- Title
- A diversified approach to improving fertility outcomes: understanding women’s fertility knowledge through apps and primordial follicle activation in granulosa cells
- Creator
- Ford, Emmalee A.
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Infertility is a global public health issue which affects up to 15% of people, with female factors contributing to 50% of all known cases of infertility. 1 in every 100 women become infertile from premature ovarian insufficiency (POI), a condition characterised by the early onset of menopause and subsequent infertility due to premature oocyte depletion. In POI, oocytes can be depleted through accelerated primordial follicle activation, where immature, dormant oocytes encapsulated within granulosa cells, or primordial follicles, are selectively activated for growth and development. Beyond the characterisation of a few dominant signalling pathways, there is limited evidence to explain the process and mechanisms controlling primordial follicle activation. Compounding the implications of female infertility, is compelling evidence to suggest that a general gap in fertility knowledge among Australian women. Studies confirm a lack of knowledge about factors that may influence fertility, and a misconception that assisted reproductive technology can solve these issues. Effective educational intervention strategies have not yet been discovered, but the accessibility and popularity of reproductive health smartphone applications (apps) makes them a worthwhile avenue to explore. This thesis takes a diversified approach to improving fertility outcomes in women by successfully merging discovery-based laboratory science with public health research. This is achieved through analysing the role of granulosa cells in primordial follicle activation, in conjunction with investigating the efficacy of reproductive health smartphone applications to provide accessible fertility education to women. Herein, I have developed a novel method to collect mass quantities of mouse granulosa cells originating from primordial, activating and primary follicles and conducted a transcriptomic study of isolated granulosa cells. This study was instrumental in providing a deeper understanding of primordial follicle activation, through highlighting pre-existing factors linked to POI and follicle activation that are understudied. Moreover, my transcriptomic investigations yielded the Wnt pathway antagonist FRZB as a potential upstream regulator of activation through its interaction with WNT3A. A scoping review was used to identify the peer-reviewed evidence of information about fertility in smartphone apps. Through this review, I determined that fertility information reported in studies on apps was very limited, and even fewer studies measured the impact of this information in the comprehension of users. Furthermore, I validated evidence of a fertility knowledge gap in Australia women, through the development and delivery of an online survey to over 600 participants. Through the detailed analysis of my survey results, I identified an association between women who used reproductive health smartphone application and increased likelihood of correctly identifying the most fertile time in the menstrual cycle. Interestingly, I found most app users in this study tracked their cycles, which may account for the increased knowledge of this aspect. Taken together, the work in this thesis contributes to improving the foundational understanding of granulosa cell-directed primordial follicle activation, emphasising the importance of elaborating on the knowledge of already existing pathways involved in primordial follicle activation, and introducing a novel role for FRZB in this process. Additionally, this thesis identified a unique opportunity for reproductive health smartphone apps to be used to increase fertility awareness in the general public, and constitutes detailed recommendations for all stakeholders in the process of app research and development to enhance their effectiveness. The intersection of public health and molecular biology in the reproductive health perspective in Australia is unique in this project. Ultimately, this thesis will create a platform from which meaningful and relevant content can be conveyed to the public, and foster a greater interest in reproductive health throughout a person’s lifetime and empower women’s family planning and lifestyle decision making.
- Subject
- female infertility; mhealth; granulosa cell; premature ovarian insufficiency; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1468610
- Identifier
- uon:48069
- Rights
- Copyright 2021 Emmalee A. Ford
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT01 | Thesis | 15 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 303 KB | Adobe Acrobat PDF | View Details Download |