Thesis (M.A.)--Indiana University, 2008. / Department of Philosophy, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Peggy Zeglin Brand, Jason T. Eberl, Michael B. Burke. Includes vitae. Includes bibliographical references (leaves 79-84).

Thesis (LL.M.)--University of Toronto, 2009. / Source: Masters Abstracts International, Volume: 48-02, page: .

Thesis (Doctoral)--Københavns universitet, 2006. / Includes bibliographical references.

Zugl.: Halle (Saale), Univ., Diss., 2008

Despite the many advances of medical technology to help treat infertility, approximately half of women seeking fertility treatment will never give birth to a child. Women coping with treatment failure face many challenges, including deciding when to abandon treatment and how to let go of their dreams of having a baby to focus on other pursuits. In order to better understand how women cope with these challenges, in depth interviews and a focus group were carried out with 12 women for whom fertility treatment had not been successful. Data was gathered and analysed using Grounded Theory, and a model of the process of adjustment from pursuing treatment to coming to terms with involuntary childlessness was co-constructed from the data. The model conceptualizes women's journey as moving through three main phases; 'living in limbo' in which women are still undergoing treatment, 'leaving treatment' in which women decide to terminate treatment and abandon the search for a resolution to their infertility, and finally 'learning to live with involuntary childlessness' in which women start the 'work' of grappling with the questions that childlessness seems to raise about the meaning of their lives, their identity and self image, and their sense of social belonging. The model goes on to highlight the factors which seem to aid women in resolving these challenges. The findings of this study suggest that the emotional challenges of coping with unsuccessful fertility treatment extend well beyond the end of treatment, highlighting the need for good access to therapeutic support for women coping with involuntary childlessness longer term. Results also point to certain sources and types of support which may be particularly helpful, including peer support from other childless women, and therapeutic interventions which help women develop more positive perspectives on childlessness and to identify alternative sources of fulfillment. The results of this study also point to the need for social action which works to challenge the misconceptions and stigma surrounding infertility and childlessness which add a further challenge to the lives of women who are involuntarily childless.

Assisted reproductive technology procedures has become a more complex treatment over the years after implementation of preimplantation genetic diagnostics and cryopreservation methods such as slow freeze and vitrification. When embryos undergo these methods they are exposed to external damage that threaten to affect their quality and thereby lead to lower survival rates and lower pregnancy rates. The aim of this study was to document blastocysts quality after vitrification, re-vitrification and preimplantation genetic diagnosis with subsequent vitrification. A total of 126 blastocysts were collected, of which 119 blastocysts were documented with the help of an experienced embryologists and the remaining seven blastocysts were from a new series of re-vitrified embryos. The 126 collected blastocyst were allocated into groups depending on their degree of preimplantation genetic diagnosis and vitrification. The gathered data was scoring according to morphology, expansion and proportion of necrotic cells at 2 and 4 hours of the expansion phase. Fisher exact test was used for statistical evaluation. There were no significant difference when comparing data before and after vitrification and preimplantation diagnosis, which indicates that these methods do not cause morphological damage to the blastocyst.

Assisted reproductive technology (ART) has been rapidly expanding since the birth of Louise Brown, the first test tube baby, in 1978. Although an increasingly complex array of laboratory skills and procedures have been developed for infertility treatments, the success rate of ART remains low. In an attempt to make ART safer and more efficient, international medical practice is trending towards single embryo transfers and the use of innovative, sophisticated technologies to identify promising gametes and embryos with the highest potential to generate a pregnancy. Laser technology is increasingly being used to accomplish these aims. The application of lasers for ART has been successfully employed in clinical practice for some time now and is continually the subject of investigative research in order to generate new methods to improve operations. Moreover, lasers serve as a powerful tool at the forefront of investigative research in the reproductive sciences, assisting in broadening our understanding of reproductive and developmental biology. Nevertheless, there is a paucity of literature pertaining to the safe standardisation of such laser procedures with evidence at the molecular level. The primary aim of this thesis was to optimise applications of laser technology for clinical ART and research applications in the reproductive sciences. This thesis utilised the mouse embryo model to investigate potential deleterious effects of different laser treatment applications, both by the operator and hardware manufacturer. Safe and unsafe laser operator parameters were elucidated by assessing deleterious effects to the plasma membrane integrity, blastocyst survival rate, DNA fragmentation levels, and changes in gene expression of key developmental genes. The effect of altering the laser hardware to lower the power output was evaluated and it was determined that if a lower power laser is used to deliver a set amount of energy over a longer period of time, a smaller amount of damage is incurred. Work in this thesis also established a new method in which laser technology can be used as a research tool for the reproductive sciences, by creating a novel stimuli-responsive laser-activated nanoparticle delivery system with spatial control and increased efficiency in a mammalian cell model. The field of reproductive science continues to benefit greatly from laser application clinically to improve infertility treatments, and in research, to elucidate mechanisms underlying infertility, with a hope of increasing our understanding and eventually developing new treatment options.

Orientador: José Maurício Barbanti Duarte / Coorientador: Eveline dos Santos Zanetti / Banca: Maria Emilia Franco Oliveira / Banca: Gisele Zoccal Mingoti / Banca: Maria Denise Lopes / Resumo: A região neotropical passa por um período crítico em termos de perda de biodiversidade. Dentro deste contexto, há um crescente aumento do número de espécies de cervídeos neotropicais sofrendo redução em seu tamanho populacional, podendo ocasionar ausência de fluxo gênico e consequente diminuição da variabilidade genética e à endogamia, afetando o desempenho reprodutivo e aumentando o risco de extinção. Neste contexto, o uso das biotécnicas da reprodução nos animais silvestres será útil para programas de conservação das mais diversas espécies. Assim, o objetivo do presente trabalho foi avaliar a viabilidade da técnica de inseminação artificial intrauterina por videolaparoscopia (IAUL), com sêmen congelado, na espécie M. gouazoubira. Foram utilizadas cinco fêmeas adultas e dois machos adultos inteiros, da espécie M. gouazoubira, sendo que, quatro fêmeas foram submetidas a dois procedimentos de IAUL com intervalo aproximado de 5 meses e uma fêmea passou por um procedimento, totalizando nove inseminações. As fêmeas receberam um dispositivo intravaginal contendo 0,33g de progesterona, cuja permanência foi de oito dias. No momento da retirada do dispositivo, foi administrado 265μg (1mL) de cloprostenol sódico. Oito horas após a retirada do dispositivo as fêmeas passaram a ser monitoradas (com rufiões) quanto a manifestação do estro comportamental a cada seis horas. Os procedimentos de IAUL foram realizados 12-14 horas após início do estro e os animais receberam uma aplicação de 2,5mg (2mL) de hormônio luteinizante (LH). As inseminações foram realizadas com sêmen descongelado, na concentração de 50 x 106 espermatozoides/dose, envasados em palhetas de 0,25mL, com motilidade e vigor mínimos de 30% e 2, respectivamente, pós descongelação. A avaliação da presença do corpo lúteo (CL) funcional foi feita com a dosagem hormonal de metabólitos fecais ... / Abstract: The neotropical region undergoes a critical period in terms of biodiversity loss. Within this context there is a rising increasing of neotropical deer species suffering a shrinking in its population. The population decreasing as well the gene flow absence can lead to the genetic variability reduction and endogamy, affecting the reproductive performance and increasing the extinction risk. In this context, the wild animal reproduction biotechnique knowledge might be useful to further conservation programs to several species. Thus, this work aim was evaluate the videolaparoscopic intrauterine artificial insemination technique (LAI), using frozen semen of M. gouazoubira. To the procedure, five adult females and two stags of M. gouazoubira were used. Four females were submitted two LAI procedures in a five months interval and one female suffered one procedure, totalizing nine inseminations. The females received an intravaginal device containing 0.33g of progesterone foreight days. At the device removal time, 265μg (1mL) of sodium cloprostenol was i.m. administred. Eight hours later the females started being monitored (with teasers ) regarding to the behaviorial estrus every six hours. The LAI procedures were done 12-24 hours after the estrus beginning, when the animals received 2.5mg (2mL) of luteinizing hormone (LH). Inseminations were done using 0.25mL straws (50x106 espermatozoons/mL) of thawed semen, with minimal motility and vigor of 30% and 2, respectively, in the post thaw. The corpus luteum (CL) presence evaluation was done by progesterone fecal metabolites hormonal dosage. The gestation diagnostic was done from 45 to 55 days after LAI by transabdominal ultrasonography. Only eight LAI procedures were able to be evaluated regarding the gestation percentage due the death of one female just after the second insemination procedure, resulting in 50% (4/8) of gestation. The average time from ... / Mestre

Made available in DSpace on 2014-06-11T19:29:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-07-05Bitstream added on 2014-06-13T20:19:13Z : No. of bitstreams: 1 000735376.pdf: 1660982 bytes, checksum: f699d8220bf1b7df5f2e9012026d973c (MD5) / A região neotropical passa por um período crítico em termos de perda de biodiversidade. Dentro deste contexto, há um crescente aumento do número de espécies de cervídeos neotropicais sofrendo redução em seu tamanho populacional, podendo ocasionar ausência de fluxo gênico e consequente diminuição da variabilidade genética e à endogamia, afetando o desempenho reprodutivo e aumentando o risco de extinção. Neste contexto, o uso das biotécnicas da reprodução nos animais silvestres será útil para programas de conservação das mais diversas espécies. Assim, o objetivo do presente trabalho foi avaliar a viabilidade da técnica de inseminação artificial intrauterina por videolaparoscopia (IAUL), com sêmen congelado, na espécie M. gouazoubira. Foram utilizadas cinco fêmeas adultas e dois machos adultos inteiros, da espécie M. gouazoubira, sendo que, quatro fêmeas foram submetidas a dois procedimentos de IAUL com intervalo aproximado de 5 meses e uma fêmea passou por um procedimento, totalizando nove inseminações. As fêmeas receberam um dispositivo intravaginal contendo 0,33g de progesterona, cuja permanência foi de oito dias. No momento da retirada do dispositivo, foi administrado 265μg (1mL) de cloprostenol sódico. Oito horas após a retirada do dispositivo as fêmeas passaram a ser monitoradas (com rufiões) quanto a manifestação do estro comportamental a cada seis horas. Os procedimentos de IAUL foram realizados 12-14 horas após início do estro e os animais receberam uma aplicação de 2,5mg (2mL) de hormônio luteinizante (LH). As inseminações foram realizadas com sêmen descongelado, na concentração de 50 x 106 espermatozoides/dose, envasados em palhetas de 0,25mL, com motilidade e vigor mínimos de 30% e 2, respectivamente, pós descongelação. A avaliação da presença do corpo lúteo (CL) funcional foi feita com a dosagem hormonal de metabólitos fecais... / The neotropical region undergoes a critical period in terms of biodiversity loss. Within this context there is a rising increasing of neotropical deer species suffering a shrinking in its population. The population decreasing as well the gene flow absence can lead to the genetic variability reduction and endogamy, affecting the reproductive performance and increasing the extinction risk. In this context, the wild animal reproduction biotechnique knowledge might be useful to further conservation programs to several species. Thus, this work aim was evaluate the videolaparoscopic intrauterine artificial insemination technique (LAI), using frozen semen of M. gouazoubira. To the procedure, five adult females and two stags of M. gouazoubira were used. Four females were submitted two LAI procedures in a five months interval and one female suffered one procedure, totalizing nine inseminations. The females received an intravaginal device containing 0.33g of progesterone foreight days. At the device removal time, 265μg (1mL) of sodium cloprostenol was i.m. administred. Eight hours later the females started being monitored (with teasers ) regarding to the behaviorial estrus every six hours. The LAI procedures were done 12-24 hours after the estrus beginning, when the animals received 2.5mg (2mL) of luteinizing hormone (LH). Inseminations were done using 0.25mL straws (50x106 espermatozoons/mL) of thawed semen, with minimal motility and vigor of 30% and 2, respectively, in the post thaw. The corpus luteum (CL) presence evaluation was done by progesterone fecal metabolites hormonal dosage. The gestation diagnostic was done from 45 to 55 days after LAI by transabdominal ultrasonography. Only eight LAI procedures were able to be evaluated regarding the gestation percentage due the death of one female just after the second insemination procedure, resulting in 50% (4/8) of gestation. The average time from ...

This dissertation describes the patient experience. In Chapter One, we review the currentstate of patient-centered care with a specific focus on women’s experiences in infertility treatments, highlighting the gaps in our understanding of their experiences. The four independent but complementary aims of the dissertation studies are then introduced, and we identify how they address current gaps to advance our understanding of women’s experiences using reproductive technology. In Chapter One, we also introduce an innovative service design tool, journey mapping, as well as the Burden of Treatment Framework which guided the dissertation. Chapter Two, An Integrative Review of Journey Mapping to Document the Patient Experience, presents an integrative review examining the use of journey mapping in health care services research. In the analysis of these twenty-two studies, we demonstrate how journey mapping has been adapted to describe the patient experience. While the qualitative rigor of the included studies is of good quality, the inconsistent application of design standards in the accompanying visualizations, when present, suggests that further work and guidance is needed in the adaptation of this service design tool for the health research field. In Chapter Three, Journey Mapping the Patient Experience of IVF: A Social Media Analysis, we used posts from the largest infertility subreddit and patient-facing online resources to describe and visually depict the patient experience of IVF in two journey maps representing the experiences of women in their first cycle of infertility treatment and women in repeat cycles. Findings highlighted problems and unmet needs in the infertility treatment experience, including information needs, communication needs, and support needs. Chapter Four, The Burden of Treatment in IVF: An Analysis of Social Media Using a Framework for Chronic Complex Conditions, used qualitative descriptive methodology to guide inductive and deductive content analysis of posts from the same infertility subreddit. Findings suggest that Eton’s framework is applicable to infertility, but can be expanded by the inclusion of three new constructs that we identified. Finally, Chapter Five synthesizes the key findings across these four aims, outlining their strengths and limitations, and discussing implications for future research, policy, and clinical practice.