| 1. |
- Liffner, Susanne, et al.
(författare)
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Birth characteristics in men with infertility
- 2020
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Ingår i: Reproductive BioMedicine Online. - : ELSEVIER SCI LTD. - 1472-6483 .- 1472-6491. ; 41:3, s. 455-463
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Tidskriftsartikel (refereegranskat)abstract
- Research question: Are low birth weight, prematurity, being born small for gestational age, or both, associated with a higher risk of male factor infertility in adulthood? Design: Retrospective study of a clinical sample of 892 men, diagnosed with an infertility factor (male, female, combined or unexplained) together with their female partner at a University Hospital clinic in Sweden between 2005 and 2010. Data on birth weight and gestational age at birth were retrieved from the Swedish Medical Birth Register. The distribution of non-optimal birth characteristics in relation to infertility factor was described. A control group was created consisting of two men for each index man, born in Sweden in the same year as each index men, as well as a reference group consisting of all men born in Sweden the same years. Results: The likelihood of having been born small for gestational age was almost fivefold higher in men with male factor infertility than in men with unexplained infertility (OR 4.84, 95% CI 1.32 to 1780). Men with male factor infertility were more often born with non-optimal birth characteristics than the control group (14.8% versus 8.5%; P = 0.010) and the reference group (14.8% versus 11.4%; P < 0.001). Men with azoospermia were more often born with non-optimal birth characteristics, compared with men without azoospermia (21.3% versus 12.1%; P = 0.038). Conclusions: The results suggest an association between intrauterine growth restriction and male factor infertility in adulthood.
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| 2. |
- Liffner, Susanne, et al.
(författare)
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Diagnostics of DNA fragmentation in human spermatozoa: Are sperm chromatin structure analysis and sperm chromatin dispersion tests (SCD-HaloSpermG2 (R)) comparable?
- 2019
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Ingår i: Andrologia. - : WILEY. - 0303-4569 .- 1439-0272. ; 51:8
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Tidskriftsartikel (refereegranskat)abstract
- Men affected with idiopathic infertility often display basic spermiogramme values similar to fertile individuals, questioning the diagnostic impact of the World Health Organization (WHO) thresholds used. This study explored sperm DNA fragmentation in single ejaculates from 14 fertile donors and 42 patients with idiopathic infertility providing semen for assisted reproductive techniques in a university fertility clinic. Each ejaculate was simultaneously studied for sperm DNA fragmentation by the flow cytometer-based sperm chromatin structure analysis (SCSA) and the new light-microscopy-based sperm chromatin dispersion assay (SCD-HaloSpermG2 (R)), before and after sperm selection for in vitro fertilisation with a colloid discontinuous gradient. The WHO semen variables did not differ between groups, but DNA fragmentation after SCSA (DFI) or SCD (SDF) was significantly (p amp;lt; 0.05) higher in patients (DFI: 40.2% +/- 3.0 vs. SDF: 40.3% +/- 1.4) than in fertile donors (DFI: 17.1% +/- 2.1 vs. SDF: 20.9% +/- 2.5). Sperm selection led to lower proportions of DNA-fragmented spermatozoa (DFI: 11.9 +/- 1.7 vs. SCD: 10.0 +/- 0.9, p amp;lt; 0.05). The techniques output correlated highly and significantly (r(2) = 0.82). DNA fragmentation is confirmed as a relevant variable for scrutinising patients with idiopathic infertility, beyond the evidently insufficient WHO semen analyses. Since both techniques yielded similar results, the reduced necessity of complex equipment when running SCD ought to be considered for a clinical setting.
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| 3. |
- Liffner, Susanne, 1974-
(författare)
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Infertility in Men in Relation to Their Birth Characteristics
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: About 10-15 % of couples worldwide suffer from infertility, the inability to achieve a pregnancy after more than 12 months of unprotected intercourse. Causes can be related to female factors, male factors, or both. In about 20 % of the couples, the cause remains unexplained. Male factor infertility is based on semen sample evaluation and is defined as poor semen quantity or quality, preferably in two or more samples. When assisted reproductive technology (ART) is considered for a couple with male factor infertility, intra-cytoplasmic sperm injection (ICSI) where the sperm is injected into the oocyte, is often needed to achieve embryo development.Men born small for gestational age (SGA), with low birth weight (LBW, £2,5000g) and/or prematurely (before the 37th gestational week) do not become fathers as often as men born with appropriate size for gestational age (AGA) at term. The aims of the present thesis were to investigate if this lower likelihood to become a father for men born SGA, preterm, or with low birth weight could be related to an increased risk of male factor infertility, if ICSI and sperm donation more often were needed and if the chance of conceiving by ART was lower than in men born AGA. An additional aim was to investigate if sperm DNA damage was more common in men born SGA compared with men born with normal size for gestational age.Material and Methods: Paper I and II were based on retrospective case control studies on men becoming fathers by ART in study I, and infertile men, patients at the Centre of Reproductive Medicine, University Hospital, Linköping, Sweden (RMC), in study II. Paper III was based on a cohort study on all men born in Sweden between 1973 and 1993. All three studies used data from national registers held by the National Board of Health and Welfare and Statistics Sweden. Study III also used information from the Swedish National Quality Register of Assisted Reproduction.Paper IV was based on a case series study of sperm DNA fragmentation in infertile patients and sperm donors at RMC, where two different methods of measuring sperm DNA fragmentation were compared, Halosperm® (easier to perform) and Sperm Chromatin Structure Assay (reference method). Paper V was based on a cohort study of men undergoing ART at RMC. The proportion of sperm with DNA fragmentation was compared between men born SGA and men born AGA.Results and conclusions: Men becoming fathers after ART were more often born with low birth weight than men conceiving naturally. Men becoming fathers after ICSI, presuming a poor semen sample, were more often born SGA than men conceiving by conventional IVF, or conceiving without treatment. ICSI had to be performed in 63% of men born SGA but only in 45% of men born AGA. Men with male factor infertility were more often born SGA or with LBW than men with female factor infertility, or when the infertility was unexplained. The results after ART were not affected by birth weight or size at birth.The likelihood of becoming a father was lower for men born SGA or with LBW compared with men born with normal birth weight. These men were also more often single (never married or with a registered partner) and had a higher risk of being born with undescended testicles, which increases the risk of infertility. Men born SGA more often needed ICSI or sperm donation.The two different methods to analyse sperm DNA fragmentation had high correlation and agreement, and Halosperm® could be considered a reliable and more easily handled method in the clinical setting. The median proportion of sperm with DNA fragmentation were higher for men born SGA (16.6%) compared with men born AGA (6.4%). The result was not statistically significant as the absolute number of men born SGA was much smaller than expected in this sample of 550 men. Larger studies are needed to confirm the hypothesis that DNA fragmentation contributes to a lower likelihood to become a father in men born SGA.
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| 4. |
- Liffner, Susanne, et al.
(författare)
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Men becoming fathers by intracytoplasmic sperm injection were more often born small for gestational to age
- 2017
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Ingår i: Asian Journal of Andrology. - : MEDKNOW PUBLICATIONS & MEDIA PVT LTD. - 1008-682X .- 1745-7262. ; 19:1, s. 103-106
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Tidskriftsartikel (refereegranskat)abstract
- Being born with nonoptimal birth characteristics decreases the chance of becoming a father. Urogenital malformations as well as metabolic syndrome are more common in men born small for gestational age (SGA) and could be contributing factors to the reduced fertility rate seen in these men. It could imply that men becoming fathers by assisted reproductive technology (ART) more often are born with low birth weight (LBW), preterm, and/or SGA than men conceiving without treatment and also that men where intracytoplasmic sperm injection (ICSI) had to be performed more often are born with nonoptimal birth characteristics than men where conventional in vitro fertilization (IVF) successfully could be used. In this retrospective, case-control study using Swedish national registers, we compared the birth characteristics of 1206 men who have become fathers by ART with a control group consisting of age-matched men who became fathers without treatment. The differences in birth characteristics between men becoming fathers by IVF and ICSI were also assessed. For men becoming fathers by ART, OR of being born with LBW was 1.66 (95% CI = 1.17-2.36) compared with fathers who conceived without treatment. OR of being born prematurely was 1.32 (95% CI = 1.00-1.77). Men becoming fathers via ICSI had a doubled increased likelihood of being born SGA compared with men who became fathers via IVF (OR = 2.12; 95% CI = 1.17-3.83). In conclusion, we have found that men becoming fathers by ICSI treatments had more often been born SGA than men becoming fathers by conventional IVF.
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| 5. |
- Liffner, Susanne, et al.
(författare)
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Men born small for gestational age or with low birth weight do not improve their rate of reproduction over time : a Swedish population-based study
- 2021
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Ingår i: Fertility and Sterility. - : Elsevier Science Inc. - 0015-0282 .- 1556-5653. ; 116:3, s. 721-730
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether the reduced reproductive rate among men born small for gestational age (SGA) or with low birth weight (LBW) is present after up to 44 years of follow-up. Design: Population-based register study. Setting: National registers in Sweden. Patient(s): All men born in Sweden between 1973 and 1993 (n = 1,045,167) followed up to 2018. Intervention(s): None. Main Outcome Measure(s): Registered fatherhood, infertility diagnoses, and fertility treatments obtained from registers up to 2018 Result(s): Men born SGA or with LBW have a lower chance of becoming fathers than men born with normal birth characteristics: hazard ratio (95% confidence interval) 0.91 (0.90-0.92) and 0.88 (0.86-0.90), respectively. The reduction in reproductive rate is more evident after a longer follow-up time. Men born SGA were more likely to receive a diagnosis of infertility. Sperm donation and intracytoplasmic sperm injection were more often used in men born SGA, further strengthening the hypothesis of an association between birth characteristics and male infertility. Conclusion(s): Men born SGA or with LBW have a lower chance of becoming fathers, but the reduction in fertility is smaller for the younger cohort. Further studies are needed to determine if this difference is maintained. (C) 2021 by American Society for Reproductive Medicine.
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| 6. |
- Lindh-Åstrand, Lotta, et al.
(författare)
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Attitudes towards the menopause and hormone therapy over the turn of the century
- 2007
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Ingår i: Maturitas. - : Institutionen för klinisk och experimentell medicin. - 0378-5122 .- 1873-4111. ; 56:1, s. 12-20
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess attitudes and beliefs about the menopausal transition in a population of peri- and postmenopausal women, and if these attitudes differed before and after publication of studies on risks and benefits with hormone therapy (HT). Material and methods: In 1999 and 2003 all women aged 53 and 54 years in the community of Linköping, Sweden, were sent a questionnaire about use of HT, menopausal status and attitudes regarding menopause and HT. Results: Most women regarded menopause as a natural process characterized by both hormonal deficiency and aging and these views did not differ between 1999 and 2003. A majority of women thought that significant climacteric symptoms were a good reason to use HT, but not that women without symptoms should use HT. The fraction of women who supported HT use was, however, significantly lower in 2003 than in 1999. Most women agreed that menopause leads to increased freedom and that it is a relief not to have to think about contraception and pregnancies. Conclusions: Most Swedish women had a mainly biological view on menopause but nevertheless they thought that only women with climacteric symptoms should use HT. Women’s attitudes towards HT have changed after recent reports on risks from long-term use of HT whereas the attitudes towards the menopausal transition were stable. Other factors than attitudes towards menopause affect women’s actual use of HT. Probably women’s and health care provider’s apprehension of the risk-benefit balance of HT use is one such factor.
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| 7. |
- Stadelmann, Caroline, et al.
(författare)
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Vaginal progesterone as luteal phase support in natural cycle frozen-thawed embryo transfer (ProFET) : protocol for a multicentre, open-label, randomised controlled trial
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group. - 2044-6055. ; 12:7
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Vaginal progesterone supplementation is frequently given to patients receiving frozen embryo transfer (FET) in the natural cycle aiming to increase the chance of pregnancy and live birth. To date, only a few studies have investigated if progesterone supplementation is beneficial in these cycles and the level of evidence for progesterone supplementation is very low. Methods and analysis The ProFET trial is a multicentre, open-label, randomised controlled trial powered for this investigation, including 1800 women with regular menstrual cycles (24-35days), aged 18-43 years planned for natural cycle-FET receiving a single blastocyst for transfer. Participants are randomised (1:1:1) to either luteal phase progesterone for 3 weeks, luteal phase progesterone for 7 weeks or no luteal phase progesterone. The participating study centres consist of 12 in vitro fertilisation-clinics in Sweden and 1 in Iceland. The primary outcome is to investigate if luteal phase support (LPS) by vaginal progesterone increases the chance of a live birth per randomised patient in a natural FET cycle compared with no LPS. Ethics and dissemination The trial was approved by the Swedish Ethical Review Authority (ID 2020-06774, 2021-02822 and 2022-01502-02) and the Swedish Medical Products Agency (ID nr 5.1-2020-102613). All participants are required to provide written informed consent. The outcome of this study will be disseminated to the public through broadcasts, newspapers and presentations at scientific congresses as well as publications in international scientific journals.
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