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- Borgström, Birgit, et al.
(författare)
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Fertility preservation in girls with turner syndrome : prognostic signs of the presence of ovarian follicles
- 2009
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 94:1, s. 74-80
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Many girls with Turner syndrome have follicles in their ovaries at adolescence. Objective: Our objective was to study which girls might benefit from ovarian tissue freezing for fertility preservation. Design: Clinical and laboratory parameters and ovarian follicle counts were analyzed among girls referred by 25 pediatric endocrinologists. SUBJECTS AND SETTING: Fifty-seven girls with Turner syndrome, aged 8-19.8 yr, were studied at a university hospital. Interventions: Ovarian tissue was biopsied laparoscopically, studied for the presence of follicles, and cryopreserved. Blood samples were drawn for hormone measurements. MAIN OUTCOME MEASURES: Presence of follicles in the biopsied tissue related to age, signs of spontaneous puberty, karyotype, and serum concentrations of gonadotropins and anti-Müllerian hormone were assessed. RESULTS: Ovarian biopsy was feasible in 47 of the 57 girls. In 15 of the 57 girls (26%), there were follicles in the tissue piece analyzed histologically. Six of seven girls (86%) with mosaicism, six of 22 (27%) with structural chromosomal abnormalities, and three of 28 with karyotype 45X (10.7%) had follicles. Eight of the 13 girls (62%) with spontaneous menarche had follicles, and 11 of the 19 girls (58%) who had signs of spontaneous puberty had follicles. The age group 12-16 yr had the highest proportion of girls with follicles. Normal FSH and anti-Müllerian hormone concentrations for age and pubertal stage were more frequent in girls with follicles. CONCLUSIONS: Signs of spontaneous puberty, mosaicism, and normal hormone concentrations were positive and statistically significant but not exclusive prognostic factors as regards finding follicles.
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| 2. |
- Fridström, Margareta
(författare)
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Endocrine and therapeutic aspects of infertile women with the polycystic ovary syndrome
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Fertility treatment with gonadotrophins in infertile clomiphene resistant women with the polycystic ovary syndrome (PCOS) is troublesome with an unpredictive ovarian response. The purpose of this study was to elucidate aspects of ovarian sensitivity and to evaluate treatment efficiency and costs of ovulation induction (OI) and in vitro fertilisation (IVF), as well as pregnancy outcome after infertility treatment in patients with PCOS. Infertile women with PCOS, defined as polycystic ovaries (PCO) in combination with amenorrhea/oligomenorrhea underwent OI with FSH in a low-dose step up regimen combined with down regulation with gonadotrophin releasing hormone (GnRH) agonist. Alternatively, the patients underwent treatment by in vitro fertilisation (IVF) with a long protocol down regulation and controlled ovarian hyperstimulation (COH) with FSH. The OI cycles were monitored by serum samplings of FSH and estrogen and by ultrasound. FSH threshold levels for continuous follicle growth were calculated. The effect of adrenal suppression by glucocorticoids on the intrafollicular androgen environment and oocyte/embryo quality was investigated in a double-blind, randomised control trial of adjuvant prednisolone in PCOS and control women undergoing IVF. Glucose metabolism in ovaries from PCOS and normal women in women undergoing IVF treatment was studied by investigating the effects of insulin on lactate accumulation in cultured granulosa-luteal cells. Following randomisation to OI or IVF, treatment cycles were compared with respect to conversion or cancellation of cycles, pregnancy and delivery rates, directs costs (treatments and drugs) and indirect costs (e.g. care in connection with hyperstimulation, miscarriage, maternity care and delivery). The course and outcome of pregnancies achieved by assisted reproduction techniques, as well as perinatal and neonatal complications was studied in a group of PCOS patients and compared to that seen in non PCOS patients. The FSH threshold levels for continuous follicular growth was found to vary more between patients than between repeated cycles in the same patient. Obese patients with PCOS had different kinetics of resorption/elimination of s.c. administered exogenous FSH compared to lean patients with PCOS, resulting in lower serum FSH levels for a given dose. A decreased ovarian sensitivity to insulin, measured as lactate accumulation in cultured granulosa-luteal cells was seen in PCO as compared to normal ovaries. Adjuvant corticosteroid treatment during COH for IVF in patients with PCOS resulted in a reduction of serum concentrations of DHA and DHAS, and of follicular fluid DHAS, but no beneficial effects on oocyte quality, fertilisation, cleavage and implantation rates were found. In obese patients with PCOS, no difference in the proportion of successfully completed treatments of OI or IVF was found. The cumulative pregnancy rate after five cycles was 33% in OI cycles and 62% in IVF cycles (77%, if cycles with thawed embryos were included). The cost per started cycle was lower for OI than for IVF but the cost per obtained pregnancy was twice as high for OI cycles as for IVF cycles. During pregnancy and labour it was found that women with PCOS had a higher risk of developing hypertension and/or preeclampsia. In conclusion, ultrasound monitoring is the most important tool for monitoring treatment cycles of OI and determinations of FSH threshold levels are of limited clinical value. In PCOS women, decreased insulin sensitivity is also seen in follicular cells of the ovary. Adjuvant corticosteroid therapy does not improve oocyte and embryo quality in IVF treatment of PCOS patients. Antenatal care of women with PCOS should focus on blood pressure since these women seem to have an increased risk of hypertension/preeclampsia during pregnancy. Finally, for obese patients with clomiphene resistant PCOS, IVF seem a cost-effective treatment.
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| 3. |
- Fridström, Margareta, et al.
(författare)
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Evaluating Emdogain and healing of replanted teeth using an intra-individual experimental-control study design
- 2008
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Ingår i: Dental Traumatology. - : Wiley. - 1600-4469 .- 1600-9657. ; 24, s. 299-304
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the present investigation was to use an intra-individual experimental-control study design to explore if application of Emdogain prior to re-plantation after a dry extra-alveolar period of 60 min would promote a favorable healing of the periodontal ligament cells. Ten patients, for whom already decisions had been taken to extract two maxillary premolars because of crowding, participated in the study. The teeth were extracted and endodontic treatment was performed extra orally. The experimental tooth and its alveolar socket were covered with Emdogain prior to replantation. The contra lateral tooth served as a control and was replanted without any prior treatment. The teeth were stabilized with a retainer for 3-7 days and the patients were followed up every third week. After 13 weeks, the teeth were finally extracted and prepared for histological examination. Radiographs were taken before the study period, at day 29 and prior to the final extraction. The results were in favor of Emdogain, but the overall difference between the Emdogain-treated tooth and its control was rather small, and it seemed questionable if the registered differences could be of any obvious practical clinical importance. Histologically, all the teeth showed some degree of pathology after such a long dry extra-oral time and the outcome seemed to be more correlated to the individual than to the treatment. Given more favorable conditions regarding storage medium and/or extra-oral time, Emdogain might still be of value for an uncomplicated healing after replantation.
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