| 1. |
- Aittomaki, K, et al.
(författare)
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Genetics and assisted reproduction technology
- 2005
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Ingår i: Acta Obstet Gynecol Scand. - : Wiley. ; 84:5, s. 463-473
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Tidskriftsartikel (refereegranskat)abstract
- In the past 20 years, a significant improvement has been shown in the treatment for infertility in both women and men through the development of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Only donated sperm could be previously used for treatment; now oocytes can also be donated. Furthermore, the combination of IVF and ICSI with advanced genetic methods has made preimplantation genetic diagnosis possible for many genetic conditions. These methods enable genetic testing of the early human embryo by using only a single cell, one blastomere biopsied from the embryo, as the sample from which the diagnosis of many chromosome rearrangements and other inherited diseases can be made. It has also been established that a considerable proportion of infertility is caused by genetic defects, which have several implications for infertility treatment. The purpose of this review is to give a concise introduction on how genetics is involved in assisted reproduction technology to specialists who may not be working in this particular field of gynecology, but who would need some knowledge of this for proper care of their patients.
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| 2. |
- Aittomaki, K, et al.
(författare)
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Safety issues in assisted reproduction technology: should ICSI patients have genetic testing before treatment? A practical proposition to help patient information
- 2004
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Ingår i: Hum Reprod. - : Oxford University Press (OUP). ; 19:3, s. 472-476
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Tidskriftsartikel (refereegranskat)abstract
- ICSI is a highly efficient treatment of male factor infertility and therefore increasingly used to treat infertile men successfully. However, when used to treat patients with a genetic cause for their infertility, there may be an increased risk for the offspring. Chromosome aberrations, Y chromosome microdeletions and CFTR (cystic fibrosis transmembrane conductance regulator) mutations alone may explain up to 25% of azoospermia and severe oligozoospermia. These genetic defects could be identified before treatment, in which case informed decisions could be made by the couple to be treated concerning the treatment, prenatal testing or preimplantation genetic diagnosis. Therefore, we propose that men with very low sperm counts (<5 x 10(6)/ml) considering ICSI should always be informed of the possibility of genetic testing. The information should include a precise statement of the implications of the results for the patient, his family and his offspring, and reassurance that a decision to test or not to test, or the subsequent test results will not be used as a reason for withholding treatment. Testing should always remain voluntary, and the couples themselves should decide whether or not they choose to be tested. If an abnormality is identified, patients should be referred to specialist genetic counselling.
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| 3. |
- Bergh, Christina, 1953, et al.
(författare)
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Attitudes towards and management of single embryo transfer among Nordic IVF doctors
- 2007
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 86:10, s. 1222-1230
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Tidskriftsartikel (refereegranskat)abstract
- Background. The objective of this study was to investigate the attitudes towards and management of single embryo transfer (SET) among Nordic in vitro fertilisation (IVF) doctors, and to present the rate of SET and multiple pregnancies in the different countries. Methods. A questionnaire was sent to all IVF doctors in the Nordic countries (n=198, 78.5% responded). Pregnancy rates, SET and multiple births rates were extracted from registries. Main outcome measure was attitudes and management of SET. Results. Almost all doctors thought that a twin pregnancy compared unfavourably to a singleton. A twin rate >10% was acceptable for 5% of Swedish doctors. Corresponding figures for Finnish, Danish and Norwegian doctors were 21, 35 and 35%, respectively. For a woman <36 years, performing her first cycle and with two good quality embryos, almost all doctors would recommend SET. For a woman =36 years in a similar situation, SET would be recommended only in Sweden and Finland. The pregnancy rate per embryo transfer (ET), the SET rate 2003, the multiple birth rate, and the estimated SET rate 2004 were 33.3, 21.5, 22.7 and 25% (Denmark), 31.3, 43.4, 14 and 51% (Finland), 40.5, 10.5, 26.5 and 16% (Iceland), 30.6, 18, 25.2 and 26% (Norway), and 35.3, 55.1, 11.8 and 71% (Sweden). Conclusions. The SET and multiple birth rates reflect the attitudes of Nordic IVF doctors to SET and multiple births well. When introducing SET, the attitude of the IVF doctor seems to be important. © 2007 Taylor & Francis.
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| 4. |
- Cesta, C. E., et al.
(författare)
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Depression, anxiety, and antidepressant treatment in women: association with in vitro fertilization outcome
- 2016
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 0015-0282 .- 1556-5653. ; 105:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate associations between depression, anxiety, and antidepressants before in vitro fertilization (1VF) and IVF cycle outcomes, including pregnancy, live birth, and miscarriage. Patient(s): Nulliparous women undergoing their first 1VF cycle recorded in the Swedish Quality Register of Assisted Reproduction, January 2007 to December 2012 (n = 23,557). Main Outcome Measure(s): Associations between diagnoses of depression/anxiety, antidepressants, and IVF cycle outcome evaluated using logistic regression to produce adjusted odds ratios (AOR) and 950/o confidence intervals (CI). Result(s): In total, 4.40/o of women had been diagnosed with depression/anxiety and/or dispensed antidepressants before their IVF first cycle. The odds for pregnancy and live birth were decreased (n = 1,044; AOR = 0.86; 950/0 CI, 0.75-0.98; and AOR = 0.83; 950/o CI, 0.720.96, respectively). For women with a prescription for a selective serotonin reuptake inhibitor (SSRI) only (n = 829), no statistically significant associations were found. Women with non-SSRI antidepressants (n = 52) were at reduced odds of pregnancy (AOR = 0.41; 950/0 CI, 0.21-0.80) and live birth (AOR = 0.27; 950/o CI, 0.11-0.68). Women with a depression/anxiety diagnosis with no antidepressant (n = 164) also had reduced odds of pregnancy (AOR = 0.58; 950/0 CI, 0.41-0.82) and live birth (AOR = 0.60; 95% CI, 0.41-0.89). Among the women who became pregnant (39.70/0, there were no statistically significant associations between exposure and miscarriage except for the women taking non-SSRI antidepressants (AOR = 3.56; 950/o CI, 1.06-11.9). Conclusion(s): A diagnosis of depression/anxiety and/or treatment with antidepressants before IVF was associated with slightly reduced odds of pregnancy and live birth. Women with the presence of depression/anxiety without antidepressants had a more pronounced reduction in odds, implying that the underlying disorder is important for the observed association.
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| 5. |
- Finnström, Orvar, 1938-, et al.
(författare)
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IVF i Sverige - Fortsatt uppföljning av barn och mödrar
- 2006
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 103:32-33, s. 2301-2305
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Tidskriftsartikel (refereegranskat)abstract
- This paper summarises six recently published studies which evaluate Swedish in vitro fertilization from 1982 to 2003 and is a register study, based on national registers linked through personal identification numbers. Data were available for all 12186 mothers and their 16280 children. Comparisons were made with the total delivering population. The number of children born after IVF increases steadily and amounts to 3% presently. The number of twins has decreased considerably. Some increased risks persist after IVF, a slightly higher perinatal death rate and an increased risk for congenital malformations. There were no differences between conventional IVF and ICSI. The risk for cancer was not increased with one possible exception, histiocytosis. Morbidity during childhood measured as hospital admissions, was increased due to more preterm births and multiple births in the IVF group. IVF mothers were older and smoked less than other mothers. Their medical drug use differed from that of other pregnant women. In general they had a decreased cancer risk, but probably an increased risk for ovarian cancer. Maternal mortality was not increased. Several obstetric complications were more common in IVF mothers: ovarial torsion, preeclampsia, premature rupture of membranes, bleeding at delivery and placental abruption. The deliveries were more often induced, and the frequency of caesarean section was increased.
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| 6. |
- Glimelius, B, et al.
(författare)
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The Swedish Council on Technology Assessment in Health Care (SBU) systematic overview of chemotherapy effects in some major tumour types--summary and conclusions
- 2001
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Ingår i: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 0284-186X. ; 40, s. 135-
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Forskningsöversikt (refereegranskat)abstract
- This report by The Swedish Council on Technology Assessment in Health Care (SBU) reviews, classifies, and grades the scientific literature on cancer chemotherapy in some major tumour types, describes the practice of chemotherapy in Sweden, compares practice with scientific knowledge, and analyses the costs and cost-effectiveness of chemotherapy. The report is intended primarily for decision-makers at various levels, both practitioners and administrators. It is also of interest for the medical profession. The extensive body of scientific literature was reviewed according to strict criteria that reflected the scientific weight of the literature. Sixteen experts representing different disciplines (oncology, surgery, internal medicine, health economy and quality of life research) participated in the literature review. Each section was discussed within the project group and was reviewed by at least one, but usually two international researchers. Additional input was provided by national experts representing different scientific disciplines. For the final evaluation to be as close to the objective truth as possible, a concerted effort was made to guarantee objectivity and thorough assessment of current knowledge about the effects of chemotherapy on the selected cancers. The tumour types selected for this assessment include firstly those types where three investigations had shown an increased use of chemotherapy in Sweden during the latest decade. These were non-small cell lung cancer (NSCLC), gastric cancer, pancreatic cancer, colorectal cancer and urinary bladder cancer. Secondly, the two tumour types comprising the greatest number of patients treated with chemotherapy in Sweden, breast cancer and haematological malignancies, were included. Among the haematological malignancies, the most prevalent ones, acute myeloid leukaemia (AML), chronic lymphocytic leukaemia (CLL), Hodgkin's disease (HD), aggressive non-Hodgkin's lymphoma (NHL) of the large B-cell type and indolent NHL of follicular type were evaluated. These constitute about 75%, of all haematological malignancies. Thirdly, ovarian cancer was included since chemotherapy has been extensively used and since, at the time of the planning of this overview, a group of very expensive drugs, the taxanes, had preliminarily shown promising results. A wealth of scientific literature has been published on cancer therapy. The review presented in this report is limited to scientific studies judged to be important for evaluating chemotherapy efficacy. Assessments of the content and quality of these studies, and a critical summary of the results in all stages of the selected tumours, have never before been attempted in this way. However, similar comprehensive overviews of certain stages of the tumours have previously been made. These overviews were also critically evaluated. Totally 1,496 studies involving 558,743 patients were reviewed. The survey of practice of chemotherapy use involved all departments of surgery, urology, gynaecology, internal medicine including haematologic units, pulmonary medicine and general and gynaecologic oncology at 16 hospitals in two health care regions in Sweden, covering 39% of the Swedish population. During the 4 weeks of the survey, all patients with the diagnoses concerned who received chemotherapy were registered. The study included 1,590 patients. The working group's general conclusions are summarised in the following points: The literature on the effects of chemotherapy is extensive. Chemotherapy has a well-documented role in the curative and palliative treatment of patients with several types of cancer. The use of chemotherapy is of utmost importance for the possibility of cure in certain tumour types. In other tumours, chemotherapy increases the possibility of cure when added to local and regional treatments, particularly surgery. In the instances of no possibility of cure, chemotherapy may to a variable extent improve both patient survival and well-being. In Sweden chemotherapy is largely used in accordance with that documented in the scientific literature. The extent of both over- and under-treatment seems to be limited but cannot be excluded at the individual patient level. The literature-based knowledge is scientifically of lower quality in the most chemotherapy sensitive tumours than in tumours showing more limited sensitivity. In the more sensitive tumours, positive effects on a symptomatic stage and survival were seen several decades ago. In those days, clinical treatment studies did not fulfil the current high quality requirements. Small life-prolonging effects of chemotherapy are sometimes very well documented in large, high quality scientific studies. Some of these s
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| 7. |
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| 8. |
- Källén, Bengt, et al.
(författare)
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In vitro fertilisation in Sweden: obstetric characteristics, maternal morbidity and mortality
- 2005
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Ingår i: Bjog. - : Wiley. ; 112:11, s. 1529-1535
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate obstetric characteristics, maternal morbidity and mortality among Swedish women giving birth after in vitro fertilisation (IVF) treatment. DESIGN: Register study. SETTING: Nationwide study in Sweden. SAMPLE: All women known to have had IVF in Sweden 1982-2001. METHODS: Using Swedish health registers, women who had given birth after IVF were identified from all Swedish IVF clinics and compared with all women who gave birth. Analysis was performed with the Mantel-Haenszel technique. MAIN OUTCOME MEASURES: Diagnoses during pregnancy, at delivery and at re-admission within 60 days after delivery and risk of cancer. RESULTS: IVF women had an increased risk of bleeding in early pregnancy [odds ratio (OR) = 4.59, 95% confidence interval (95% CI) 4.08-5.15] and of ovarian torsion during pregnancy (OR = 10.6, 5.69-10.7). They were also more likely to encounter pre-eclampsia (OR = 1.63, 1.53-1.74), placental abruption (2.17, 1.74-2.72), placenta praevia (3.65, 3.15-4.23), bleeding in association with vaginal delivery (1.40, 1.38-1.50) and premature rupture of membranes (PROM) (2.54, 2.34-2.76). Interventions including caesarean sections (1.38, 1.32-1.43) and induction of labour (1.37, 1.29-1.46) in singleton pregnancies was more frequent. The type of IVF method had little effect on these results, but there was a tendency for women who had received intra-cytoplasmatic sperm injection (ICSI) to have slightly fewer complications than women having standard IVF. There was a significant decrease in cancer risk after IVF (0.79, 0.69-0.91) but a suggested increase in the risk of ovarian cancer both before (2.70, 1.49-4.91) and after (2.08, 1.15-3.76) IVF. No change in mortality was observed. CONCLUSIONS: Women treated with IVF had an increased obstetric morbidity. This seems to contribute little to the well-known increased risk of preterm delivery.
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| 9. |
- Källén, Bengt, et al.
(författare)
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In vitro fertilization in Sweden : Child morbidity including cancer risk
- 2005
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 0015-0282 .- 1556-5653. ; 84:3, s. 605-610
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study long-term morbidity among children conceived by IVF. Design: A register study in Sweden of IVF infants compared with all infants born. Setting: National health registers. Patient(s): More than 16,000 children born after IVF (30% of them after intracytoplasmic sperm injection) were studied with national health registers. Main Outcome Measure(s): Total number of days in hospital care at different ages, hospitalization for specific diagnoses, childhood cancer. Result(s): An overuse of hospital care was found among IVF children up to 6 years of age, which was partly explained by maternal characteristics. Discharge diagnoses indicating brain damage (mental retardation, cerebral palsy, epilepsy, behavioral problems) occurred in excess and seemed to be completely explained by preterm births. In addition, other discharge diagnoses were overrepresented, some of them linked to preterm birth. There were 29 children with cancer (21 expected), 5 of them had Langerhan's histiocytosis. Conclusion(s): Long-term morbidity among children conceived by IVF is higher than among naturally conceived infants. This was partly explained by an excess of preterm and multiple births but might also mirror different parental attitudes toward medical care for their children. No general increase in cancer risk was seen, but unexpectedly many children with histiocytosis were noted. ©2005 by American Society for Reproductive Medicine.
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| 10. |
- Källén, Bengt, et al.
(författare)
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In vitro fertilization (IVF) in Sweden : Infant outcome after different IVF fertilization methods
- 2005
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 0015-0282 .- 1556-5653. ; 84:3, s. 611-617
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare infant outcome after different IVF techniques. Design: A register study in Sweden of IVF infants compared with all infants born. Setting: National health registers. Patient(s): We studied 16,280 IVF infants, 30% of whom were conceived by intracytoplasmic sperm injection (ICSI). Intervention(s): None. Main Outcome Measure(s): Multiple births, infant sex, preterm birth, low birth weight, and small for gestational age among singletons, mortality, low Apgar score, neonatal diagnoses. Result(s): Twinning was less frequent after frozen standard IVF (18.1%) and after ICSI (21.8%) than after fresh standard IVF (24.4%). The male/female ratio was significantly increased in infants conceived after standard IVF. No significant differences were seen between singleton infants conceived after different IVF methods with respect to preterm birth, low birth weight, or infant mortality, with the possible exception of frozen standard IVF, for which some of these rates were lower than after fresh standard IVF. Infants born after ICSI had an indicated lower risk of respiratory problems than infants born after standard IVF. Conclusion(s): Little difference in outcome was seen after different IVF methods. The differences observed might be due to dissimilar characteristics of the treated women (e.g., because ICSI was mainly used in connection with male infertility). ©2005 by American Society for Reproductive Medicine.
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