子宫内膜异位症导致不孕机理探讨

近年来的研究表明了EMT和不孕之间存在较强的相关性,但是两者之间的因果关系和发病机制目前仍存在争议.本文对子宫内膜异位症与不孕之间机理探讨是从分析和综合相结合的认识方法来达到掌握两者关系的本质及其规律性的目的.遵循这样科学的发展战略才能更有利于人类医学领域的繁荣发展.     

论子宫内膜异位症的诊断和治疗

子宫内膜异位症 (ｅｎｄｏｍｅｔｒｉｏｓｉｓ ,ＥＭＴ)是生育年龄妇女的常见疾病 ,对妇女的身体健康和生活质量有着很大的影响 ,其发生率为 4 %～ 17% ,而ＥＭＴ患者中合并不孕者约 30 %～ 4 0 %。近几十年来 ,对ＥＭＴ不孕的诊断和治疗的过程 ,也就是对ＥＭＴ不孕发病机理认识的不断深化的过程。1　对ＥＭＴ引起不孕的发病机理的探讨和认识ＥＭＴ首先于 1860年由Ｒｏｋｉｔａｎｓｋｙ在一尸解病例中记述 ,直到 192 1年由Ｓａｍｐｓｏｎ定名为子宫内膜异位症。对ＥＭＴ与不孕症之间的密切关系早已众所周知 ,但对其发病机理尚不十分清楚。重…     

神圣出生叙事与民族身份认同——对撒拉不孕故事的历史批评解读

不孕女性是《希伯来圣经》中的重要母题,撒拉的不孕故事在亚伯拉罕故事链中占据核心位置。在前祭司本中的撒拉故事,文本围绕着她的不孕、对应许的质疑和生育,塑造了一个丰富而立体的撒拉形象。通过对先知书和族长故事的分析,并且结合考古学研究成果,本文指出撒拉不孕故事是在以色列巴比伦流放期间,由留居犹大地的土地贵族阶层所编纂的。通过书写先祖的神圣出生叙事,这一群体试图激励处于危难中的留居之民,塑造自身的政治话语,确立以色列与周边民族之间的土地边界。     

亲子互动中游戏参与方式、情感交流和儿童心理理论的关系

本研究通过亲子互动游戏观察来考查亲子游戏参与方式、情感交流与儿童心理理论发展的关系。实验结果如下:第一,控制了年龄因素后,儿童的亲子游戏参与方式中的主动参与和建议游戏两种方式与儿童心理理论发展之间存在显著的相关;而对于母亲来说,指导游戏的参与方式和儿童心理理论发展存在显著相关。第二,控制了年龄因素之后,儿童情感交流方面的分享积极情感和心理理论发展之间存在显著相关。而母亲这方面的指标和儿童心理理论发展没有显著相关。文章对上述结果进行了分析讨论。     

智力理论的最近发展

介绍了20世纪80年代以来智力理论的最近发展,主要包括:Gardner的多重智力理论,认为存在7种相互独立的智力;Anderson的智力与认知发展的理论,认为智力的个别差异和发展变化可以用不同的加工机制来说明;Sternberg的三元理论,包括成分子理论、经验子理论和背景子理论;Ceci的生物生态学理论,认为智力性成果有赖于具有丰富的并很好组织的知识基础的多重认知潜能之间的相互作用。智力的研究焦点是探索生理和环境之间复杂的相互作用。     

辅助生殖技术与女性生殖系统肿瘤的关系及其辩证思考

辅助生殖技术给不孕患者带来了希望,为肿瘤患者保留了生育能力,另一方面也可能导致女性生殖系统肿瘤和一系列伦理学问题。因此,用哲学的观点客观地看待辅助生殖技术与女性生殖系统肿瘤发生风险之间的关系,将有助于临床医生进一步提高辅助生殖技术安全性的认识,选择最佳的促排卵方案。     

心理理论与同伴接纳

近年来的相关研究表明 ,心理理论能力的发展与儿童被同伴喜欢接纳的程度之间具有复杂的、双向作用的关系 ,二者的相关程度随着年龄增长有增强的趋势并且存在性别差异。对矛盾的和被忽视群体以及学龄儿童的研究也许有助于进一步理解二者间的关系。     

促排卵治疗及其风险的探讨

促排卵药物在临床中的广泛应用,给不孕患者带来了希望,另一方面促排卵带来的风险也越来越引起人们的重视,如卵巢过度刺激综合征(OHSS)、妊娠并发症、出生缺陷和肿瘤等。因此,用哲学的观点客观地看待促排卵的成效与风险之间的关系有助于临床医生进一步提高促排卵安全性的认识,做出正确的决策。     

不孕症女性污名现象产生原因、影响及对策思考

不孕症女性患者的污名或歧视现象是一个值得关注的话题。在我国,不孕污名的产生具有传统文化背景。不孕污名影响患者的身心健康,造成患者社会隔离,提出相关对策对改善不孕症女性患者及其家属认知与态度、提高不孕女性心理保健水平是有积极意义的。     

智力理论的最近发展

介绍了20世纪80年代以来智力理论的最近发展,主要包括：Gardner的多重智力理论,认为存在7种相互独立的智力：Anderson的智力与认知发展的理论,认为智力的个别差异和发展变化可以用不同的加工机制来说明：Sternberg的三元理论,包括成分子理论、经验子理论和背景子理论;Ceci的生物生态学理论,认为智力性成果有赖于具有丰富的并很好组织的知识基础的多重认知潜能之间的相互作用。智力的研究焦点是探索生理和环境之间复杂的相互作用。     

Using Acceptance and Commitment Therapy to Treat Infertility Stress

Women and men diagnosed with infertility experience a variety of infertility-related stressors, including changes to their family and social networks, strain on their sexual relationship, and difficulties and unexpected challenges in their relationship. Infertility stress is linked with depression and psychological distress, and can lead to premature dropout from medical treatments and unresolved feelings of loss and grief. The current study examined the effectiveness of treating infertility stress using Acceptance and Commitment Therapy (ACT), a promising new behavior therapy that targets experiential avoidance through mindfulness, acceptance strategies, and value-directed action. This single-case study followed a couple experiencing infertility-related stress following a failed in vitro fertilization (IVF) procedure. The couple completed 6 self-report measures at 7 time points, including a second failed IVF attempt and a 1-year follow-up. Measures included both distress-focused instruments and therapy process-related questionnaires. The female participant reported higher pretreatment stress and depression scores compared to her partner. She reported significant decreases in global infertility stress, social infertility stress, sexual infertility stress, psychological distress, and depression from pretherapy to 1-year follow-up. She also reported a decrease in infertility stress following her second failed in vitro fertilization (IVF) attempt. The male participant reported significant decreases in sexual infertility stress. The study suggests that acceptance-based therapy shows promise in treating infertility stress in patients experiencing infertility who undergo medical treatments. The data from this preliminary case study also suggest that ACT may be helpful for couples following IVF treatment failure. Treatment gains were maintained 1-year posttherapy, indicating that an ACT approach to treating infertility has the potential to produce lasting change.     

Examining congruence between partners' perceived infertility-related stress and its relationship to marital adjustment and depression in infertile couples

Because studies examining the emotional impact of infertility-related stress generally focus on individuals, there has been little research examining how relationship and individual variables are linked. The purpose of this study was to explore the impact of congruence (e.g., agreement) between partner's perceived infertility-related stress and its effects on depression and marital adjustment in infertile men and women. Couples referred for infertility treatments at a University-affiliated teaching hospital completed the Fertility Problem Inventory (FPI), the Beck Depression Inventory (BDI), and the Dyadic Adjustment Scale (DAS) 3 months prior to their first treatment cycle. Study findings show that men and women in couples who perceived equal levels of social infertility stress reported higher levels of marital adjustment when compared to men and women in couples who perceived the stress differently. In addition, women in couples who felt a similar need for parenthood reported significantly higher levels of marital satisfaction when compared to women in couples where the males reported a greater need for parenthood. While couple incongruence was unrelated to depression in males, incongruence over relationship concerns and the need for parenthood was related to female depression. These findings provide initial support for the theory that high levels of agreement between partners related to the stresses they experience help them successfully manage the impact of these stressful life events. Possibilities for future research examining the construct of couple congruence are discussed.     

The psychological impact of reproductive difficulties on women's lives

Little is known about the long-term impact of reproductive experiences on women's lives. This paper uses questionnaire data collected from 107 White female college graduates, when they were approximately 47 years old. More than half the sample had experienced at least one type of reproductive difficulty (abortion, miscarriage, or infertility). The stress and coping model of life difficulties (Lazarus and Folkman, 1984) was used to examine the relationship between the women's reproductive difficulties and emotional sequelae, politicization, and orientation to motherhood at midlife. As predicted, emotional responses to the reproductive difficulties varied according to the particular nature of each experience. In addition, women who had abortions and no other difficulties were more politicized at midlife than other women. Women whose reproductive experiences were especially likely to arouse feelings of not being in control of their life (those who had miscarriages or infertility) described a more agentic orientation to motherhood when compared with other women.     

The Role of Dyadic Coping on the Marital and Emotional Adjustment of Couples With Infertility

Infertility is a challenging experience, affecting individual and couples’ adjustment. However, the way the members of the couple support each other may affect the experience of infertility and their adjustment. This study aimed to investigate the role of dyadic coping by oneself and by the partner in the association between the impact of infertility and dyadic and emotional adjustment (anxiety and depression) to infertility. In this cross‐sectional study, a total of 134 participants (67 couples with infertility) completed self‐report questionnaires assessing infertility‐related stress, dyadic coping, dyadic adjustment, and depression and anxiety symptoms. A path analysis examined the direct and indirect effects between the impact of infertility in one's life and dyadic and emotional adjustment. There is an indirect effect of the impact of infertility in one's life on dyadic adjustment through men's perceived dyadic coping efforts employed by the self (dyadic coping by oneself) and women's perceived dyadic coping efforts of the partner (dyadic coping by the partner). Regarding the emotional adjustment of infertile couples, infertility stress impact had an indirect effect only on depressive symptoms through men's dyadic coping by oneself. The results highlight the importance of men's dyadic coping strategies for the marital adjustment of couples as well as for men's emotional adjustment. Findings emphasize the importance of involving men in the fertility treatment process, reinforcing the dyadic nature of infertility processes.     

Psychological state and psychological strain in relation to infertility

The purpose of the study was to explore the relationship between psychological state and perceived strain in relation to fertility problems. Couples presenting at an infertility clinic completed, on two occasions seven months apart, a series of standardized measures to assess psychopathology. In addition, they completed a weekly diary rating their mood state or distress/strain over a period of 22 weeks, during which investigations and treatment were taking place. Little evidence of psychopathology was found in the sample; the weekly diaries also suggested a general lack of distress/strain, even in response to medical investigations and diagnosis. The results are discussed in the light of wide individual variations in ratings obtained from the diaries. Participants with high distress/strain scores tended to have significantly higher initial scores on the psychometric measures administered. Participants with high distress/strain scores were also more likely to show a further significant increase in distress/strain scores in relation to diagnostic information. It is argued that a task for future research is to determine the characteristics of those couples who are likely to experience difficulty in coping with the strain of infertility investigations so that counselling resources and support services can be most effectively targeted. © 1998 John Wiley & Sons, Ltd.     

A biopsychosocial model for treating infertility

With approximately one out of six married couples experiencing infertility, having a basic knowledge of infertility is important to marriage and family therapists. This paper presents important themes that infertile couples often struggle with and stresses the importance of having a biological, psychological, and social understanding of infertility. In addition, the paper suggests possible interventions that family therapists can use in helping infertile couples.     

Characteristics of the Biopsychosocial Crisis of Infertility

As many as 5 to 12 million individuals of childbearing age in the United States may now be infertile. For couples who wish to conceive but cannot do so, discovery of physical infertility, coupled with strong expectations about conceiving and raising children, sets the stage for a complex series of reactions labeled here as the crisis of infertility. Infertile couples frequently struggle with strong feelings, ranging from disbelief and denial to isolation, guilt, and grief. Problems coping with infertility are worsened by physical and psychological stresses accompanying medical procedures. The marital relationship may be severely tested as well. For many individuals, the infertility crisis is resolved with virtually no support from anyone. With empathy and understanding, counselors can help infertile individuals to work through this crisis productively.     

The Relationship of Infertility and Death: Using the Relational/Cultural Model of Counseling in Making Meaning

Although the crisis of infertility and attitudes associated with death are often approached differently in counseling, they both share similar attributes. Often, these experiences are described negatively and are associated with at least some form of loss. These negative experiences affect individuals' personal and existential meaning in a profound way. In this article, these experiences will be explored. Specifically, the relationship between these 2 experiences will be explored in order to understand how individuals attempt to make meaning. Finally, the application of the Relational/Cultural Model of counseling will be introduced as a way to facilitate meaning making.     

PSYCHOANALYSIS AND INFERTILITY MYTHS AND REALITIES

Psychoanalysis, long interested in infertility, and a valuable treatment for men and women suffering with this affliction, has also helped to create and support a myth of psychogenic infertility. Multiple causes of infertility exist across the physiological - psychological spectrum. There is no simple psychodynamic causality. Advances in assisted reproductive technologies provide treatments that create emotional stress and outpace psychological preparedness of patients and analysts. This paper is based on the experience of a unique study group in Boston. An analytic case illustrates some of the ways analysis can be a treatment of choice for people using assisted reproduction. In fact, analysis offers a unique opportunity to elaborate fully the complex realities and dilemmas faced by people and their therapists throughout the infertility experience. More generally, this study of the concept of psychogenic infertility explores a valuable role for psychoanalysis in the treatment of medical conditions.     

The Infertility Resilience Model: Assessing Individual,Couple, and External Predictive Factors

Resilience in couples experiencing infertility is critical to decrease the impact of infertility-related stress and sustain positive interactions and collective perceptions in couples. The Infertility Resilience Model (IRM) presented in this article provides a framework within which various individual, couple, and external factors that influence resilience can be understood. Although numerous approaches have been applied to infertility, few of them have examined resilience and the interconnections between individual, couple, and external influences. The concepts and connections within the model can be used by clinicians for assessment and interventions when working with couples facing infertility.