Conception by egg donation: perceptions, maternal bonding and health practices

Infertility is a condition that affects a significant number of couples around the world and Assisted Reproductive Technology (ART), which offers a range of possible treatments, is the most effective means to treat infertility. One of the key features of ART is conception by egg donation in which the child has no genetic link with the mother. The aim of the present thesis is to examine how the Iranian (Eastern) and British (Western) public, as well as mothers (both Iranian and British) who have conceived a child by egg donation, differ in their perceptions of the consequences of children born by egg donation from psychological, social and medical perspectives (study1). Furthermore, it aims to examine how Iranian pregnant women who have conceived by egg donation differ in their maternal bonding and health practices from those who conceived naturally (study 2). The sample group in study 1 consisted of 121 participants, 63 Iranian (Male = 26, Female = 37, Mean Age = 42.91, SD = 13.58) and 58 British (Male = 19, Female = 39, Mean Age = 32.36, SD = 14.02), in which 8 participants (4 Iranian and 4 British) were mothers with a donor egg child of primary school age. A 12-item questionnaire/statements was presented to the participants based on key reported literature on various scientific research findings on psychological, medical and social issues related to children born through ART. The participants were requested to respond to each statement by choosing one of the Likert scale options ranging from 1 to 4, Strongly agree, Agree, and Disagree to Strongly disagree. There was also an opportunity for the participants to write down additional comments in response to each of the statements about the reasons for their choice on each of the options. The process of data collection took 5 months to complete from January to May 2015. Study 1 results were subjected to quantitative analyses for the Iranian and the British public and for the Iranian and British mothers who have children born as a result of egg donation. Furthermore, all written comments were subjected to content analysis. The results showed that Iranian mothers with a donor egg child agreed more than their British counterparts (8 participants) that conception via egg donation might have psychological, social and medical problems for the resulting children due to a) lack of genetic link b) being unhappier than naturally born and c) might experience overt prejudice from the society. Overall, study 1 found that men more than women and the Iranians more than the British were in agreement with scientific research that children conceived via egg donation have more medical, psychological and social problems than naturally born children due to lack of genetic link, being unhappier and experience more prejudice from their society. Study 2 conducted in a hospital in Tehran aimed to explore maternal bonding between mother and fetus, and health practices in Iranian pregnant women via egg donation and naturally through the Maternal-Fetal Attachment (MFA), Fetal Health Locus of Control (FHLC) and Maternal Health Practices (MHP). The target group consisted of 21 Iranian women pregnant via egg donation (Mean Age = 32.42, SD = 4.48). For comparison, a sample of 50 women pregnant by natural conception (Mean Age = 28.06, SD = 5.45) was also recruited. The process of data collection initiated in January 2018 and concluded in May 2018. The results showed women who conceived via donor egg, compared to women who conceived naturally, scored lower on the 4 subscales of MFA namely: Attributing characteristics to the fetus, Giving of self, Differentiation of self from the fetus and Interaction with the fetus. On the FHLC scale, women who conceived via donor egg, compared to women who conceived naturally, considered both Chance and Professionals/Powerful Others (External factors) as being more responsible for the health of their baby rather than Internal factors (or themselves). Finally, women who conceived via donor egg, compared to women who conceived naturally, scored lower on MHP indicating they paid significantly less attention to their health activities during pregnancy. Overall, the results of the two studies are argued to make an original contribution to public perceptions of donor egg children and maternal bonding, and health practices of pregnant women who conceived by egg donation, in particular, in a culture such as Iran. It is hoped that practitioners and those involved in infertility treatment benefit from the results of the present study in giving the best advice to their patients. The limitations of the thesis, as well as recommendations and future directions, are discussed

A cross-cultural perspective on mothers’ attitudes on sharing information with the teachers on which child has been conceived by egg donation

There is now a growing body of research examining psychological aspects of children born as a result of Assisted Reproductive Technologies (ARTs), in particular via egg donation. Some research suggests that concealment of children’s biological origins may affect their psychological development. Hence, there is current debate to decide how widely details about children’s conception should be disclosed to the public in particular to those involved in the education of children. Some parents maintain that the school should be informed so that teachers can offer support to children that reveal details about their origin. Others think this information should be kept private. The present study is focused on the debate as to whether the private information about the children’s conception should be shared with their teachers. This will be studied from the point of view of mothers with naturally conceived children and mothers of children born as a result of egg donation. Furthermore, the topic will be investigated from a cross-cultural perspective. Mothers of children born as a result of egg donation from Iran (N =4) and Britain (N =4), overall mean age = 39.37, and 69 mothers with naturally conceived children from Iran (N = 33) and Britain (N = 36), overall mean age = 36.79, were asked if they would agree that information about how their child was born should be shared with their teachers. The results were an overwhelming disagreement from all women that this information should be shared with teachers. However, Iranian women with naturally born children differed from their British counterparts in being relatively more positive on this subject, possibly an indication that they do not agree with conception via egg donation. The implications of the results are discussed

A cross-cultural perspective on mothers’ attitudes on sharing information with the teachers on which child has been conceived by egg donation

There is now a growing body of research examining psychological aspects of children born as a result of Assisted Reproductive Technologies (ARTs), in particular via egg donation. Some research suggests that concealment of children’s biological origins may affect their psychological development. Hence, there is current debate to decide how widely details about children’s conception should be disclosed to the public in particular to those involved in the education of children. Some parents maintain that the school should be informed so that teachers can offer support to children that reveal details about their origin. Others think this information should be kept private. The present study is focused on the debate as to whether the private information about the children’s conception should be shared with their teachers. This will be studied from the point of view of mothers with naturally conceived children and mothers of children born as a result of egg donation. Furthermore, the topic will be investigated from a cross-cultural perspective. Mothers of children born as a result of egg donation from Iran (N =4) and Britain (N =4), overall mean age = 39.37, and 69 mothers with naturally conceived children from Iran (N = 33) and Britain (N = 36), overall mean age = 36.79, were asked if they would agree that information about how their child was born should be shared with their teachers. The results were an overwhelming disagreement from all women that this information should be shared with teachers. However, Iranian women with naturally born children differed from their British counterparts in being relatively more positive on this subject, possibly an indication that they do not agree with conception via egg donation. The implications of the results are discussed

Longitudinal, 3D in vivo imaging of sebaceous glands by coherent anti-Stokes Raman scattering microscopy –normal function and response to cryotherapy

Sebaceous glands perform complex functions, and are centrally involved in the pathogenesis of acne vulgaris. Current techniques for studying sebaceous glands are mostly static in nature, whereas the gland’s main function – excretion of sebum via the holocrine mechanism – can only be evaluated over time. We present a longitudinal, real-time alternative – the in vivo, label-free imaging of sebaceous glands using Coherent Anti-Stokes Raman Scattering (CARS) microscopy, which is used to selectively visualize lipids. In mouse ears, CARS microscopy revealed dynamic changes in sebaceous glands during the holocrine secretion process, as well as in response to damage to the glands caused by cooling. Detailed gland structure, plus the active migration of individual sebocytes and cohorts of sebocytes were measured. Cooling produced characteristic changes in sebocyte structure and migration. This study demonstrates that CARS microscopy is a promising tool for studying the sebaceous gland and its associated disorders in three-dimensions in vivo

Protease-activated receptor-2 mediates the expression of inflammatory cytokines, antimicrobial peptides, and matrix metalloproteinases in keratinocytes in response to Propionibacterium acnes

Propionibacterium acnes (P. acnes) has been known to produce various exogenous proteases, however, their role in acne pathogenesis remains largely unknown. Proteases elicit cellular responses, at least in part, via proteinase-activated receptor-2 (PAR-2), which is known to mediate inflammation and immune response. In this study, we investigated whether proteases from P. acnes could activate PAR-2 on keratinocytes and induce pro-inflammatory cytokines, antimicrobial peptides (AMPs), and matrix metalloproteinases (MMPs) via PAR-2 signaling. We examined PAR-2 expression and protease activity in acne lesions using immunofluorescence staining and in situ zymography. The effect of the culture supernatant of P. acnes on Ca2+ signaling in immortalized keratinocytes (HaCaT) was measured using a fluorescence method. HaCaT cells were treated with P. acnes strain ATCC 6919 culture supernatant, with or without pretreatment with serine protease inhibitor or selective PAR-2 antagonist and the gene expression of pro-inflammatory cytokines, AMPs, and MMPs was detected using real-time reverse transcription-polymerase chain reaction. We found that the protease activity and PAR-2 expression were increased in acne lesions. The P. acnes culture supernatant induced calcium signaling in keratinocytes via PAR-2 and stimulated the mRNA expression of interleukin (IL)-1α, -8, tumor necrosis factor (TNF)-α, human beta defensin (hBD)-2, LL-37, MMP-1, -2, -3, -9, and -13 in keratinocytes, which was significantly inhibited by serine protease inhibitor as well as selective PAR-2 specific antagonist. These results indicate that PAR-2 plays an important role in the pathogenesis of acne by inducing inflammatory mediators in response to proteases secreted from P. acnes

Vitamin A Metabolism by Dendritic Cells Triggers an Antimicrobial Response against Mycobacterium tuberculosis.

Epidemiological evidence correlates low serum vitamin A (retinol) levels with increased susceptibility to active tuberculosis (TB); however, retinol is biologically inactive and must be converted into its bioactive form, all-trans retinoic acid (ATRA). Given that ATRA triggers a Niemann-Pick type C2 (NPC2)-dependent antimicrobial response against Mycobacterium tuberculosis, we investigated the mechanism by which the immune system converts retinol into ATRA at the site of infection. We demonstrate that granulocyte-macrophage colony-stimulating factor (GM-CSF)-derived dendritic cells (DCs), but not macrophages, express enzymes in the vitamin A metabolic pathway, including aldehyde dehydrogenase 1 family, member a2 (ALDH1A2) and short-chain dehydrogenase/reductase family, member 9 (DHRS9), enzymes capable of the two-step conversion of retinol into ATRA, which is subsequently released from the cell. Additionally, mRNA and protein expression levels of ALDH1A2 and DC marker CD1B were lower in tuberculosis lung tissues than in normal lung. The conditioned medium from DCs cultured with retinol stimulated antimicrobial activity from M. tuberculosis-infected macrophages, as well as the expression of NPC2 in monocytes, which was blocked by specific inhibitors, including retinoic acid receptor inhibitor (RARi) or N,N-diethylaminobenzaldehyde (DEAB), an ALDH1A2 inhibitor. These results indicate that metabolism of vitamin A by DCs transactivates macrophage antimicrobial responses.IMPORTANCE Tuberculosis (TB) is the leading cause of death by a single infectious agent worldwide. One factor that contributes to the success of the microbe is the deficiency in immunomodulatory nutrients, such as vitamin A (retinol), which are prevalent in areas where TB is endemic. Clinical trials show that restoration of systemic retinol levels in active TB patients is ineffective in mitigating the disease; however, laboratory studies demonstrate that activation of the vitamin A pathway in Mycobacterium tuberculosis-infected macrophages triggers an antimicrobial response. Therefore, the goal of this study was to determine the link between host retinol levels and retinoic acid-mediated antimicrobial responses against M. tuberculosis By combining established in vitro models with in situ studies of lung tissue from TB patients, this study demonstrates that the innate immune system utilizes transcellular metabolism leading to activation between dendritic cells and macrophages as a means to combat the pathogen

What are the factors to consider in assisted reproductive technology? [Blog post]

In Assisted Reproductive Technology especially third party involvement the key issues to consider for medical personnel and practitioners is that with any new medical innovations, consideration of balancing the positive and negative aspects of new innovations regarding public perceptions, existing norms, traditions and religious beliefs is of prime importance, particularly in relation to sensitive actions such as conception by egg donation