<p>Within the United States, infertility diagnoses are becoming increasingly commonplace, yet treatment often remains shrouded in stigma and silence. Consequently, for the women going through it, infertility is an isolating experience. Infertility is frequently conceived through notions of medicalization, which prompts a disembodied, scientific, ‘never give up’ discourse that often leaves women feeling disempowered and further alone. This study considers how individual narratives of infertility contributes to the organizing of a social identity of infertility, one which abuts and diverges from medicalized notions. In adopting theories related to narrative organizing, tenuous identity/identification, resilience, and social support this project engages a feminist-interpretivist framework. In doing so, this study draws upon a three-phase methodological engagement of (1) online ethnographic observations and auto-ethnographic reflections, (2) in-depth interviewing of participants narratives and networks related to (in)fertility, and (3) text mining and semantic network analysis of public discourses related to (in)fertility.</p><p>Findings from this project reveal how infertility is discursively-materiality organized to both embrace and disengage from medicalized logics. First, analysis of personal and organizational narratives illustrate how infertility is construed through competing tensions of loss, empowerment, and support. Second, identities were shown to be communicated as potentially tenuous, liminal, and/or challenged during the process of infertility as women cope with an ambiguous future; however, so too can identities be considered a source of strength and hope. Third, through conceptualizing resilience as a communicatively constructed process, this study showcases the embodied nature of resilience as it ebbs and flows throughout treatment. And fourth, in analyzing social and semantic networks this project interrogates individual and organizational discourses, building a more holistic, yet still thoroughly partial, understanding of effective supportive communication during treatment. Through this process, this study reveals how online support groups re-center the women’s body and emotions as central to the (in)fertility experience, while noting the disembodiment that occurs within health clinics. This study advances knowledge on emergent, embodied organizing and the communicative construction of resilience through considering the intrapersonal and embodied aspects of resilience. Through conceptualizing embodied organizing and embodied resilience, this project advances theories of antenarrative, emergent organizing, and self-persuasive rhetoric. Methodologically, this study contributes to qualitative inquiry by linking crystallization methodologies with network science. Additionally, this project offers recommendations for family members, friends, and medical professionals on how to promote resilience within women receiving infertility treatment.<b> </b></p><p><b> </b></p><div><br></div>

The aim of this dissertation was to find out how does a woman experience infertility and how do women experience the process of assisted reproduction, comunication with the personel in the centres of reproductive medicine, relationships with their surroundings, family and friends. This dissertation answers three main questions: How does a person experiences asisted reproduction? What kind of copying strategies they use to overcome the stress connected with assisted reproduction? How does an individual experience approach and communication skills of the personel of a centres of reproductive medicine. According to chosen topic of experiencing infertility I have chosen a qualitative research method in the form of case study. Basic strategy for sample selection was purposive (judgemental) sampling through centre of reproductive medicine. I have chosen grounded theory method for the data analysis. Standardized interview was made with every participant. Findings of this qualitative research brings the understanding to person experiencing infertility. Those findings will contribute to more empathy understanding to patiens and their partners during hard time in their life from health care profesionals working in centrs of reproductive medicine. The facts that emerged from this research forms a...

Philosophiae Doctor - PhD / Infertility is currently a serious problem that is escalating, not only in South Africa, but also worldwide. In Cape Town, a culturally diverse, urban community of approximately 1000 couples are referred to the Groote Schuur Hospital Infertility Clinic annually. Although infertility is primarily regarded as a medical condition, the treatments have emotional effects on infertile couples due to the recurring highs and lows that often accompany treatments. This study aimed to qualitatively explore and understand the emotional and psychological experiences of infertility and its treatments (specifically In Vitro Fertilisation and Embryo Transfer). Social constructionism is based on the premise that realities are not constructed in a vacuum but rather undergo a process whereby the subjective and inter-subjective experiences over time and through cultural processes come to be regarded as truths. These truths become internalised and function as lenses through which we see ourselves, compose and invent ourselves accordingly, making sense of what would otherwise have been chaotic and meaningless experiences. Additional aims were to examine women's experiences of infertility care whilst undergoing treatment and describe their experiences of coping with infertility and In Vitro Fertilisation and Embryo Transfer (IVF-ET). Semi-structured, in-depth individual interviews were conducted with 21 women presenting with primary infertility at a fertility clinic. This study utilised an ethnographic case study design. The results of the study suggested that women perceived themselves as not conforming to a dominant belief system that promotes motherhood as the most important role for women. The women described their 'failure' to fulfill socio-cultural expectations as emotionally turbulent. Some of the psychological responses to infertility included feelings of disappointment, shock, denial, devastation, anger, frustration, sadness, inadequacy, poor self-image and self-esteem. The women's personal accounts of their experiences of In Vitro Fertilisation and Embryo Transfer (IVF-ET) revealed that they found the treatment to be highly stressful, with emotional bouts of anxiety, nervousness, excitement and optimism. A psychological synopsis of infertility and IVF-ET is infertility and IVF-ET presents. The findings in this study suggest the need for the incorporation of 6 presented. This diagrammatic representation shows the intensity of the emotional rollercoaster that psychosocial intervention into infertility management. Greater attention to the psychological and emotional repercussions of infertility treatment could lead to a more personalised approach which, in turn, would optimise patient satisfaction and also prepare couples for the demands of the program by informing them about better ways of coping.

OBJECTIVE: To evaluate the effectiveness of offering double intrauterine insemination (IUI) to clients in our fertility program. STUDY DESIGN: In this prospective, nonrandomized study, 595 couples with ovulatory dysfunction, endometriosis, male factor, unexplained, tubal factor and combined diagnoses utilizing clomiphene citrate-hCG (CC-hCG), CC-gonadotropin-hCG (CC-Gn-hCG), Gn-hCG, lupron-Gn-hCG (L-Gn-hCG) or luteinizing hormone (LH) surge monitoring of natural cycles were offered single or double IUI in a total of 1,276 cycles. Single IUIs were performed at 36 hours following hCG or the day following LH surge; double IUIs were performed 18 and 36 hours following hCG or the day of and day following LH surge. Single versus double IUI clinical pregnancy outcomes were compared between ovarian stimulation protocols and diagnostic categories. RESULTS: One hundred ten clinical pregnancies occurred for 508 couples in 999 single IUI cycles (fecundity, 11.0%); 45 clinical pregnancies for 174 couples occurred in 277 double IUI cycles (16.2%, p < 0.004). The single IUI group was younger than the double IUI group (32.8 vs 33.7, p < 0.004). Differences for fecundity were noted regarding diagnostic categories between single and double IUI groups (ovulation dysfunction, 12.9% vs 19.5%, p < 0.048, and male factor, 7.9% vs 17.5%, p < 0.030) and ovulation protocols (CC-Gn-hCG, 13.0% vs 21.3%, p < 0.031, and L-Gn-hCG, 4.2% vs 25.0%, p < 0.002). CONCLUSION: Double IUI is superior to single IUI overall, especially when comparing Gn-containing ovarian stimulation protocols or within the ovulatory dysfunction and malefactor diagnostic categories.

Ghanaian women experiencing infertility problem, have been seeking invitro fertilisation treatment in the quest for motherhood, however there is a dearth in the nursing studies researching this phenomenon. It appears that the concept and meanings of infertility is inadequately explored from the perspective of women experiences following unsuccessful invitro fertilisation treatment. In particular, it is vital to be knowledgeable about the challenges women encounter when undergoing IVF treatment and following unsuccessful procedure. The study sought to gain a deeper knowledge and to understand the meanings women struggling with infertility and its treatment experience and how invitro fertilisation treatment failure affects women in their everyday life. To unearth the women perception and meaning attributed to their experiences of unsuccessful infertility treatment, Heidegger's philosophy of phenomenology underpinned this study. A semistructured opening question and further probing questions were used to gather information which was reduced to sub-themes and main themes which captured the participant's lived experiences of unsuccessful invitro fertilisation treatment. I adopted van Manen's (1990) six steps of research activities as a structure to unravel the participants' phenomenological conversations. Applying Heidegger's concept of the three modes of existence (Existenze): authenticity, inauthenticity and undifferentiatedness, four major themes were identified: 1. Seeking wholistic and authentic care- authenticity 2. Facing up to the Angst- inauthenticity 3. The vulnerable self - inauthenticity 4. Living with infertility (being-in-the-world-of-motherless) - undifferentiatedness The participants' phenomenological conversations and their stories have revealed a range of challenges Ghanaian women who seek invitro fertilisation treatment go through. The study contribute significantly by giving insight to the painful experiences Ghanaian women go through when seeking invitro fertilisation treatment and has given a voice to how assisted reproductive technologies are currently experienced in the Ghanaian context. From the women's narrative, it appeared that their emotional and informational needs were not being met and were not being cared for as expected. The findings provide some direction regarding the needs of women experiencing infertility for information, support and advocacy in their pursuit of assisted reproductive technology services in Ghana. There is a critical need to simplify invitro fertilisation treatment and provision of safe, affordable procedure so that the average Ghanaian women can access it.

Thesis advisor: Lisa S. Cahill / Weaving qualitative interview analysis together with ethical inquiry, this project traces the trajectories of Catholic women and couples who hope to form families but contend with infertility and consider whether and how to treat it. Motivating this study is the challenge of balancing individual agency with the role of powerful social forces that shape agency. Examining and critiquing the social forces that shape the circumstances in which Catholic women and couples in the U.S. contend with infertility, this dissertation demonstrates how agential freedom is conditioned by familial, clinical, and ecclesial cultures and structures. It harnesses sociological tools and theological resources to argue for an account of agency that prioritizes critical engagement of contextual factors and suggests that the Church as a moral teacher ought to support the cultivation of this agency. Chapter one challenges the model of moral agency found in magisterial teachings that oppose the use of contraception and reproductive technologies, which suggests that lay Catholics ought to obey magisterially prescribed norms regardless of context. The chapter argues that the magisterial model of moral agency does not adequately account for the role of context in shaping agency, and it instead proposes an account of contextually situated agency that resonates with Pope Francis’ prioritization of contextual realties in his apostolic exhortation Amoris Laetitia. The second chapter demonstrates how various social forces, including structures supporting heterosexual marriage, cultural ideals related to biological childbearing, and ecclesial structures of marital formation all contribute to U.S. Catholic couples’ family formation choices and can intensify burdens of infertility. The chapter proposes a reorientation of Catholic support for families centered on justice in relationships and Christian discipleship instead of family structure. The third chapter examines how cultural ideals related to childbearing, the medicalization of infertility, and social location all contribute to shaping how Catholic women in the U.S. make sense of infertility. Contesting the cultural notion that women are responsible for infertility with reference to a criterion of justice, it describes infertility as a kind of biological bad luck also shaped by systemic forces. Structural injustices related to sexism and racism in healthcare function to distribute the bad luck of infertility unjustly based on societal vulnerabilities, which constitutes a kind of social sin. The fourth chapter considers how two different understandings of Catholic identity shape treatment trajectories of Catholics contending with infertility toward either secular fertility clinics or Catholic clinics. It then examines these two clinical settings, demonstrating how contextual pressures shape how Catholics make treatment choices and underscoring how Catholic moral commitments can support moral agents’ resistance to these pressures. Its final section considers the social forces at work in adoption and fostering. The final chapter turns to the role of the Church in supporting the moral agency of Catholics making decisions regarding family formation and infertility treatment. After analyzing and critiquing the dominant ideals found in Catholic and secular support group settings, it suggests that synodal commitments of mutual listening and inclusive dialogue can support the development of new structures of moral discernment in the Church. It concludes by considering how the social witness of the Church can contribute to the transformation of sinful social forces that constrain the freedom of women and couples contending with infertility. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Theology.

Abstract available in the Annals of Behavioral Medicine.

Infertility affects approximately 15% of couples. Testing and interventions are costly, in time, money, and emotional energy. This paper will discuss using Markov decision and multi-armed bandit processes to identify a systematic approach of interventions that will lead to the desired baby while minimizing costs.

Fecundity, defined as the biologic capacity for reproduction, is measured operationally as time-to-pregnancy (TTP) among non-contracepting couples. While most couples conceive naturally within six menstrual cycles of trying, 10-24% of couples take longer than six cycles. Fecundity impairments are associated with long-term adverse health consequences including insulin resistance and gynecologic cancers, can cause substantial psychological and economic hardship, and cost over $5 billion annually in the U.S. Therefore, identifying risk factors for subfecundity in order to increase the chances of natural conception among pregnancy planners is an important public health goal. Environmental and psychosocial risk factors are understudied in relation to reproductive health. The goal of this dissertation is to examine the independent associations between exposure to tetrachloroethylene, perceived stress, and cigarette smoking and fecundability, the per cycle probability of conception. In study one, we used data from a retrospective cohort study of Cape Cod women who were exposed to tetrachloroethylene-contaminated drinking water in the 1960s-1980s to examine the relation between tetrachloroethylene exposure and fertility. We found that women with the highest modeled tetrachloroethylene exposure around the time of the pregnancy attempt had increased risk of TTP>12 months compared with unexposed women. Cumulative exposure, however, was not associated with elevated risk of TTP>12 months. Studies two and three used data from Pregnancy Study Online (PRESTO), a preconception cohort study of pregnancy planners from North America. In study two, we found that perceived stress levels in women, but not their male partners, were associated with lower fecundability, with little evidence of mediation by measured behavioral factors. In study three, we found that male current active smoking was associated with lower fecundability. In women, current smoking was only associated with reduced fecundability among women who smoked with high intensity and/or long duration. Passive smoking was not substantially associated with fecundability in either partner, but women exposed in utero to high intensity smoking had lower fecundability than unexposed women. Overall, we observed weak associations between tetrachloroethylene exposure, perceived stress, and active smoking and fertility among pregnancy planners. These findings indicate that environmental and psychosocial factors may play a role in the etiology of infertility. In addition, given that these exposures are common and modifiable, they may be important targets for public health interventions.

The full text of the thesis is currently restricted. / The full text will be available at the end of the embargo period: 1st Nov 2021