There is a gap in infertility research regarding resource availability within rural communities, yet existing research declares infertility a public health concern. This qualitative study was grounded in the Heggerian phenomenological framework by way of assessing participants' perceptions of and experiences with infertility resources in a rural community. The purpose was to analyze the meaning of those experiences within their world. To accomplish this, Antonovsky's salutogenic theory was applied to investigate the strengths and weaknesses of infertility resources including the availability of resources, participant understanding of, and participants' experiences. Purposive sampling was used and in-depth interviews were conducted with 12 women, ages 24 to 39, who reside within rural communities. Interviews consisted of 60 questions that were designed to examine 13 research questions. Data were analyzed following Ritchie and Spencer's framework, requiring documentation and data classification, through 3 phases: open coding, focused coding, and axial coding. Emerging themes included a need for more resources on infertility, assistance with locating infertility resources, and an association between insurance coverage and use of infertility treatments. Findings from this study indicated a need for additional resources and knowledge regarding infertility in rural areas, also confirming a need for additional research on the topic. Social change implications for this research include developing resources for consumers and health care providers as well as improved provider knowledge. With increased knowledge and resources, these individuals may be able to achieve their goals and cope with the challenges of understanding and dealing with infertility.

In Canada, the natural birth rate is declining in part because of delayed childbirth (Canada 2016). As a result of their decision to postpone parenthood and their increasing age, more couples are turning to assisted reproductive treatment (ART) including in-vitro fertilization (IVF) to conceive. The risk of IVF failure, the detrimental mental health outcomes (i.e. depression) associated with infertility, and the strain on physical, financial, spiritual, and emotional resources contribute to heightened stress for IVF patients, and compel them to identify and leverage psychosocial supports. Since the quality of social support individuals receive depends on the nature of communication they share with the receiver, it is important to consider how disclosure builds social support. Common social support channels such as spouses, family, friends, counsellors, and support groups and their associated communication patterns have already been explored in the fertility literature whereas processes integral to peer relationships, a support that women have signaled as promising, remain uncovered. It remains important to understand the nature of peer relationships in the context of infertility. This dissertation explores how in-vitro fertilization (IVF) users approached their decision to disclose to a peer and carried out their communication. Guided by the Disclosure-Decision Making Model (DD-MM) it starts by showing how IVF patients assess their support needs, and peers as recipients before communication takes place. It then delineates how these women execute their communication with specific focus on the modalities of their process and the scope of the disclosures of fertility-related and non-fertility related information between them. A sample population of 23 first-time and recurring IVF patients were interviewed. Results show that prior to disclosing to a peer, women reflect on information about their condition and their personal support needs on the basis of the adequacy of their social circles and perceptions of stigma, the benefits and drawbacks of secrecy versus transparency, and their personal motivation to leverage peer support. They also assess their peers, considering diverse pathways of connection as well as desirable peer traits which include IVF experience, other common ground and transparency. Relating to their communication, patients showed a distinct capacity to communicate with their peers and meet their support needs. The IVF patient-peer communication process is characterized through immediate disclosure transitions and backwards introductions, a solid mutual understanding when it comes to engagement and disengagement boundaries, a preference for digital communication via texting and instant messaging, and the coverage of a broad range of fertility topics in reciprocal conversations. The findings also show however that the majority of women choose to distance themselves and limit their conversations during the post embryo transfer waiting period and refrain from discussing pregnancy testing as a form of self- preservation. IVF patients share a natural relationship with peers. This dissertation points to opportunities to facilitate patient-peer relationships and enhance the fertility-care experience overall by embracing: the transparency of patients, better coping resources for men, safe places to personally connect in clinic and support group settings, and roles for all IVF patients in social support regardless of their outcome. It also suggests that patient-peer support is a pragmatic and flexible support channel that when managed properly can respond to patients’ personal disclosure and communication needs and preferences.

No description available.

Blastocyst implantation is the process in which a competent blastocyst acquires the ability to tether into the mother endometrium. At the same time, the endometrial tissue undergoes the process of decidualization to support the anchoring of the blastocyst and provides the blastocyst with nutrition until the fully functional placenta is formed. Although the process of implantation and decidualization are under control of progesterone and estrogen, the precise mechanisms involved in this regulation are not fully understood. Here, we report the expression and function of a transcription factor, HAND2, in sensitizing mouse uterus for implantation and decidualization. In mouse, HAND2 expression was localized mainly in the endometrial stromal cells even before the blastocyst implantation. The expression of HAND2 increased after blastocyst implantation and correlated with the increase in decidual compartment. The expression of HAND2 depended on progesterone but not estrogen. Further investigation using conditional knockout mouse revealed that HAND2 was important for both implantation and decidualization. Hand2d/d mice were infertile and had defects in decidualization. It seemed that HAND2 was an important factor that mediates the anti-estrogenic effect of progesterone on luminal epithelial proliferation. The abnormal in expression of Mucin 1, Calcitonin and E-Cadherin in Hand KO uterus may be responsible for defects in the uterine receptivity. The expression of HAND2 was also critical in decidualization in vitro. Silencing and over-expression HAND2 disclosed the roles of HAND2 in regulating the expression of FOXO1A, IGFBP1, BMP2 as well as WNT4. It seemed that HAND2 promoter worked in tissue specific manner and although both HOXA10 and cAMP binding sites were found in proposed HAND2 promoters, its activity was stimulated by cAMP and steroid hormones rather than the expression of HOXA10.

Abstract available in the Annals of Behavioral Medicine.

Indiana University-Purdue University Indianapolis (IUPUI) / In the United States, approximately one in five women are unable to get pregnant after one year of trying. Due to the pervasiveness of pronatalism in Western society, having a child is widely assumed to be a natural and expected part of womanhood. Society’s master narratives reinforce these ideals and stigmatize the experiences of women who have infertility. This multi-phase research study examined how women discuss their infertility journey with their friends. The study’s aims were to understand friendships within the context of infertility, how the relationship affects a woman’s identity, and the communicative behaviors used in conversations. Fifteen interviews were conducted with women who experienced or are experiencing infertility and had discussed their past or current challenges with a friend. Results of a phronetic iterative analysis suggested that women who have personal experience with infertility (a) disclose to close/best friends, (b) communicate their identity as “broken,” (c) desire emotional support, and (d) strategically navigate conversations as they encounter positive and negative messages. These results were transformed into a performance, which included six monologues and a talkback. The purpose of the arts-based methodology was to disseminate results and assess the performance’s impact. Seventy-three individuals attended one of the two performances in April 2023, and 50 attendees completed the post-performance evaluation. The quantitative results suggest that attendees felt informed about the complexities of infertility, gained a new perspective, received advice about how to have future conversations, and did not feel offended by the content. Through a thematic analysis, four themes emerged from the two talkback sessions and evaluation comments: being informed about infertility as a health condition, appreciating the theatrical format to learn, connecting to the performance to understand the illness experience, and feeling comfortable navigating conversations about infertility. Despite the variance in infertility experiences, friends are essential social support figures as women navigate infertility, and there are best practices when having a conversation, as demonstrated in the performance. This study’s implications include providing communication strategies to support women with infertility and recognizing that an arts-based methodology can highlight counterstories, inform about a stigmatized health issue, and engage the community.

Yes / Over the past few decades, the number of women having their first babies over the age of thirty-five in most developed societies has steadily increased. Concerns have been raised over this trend amidst warnings of both the increased risk of fertility problems and health risks to mother and child. Despite this, research into the timing of pregnancy in the context of decreasing fertility has been somewhat neglected, with research typically framed in biomedical rather than social terms. However, this area merits closer attention given the contradictory nature of societal messages that simultaneously encourage women to pursue careers and enhance lifestyle, whilst warning of ‘risks’ of infertility and problems in ‘delaying’ motherhood. This article is based on a small-scale qualitative study that uses data drawn from eleven in-depth interviews with ‘older mothers’ about their transition to motherhood. The data was thematically analysed. We found that the women drew upon risk discourses around decreasing fertility and advancing maternal age, and that these discourses impacted on their decisions about the timing of their pregnancies. Some mothers felt that they started trying to conceive at ‘non-ideal’ times, owing to expectations they held about decreasing fertility. We suggest that the impact of contradictory societal messages around the timing of motherhood need to be more clearly considered for their potential effects on the timing of pregnancy and note how this topic brings the personal, and, by implication, the societal, into conflict with the (narrated) biological.

This study explored the individual and dyadic coping processes of men and women in infertile couples and their relationship to infertility stress, marital adjustment, and depression. Study participants were comprised of 1,026 men and women (420 of which were couples) who were referred to a university-affiliated teaching hospital for advanced reproductive treatments between the years of 1991 and 2001. Three months prior to treatment, participants completed the Ways of Coping Questionnaire (WCQ), the Fertility Problem Inventory (FPI), the Dyadic Adjustment Scale (DAS), and the Beck Depression Inventory (BDI). Findings from the study showed that escape avoidance, accepting responsibility, and self controlling were strongly related to increased stress, depression, and decreased marital adjustment for both men and women; while seeking social support was related to increased marital adjustment. Multivariate analyses of variance and covariance consistently showed that participants in four groups of couples who used high and low amounts of coping differed in their reports of infertility stress, marital adjustment, and depression. In addition, gender differences were found, with females consistently reporting greater levels of stress and depression than males. Several significant couple pairings among the four groups were found. Clinical implications linking study findings with marital and family therapies and ideas for future research are discussed. / Ph. D.

Recent studies have shown that the experience of infertility is linked with emotional responses such as depression, anxiety, guilt, social isolation, and decreased self-esteem in both men and women. This study explored the impact of congruence between couples' infertility-related stress and its effects on depression and marital adjustment in infertile men and women. Study participants were comprised of 525 couples referred to a university-affiliated teaching hospital for assessment and treatment with advanced reproductive technologies. Participants completed the Fertility Problem Inventory (FPI), the Beck Depression Inventory (BDI), and the Dyadic Adjustment Scale (DAS) three months prior to their first treatment cycle. The impact of differences between couples' perceptions of infertility-related stress were examined in relation to their effect on individual levels of depression and marital adjustment in both men and women. Results showed that differences between couple's evaluations of infertility-related stress were predictive of female depression, but not male depression. Women in couples who reported high levels of congruence (e.g., agreement) concerning the impact of infertility-related stress had significantly lower levels of depression when compared to couples in which females experienced a greater amount of stress than their partners. In terms of marital adjustment, men and women in couples who reported high levels of congruence concerning the impact of infertility-related stress reported significantly higher levels of adjustment when compared to couples who differed in their appraisals of the stress. Treatment implications based on these findings and future research directions are discussed. / Master of Science

No / BACKGROUND: The possibility that oligozoospermic men may have elevated levels of genetic damage in their sperm is of particular concern as they could transmit defects to their offspring. METHODS: Sperm samples were obtained from 12 infertile, oligozoospermic patients and 12 healthy normozoospermic volunteers. Fluorescence in-situ hybridization (FISH) was used to determine aneuploidy rates in sperm and inverse restriction site mutation (iRSM) assay to determine gene mutations; defective chromatin packaging was quantified by sperm chromatin structure assay (SCSA) and DNA strand breaks by the Comet assay. RESULTS: FISH analysis showed a significant increase in gonosomal X,Y,18 (P < 0.01) disomy and diploid sperm with X,Y,18,18 (P < 0.05) in the infertility patients compared with the controls. A significant increase (P < 0.01) in disturbed sperm chromatin was found in the infertility patients compared with the control group using the SCSA assay. In the Comet assay, a significant increase (P < 0.01) in the tail moment was found in the infertility patients compared with the control group, indicating significantly high levels of DNA strand breaks. There was no significant increase in point mutations detected by iRSM assay. CONCLUSIONS: The data indicate that infertile oligozoospermic men have an elevated level of XY aneuploidy and XY diploidy in the germ-line, as well as elevated levels of sperm chromatin disturbances and sperm DNA strand breaks. These data demonstrate that oligozoospermic infertility patients show several different types of genetic damage in their sperm. Thus, such men appear to have defects at a variety of levels of spermatogenesis and their infertility may not just be a result of the oligozoospermia.