Transition to parenthood after successful non-donor in vitro fertilisation: The effects of infertility and in vitro fertilisation on previously infertile couples' experiences of early parenthood

Recent social science research in the field of parenting following assisted conception has focused on the experiences of donor assisted conception and surrogacy. This paper draws from a study which explored the experiences of the transition to early parenthood in 16 heterosexual non-donor couples and includes a specific consideration of the experiences of men as they navigate this journey. We argue that these couples’ transition to early parenthood can be as complex and provisional as in other newer forms of family making as they struggle with an emerging identity as a parent after successful non-donor IVF following their experiences of infertility. Their family making is contingent upon their ability to work at integrating their experiences of infertility and IVF into their emerging identity as a parent. This struggle is prominent when they contemplate a further pregnancy. Considering a sibling causes them further uncertainty and anxiety because it reminds them of their infertile identify and the possibility of further IVF. We report novel findings about the experiences of this transition to parenthood: how couples’ identity as parents is shaped by the losses and grief of infertility and the anxiety of IVF. We argue that their struggle with an emerging parenthood identity challenges the normative, naturalised view of non-donor heterosexual IVF parenthood. Our work contributes to the work on identity in parenthood after IVF in an ongoing effort to understand how assisted technologies shape infertile parents’ lives. This paper reports a small study with a relatively homogenous sample recruited from one fertility clinic. Nevertheless as an exploratory study of an under researched topic, we discuss useful insights and ideas for further research with larger and more diverse samples

Experiences of the early ‘infertility journey’ : an ethnography of couples commencing infertility investigations and treatment.

Infertility is a significant life event affecting around one in seven couples in the UK. The development of Assisted Reproductive Technologies (ARTs) such as In Vitro Fertilisation (IVF) have encouraged the idea that infertility can, and should, be treated. By seeking medical attention to overcome this condition, couples are understood to have begun an ‘infertility journey’. The study aim was to investigate the experiences of couples starting infertility investigations and treatments. Using an ethnographic methodology with a longitudinal design, involving iterative rounds of observation and interviews with the same participants. The findings show couples were resistant to becoming fertility patients and starting treatments, and this was often connected to the meaning that infertility had for them. The discomfort and challenge of this transition, previously described as ‘mazing’, was not always recognised or fully appreciated by the healthcare staff involved with the couples. ARTs are becoming ubiquitous and this has increased the mazing undertaken by couples because of the necessity for multiple treatment cycles. The commercialisation of fertility treatments, often including payment for cycles, is also unhelpful for couples’ decision-making. Couples are jointly involved in negotiating treatments and future planning, but clinics focus almost exclusively on the female partner. The ‘journey’ retains its open-ended quality because treatments, belying their promise and hope, do not usually resolve the uncertainty of infertility. Conclusion Treatments for infertility, including ARTs, are portrayed as straightforward, however this study finds that couples, particularly during the early stages from first GP referral, are reluctant to engage with medical fertility pathways and do not find the processes ‘routine’. By acknowledging this, and showing an interest in the personal and social context of their patients’ infertility, clinical staff can demonstrate they are listening to their patients. Couples may find this altered communication helps improve their experiences of fertility treatments

'Just have some IVF!': A longitudinal ethnographic study of couples' experiences of seeking fertility treatment

We present findings from a longitudinal ethnographic study of infertile couples seeking treatment following initial GP referral to specialist fertility services. Repeated observations and interviews were undertaken with the same 14 heterosexual participants over an 18‐month period. Heterosexual, non‐donor couples comprise the majority of fertility clinic patients; however, research interest in this group has dwindled over time as IVF cycles have increased. In the United Kingdom, IVF is presented as a logical response to involuntary childlessness, and as an entirely predictable, and linear, course of action. The market is well‐developed and often patients' first experience of privatised health care in the NHS. Our couples were challenged by this, and while they felt expected to move on to IVF, some wished to explore other options. While IVF is ubiquitous, the discomfort and challenge around fertility treatments remain; experiences are prolonged and characterised by recursive narratives and expressions of disequilibrium, which are rarely acknowledged and reflected in ongoing clinic‐patient interactions. Our findings develop understanding of the process of ‘mazing’ (Image ‐ The Journal of Nursing Scholarship, 1989, 21, 220), the pursuit of parenthood, by showing that the routine and normative status of IVF, at least in the current health care context, is at odds with the lived experiences of individuals

Antigen unmasking does not improve the visualization of phospholipase C zeta in human spermatozoa

Phospholipase C zeta (PLCζ) is a sperm-specific protein that triggers oocyte activation. The analysis of PLCζ expression in human spermatozoa can be used as a diagnostic marker for oocyte activation deficiency. Our laboratory has previously optimized a standard “in-house” assay to determine PLCζ expression in human spermatozoa. However, one study has suggested that an antigen unmasking method (AUM) would be more efficient in visualizing PLCζ in human sperm. This study aimed to compare our established assay and AUM (involving HCl, acidic Tyrode's solution [AT], and heat). The mean relative fluorescence (RF) intensity of PLCζ in frozen-thawed spermatozoa from fourteen fertile donors stained with the in-house method was significantly higher than three other AUM groups (in-house [mean ± standard error of mean]: 18.87 ± 2.39 arbitrary units [a.u.] vs non-AUM: 11.44 ± 1.61 a.u., AT-AUM: 12.38 ± 1.89 a.u., and HCl-AUM: 12.51 ± 2.16 a.u., P < 0.05, one-way analysis of variance). The mean RF intensity of PLCζ in AT- and HCl-treated spermatozoa from 12 infertile males was not significantly different from that of the non-AUM group. However, the in-house method resulted in the highest RF intensity (12.11 ± 1.36 a.u., P < 0.01). Furthermore, specificity testing of antibody-antigen binding indicated that the in-house method showed more specific binding than spermatozoa treated by the AUM. In conclusion, our in-house method showed superior visualization and reliability than the AUM, thus supporting the continued use of our in-house assay for clinical research screening

Pulling it all together: emotional reflexivity in health and social care field research

All the contributors to this book recommend taking a self-conscious decision to use emotional reflexivity as part of their research practice. In practice, much thought has gone in to what it means to do reflexivity and what it means to be transparent about the goings-on in the field. This is important as dual roles such as researcher practitioner can have an impact on the research, especially where practice and research roles collide and influence the data we collect. Having ways to step back and to reflect on subjectivities and practice and research identities enables an analytic eye on our own reactions as practitioner researchers

An integrative literature review of psychosocial factors in the transition to parenthood following non-donor-assisted reproduction compared with spontaneously conceiving couples

An integrative literature review of research into the psychosocial factors which shape the transition to parenthood in couples following non-donor in vitro fertilisation in comparison with spontaneously conceiving couples was undertaken following adapted PRISMA guidelines. Nineteen papers of non-donor IVF and SC mothers and fathers were included in the review. This is the first review to report on research comparing the transition to parenthood of couples following successful non-donor singleton AR and SC couples. The small number of studies were over reliant on survey methodologies. Differences between groups were reported on a range of psychosocial measures during the transition from pregnancy to parenthood: locus of control, parental adjustment and child behaviour, parental stress, parental investment in the child, self-esteem and self-efficacy, greater levels of protectiveness (separation anxiety) towards child, marital and family functioning, family alliance, marital satisfaction and communication as well anxiety, indirect aggression and less respect for child. We have conceptualised these differences as three substantive themes which reflect psychosocial factors shaping transition to parenthood in parents after non-donor AR: social support, relationships, and emotional well-being which are in turn intersected by gender differences. These findings have implications for health care professionals’ assessment of individual couples’ support needs

Does advancing male age influence the expression levels and localisation patterns of phospholipase C zeta (PLCζ) in human sperm?

Socio-economic factors have led to an increasing trend for couples to delay parenthood. However, advancing age exerts detrimental effects upon gametes which can have serious consequences upon embryo viability. While such effects are well documented for the oocyte, relatively little is known with regard to the sperm. One fundamental role of sperm is to activate the oocyte at fertilisation, a process initiated by phospholipase C zeta (PLCζ), a sperm-specific protein. While PLCζ deficiency can lead to oocyte activation deficiency and infertility, it is currently unknown whether the expression or function of PLCζ is compromised by advancing male age. Here, we evaluate sperm motility and the proportion of sperm expressing PLCζ in 71 males (22–54 years; 44 fertile controls and 27 infertile patients), along with total levels and localisation patterns of PLCζ within the sperm head. Three different statistical approaches were deployed with male age considered both as a categorical and a continuous factor. While progressive motility was negatively correlated with male age, all three statistical models concurred that no PLCζ–related parameter was associated with male age, suggesting that advancing male age is unlikely to cause problems in terms of the sperm’s fundamental ability to activate an oocyt

Total levels, localization patterns, and proportions of sperm exhibiting phospholipase C zeta are significantly correlated with fertilization rates after intracytoplasmic sperm injection

To study the relationship of total levels, localization patterns, and proportions of sperm exhibiting phospholipase C zeta, with fertilization rates after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).Laboratory study; controls vs. patients after IVF (n = 27) or ICSI (n = 17) treatment.Fertility center.A total of 44 semen samples, subjected to either IVF or ICSI treatment. Oocyte collection, ICSI or IVF, determination of sperm concentration and motility, and immunocytochemical analyses of phospholipase C zeta (PLCζ).None.Percentages of sperm exhibiting PLCζ.Significant positive correlation between ICSI fertilization rates and total levels, localization patterns, and the proportion (percentage) of sperm exhibiting PLCζ. Total levels, localization patterns, and the proportion of sperm exhibiting PLCζ are correlated with fertilization rates for ICSI, but not for IVF.Evaluating total levels, localization patterns, and proportions of PLCζ may represent a useful diagnostic tool for clinical purposes in men for whom IVF is not advised or has previously failed. This clinical study further supports the fundamental role of PLCζ in the oocyte activation process

Successful integration of newborn genetic testing into UK routine screening using prospective consent to determine eligibility for clinical trials.

peer reviewedOBJECTIVE: INGR1D (INvestigating Genetic Risk for type 1 Diabetes) was a type 1 diabetes (T1D) genetic screening study established to identify participants for a primary prevention trial (POInT, Primary Oral Insulin Trial). METHODS: The majority of participants were recruited by research midwives in antenatal clinics from 18 weeks' gestation. Using the NHS Newborn Bloodspot Screening Programme (NBSP) infrastructure, participants enrolled in INGR1D had an extra sample taken from their day 5 bloodspot card sent for T1D genetic screening. Those at an increased risk of T1D were informed of the result, given education about T1D and the opportunity to take part in POInT. RESULTS: Between April 2018 and November 2020, 66% of women approached about INGR1D chose to participate. 15 660 babies were enrolled into INGR1D and 14 731 blood samples were processed. Of the processed samples, 157 (1%) had confirmed positive results, indicating an increased risk of T1D, of whom a third (n=49) enrolled into POInT (20 families were unable to participate in POInT due to COVID-19 lockdown restrictions). CONCLUSION: The use of prospective consent to perform personalised genetic testing on samples obtained through the routine NBSP represents a novel mechanism for clinical genetic research in the UK and provides a model for further population-based genetic studies in the newborn