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The National Survey of Australian Secondary Students and Sexual Health (SSASH) is a periodic survey of sexual health among school-aged young people in Australia. The survey began in 1992 and, in this report, we present findings from the seventh iteration. The SSASH survey reports on a range of issues related to sexual identity and experiences, STI and HIV prevention, and relationships and sexuality education (RSE) and provides information about the progress of key priority areas in the Fourth National Sexually Transmissible Infections Strategy (Australian Department of Health, 2018).

This thesis is submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy to the School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.

This is a project that studies the correlation between egg quality and mitochondrial function, investigates the mtDNA integrity in different mouse models that have defective mitochondria, and most important, explores if there is any mitochondrial sorting during early development.

Hastening environmental decline means many fish species are now vulnerable to extinction. This thesis examines the reproductive biology of native fish, and develops assisted breeding methods to aid in the conservation of fish species in Australia.

This thesis provides a comprehensive analysis of access to egg freezing, a method of fertility preservation. The evidence presented in this thesis reveals that current policies governing egg freezing are outdated, do not permit fair access to egg freezing, and suggest an update of policy needs to be further considered.

My thesis examined how obesity affects fertility, both how it impacts the mother and the baby. Enriched in the uterine fluid of obese women are Advanced Glycation Endproducts, a proinflammatory modification of sugars and proteins, which are formed when foods are browned during cooking- the golden colour on a morning slice of toast. When in the uterine fluid Advanced Glycation Endproducts compromise the development of the early embryo and how it interacts with the mother. Elevated AGEs are detrimental to fertility, and in the clinic, preconception reduction of uterine AGEs may improve the fertility of obese women.

This thesis uses a mouse model of Chlamydia infection to investigate the impacts of infection and inflammation on the ovary. In a new and striking finding, Chlamydia infection can persist in the ovary long-term and cause damage to the quantity and quality of oocytes within the ovary. This is the first time this sexually transmitted infection has been associated with infertility specific to the ovary. This has major implications for female reproductive health outcomes.

This project investigated mitochondrial damage in mouse oocytes after radiotherapy and chemotherapy. The protection of MitoQ, a mitochondrial targeted antioxidant, against toxic cancer treatments in ovaries was examined as well.

This presentation summarises the views of women from a general practice setting on intrauterine contraception

A thesis submitted in total fulfilment of the requirements for the degree of Master of Science by Research to Molecular Proteomics, Baker Heart and Diabetes Research Institute, and, Department of Physiology, Anatomy and Microbiology, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.

The age-related decrease in female fertility occurs because of ovarian ageing, which is when the number of healthy ovarian follicles stored in the ovary declines as women get older. The factors that control the rate of age-associated follicle depletion is unknown. However, preliminary data from mouse models suggest that inflammation may be a causative factor in the ovarian ageing process. The goal of this thesis is to determine if inflammation contributes to ovarian ageing, with a focus on follicle number. In the long term, the information gained from this study will help us to develop new strategies to improve reproductive health for women in advanced reproductive age.

This thesis investigated the contractile effect of oxytocin on the prostate and epididymis of rat and human ex vivo using live imaging. While only having a slight effect in most of the epididymis oxytocin evoked a uniquely forceful contractile response in the most distal part of the epididymis. This response was comparable to the one induced by noradrenaline. Oxytocin significantly increased contractions in the human prostate. These results substantiate the physiological involvement of oxytocin in male sexual function. In addition, this thesis provides the first insight into the fine structure of the human prostatic duct system, using several investigative approaches.

© 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Background: We know very little about the microbiota inhabiting the upper female reproductive tract and how it impacts on fertility. Aims: This pilot study aimed to examine the vaginal, cervical and endometrial microbiota for women with a history of infertility compared to women with a history of fertility. Materials and methods: Using a retrospective case–control study design, women were recruited for collection of vaginal, cervical and endometrial samples. The microbiota composition was analysed by 16S ribosomal RNA (rRNA) gene amplification and endometrial expression of selected human genes by quantitative reverse transcription polymerase chain reaction. Results: Sixty-five specimens from the reproductive tract of 31 women were successfully analysed using 16S rRNA gene amplicon sequencing (16 controls and 15 cases). The dominant microbial community members were consistent in the vagina and cervix, and generally consistent with the endometrium although the relative proportions varied. We detected three major microbiota clusters that did not group by tissue location or case–control status. There was a trend that infertile women more often had Ureaplasma in the vagina and Gardnerella in the cervix. Testing for the expression of selected genes in the endometrium did not show evidence of correlation with case–control status, or with microbial community composition, although Tenascin-C expression correlated with a history of miscarriage. Conclusions: There is a need for further exploration of the endometrial microbiota, and how the microbiota members or profile interplays with fertility or assisted reproductive technologies.

This thesis addresses how disruptions to signalling pathways within the developing testis can alter fetal germ (sex) cell development. I have demonstrated that altered TGFβ superfamily signalling, particularly the growth factor activin A, can directly affect male fetal germ cells. This research is important in the wider context of declining male fertility and increased testicular cancer rates worldwide. Understanding key developmental processes will aid our understanding of how testicular pathologies may arise.

This thesis examines the effect of ageing on the DNA repair capacity of oocytes by studying the expression of oocyte DNA repair genes and DNA damage response (DDR) in an in vitro fertilisation (IVF) experimental model using controlled levels of sperm DNA damage. It also examined the effect of male and female age on the clinical outcomes of couples presenting with idiopathic infertility at an IVF clinic. The current findings suggests that ageing results in a diminished oocyte DNA repair capacity to amend DNA damage or paternal origin. In the clinical setting, this thesis also showed that male ageing is negatively associated with the clinical outcomes of ARTs in couples with idiopathic infertility independent of female age.

BACKGROUND: Knowledge of family planning (FP) is a key determinant of contraceptive use which ultimately plays a role in attainment of good health and in conduct of clinical research. People living in fishing communities (FCs) have limited access to health services including FP and are targeted for future clinical research but their knowledge of FP and its correlates are scantily known. We determined correlates of knowledge of FP among people living in FCs of L. victoria in Uganda to inform future FP education programs in FCs. METHODS: We conducted a comparative cross-sectional survey among participants aged 15-49 years from Kigungu and Nsazi. Participants were asked if they were aware of any FP method. All those who responded in the affirmative were further asked to mention what FP methods they had heard of or knew. Those who reported knowledge of at least one FP method were asked a series of questions about FP methods and their side effects. Knowledge was categorized into good or poor knowledge based on their mean total score. Poor knowledge constituted a score below the mean while good knowledge constituted a score of more than or equal to the mean total score. To further explore attitudes and perceptions of FP, ten in-depth interviews and four focus group discussions were conducted. RESULTS: Of the 1410 screened participants, 94.5% were aware of at least one FP method. Pills and injectable hormonal methods were the most commonly known methods. Slightly over a third (38%) had good knowledge of FP. Correlates of knowledge of FP were; being female (aOR: 1.92 95% CI: 1.39-2.67), residing in Kigungu (aOR: 4.01 95% CI: 2.77-5.81), being married (aOR: 1.59 95% CI: 1.11-2.28) and currently being in a sexual relationship (aOR: 1.75 95% CI: 1.18-2.60). Concerns about safety and effectiveness of some modern FP methods exist. Misconceptions on effects of FP like sterility, cancers and foetal abnormalities were common. CONCLUSION: FP awareness among people living in FCs of L. Victoria in Uganda is high. However, good knowledge about specific methods tends to be low. Correlates of knowledge of FP include gender, residence, marital status and sexual engagement.

A nationwide ‘Sleep-On-Side When Baby’s Inside’ public health campaign was initiated in New Zealand in 2018. This was in response to evidence that maternal supine late pregnancy going-to-sleep position was an independent risk factor for stillbirth from 28 weeks’ gestation. We plan to evaluate the success of the campaign through two nation-wide surveys of 1) pregnant women in the third trimester and 2) health professionals who provide care for pregnant women.

The production of sperm requires the coordinated action of thousands of genes, including many that are poorly understood. This thesis focused on the role of cysteine-rich secretory proteins, antigen 5, and pathogenesis-related 1 (CAP) superfamily proteins in sperm function. Using a combination of genetic models, state-of-the-art imaging technologies and custom written codes based on fluid mechanics principals. I have defined the role of four CAP proteins in male fertility. This research is relevant to the human reproductive medicine, the agricultural sector wherein assisted reproductive technologies are common, and evolution wherein sperm competition is a major determinant.

The following study used a liberal feminist lens to address a gap in the literature on contraceptive method use and romantic relationships by examining the association between contraceptive method use and both relationship satisfaction and balance of power. Specifically, it surveyed married women between the ages of 20-49 using either oral contraceptives (OCs) or natural family planning (NFP). Relationship satisfaction was measured using the Couple Satisfaction Index (CSI-4). Balance of power in the relationship was measured using the Relationship Balance Assessment (RBA). It was hypothesized that women using NFP would report higher relationship satisfaction and greater balance of power than women using OCs. Instead, results of the multiple regression analyses indicated that women using NFP experienced significantly lower rates of balance of power in their relationship. There was no significant difference in relationship satisfaction between groups. Additionally, control variables of religious importance and number of children were found to be associated with balance of power. Controls of age and religious importance were found to be associated with relationship satisfaction. Clinical implications, strengths and limitations, and future directions for research were discussed.

This thesis sought to examine the interplay of key molecular processes involved in the pathogenesis of cancer. Ground-breaking re-emergence of Nodal/Cripto was detected in endometrial cancer patient samples compared to healthy controls. Interestingly blockade of Nodal/Cripto activities, using monoclonal antibody treatment significantly reversed the carcinogenic behaviour of cellular models. This thesis also examined another molecule, with important functions within the female reproductive tract, the Interferon Epsilon. It was demonstrated that Interferon Epsilon treatment of aggressive endometrial cancer cells dramatically reduced cell growth. These findings could be utilized in the potential development of novel therapeutic agents for endometrial cancer.

The spiny mouse is a small rodent that displays remarkable physiological traits: they can regenerate skin without scarring, they have a human-like hormone profile, and they are the only known rodent with a menstrual cycle. During my PhD I explored early development in this species. I assembled a reference transcriptome and mapped gene expression during the 2-cell, 4-cell and 8-cell stages of embryo development. Ultimately, I found that the spiny mouse is a more accurate model of human embryo development in the earliest stages compared to lab mice. This work provides novel insight into the biological mechanisms that govern the creation of new life.

Supplemental Tables S1-S5 from:Toll-like receptor-4 antagonist (+)-naloxone elicits sexually dimorphic attenuation of inflammation-induced fetal programming in miceChin P-Y, Dorian C, Sharkey DJ, Hutchinson MR, Rice KC, Moldenhauer LM, Robertson SA.

Polycystic ovary syndrome (PCOS) is associated with increased risk of adverse pregnancy and birth outcomes, however this may be most related to the conditions associated with PCOS rather than PCOS per se. Current evidence on pregnancy and birth outcomes is poor and uncertain, mostly due to inclusion of selected populations and inclusion of multiple outcomes of interest with different sort of risk factors and confounders. To address the knowledge gaps in this area, future research should target community-based women with medically diagnosed PCOS status and defined PCOS phenotype and should focus on pathophysiologically related outcomes at each study.

Most mammalian testes originate in the stomach then descend during early life to reside in the scrotum, where the temperature is 2–7 °C lower than the body temperature. Elevation above the scrotal temperature can cause the death of the heat-sensitive spermatogenic cells. Although the physiological and cellular responses of the testes to heat stress have been well established, the molecular mechanisms that control these responses remain mostly unknown. In this thesis, the impact of heat on genes and proteins in the testis was investigated using two different heat exposure models: acute mild heat and surgical translocation to the abdomen in the adult rat. These studies have identified a number of molecules that are affected by the heat in the testis.

Oxygen free radicals are created during the IVF process. These have the potential to damage DNA in human eggs and embryos thereby reducing pregnancy rates after IVF. Melatonin has the ability to reduce the effects of oxygen free radicals. In the Melatonin in Assisted Reproductive Technology trial, I found that, while oral melatonin can increase levels of melatonin in follicular fluid, this does not significantly improve IVF success rates.

Preeclampsia is a life-threatening complication of human pregnancy that is associated with wide-spread damage to endothelial cells, which cover all of the maternal blood vessels. HtrA4 is a protein that is specifically produced by the placenta and is found to be highly elevated in preeclampsia, especially in early-onset subtype. This PhD study demonstrated that HtrA4 has a detrimental effect on endothelial cells, including circulating endothelial progenitor cells, which are involved in repair. It was also found that HtrA4 can cleave receptors on endothelial cell surface to block normal cellular function. Therefore, HtrA4 may contribute to the pathogenesis of early-onset preeclampsia.

The rate of testicular cancer is increasing. Although we don’t understand exactly how it develops. We know that receptors for one particular growth factor, activin A, are present on testis cancer cells. Activin A signalling may influence the migration of these cells; as indicated by upregulation of important migratory molecules (CXCL12, CCL17), their receptors (CXCR4, CXCR7) and enzymes (MMP2 and MMP9). We hypothesized that activin A influences these molecules, thereby stimulating testicular cancer progression. The demonstration that activin A changes the levels of these important molecules during a critical period of development highlights the importance of understanding this mechanism, which may underpin testicular cancer formation.

This thesis details the discovery of the only naturally menstruating rodent, the spiny mouse. While reproduction in every other rodent is dictated by the environment and, importantly, the lining of the womb is not shed, the spiny mouse behaves like humans, and cyclically menstruates. The menstrual cycle lasts only 9 days, although shares many aspects with the 28-day human cycle. Each animal is unique in the length and heaviness of their menstrual period, the degree of inflammation and fluctuation of physical parameters (i.e. food consumption and body weight). This world first discovery advocates for the spiny mouse to be recognized for its extraordinary potential in studying women’s reproductive health and menstrual associated conditions.

Background: NICE Guidelines recommend that equal access to treatment should be given to every patient, however there are many reports of inequality across the country in accessing these treatments.Aims:To identify differences in policy for NHS funding of In-Vitro Fertilisation (IVF) across England.To identify how policy differences affect activity.Method: This study is a dataset analysis, looking at the 209 CCGs in England. All data on funding is from the period 2012-2014. This data was transformed and then used to investigate the relationship between policy, activity and funding of IVF across the country.Outcomes: Most CCGs (61.2%) offer only 1 NHS-funded cycles35% of CCGs in the North of England offer 3 cycles - this is the highest for any area of the country8% of CCGs in the Midlands and the East offer 0 cyclesThe correlation co-efficient between the number of cycles offered and the number of NHS-funded cycles carried out is 0.095.43 IVF cycles per 1000 people were carried out in Hertfordshire and the South Midlands - the most active region of the country per capita77.9% of IVF cycles carried out in the region of Cheshire, Warrington and Wirral were NHS-funded - the highest of any regionDiscussion: The discussion analyses these results in further detail and through the inclusion of a divided coloured map of England, helps to further illustrate the regional bias. Apparent from this is that the North of England prioritises IVF funding more than any other region, and thereby a greater proportion of NHS-funded cycles take place here than anywhere else in the countryReferences: A.Borini, Fertility Fairness; HFEA: I.Messinis, NICE; The Online Recruitment Resource: Your FertilityThis work was presented at Fertility 2018, the UK's largest annual conference which focuses on fertility and reproductive medicine. The link to the conference's abstract booklet is linked in the Reference section below.

Lecture given by Doctor Bernard Jégou, Director of the INSERM Groupe d'etude de la Reproduction chez le Male, Université de Rennes, France at the Waite Campus, University of Adelaide, 16.9.1994This lecture is part of the Campus Seminars and Distinguished Lecturer Series, Waite Campus, University of Adelaide, 1991 – 1997. https://figshare.com/projects/Campus_Seminars_and_Distinguished_Lecturer_Series_Waite_Campus_University_of_Adelaide/17756

A PCR assay, using three primer pairs, was developed for the detection of Ureaplasma urealyticum , parvo biovar, mba types 1, 3, and 6, in cultured clinical specimens. The primer pairs were designed by using the polymorphic base positions within a 310- to 311-bp fragment of the 5′ end and upstream control region of the mba gene. The specificity of the assay was confirmed with reference serovars 1, 3, 6, and 14 and by the amplified-fragment sizes (81 bp for mba 1, 262 bp for mba 3, and 193 bp for mba 6). A more sensitive nested PCR was also developed. This involved a first-step PCR, using the primers UMS-125 and UMA226, followed by the nested mba -type PCR described above. This nested PCR enabled the detection and typing of small numbers of U. urealyticum cells, including mixtures, directly in original clinical specimens. By using random amplified polymorphic DNA (RAPD) PCR with seven arbitrary primers, we were also able to differentiate the two biovars of U. urealyticum and to identify 13 RAPD-PCR subtypes. By applying these subtyping techniques to clinical samples collected from pregnant women, we established that (i) U. urealyticum is often a persistent colonizer of the lower genital tract from early midtrimester until the third trimester of pregnancy, (ii) mba type 6 was isolated significantly more often ( P = 0.048) from women who delivered preterm than from women who delivered at term, (iii) no particular ureaplasma subtype(s) was associated with placental infections and/or adverse pregnancy outcomes, and (iv) the ureaplasma subtypes most frequently isolated from women were the same subtypes most often isolated from infected placentas.

Ureaplasmas are the microorganisms most frequently isolated from the amniotic fluid of pregnant women and can cause chronic intrauterine infections. These tiny bacteria are thought to undergo rapid evolution and exhibit a hypermutatable phenotype; however, little is known about how ureaplasmas respond to selective pressures in utero. Using an ovine model of chronic intra-amniotic infection, we investigated if exposure of ureaplasmas to sub-inhibitory concentrations of erythromycin could induce phenotypic or genetic indicators of macrolide resistance. At 55 days gestation, 12 pregnant ewes received an intra-amniotic injection of a non-clonal, clinical U. parvum strain, followed by: (i) erythromycin treatment (IM, 30 mg/kg/day, n=6); or (ii) saline (IM, n=6) at 100 days gestation. Fetuses were then delivered surgically at 125 days gestation. Despite injecting the same inoculum into all ewes, significant differences between amniotic fluid and chorioamnion ureaplasmas were detected following chronic intra-amniotic infection. Numerous polymorphisms were observed in domain V of the 23S rRNA gene of ureaplasmas isolated from the chorioamnion (but not the amniotic fluid), resulting in a mosaic-like sequence. Chorioamnion isolates also harboured the macrolide resistance genes erm(B) and msr(D) and were associated with variable roxithromycin minimum inhibitory concentrations. Remarkably, this variability occurred independently of exposure of ureaplasmas to erythromycin, suggesting that low-level erythromycin exposure does not induce ureaplasmal macrolide resistance in utero. Rather, the significant differences observed between amniotic fluid and chorioamnion ureaplasmas suggest that different anatomical sites may select for ureaplasma sub-types within non-clonal, clinical strains. This may have implications for the treatment of intrauterine ureaplasma infections.