Thesis (M.A.)--Trinity International University, 2000. / Abstract. Includes bibliographical references (leaves 67-72).

Inaug.-Diss.--Berlin. / At head of title; Aus der chirugischen abteilung des krankenhauses "Am urban" zu Berlin (Direktor: prof. dr. Gohrbandt). Lebenslauf. "Literaturangabe": p. [57]-58.

Thesis (M.D.)--University of Hong Kong, 1988. / Also available in print.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Endometriose à uma doenÃa caracterizada pela presenÃa de glÃndulas e estroma endometriais for a da cavidade uterina e do miomÃtrio. Clinicamente pode causar tumores, dor (dor pÃlvica crÃnica, dispareunia e dismenorrÃia) e infertilidade. EvidÃncias correntes indicam que as cÃlulas endometriais ectÃpicas durante a menstruaÃÃo (menstruaÃÃo retrÃgrada) jogadas a cavidade peritoneal em mulheres com endometriose, implantam e proliferam ectÃpicamente no peritÃnio e em outros ÃrgÃos, uma aÃÃo que està associada com a mobilizaÃÃo de cÃlulas do sistema imune para a cavidade peritoneal e com uma profunda resposta imune e local. Um aumento na quantidade do lÃquido peritoneal à um achado caracterÃstico na endometriose e està associado com a presenÃa aumentada de cÃlulas imunes como os macrÃfagos assim como um sem numero de substancias solÃveis derivadas daqueles macrÃfagos como prostaglandinas, interleucinas, TNF, fatores de crescimento e espÃcies reativas de oxigÃnio. à provÃvel por isso que novas medicaÃÃes para essa doenÃa evoluam no futuro prÃximo, para isso devem-se elucidar os mecanismos de todas essas substÃncias na patogÃnese da endometriose. Os objetivos desse trabalho sÃo verificar: (i) os efeitos de drogas inibidoras seletivas da enzima ciclooxigenase tipo 1 (COX-1) responsÃvel pelos eventos fisiolÃgicos do organismo e pela induzida COX-2, envolvida nos processos inflamatÃrios; (ii) os efeitos do L-NAME, um antagonista competitivo do Ãxido nÃtrico assim como a atividade da NO-sintase avaliada pelo ensaio da citrulina marcada (3H-labelled citrulline from labelled L-arginine) e (iii) os efeitos da drogas moduladoras de TNF-alfa (Talidomida e pentoxifilina) sobre o desenvolvimento da endometriose experimental e suas repercussÃes sobre a dor e a fertilidade em ratas. Endometriose experimental foi desenvolvida em ratas Wistar e os animais foram divididos em grupos testes. O tratamento foi dado do 5o ao 15o dia da induÃÃo da endometriose para verificar os efeitos sobre o crescimento dos endometriomas avaliados pelo peso Ãmido e histopatologia e agudamente 30 minutos antes do estÃmulo nociceptivo para avaliar a dor (contorÃÃes abdominais) e a fertilidade investigada pela percentagem de ratas grÃvidas e pelo numero de embriÃes por corno uterino. Aspirina (30mg/kg - um inibidor de seletividade intermediÃria entre as COXs); piroxicam (1mg/kg) e indometacina (2mg/kg), um inibidor seletivo especÃfico da COX-1 e nabumetona (5 e 15mg/kg) e meloxicam (0,4mg/kg) inibidor seletivo relativo da COX-2 foram usados por via oral. Todos os tratamentos realizados diminuÃram significativamente a dor quando avaliadas pelo teste de contorÃÃes. A mÃdia dos pesos Ãmidos dos endometriomas (g%) sÃo mostrados (Controle endometriose: 0,595Â0,085; Aspirina: 0,122Â0,019; piroxicam: 0,766Â0,35; indometacina: 2,05Â0,96 e para Nabumetona 5mg: 0,52 0,032; Nabumetona 15mg: 0,135Â0,03 e meloxicam: 0,387Â0,04). Com relaÃÃo à fertilidade, a percentagem de ratas grÃvidas foi: Controle endometriose, 40%; controle intacto, 100%; Falso-operado, 100%; Indometacina, Zero%; meloxicam, 60%; Aspirina, 60% e Nabumetona 5 e 15, 50 e 58% respectivamente. Os tratamentos com Aspirina e Nabumetona diminuÃram significativamente o desenvolvimento dos endometriomas assim como contribuÃram para o alivio da dor e incrementaram a fertilidade. Estes resultados sugerem o papel da COX-1 e -2 na fisiopatologia da dor relacionada a endometriose assim como a infertilidade e o crescimento dos endometriomas. A atividade da sintase de Ãxido nÃtrico realizada atravÃs da citrulina marcada dada em pmol de citrullina/mgxproteÃna/min à expressa nos endometriomas. A iNOS no 5o dia: 1,94+0,5; 10o dia: 2,46Â0,2 e no dia 15: 1,17Â0,3 assim como com a cNOS que diminui de forma tempo-dependente (5 dia: 2,48Â0,7; 10 dia: 1,8Â0,19; e dia 15: 0,78Â0,3). Essa diminuiÃÃo da atividade da cNOS à provavelmente devida a descamaÃÃo endometrial que ocorre normalmente com a evoluÃÃo da doenÃa assim como devida a fibrose que circunda os endometriomas e o aumento da iNOS pelo processo inflamatÃrio peritoneal encontrado na endometriose. O uso do L-NAME tambÃm fez diminuir os pesos Ãmidos dos endometriomas assim como melhorou a fertilidade e aliviou a dor de forma dose-dependente. A Pentoxifilina (30mg/Kg/day) administrada entre o 5 e o 14 dia da induÃÃo da endometriose foi efetiva na diminuiÃÃo da expressÃo da sintase de Ãxido nÃtrico, ambas constitutiva como induzida. Os resultados desse estudo sugerem o envolvimento do Ãxido nÃtrico no desenvolvimento da endometriose experimental assim como nas suas repercussÃes: dor e infertilidade. Os nÃveis peritoneais de TNF-alfa em ratas intactas foram de 28,95Â1,18ng/ml. Os nÃveis de TNF-alfa aumentaram no lÃquido peritoneal de ratas endometriÃticas de forma tempo dependente. Drogas que modulam o TNF foram efetivas em reduzir o crescimento de endometriomas experimentais: Controle: 0,595Â0,085g%; pentoxifilina (30 mg/Kg): 0,06Â0,008g%; talidomida (5mg/Kg): 0,20Â0,049g% e dexametasona (0,2mg/Kg): 0,145Â0,02g%. Essas drogas tambÃm aliviaram a dor e incrementaram a fertilidade. Esses resultados sugerem o envolvimento do TNF na fisiopatologia da endometriose. / Endometriosis is a disease characterized by the presence of endometrial glands and stroma out of the uterine cavity and of the myometrium. It may cause tumor, pain (chronic pelvic pain, dyspareunia and dysmenorrhea) and infertility. Currently available evidence indicates that endometrial cells misplaced during menses into the peritoneal cavity in women with endometriosis, implant and proliferate in the ectopic locations, an action that is associated with mobilization of the immune cells into the peritoneal cavity and a profound local and systemic immune response. An increase in the amount of peritoneal fluid is a characteristic finding in endometriosis and associated with improved presence of immune cells like macrophages as well as a wide range of soluble substances derived from those macrophages like prostaglandins, interleukins, TNF, growth factors and reactive oxygen species. It is likely the role of medication for this disease will expand in the future. Also the mechanisms of all these substances must be elucidated in the pathogenesis of endometriosis. The purpose of this study is to verify: (i) the drugs effects that selectively inhibits one of the enzymes ciclooxigenase type 1 (COX-1) responsible for the physiologic events of the organism and the induced COX-2, involved in the inflammatory process; (ii) the effects of L-NAME, a competitive antagonist of nitric oxide as well as NO synthase actvity assayed by 3H-labelled citrulline from labelled L-arginine and (iii) the effects of TNF-alfa modulating drugs (Thalidomide and pentoxifilline) on the development of experimental endometriosis and on its related pain and infertility in female rats. Experimental endometriosis was developed in female Wistar rats and the animals were divided into tests groups. The treatment was given from the 5th to the 14th day of endometriosis induction to verify the effects on growth of endometriomas evaluated by its wet weight and histopathology and acutely 30 minutes before the nociceptive stimulus in order to evaluating pain (writhing test) and fertility was assessed through the percentage of pregnant rats. Aspirin (30mg/kg - an inhibitor of intermediate selectivity among COXs); piroxicam (1mg/kg) and indomethacin (2mg/kg), specific selective inhibitors of COX-1 and nabumetone (5 and 15mg/kg) and meloxicam (0.4mg/kg) relative selective inhibitors against COX-2 were used per os. All the accomplished treatments decreased significantly the pain as evaluated by the writhing test. The mean wet weights of the endometriomas (g%) were as shown [Endo control: 0.595  0.085; Aspirin: 0.122  0.019; piroxicam: 0.766  0.35; indomethacin: 2.058  0.96 and for Nabumetone 5mg: 0.252  0.032; Nabumetone 15mg: 0.135  0.03 and meloxicam: 0.387  0.04]. As to fertility, the percentage of pregnant animals were as follows: Endo control, 40%; intact control, 100%; Sham operated, 100%; Indomethacin, Zero%; meloxicam, 60%; Aspirin, 60% and Nabumetone 5 and 15, 50 e 58% respectively. The treatments with Aspirin and Nabumetone had decreased the development of the endometriomas significantly as well as contributed to the relief of the pain and increasing fertility. These results suggest the role of COX-1 and -2 in the pathophysiology of endometriosis related pain, fertility and on its growth. NO synthase actvity assayed by 3H-labelled citrulline from labelled L-arginine. The nitric oxide synthase was expressed as pmol of citrulline/mg protein/min. The endometriomas expressed iNOS at the: 5th day: 1.94 + 0.5; 10th day: 2.46  0.2 and day 15: 1.17  0.3 as well as cNOS that decreased in a time-dependent way (5th day: 2.48  0.7; 10th day: 1.8  0.19; and day 15: 0.78  0.3). This decreasing activity of cNOS was probably found by the endometrial shedding that occurs normally in the course of this disease as well as by the fibrosis that surrounds the endometriomas and the increasing iNOS by the inflammatory peritoneal and tissue reaction that is frequently found in endometriosis. The use of L-NAME also decreased the wet weight of endometriomas as well as ameliorates the pain and fertility in a dose dependent fashion. Pentoxifylline (30mg/Kg/day) administered subcutaneously for 10 consecutive days during the established phase of endometriosis (days 5-14 post induction) was effective in decreasing the expression of nitric oxide synthase, both induced and constitutive. The results of the present study as those previously shown suggest the involvement of nitric oxide in the development of experimental endometriosis. TNF-alfa modulating drugs proved to reduce the mean weights of endometrial implants, obtained at day 15 of endometriosis induction with pentoxifylline (30 mg/Kg), thalidomide (5mg/Kg) and dexamethasone (0.2mg/Kg) treated rats (control: 0.595  0.085g%; pentoxifylline: 0.06  0.008g%; thalidomide: 0.206  0.049g% and dexamethasone: 0.145  0.02g%). The results of the present study suggest the involvement of TNF-alfa in the pathophysiology of experimental endometriosis. The peritoneal levels of TNF-alfa evaluated in intact rats showed 28.95  1.18ng of TNF-alfa/ml. The levels of TNF-alfa increased in the peritoneal fluid in a time dependent way after the peritoneal implant (endometriotic rat). These drugs also attenuated pain and increased fertility.

This exploratory-descriptive study, using multiple case studies, investigated the self-esteem, coping and psychology of infertility of a sample of individuals who have received infertility treatment at a privately managed health care unit. Infertility is a complex condition associated with the inability to conceive a child, frequently manifesting itself as a result of various biological factors. A literature review indicated that being on Artificial Reproductive Technology (ART) treatment significantly increases the stress in an individual. In an attempt to gain insight into the way patients undergoing infertility treatment find the strength to complete their treatment cycles, and to endure and overcome the pressures associated therewith, in order to continue their lives – in spite of a negative treatment/pregnancy result, the researcher found it necessary to investigate the self-esteem, coping and the psychology of patients undergoing infertility treatment. An exploratory descriptive research design was used and the participants were chosen by means of a non-probability purposive sampling procedure. The participants were given a package of questionnaires to complete under the supervision of the group facilitator and researcher, prior to, as well as after the intervention. The assessment consisted of a biographical questionnaire and two standardised paper and pencil measures. The participants’ self-esteem was explored using James Battle’s (1981) Culture-Free Self-Esteem Inventory; while the coping resources were explored using Hammer and Marting’s (1988) Coping Resource Inventory (CRI). Although these data were not analysable, due to the small sample size, it was utilised in a qualitative manner to support the findings from the qualitative data. The data were also gathered from the participants via a psychological intervention programme in the format of three focus group sessions. All the qualitative results were analysed, according to Tesch’s model of content analysis. The general finding was that the period of infertility treatment is experienced as both difficult and challenging by individuals, and that there is immense healing in the sharing of one’s narrative with other infertility patients. It also surfaced that selfesteem, especially one’s feelings of worth, is most affected by a diagnosis of infertility, as well as by going through the roller coaster of the emotions associated with the treatment and monthly cycle of infertility. It was evident from the narratives told by the participants that every domain of one’s self-esteem is affected by a diagnosis of infertility, and that the biggest challenge in maintaining a positive selfesteem seemed to be in finding a balance between one’s real self and one’s ideal self. Furthermore, this study found that the challenge related to coping for the participants in this study was to present a coherent life narrative to the ‘world’, despite intense feelings of being misunderstood by others, and being faced with the discourse of infertility, as part of one’s life script. The main coping responses utilized by participants included the re-channelling of one’s focus, using denial, seeking out familial and social support, bargaining with God, and nurturing hope and faith that this journey of infertility is merely just a journey and not a destination, with the destination that of being blessed with a biological child of one’s own.

M.A. (Social Work) / This research deals with the structuring, empirical testing and finalising of a model for the evaluation of the degree to which adoptive parents have accepted their infertility. The practice model provides guidelines for the assessment of the extent of acceptance of infertility on the part of prospective adoptive parents. Guidelines are also given for the provision of assistance to infertile couples within the boundaries of social care. This study does not pretend to provide the ultimate solution to the question of evaluation, but serves only as a social work orientated set of guidelines for evaluation ...

In previous articles I discussed the ethics of human reproductive cloning, focusing on a possible future scenario in which reproductive cloning can be accomplished without an elevated risk of anomalies to the children who are created. I argued that in such a scenario it would be ethically permissible for infertile couples to use cloning as a way to have genetically related children and that such use should not be prohibited. In 'Reproductive Cloning and a (Kind of) Genetic Fallacy', Neil Levy and Mianna Lotz raise objections to my conclusions. They disagree with the view, for which I argued, that some couples can have defensible reasons for desiring genetically related children. They also offer several new arguments against reproductive cloning, including an argument that it would diminish the number of adoptions, thereby adversely affecting the welfare of children who need to be adopted. In this paper I point out that Levy and Lotz's criticisms misconstrue my arguments and that there are serious problems with their arguments for prohibiting infertile couples from using cloning, including their argument from adoption.

Purpose - The purpose of the present study is to compare intrauterine msemination (IUI) pregnancy rates (PR) as a function of diagnosis and ovulation protocol utilizing an extended semen transport time. This allowed clients to conveniently collect IUI specimens in the comfort and privacy of their home. A single IUI per treatment cycle was performed. Basic Procedures - Three-hundred-ten consecutive infertilty couples having unexplained, male factor, ovulatory dysfunction, endometriosis, tubal factor or combined diagnostic factors receiving a total of 584 cycles of IUI were included. Ovulation protocols included LH surge, clomiphene citrate (CC)-hCG, CC-gonadotropins(Gn)-hCG, Gn-hCG or leuprolide acetate (L)-Gn-hCG followed 36-42 hours by a single IUI. Pregnancy rates per cycle (fecundity) and per couple (fertility) as a function of diagnosis, ovulation protocol and cycle number were evaluated. In each cycle the couples processed the specimen by adding sperm washing medium at room temperature to the specimen 30 min following collection and allowed it to incubate for two hours prior to IUI during transport. Main Findings - Overall, fecundity was 11.8% (69/584) and fertility was 22.3% (69/310); respectively by diagnosis was: unexplained 22.6%,38.8%; male factor 18.8%,42.9%; ovulatory dysfunction 12.4,22.6%; endometriosis 5.3%,11.1%; tubal factor 7.6%,13.3%; and combined factors 9.7%, 20.0%. Unexplained vs endometriosis (P < 0.0001, P < 0.005), tubal factor (fecundity P < 0.008) and ovulatory dysfunction (fecundity P < 0.027) was statistically different. Male factor vs endometriosis (P < 0.011, P < 0.036) was significantly different. Ovulatory dysfunction vs endometriosis was significantly different (fecundity P < 0.027). Pregnancies by ovulation protocol: LH surge 4.5%,10.5%; CC-hCG 9.4%,14.9%; CC-Gn-hCG 13.7%,23.7%; Gn-hCG 17.5%,45.3%; L-Gn-hCG 3.5%,6.7%. For Gn-hCG vs L-Gn-hCG (P < 0.009, P < 0.030) and LH surge (fecundity P < 0.033). CC-Gn-hCG vs CC-hCG (fertility P < 0.050) and L-Gn-hCG (P < 0.033, P < 0.034). Gn-hCG vs CC-hCG (fecundity P < 0.043). Conclusions - We conclude that IUI is effective when utilizing an extended transport time allowing most couples to collect the specimen at home and is most effective when utilizing Gn-hCG therapy. Based on our analysis, endometriosis, tubal factor and combined diagnostic categories should proceed earlier to higher level assisted reproductive technologies.

Trichomonosis is currently the most important venereal disease of cattle in South Africa with adverse economic implications to the beef production industry due to cow abortions, infertility and culling of carrier bulls. Once diagnosed in a herd, eradication is difficult due to financial and biological implications. Bulls are asymptomatic carriers and susceptibility increases with age. In infected females, clinical signs include embryonal death, abortion, pyometra, foetal maceration and uterine discharge. Diagnostic accuracy is one of the major clinical problems preventing easy eradication of trichomonosis from a herd and can be influenced by biological variance in the occurrence of the organism, sampling errors, sample degradation during sample transport and diagnostic laboratory inaccuracies. This study aimed to validate the accuracy of voluntarily enrolled private (n = 8) and state-owned (n = 5) laboratories that perform trichomonosis diagnostic tests by estimating the sensitivity (Se) and specificity (Sp) per laboratory. It was hypothesized that diagnostic laboratories in South Africa play an insignificant role in the inaccuracy of the diagnosis of trichomonosis. Laboratories performed either the culture method (n = 5), polymerase chain reaction (PCR) (n = 6) or a combination of culture and PCR (n= 2). Fresh preputial scrapings from four bulls with known negative status for trichomonosis were pooled in 200ml of phosphate buffered saline (PBS) to form the sample base for 12 subsamples of 13ml each. Duplicate subsamples were then contaminated with 2ml originating from four different laboratory cultures of Tritrichomonas foetus or 2ml of culture medium for four negative samples. Aliquots of the subsamples were transferred to an anaerobic transport medium, and the final concentration reached in these samples submitted to the laboratories, were categorised as follows: weak (<10 organisms/μl), moderate (10 – 30 organisms/μl) or strong (>30 organisms/μl). A total of 312 samples were sent by courier in two separate rounds: eight (4 duplicates) positive and four negative samples per round. Multiple logistic regression was performed on sensitivity, using sampling round, laboratory sector, diagnostic test type and sample concentration as independent variables, and removing variables in a stepwise manner based on the highest P-value. Two public laboratories only reported on one round of sampling, and one batch of 12 samples was severely delayed in reaching another public laboratory. The sample identifications of a further two batches were not recorded by the respective private laboratories. The results from these 60 unreported samples were not included in the analysis. Laboratories that performed the PCR assay (solely, or in addition to culture) were grouped for data analysis. The overall specificity (Sp) was 100% and the sensitivity was 88.7% (95% CI 83.9% - 93.5%). Laboratories using PCR recorded higher sensitivity than those using the culture method (95.5%; 95% CI 91.0% – 99.9% and 81.3%; 95% CI 72.5% - 90.0% respectively, P < 0.01), and private laboratories recorded higher Se than public laboratories (96.4%; 95% CI 92.9% - 99.9% and 73.2%; 95% CI 61.2% - 85.2%, P < 0.01). For laboratories using PCR, weak positive samples recorded a lower sensitivity than strong positive samples (86.4%; 95% CI 70.8% - 101.9% and 100%; 95% CI 100% - 100%, respectively, P < 0.01). One public and six private laboratories obtained 100% accuracy during the two sampling rounds. In the logistic regression model, private sector (compared to public), an increasing concentration of organisms in the sample and the second round of sampling (compared to the first round) were independent predictors of laboratory sensitivity for the detection of Tritrichomonas foetus. It is concluded that inaccuracies in the diagnostic laboratory contributes to the deficiencies in diagnostic sensitivity for trichomonosis in South Africa, but does not influence diagnostic specificity. It is further concluded that diagnostic sensitivity was independently influenced by the sector in which the laboratory operates (private vs public) and the concentration of Tritrichomonas foetus organisms in the sample. / Dissertation (MSc)--University of Pretoria, 2019. / Production Animal Studies / MSc (Veterinary Science) / Unrestricted

Abstract Because endometriosis is considered to be the primary cause of infertility in women and the diagnosis is known to be delayed by many years, it is important to understand the association between endometriosis and infertility. The purpose of this cross-sectional, secondary data analysis study was to determine whether there was an association between the age of women when diagnosed with endometriosis and infertility. Using the general model of total patient delay (i.e., the Andersen model) as a theoretical foundation, data for this study was collected by assessing patient medical records of women with endometriosis at multiple OB-GYN clinics in Eastern North Carolina. Multiple logistic regression was conducted to determine potential association between variables. The results presented that diagnosis at an older age and presence of uterine fibroids are significant risk factors for infertility among women with endometriosis. From the results, it can be concluded that infertility may be preventable in women diagnosed with endometriosis and uterine fibroids in younger age. This study presents positive social change by preventing infertility amongst women who suffer from both endometriosis and uterine fibroids; potentially creating preventative programs aimed at better educating women on the risks of endometriosis and uterine fibroids (especially when presented together).