In the general population, one in five couples experiences difficulty in conceiving a child. The role of obesity on women’s fecundity has become a focus of attention in recent years. Successful treatment of infertility through Assisted Reproductive Technology (ART) is also compromised by the presence of obesity, which occurs in 30 % of women seeking treatment. A negative correlation exists between increased body mass index (BMI) and the number of collected oocytes and a lower birth rate after ART. Furthermore, a number of studies have established that weight loss improves natural conception rates in overweight women. Whether weight management can improve success rates in overweight / obese women undergoing in vitro fertilisation (IVF) has not been studied. The purpose of this project was to explore the role of short–term weight loss on potential pregnancy outcomes in overweight / obese women undergoing IVF programme. However, to establish this relationship, we proposed to carry out two studies to assess the following: (I) The feasibility of very low calorie diet (VLCD) during IVF treatment with respect to duration, level of restriction and tolerability of the diet during hormonal down regulation in women (Chapter 2). (II) How energy restriction may affect the quality of an early embryo in diet - induced obese mice with respect to various body weight and caloric intake (Chapter 3). In study (I), women preferred a shorter dietary intervention with greater energy restriction (456 kcal per day) to gradual energy restriction (1200 kcal / day for the first week, and afterward, 456 kcal / day) prior to oocyte transfer. Women were able to comply with the VLCD during IVF treatment and both dietary groups achieved a significant weight loss (mean 6.3 %). In study (II), by using obese mice, the effect of rapid weight loss (mean 12 %) was observed after 5 days of energy restriction. Ovulation rate was greater in the Obese group (HFD) (55.6%) and equal in both Control (CD) and Energy Restricted (HF / ER) (44.4 %) groups. The HF / ER group showed higher fertilisation rate (80 %) than HFD and CD (55% and 45.5%, correspondingly). The blastocyst stage was reached by half of the cultured embryos in both HF / ER and HFD groups and 33 % in the CD group. The quality of embryos that completed blastocyst formation did not differ between groups. However, postfertilisation development in females fed a high fat diet was slower compared to CD and HF / ER groups. In conclusion, this work illustrated a weight management prior conception and use of VLCD during IVF treatment in clinical study needs further investigation with regard to the dietary duration, level of energy restriction and how this combination will influence IVF treatment outcomes. Furthermore, as we were unable to determine the question of how the dietary intervention affects the quality of oocytes and the animal study illustrated a promising result, thus further studies are required. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1311579 / Thesis (M.Med.Sc.) -- University of Adelaide, School of Paediatrics and Reproductive Health, 2008

Thesis (doctoral)--Göteborg University, 2005. / Includes bibliographical references (p. 438-449) and index.

Thesis (doctoral)--Uppsala University, 1991. / Includes bibliographical references (p. 201-207) and index.

Les services reproductifs transfrontaliers (SRT) réfèrent au déplacement d'une juridiction à une autre, de personnes ou de matériel reproductif dans le cadre d'un projet de procréation assistée (PA). Ce phénomène a été observé dans de nombreux pays, mais le système de PA mondialisé canadien, ou reproscape, demeure sous-étudié. Ce manque de connaissances nuit au développement normatif en matière de PA. En adoptant un cadre conceptuel issu de l'anthropologie médicale, l'objectif général de cette thèse était de décrire et comprendre le reproscape canadien. Pour alimenter la réflexion éthique et juridique et la prestation des services de PA, nous avons réalisé une enquête ethnographique clinique multisite combinant : (1) une revue de la littérature, (2) l'observation participante et non participante de deux cliniques de fertilité (Québec et Ontario), d'une agence d'importation de gamètes et d'une dizaine de congrès scientifiques, ainsi que (3) des entrevues semi-dirigées avec 45 actrices et acteurs des SRT : personnes utilisatrices, personnel médical et intermédiaires. Les données ont fait l'objet d'une analyse qualitative inductive, assistée du logiciel NVivo 11. Trois dimensions émergent de nos résultats. (1) Le Canada se caractérise par une mosaïque de lois et de règlements locaux, fédéraux et provinciaux qui influencent de façon paradoxale les SRT. L'obligation de don altruiste, établie par la Loi sur la procréation assistée (LPA), joue un rôle prédominant sur le reproscape canadien. (2) Au niveau de l'expérience des SRT, la simplicité de certains SRT intégrés à la pratique clinique, comme l'importation de sperme ou d'ovocytes, contraste avec la complexité des voyages vers l'étranger auxquels les personnes utilisatrices se sentent souvent contraintes. (3) Interrogées sur leurs perspectives éthiques, quatre positions principales ressortent des entrevues: (a) le respect de leur autonomie reproductive, (b) les risques individuels et (c) sociaux des SRT, dont celui d'exploitation des gestatrices et des donneuses d'ovules, ainsi que (d) les incohérences de la LPA quant à sa capacité d'atténuer ces risques. En conclusion, le reproscape canadien se caractérise, entre autres, par une situation de " sous-traitance reproductive " : une reconnaissance institutionnelle des SRT, combinée à une délocalisation des risques moraux et médicaux hors des frontières nationales. Les conclusions de notre étude mettent en évidence le caractère inextricable du local et du global en PA et comment le reproscape mondial fonctionne par vases communicants. / Abstract : Cross-border reproductive care (CBRC) refers to the movement from one jurisdiction to another of persons or reproductive material as part of assisted reproductive technology (ART) treatment. This phenomenon has been observed in many countries, but the Canadian globalized ART system (or "reproscape") remains understudied empirically. This lack of data undermines the normative development in terms of ART. The aim of this dissertation is to describe and understand the Canadian reproscape in order to support ethical and legal reflection. To achieve this goal, we conducted a multi-site clinical ethnography combining (1) literature reviews, (2) participant and non-participant observation in two fertility clinics (Quebec and Ontario), a gamete importation and distribution agency and a dozen scientific congresses, (3) as well as semi-directed interviews with 45 actors of CBRC: users, medical professionals and intermediaries. The data were analyzed by inductive qualitative analysis assisted by NVivo 11 software. Three dimensions emerge from our results. (1) Regarding the legal and clinical contexts of ART, Canada is characterized by a local mosaic of laws and regulations that paradoxically influence CBRC. The altruistic obligation established by the Assisted Human Reproduction Act (AHRA) plays a predominant role on the reproscape. (2) In terms of the experience of the main actors, the simplicity of CBRC integrated to the clinic, such as the import of semen or oocytes, contrasts with the complexity of journeys abroad for which users often feel constrained. (3) When asked about their ethical perspectives, the actors mentioned four main positions: (a) the respect for their reproductive autonomy, (b) the individual and (c) social risks of CBRC, including the exploitation of egg donors as well as gestational surrogates, and (d) AHRA inconsistencies in its ability to mitigate these risks. Our conclusion is that the Canadian reproscape is characterized, inter alia, by a situation of "reproductive outsourcing." This concept is characterized by an institutional recognition of CBRC combined with a relocation of moral and medical risks outside national borders. The results of our study underline the inextricable local and global nature of ART and how CBRC works as communicating vessels.

La présente recherche porte sur les processus de filiation et de parentalité chez les couples demandeurs d'une aide médicale à la procréation nécessitant le recours à une mère porteuse.Pour aborder la spécificité et la complexité de ces situations, nous avons élaboré un modèle théorique paradigmatique qui propose un rapport dialogique entre les concepts de filiation et de parentalité. Cette modélisation se présente sous forme matricielle. Elle permet de connecter des savoirs issus de diverses disciplines et ouvre sur la possibilité de repenser nos schémas conceptuels de la filiation et la parentalité à l'ère des modifications des conditions de la reproduction, de la gestation et de la naissance. / Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

Contexte : Une amélioration des habitudes de vie, avec une légère perte pondérale (5 %), augmenterait les chances de concevoir un enfant chez les femmes obèses souffrant d’infertilité. La perte de poids est considérée comme le principal déterminant de la survenue d’une grossesse, mais aucune étude n’a évalué le rôle la qualité alimentaire. Objectif principal : Évaluer l’impact de l’amélioration de la qualité alimentaire sur les chances de survenue d’une grossesse auprès de femmes obèses et infertiles. Méthodologie : Étude prospective s’insérant dans un essai randomisé contrôlé évaluant l'impact d'une intervention interdisciplinaire visant l’amélioration des habitudes de vie sur la fertilité des femmes obèses suivies à la clinique de fertilité du CHUS en comparaison à des femmes ayant accès aux soins standards en fertilité seulement (n = 102). Des visites de recherche ont lieu à l’entrée de l’étude puis aux 6 mois jusqu’à la fin du projet, soit après 18 mois ou jusqu’à l’accouchement. La collecte de données inclut un questionnaire de fréquence alimentaire, des mesures anthropométriques et un test de condition physique. Un index de qualité alimentaire, le Healthy Eating Index modifié (mHEI, 0-100 points), a été calculé. Résultats : Pour l’ensemble des participantes, l’amélioration de la qualité alimentaire n’était pas associée à de meilleures chances de grossesse. À l’aide d’un modèle de régression de Cox, il a été possible d’observer que la qualité alimentaire initiale était un prédicteur important de grossesse au sein des deux groupes confondus (HR (par 10 unités) : 1,24 [1,03 – 1,50], p = 0,027), indépendamment du niveau de condition physique et de l’anthropométrie. De façon similaire, une meilleure qualité alimentaire observée avant conception présentait une association significative indépendante avec les chances de concevoir dans le temps (HR (par 10 unités) : 1,25 [1,04 – 1,49], p = 0,017). Les variables anthropométriques, incluant le poids, n’étaient pas associées à une probabilité accrue de concevoir. Conclusion : Une meilleure qualité alimentaire en préconception augmenterait les chances de grossesse chez les femmes infertiles souffrant d’obésité. / Abstract : Background : Improvement of lifestyle habits, associated with a modest weight loss (5 %), has shown to increase odds of pregnancy in overweight and obese women diagnosed with infertility. Weight loss is considered as the main factor that explains the improvement of fertility, but no study evaluated the specific role of diet quality on fertility in this population. Objective : Evaluate the impact of improving diet quality on odds of pregnancy in obese and infertile women seeking for fertility treatments. Methods : Prospective study nested in a randomized controlled trial evaluating the impact of an interdisciplinary lifestyle intervention on fertility of obese women followed at the fertility clinic of the CHUS, in comparison to standard fertility care only. Research visits take place every 6 months until the end of the project, which is after 18 months or delivery. Data collection include a food frequency questionnaire, anthropometric measurement and a fitness evaluation. A score of diet quality, the modified Healthy Eating Index (mHEI, 0-100 units), was calculated. Results : For all the participants, improvement of diet quality was not associated with the probability of pregnancy. With Cox regression, we observed that the initial diet quality was an important predictor of pregnancy within the two confounded groups (HR (by 10 units) : 1.24 [1.03 – 1.50], p = 0.027), independently of cardiorespiratory fitness and anthropometry. Similarly, the best diet quality observed before conception presented a significant independent association with odds of pregnancy over time (HR (by 10 units) : 1.25 [1.04 – 1.49], p = 0.017). Anthropometric variables, including weight, were not associated with a higher probability of conception. Conclusion : A greater diet quality in preconception seems to increase probability of pregnancy in obese infertile women.

The question of whether there might be a moral obligation to select against disability in our offspring has received considerable attention and attracted great controversy within both the philosophical community and beyond over the last couple of decades. Within this thesis I examine this question, taking as a basis for discussion the view that prospective parents should be formally free to choose whether or not to select against disability in their offspring in the absence of adequate justifying reasons to the contrary. I then move on to examine and outline arguments that suggest variously and for a plethora of different reasons that selection against disability should be condemned morally or required. After this is done and it is noted that the sheer volume of different positions and arguments requires a more specific focus I, in my thesis articles take what I view to be the strongest of moral reasons, person-affecting reasons, and look to the question of whether it is possible ground a moral obligation to select against disability in our offspring in the person affecting harms that our reproductive choices might produce. In the first paper I ask whether the non- identity problem really poses such an insurmountable obstacle to the claim that to select against disability may harm those that are created as a result of our selection choices. This leads to the conclusion that on certain accounts of personal identity over time and trans-world identity it is possible to determine harm in a number of previously non-identity cases of which the selection against disability case is one. In the second paper I broaden my focus slightly by looking to the possible harms that our procreative choices might impose on others than the children we may create: ourselves, our existing dependents and existing members of society. In doing this it is shown that our reproductive choices do, at least in societies with advanced social and medical welfare systems, have the potential to impose significant burdens on others. However, whilst this is so, it is also demonstrated that this is not necessarily a decisive reason to condemn a reproductive choice to select for or to fail to select against disability in our offspring. In my final paper I take a slightly different approach, focusing less on the question of whether there should be a moral obligation to select against disability in our offspring and more on the question of whether there should exist a legal imperative to do so. Taking as a basis a liberal approach to the moral limits of law I suggest that impingements on individual liberty may only be justified when it can be shown that our reproductive choices cause significant harms or offence to others, I ask whether the recent insertion into English and Welsh Law of a prohibition on selection for disability can be justified. In line with the findings of the previous two papers which are far from conclusive and by examining the reasons given in legal and policy documents in England and Wales relating to this prohibition I suggest that as it stands such a prohibition cannot be justified. This ultimately leads to a rather unsatisfying – but perhaps inevitable, in light of the messy nature of reproduction – conclusion: It is possible to discuss the ethics of selection against and for disability on person-affecting accounts of morality and to discuss the matter in this way offers sensitive and sensible prescriptions. However, such discussions turn out to be, in virtue of the many competing claims of those affected by reproductive decisions and policy, far more complex than might be assumed and do not fit neatly with the commonly held moral intuition that it is always morally preferable to select against disability in our offspring.

Limited breeding success in captive breeding programs has necessitated the development of assisted reproductive technologies (ART) to preserve and increase genetic variation and population numbers of both captive and wild amphibian groups. ART has been shown to be successful in numerous anuran species, and current studies focus on the application of ART in ex-situ populations. The focus of this project is to show that linking in-situ and ex-situ amphibian populations through sperm cryopreservation, genome banking, and in-vitro fertilization is possible, with the goal of increasing gene diversity throughout groups in order to produce self-sustaining, wild populations in the future. Specific objectives include developing a sperm-cryopreservation methodology using sperm from the model species Anaxyrus fowleri, applying this protocol to the cryopreservation of spermatozoa from two other threatened anurans to determine protocol transmissibility, and linking in-situ and ex-situ populations of an endangered species using cryopreserved sperm form wild males to produce viable offspring.

Infertility is a global challenge, often remedied with In vitro fertilization (IVF) and Intra cytoplasmic sperm injection (ICSI). Sperm quality is crucial, prompting ICSI when compromised. Routine sperm preparation via gradient centrifugation raises concerns about sperm stress and DNA fragmentation. Zymot, a new device that utilizes microfluidic technology, emerges as a promising alternative. It minimizes sperm stress and DNA damage, potentially enhancing fertilization rates and embryo quality. The aim of this study was to compare the outcome of ICSI samples treated with Zymot against gradient centrifuged samples. Focus was on fertilization rates, embryo quality, and pregnancy outcomes.  The results of 104 Zymot treated samples from men with compromised sperm quality were compared with 144 gradient centrifugations retrospective. Results revealed a significant difference between methods in the number of pronulear (PN), specifically in the Good Quality Embryo (GQE) where 62% with Zymot were 2PN compared to 59% with gradient (p=0.017). No significant difference in pregnancy rates or embryo utilization rate were observed. A tendency towards higher proportion (54.6%) of Zymot-treated embryos were cryopreserved compared to gradient (49.4%, p=0,27). In conclusion, a significant difference between methods in the GQE proportion of 2PN embryos favored Zymot. Closer examination revealed a higher proportion of embryos cryopreserved with Zymot, suggesting a potential for increased treatment success in future cycles. Zymot, requiring less time, yielded equivalent results to gradient centrifugation, with higher GQE proportions and more embryos cryopreserved. This merits consideration as a high-quality alternative to sperm preparation for ICSI in cases of poor sperm quality.

Pas de résumé / Doctorat en droit / info:eu-repo/semantics/nonPublished