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This paper advances understanding of the consequences of female infertility in sub-Saharan Africa on the individual level. It illustrates how local meanings of infertility are shaped by the social and cultural context and how they influence the life experiences and coping behaviours of infertile women in an Ijo community in the Niger Delta. Infertility in Amakiri is a stigma. Barren women cannot attain full womanhood and join appropriate age associations since they cannot be circumcised without having given birth. Uncircumcised women cannot be burried within the town, rather, their corpses are buried in a designated forest. The paper is based on over twenty years of ethnographic field work, a complete census of one of the town's quarters to estimate the level of infertility and on the life histories of infertile women. The life histories are used to illustrate how women of various ages, educational levels and occupations cope with their common experience of infertility.
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PMID:Profiles of infertility in southern Nigeria: women's voices from Amakiri. 1467

We report that infertile women in Japan as well as in the Western world have high levels of emotional distress, anxiety, and depression. The reasons for anxiety and depression in infertile women are easy to presume but remain unclear. We conducted the present study to assess the relationship between the anxiety and depression of infertile Japanese women and their thought processes and emotional well-being with regard to their infertility. A cross-sectional questionnaire was administered to 101 infertile Japanese women who visited the infertility clinic at Tokai University. Inventories included the Hospital Anxiety and Depression Scale (HADS) and our original infertility questionnaire, which is composed of 22 questions to assess attitudes and emotional status in facing the stigma of infertility. After factor analysis, comparison between the HADS and the infertility questionnaire was made with simultaneous multiple regression analyses. Anxiety and depression in childless Japanese women were significantly associated with lack of husband's support and feeling stress. Our findings should prove useful in designing and implementing psychological support programs for infertile Japanese women. Psychological interventions to relieve or diminish these conditions might have significant therapeutic benefits for women attending infertility clinics in Japan.
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PMID:Increased depression and anxiety in infertile Japanese women resulting from lack of husband's support and feelings of stress. 1547 40

The traditional notion that a family is built around and based on blood or genetic ties is challenged when assisted human reproduction utilizing donor gametes is used. A focus on the family--in contrast to the individual--requires from medicine an extension of thinking in which a model that incorporates treating infertility and building a family becomes the norm. Such a model will require that attention is given to the psychological and social needs of the would-be parents, thus enabling them to approach their family building with confidence. This confidence is expected to carry through to their sharing with their offspring the nature of their family building and thus avoid the stigma that leads to secrecy. Research relating to dimensions of family building when donor insemination has been used is reviewed. The impact of professional attitudes, along with the policies adopted by governments concerning access to genetic information for offspring, significantly influences the families built with assistance of donor gametes or embryos. The evolution of professional thinking in this area is reviewed, along with the increasing involvement of governments.
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PMID:Is blood really thicker than water? Assisted reproduction and its impact on our thinking about family. 1645 22

The ovaries of 74 llamas were examined daily by transrectal ultrasonography for at least 30 d. Hemorrhagic follicles were observed in 13 (18%) llamas (incidence per anovulatory dominant follicle, 16%). The proportion of llamas in which a hemorrhagic follicle was detected was different among groups (nonmated, 8/25; mated to a vasectomized male, 4/21; mated to an intact male, nonpregnant, 1/10; mated to an intact male, pregnant, 0/18; P<0.05). A hemorrhagic follicle, observed grossly after ovariectomy, was large (13 mm) and fluctuant, with a thin translucent wall and dark red contents. No ovulatory stigma was detected, and after incising the wall, bloody fluid escaped and the follicle collapsed leaving only a small blood clot within the antrum. Ultrasonically, the formation of a hemorrhagic follicle was indicated by scattered free-floating echogenic spots within the follicular antrum which swirled upon ballottement of the ovary. The antral contents appeared to become organized (did not swirl when ballotted) after follicle growth ceased. Ultrasonic indications of antral hemorrhage were not observed in any follicles in which ovulation was later detected (0/45 ovulatory follicles). All of the hemorrhagic follicles (13/13) involved the dominant follicle of a wave during which no copulatory stimulus was applied. Hemorrhagic follicles were apparently anovulatory and were repeatable (P<0.05) within individuals. The interval from first detection to the first day of maximum diameter was longer (P<0.05) and maximum diameter was greater (P<0.0001) for hemorrhagic follicles than nonhemorrhagic follicles (16.4 versus 13.1 d and 22.1 versus 12.8 mm, respectively); however, the interwave interval was not affected by the presence of a hemorrhagic follicle. Luteinization of the hemorrhagic follicle was indicated (thickened wall) in two llamas by an elevated plasma progesterone concentration and/or by ultrasound. By their large size, hemorrhagic follicles may be interpreted as hemorrhagic follicular cysts; however, they were not associated with other ovarian irregularities or with infertility.
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PMID:Hemorrhagic ovarian follicles in llamas. 1672 25

A growing number of jurisdictions have introduced legislation to give children the right to information about, and identity of, 'their' gamete donor. This has been accompanied by a reduction in the social stigma associated with infertility and building families with the assistance of donated gametes. This changing culture has meant that an increasing number of parents are seeking assistance regarding how to share their family history, including the donor insemination conception story. The literature suggests that the sharing of information is best undertaken when the children are young. There is virtually no literature available for parents who wish to share their family history with adult offspring, or for those professionals whose guidance they may seek. This paper addresses this emerging area of practice. It is suggested that there are three main areas that will be of assistance with any attempt to understand the individual and family dynamics involved: identity and self-image, stigma and power. Strategies and suggestions emerging from each of these areas of knowledge are outlined. This paper aims to generate discussion and to encourage others to share their clinical experiences in this area.
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PMID:Sharing information with adults conceived as a result of donor insemination. 1682 10

The practice of gamete donation has, until recently, been shrouded in secrecy. The stigma associated with infertility and, in particular, donor insemination has been the main factor contributing to this secrecy. Over the last 20 years, this secrecy and the anonymity of the gamete donors has been challenged. In the first instance, the challenge came from governments in some countries legislating to abolish donor anonymity. Counsellors, social workers and psychologists advocating for the interests and needs of children and their families, as well as parents who did not wish to keep gamete donation secret from their children, were also instrumental in the change of policies and practice. Those offspring who know that they were conceived as a result of gamete donation are also calling for an end to the secrecy. This chapter reviews the changes that have occurred and which are still occurring, and reviews the research associated with these changes.
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PMID:Donor gametes: anonymous or identified? 1708 77

This research aimed to investigate the extent to which women in Southern Ghana seeking infertility treatment perceived themselves as stigmatised in order to investigate the relationship between perceived stigma and infertility-related stress. A survey was conducted using face-to-face interviews in three languages with 615 women receiving infertility treatment on three health sites in Southern Ghana. The majority (64%) of women in this sample felt stigmatised. Sequential multiple regression analyses indicated that higher levels of perceived stigma were associated with increased infertility-related stress. Also women with higher levels of education felt less infertility-related stress. The presence of an existing child/children, the number of years spent in infertility treatment and the type of marriage (monogamous/polygamous union) were less important in predicting stress. The findings suggest that the social status of infertile women derived from other factors can be of importance in minimising the impact of stigmatisation and stress related to infertility. These findings highlight the wider beneficial effects of improved educational opportunities for girls and women.
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PMID:The impact of perceived stigma and mediating social factors on infertility-related stress among women seeking infertility treatment in Southern Ghana. 1767 44

Successful fertilization in plants requires the properly coordinated development of female reproductive tissues, including stigma, style, septum and transmitting tract. We have identified three closely related genes, HECATE1 (HEC1), HECATE2 (HEC2) and HECATE3 (HEC3), the expression domains of which encompass these regions of the Arabidopsis gynoecium. The HEC genes encode putative basic helix-loop-helix (bHLH) transcription factors with overlapping functionality. Depending on the amount of HEC function missing, plants exhibit varying degrees of infertility, defects in septum, transmitting tract and stigma development and impaired pollen tube growth. The observed phenotypes are similar to those reported for mutations in the SPATULA (SPT) gene, which also encodes a bHLH transcription factor required for development of the same female tissues. We show that the HEC proteins can dimerize with SPT in a yeast two-hybrid system, indicating that the HEC genes work in concert with SPT to coordinately regulate development of the female reproductive tract. Furthermore, when the HEC genes are ectopically expressed from the CaMV 35S promoter, some of the resulting transgenic plants show pin-shaped inflorescences, suggesting that the HEC genes are probably involved in auxin-mediated control of gynoecium patterning.
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PMID:The HECATE genes regulate female reproductive tract development in Arabidopsis thaliana. 1785 26

This article reviews the epidemiology of sexually transmitted disease (STD) disparities for African American communities in the United States. Data are reviewed from a variety of sources such as national case reporting and population-based studies. Data clearly show a disproportionately higher burden of STDs in African American communities compared with white communities. Although disparities exist for both viral and bacterial STDs, disparities are greatest for bacterial STDs such as gonorrhea, chlamydia, and syphilis. Gonorrhea rates among African Americans are highest for adolescents and young adults, and disparities are greatest for adolescent men. Although disparities for men who have sex with men (MSM) are not as great as for heterosexual populations, STD rates for both white and African American MSM populations are high, so efforts to address disparities must also include African American MSM. Individual risk behavior and sociodemographic characteristics of African Americans do not seem to account fully for increased STD rates for African Americans. Population-level determinants such as sexual networks seem to play an important role in STD disparities. An understanding of the epidemiology of STD disparities is critical for identifying appropriate strategies and tailoring strategies for African American communities. Active efforts are needed to reduce not only the physical consequences of STDs, such as infertility, ectopic pregnancy, chronic pelvic pain, newborn disease, and increased risk of HIV infection, but also the social consequences of STDs such as economic burden, shame, and stigma.
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PMID:Epidemiology of STD disparities in African American communities. 1897 96

Acquired immune deficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV), disproportionately affects Africa whereby the majority of new infections and deaths occur in sub-Saharan Africa. It is the leading cause of death in Africa and a major cause of maternal mortality. HIV/AIDS impacts on every aspect of reproductive health and presents considerable challenges to healthcare systems. Fertility is particularly valued in Africa and voluntary childlessness is unusual. AIDS results in a reduction in both fecundity and fertility, as well as compromising the outcome of pregnancy. The stigma of childlessness is quite profound and impacts both social life and social standing within the community, particularly of the women who are affected. Unfortunately, treatment for infertility is often inadequate and, because of limited resources, is frequently denied to HIV-positive couples. Undoubtedly the challenges in dealing with the HIV/AIDS pandemic in Africa are enormous; however, appropriate solutions are available and these need to be put in place. It is essential that the management of the HIV patient is holistic and takes all needs, including that of fertility, into account.
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PMID:HIV and reproductive health: a South African experience. 1940 24


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