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SAMMANFATTNING Bakgrund: Ett par som önskar bli gravida, och som under minst ett år med upprepade oskyddade samlag inte lyckats bli gravida, benämns som infertila. Av alla dessa par beräknas tio till femton procent vara infertila. Orsakerna till infertiliteten kan vara många och ligga hos både mannen och kvinnan, ålder och livsstilsfaktorer anses vara viktiga bidragande orsaker. Endast tjugofem till femtio procent av de par som är infertila och söker behandling får uppleva den efterlängtade förlossningen. Det är inte ovanligt att kvinnor i denna situation drabbas av en livskris. Barnmorskan har en stödjande roll i samband med det infertila parets behandlingsprocess. Syfte: Syftet med detta arbete var att belysa kvinnors upplevelser av den sociala och psykiska påverkan som den ofrivilliga barnlösheten kan medföra, samt hur de hanterar dessa upplevelser. Metod: Den metod som valts för detta arbete är en litteraturöversikt. Arbetet baserades på 15 vetenskapliga artiklar publicerade 2005- 2015. För att finna material gjordes artikelsökningar i olika databaser. De valda artiklarna granskades enligt Sophiahemmets Högskolas riktlinjer för kvalitetsgranskning. Artiklarna lästes upprepade gånger och med hjälp av understrykningar i texten kunde relevant information delas in under tre olika rubriker som svarade på studiens syfte och frågeställningar. Resultat: Resultatet har delats in i tre huvudrubriker vilka är; Kvinnors upplevelser av den psykiska påverkan, Kvinnors upplevelser av den sociala påverkan och Att hantera den nya livssituationen. Slutsats: Kvinnornas upplevelser av den psykisk påverkan kan beskrivas med många ord, men de känslor som ofta återkommer är skuld, skam, sorg, förlust av självkänsla, stress, ångest och depression. Kvinnornas upplevelser av den social påverkan beskrivs oftast som isolering och stigmatisering. Kvinnor hanterar den nya livssituationen på olika sätt, men det viktigaste är att ha en aktiv och medveten strategi.

Testicular germ cell tumors (TGCTs) are thought to arise during early embryogenesis due to the arrest of germ cell differentiation at primordial germ cells (PGCs) or gonocytes. Oxidative stress (OS) is implicated in cancer development as a factor leading to DNA damage. Reactive oxygen species (ROS) -induced instability occurs as a series of progressive steps. The cell has several defense mechanisms against the deleterious effect of ROS (e.g. antioxidants and DNA repair). When the defense mechanisms are exhausted by increasing OS, DNA damage leads to genomic instability with subsequent mutations that can be transmitted during cell division. On the other hand, male infertility is a representation of testicular dysgenesis syndrome, which carries a risk for TGCTs development. The mechanisms underlying both TGCTs and male infertility are thought to be overlapping to some extent. The central hypothesis of this work is that OS induces germ line genomic instability leading to testicular germ cell tumors. To test this hypothesis, mouse germ cell lines were established and subjected to different doses of OS in the form of H2O2. The mutation frequency was associated with the treatment dose 2 uM at days 3, 6, and 9 (p<0.001, p<0.001, and p<0.0003, respectively). The mBAT27 marker showed a mutation frequency fitting quadratic response surface regression. The mutation frequencies pointed to the possible role of OS leading to accumulation of DNA damage and initiating events that lead to TGCTs development that may occur early in life, possibly during the prenatal period. In addition, different panels of microsatellite markers from across the genome were analyzed to test for differential instability in both somatic cells and germline cells. Blood and semen samples from 18 infertile patients and 7 ethnically matched controls were used. Microsatellite markers were selected; 26 on the Y chromosome, 16 on the X chromosome, and 20 on different autosomes. Microsatellite instability was detected in markers located near genes responsible for testis development, spermatogenesis, cell differentiation, and proteins involved in mismatch repair mechanisms. This supports the hypothesis that testicular germ cell tumors may arise during early embryogenesis through acquiring multiple mutations that accumulate over time.

Inhibin A and B participate to regulation of gametogenesis. We investigated their applicability as a marker of gametogenesis of men fertility disorders. We monitored the levels of inhibins during the treatment. We interested in their paracrine activity, relationship in sera, follicular fluid and seminal plasma depending on cause of fertility failure. We studied the levels of inhibin B in serum and seminal plasma from 355 men treated for fertility failure, in the context of their andrological and immunological findings (quality of spermiogrammes and acrosome area). We monitored concentration of levels of inhibin A and B in serum and follicular fluids depending on cause of fertility failure, on course and treatment outcome. We took blood samples in the time of the oocytes collection, of the embryotransfer and early pregnancy. The follicular fluids were obtained during the oocytes collection. The levels of both of inhibins were measured by ELISA in all medium (serum, follicular fluid, seminal plasma). We confirm, that inhibin B is useful marker of spermatogenesis in men, but is necessary to examine patient in complex with determination of immunology profile or quality of acrosome. Seminal plasma is, in some indicated cases, more suitable diagnostics material. Similarly inhibin B in women seems to be...

The lived experiences of previously infertile mothers in the early postpartum period have not been previously studied. The purpose of the research was to explore the experiences of previously infertile mothers during their early postpartum period. Colaizzi’s (1978) approach to descriptive phenomenological inquiry was used to analyze the interview data obtained from twelve first-time, previously infertile mothers. These new mothers, aged 27 to 43 years, were interviewed twice. The first interview focused on eliciting descriptions of new motherhood in the early postpartum period after overcoming infertility. The second interview validated the interpretations from the first interview and provided additional information and reflection. Two main themes emerged that described the early postpartum experience of first-time, previously infertile mothers: 1) Lingering Identity as Infertile; and 2) Gratitude for the Gift of Motherhood. Participants reported that their lingering identity as infertile and immense gratitude for the gift of motherhood propelled them to establish unrealistic expectations to be the perfect mother. When they were unable to live up to being the perfect mother, they censored their feelings of inadequacy, guilt, and shame. Findings from this study sensitize healthcare providers to the difficulties faced by previously infertile women during their transition to motherhood.

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<p>The adoption of children across international borders has emerged as an important cultural phenomenon. It shapes the way North Americans understand families, and forms relationships between sending and receiving countries. This dissertation explores the transnational adoption of children between Canada and China with a focus on the subjective experiences of Canadian women who have adopted children from China, their dreams, motivations and lived experiences of becoming an adoptive mother. Highlighting these narratives, this dissertation serves to balance critique with advocacy, and complicates the binary opposition in both scholarly and popular culture presentations of transnational adoption as either ‘good’ or ‘bad’. The dissertation also explores the social pressures that Canadian women endure and how gender expectations and cultural ideas of femininity depend on a woman experiencing motherhood. Through the window of transnational adoption this dissertation examines discourses about infertility, philanthropy, kinship, gender and the construction of transnational adoption as kidnap or rescue.</p> / Doctor of Philosophy (PhD)

Bakgrund: Det råder ojämlikheter i vården, och kvinnor är en grupp som drabbas av sämre hälsa och sämre tillgång till vård. Endometrios, en kronisk kvinnosjukdom som drabbar var tionde kvinna, orsakar smärtsamma symtom kopplade till menstruation. Diagnosfördröjningar beror ofta på normalisering av menstruationssmärta. Trots dess vanliga förekomst finns ingen känd orsak eller botemedel för endometrios. Sjuksköterskor spelar en viktig roll i att stödja dessa patienter. Syfte: Syftet var att belysa kvinnors erfarenheter av att leva med endometrios. Metod: En litteraturöversikt med tio kvalitativa artiklar inkluderade i resultatet från två databaser; Cinahl Complete och PubMed. Resultat: Resultatet bestod av tre huvudteman och sju underteman: 1. Att bli misstrodd; En lång väntan på diagnos; Bristande förtroende för vården 2. Att hantera vardagen; Hinder i vardagen; Strategier i vardagen 3. En känslomässig berg- och dalbana; Påverkan på intima relationer; En förändrad kvinnlighet; En förändrad kroppsuppfattning Slutsats: Kvinnor med endometrios upplever att hela livet påverkas vilket resulterar i många olika känslor och en förlorad autonomi. Många tappar förtroende för vården och känner sig felbehandlade. Misstro från omgivningen bidrar till ytterligare lidande för kvinnorna. / Background: Inequalities exist in healthcare, and women are a group disproportionately affected by poorer health and limited access to healthcare. Endometriosis, a chronic women's health condition affecting one in ten women, causes painful symptoms linked to menstruation. Delays in diagnosis often stem from normalization of menstrual pain. Despite its common occurrence, there is no known cause or cure for endometriosis. Nurses play a crucial role in supporting these patients. Aim: The aim was to explore women's experiences of living with endometriosis. Method: A literature review with ten qualitative articles included in the results from two databases; Cinahl Complete and PubMed. Results: The results consisted of three main themes and seven subthemes: 1. Being disbelieved; A long wait for a diagnosis; Lack of trust in healthcare 2. Managing everyday life; Daily life obstacles; Strategies in daily life 3. Emotional turmoils; Impact on intimate relationships; Altered femininity; Altered body perception Conclusions: Women with endometriosis experience that their entire lives are affected, resulting in many different emotions and a lost autonomy. Many lose trust in healthcare and feel mistreated. Distrust from their surroundings contributes to further suffering for the women.

Charles University in Prague Faculty of Natural Sciences Summary of Ph.D. thesis The role of LIF gene mutations and the relative distribution of NK cells, NKT and T lymphocytes in follicular fluid and blood of women with different history of infertility Jiří Křížan Prague 2010 1 | P a g e Doctoral degree programs in biomedicine Charles University in Prague and the Academy of Sciences of the Czech Republic Programme: Biomedicine Chairman of the Subject Board: Doc. RNDr. Vladimír Holáň, Dr.Sc. Place of study: Institute of Microbiology, v.v.i., Academy of the Czech Sciences Vídeňská 1083, 142 20 Prague 4 phone: +420 296 442 318 Autor: Mgr. Jiří Křížan Supervisor: RNDr. Petr Šíma, CSc. The dissertation can be found at Dean's Office Faculty of Charles University in Prague 2 | P a g e CONTENTS Contents 2 Summary 3 1. Introduction 5 2. Hypotheses and aims 6 3. Material and methods 7 Material: 7 Methods: 8 4. Results 10 5. Discussion 12 6. Conclusion 15 7. References 16 Bibliography of Autor: 18 1. papers in extenso (thesis background) 18 2. papers in extenso (without regard to thesis) 19 3 | P a g e SUMMARY The aim of the dissertation thesis "The role of LIF gene mutations and the relative distribution of NK cells, NKT, and T lymphocytes in follicular fluid and blood of women with different history of infertility"...

När den reproduktiva hälsan sviktar kan känslor av att vara mindre värd uppkomma och såväl manlighet som kvinnlighet är begrepp som tycks vara starkt knutna till människans förmåga att reproducera sig. Infertilitet är ett problem vilket uppstår i en relation. Trots detta har det under lång tid setts som ett kvinnligt problem. Studien syftar till att belysa fenomenet infertilitet ur mäns perspektiv och utgår från ett livsvärldsperspektiv. Totalt deltog sju män i studien, livsvärldsintervjuer genomfördes och materialet analyserades utifrån en fenomenologisk hermeneutisk ansats. Materialet mynnade ut i sammanlagt tolv subteman vilka resulterade i fyra stycken teman. Framtidstro, Intimitet, Maktlöshet samt Uthärdande tycks tillsammans stå för innebörden av fenomenet. Männen har ett behov av att finna strategier och på så vis öka känslan av att hantera och begripa den egna livssituationen vilket ses som en röd tråd genom resultatet. Männen tycks se sina upplevelser kring infertilitet som något positivt. De har intagit en ny roll och en stärkt relation till partnern belyses. Kopplingar till Antonovskys teorier kring KASAM kan ses och vikten av delaktighet betonas i resultatet. Diskussion förs även kring huruvida skillnader i bakomliggande orsaker till infertiliteten kan påverka resultatet. / When reproductive health is failing and feelings of being less worthy arise and both masculinity and femininity are concepts that seem to be strongly linked to man's ability to reproduce. Infertility is a problem which arises in a relationship. Despite this, it has for a long time been seen as a women's problem. The study aims to shed light on the phenomenon of infertility from men´s perspective and based on a life-world perspective. The study includes seven men, life-world interviews and material reviewed on the basis of a phenomenon logical hermeneutical approach. The material resulted in a total of twelve subthemes resulting four themes. Optimism in the future, Intimacy, Powerlessness and Persevering seem to stand together for the meaning of the phenomenon. The men have a need to find strategies and thereby increase the feeling of manage and comprehend their life situation. The men seem to see their experiences of infertility as something positive. They have taken on a new role and a stronger relationship with the partner is illuminated. Links with Antonovskys theories about KASAM can be seen and the importance of participation is emphasized in the outcome. There are also discussions on whether the differences in the underlying causes of infertility can affect results.