<p>The main aims were to investigate emotional reactions during in vitro fertilization (IVF) treatment among women and men, attitudes of IVF couples towards cryopreserved embryos and public attitudes towards various aspects of oocyte donation in Sweden. Assessments of emotional, physical and social reactions were made on a daily reaction scale and attitudes on the basis of study-specific questionnaires. Both women and men experienced the stages of oocyte retrieval and embryo transfer, as well as the luteal phase, as being particularly stressful and there was a similarity in the type of reaction pattern. Presence of supernumerary embryos for cryopreservation increased the women’s optimism, but did not seem to reduce their level of distress on the day of embryo transfer. One-third of IVF couples chose not to use their cryopreserved embryos. The main reasons among the respondents concerned family planning and too short a legally allowed time of embryo storage. There was strong support for oocyte donation among a subset of the Swedish population. Women were more positive than men towards oocyte donation and to disclosure of the origin to offspring. Factors that might increase the likelihood of women becoming oocyte donors were talking to women with experience of donating oocytes, proximity to the clinic, accessibility of counselling and having children of their own. These results indicate that different approaches to psychological care for women and men may not be warranted during IVF treatment. Contact should be maintained during the cryopreservation period in order to adress the couple’s questions and concerns about the embryos. To increase the donor pool, IVF clinics could provide information about donation to potential donors through the Internet and through experienced donors. The information to donors and recipient couples about different consequences of donation seems to be of great importance.</p>

The main aims were to investigate emotional reactions during in vitro fertilization (IVF) treatment among women and men, attitudes of IVF couples towards cryopreserved embryos and public attitudes towards various aspects of oocyte donation in Sweden. Assessments of emotional, physical and social reactions were made on a daily reaction scale and attitudes on the basis of study-specific questionnaires. Both women and men experienced the stages of oocyte retrieval and embryo transfer, as well as the luteal phase, as being particularly stressful and there was a similarity in the type of reaction pattern. Presence of supernumerary embryos for cryopreservation increased the women’s optimism, but did not seem to reduce their level of distress on the day of embryo transfer. One-third of IVF couples chose not to use their cryopreserved embryos. The main reasons among the respondents concerned family planning and too short a legally allowed time of embryo storage. There was strong support for oocyte donation among a subset of the Swedish population. Women were more positive than men towards oocyte donation and to disclosure of the origin to offspring. Factors that might increase the likelihood of women becoming oocyte donors were talking to women with experience of donating oocytes, proximity to the clinic, accessibility of counselling and having children of their own. These results indicate that different approaches to psychological care for women and men may not be warranted during IVF treatment. Contact should be maintained during the cryopreservation period in order to adress the couple’s questions and concerns about the embryos. To increase the donor pool, IVF clinics could provide information about donation to potential donors through the Internet and through experienced donors. The information to donors and recipient couples about different consequences of donation seems to be of great importance.

The Royal Commission on New Reproductive Technologies developed rapidly in Canada after the birth of world’s first “test tube baby,” Louise Brown, in 1978. Canadian feminists, propelled by the women’s health movement, perceived these technologies as a threat to women’s control over their bodies, the gains made to redefine the identity “woman” against the biological tradition of “mother,” and against the safety and freedom of women based on race, disability and class. In response to the lobby efforts of the women’s movement under the Canadian Coalition for a Royal Commission on New Reproductive Technologies, the Mulroney government established a commission in 1989 to study the medical, legal, and social implications these technologies would have on Canadian society. Through a qualitative analysis of manuscript and printed sources, this thesis explores the debate surrounding new reproductive technologies (NRTs) before and after the mandate of the Royal Commission (1989 to 1993). It discusses the views and positions of some of the key stakeholders such as the National Action Committee on the Status of Women, the Canadian Medical Association, the DisAbled Women’s Network, as well as adds the voice of infertile women through the Infertility Awareness Association of Canada. This thesis also examines the controversy and discontent created by the Commission’s dismissal of several members, by the management’s style of its Chair, and by the final report’s narrow scope. In the end, the reaction to the report was one of considerable disappointment amongst all major stakeholders, starting with NAC, which claimed that its voice had not been heard. At the same time, the debate over NRTs illustrates NAC’s ongoing internal problems as it faced the challenge of “identity politics.”

The Royal Commission on New Reproductive Technologies developed rapidly in Canada after the birth of world’s first “test tube baby,” Louise Brown, in 1978. Canadian feminists, propelled by the women’s health movement, perceived these technologies as a threat to women’s control over their bodies, the gains made to redefine the identity “woman” against the biological tradition of “mother,” and against the safety and freedom of women based on race, disability and class. In response to the lobby efforts of the women’s movement under the Canadian Coalition for a Royal Commission on New Reproductive Technologies, the Mulroney government established a commission in 1989 to study the medical, legal, and social implications these technologies would have on Canadian society. Through a qualitative analysis of manuscript and printed sources, this thesis explores the debate surrounding new reproductive technologies (NRTs) before and after the mandate of the Royal Commission (1989 to 1993). It discusses the views and positions of some of the key stakeholders such as the National Action Committee on the Status of Women, the Canadian Medical Association, the DisAbled Women’s Network, as well as adds the voice of infertile women through the Infertility Awareness Association of Canada. This thesis also examines the controversy and discontent created by the Commission’s dismissal of several members, by the management’s style of its Chair, and by the final report’s narrow scope. In the end, the reaction to the report was one of considerable disappointment amongst all major stakeholders, starting with NAC, which claimed that its voice had not been heard. At the same time, the debate over NRTs illustrates NAC’s ongoing internal problems as it faced the challenge of “identity politics.”

Av par i fertil ålder som aktivt försöker få barn är det 10-15 procent som inte lyckas inom ett år och räknas då till kategorin ofrivilligt barnlösa. Att drabbas av ofrivillig barnlöshet innebär stor sorg och prövning för det drabbade paret. Med hjälp av assisterad befruktning kan parets möjligheter till graviditet öka. En IVF-process innebär psykisk och fysisk påfrestning, vilket ställer stora krav på vårdens bemötande, kompetens och stöd. Denna studie syftar till att undersöka hur par som genomgår IVF-behandling upplever vårdens bemötande samt om och i så fall hur parets relation påverkats under och efter IVF-processen. Studien har en kvalitativ ansats och för att uppfylla syfte och besvara frågeställningar har semistrukturerade intervjuer använts som metod. Undersökningen består av fem intervjupar vilka genomgått eller genomgår en IVF-process. Resultatet visar att respondenterna från en början upplevde ett varmt och välkomnande bemötande, men att det efterhand förändrades. Respondenterna beskriver brister hos vårdpersonalen såsom kränkning, kompetens- och tidsbrist. Vidare framgår att flertalet upplever att de blivit bemötta som en i mängden, framförallt av läkare, då de inte fått den individanpassade vård som krävdes. Resultatet visar att paret under IVF-processen utsätts för flertalet påfrestningar, vilket kan vara krävande för parrelationen. Trots detta upplever paren att påfrestningarna medfört en stärkt parrelation. / Of couples of reproductive age who are actively trying to conceive, 10-15 percent fails within a year, and is then counted in the category of involuntary childlessness. Couples that suffer from infertility often experience great emotional distress. With the help of assisted reproduction, the couple's possibility of a pregnancy may increase. The IVF process involves mental and physical stress, which leads to heavy demands on health care treatment, expertise and support. This study aims to examine how couples undergoing IVF treatment experienced the response they received from health care system. This includes whether or not the couple's relationship was affected during and after the IVF treatment process and if so how it was affected. The study was made with a qualitative approach. Semi-structured interviews have been our method for obtaining data this study. The study is based on interviews of five couples who underwent, or are still undergoing an IVF treatment process. The results show that respondents initially experienced a warm and friendly welcome from the health care system, but it gradually changed for worse. The respondents describe what they see as inadequacies of healthcare providers such as offensiveness, lack of skills, and time constraints. Furthermore, it appears that the majority feels that they have been overlooked, especially by doctors, when they did not receive the personalized care they needed. The results show that during the IVF treatment process the couples are subjected to intense and varying forms of stress that can be hard on their relationships. Despite the strain it has put on them, the couple's feel that it has strengthened their relationships.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser.

Το σύνδρομο των πολυκυστικών ωοθηκών (PCOS) είναι η συχνότερη ενδοκρινοπάθεια σε γυναίκες αναπαραγωγικής ηλικίας, προσβάλλοντας το 6%-10% του πληθυσμού και είναι το κυριότερο αίτιο ανωοθηλακιορηκτικής υπογονιμότητας στις γυναίκες. Χαρακτηρίζεται από υπερτρίχωση, ανωοθηλακιορηξία και υπερανδρογοναιμία και σχετίζεται σε μεγάλο βαθμό με την παχυσαρκία και την αντίσταση στην ινσουλίνη (IR). Ο σκοπός της μελέτης μας ήταν να διερευνήσουμε αν πολυμορφισμοί των γονιδίων τα οποία σχετίζονται με ειδικά χαρακτηριστικά του PCOS συνδέονται με κλινικές παραμέτρους του συνδρόμου, όπως η υπερανδρογοναιμία, ο βασικός μεταβολικός ρυθμός (BMR) και αντίσταση στην ινσουλίνη. Τα υποψήφια γονίδια τα οποία επιλέχθηκαν σε αυτήν την μελέτη ήταν τα γονίδια των αδρενεργικών υποδοχέων α2Β, β3, το γονίδιο της 17β-Υδροξυστεροειδούς Δεϋδρογενάσης τύπος 5 (HSD17B5), το γονίδιο του υποδοχέα της ινσουλίνης (IRS-1) και το γονίδιο PPARγ. Τα γονίδια των αδρενεργικών υποδοχέων α2Β, β3 είχαν συσχετισθεί με χαμηλό μεταβολικό ρυθμό και αύξηση του σωματικού βάρους σε προηγούμενες μελέτες. Καθώς η παχυσαρκία αποτελεί χαρακτηριστικό των γυναικών με PCOS, διερευνήσαμε εάν ο πολυμορφισμός του α2Β βρίσκεται στο PCOS. Το γονίδιο της 17β-Υδροξυστεροειδούς Δεϋδρογενάσης τύπος 5, (HSD17B5) είναι το γονίδιο του ενζύμου για την αναγωγή της ανδροστενεδιόνης σε τεστοστερόνη. Το γονίδιο IRS-1 έχει ένα σημαντικό ρόλο στην ρύθμιση του κυτταρικού αποτελέσματος της ινσουλίνης. Ο πολυμορφισμός της πρωτεΐνης του IRS-1 (Gly972Arg refSNP ID: rs1801278) απαντά στο 5-6% του γενικού πληθυσμού, διαταράσσει την λειτουργία του IRS-1 και σχετίζεται με την αντίσταση στην ινσουλίνη, την υπερλιπιδαιμία και σακχαρώδη διαβήτη τύπου 2. Το γονίδιο PPARγ ρυθμίζει την έκφραση πολλών γονιδίων τα οποία ενέχονται στην ομοιοστασία της γλυκόζης και των λιπιδίων. Εμείς βρήκαμε ότι ο πολυμορφισμός του α2Β (έλλειψη 301-303) δεν επηρεάζει τον βασικό μεταβολικό ρυθμό, την αντίσταση στην ινσουλίνη ή την αύξηση του σωματικού βάρους σε γυναίκες με PCOS και η επίπτωση του δεν διαφέρει από ότι στον γενικό πληθυσμό. Ο πολυμορφισμός του HSD17B5 σχετίσθηκε με αυξημένα επίπεδα τεστοστερόνης ορού και ελαττωμένο τον λόγο ανδροστενεδιόνης (Α)/ τεστοστερόνη (Τ). Η διάγνωση του PCOS βασίσθηκε στην ταυτόχρονη παρουσία βιοχημικής υπερανδρογοναιμίας, η οποία ορίσθηκε ως αυξημένη τεστοστερόνη ορού και/ή αυξημένο δείκτη ελευθέρων ανδρογόνων, χρόνια ανωορρηξία και πολυκυστική μορφολογία ωοθηκών στους υπερηχογραφικό έλεγχο. Τα αποτελέσματα της μελέτης μας επιβεβαιώνουν προηγούμενη αναφορά ότι ο πολυμορφισμός δεν έχει σημαντικό ρόλο στην γενετική παθογένεια του PCOS. Ωστόσο η παρουσία του πολυμορφισμού έχει κλινική σημασία καθώς συμβάλλει στην βαρύτητα της υπερανδρογοναιμίας. Οι συχνότητες των πολυμορφισμών των γονιδίων Pro12Ala στο PPARγ και Gly972Arg στο IRS-1στις γυναίκες με PCOS δεν διαφέρουν από το γενικό πληθυσμό, αν και η παρουσία του πολυμορφισμού Pro12Ala του PPARγ σχετίσθηκε με χαμηλό μεταβολικό ρυθμό (BMR). / Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-age women, affecting 6%–10% of the population and is the leading cause of anovulatory infertility in women. It is characterized by hirsutism, anovulation, and hyperandrogenemia and is highly associated with obesity and insulin resistance (IR). The aim of our study was to investigate, whether polymorphisms of genes associated with certain characteristics of PCOS were linked with various clinical parameters of PCOS, such as hyperandogenemia, basic metabolic rate (BMR) and insulin resistance. The candidate genes chosen for this study were the α2Β, β3 adrenergic receptor gene, 17b-Hydroxysteroid dehydrogenase type 5 gene, the IRS-1 gene, and the PPARγ gene. The α2Β, β3 adrenergic receptor gene polymorphisms were associated with low basal metabolic rate and weight gain in previous studies. As obesity is a characteristic of PCOS women, we investigated whether α2Β adrenergic receptor polymorphism is present in PCOS. 17b-Hydroxysteroid dehydrogenase type 5 (HSD17B5) is the enzyme responsible for reduction of androstenedione to testosterone. IRS-1 has an important role in regulating the cellular effect of insulin. (Gly972Arg refSNP ID: rs1801278) the polymorphism of IRS-1 protein which occurs in about 5-6% of the general population, significantly impairs IRS-1 function and is associated with IR, lipid abnormalities, and type 2 diabetes mellitus. PPARγ gene modulates the expression of many genes involved in glucose and lipid homeostasis. We found that α2Β adrenoreceptor 301–303 deletion polymorphism does not influence basal metabolic rate, insulin resistance or weight gain in women with PCOS and its prevalence did not differ from the general population. HSD17B5 variant was associated with increased serum testosterone levels and decreased androstenedione (A)/testosterone (T) ratio. Diagnosis of PCOS was based on the simultaneous presence of biochemical hyperandrogenism, which was defined as increased serum Testosterone and/or increased free androgen index, chronic anovulation, and polycystic ovarian morphology on ultrasound. The results of our study confirm an earlier report that the polymorphism can not play a major role in the genetic pathogenesis of PCOS. However the presence of the polymorphism has a clinical significance as it contributes to the severity of hyperandrogenemia in PCOS patients with biochemical hyperandrogenism. Genotype frequencies of the Pro12Ala in PPARγ2 and the Gly972Arg in IRS-1 gene polymorphisms among PCOS women did not differ from that of the general population, still the presence of Pro12Ala polymorphism of PPARγ2 was associated with lower Basic Metabolic Rate (BMR).

Background: Chlamydia trachomatis in women is a risk factor for tubal factor infertility and extra uterine pregnancies, but the impact of a C. trachomatis infection on male fertility is unclear. It is also hypothesized that persistent infection with C. trachomatis, or other microorganisms, might initiate/promote ovarian tumor development. The aims of the thesis were to study whether C. trachomatis serum antibodies in women and men had an impact on infertility diagnoses, semen characteristics, pregnancy rates and pregnancy outcomes; furthermore, to explore associations of C. trachomatis, and Mycoplasma genitalium, plasma antibodies with epithelial ovarian cancer and borderline ovarian tumors, as well as the presence of C. trachomatis bacteria, and other microorganisms, in ovarian tissues. Materials and methods: Papers I and II: 244/226 infertile couples were tested for serum C. trachomatis IgG, IgA, IgM and chlamydial Heat Shock Protein 60 (cHSP60) IgG antibodies. C. trachomatis IgG positive couples were also tested for C. trachomatis DNA in a urine sample. The follow-up period was 14-54 months. 244 spontaneously pregnant women were also tested for serum C. trachomatis IgG antibodies. Papers III and IV: Plasma samples from 291 women with epithelial ovarian cancer, borderline ovarian tumors and benign conditions, and plasma samples from 271 healthy controls, were analyzed for C. trachomatis IgG, IgA and cHSP60-1 IgG and M. genitalium IgG antibodies. Ovarian tissues from 186 women with benign ovaries, borderline ovarian tumors and epithelial ovarian cancer, as well as tissues from the contra lateral ovary in 126 women, were analyzed for the presence of C. trachomatis, M. genitalium, Neisseria gonorrhoeae, HPV and the polyoma viruses BKV and JCV with nucleic acid amplification tests. Results: Papers I and II: The prevalence of C. trachomatis IgG antibodies was higher among infertile than fertile women, and there were 9 couples with ongoing C. trachomatis infections. In men, C. trachomatis IgG and IgA antibodies were associated with a reduced likelihood to achieve pregnancy for the couple, as well as lower sperm concentration, reduced sperm motility and vitality, increased teratozoospermia index and the occurrence of leukocytes. C. trachomatis IgG and cHSP60 IgG antibodies in infertile women were associated with tubal factor infertility, but not with reduced pregnancy rates or outcomes. Paper III: cHSP60-1 IgG antibodies were associated with ovarian cancer belonging to the postulated type II pathogenetic pathway when plasma samples obtained more than one year prior to diagnosis were analyzed. M. genitalium IgG antibodies were associated with borderline ovarian tumors; however a statistical type 1 error cannot be excluded. Paper IV: None of the microorganisms studied were found in the ovarian tissue samples. Conclusions: C. trachomatis IgG and IgA antibodies in the man substantially decreases the chances of the infertile couple to achieve pregnancy, and are associated with subtle negative changes in semen characteristics. C. trachomatis IgG and cHSP60 IgG antibodies in the woman are risk factors for tubal factor infertility. Prospective plasma cHSP60-1 IgG antibodies are associated with type II ovarian carcinomas, but C. trachomatis bacteria, or the other microorganisms studied, could not be detected in benign, borderline or malignant ovarian tissues.

No description available.

Darbo tikslas. Išanalizuoti pagalbinių apvaisinimo būdų taikymo etines problemas pacientų požiūriu. Uždaviniai. Ištirti ir palyginti vaisingų ir nevaisingų šeimų požiūrį į pagalbinius apvaisinimo būdus; Nustatyti etines problemas, kylančias nevaisingoms šeimoms, naudojant pagalbinius apvaisinimo būdus; Įvertinti nevaisingų šeimų požiūrį į pagalbinių apvaisinimo būdų įstatyminę bazę. Tyrimo metodika. Anoniminė anketinė apklausa. Tirtos dvi respondentų grupės: nevaisingi asmenys (vaisingumo asociacijos nariai, n=93) ir vaisingi asmenys (besilaukiančios moterys, n=146). Rezultatai. Didžioji dalis respondentų yra girdėję apie pagalbinius apvaisinimo būdus ir jų taikymą. Vaisingi asmenys linkę pritarti įvairiems IVF taikymo apribojimams (amžiaus riba, IVF tik susituokusioms poroms ir pan.), vaisingumo sutrikimų turintys asmenys linkę naudotis PAB be jokių apribojimų. Nevaisingi žmonės pritaria embrionų užšaldymui, donorystei bei surogatinei motinystei, siekdami išnaudoti visus įmanomus būdus pasiekti norimo nėštumo. Nevaisingų asmenų nuomone, būtiname DA įstatyme privalo atsispindėti embrionų šaldymas, donorystė bei procedūrų kompensavimo tvarka. Išvados. 84,9 proc. visų tyrime dalyvavusių respondentų mano, kad nevaisingumas yra liga; 88,7 proc. visų respondentų yra girdėję apie pagalbinius apvaisinimo būdus. Abiejų grupių respondentai pritaria tiek in vivo, tiek in vitro procedūroms. Nevaisingos šeimos perteklinių embrionų sukūrime, jų šaldyme, spermos ar kiaušialąsčių... [toliau žr. visą tekstą] / Aim of the study. To analyse the patient‘s view of ethical issues in assisted reproductive technologies use. Objectives. To investigate and compare the fertile and infertile person‘s view of assisted reproductive technologies; To identify an ethical problems arising for infertile persons from assisted reproductive technologies use; To evaluate infertile person‘s view of assisted reproductive technologies legislative base. Methods. Anonymous questionnaire survey. Inquired two groups of respondents: infertile persons (members of Fertility Association, n=93) and fertile persons (pregnant women, n=146). Results. Most of respondents have heard about the use of assisted reproductive technologies. Fertile persons are minded to agree with various limitations of IVF use (age limit, IVF only for married couples, etc.), infertile persons prefer to use ART without any restrictions. Infertile people accept embryos cryopreservation, use of donors and surrogate motherhood, seeking to use all possibilities in order to receive pregnancy. According to infertile people opinion, new ART law is mandatory and must cover embryo cryopreservation, use of donors and reimbursement of procedures. Conclusions. 84.9 % of all respondents thinks, that infertility is a disease; 88.7 % of all respondents have heard about assisted reproductive technologies. Respondents of both groups approves in vivo and in vitro procedures. Infertile persons do not see serious ethical issues in creation of spare embryos... [to full text]