Orientador: Maria José Martins Duarte Osis, Maria Yolanda Makuch / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-11-07T13:36:06Z (GMT). No. of bitstreams: 1 Gradvohl_SilviaMayumiObana_M.pdf: 2337458 bytes, checksum: 4aaab62f6d0a20f99280461325358051 (MD5) Previous issue date: 2011 / Resumo: Objetivo: Avaliar o estresse de homens e mulheres, membros de casais inférteis, e identificar fatores associados à sua ocorrência. Sujeitos e métodos: Estudo de corte transversal com 101 homens e 101 mulheres que realizavam primeira consulta no Ambulatório de Esterilidade da Unidade de Reprodução Humana do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas. Os participantes autorresponderam o Inventário de Problemas de Fertilidade para verificar o nível de estresse em relação aos domínios: relacionamentos sociais, vida sem filhos, relacionamento conjugal/sexual e maternidade/paternidade; e um questionário de caracterização socioeconômica e da infertilidade. Os dados foram coletados entre outubro de 2009 e março de 2010. Realizou-se análise bivariada através dos testes qui-quadrado e exato de Fisher, considerando p<0,05 significativo. Posteriormente realizou-se análise multivariada de correspondência, na qual foram incluídas as variáveis com p< 0,20. Resultados: Em cada domínio avaliado foi maior a proporção de participantes com estresse alto, exceto no domínio vida sem filhos. A análise bivariada apontou associações entre o nível de estresse no domínio relacionamentos sociais e as variáveis sexo e idade; no domínio vida sem filhos as variáveis sexo, ter feito tratamento anterior para engravidar, e quem sabia da dificuldade para engravidar estiveram associadas ao nível de estresse. Sexo, qualidade do relacionamento conjugal, alguém saber da dificuldade para engravidar associaram-se ao estresse no domínio relacionamento conjugal/sexual; no domínio maternidade/paternidade associaram-se às variáveis sexo e qualidade do relacionamento conjugal. Na análise multivariada por correspondência observou-se que as variáveis que se aproximaram do estresse alto no domínio relacionamentos sociais foram: ser do sexo feminino, ter o problema para obter a gravidez, e considerar a qualidade do relacionamento conjugal regular. No domínio vida sem filhos as variáveis que se aproximaram do estresse alto foram: ser do sexo feminino, ter idade entre 18 e 24 anos, e a pessoa ter o problema para obter a gravidez. Ser do sexo masculino, considerar a adoção, não ter filhos, pais e/ou sogros e outras pessoas saberem da dificuldade para engravidar, e considerar a qualidade do relacionamento conjugal ótimo aproximaram-se do alto nível de estresse no domínio relacionamento conjugal/sexual. Para o domínio maternidade/ paternidade evidenciou-se que as variáveis ser do sexo feminino, considerar a qualidade do relacionamento conjugal regular, ter idade entre 25 e 35 anos, e praticar religião evangélica ou protestante aproximaram-se do alto nível de estresse. Conclusão: Homens e mulheres, membros de casais inférteis, apresentaram alto estresse em quase todos os domínios avaliados. A variável sexo esteve associada ao estresse mais alto em todos os domínios. Idade, quem tinha o problema para obter a gravidez, quem sabia da dificuldade para engravidar e qualidade do relacionamento conjugal estiveram associadas ao maior estresse nos vários domínios estudados. Os resultados sugerem que o apoio psicológico para casais inférteis que buscam tratamento é importante e que as intervenções psicológicas devem ser diferentes para homens e mulheres / Abstract: Objective: To evaluate the level of stress in men and women, members of infertile couples, and to identify the variables associated with its occurrence. Subjects and Methods: Cross-sectional study with 101 men and 101 women, members of infertile couples, consulting for the first time for infertility treatment at the Human Reproduction Unit of Center for Integral Assistance to Women's Health at in the State University of Campinas. Participants auto respondend the Inventário de Problemas de Fertilidade to evaluate the level of stress in four scales: social relationships, life without children, marital/sexual relationship and maternity/paternity, and a questionnaire with socioeconomic and reproductive variables. Data were collected between October 2009 and March 2010. Bivariate analysis was performed using the Chi-square and Fisher's Exact, considering p <0.05 significant. Multivariate analysis of correspondence was performed and included variables with p < 0.20. Result(s): Overall, the participants presented high level of stress in all scales, except in life without children. Bivariate analysis showed associations between level of stress and the variables gender and age in the social relationships scale; in the life without children scale, gender, had previous infertility treatment, and who knew about the difficulty to obtain pregnancy were associated with stress. Gender, marital relationship quality, someone know about the difficulty to obtain pregnancy were associated with the marital/sexual relationship scale; gender and marital relationship quality to the maternity/paternity scale. Multivariate analysis of correspondence showed that variables associated with the high level of stress in the social relationships scale were to be a woman, have problem to obtain pregnancy, and consider the marital relationship quality regular. In the life without children scale, variables associated with the high level of stress were to be a woman, age between 18 and 24 years, and have problem to obtain pregnancy. To be a man, consider adoption, to be childless, parents and/or in-laws and other people know about the difficulty to obtain pregnancy, and consider the marital relationship quality excellent were associated with high level of stress in the marital/sexual relationship scale. For the maternity/paternity scale, to be a woman, consider the marital relationship regular, age between 25 and 35 years, practice evangelical religion or protestant were associated with high level of stress. Conclusion(s): Men and women showed high level of stress in almost all scales evaluated. The variable gender was associated with high level of stress in all scales. Age, who has the problem to obtain pregnancy, who knew about the difficulty to obtain pregnancy, and marital relationship quality were associated with increased stress in the various scales evaluated. The results suggest that psychological support for infertile couples seeking treatment is important and psychological interventions should be different for men and women / Mestrado / Fisiopatologia Ginecológica / Mestre em Ciências da Saúde

La infertilidad en el Perú, actualmente no se encuentra considerada como una enfermedad importante para el ámbito de la salud pública, no obstante, afecta al 15% de la población en edad reproductiva y la demanda de Centros de Reproducción Asistida cada vez aumenta. Se considera que el factor masculino contribuye con el 40% de los casos como factor de infertilidad en la pareja. El análisis clínico del semen aporta al conocimiento de la calidad seminal que pueda presentar, que luego permitirá tratar a los pacientes exitosamente. El objetivo de este estudio fue evaluar la calidad seminal de pacientes con problemas de fertilidad que asistieron al Centro de Reproducción Humana de Lima (NACER) durante el periodo de Mayo del 2015 hasta Mayo del 2016. La población de estudio estuvo conformada por 150 individuos con edades comprendidas entre 27 y 70 años, a quienes se les realizó un análisis seminal, donde se evaluó parámetros seminales como volumen, viscosidad, pH, vitalidad, concentración y morfología espermática, según el manual del líquido seminal de la Organización Mundial de la Salud en su 5ta edición 2010. Se calcularon los estadísticos descriptivos, frecuencias y medias de las anomalías más frecuentes y se compararon con una condición normal en los parámetros seminales más importantes en fertilidad. Todos los análisis se realizaron con un nivel de confianza de 95% utilizando el programa SPSS versión 23 para Windows 2010, además se realizó una tabla de frecuencias que fue utilizada para obtener gráficos en excel indicando la prevalencia e incidencias de las alteraciones en los espermatogramas realizados. Del total de muestras analizadas el 50.6% presentaron por lo menos un parámetro alterado, mientras que el 49.3% de los casos están sobre los valores de referencia establecidos en la 5ta edición del manual de la OMS (2010). La astenozoospermia fue la anomalía más prevalente en los pacientes con un porcentaje de 28%, seguido de la oligozoospermia e hipospermia con un porcentaje de 19.3% en ambos casos. En las características macroscópicas se encontró que 45 (30%) de los casos evaluados presentaron anormalidades en su consistencia y el 8.6% de los casos estudiados presentaron un cuadro de azoospermia. La presencia de alteraciones como astenozoospermia, oligozoospermia, hipospermia y teratozoospermia refleja la mala calidad seminal poblacional que viene experimentando el hombre en los últimos años.Infertility in Peru is not currently considered an important disease for the field of public health; however, it affects 15% of the reproductive-age population and demand for Assisted Reproduction Centers each time increases. It is considered that the male factor contributes 40% of cases as a factor of infertility in couples. The clinical analysis of semen provides the knowledge of seminal quality that can present, that then it will allow treat patients successfully. The aim of this study was evaluate the semen quality of patients with fertility problems who attended to the Human Reproduction Center of Lima (NACER) during the period May 2015 to May 2016. The study population consisted of 150 individuals with aged between 27 and 70 years who underwent a seminal analysis, where seminal parameters was assessed such as volume, viscosity, pH, vitality, concentration and sperm morphology according to criteria of the World Health Organization (2010). Descriptive statistics, frequencies and media of the most frequent anomalies were calculated and compared with a normal condition in the most important seminal parameters in fertility. All analyzes were performed with a confidence level of 95% using SPSS version 23 for Windows 2010, also it was performed a frequency table that was used for get graphics in excel indicating the prevalence and incidence of alterations in semen analysis made. Of the total samples analyzed 50.6% showed at least one parameter altered, while 49.3% of cases fulfill the benchmarks set out in the 5th edition of the WHO manual (2010). The astenozoospermia was the anomaly most prevalent in the patients studied with a percentage of 28%, followed by oligozoospermia and hipospermia with a percentage of 19.3% each anomaly. In the macroscopic characteristics it found that 45 (30%) of cases evaluated presented abnormalities in consistency and 29% of the cases studied presented azoospermia. The presence of alterations as astenozoospermia, oligozoospermia, hipospermia and Teratozoospermia reflects the decline in semen quality population that man has experienced in recent years.

L’intégration du sexuel infantile dans une organisation sexuelle régie par les capacités spécifiques au sexuel adulte est entravée par la superposition psychique entre l’inachèvement de la sexualité infantile et l’infertilité. L’infertilité est autant liée à des fantasmatiques oedipiennes et à une sexualité infantile phallique (avec les rivalités et les tendances parricides et infanticides correspondantes) qu’aux ambivalences infantiles plus ou moins objectales ou narcissiques de l’analité. De telles représentations menacent le refoulement et déclenchent des mouvements défensifs chez les patients, entraînant la mise en acte des fantasmatiques inconscientes en jeu. Dans une telle conjoncture, la compréhension de l’infertilité et sa prise en charge sont facilement mises en impasse. L’intervenant est entraîné dans des agis contretransférentiels qui soit confirment les fantasmes d’incapacité des patients, soit laissent ces derniers seuls avec les fantasmes en question, ce qui rend stérile l’intervention. La fonction psychique médiatrice du psychologue peut nécessiter d’être étayée par un dispositif qui la préserve permettant la mise en représentation, la différenciation et l’intégration psychique des éléments en jeu. / The integration of infantile sexuality in a sexual organisation governed by the capacities specific to adult sexuality is hindered by the psychic superposition of the incompletion of infantile sexuality and infertility. Infertility is both related to oedipal fantasies and infantile phallic sexuality (with the corresponding rivalries and the parricide and infanticide tendencies) and to the more or less objectal or narcissistic infantile ambivalences of anality. Such representations threaten repression and set off defensive reactions in the patients, which leads to the acting out of unconscious fantasies at stake. In such a situation, the comprehension of infertility and its taking charge of are easily put in impasse. The psychologist is led into countertransferential acting outs that either confirm the patients’ incapacity fantasies or leave them alone with these fantasies, making the intervention sterile. The psychologist’s mediatory psychic function can require to be upheld by devices that protect it, allowing the representation, the differentiation and the psychic integration of the elements at stake.

A leading cause of male infertility is genetic variation in genes required for sperm formation and/or function. There is evidence to suggest PACRG is involved in mammalian spermatogenesis. Specifically, the loss of Pacrg function causes a spermatogenic defect and male infertility in mice. To investigate if PACRG plays a similar role in human spermatogenesis, the localisation of PACRG was determined in human testis. Using an immunohistochemical approach, this study demonstrated that PACRG is localised to the human sperm flagella. To investigate a potential role for PACRG in human male infertility, sequence analysis and an association study were performed. Sequence analysis did not identify any pathological alterations. However, 1 of 3 variants identified (rs9347683) was shown to be significantly associated with male infertility by association analysis (p=0.009, Odds Ratio=1.6, n=766). / A high degree of structural and functional conservation exists between different types of motile cilia/flagella. Evidence from studies in C.reinhardtii and T.brucei indicate Pacrg is necessary for axoneme formation and microtubule stability. To test the role of the mammalian homologue, this study characterised the Pacrg knockout mouse, quakingviable (qkv) and generated Pacrg transgenic qkv mice (qkv-Tg). Using immunohistochemistry and immunoelectron microscopy this study demonstrated that Pacrg was localised to the axonemal microtubule doublets of sperm and ependymal cilia. The absence of Pacrg was associated with compromised sperm flagella formation and male infertility. In addition, histological and MRI analysis of qkv mutant mice revealed hydrocephalus. Specifically, qkv mutant mice showed a ~2.5 fold expansion of the lateral ventricle area compared to wildtype mice. The hydrocephalus phenotype was associated with a reduction in ependymal cilial beat frequency (CBF). Transgenic expression of Pacrg was sufficient to rescue the hydrocephalus and infertility phenotypes. In conclusion, this study has demonstrated that Pacrg is a novel axonemal protein in a subset of motile cilia and loss of Pacrg function results in spermiogenic defects and hydrocephalus in mice. Further, this study has shown that variations in the human PACRG promoter are a risk factor in human male infertility. Collectively these data provide evidence for a conserved role of PACRG in the cilial axoneme. This suggests the protein may be a candidate for a variety of human diseases characterised by cilial dysfunction.

Background: One in ten couples suffers from some form of involuntary childlessness or infertility in Sweden. Involuntary childlessness or infertility is when an individual or a couple has a desire for a child but are unable to conceive on their own. To suffer from involuntary childlessness can be a mental strain that can result in a personal crisis, where the existential issues become central and contested. Regardless of the reason for their changed life world is because of involuntary childlessness or infertility, it is always important for the nurse to have an understanding of individual’s life-changing world and experiences.  Aim: The aim of the study was to describe men and women experiences of involuntary childlessness during investigation and treatment. Method: Selected method was a literature review. The study was based on articles from systematic and unsystematic searches in databases and analyzed from the chosen method. Results: Four main themes emerged from the analysis, 'The changing life-world', 'The mental strain', 'Perceptions of relationships and social life' and 'experiences related to treatment'. Conclusion: Being involuntarily childless and infertile create a mental, physical and social stress. Clinically, this means a responsibility to offer a personalized support. For the nurse it is important to have an understanding of individual life-world and how the involuntary childlessness affects them.

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Thesis (M. Phil.)--University of Hong Kong, 2001. / Includes bibliographical references (leaves.

Thesis (Ph. D.)--Drexel University, 2003. / Includes abstract and vita. Includes bibliographical references (leaves 100-114).