| 81821. |
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| 81822. |
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| 81823. |
- Kluge, Linda, 1968, et al.
(författare)
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Cumulative live birth rates after weight reduction in obese women scheduled for IVF: follow-up of a randomized controlled trial.
- 2019
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Ingår i: Human reproduction open. - : Oxford University Press (OUP). - 2399-3529. ; 2019:4
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Tidskriftsartikel (refereegranskat)abstract
- Did weight reduction in obese women scheduled for IVF increase cumulative live birth rate (CLBR) after 2years?Weight loss prior to IVF did not increase CLBR.Few studies have investigated the effect of weight reduction in obese infertile women scheduled for IVF. In a recent randomized controlled trial (RCT), including one IVF cycle, we found no increase in live birth rate after weight reduction. Weight regain after obesity reduction treatment often occurs, and children born to obese women have a higher risk of childhood obesity.A 2-year follow-up of a multicenter, RCT running between 2012 and 2018 was performed. Out of 317 women randomized to weight reduction followed by IVF treatment or IVF treatment-only, 305 remained in the full analysis set. Of these women, 90.5% (276/305) participated in this study.Nine infertility clinics in Sweden, Denmark and Iceland participated in the RCT. Obese women under 38years of age having a BMI ≥30 and<35kg/m2 were randomized to weight reduction and IVF or IVF-only. In all, 160 patients were randomized to a low calorie diet for 12weeks and 3-5weeks of weight stabilization, before IVF and 157 patients to IVF-only. Two years after randomization, the patients filled in a questionnaire regarding current weight, live births and ongoing pregnancies.42 additional live births were achieved during the follow-up in the weight reduction and IVF group, and 40 additional live births in the IVF-only group, giving a CLBR, the main outcome of this study, of 57.2% (87/152) and 53.6% (82/153), respectively (P=0.56; odds ratio (OR) 1.16, 95% CI: 0.74-1.52). Most of the women in the weight reduction and IVF group had regained their pre-study weight after 2years. The mean weight gain over the 2years was 8.6kg, while women in the IVF-only group had a mean weight loss of 1.2kg. At the 2-year follow-up, the weight standard deviation scores of the children born in the original RCT (index cycle) were 0.218 (1.329) (mean, SD) in the weight reduction and IVF group and-0.055 (1.271) (mean, SD) in the IVF-only group (P=0.25; mean difference between groups, 0.327; 95% CI: -0.272 to 0.932).All data presented in this follow-up study were self-reported by the participants, which could affect the results. A further limitation is in power for the main outcome. The study is a secondary analysis of a large RCT, where the original power calculation was based on live-birth rate after one cycle and not on CLBR.The follow-up indicates that for women with a BMI ≥30 and<35kg/m2 and scheduled for IVF, the weight reduction did not increase their chance of a live birth either in the index cycle or after 2years. It also shows that even in this highly motivated group, a regain of pre-study weight occurred.The 2-year follow-up was financed by grants from the Swedish state under the agreement between the Swedish Government and the county councils, the ALF-agreement (ALFGBG-70940 and ALFGBG-77690), Merck AB, Solna, Sweden (an affiliate of Merck KGaA, Darmstadt, Germany), Hjalmar Svensson Foundation. Ms Kluge has nothing to disclose. Dr Bergh has been reimbursed for lectures and other informational activities (Ferring, MSD, Merck, Gedeon Richter). Dr Einarsson has been reimbursed for lectures for Merck and Ferring. Dr Thurin-Kjellberg reports grants from Merck, and reimbursement for lectures from Merck outside the submitted work. Dr Pinborg has been reimbursed for lectures and other informational activities (Ferring, MSD, Merck, Gedeon Richter). Dr Englund has nothing to disclose.ClinicalTrials.gov number, NCT01566929.
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| 81824. |
- Kluge, Linda, 1968
(författare)
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Obesity and IVF outcome. The hope of improvements through weight reduction
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Female obesity is associated with decreased live birth rate (LBR) after in vitro fertilization (IVF) and adverse maternal and perinatal outcomes are increased in obese women compared to normal weight women after spontaneous conceived pregnancies. If the same applies in pregnancies achieved after IVF is scarcely investigated. Publicly funded IVF clinics in Sweden have BMI limits that women must meet to be accepted for IVF. Aim: To assess if weight reduction prior to IVF can increase LBR and cumulative live birth rates (CLBR) in obese women. To explore the women’s views of the having participated in a randomized weight reduction trial prior to IVF and further, to inves-tigate the association between obesity and CLBR and maternal and perinatal outcomes after IVF. Methods: Paper I: A randomized controlled trial (RCT) including 317 infertile obese women, comparing a weight reduction intervention for 16 weeks prior to IVF to immediate IVF, to assess LBR in the two groups. Paper II: A two-year follow-up to assess CLBR and whether the weight reduction achieved in the RCT remained. Paper III: A qualitative interview study, using thematic content analysis, to explore the women’s experiences and views of the RCT. Ten women from the intervention group and seven women from the control group participated in the interviews. Paper IV: A nationwide population-based register study including 126 620 fresh IVF cycles and subsequent frozen embryo transfers (FET) stratified by body mass index (BMI). The fresh cycles were performed between 2007 to 2019 and the main outcome was CLBR. In addition, 58 187 singleton deliveries, achieved after fresh or FET, were included to assess maternal and perinatal outcomes stratified by BMI. The transfers were performed between 2002 to 2020 and the primary outcomes were hypertensive disorders of pregnancy (HDP) and preterm birth less the 37 weeks. Results: Paper I: Despite a substantial weight reduction in the intervention group, mean 9.44 kg no significant difference in LBR could be shown between the weight reduction and IVF group compared to the IVF only group, 29.6% respective 27.5% (differ-ence 2.1%, confidence interval 12.9 to – 8.6). In the weight reduction and IVF group a higher frequency of children born after spontaneous conception was noted. Paper II: The CLBR was similar in the two groups and the women in the weight reduction and IVF group had regained the weight they had lost. Paper 3: The women were happy about the invitation to participate in the RCT. They described the weight reduction treatment as tough, and the support during the weight loss as crucial. They were against a strict BMI limit, and they wished to be evaluated individually. Paper 4: The CLBR decreased in overweight and obese women compared to normal weight women and the adverse maternal and perinatal outcomes increased with severity of obesity. Conclusion: Weight loss prior to IVF did not increase LBRs, nor CLBR after two years. Most interviewed women had a positive attitude to an offer of weight reduction prior to IVF. They wished to be assessed individually and not solely on the basis of their BMI. Overweight and obesity are associated with decreased CLBR and adverse maternal and perinatal outcomes after IVF.
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| 81825. |
- Kluge, Linda, 1968, et al.
(författare)
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The association between body mass index and live birth and maternal and perinatal outcomes after in-vitro fertilization: a national cohort study
- 2023
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Ingår i: Frontiers in Endocrinology. - 1664-2392. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the association between female body mass index (BMI) and live birth rates and maternal and perinatal outcomes after in-vitro fertilization (IVF). Methods: We performed a national, population-based cohort study including women undergoing IVF between 2002 and 2020. The cohort included 126,620 fresh cycles and subsequent frozen embryo transfers between 2007 and 2019 (subpopulation 1) and 58,187 singleton deliveries between 2002 and 2020 (subpopulation 2). Exposure was female BMI (kg/m2) categorized according to the World Health Organization as underweight (<18.5), normal weight (18.5–24.9, reference), overweight (25.0–29.9), class I obesity (30.0–34.9), class II obesity (35.0–39.9), and class III obesity (≥40.0). The primary outcome in subpopulation 1 was cumulative live birth per started fresh IVF cycle, including fresh and subsequent frozen embryo transfers. Primary outcomes in subpopulation 2 were hypertensive disorders of pregnancy and preterm birth at less than 37 weeks. Risk ratios (RRs) with 95% confidence intervals (CIs) for the association between BMI class and outcomes were calculated using generalized linear models after adjustment for relevant confounders. Results: The cumulative live birth rate decreased significantly with increasing BMI from 32.6% in normal-weight women to 29.4% in overweight women, 27.0% in women in obesity class I, 21.8% in women in obesity class II, and 7.6% in women in obesity class III. The risk of hypertensive disorders of pregnancy increased significantly and progressively with increasing BMI, from 4.6% in normal-weight women to 7.8% in overweight women and 12.5%, 17.9%, and 20.3% in women in obesity classes I, II, and III. The risk of preterm birth followed a similar pattern, from 6.3% in normal-weight women to 7.5% in overweight women and 8.9%, 9.9%, and 15.3% in women in obesity classes I, II, and III. The risks of other perinatal complications, such as perinatal death, showed an even more pronounced increase. Conclusion: Using a large and complete national cohort of women undergoing IVF, we demonstrate a dose-dependent decrease in live birth rate and a substantial increase in maternal and perinatal complications with increasing BMI. Strategies to improve this situation are warranted.
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| 81826. |
- Kluge, Linda, 1968, et al.
(författare)
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Women´s experience and long-term perspectives: a qualitative sub-study of a randomized controlled trial on weight reduction prior to in vitro fertilization.
- 2023
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Ingår i: Reproductive, Female and Child Health. ; 2:3, s. 143-151
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Obesity is associated with impaired results after in vitro fertilisation (IVF). Consequently, several fertility clinics have set limits of body mass index (BMI) and obese infertile women are thus obliged to lose weight before treatment. Randomised controlled trials (RCTs) have not been able to show an increase in live birth rate after weight reduction before fertility treatment. The purpose of this study was to investigate the patients' experiences and views of participating in a RCT on weight reduction for obese women before IVF, in a long-term perspective. Methods A qualitative follow-up interview study including 17 women was performed between September and December 2020. The interviewed women had all been included in an RCT around 6 years earlier. Semistructured interviews were conducted, the interviews were audio recorded, transcribed verbatim, and analysed using thematic content analysis. Results During the analysis two main themes emerged; ‘Pros and cons related to trial participation’ and ‘Message to health care’. Several women were excited about the prospect of possibly receiving weight reduction before IVF. The women appreciated the support during the intervention but expressed that the diet was tough, and it was hard to maintain the weight loss. Their views regarding BMI limits differed. They advocated an individual assessment regardless of the woman's BMI and expressed that it could be of value to offer weight reduction treatment before IVF. Conclusions Even though the RCT and a 2-year follow-up could not show an increase in live birth rate in the intervention group most women had a positive attitude to weight reduction treatment before IVF. The importance of this study is that the views of the women have been highlighted and their opinions can add valuable information for fertility clinics in their care of obese infertile women.
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| 81827. |
- Klunder, J., et al.
(författare)
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Catching up with Method and Process Practice: An Industry-Informed Baseline for Researchers
- 2019
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Ingår i: IEEE/ACM 41st International Conference on Software Engineering, 25-31 May 2019: Software Engineering in Practice (ICSE-SEIP). - : IEEE. - 9781728117607
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Konferensbidrag (refereegranskat)abstract
- Software development methods are usually not applied by the book. Companies are under pressure to continuously deploy software products that meet market needs and stakeholders' requests. To implement efficient and effective development processes, companies utilize multiple frameworks, methods and practices, and combine these into hybrid methods. A common combination contains a rich management framework to organize and steer projects complemented with a number of smaller practices providing the development teams with tools to complete their tasks. In this paper, based on 732 data points collected through an international survey, we study the software development process use in practice. Our results show that 76.8% of the companies implement hybrid methods. Company size as well as the strategy in devising and evolving hybrid methods affect the suitability of the chosen process to reach company or project goals. Our findings show that companies that combine planned improvement programs with process evolution can increase their process' suitability by up to 5%.
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| 81828. |
- Klünder, Jil, et al.
(författare)
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Determining context factors for hybrid development methods with trained models
- 2020
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Ingår i: Proceedings - 2020 IEEE/ACM International Conference on Software and System Processes, ICSSP 2020. - New York, NY, USA : ACM.
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Konferensbidrag (refereegranskat)abstract
- © 2020 ACM. Selecting a suitable development method for a specific project context is one of the most challenging activities in process design. Every project is unique and, thus, many context factors have to be considered. Recent research took some initial steps towards statistically constructing hybrid development methods, yet, paid little attention to the peculiarities of context factors influencing method and practice selection. In this paper, we utilize exploratory factor analysis and logistic regression analysis to learn such context factors and to identify methods that are correlated with these factors. Our analysis is based on 829 data points from the HELENA dataset. We provide five base clusters of methods consisting of up to 10 methods that lay the foundation for devising hybrid development methods. The analysis of the five clusters using trained models reveals only a few context factors, e.g., project/product size and target application domain, that seem to significantly influence the selection of methods. An extended descriptive analysis of these practices in the context of the identified method clusters also suggests a consolidation of the relevant practice sets used in specific project contexts.
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| 81829. |
- Kluzniak, Wlodek, et al.
(författare)
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High-frequency QPOs as a problem in physics: non-linear resonance
- 2004
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Ingår i: AIP Conference Proceedings. - 0094-243X. ; 714, s. 379-382
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The presence of a kHz frequency in LMXBs has been expected from scaling laws, by analogy with the QPO phenomenon in HMXB X-ray pulsars. Interpretation of the two kHz frequencies, observed in accreting neutron stars, in terms of non-linear resonance in strong-field gravity led to the prediction of twin QPOs in black hole systems, in a definite frequency ratio (such as 2/3). The imprint of a subharmonic of the 401 Hz rotation rate in the frequencies of the QPOs detected in the accreting millisecond pulsar is at once a signature of non-linear resonance and of coupling between accretion disk modes and the neutron star spin.
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| 81830. |
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