight the historicity of assisted human reproduction techniques, and we demonstrate that currently the procedure for the implementation of these techniques is based on the RESOLUTION of the CFM nº 2.168 / 2017 and that is processed in the National Congress the Draft Law 115 / 15, which establishes the Statute of Assisted Reproduction. In the second chapter, we emphasize that the constitutional protection granted to the family extends to the protection of the freedom of its members, marking, in this sense, the social function of assisted human reproduction. In the third chapter, we analyze that the direct to the genetic identity has its foundation in the principle of the human dignity, and does not imply presumption of filiation; and that when there is a collision between other fundamental rights, it will be necessary to establish an axiological hierarchy, placing the consideration of such rights in the hands of the Brazilian judiciary. / O presente trabalho tem como objetivo precípuo o estudo sobre o perfil jurídico-constitucional do direito à identidade genética da pessoa humana na ordem jurídico-constitucional pátria, especialmente fundamentando a consagração, ainda que implícita, de tal direito na Constituição de 1988, como manifestação e exigência do princípio da dignidade da pessoa humana, da cláusula geral implícita de tutela de todas as manifestações essenciais da personalidade humana e do direito fundamental à vida, com destaque ao anonimato ou não do doador do material genético na técnica de reprodução humana heteróloga, vez que a presente pesquisa terá como problemática a ser investigada a reprodução humana heteróloga, medicamente assistida, especificamente no que toca ao direito fundamental da pessoa que foi gerada por essa técnica de conhecer a origem genética(identidade civil) do doador, mesmo que em confronto com o direito ao sigilo dos doadores de gametas masculino e/ou feminino. Fizemos uma breve análise sobre a constitucionalização do direito privado, bem como buscamos extrair as lições mais relevantes acerca dos princípios constitucionais aplicáveis ao instituto, notadamente o da dignidade da pessoa humana, repita-se, que se revela um inquestionável direito fundamental frente ao direito da personalidade, objetivando, por conseguinte, harmonizar os direitos em questão, posto que o direito de conhecer a identidade biológica não se revela incompatível com a filiação afetiva, máxime que tanto a busca pela ascendência genética, quanto o sigilo dos doadores de gametas, encontram-se resguardados pelo ordenamento jurídico brasileiro. No primeiro capítulo do desenvolvimento, destacamos historicidade das técnicas de reprodução humana assistida, e demonstramos que atualmente o procedimento para a efetivação das aludidas técnicas baseia-se na RESOLUÇÃO do CFM nº 2.168/2017 e que tramita no Congresso Nacional o Projeto de Lei 115/15, que institui o Estatuto da Reprodução Assistida. No segundo capítulo, destacamos que a proteção Constitucional deferida à família estende-se à tutela da liberdade de seus membros, marcando, nesse sentido, a função social da reprodução humana assistida. No terceiro capítulo, analisamos que o direto à identidade genética tem seu fundamento no princípio da dignidade humana, e não implica em presunção de filiação; e que quando houver colisão entre outros direitos fundamentais, será necessário estabelecer uma hierarquia axiológica, colocando-se a ponderação de tais direitos nas mãos da magistratura brasileira. / São Cristóvão, SE

Introduction: The desire to have a biological child transcends race, religion and socio-economic status. However for those faced with infertility, the financial resources needed to conceive are often not available. Current research in assisted reproduction has gravitated towards cost reduction to address restricting financial factors, without compromising quality of treatment. One such initiative is the development of a low-cost embryo culture method by The Walking Egg foundation. This method utilizes a standard chemical reaction and simple equipment to equilibrate culture media pH and to regulate temperature; both aspects were investigated in this study. An exploration into the insemination concentration to achieve oocyte fertilization was also undertaken. Methods: Quality control of temperature regulation on six different heating devices, including a comparison of inter- and intra-variations was carried out. The utilization of citric acid and bicarbonate of soda for carbon dioxide production, which subsequently facilitate setting of pH values, was tested by injecting increasing citric acid volumes (1.2 ml – 3.0 ml in 0.2 ml increments) into set volumes of bicarbonate of soda. Further investigation evaluated gas production at various temperatures (37°C, 25°C and 15°C), at increasing intervals (16 – 30 hours) of equilibration and these were compared by measuring pH of the culture media. The influence of altitude on pH was explored by repeating the chemical reaction experiment at five different locations in South Africa. Furthermore, the addition of water to citric acid before gas generation was explored. The minimal insemination concentration needed for fertilization was determined by the addition of decreasing numbers of spermatozoa to non-fertilized bisected oocytes. The experiment was repeated with a selected sperm insemination number in 1 ml or 50 μl culture media to compare the tested culture system with conventional culture. Spermatozoa bound to the hemi-zonae were counted with the aid of an inverted phase contrast microscope. Hemi-zonae with bound sperm were also stained with ethidium homodimer and evaluated using a confocal laser-scanning microscopy system. After removal of hemi-zonae, the spermatozoa in culture were isolated for deoxyribonucleic acid fragmentation analyses and reactive oxygen species presence in the culture media was measured. Additionally, reactive oxygen species generation in simulated culture was measured over time. Results: All the equipment tested bar one, the warming oven, proved useable with the simplified Walking Egg in vitro fertilization culture system. By decreasing the citric acid volumes, it was indicated that 1.8 ml citric acid, diluted with 1.2 ml water, is the optimal volume to facilitate the required culture media pH. Omitting the water dilution from citric acid volumes affected the culture media pH adversely, however reducing the temperature during gas equilibration did not. A change in altitude had no effect on culture media pH. Lower insemination numbers resulted in decreased sperm binding, with 2 x 103 motile sperm insemination providing the lowest number to still obtain sufficient sperm–zona binding (≥20 sperm bound). Incubation in 1 ml vs. 200 μl culture media indicated decrease in sperm bound. Sperm deoxyribonucleic acid fragmentation and the presence of reactive oxygen species in the culture media were similar in both the test and control groups. A comparison over time revealed less reactive oxygen species in 1 ml culture media, from the simplified Walking Egg in vitro fertilization culture system after three days of culture, than 200 μl culture media drops under oil, from conventional culture after 18 hours, however the results were not statistically significant. Discussion: Purpose-made heating devices provide superior stabilization of culture media temperature. When selecting a heating device, intra-variations should be considered. Culture media can be manipulated to the required pH by carbon dioxide production, with meticulous attention paid to the citric acid volumes used. However, if gas generation is performed at room temperature, equilibration time must be increased. In conventional culture, the minimum insemination number can be reduced to 2 x 103 motile sperm. Due to lower binding of sperm in large volumes of culture media, 2 – 5 x 103 motile sperm should be considered for the simplified culture system, depending on a holistic consideration of all sperm parameters. Extended culture for at least three days with the simplified culture system can be performed without increasing reactive oxygen species present in culture media. Further research of this novel culture method should include the application of the culture method in a South African environment. / Dissertation (MSc)--University of Pretoria, 2017. / Obstetrics and Gynaecology / MSc / Unrestricted

Surrogacy is a contemporary and highly controversial social issue. It is closely linked to assisted reproduction, bioethics and the status rights of the individual. It is generally considered an alternative, extreme way to treat infertility, but it raises a number of moral, ethical and legal issues. Solutions are approached by individual states on individual bases, in the context of cultural, historical and religious values and traditions professed by their societies. This work deals with the comparison of individual national views on surrogacy, which are reflected in the legislation. It compares the German, French and Spanish regulations, as a representative sample of restrictive approaches and the British and Ukrainian regulations, which in turn reflect the supportive attitude toward surrogate motherhood. The dynamic development experienced by the legislation on surrogacy in Portugal is highly interesting. The ruling of the Portuguese Constitutional Court provides valuable insight into the current thinking of the democratic rule of law on surrogacy and its adjustment to meet the standard of human rights protection. The work also describes the dangers posed by cross-border surrogacy using relevant case law, especially with regard to the protection of the best interests of the surrogate child. It...