The study explored the narratives of three adoptive couples. The participants were selected using criterion based convenience and snowball sampling. The adoptive couples’ data was captured through written narratives and/or individual or joint semi-structured interviews. The data was then analysed by means of thematic analysis conducted from the perspective of second order cybernetics. The results note the participants’ experiences of their infertility threatened their functioning as a couple. However, this threat to the couples’ functioning was limited by the adoptions through two means. First, the adoptions limited the couples’ communication about their infertility. Second, the adoptions allowed the couples to continue functioning as a couple dedicated to the goal of becoming parents. Differences between the participant couples’ experiences surrounded their interactions with social workers; their selection of support structures; their interaction with external systems; as well as their anxiety towards the individuation of the adopted child. / Psychology / M.A. (Clinical Psychology)

Abstrakt (svenska) Titel: Infertilitet – vems rätt att bestämma? En kvalitativ intervjustudie kring barnmorskors erfarenheter av att arbeta med infertilitet. Författare: Rebecka Kristensen Berlin, Umeå Universitet -Institutionen för Omvårdnad   Syfte: Att undersöka hur barnmorskans erfarenheter av parens reaktioner uppfattas i samband med infertilitetsproblematik. Studiedesign: En kvalitativ intervjustudie innefattande fyra barnmorskor har genomförts på en barnmorskemottagning. Intervjumaterialet analyserades utifrån kvalitativ innehållsanalys, vilket i korthet innebar följande steg: Materialet transkriberades ordagrant och bröts därefter ned i meningsbärande enheter, för att kunna sortera data utifrån innehåll. Kondensering utfördes i syfte att lyfta fram kärninnehållet. Abstraktion utfördes för att få fram koder, i syfte att reducera mängden text men även för att därefter kunna sammanfoga snarlika ämnen till underkategorier, vilka sedan grupperades i huvudkategorier tillhörande ett gemensamt tema. Resultat: De fyra huvudkategorier som uppkom var känslor, kommunikation, rättighet och prevention. Känslor: Oro, stress samt nedstämdhet var vanligt förekommande. Mäns känslor var svårare att identifiera då kvinnor ibland kom ensamma till besöken, samt män ibland dolde känslor bakom aggressivitet. Kommunikation: God information skapade förtroende. Råd om livsstilsförändringar samt vidareremittering var en viktig form av stöd. Rättighet: Ingen har rätt till barn, men alla ansågs ha rätt att försöka få barn. Privatekonomi samt samhällets krav påverkar dock i stor utsträckning paren vid misslyckade försök eller önskan om ytterligare barn. Prevention: Vikten av information kring infertilitet vid undervisning i skolan, vid preventivmedelsamtal och vid cellprovtagning poängterades. Slutsats: Att vara väl införstådd med de känslor som kan uppstå i samband med infertilitet möjliggör att ge tillfredställande stöd. Särskilda ansträngningar behöver göras för att nå män, såväl emotionellt som preventivt. Stort utrymme för förbättring finns gällande preventiva åtgärder, i syfte att fördjupa allmänhetens kunskaper kring infertilitet. Nyckelord: kvinnlig infertilitet; manlig infertilitet; känslor; barnmorska; kvalitativ forskning / Abstract (English)     Title: Infertility. Who´s right to decide? A qualitative interview study regarding midwives experiences to work with infertility. Author: Rebecka Kristensen Berlin, Umeå University- Department of nursing   Objective: To investigate midwives thoughts and experiences regarding couples reactions in connection with infertility.  Study design: A qualitative interview study comprising four midwives have been conducted. The resulting data was analyzed using qualitative content analysis, consisting of the following steps: The material was transcribed verbatim and then broken down into sentences, to aid in sorting the data based on content. Condensation was carried out in order to highlight the core content. Abstraction was performed to obtain codes, in order to reduce the amount of text , but also to subsequently merge similar content into subcategories , which were then grouped into categories. Results: Four main categories emerged. Feelings: anxiety, stress and depression were common. Men’s feelings were more difficult to identify since women sometimes came alone to appointments, and men sometimes concealed their feelings behind aggression. Communication: Good information created trust. Advice on lifestyle changes and referrals were important forms of support. Empowerment: No-one has the right to a child, but the right to try to have a child. Personal and societal demands, however, affect the couples at failure to conceive or desire for additional children. Prevention: The importance of information about fertility in school, at contraception counselling and routine smear exams was emphasized. Conclusion: Awareness of the feelings that infertility may give rise to, enables providing satisfactory support. Further efforts need to be made to reach males emotionally as well as preventatively. There is great possibility for improvement in regards to public awareness about infertility. Keywords: female infertility; male infertility; emotions; midwife; qualitative research

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

Bakgrund: Ofrivillig barnlöshet är ett vanligt problem hos par i fertil ålder och drabbar runt 15–20 % av alla par i västvärlden som önskar få barn. Infertilitet och infertilitetsvård kan bidra till sämre hälsa och kan vara påfrestande för båda parter i paret. Processen kan även leda till ett lidande där sjuksköterskan har en viktig roll. För att bemöta par och tillgodose deras önskemål är det angeläget att studera vilka behov de upplever. Syfte: Att beskriva behov par erfar i samband med infertilitetsvård. Metod: En litteraturöversikt där datamaterial bestod av sju vetenskapliga artiklar varav två kvantitativa, fyra kvalitativa och en av mixad metod. Resultat: I resultatet framkom tre teman, Stöd, Respekt och förståelse samt En utformad och anpassad miljö. Det framkom även sex subteman. Konklusion: Att möta par inom infertilitetsvård kan vara komplext och ytterligare kunskap kring vilka behov de upplever kan vara angeläget. Som sjuksköterska är det viktigt att bidra med stöd och information gällande processen. Det är även viktigt att individualisera vården och se till varje pars egna önskemål. Respekt och förståelse samt anpassning och utveckling av organisationen är angeläget där högre instanser bör bli engagerade. / Background: Involuntary infertility is a common problem in couples of fertile age and affects around 15–20% of all couples in the Western world who wish to have children. Infertility and the care can contribute to poorer health, which can be stressful for both parties in the couple. The process can also lead to a suffering were the nurse has an important role to play. To respond to the couple and meet their wishes, it is important to study the needs they experiences. Aim: To describe the needs couple experiences in connection with infertility care. Method: A literature review where data material consisted of seven scientific articles, two of which were quantitative, four qualitative and one of mixed method. Results: From the result, three themes appeared, Support, Respect and understanding and An Adapted and developed environment. There were also six sub-themes. Conclusion: Meeting couples in infertility care can be complex and further knowledge about what needs they are experiencing can be important. As a nurse, it is important to contribute with support and information regarding the process. It is also important to individualize the care and look to each couple's own wishes. Respect and understanding as well as adaptation and development of the organization are urgent where higher instances should become involved.

As CFTR plays an important role in HCO3- transport, and HCO3- sensitive soluble adenylyl cyclase (sAC) has been shown to be largely responsible for the cAMP production in spermatogenetic cells, we hypothesized that CFTR-mediated HCO3- transport was important to spermatogenesis via sAC pathway in spermatogenetic and Sertoli cells. Using intracellular pH measurement, we demonstrated that CFTR is involved in HCO3- transport in Sertoli cells. RT-PCR results showed that increased HCO3- concentrations in the culture medium resulted in upregulation of CFTR expression. The results also showed that the intracellular cAMP level in Sertoli cells increased as the extracellular HCO3- concentration increased. HCO3- also caused phosphorylation of the cAMP response element binding (pCREB) proteins transcription factor on serine 133, a modification known to be required by Sertoli cells to support spermatogenesis. This phosphorylation could be inhibited by CFTR inhibitor, further lending support to the notion that CFTR is important for HCO3- transport in Sertoli cells, leading to HCO3- dependent events that are important for spermatogenesis. / CFTR is known to be widely expressed in epithelial cells of male reproductive tracts, but its expression in spermatogenic cells is less well known. We first confirmed the expression of CFTR in spermatogenic cells and mature sperm in rodents. Our study thus focused on the important role of CFTR in the processes related to male fertility including spermatogenesis and sperm capacitation. / Cystic fibrosis transmembrane conductance regulator (CFTR) is an anion channel, mutations of which cause cystic fibrosis, a disease characterized by defective Cl- and HCO3- transport. While over 95% of CF male patients are infertile because of congenital bilateral absence of the vas deferens (CBAVD), the question whether CFTR mutations are involved in other forms of male infertility is under intense debates. / In conclusion, our study has demonstrated the role of CFTR in male reproductive system. We have further elucidated its possible physiological role and the underlying molecular mechanisms. These studies may pave the way for the development of method strategies for diagnosis and treatment of CFTR related infertility in male. / Our study also detected CFTR in both human and mouse sperm. CFTR inhibitor or antibody significantly reduced sperm capacitation, and the associated HCO 3--dependent events including increases in intracellular pH, cAMP production and membrane hyperpolarization. The fertilizing capacity of the sperm obtained from heterozygous CFTR mutant mice is also significantly lower as compared to that of the wild type. These results suggest that CFTR in sperm may be involved in the transport of HCO3- important for sperm capacitation and that CFTR mutations with impaired CFTR function may lead to reduced sperm fertilizing capacity and male infertility other than CBAVD. / We further demonstrated the physiological role of CFTR in spermatogenesis using CFTR knockout mice as an in vivo model. Although TUNNEL staining showed normal percentage of apoptotic cells in seminiferous tubules, Cftr -/- mice had spermatogenetic defects in histology section and fewer number of mature sperm compared with wild type (WT) mice. Consistent with the proposed role of CFTR in spermatogenesis, RT-PCR and Western blot results showed reduced expression of spennatids specific gene, Protamine 1, Protamine 2, and CREM, which have been known to be involved in the process of spermatogenesis, in Cftr-/- mice. / Xu, Wenming. / "January 2008." / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4506. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (p. 121-138). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Thesis (M. A.(Social Work)) --University of Limpopo, 2018 / Involuntary childlessness and infertility affects women from various cultural and religious backgrounds. Childless women suffer from social and psychological ailments because of their circumstances. Previous research reveals that women who suffer from infertility and childlessness experience social exclusion and ridicule from their women folk who have children. In South Africa reproduction is a human right and everyone is allowed to make decisions on whether or not they should have children. Surrogacy as an assisted reproductive technique is allowed and governed through the Children’s Act 38 of 2005. However, the knowledge of childless women on surrogacy, their belief system and willingness to take up surrogacy as a way to have children is unknown to the researcher. The aim of this study was to explore the perceptions of childless women on surrogacy as an assisted reproductive technique. The study was exploratory and qualitative in nature. The participants were identified through purposive and snowball sampling. Data was collected until saturation point and seven participants were interviewed. Unstructured, face to face interviews were conducted. An audio recorder was utilised during the interviews. Thematic analysis was employed in data analysis and trustworthiness was used to establish the credibility, transferability, dependability and conformability of the study. Most women in this study mentioned that they had heard and were aware of surrogacy but they were not well-informed about the relevant legislation. Women in this study were willing to take up surrogacy as an option to have their own children.

The experience of difficulties in conception, the diagnosis of infertility and its treatment are frequently associated with anxiety and overall distress. However, current understanding regarding the determinants of variability in the levels of distress among women undergoing infertility treatment is limited; and the evidence of the significance of distress as a risk factor for assisted conception following IVF/ICSI is inconsistent. The thesis addressed both these issues. Overall the thesis is informed by the biopsychosocial model of health and illness. Four studies were conducted. The data was collected in three IVF clinics in India. A consecutive sample of 85 infertile women about to commence IVF/ICSI cycle was recruited in the project at cycle baseline and followed through one treatment cycle. The first two studies examined this sample of women at baseline to identify the biopsychosocial factors associated with infertility related distress. The first study examined the degree of cognitive–behavioural adjustment to infertility, its treatment and treatment related eventualities, while the second study focused on the factors associated with affective aspects of infertility related distress such as increase in negativity and decrease in positivity. The third study examined the pattern of change in stress operationalized in terms of changes in Affect and State Anxiety in a sample of 74 infertile women during an IVF/ICSI cycle. The final study developed a prognostic model for evaluating the unique contribution of baseline distress as well as treatment related stress in estimating the odds of pregnancy following IVF based on a consecutive sample of 73 women. Collectively, the first two studies indicate that at the outset of the IVF/ICSI cycle, some women are more prone to distress than others, and that this variability is associated with their intrapersonal, interpersonal and sociodemographic attributes. These two studies have identified a set of protective and vulnerability factors related to cognitive-behavioural and affective aspects of distress. The last two studies clearly indicate that the level of distress tends to rise during the treatment among the majority of infertile women. The rising trend continued to be significant even after controlling for variables known to somewhat influence infertility related distress such as age, education, occupation, employment, financial burden and etiological factors. Further, a prognostic model is developed that proposes that both baseline level of stress and treatment stress make a unique contribution in defining the odds of pregnancy outcome for the patients. In short the thesis clearly brings out the case for integrating psychosocial care with the routine medical interventions for infertility. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1325419 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008

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All thirty women who were to undergo microsurgical treatment for tubal infertility in 1981 and their men were investigated. Over a period of 2 years four interviews were performed with the women and two with their men. A questionnaire, semistructured interviews, symptom checklist and the Eysenck Personality Inventory were used. During this longitudinal study the couples' background, current situation and emotional and social impact of the infertility problem were investigated. The psychological and social effects of the medical investigation and treatment have been described. Expectations and hopes about the future after unsuccessful surgical treatment and the need of professional psychosocial counselling have been noted. Furthermore, the extent of psychological reactions compatible with a crisis pattern has been identified and classified. Finally, overt motives for having a child have been studied. The infertile couples generally did not differ with respect to psychosocial background, current life situation, psychiatric anamnesis or personality characteristics when compared with apparently normal reference groups. Several deleterious emotional and social effects of the infertility were found both before and 2 years after the surgical treatment. The women admitted to suffering such effects more frequently than the men. The partners' feeling for each other were getting worse 2 years after the operation. There was also a tendency to a deterioration in opinions about marital relationships. Most of the mental symptoms recorded could be classified in terms of depression, guilt and isolation, which all are parts of the reactive phase of the common crisis pattern. The crisis of infertility, however, differs from the common traumatic crisis; it is more prolonged and there are often repeated crisis reactions. Negative effects on the couples' sexual life were reported by all individuals. The medical investigation and surgical treatment of infertility influenced the couples' mutual relationship and sexual life negatively. Intrapsychic and interpersonal motives of childwish were dominant among both women and men. A central motive was that a child is an ultimate expression of love between a man and a woman. The motives of the infertile couples generally did not differ from those of the reference groups. Most of the couples had difficulty in working their way through and finding a solution to their infertility problem by their own means. Relatives and friends failed to fulfil a supportive function. The importance of having the possibility of professional psychosocial counselling and support parallel with the investigation and treatment were stressed by all participants. / digitalisering@umu

The experience of difficulties in conception, the diagnosis of infertility and its treatment are frequently associated with anxiety and overall distress. However, current understanding regarding the determinants of variability in the levels of distress among women undergoing infertility treatment is limited; and the evidence of the significance of distress as a risk factor for assisted conception following IVF/ICSI is inconsistent. The thesis addressed both these issues. Overall the thesis is informed by the biopsychosocial model of health and illness. Four studies were conducted. The data was collected in three IVF clinics in India. A consecutive sample of 85 infertile women about to commence IVF/ICSI cycle was recruited in the project at cycle baseline and followed through one treatment cycle. The first two studies examined this sample of women at baseline to identify the biopsychosocial factors associated with infertility related distress. The first study examined the degree of cognitive–behavioural adjustment to infertility, its treatment and treatment related eventualities, while the second study focused on the factors associated with affective aspects of infertility related distress such as increase in negativity and decrease in positivity. The third study examined the pattern of change in stress operationalized in terms of changes in Affect and State Anxiety in a sample of 74 infertile women during an IVF/ICSI cycle. The final study developed a prognostic model for evaluating the unique contribution of baseline distress as well as treatment related stress in estimating the odds of pregnancy following IVF based on a consecutive sample of 73 women. Collectively, the first two studies indicate that at the outset of the IVF/ICSI cycle, some women are more prone to distress than others, and that this variability is associated with their intrapersonal, interpersonal and sociodemographic attributes. These two studies have identified a set of protective and vulnerability factors related to cognitive-behavioural and affective aspects of distress. The last two studies clearly indicate that the level of distress tends to rise during the treatment among the majority of infertile women. The rising trend continued to be significant even after controlling for variables known to somewhat influence infertility related distress such as age, education, occupation, employment, financial burden and etiological factors. Further, a prognostic model is developed that proposes that both baseline level of stress and treatment stress make a unique contribution in defining the odds of pregnancy outcome for the patients. In short the thesis clearly brings out the case for integrating psychosocial care with the routine medical interventions for infertility. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1325419 / Thesis (Ph.D.) - University of Adelaide, School of Psychology, 2008