| 1. |
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| 2. |
- Bungum, Leif, et al.
(författare)
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The circadian variation in anti-müllerian hormone in patients with polycystic ovary syndrome differs significantly from normally ovulating women.
- 2013
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:9
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Tidskriftsartikel (refereegranskat)abstract
- To improve the biologic understanding of the Polycystic Ovarian Syndrome (PCOS) condition by examining the circadian variation and relationship between Anti Müllerian Hormone (AMH), gonadotropins and ovarian steroids in PCOS patients compared to normally ovulating and menstruating women. By comparing the pattern of co-variation between AMH and Luteinizing Hormone, two compounds closely linked to hyperandrogenism and anovulation in PCOS, the involvement of the Hypothalamic-Pituitary-Ovarian axis in PCOS pathology could be elucidated.
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| 3. |
- Bungum, Mona, et al.
(författare)
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A prospective study, using sibling oocytes, examining the effect of 30 seconds versus 90 minutes gamete co-incubation in IVF.
- 2006
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 21:2, s. 518-523
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Traditionally oocytes have been exposed to sperm overnight, for 16-20 h. This long period of co-incubation, however, has been shown to create problems with high levels of reactive oxygen species (ROS), which may affect embryo viability and cause hardening of the zona pellucida. Recently, a positive effect of reducing the co-incubation time to 90-120 min was reported. The objective of this study was to evaluate whether a further reduction of the co-incubation period could benefit the outcome of IVF. METHODS: In this prospective study, 777 sibling oocytes from 81 women undergoing IVF were divided via alternate allocation to co-incubation for either 30 s (ultrashort co-incubation) (group A) or for 90 min (standard co-incubation) (group B). Endpoints were normal fertilization (two-pronuclear, 2PN), polyspermy (> 2PN), embryo quality (EQ), clinical pregnancy (CP) and implantation (IR). RESULTS: The normal fertilization rates of the two groups were comparable: group A 58.6% versus group B 58.0%. Significantly lower rates of polyspermy were seen in group A compared to group B (2.8 versus 7.2%, P = 0.008). No statistically significant differences in EQ, CP or IR were seen. CONCLUSION: This is the first study demonstrating the achievement of good fertilization rates in IVF with ultrashort co-incubation. Significantly lower rates of polyspermy were seen in the group with ultrashort compared to the standard co-incubation group. Further studies are, however, needed in order to evaluate whether ultrashort co-incubation has any effect on the outcome of IVF.
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| 4. |
- Bungum, Mona, et al.
(författare)
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Polymorphisms in the protein C inhibitor gene in in vitro fertilization failure.
- 2010
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 1556-5653 .- 0015-0282. ; 93:1, s. 277-279
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to determine whether total fertilization failure in human IVF can be partially explained by alterations in the gene that codes for protein C inhibitor. Forty-six men had IVF total fertilization failure and 51 controls with normal fertilization were screened for mutations in the protein C inhibitor gene by direct sequencing. The main finding was that in men involved in total fertilization failure, a heterozygous adenosine/guanine (A/G) base combination in position 1389 (rs2069990) (exon 6) in the protein C inhibitor gene was significantly more common compared with controls (10.9% vs. 0).
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| 5. |
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| 6. |
- Bungum, Mona, et al.
(författare)
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Sperm chromatin structure assay (SCSA): a tool in diagnosis and treatment of infertility
- 2011
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Ingår i: Asian Journal of Andrology. - : Medknow. - 1008-682X .- 1745-7262. ; 13:1, s. 69-75
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Forskningsöversikt (refereegranskat)abstract
- Diagnosis of male infertility has mainly been based on the World Health Organization (WHO) manual-based semen parameter's concentration, motility and morphology. It has, however, become apparent that none of these parameters are reliable markers for evaluation of the fertility potential of a couple. A search for better markers has led to an increased focus on sperm chromatin integrity testing in fertility work-up and assisted reproductive techniques. During the last couple of decades, numerous sperm DNA integrity tests have been developed. These are claimed to be characterized by a lower intraindividual variation, less intralaboratory and interlaboratory variation and thus less subjective than the conventional sperm analysis. However, not all the sperm chromatin integrity tests have yet been shown to be of clinical value. So far, the test that has been found to have the most stable clinical threshold values in relation to fertility is the sperm chromatin structure assay (SCSA), a flow cytometric test that measures the susceptibility of sperm DNA to acid-induced DNA denaturation in situ. Sperm DNA fragmentation as measured by SCSA has shown to be an independent predictor of successful pregnancy in first pregnancy planners as well as in couples undergoing intrauterine insemination, and can be used as a tool in investigation, counseling and treatment of involuntary childlessness. More conflicting data exist regarding the role of sperm DNA fragmentation in relation to fertilization, pre-embryo development and pregnancy outcome in in vitro fertilization and intracytoplasmic sperm injection (ICSI). Asian Journal of Andrology (2011) 13, 69-75; doi: 10.1038/aja.2010.73; published online 8 November 2010
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| 7. |
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| 8. |
- Bungum, Mona, et al.
(författare)
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Spermatozoa DNA damage measured by sperm chromatin structure assay (SCSA) and birth characteristics in children conceived by IVF and ICSI.
- 2012
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Ingår i: International Journal of Andrology. - : Wiley. - 1365-2605 .- 0105-6263. ; 35:4, s. 485-490
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Tidskriftsartikel (refereegranskat)abstract
- High levels of spermatozoa DNA damage hinder fertility in vivo but not in vitro. It is a source of worry that following in vitro fertilization (IVF) spermatozoa DNA damage, if not repaired by the oocyte, might have a negative impact on the offspring. The aim of this study was to assess if a high spermatozoa DNA Fragmentation Index (DFI) is associated with alterations in birthweight (BW) and/or gestational length in IVF children. One hundred and thirty-one singleton pregnancies established by standard IVF or intracytoplasmic sperm injection (ICSI) were included in the study. DFI was measured by sperm chromatin structure assay (SCSA) in semen samples used for fertilization. DFI was categorized as low and high, using 20, 30, 40 and 50% as cut-off levels. Birthweight, gestational age, as well as gestational age adjusted BW score were used in a linear regression model as end points For none of the tested birth characteristics, statistically significant differences between the groups with low and high DFI were seen regardless of whether 20, 30, 40 or 50% were used as cut-off levels, both when the IVF and ICSI data were merged or analysed separately. Spermatozoa DNA damage as assessed by SCSA is not associated with BW or gestational length in IVF and ICSI children.
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| 9. |
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| 10. |
- Thomsen, Lise, et al.
(författare)
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The impact of male overweight on semen quality and outcome of assisted reproduction
- 2014
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Ingår i: Asian Journal of Andrology. - 1008-682X. ; 16:5, s. 749-754
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Tidskriftsartikel (refereegranskat)abstract
- It is well-documented that male overweight and obesity causes endocrine disorders that might diminish the male reproductive capacity; however, reports have been conflicting regarding the influence of male body mass index (BMI) on semen quality and the outcome of assisted reproductive technology (ART). The aim of this study was to investigate whether increased male BMI affects sperm quality and the outcome of assisted reproduction in couples with an overweight or obese man and a non-obese partner. Data was prospectively collected from 612 infertile couples undergoing ART at a Danish fertility center. Self-reported information on paternal height and weight were recorded and BMI was calculated. The men were divided into four BMI categories: underweight BMI < 20 kg m(2) , normal BMI 20-24.9 kg m(2) , overweight BMI 25-29.9 kg m(2) and obese BMI > 30 kg m(2) . Conventional semen analysis was performed according to the World Health Organization guideline and sperm DNA integrity was analyzed by the Sperm Chromatin Structure Assay (SCSA). No statistically significant effect of male BMI was seen on conventional semen parameters (sperm concentration, total sperm count, seminal volume and motility) or on SCSA-results. Furthermore, the outcome of ART regarding fertilization rate, number of good quality embryos (GQE ), implantation and pregnancy outcome was not influenced by the increasing male BMI.
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| 11. |
- Alson, Sara S.E., et al.
(författare)
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Anti-müllerian hormone levels are associated with live birth rates in ART, but the predictive ability of anti-müllerian hormone is modest
- 2018
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Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115. ; 225, s. 199-204
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to evaluate the association between serum Anti-Müllerian Hormone (AMH) level and cumulative live birth rates (LBR) in patients undergoing their first in vitro fertilization (IVF) treatment cycle, and to compare serum AMH levels with Antral Follicle Count (AFC) and Ovarian Sensitivity Index (OSI) as predictors of live birth. Study design: A prospective cohort study of 454 patients under the age of 40 and with a regular menstrual cycle of 21-35 days, undergoing their first IVF treatment cycles between September 2010 and June 2015. Participants were divided into three groups based on their AMH level, (AMH ≤10, AMH 10-<30 and AMH ≥30 pmol/l). Any difference in AMH-distribution between patients with or without live birth was analyzed using a Mann-Whitney-test, and live birth rates were compared between groups by a chi-squared test for linear trend. The ability of AMH, OSI and AFC as predictors of live birth was assessed by a receiver operating characteristics-analysis and the area under the curve (AUC) was calculated. Results: Patients with live birth had a higher AMH, median (range) 26 [0-137] pmol/l, compared with patients without live birth, AMH 22 [0-154] pmol/l, p = 0.035. Mean live birth rate (SD) was 0.36 (0.48) in the total cohort, 0.26 (0.44) in AMH-group <10, 0.34 (0.48) in AMH-group 10-<30, and 0.41(0.49) in AMH-group ≥30. Thus live birth rates increased with 8% per AMH-group (95% CI: 0.02 −0.14, p = 0.015). The AUC for AFC was 0.56, for AMH 0.57 and for OSI 0.63, respectively. Conclusion: AMH concentration in serum is associated with live birth rates after IVF. Our results suggest that both AMH, AFC and OSI have an equal but modest predictive ability in relation to live birth rate.
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| 12. |
- Andersen, Claus Yding, et al.
(författare)
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Preovulatory progesterone concentration associates significantly to follicle number and LH concentration but not to pregnancy rate
- 2011
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Ingår i: Reproductive BioMedicine Online. - : Elsevier BV. - 1472-6491 .- 1472-6483. ; 23:2, s. 187-195
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Tidskriftsartikel (refereegranskat)abstract
- Using data from a large prospective randomized controlled trial that evaluated the effect of recombinant LH (rLH) co-administration for ovarian stimulation, the present study assessed whether progesterone concentration on the day of human chorionic gonadotrophin (HCG) administration was associated with pregnancy outcome. Progesterone concentration was measured on stimulation day 1 and on the day of HCG administration in 475 patients who underwent IVF/intracytoplasmic sperm injection treatment following ovarian stimulation with gonadotrophin-releasing hormone (GnRH) agonist and recombinant FSH with or without rLH administration from day 6 of stimulation. There was no significant association between the late-follicular-phase progesterone concentration and the clinical pregnancy rate. However, progesterone concentration was strongly associated with the number of follicles and retrieved oocytes. Late-follicular-phase LH concentration also showed a significant positive association with progesterone concentration (P = 0.018). Administration of rLH during ovarian stimulation did not affect progesterone concentration. The present study does not support an association between progesterone concentration on the day of HCG administration and the probability of clinical pregnancy in women undergoing ovarian stimulation with GnRH agonists and gonadotrophins for assisted reproduction treatment. Instead, late-follicular-phase progesterone concentration appears to be governed by the number of preovulatory follicles and LH concentration. (C) 2011, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
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| 13. |
- Bungum, Leif, et al.
(författare)
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Circadian variation in concentration of anti-Mullerian hormone in regularly menstruating females: relation to age, gonadotrophin and sex steroid levels.
- 2011
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 26, s. 678-684
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Anti-Müllerian hormone (AMH) is a promising marker of ovarian reserve. The aim of the study is to assess the circadian variation in AMH, and to evaluate its clinical relevance and biological aspects as an effect of age and other endocrine mechanisms involved in the regulation of AMH secretion. METHODS Nineteen healthy non-smoking, regularly menstruating female volunteers with body mass index below 30 kg/m(2), 10 aged 20-30 years (Group A) and 9 aged 35-45 (Group B) were included. Blood sampling, initiated at 8:00 a.m. on Days 2-6 of the menstrual cycle, was continued every second hour until 8:00 a.m. the following day. Serum levels of AMH, FSH, LH, progesterone and estradiol were measured. RESULTS With 8:00 a.m. values at the first day of investigation as a reference, the mean concentrations in the pooled data revealed a significantly lower level at 4:00 a.m. (P = 0.021) and 6:00 a.m. (P = 0.005) with a maximum mean difference of 1.9 pmol/l (10.6%). The same pattern was seen in both the age groups. Including both the age groups, the overall circadian variation of the AMH levels did not reach statistical significance (P = 0.059). A significant positive correlation between AMH and LH concentration was seen over the 24-h period (P < 0.001). CONCLUSIONS A slight decrease in serum AMH levels during the late night appears not clinically relevant. Co-variation in the levels of LH and AMH might indicate joint regulatory mechanisms for the latter hormone and gonadotrophins.
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| 14. |
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| 15. |
- Bungum, Leif
(författare)
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Endocrine markers of ovarian function: Clinical and biological aspects with focus on Anti Müllerian hormone
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Declining birthrates and infertility are now a common problem in the Western World. Due to the tendency to postpone childbearing an increasing age of women who consider motherhood is generally seen. A factor closely related to female fertility is the ovarian reserve, a term used to designate both quantitative as well as qualitative aspects of the remaining gametes in the female gonads. Despite a natural age-dependent decline in terms of the amount of gametes, a substantial variability exists between individuals as to the age at which the actual decrease starts. In this setting biomarkers to assess the individual fertility potential are often requested. Currently the antral follicle count and the Anti Müllerian Hormone (AMH) level are considered to be the most predictive markers. The two markers roughly describe the same issue as they are both related to certain developmental stages of the folliculogenisis. Furthermore, the number of growing follicles is closely related to the activity of the hypothalamic-pituitary axis which controls the secretion of Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). The aim of the present thesis was firstly to explore the age-related circadian variation of AMH in normally ovulating women and patients with Polycystic Ovarian syndrome (PCOS) and its relation to gonadotropin secretion; secondly to explore the inter- and intra-cyclic variation of AMH related to the number of antral follicles measured by ultrasound; thirdly to explore AMH as a marker of time to pregnancy in fertile women, and finally, to examine the significance of mid-follicular phase LH levels in patients undergoing IVF. The results show that, in contrast to women with PCOS, normally ovulating women reveal a significant circadian variation in AMH. The co-variation with androgens and LH, may indicate that LH masters the secretion of AMH. Moreover, in normally ovulating women, AMH shows a significant intra-and inter-cyclic variation which may question the current use of one measurement of the hormone as sufficient to evaluate the ovarian reserve. A significant positive correlation was found between AMH and the number of small antral follicles. Moreover, in a cohort of spontaneously pregnant women, AMH was found to be related to the number of menstrual cycles required to obtain a pregnancy. In women undergoing a long pituitary down-regulation with GnRHa and hormonal stimulation with gonadotropins to obtain multi-follicuar development prior to In Vitro Fertilization, the clinical pregnancy rate as well as the consumption of exogenous gonadotropins was inversely correlated to the mid-follicular LH levels. In conclusion, the present results demonstrate that normally ovulating women have circadian as well as intra- and inter-cyclic variations in AMH. Moreover, the AMH level seems to be related to time to pregnancy and closely linked to LH as a key player during folliculogenesis
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| 16. |
- Humaidan, Peter, et al.
(författare)
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Pain relief during oocyte retrieval--exploring the role of different frequencies of electro-acupuncture.
- 2006
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Ingår i: Reproductive biomedicine online. - 1472-6483. ; 13:1, s. 120-5
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Tidskriftsartikel (refereegranskat)abstract
- Electro-acupuncture has previously proven its analgesic effect in oocyte retrieval for IVF. The aim of the present prospective randomized study was to explore the optimal frequency for analgesia when electro-acupuncture was applied a few minutes prior to oocyte retrieval. A total of 152 patients were prospectively randomized to receive either a combination of high (80 Hz) and low frequency (2 Hz), 3 s each, a so-called mixed frequency, or a fixed frequency of 20 Hz during oocyte retrieval. In addition to electro-acupuncture, both groups had a paracervical block and manual acupuncture. No differences in pain before, during or after oocyte retrieval between the two groups were seen. In the fixed frequency group, however, a higher level of anxiety (P < 0.05) before oocyte retrieval was seen, and a higher level of nausea after aspiration of one ovary (P < 0.01) was seen in the mixed frequency group. No differences were seen regarding clinical outcome parameters. Contrary to previous reports on acute and chronic pain, the analgesic effect of the mixed frequency and the fixed frequency was similar when used for short duration electro-acupuncture.
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| 17. |
- Wikland, Matts, et al.
(författare)
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A randomized controlled study comparing pain experience between a newly designed needle with a thin tip and a standard needle for oocyte aspiration
- 2011
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 26:6 (Jun), s. 1377-83
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Ultrasound-guided transvaginal oocyte retrieval is often performed under local anaesthesia on an outpatient basis. The objective of this study was to compare the overall pain experience of a newly designed reduced needle (RN) compared with a thicker standard needle (SN). METHODS A prospective, randomized, multi-centre study was performed at four different clinics from June to December 2009. The oocyte aspiration was performed under local anaesthesia, either with a needle with a reduced diameter (0.9 mm) for the last 50 mm from the tip (RN) or with a SN (1.4 mm). A total of 257 patients were randomized (RN: n = 129; SN: n = 128). The primary endpoint was the overall pain experience self-assessed and registered by the patient on a visual analogue scale (VAS 0 mm = no pain to 100 mm = unbearable pain) immediately after the oocyte retrieval. Secondary end-points such as vaginal bleeding and several embryological parameters were also registered. RESULTS The overall pain during the oocyte retrieval procedure was significantly lower in the RN group than in the SN group (mean 21.0 mm, SD 17.5 mm and median 19.0 mm versus mean 26.0 mm, SD 19.9 mm and median 24.0 mm; P = 0.040, difference between groups mean−5.0 mm, 95% CI: 9.7 to−0.4). This was also true when adjusting for baseline characteristics such as number of follicles, number of previous oocyte pick-up, body mass index and age, by a multiple linear regression analysis. Significantly more patients (40 of 126) had less than expected vaginal bleeding in the RN group when compared with the SN group (24 of 124; 32 versus 19%; P = 0.03 and 95% CI 1.7–23.0%). No differences were found between the two needles with regard to additional i.v. analgesia, aspiration time, oocyte recovery, fertilization, cleavage rate, number of good quality embryos, number of embryos for freezing and pregnancy rate. CONCLUSIONS Oocyte aspiration performed with the newly designed thinner-tipped needle resulted in significantly less overall pain and less vaginal bleeding, without prolonging the retrieval procedure or influence the oocyte recovery rate, when compared with a SN. Clinicaltrials.gov: NCT00924885
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