| 1. |
- Bjorvang, Richelle D., et al.
(författare)
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Persistent organic pollutants, pre-pregnancy use of combined oral contraceptives, age, and time-to-pregnancy in the SELMA cohort
- 2020
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Ingår i: Environmental Health. - : BMC. - 1476-069X. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background We are exposed to several chemicals such as persistent organic pollutants (POPs) in our everyday lives. Prior evidence has suggested that POPs may have adverse effects on reproductive function by disrupting hormone synthesis and metabolism. While there is age-related decline of fertility, the use of hormonal combined oral contraceptives (COCs) and its association to return of fertility remains controversial. The goal of this study is to investigate the association between exposure to POPs, both individually and as a mixture, and fecundability measured as time-to-pregnancy (TTP) according to pre-pregnancy use of COCs and age. Methods Using the SELMA (Swedish Environmental Longitudinal Mother and Child, Allergy and Asthma) study, we have identified 818 pregnant women aged 18-43 years (mean 29 years) with data on how long they tried to get pregnant and what was their most recently used contraceptive method. These data were collected at enrollment to the study (median week 10 of pregnancy). Concentrations of 22 POPs and cotinine were analyzed in the blood samples collected at the same time as the questions on TTP and pre-pregnancy use of contraceptive. Analyses were done on the association between POPs exposure and TTP measured as continuous (months) and binary (infertile for those with TTP > 12 months). To study the chemicals individually, Cox regression and logistic regression were used to estimate fecundability ratios (FRs) and odds ratios (ORs), respectively. Weighted quantile sum (WQS) regression was used to investigate the chemicals as a mixture where chemicals of concern were identified above the 7.6% threshold of equal weights. To perform the subgroup analysis, we stratified the sample according to use of COCs as the most recent pre-pregnancy contraception method and age (< 29 years, and >= 29 years). The models were adjusted for parity, regularity of menses, maternal body mass index (BMI) and smoking status, and stratified as described above. Results Prior to stratification, none of the POPs were associated with fecundability while increased exposure to HCB, PCB 74 and 118 had higher odds of infertility. Upon stratification, POP exposure was significantly associated with longer TTP in women aged >= 29 years who did not use COC. Specifically, PCBs 156, 180, 183, and 187 were associated with reduced fecundability while PCBs 99, 153, 156, 180, 183, and 187 had higher odds of infertility. As a mixture, we identified the chemicals of concern for a longer TTP include PCBs 118, 156, 183, and 187. Moreover, chemicals of concern identified with increased odds of infertility were PCB 74, 156, 183, 187, and transnonachlor. Conclusion Serum concentrations of selected POPs, both as individual chemicals and as a mixture, were significantly associated with lower fecundability and increased odds of infertility in women aged 29 years and above not using COC as their most recent pre-pregnancy contraceptive. Our findings suggest that pre-pregnancy use of oral contraceptive and age may modify the link between POPs and fecundability. The differences of specific chemicals in the individual analysis and as a mixture support the need to study combination effects of chemicals when evaluating reproductive outcomes.
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| 2. |
- Brännström, Mats, 1958, et al.
(författare)
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Uterus transplantation as an infertility treatment
- 2023
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Ingår i: Human Reproductive and Prenatal Genetics. - 9780323913805 ; , s. 657-678
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Bokkapitel (refereegranskat)abstract
- Uterus transplantation (UTx) has during the past two decades evolved as the first treatment for absolute uterine factor infertility (AUFI). Our team started a step-by-step animal research project to understand if UTx was a feasible option and to optimize the procedure before possible introduction in the human. Research was initiated in rodents and was then further developed in animal models of larger domestic species and primates. In 2012, our team in Sweden launched the first clinical UTx trial and with the announcement of the world's first live birth after UTx in 2014. After that, several UTx trials were started and with results gradually evolving. In the present chapter, we will outline possible patient groups for UTx, surgery of UTx, clinical outcomes of trials and assisted reproduction in UTx patients.
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| 3. |
- Brännström, Mats, 1958, et al.
(författare)
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UTERUS TRANSPLANTATION: In Transition from Experimental to Clinical Procedure
- 2023
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Ingår i: Textbook of Assisted Reproductive Techniques: Volume 2: Clinical Perspectives, Sixth Edition. - 9781000933505 ; , s. 746-755
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Uterus transplantation (UTx) during the last decades has developed as a novel infertility treatment for absolute uterine factor infertility (AUFI) caused by absence of a functional uterus. After systematic animal research [1] over a decade, and involving rodents, domestic species, and non-human primates, the first clinical UTx trial was launched in 2013 [2]. This was a live donor (LD) UTx trial and one out of nine participating women gave birth to the world’s first UTx baby in September 2014 [3]. Since then, more than 10 clinical UTx trials have been initiated, with a mix between LD UTx and deceased donor (DD) UTx. Based on data from all registered ongoing trials and our personal experience, we describe plausible patient groups for UTx and cover different techniques of surgery and assisted reproduction in conjunction with UTx.
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| 4. |
- Wikström, Sverre, 1978-, et al.
(författare)
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Exposure to perfluoroalkyl substances in early pregnancy and risk of sporadic first trimester miscarriage
- 2021
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Many first trimester sporadic miscarriages are unexplained and the role of environmental exposures is unknown. The present aim was to study if levels of Perfluoroalkyl substances (PFASs) in early pregnancy are associated with unexplained, sporadic first trimester miscarriage. The study was performed within the Swedish SELMA pregnancy cohort. Seventy-eight women with non-recurrent first trimester miscarriage were included and 1449 women were available as live birth controls. Eight PFASs were measured in first trimester serum. A doubling of perfluorooctanoic acid (PFOA) exposure, corresponding to an inter-quartile increase, was associated with an odds ratio (95%CI) for miscarriage of 1.48 (1.09-2.01) when adjusting for parity, age and smoking. Analyses per quartiles of PFOA exposure indicated a monotonic dose response association with miscarriage. A similar, but not significant, pattern was observed for perfluorononanoic acid (PFNA). For other PFAS, there were no associations with miscarriage. We have previously shown associations between early pregnancy PFAS exposures and preeclampsia, as well as lower birth weight. Now we report an association between PFOA and miscarriage within the same cohort, which may suggest shared but unknown mechanisms. The study can only represent a period of early placentation and clinical pregnancy loss during the second half of the first trimester.
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