Psychological problems are common in infertile women undergoing in vitro fertilization (IVF) treatment.  The aim of this thesis was to determine the prevalence of psychiatric disorders, such as mood and anxiety disorders, and related risk factors and personality traits in women and men undergoing IVF. Participants were 1090 consecutive women and men, 545 couples, attending a fertility clinic in Sweden during a two-year period. The Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), was used for evaluating mood and anxiety disorders. The participation rate was 862 (79 %) subjects. Any psychiatric disorder was present in 31 % of females and in 10 % of males. Major depression was prevalent in 11 % of females and 5 % of males. Only 21 % of the subjects with a psychiatric disorder had some form of treatment. A negative pregnancy test and obesity (BMI ≥ 30) were risk factors for mood disorders in women and the only risk factor for depression in men was unexplained infertility. Anxiety disorders were less common than in the general population and no IVF-related risk factors were identified. The Swedish universities Scales of Personality (SSP), a self-rating questionnaire, was used for evaluation of personality traits. High scores of personality traits related to neuroticism were associated with mood and/or anxiety disorders among both women and men. Another objective was to explore the experience of childlessness three years after unsuccessful IVF by a qualitative-approach, assessing data by interviews. Failure after IVF was experienced by women in terms of grief, whereas men took upon themselves a supportive role not expressing grief. A need for professional support and counselling in how to handle grief was described. An unstructured end after IVF treatment left unanswered questions. Three years after the end of treatment, men and women were still processing and had not adapted to childlessness, indicating the grieving process was unresolved.

The World health Organization reports infertility as a disease and a failure of reproductive tract to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. Nowadays, infertility has become a common life phenomenon affecting 1 out of 5 couples at reproductive age. Idiopathic cause is mostly associated with active immune system which may produce high levels of anti-seminal and/or anti-sperm antibodies. Auto-immunization as well as iso-immunization has a significant role in up to 30% of reported cases of infertility. Semen that is defined as a complex fluid containing sperm, cellular vesicles and other cells and components, could immunize the female genital tract. This thesis is related to female immune infertility, in particular to female iso-immunization. The better understanding of this pathophysiological event consists of (1) the determination of antibody isotype playing a significant role in this disease, then (2) the characterization and identification of semen antibody-binding proteins, seminal and/or sperm, (3) the proposal of potential diagnostic markers to adapt specific therapy and, in addition, the design of miniaturized diagnostic tool based on the selected markers, (4) the suggestion of potential immuno-intervention. Based on the distribution of seminal/sperm-specific antibody isotypes, we suggest that immunoglobulins E, M, A1,2, G3 are not involved in the primary pathophysiological female sensitization. IgG4 appears to be the major subclass interacting with sperm proteins. On a contrary, IgG1 seems to be the one mainly involved in the reactivity towards seminal proteins. We have also extended the existing group of IgG-binding sperm proteins, among which heat shock protein 70 1A/1B, heat shock cognate protein 71 kDa and alpha-enolase have been shown, for the first time, to be related to female iso-immunization. We have put the emphasis on the role of seminal proteins in iso-immunization and not only in the IgE-mediated semen hypersensitivity as known so far. In particular, prostate-specific antigen, prostatic acid phosphatase and zinc finger protein 778 have been determined as immunodominant among IgG-binding seminal proteins. The determination of female serum seminal/sperm-specific IgG subclasses could make the patient diagnoses more comprehensive. Anti-seminal/sperm IgG1,4 might be of interest for immunotherapy. Furthermore, the herein described proteins could be useful biomarkers of such pathology. The miniaturized chip could be a lateral flow immunoassay-based device acting on the immunochemical detection of specific antibodies. The intended immuno-intervention could consist of the effect of intravenous immunoglobulins.

Various hormones have been studied as regards prediction of pregnancy outcome after infertility treatment, but no ideal candidate has been found. Folate and genetic variations in folate metabolism have also been associated with infertility, but it remains unclear how these factors affect IVF pregnancy outcome. It is known that infertility is associated with active folic acid supplement use, but the effect of socioeconomic and lifestyle factors on folic acid supplement use in infertile women has not been well investigated. The overall aim of this work was to obtain information on the prediction of live birth, and to study factors affecting the role of folate and folic acid intake in relation to IVF pregnancy outcome. Infertile women with various infertility diagnoses were studied. Healthy, fertile non-pregnant women were used as controls in three of the studies. Blood samples were taken for assay of eight different hormones, folate and homocysteine, and for genomic DNA extraction. A questionnaire was used to assess background data and use of folic acid supplements. Twenty-four-hour recall interviews were performed for validation of the questionnaire. The studied hormones were not good predictors of live birth. The best predictor was age of the women, together with ovulatory menstrual cycles, and thyroid-stimulating hormone and anti-Müllerian hormone (AMH) status. Well-educated women, high-status employed women, and married and infertile women used the most folic acid supplements. Infertile women had better folate status than fertile women. However, pregnancy outcome after infertility treatment was not dependent on folic acid intake, folate status, genetic variation of 5,10-methylenetetrahydrofolate reductase or socioeconomic status. In conclusion, AMH levels vary less than those of other hormones during the menstrual cycle, and AMH could be used as a predictive marker of live birth together with age and ovulation. Folate might play a minor role in IVF pregnancy outcome, but the importance of folate as regards other health perspectives should not be forgotten.

Thesis (D.Phil.)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: Chapter 1 provides literature based background information on the clinical importance of sperm morphology as recorded by strict criteria during the diagnostic approach of the infertile couple. Furthermore, the use of a sequential diagnostic schedule for couples in an assisted reproductive programme is emphasized. The author revisited the literature on chromatin packaging of spermatozoa and addresses this issue as an additional semen parameter providing information relating to DNA damaged spermatozoa. The chapter also includes evidence underlining the growing need for the implementation of the acrosome reaction as an important contribution to the assisted reproductive programme. Chapter 2 provides detailed descriptions of the material and methods used during the study. Chapter 3 is sub-divided into 5 sections, each of which represents a separate study that was prepared as a scientific paper. The study included 338 couples consulting for infertility treatment at various gynaecologists in Pretoria and Johannesburg. The diagnostic assisted reproductive laboratory support was provided by the Andrology laboratory of Drs du Buisson and partners from Pretoria. In the first study the role of chromatin packaging as an indicator of in vitro fertilization rates, the semen samples from 72 men were used to record their chromatin packaging quality as well as their sperm morphology classification. Significant different percentages CMA3staining (mean±SE) were recorded among the 2 morphology groups, namely 65.9%±3.5 and 44.5%±1.7 (p=0.001). Using cut off values for chromatin packaging established during the first study, the second study utilized semen from 140 men in the in vitro fertilization (IVF) and intracytoplasmic sperm injection programme (ICSI) to analyze for sperm concentration, motility, morphology and chromatin packaging (CMA3).IVF and ICSI data were stratified using 3 basic cut off values for CMA3staining, namely <44%, >44-60% and >60%. The study concluded that results on the chromatin packaging quality of spermatozoa could be used as an additional parameter of sperm quality since it could provide valuable information on decondensation status of a given sperm population. The third study aimed to establish zona pellucida induced acrosome reaction response (ZIAR) among 35 couples with normal and G-pattern sperm morphology and repeated poor fertilization results during assisted reproduction treatment. Interactive dot diagrams, divided patients into 2 groups i.e. ZIAR<15% and ZIAR>15% with mean fertilization rates of 49% and 79%, respectively. The study concluded that the ZIAR test has diagnostic potential, since it can assist the clinician to identify couples that will benefit from ICSI therapy. The forth study revisited the importance of micro-assay for acrosome reaction determinations in a diagnostic andrology laboratory. The micro-assay not only allows the use of a single zona pellucida, but also facilitates the future possibility of using recombinant zona pellucida proteins in a diagnostic test system. The final study in Chapter 3 includes results obtained from 49 couples (172 oocytes) and aimed to evaluate the role of chromatin packaging and sperm morphology during sperm-zona binding, sperm decondensation and the presence of polar bodies among 170 oocytes that failed in vitro fertilization (IVF). Odds ratio analyses indicated that being in the a group with elevated CMA3 staining i.e. >60%, the risk of decondensation failure increases 15.6 fold relative to normal CMA3 staining <44%. Chapter 4 underlines the validity of the sequential diagnostic approach and summarizes the results and value of a multistep diagnostic scheme. The chapter concludes with the recommendation that both chromatin packaging quality and zona pellucida mediation of the acrosome reaction should be part of the diagnostic tools in the assisted reproductive programme. / AFRIKAANSE OPSOMMING: Die literatuuroorsig in Hoofstuk 1 konsentreer in hoofsaak op die kliniese belang van sperm morfologie en die uitbreiding van die diagnostiese toetse en hantering van die egpaar in die reproduktiewe ondersteuningsprogram. Die kromatien pakkingskwaliteit van die spermsel word onderskryf as In belangrike toevoeging tot die diganostiese program, aangesien ONS skade dikwels saam met kromatiendefekte aangetref word. Die rol van die akrosoomreaksie word ook in detail literatuuroorsigtelik beklemtoon. Hoofstuk 2 bevat volledige inligting omtrent materiaal en metodes wat in die studie gebruik is. Hoofstuk 3 bevat die eksperimentele gegewens wat in 5 afsonderlike sub-afdelings as wetenskaplike publikasies aangebied word. Die studies bestaan uit data van 338 pasiënte, wat deur verskillende ginekoloë van Pretoria en Johannesburg gekonsulteer is waartydens drs. du Boisson en vennote van Pretoria die diagnostiese reproduktiewe laboratoriumdienste verskaf het. Die eerste studie stel dit ten doel om die belang en korrelasie van die spermsel kromatienpakkingskwaliteit van 72 mans te vergelyk met die morfologiese bou van sie sel. Aangesien morfologie reeds gevertig is as 'n kliniese voorspeller van bevrugting was dit nodig om hierdie parameter te vergelyk met die kromatienpakking van die sel. Twee afsnypunte word vir die normo-en teratozoospermiese mans identifiseer naamlik, 44.5%±1.7 en 65.9%±3.5 (p=O.001),respektiewelik. Die tweede studie gebruik die afsnypunte 44% en 66% om die in vitro bevrugting en intrasellulêre sperm inspuiting (ICSI) data te ontleed. Die resultate dui aan dat kromatienpakking In waardevolle bydrae tot die diagnostiek van die pasiënte lewer. Die derde studie stel dit ten doelom die waarde van die zona pellucida geinduseerde akrosoomreaksie (ZIAR) te bepaal. Die studie sluit die data van 35 egpare in wat almal normale of G-patroon morfologie het en verder onverklaarde swak bevrugtings resultate tydens in vitro bevrugtingsterapie. Interaktiewe punt diagram (interactive dot diagrams) verdeel die data in twee groepe naamlik, ZIAR<15% en ZIAR>15% met gemiddelde bevrugtingssyfers van 49% en 79%, respektiewelik. Die studie sluit af met die gedagte dat die ZIAR toets 'n groep pasiënte identifiseer met 'n besondere fisiologiese afwyking d.i. subnormale akrosoom respons op zona pellucida blootstelling. Die vierde afdeling van die hoofstuk onderstreep die belang van die mikro-tegniek vir die bepaling van die akrosoom reaksie, wat tydens die projek gebruik is Die vyfde afdeling van Hoofstuk 3 stel dit ten doelom 170 onbevrugde eierselle van 49 pasiënte te ontleed vir moontlike oorsake vir die mislukte bevrugting. Ondersoeke sluit in die kromatienpakking, sperm-zona binding, sperm dekondensasie en die teenwoordigheid van polêre liggaampies. Statisties blyk dit dat indien 'n kromtienpakking nie normaal is nie (>66%) het die spermsel 'n 15 keer groter kans om nie te dekondenseer nie. Hoofstuk 4 bespreek die noodsaaklikheid van die diagnostiese skedule by die hantering van die onvrugbare egpaar in.

Social workers are increasingly being called upon to work with clients who wish to have a child but are unable to do so without medical intervention. This study, a cross-sectional survey design, examines the attitudes of couples towards donor insemination (DI), in vitro fertilization (IVF), contractual pregnancy, adoption and living child free. A random sample of 200 names was drawn from the membership of the Infertility Awareness Association of Canada, Toronto Chapter. Surveys were completed by 74 participants (37 couples). Participants were generally well educated, affluent and ranged in age from 26 to 63 years. Women were one third more likely to report feeling pressure to have children than were men. The source of this pressure was most often reported to be external/interpersonal relationships (e.g., friends, family, partner). Women were significantly more likely to strongly agree that they would use DI or IVF if they were infertile; whereas, men were more likely to only agree when considering DI, and to be unsure or neutral when considering IVF. The possibility of living child free was an alternative that very few participants had seriously considered, as many were still pursuing one or more reproductive alternative. Although significant differences were found within couples for DI, IVF and living child free in the vignettes, unexpectedly an overall theme of agreement between women and men was found as well. In addition, participants revealed a desire for support in their consideration of, and decision making regarding, the reproductive alternatives they may pursue. Clearly, the findings point to the need participants have to receive counselling, and/or follow-up to help them cope with their infertility and the possibility that they may not be able to have children.

This thesis aims to discuss the concept of Assisted Reproduction Technology and its social and affective impacts. Women will be at the center of this research as it has been thought that emotional stressors are mostly effective on them. In the present work, an investigation will be carried out among women who have used assisted reproduction technology methods and women who are able to reproduce and conceive &ldquo / naturally&rdquo / . The comparison of these two groups will illuminate problematical aspects of assisted reproduction technology. The research will be based on two sets of questionnaires designed for each group of women. In this study, both qualitative and quantitative data were used. These analyses will not only lead us to compare infertile and fertile women&rsquo / s responses and evaluate the consequences of emergent assisted reproduction technology but also to assess its social and emotional impacts.

Reproductive performance of lactating dairy cows was studied using a prospective observational study of 29,462 cows in 168 commercial herds in 9 regions in Australia. There was substantial variation in all reproductive performance measures between herds, suggesting that important increases in reproductive performance would be possible in many commercial Australian herds if causal factors were identified and modified. Multivariable multilevel logistic models were used to study potential determinants for two measures of overall reproductive performance - pregnancy by week 6 after start of the mating period (mating start date or MSD) and non-pregnancy by week 21 after MSD, and for two components of overall reproductive performance - submission by week 3 after MSD and conception to first service.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 1988. / Includes bibliographical references (leaves 165-175).

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.