| 1. |
- Bratt, Ewa-Lena, 1970, et al.
(författare)
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Continuing pregnancy following a prenatal diagnosis of a cardiac defect: What support do parents need?
- 2015
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Ingår i: Cardiology 2015. 18th Annual Update on Pediatroc and Congenital Cardiovascular Disease. Challenges and Dilemmas. Feb 11-15, 2015. Scottsdale, Arizona, US..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Purpose To explore pregnant women´s/couples’ experiences of counseling and need for support during continued pregnancy following a prenatal diagnosis of congenital heart disease (CHD). Conceptual framework Couples choosing continued pregnancy need support from the time of prenatal diagnosis until delivery. Method Design: Qualitative study, using in-depth interviews 4-8 weeks after prenatal diagnosis. Setting: A tertiary center fetal cardiology unit in Sweden Sample: 12 pregnant women and their partners, consecutively recruited after a prenatal diagnosis of an isolated and significant cardiac defect in their fetus. Data analysis: Qualitative content analysis. Major findings The analysis resulted in four themes: Making the decision: Short waiting time for specialist evaluation together with clear, honest and straightforward information was essential. The importance of knowledge: Parents called for written information together with a high-quality regulated website with information about CHD. The importance of support: Continued and easy access, throughout pregnancy, to health care professionals, including a pediatric specialist nurse, was important. Other parents with similar experiences and social media were also valuable sources of support. Future and daily life: Practical and economical issues during the hospital stay and the initial period after the hospital stay were common concerns. Conclusion The results provided valuable knowledge of how to improve information and support during pregnancy. Short waiting time from first suspicion to definitive diagnosis and continued support throughout pregnancy emphasizing the role of the pediatric cardiology specialist nurse was important. Web-based information was warranted Clinical implications These results provide important information for a future intervention study of a structured follow-up program in collaboration between antenatal- and pediatric cardiac caregivers.
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| 2. |
- Bratt, Ewa-Lena, 1970, et al.
(författare)
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Parental reactions, distress, and sense of coherence after prenatal versus postnatal diagnosis of complex congenital heart disease
- 2019
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Ingår i: Cardiology in the Young. - 1047-9511 .- 1467-1107. ; 29:11, s. 1328-1334
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: A diagnosis of congenital heart disease (CHD) in offspring triggers psychological distress in parents. Results of previous studies have been inconsistent regarding the psychological impact of a prenatal versus a postnatal diagnosis. The aim of this study was to evaluate the influence of the time of diagnosis on levels of parental distress. Methods: Pregnant women and their partners with a fetus diagnosed with complex CHD, parents of children with postnatally diagnosed CHD, and pregnant women and their partners with uncomplicated pregnancies were invited to participate. Data were collected during pregnancy and 2–6 months after delivery using the Hospital Anxiety and Depression Scale, sense of coherence, life satisfaction, and Dyadic Adjustment Scale. Results: During pregnancy, the prenatal group scored lower sense of coherence compared to controls (p=0.044). Postnatally the prenatal group scored lower on sense of coherence compared to the postnatal group and controls (p=0.001; p=0.001). Postnatally, the prenatal and postnatal groups had higher levels of anxiety compared to controls (p=0.025; p=0.0003). Life satisfaction was lower in the prenatal group compared to that in the postnatal group and in controls (p=0.000; p=0.0004). Conclusion: Parents with a prenatal diagnosis of CHD in offspring report a low sense of coherence already during pregnancy which decreased further at follow-up. The same group reported a lower satisfaction with life compared to parents of a child with postnatal diagnosis of CHD and parents of a healthy child. This motivates further efforts to improve counselling and support during pregnancy and for parents after a prenatal diagnosis.
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| 3. |
- Bratt, Ewa-Lena, 1970, et al.
(författare)
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Parent’s experiences of counselling and their need for support following a prenatal diagnosis of congenital heart disease - a qualitative study in a Swedish context
- 2015
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Prenatal screening for foetal cardiac abnormalities has been increasingly practiced in Sweden during the last 25 years. A prenatal diagnosis may have medical benefits but may also cause sustained parental psychological distress. The aim of this study was to explore pregnant women’s, and their partner’s, experiences of counselling and need for support during continued pregnancy following a prenatal diagnosis of a cardiac defect. A second aim was to use this information to propose a structured follow-up programme for continued support after the first counselling. Method: Design: Qualitative study, using interviews performed 5–9 weeks after a prenatal diagnosis of congenital heart disease. Setting: A tertiary foetal cardiology unit in Sweden Sample: Six pregnant women and their 6 partners, consecutively recruited after a prenatal diagnosis of an isolated and significant cardiac defect. Data analysis: Qualitative content analysis. Results: The analysis resulted in three themes. 1/ Counselling and making a decision - the importance of knowledge and understanding: Short waiting time for specialist evaluation together with clear and straightforward information was essential. Parents called for written information together with a high-quality website with relevant information about congenital heart disease. 2/ Continued support during pregnancy: Continued and easy access to health care professionals, including a paediatric specialist nurse, throughout pregnancy, was important. Contact with couples with similar experiences and social media were also considered valuable sources of support. 3/ Next step – the near future: Practical and economical issues during the postnatal hospital stay and the initial period following the hospital stay were common concerns. Conclusions: The following aspects should be considered in a structured follow up program during pregnancy after a prenatal diagnosis of CHD; written information, access to a safe web-site with information of high quality in their native language, support from parents with similar experiences and continued contact with a specialist liaison nurse with experience of paediatric cardiology.
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| 4. |
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| 5. |
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| 6. |
- Brucker, S. Y., et al.
(författare)
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Experiences of a multistep process with medical and psychological interventions for patients with congenital uterine aplasia to achieve motherhood: the Gothenburg-Tubingen collaboration
- 2019
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Ingår i: Facts Views and Vision in Obgyn. - 2032-0418. ; 11:2, s. 121-126
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Tidskriftsartikel (refereegranskat)abstract
- Congenital uterine aplasia, also known as Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) is a condition associated to a non-functional uterus in the presence of functional ovaries. In a setting where surrogacy is illegal (or not accepted) and adoption is the only alternative, neovaginoplasty and subsequent uterus transplantation (UTx) can provide a route to motherhood for women with MRKHS. This review article describes a multistep process by which patients with MRKHS can achieve motherhood with their own biological child. This process involving a careful clinical diagnosis, psychological counselling, assessment of eligibility for neovagina creation and UTx, the surgical treatment, fertility treatment, and long-term follow-up was developed at the Tubingen University Hospital and in close collaboration with Sahlgrenska Academy, University of Gothenburg, Sweden, where the basic experimental and clinical groundwork for UTx was laid and the first-ever UTx procedure was performed.
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| 7. |
- Brännström, Mats, 1958, et al.
(författare)
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Reproductive, obstetric, and long-term health outcome after uterus transplantation: results of the first clinical trial
- 2022
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 0015-0282 .- 1556-5653. ; 118:3, s. 576-585
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate reproductive, obstetric, and long-term health of the first completed study of uterus transplantation (UTx). Design: Prospective. Setting: University hospital. Patient(s): Nine live donor UTx procedures were conducted and seven were successful. Donors, recipients, and children born were observed. Intervention(s): In vitro fertilization was performed with embryo transfer (ET) of day 2 or day 5 embryos in natural cycles. Pregnancies and growth trajectory of the children born were observed. Health-related quality of life, psychosocial outcome, and medical health of donors and recipients were evaluated by questionnaires. Main Outcome Measure(s): The results of in vitro fertilization, pregnancies, growth of children, and long-term health of patients were reported. Result(s): Six women delivered nine infants, with three women giving birth twice (cumulative birth rates of 86% and 67% in surgically successful and performed transplants, respectively). The overall clinical pregnancy rate (CPR) and live birth rate (LBR) per ET were 32.6% and 19.6%, respectively. For day 2 embryos, the CPR and LBR per ET were 12.5% and 8.6%, respectively. For day 5 embryos, the CPR and LBR per ET were 81.8% and 45.4%, respectively. Fetal growth and blood flow were normal in all pregnancies. Time of delivery (median in full pregnancy weeks + days [ranges]) by cesarean section and weight deviations was 35 + 3 (31 + 6 to 38 + 0) and -1% (-13% to 23%), respectively. Three women developed preeclampsia and four neonates acquired respiratory distress syndrome. All children were healthy and followed a normal growth trajectory. Measures of long-term health in both donors and recipients were noted to be favorable. When UTx resulted in a birth, scores for anxiety, depression, and relationship satisfaction were reassuring for both the donors and recipients. Conclusion(s): The results of this first complete UTx trial show that this is an effective infertility treatment, resulting in births of healthy children and associated with only minor psychological and medical long-term effects for donors and recipients. Clinical Trial Registration Number: NCT02987023.
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| 8. |
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| 9. |
- Johannesson, Liza, 1976, et al.
(författare)
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Uterus transplantation: current progress and future prospects
- 2016
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Ingår i: International Journal of Womens Health. - : Informa UK Limited. - 1179-1411. ; 8, s. 43-51
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Tidskriftsartikel (refereegranskat)abstract
- Even if reproductive medicine has been remarkably successful during the past few decades, with the introduction of in vitro fertilization in the late 1970s and intracytoplasmic sperm injection in the early 1990s, it has been repeatedly mocked by infertility due to an absolute uterine factor. No treatment has been available for the women suffering from an absent or dysfunctional uterus, in terms of carrying a pregnancy. Approximately one in 500 women suffer from absolute uterine infertility, and the option so far to become a mother has been to either adopt or utilize gestational surrogacy. As of today, a total of eleven cases of human uterus transplantations have been reported worldwide, conducted in three different countries. The results of these initial experimental cases far exceed what might be expected of a novel surgical method. Many more uterus transplantations are to be expected in the near future, as other research teams' preparations are being ready to be put into clinical practice. In this review, we summarize the current worldwide experience of uterus transplantation as a treatment of absolute uterine factor infertility and the future prospects of human uterus transplantation.
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| 10. |
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| 11. |
- Järvholm, Stina, et al.
(författare)
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Donors' health-related quality-of-life and psychosocial outcomes 3years after uterus donation for transplantation
- 2019
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 34:7, s. 1270-1277
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Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION: What are the effects on donors' health-related quality-of-life, mood and marital relationship 2 and 3years after uterus donation for transplantation? SUMMARY ANSWER: Overall, uterus donors were relatively stable regarding health-related quality-of-life, mood and marital relationship after donation, although slight negative deviations existed in a few participants, presumably associated with older age or with continued non-pregnancy outcomes from the donation. WHAT IS KNOWN ALREADY: Uterus transplantation has recently proved to be a successful treatment for absolute uterine factor infertility. However, there is no previous research on health-related quality-of-life and long-term psychosocial outcomes of donors. The present cohort of nine donors represents the cases of the first clinical uterus transplantation study, which took place in Sweden. Long-term follow-up studies of health-related quality-of-life in other living donors, such as of kidneys and livers, suggest that donors have above average quality-of-life prior to donation and that this typically continues during the years after donation. In our previous 1-year report on psychosocial and quality-of-life outcomes, we found that two out of nine donors showed decreased health-related quality-of-life at 6 and 12months post donation. STUDY DESIGN, SIZE, DURATION: This complete, prospective cohort study included the nine donors of the first uterus transplantation trial, which took place in Sweden in 2013. Donors were assessed by questionnaires 2 and 3years after surgery for uterus donation. PARTICIPANTS/MATERIALS, SETTING, METHODS: The nine donors (aged 39 to 62years) were all a close relative or friend of their recipient. Physical and mental component summaries of health-related quality-of-life were measured with the SF-36 questionnaire. Mood was assessed by the Hospital Anxiety Depression Scale. Relationship with partner was measured with the Dyadic Adjustment Scale. MAIN RESULTS AND THE ROLE OF CHANCE: The physical and mental components of the SF-36 were generally above the mean scores for a normative population. At Year 3, the two oldest donors (above 60years of age at surgery) showed clear negative deviations in the physical component. The mental component summary of SF-36 was essentially unaltered overall at Year 2, but slight negative deviations were seen in three donors at Year 3. These three donors were among the four with unsuccessful pregnancy outcomes for the recipients following donation. Scores of anxiety and depression (mood) were within normative values for all donors at Year 2, but one donor presented with increased (worse) values for both variables at Year 3. Two donors showed signs of relationship distress during the follow-up period and another had divorced during this period. LIMITATIONS, REASONS FOR CAUTION: The small sample size is a limitation. WIDER IMPLICATIONS OF THE FINDINGS: The present study suggests that live uterus donation does not in general negatively influence health-related quality-of-life, mood and relationship in a 2 to 3-year perspective follow-up. Longer follow-up studies, including larger number of donors and in different cultural settings, are needed. STUDY FUNDING/COMPETING INTEREST(S): The Jane and Dan Olsson Foundation for Science; the Wallenberg Foundation; an ALF grant from the Swedish state under an agreement between the government and the county councils; the Swedish Research Council; a Ferring Pharmaceuticals scholarship in memory of Robert Edwards; and the Iris Jonzén-Sandbloms and Greta Jonzéns Foundation. The authors have no competing interests. TRIAL REGISTRATION NUMBER: NCT01844362. © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.
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| 12. |
- Järvholm, Stina, et al.
(författare)
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Experiences of Pre-Implantation Genetic Diagnosis (PGD) in Sweden: a Three-Year Follow-Up of Men and Women.
- 2017
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Ingår i: Journal of genetic counseling. - : Wiley. - 1573-3599 .- 1059-7700. ; 26:5, s. 1008-1016
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Tidskriftsartikel (refereegranskat)abstract
- Men and women with a hereditary genetic disease are faced with different options when they wish to become parents. One is pre-implantation genetic diagnosis (PGD) which is a combination of in vitro fertilization (IVF) and genetic analysis of the embryo before implantation. The present study focused on men and women's psychological experiences of PGD three years after applying for PGD. Nineteen women and seventeen men (i.e. seventeen couples and two women) participated. The interviews were analysed by thematic method. It is better to have tried was identified as a master theme, under which came three underlying sub-themes, which had the following headings: Practical experience of PGD, Psychological experience of PGD and Goals of PGD. The results show that men and women three years after PGD are still psychologically affected by their experience. The men and women raised concerns that their relationship had been affected, both positively and negatively, and feelings of anxiety and depression still remained. Healthcare services should recognize the heterogeneous nature of the group being studied and therefore the need for counselling can arise at different times and in relation to different areas, regardless of the outcome of the PGD.
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| 13. |
- Järvholm, Stina, et al.
(författare)
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INFLUENCE OF FERTILITY ON FAMILY PLANNING DECISIONS AMONG MIDDLEAGED SURVIVORS OF CHILDHOOD CANCER: A QUALITATIVE STUDY
- 2020
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Ingår i: Journal of Cancer Rehabilitation (EDISCIENCES). - 2704-6494. ; 3, s. 5-13
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Tidskriftsartikel (refereegranskat)abstract
- Background As the number of childhood cancer survivors increases, there is a need to affront associated issues in adulthood such as anxiety, depression, and infertility. The aim of this qualitative study was to examine how childhood cancer survivors at the end of their fertile period were informed about fertility earlier in life and to investigate how this information influenced family planning decisions during adulthood. Methods The study included childhood cancer survivors in western Sweden ages 37–45 years identified from the Childhood Cancer Registry. Ten women and eight men ultimately participated in the study. Participants had been treated for cancer at a median age of 14 years (range, 2.5–17.5 years) and the median time since diagnosis was 26.0 years (range, 21.0–44.5 years). The study design consisted of a semi-structured interview and thematic analysis. Results A master theme that emerged from interviews was A long and uncertain road, which was divided into three underlying subthemes: Pictures of fertility e.g., from healthcare providers or parents; Experience of fertility e.g., searching as an adult, feeling like everyone else, not for me; and Emotions and fertility e.g., better not to think about it, cancer will affect my child. Women scored consistently lower than men on questionnaires regarding quality of life. Conclusion Most participants felt that they received insufficient information about fertility after cancer. The present study also highlighted a lack of support for cancer survivors into adulthood, which affected their psychological well-being and their inclination to become parents themselves.
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| 14. |
- Järvholm, Stina, et al.
(författare)
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Is pre-implantation genetic diagnosis (PGD) more of a strain regarding satisfaction with marital quality for male or female partners? A three-year follow-up study
- 2018
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Ingår i: Journal of Psychosomatic Obstetrics and Gynecology. - 0167-482X .- 1743-8942. ; 39:3, s. 182-189
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 Informa UK Limited, trading as Taylor & Francis GroupIntroduction: Men and women with a hereditary genetic disease are faced with different options when they plan to become parents. One is pre-implantation genetic diagnosis (PGD) which is a combination of in vitro fertilization (IVF) and genetic analysis of the embryo before implantation. The present study focuses on how men and women planning for PGD experience the quality of marital satisfaction when they apply for treatment and again, three years later. Methods: The study was a prospective cohort study where all couples (n=22) applying for PGD during 2010 and 2011 were eligible. Nineteen women and 17 men (i.e. 17 couples and two women) participated. Participants answered several questionnaires (Dyadic Adjustment Scale, Hospital Anxiety and Depression Scale and Parental Stress Questionnaire) before PGD treatment, and again three years later. Results: Women who underwent PGD rated the quality of their marital relationship similarly to that of first-time parents and IVF couples, whereas men rated the marital quality somewhat lower than the contrasts groups. Satisfaction with marital quality was stable over the three-year period although men were less satisfied than women on both occasions. At year three, there was a significant correlation between martial satisfaction and parental stress in men, and between martial satisfaction and anxiety and depression in women. Discussion: Men are equally, or more, affected by their situation than their female partners, with consequences for satisfaction with marital quality. For this reason they should be included in any counselling offered.
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| 15. |
- Järvholm, Stina
(författare)
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“It is better to have tried, no matter what” : Psychological perspectives on pre-implantation genetic diagnosis (PGD)
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Couples with the risk of transmitting a genetic disease face different diagnostic options when they wish to become parents. Pre-implantation genetic diagnosis (PGD) combines in vitro fertilization (IVF) with biopsy of the embryo. With PGD the couple can start a pregnancy knowing that the child will not be affected by the particular disease. PGD is however a difficult way to become a parent and little is known about the psychological challenges for men and women who undergo PGD. The overall aim of this thesis was to increase the understanding of psychological perspectives and to explore factors related to psychological health and relationship satisfaction, in men and women during the PGD process. The thesis consists of four studies, all based on data from the same group of men (n=17) and women (n=19) undergoing PGD. Interview data and self-report measures were collected at the start of PDG treatment and three years later. Study I and IV are based on interviews with men and women when they applied for PGD, and three years later. Study II and III are based on self-report questionnaires from the same group at inclusion and three years later. The second study also includes a contrast group of men (n=23) and women (n=24) applying for first time IVF. The aim of Study I was to investigate the psychological aspects of men’s and women’s decisions to undergo PGD, the influence of the healthcare system and ethical considerations. The aim of Study II was to investigate the presence of symptoms of depression and anxiety in men and women who made the choice to undergo PGD and to study the relationship between levels of depression and anxiety and six theoretically derived risk factors. In Study III the aim was to study the quality of the marital relationship in couples undergoing PGD at the start of PGD treatment and at follow-up three years later. In Study IV the aim was to investigate long-term psychological experiences of PGD on men and women. In Study I the men and women were interviewed individually. The interviews followed a semi-structured guide. The material was analysed inductively using thematic analysis and resulted in a model where Choosing was seen as a master theme, affecting three underlying sub-themes 1) Choosing in relation to myself, 2) Choosing in relation to the child, 3) Choosing in relation society. On the next level, there were nine underlying categories. Men and women had similar reflections about the decision. In Study II a comparison was made between the PGD group and a group of men and women planning for their first IVF. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression. The main findings from Study II were that women planning for PGD did not differ significantly from women planning for IVF in symptoms of anxiety or depression. Men planning for PGD reported significantly more symptoms of anxiety than men planning for IVF (p <0.03) and had lower SoC (p <0.05). Of the analysed risk factors, reproductive history and SoC gave unique significant contributions and explained 64% of the variance in levels of depression among women in the PGD group. Having an affected child and lower socioeconomic risk gave unique significant contributions and explained 56% of the variance in anxiety among men in the PGD group. In Study III the participants answered questionnaires about satisfaction with the quality of the marital relationship (Dyadic Adjustment Scale), anxiety and depression (HADS) and perceived parental stress (Parental Stress Questionnaire) before PGD treatment, and three years later. Women who underwent PGD rated the quality of their marital relationship similarly to that of first time parents and IVF couples, whereas men rated the marital quality somewhat lower than the contrast groups. Satisfaction with marital quality was stable over the three-year period and men were less satisfied than women on both occasions. At both time-points there was a significant correlation between martial satisfaction and perceived parental stress in men (-.83 and.-.70, p < 0.05). For women, anxiety (-.52, p <0.05) and depression (-.61, p <0.01) correlated significantly with lower satisfaction with the quality of the relationship at follow-up. Study IV focused on men and women’s psychological experiences of PGD three years later. Men and women were interviewed individually and data was analysed thematically. It is better to have tried was identified as a master theme, with three underlying sub-themes: Practical experience of PGD, Psychological experience of PGD and Goals of PGD. The results showed that men and women were still psychologically affected by their experiences three years later. The men and women in the study expressed the view that their relationship had been affected, both positively and negatively, and some reported that they still had feelings of anxiety and depression. Both men and women were engaged in the decision-making process leading to PGD and they were still affected three years later. Men and women having the experience of miscarriages and termination before PGD, and/or having a child affected by the genetic disease, might be at increased risk of developing psychological symptoms. Men are equally, or even more, affected by the situation than their female partners, with consequences for their satisfaction with marital quality. Results from the four studies underline that men and women who apply for PGD constitute a heterogeneous group and the need for counselling can arise at different times and in relation to different areas, regardless of the outcome of the PGD.
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| 16. |
- Järvholm, Stina, et al.
(författare)
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Long-term health-related quality-of-life and psychosocial outcomes after uterus transplantation: a 5-year follow-up of donors and recipients
- 2024
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Ingår i: Human reproduction (Oxford, England). - 1460-2350. ; 39:2, s. 374-381
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Tidskriftsartikel (refereegranskat)abstract
- What are the outcomes regarding health-related quality-of-life, mood, and marital relationship of recipients and donors 5years after uterus transplantation (UTx) and uterus donation?Both recipients and donors generally demonstrated long-term stability regarding psychosocial outcomes but with negative deviations associated with unsuccessful outcomes.UTx is the first infertility treatment for women with absolute uterine factor infertility. The procedure can be performed with either a uterus donation from a live donor (LD), typically a close relative, or from a deceased, multi-organ donor. There are many potential stressful events over several years after UTx both for recipients and for LDs and these events may have impacts on quality-of-life and mental well-being.This, prospective observational cohort study includes the nine recipients and LDs of the first human UTx trial. They were assessed in 2017-2018 by questionnaires 5years after UTx.The nine recipients (ages 32-43years) and their respective LDs (ages 44-67years) were either related (n=8) or friends (n=1). Eight recipients had congenital uterine absence and one was hysterectomized due to cervical cancer. For two recipients, UTx resulted in early graft failures, while six of the other seven recipients gave birth to a total of eight babies over the following 5years. Physical and mental component summaries of health-related quality-of-life were measured with the SF-36 questionnaire. Mood was assessed by the Hospital Anxiety and Depression Scale. Relationship with partner was measured with the Dyadic Adjustment Scale. Comparisons were made between the values after 5years and the values before uterus donation/transplantation.Five years after primary UTx, the majority of recipients scored above the predicted value of the general population on quality-of-life, except for two women, one of whom had a viable graft but no live birth and one recipient who was strained by quality-of-life changes, possibly related to parenthood transitions. Regarding mood, only one value (anxiety) was above the threshold for further clinical assessment. Recipients showed declining satisfaction with their marital relationships, but all reported scores above the 'at risk for divorce' threshold at the time of the final assessment in our study. The LDs were all found to be stable and above the predicted value of the general population regarding mental components of quality-of-life. Three LDs showed declined physical components, possibly related to older age. Only one LD reported a value in mood (anxiety) that would need further assessment. The marital satisfaction of LDs remained stable and unchanged compared to baseline values. Notably, the two recipients with early graft failures, and their related LDs, regained their mental well-being during the first years after graft failure and remained stable after 5years.The restricted sample size and the single-centre study-design are limitations of this study. Additionally the study was limited to LD UTx, as opposed to deceased donor UTx.Our study shows that both LDs and recipients had acceptable or favourable quality-of-life outcomes, including mood assessment, at the 5-year follow-up mark, and that failure to achieve a live birth negatively affected these modalities both for LDs and recipients. Moreover, an important finding was that LDs and recipients are not reacting with depression after hysterectomy, which is common after hysterectomy in the general population.Funding was provided by the Jane and Dan Olsson Foundation for Science, Knut and Alice Wallenberg Foundation, Handlanden Hjalmar Svensson Foundation, Swedish Governmental ALF Grant, and Swedish Research Council. There are no conflicts of interest to disclose.
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| 17. |
- Järvholm, Stina, et al.
(författare)
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Patient acceptance and outcome of mental health screening in Swedish adults with cystic fibrosis
- 2020
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Ingår i: Quality of Life Research. - : Springer Science and Business Media LLC. - 0962-9343 .- 1573-2649. ; 29, s. 1579-1585
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Anxiety and depression are common among adults with cystic fibrosis (CF), and the International Committee on Mental Health in CF (ICMH) recommends annual screening for mental health problems. We implemented screening according to the recently published guidelines and assessed the results from the first year, as well as the patients’ attitude to annual screening Methods: Adult patients attending Gothenburg CF-center from Feb 2015 to Dec 2016 completed the GAD-7 (anxiety) and PHQ-9 (depression) forms at the time of their annual review. In addition, questions regarding the screening process and instruments used were asked. Results: All invited patients (n = 100, 52% males, 2% lung transplanted), with a median age of 28years (range 18–65), agreed to participate. In general (83%), the patients were positive to screening on an annual basis. No significant differences in total GAD-7 and PHQ-9 scores were found when comparing men and women. Patients younger than 30years of age reported more symptoms of anxiety compared to older patients (p = 0.02). There were 21 (21%) patients with scores > 10 for GAD-7 and/or PHQ-9 indicating at least moderate anxiety or depression. Scores > 10 were reported by 15 patients on GAD-7, 15 patients on PHQ-9, and 9 patients reported scores above 10 on both measures. Conclusion: The patients considered annual check-ups for mental health issues important. Although the screening results are reassuring, the group is heterogenic and younger individuals should be given extra attention. Follow-up over longer time will provide more robust data. © 2020, The Author(s).
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| 18. |
- Järvholm, Stina
(författare)
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Psychological aspects after uterus transplantation
- 2019
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Ingår i: Uterus Transplantation. Brännström, M. (red.). - Cham : Springer. - 9783319941622 ; , s. 177-182
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Uterus transplantation is a novel form of transplantation. The first successful uterus transplantation was performed just more than 5 years ago, and we are presently accumulating more and more data about events after transplantation, both considering the donor and the recipient/partner couple. Major events concerning the health of the graft, rejections episodes, medical complications, pregnancy outcome, and hysterectomy will occur during these first 5 and more years after transplantation. The psychological aspects of these events during this time frame will be discussed in this chapter. © Springer Nature Switzerland AG 2020.
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| 19. |
- Järvholm, Stina, et al.
(författare)
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Psychological aspects in pre-transplantation assessments of patients prior to entering the first uterus transplantation trial.
- 2015
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 94:10, s. 1035-8
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Tidskriftsartikel (refereegranskat)abstract
- Uterus transplantation is a treatment of uterine factor infertility. It raises questions of psychological aspects and well-being among the participants, which is of great importance as this is a new type of a major surgical procedure. This commentary focuses on the psychology surrounding this novel type of transplantation and the importance of patient selection. In addition, psychological aspects of events during the first postoperative year and the follow-up are discussed.
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| 20. |
- Järvholm, Stina
(författare)
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Psychological evaluations before uterus transplantation
- 2019
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Ingår i: Uterus Transplantation. Brännström, M. (red.). - Cham : Springer. - 9783319941622 ; , s. 95-101
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Uterus transplantation (UTx) is a novel form of transplantation, and therefore it also needs a novel form of psychological evaluation emerging from the experiences of both solid organ transplantation and reproductive medicine. The woman, her partner, and the living donor are the focus of the psychological evaluation prior to UTx. This chapter covers specific themes to evaluate prior to UTx and suggestions of assessment tools. © Springer Nature Switzerland AG 2020.
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| 21. |
- Järvholm, Stina, et al.
(författare)
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Psychosocial outcomes of uterine transplant recipients and partners up to 3 years after transplantation: results from the Swedish trial
- 2020
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 0015-0282. ; 114:2, s. 407-415
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the psychosocial outcomes of recipients and their partners 2 and 3 years after entering this first clinical uterus transplantation study. Design: Prospective observational study. Setting: University hospital. Patient(s): Nine women with absolute uterine factor infertility and their male partners participated. Intervention(s): Psychosocial evaluations using questionnaires focusing on health-related quality-of-life, mood, relationship, and fertility-related quality-of-life were conducted at 2- and 3-year follow-up after transplantation. Main Outcome Measure(s): Scores were obtained on the validated questionnaires 36-Item Short Form Survey (SF-36), Hospital Anxiety and Depression Scale, Dyadic Adjustment Scale, and Fertility Quality of life measuring health-related quality-of-life, mood, relationship, and infertility-associated life quality, respectively. Result(s): There was a reversible decrease (at year 2) in the physical component of SF-36 concerning recipients, but not in partners. Negative deviations in the mental component of SF-36 were seen in four recipients, and in two of their partners at year 3, possibly related to the fact that live birth had not been achieved yet among three of these women. Childlessness also seemed to be related to reporting elevated anxiety scores. Most recipients and partners stated high satisfaction with marital relationship both at inclusion and at follow-up. Conclusion(s): The results of the present study show that even if the baseline psychosocial characteristics of the women to undergo transplantation and their partners were stable and equal or better compared with norm populations, graft failure and failure to achieve parenthood will pose psychological strains on couples in the period up to 3 years after transplantation. Psychological counseling should be offered past 3 years for recipients and their partners. ((C) 2020 by American Society for Reproductive Medicine.)
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| 22. |
- Järvholm, Stina, et al.
(författare)
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Risk factors for depression and anxiety among men and women planning for pre-implantation genetic diagnosis
- 2016
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Ingår i: Journal of Reproductive and Infant Psychology. - : Informa UK Limited. - 0264-6838 .- 1469-672X. ; 34:3, s. 282-292
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies have shown that women planning for in vitro fertilisation (IVF) show more distress than do men. Most studies about distress and pre-implantation genetic diagnosis (PGD) are based on women's experiences. Little is known about what are the risk factors for men and women to experience anxiety or depression when planning for PGD.Objective: The first aim was to investigate presence of symptoms of depression and anxiety in men (n=17) and women (n=19) planning for PGD and compare this to men (n=23) and women (n=24) who were planning their first IVF. The second aim was to investigate if specified risk factors could predict the presence of anxiety and depression in the PGD group.Method: Anxiety and depression were measured with the questionnaire, the Hospital Anxiety and Depressions Scale (HADS). The Swedish version of the short Sense of Coherence scale was used to measure individuals' sense of coherence. An index was created for six risk factors tested in the PGD group.Results: Low Sense of Coherence and history of miscarriage or termination were predictors of symptoms of depression among women in the PGD group. Socioeconomic risk and having a child with the genetic disease were predictors for anxiety in men.Conclusion: Women planning for PGD and IVF reported similar levels of anxiety or depression while men in the PGD group reported significantly more anxiety than men planning for IVF. Risk factors indicating depression or anxiety were found in the PGD group. The results of the present study are relevant for pre PGD counselling.
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| 23. |
- Järvholm, Stina, et al.
(författare)
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Striving for motherhood after uterus transplantation: a qualitative study concerning pregnancy attempts, and the first years of parenthood after transplantation
- 2022
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 37:2, s. 274-283
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Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION How do women experience attempts to become pregnant, and the first years of motherhood, after uterus transplantation (UTx)? SUMMARY ANSWER Women who try to become pregnant after UTx experience the general strains typically associated with infertility and childlessness, such as failure of embryo transfer (ET), and specific worries about graft survival but when they become mothers they essentially feel like other mothers, with the associated rewards and stresses. WHAT IS KNOWN ALREADY UTx has proven to be a successful treatment for absolute uterine factor infertility (AUFI). Although UTx seems to have a positive effect on self-image there is a lack of knowledge about how women who have received uterine grafts experience pregnancy attempts, pregnancy itself and the first years of motherhood. STUDY DESIGN, SIZE, DURATION This prospective cohort study included the seven participants in the first UTx trial who had experienced surgically successful grafts. Pregnancy was attempted using ET 12 months after transplantation. Structured interviews were performed once a year for 5 years after transplantation. PARTICIPANTS/MATERIALS, SETTING, METHODS Six of the seven participants (mean age 29.3 years at UTx) had AUFI owing to the congenital absence of the uterus, while the seventh woman had undergone a hysterectomy. Post-transplantation, yearly interviews (2013-2018) were performed, comprising a total of 34 interviews. Interview data were analysed thematically. MAIN RESULTS AND THE ROLE OF CHANCE All seven participants achieved pregnancy during the study period and six became mothers. Experiencing the previously unimaginable was classed as an overarching theme with the following underlying themes: The yoke of childlessness; Going through the impossible and Motherhood as surreal and normal. The results showed that the women who try to achieve motherhood after UTx generally describe their situation as manageable and present strains comparable to other women undergoing infertility treatments. LIMITATIONS, REASONS FOR CAUTION The fact that all participants came from one centre is a limitation. WIDER IMPLICATIONS OF THE FINDINGS There are real psychological strains in motherhood after UTx, such as the concern the women expressed relating to health of the child and the effects of immunosuppressants. These findings are in line with those of other women who became pregnant after transplantation of organs other than the uterus. The results show that extra psychological support and attention should be given to those with repeated pregnancy failures or unsuccessful outcomes. In the cases where women became mothers, attention needs to be given to the possible worries connected to the UTx, but in other respects, they should be treated like any mother-to-be. STUDY FUNDING/COMPETING INTEREST(S) Funding was received from the Jane and Dan Olsson Foundation for Science; Knut and Alice Wallenberg Foundation. A.L.F. grant from the Swedish state under an agreement between the government and the county councils; Swedish Research Council. The authors have no competing interests.
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| 24. |
- Järvholm, Stina, et al.
(författare)
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Uterus transplantation: joys and frustrations of becoming a 'complete' woman-a qualitative study regarding self-image in the 5-year period after transplantation
- 2020
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 35:8, s. 1855-1863
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Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION How is a women's self-image affected by uterus transplantation (UTx)? SUMMARY ANSWER Women experienced receiving a uterus in both positive and negative ways, but in general, their self-image was positively affected; regardless of whether they have given birth to a child or not, recipients describe themselves as being 'back to normal' after the hysterectomy to remove the transplanted uterus. WHAT IS KNOWN ALREADY UTx has repeatedly proved to be a successful treatment for absolute uterine factor infertility. However, there has been no previous qualitative long-term research into the self-image of women undergoing UTx. STUDY DESIGN, SIZE, DURATION This complete, prospective cohort study included the nine recipients of the first UTxs performed in Sweden mostly in 2013. Interviews took place in the 5 years following surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS Eight out of the nine recipients had congenital absence of the uterus, a characteristic of Mayer-Rokitansky-Kuster-Hauser syndrome, and one recipient lacked a uterus after a radical hysterectomy due to cervical cancer. The mean age of participants was 31.5 years at inclusion and at this time they all lived in stable marital relationships. Post-transplantation, interviews were performed annually for 5 years, comprising a total of 43 interviews. The interview followed a semi-structured guide. All interviews (median duration of around 25 minutes) were recorded, transcribed verbatim and then analysed by thematic approach. MAIN RESULTS AND THE ROLE OF CHANCE The joys and frustrations of becoming a 'complete' woman are seen as a master theme, which influences the three underlying subthemes, a changed self-perception, a changed body and a changed sexuality. Each of these subthemes have three underlying categories. LIMITATIONS, REASONS FOR CAUTION The small sample size is a limitation. WIDER IMPLICATIONS OF THE FINDINGS The results provide information that will be helpful in pre-operative screening procedures and in the psychological support offered both to women who experienced successful and unsuccessful outcomes following UTx.
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| 25. |
- Järvholm, Stina, et al.
(författare)
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Uterus Transplantation: Lessons Learned From a Psychological Perspective
- 2022
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Ingår i: Clinical Obstetrics and Gynecology. - 0009-9201. ; 65:1, s. 52-58
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Tidskriftsartikel (refereegranskat)abstract
- Uterus transplantation has gained increasing acceptance as a medically viable treatment to achieve pregnancy in women with absolute uterine infertility or loss of uterus. Over 20 live births have occurred worldwide since the first successful live birth in Sweden in 2014.However, the psychological and emotional impact on women who seek uterus transplant, their partners, and the women who donate their uterus is a critical area to explore. This paper will discuss issues related to recipient and donor selection, parenting posttransplant, and consideration of unanticipated outcomes including uterus transplant failure and inability to achieve pregnancy. © 2022Wolters Kluwer Health, Inc.
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| 26. |
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| 27. |
- Kumnig, M., et al.
(författare)
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Vascularized composite allotransplantation: emerging psychosocial issues in hand, face, and uterine transplant
- 2022
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Ingår i: Current Opinion in Organ Transplantation. - : Ovid Technologies (Wolters Kluwer Health). - 1087-2418 .- 1531-7013. ; 27:6, s. 501-507
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Tidskriftsartikel (refereegranskat)abstract
- Purpose of review Currently, several research approaches warrant further attention, given the influence of psychosocial and bioethical issues on the success of upper extremity (UETx), face (FTx), and uterine transplantation (UTx). This review will highlight recent results of psychosocial and bioethical research in the field of vascularized composite allotransplantation (VCA), discuss most recent findings, provide information to guide future research approaches, and address the importance of a multicenter research approach to develop international standards. Recent findings Previously published reports have tried to identify psychosocial factors that are essential to predict psychosocial outcomes and guide posttransplant treatment after VCA procedures. These issues in VCA are receiving more attention but we are still at the beginning of a systematic investigation of these domains. This review article summarizes the emerging psychosocial issues in UeTx, FTx, and UTx by including recent literature and current clinical practice. Even though different VCA procedures address different domains leading to specific psychosocial issues, common aspects impacting all forms of VCA would benefit of further coordination. These domains include clinical resources, public attitude and perception, bioethical considerations, adherence and rehabilitation, motives for VCA, information needs and multidisciplinary communication, body image, domains of quality of life, coping strategies, and follow-up care.
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| 28. |
- Kvarnström, Niclas, et al.
(författare)
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Live donors of the initial observational study of uterus transplantation-Psychological and medical follow up until 1 year after surgery in the 9 cases.
- 2017
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Ingår i: Transplantation. - 1534-6080. ; 101:3, s. 664-670
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Tidskriftsartikel (refereegranskat)abstract
- The first prospective observational study of uterus transplantation was initiated in 2013 with live donation to 9 women with absolute uterine factor infertility. We explored the medical complications and psychosocial wellbeing of the donors during the first postoperative year.Complications were registered and graded according to the Clavien-Dindo (C-D) classification. Symptoms related to the surgery were registered. Data on length of hospital stay, sick leave, socioeconomic parameters and life events were obtained. Psychological evaluations (PGWB, DAS, HADS, SF-36) questionnaires focusing on quality-of-life, mood, and relationship, were conducted at inclusion and at 3, 6 and 12 months after uterus donation.One major surgical complication (C-D IIIb) occurred. A ureteric-vaginal fistula developed 2 weeks after uterus procurement. The fistula was surgically repaired. Two self-reported and transient complications (C-D I) were noted (nocturia, meralgia paresthetica). Hospital stays of all donors were 6 days and median sick leave was 56 days (range 14-132). At inclusion, median scores exceeded the normative values of the Swedish population in PGWB and DAS. Anxiety (HADS-A) was detected preoperatively in 1 donor. Two donors exceeded 10-point declines in SF-36 summary scores and increased their HADS scores by 6 points during the observation period. All donors returned to their predonation levels of physical health.The results support that it is feasible to retrieve a uterus safely from a live donor. Further studies are needed to better evaluate the method.
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| 29. |
- Lindell Pettersson, Malin, 1979-
(författare)
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Women giving birth at an advanced age and their children : obstetric and neonatal outcomes, health and social support
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Postponement of parenthood is an increasing trend in Western societies today. Delaying motherhood to a later time in life increases the use of assisted reproduction technology (ART), and the risk for adverse obstetric and neonatal outcomes. Along with postponement of motherhood, the number of women requesting treatment to become solo mothers has increased. The aim of the present thesis was to evaluate the obstetric outcomes and morbidity among mothers and their children, and the association of these outcomes with advanced maternal age, single status and the use of ART.Data from the Medical Birth Register (MBR) pertaining to pregnancy, childbirth and neonatal outcomes were retrieved. In total, 37,558 mothers aged ≥ 40 years formed the index group, which was divided into two subgroups, mothers 40-44 years of age and mothers aged ≥ 45, and compared to a control group of 71,472 mothers age ≤ 39 years (Study I). To investigate the mothers’ morbidity up to five years prior to, and up to five years after childbirth (study II), and their children’s morbidity up to five years of age (study III), data from the MBR and the National Patient Register (NPR) on Swedish women giving birth during 2007-2008 and their children were retrieved. The index group comprised 8203 mothers ≥ 40 years, and the control group comprised 15,569 mothers ≤ 39 years and their children. Diagnosis and number of inpatient and outpatient visits in hospital specialized care units were studied as well as mode of conception i.e., using ART or spontaneously conceived. Civil status, defined as single or cohabiting/married, was also investigated. In study IV, 207 single women accepted for treatment with donor sperm were compared with 256 cohabiting women treated with IVF with their own gametes. The women’s sociodemographic data, their descriptions of their social networks, as well as self-assessment of their social support were investigated through a questionnaire.The results showed an increased risk for an adverse pregnancy outcome in older mothers and the children were more often born preterm, with low birthweight or were small-for-gestational age. In addition, the older mothers had more often used ART, and were more likely to be single, to use less tobacco and to have a higher BMI compared to younger women. Also, the results indicated an increased risk for morbidity among older women, both before and after pregnancy, compared to the younger women. Women of both age groups who had used ART to conceive also had higher morbidity than women who conceived spontaneously. Among mothers and children, morbidity was significantly higher in both mother and child when the mother was single at the time of pregnancy. Children born to older mothers were more often diagnosed with conditions diagnosed in the perinatal period and with congenital malformations, deformations and chromosomal abnormalities compared with children born to younger mothers.Solo women who were to be treated with sperm donation were older compared to cohabiting women. Solo women more often had a higher level of education and full-time employment, and were in a profession with a higher salary compared with cohabiting women. Solo women expected to receive much help, primarily from a parent but also from friends.The significantly increased risk for adverse outcomes in pregnancy and childbirth associated with advanced maternal age and the diagnoses their children were more likely to receive during the first five years of life is perhaps small but will have an impact on the individual. Single parenthood is historically associated with social and economic disadvantages. The results are in part promising concerning the sociodemographic characteristics of solo-mothers-to-be and their high levels of perceived social support. However, the potential risk for long-term morbidity in children born to advanced aged mothers, in combination with maternal single civil status and use of ART, is important to follow closely to provide proper and adequate support and health care to these mothers and their children.
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| 30. |
- Lindfors, Anna, et al.
(författare)
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Health-related quality of life after robotic surgery for endometrial cancer: a prospective longitudinal one-year follow-up study
- 2023
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Ingår i: Archives of Gynecology and Obstetrics. - : Springer Science and Business Media LLC. - 0932-0067 .- 1432-0711. ; 308:2, s. 515-525
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThis study aimed to explore how patients treated for endometrial cancer (EC) with robotic surgery are affected in symptoms of anxiety and depression and HRQoL in the long term.MethodsWomen scheduled for primary robotic surgery for EC were included (n = 64), in this single-center study. Socioeconomic variables were obtained at baseline. The European Organization for Research and Treatment of Cancers Quality of Life Questionnaire Core 30 (QLQ-C30), its module for EC (EN24), the Generalized Anxiety Disorder Scale (GAD-7), and the Patient Health Questionnaire Depression Scale (PHQ-9) were followed prospectively from baseline to 2 weeks, 3 months and 1 year postoperatively.ResultsThe number of patients scoring above the clinical threshold for anxiety decreased from 17 (27.0%) at baseline to 4 (7.0%) at 2 weeks (p = 0.012). Depressive symptoms were reported in 20% of patients at baseline and did not change significantly during the one-year follow-up (p = 0.58). A significant decrease in Global health status was seen at 2 weeks (from 69.8 to 62.7; p = 0.048), with return to baseline levels after 3 months (68.5; p = 0.32) and stable at 1 year. Unemployment, low income, and adjuvant therapy correlated with lower Global health status at 3 months.ConclusionThe significant proportion of patients with anxiety symptoms preoperatively reduced prompt after surgery, while the proportion with depression remained constant, indicating that the primary treatment has no long-term negative effect on patients' mental health. At 3 months, there is no obvious remaining negative impact on patients' HRQoL, and these results are consistent after 1 year.
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| 31. |
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| 32. |
- Munthe, Christian, 1962, et al.
(författare)
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Time-lapse in reproductive medicine: ethical prospects and challenges
- 2015
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Ingår i: ESHRE Annual Meeting, Lisbon, June 14-17, 2015.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Study question: What are the ethical prospects and challenges of using time-lapse (TL) for different purposes in research, clinical service, care and commercial marketing in the assisted reproductive context? What possible professional or public policy implications follow from these? Summary answer: The ethics of TL depends on its more exact use. Current knowledge indicates possible clinical benefits, but premature clinical application should be resisted. TL opens for, e.g., patient demands regarding embryo selection and implementation of TL involving display to patients mandates extra caution regarding care, counseling and marketing exploits. What is known already: Using TL to capture the process of in vitro embryo development has quickly entered reproductive medicine, with prospective uses in research and clinical service. It has also been picked up as a possible marketing tool by commercial providers, and as an add-on of patient care and counseling. Assessment of the effects and efficiency of TL is ongoing and, as yet, displaying complex and partly unclear or contradictory results. care and counseling aspects remain uncharted. Study design, size, duration: Explorative theoretical analytical applied ethics study. Participants/materials, setting, methods: Systematic analysis of ethical aspects using literature on TL and relevant aspects of the ethics of assisted reproduction and reproductive medicine. Main results and the role of chance: TL is valuable for research, but trials of TL-interventions aiming at improved IVF should not be launched prematurely or allowed to sneak into routine practice. Offering display of TL documentation of embryo development to patients during ongoing treatment has unclear benefits and risks from a care and counseling perspective and arises the issue of what to display. It may be a vehicle for increasing patient involvement, but may also create conflict between patients and clinicians regarding embryo selection, and will introduce care and counselling challenges as patients form their own reactions. Retrospective offers appear less risky, but may fuel into uncertainty about the outcome. Marketing services with such offers risks biasing patients towards an “entertainment” view and away from more important considerations counseling wise. Limitations, reason for caution: There are many unknowns regarding the more detailed effects on patient experience of incorporating TL display as part of assisted reproductive services. Such additions also have unknown cultural dimensions by making the living in vitro embryo more widely and intimately visible and acquaintable. Wider implications of the findings: Besides the need to structure, monitor and limit attempts at using TL to boost IVF results, the idea of displaying TL output to patients is in need of much probing, not least regarding patient experience and structural effects on the perception of assisted reproductive services, but also clinical policy and counseling requirements. Professional and scientific organizations should act to prevent premature and reckless clinical use.
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| 33. |
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| 34. |
- Nilsson-Condori, Emma, et al.
(författare)
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A New Beginning: Young Women's Experiences and Sexual Function 18 Months After Bariatric Surgery
- 2020
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Ingår i: Sexual Medicine. - : Oxford University Press (OUP). - 2050-1161. ; 8:4, s. 730-739
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Female patients expect improved quality of life, including sexual health and regain of fertility after bariatric surgery. Little has been published on to the extent to which patients’ expectations are met by the weight loss after surgery. Aim: To explore how women perceive the effects of bariatric surgery on quality of life, focusing on sexual health and fertility. Methods: A qualitative study based on thematic analysis, supported by questionnaire data. Interviews following a semistructured guide were conducted with childless women (n = 11) aged 25–34 years recruited from a university-affiliated Swedish bariatric center. The interviews took place 18 months after surgery in the participants’ homes or at the hospital and were recorded and transcribed verbatim. Data were analyzed with a thematic approach. Questionnaires were filled in at the time of the interviews and compared with preoperative data using a Wilcoxon test for paired data. Main outcome measures: Participants described experiences related to female sexual health after bariatric surgery. The Hospital Anxiety and Depression Scale and the Female Sexual Function Index questionnaires were administered preoperatively and postoperatively. Results: “A new beginning” was identified as the master theme, with 3 underlying subthemes: “Being worthy of love,” “Exploring sexuality,” and “Considering parenthood.” The participants described a transformation into being more comfortable with themselves that affected all areas of life, including sexual life. These findings were supported by lower scores for depression, 6.5 vs 2, and improved total Female Sexual Function Index scores, median 23.3 preoperatively and 29.1 postoperatively, P = .012. Conclusions: Improved body image and enhanced self-esteem play important roles in improved sexual functioning in women after bariatric surgery. Nilsson-Condori E, Järvholm S, Thurin-Kjellberg A, et al. A New Beginning: Young Women's Experiences and Sexual Function 18 Months After Bariatric Surgery. Sex Med 2020;XX:XXX–XXX. © 2020 The Authors
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| 35. |
- Nilsson-Condori, Emma, et al.
(författare)
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To Get Back on Track: A Qualitative Study on Childless Women's Expectations on Future Fertility Before Undergoing Bariatric Surgery
- 2019
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Ingår i: Clinical Medicine Insights-Reproductive Health. - : SAGE Publications. - 1179-5581. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In Sweden, 4700 women seek bariatric surgery annually, many of those being nulliparous. Anovulation is common among obese women, but bariatric surgery is not considered a treatment for infertility. The aim of this study was to explore the motives of women in fertile age for seeking bariatric surgery and their expectations on future fertility. MATERIALS AND METHODS: A qualitative study with semi-structured interviews with childless women (n=12) aged 20 to 35 years. Interviews were conducted 1 to 3 weeks prior to surgery. transcribed verbatim. and analyzed with thematic analysis. RESULTS: "To get back on track" was identified as a master theme with 3 underlying subthemes, with the following headings: "A better me," "A fertile me." and "A pregnant me." The participants were hoping that weight-loss would make them feel more content with themselves, break isolation, and make it easier to find a partner. The participants considered fertility to improve after bariatric surgery, mainly based on stories from other patients of bariatric surgery. Having a child was expressed to be of great importance to them. CONCLUSIONS: Even though obese young women do not seek bariatric surgery for fertility reasons alone, there is a general perception of enhanced fertility after surgery. which is regarded as positive and important.
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| 36. |
- Nilsson, Sofia, et al.
(författare)
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A survey of ovarian reserve and quality of life in female survivors of pediatric cancer.
- 2022
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 101:1, s. 84-93
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Tidskriftsartikel (refereegranskat)abstract
- Childhood cancer is rare; the incidence in Sweden is approximately 16 new cases/100000 children each year. Reduced reproductive function and fertility are well-known side effects of cancer treatment. Anti-Müllerian hormone (AMH) has been shown to correlate well with antral follicle count in healthy women but is currently not recommended as the primary surveillance modality for evaluation of premature ovarian insufficiency in this patient group. Psychological wellbeing related to fertility could affect quality of life and should be included in long-term follow-up. The aim of the study is to present the baseline data from inclusion for a prospective follow-up study of fertility surveillance where both medical and psychological aspects of fertility in female childhood cancer survivors are considered.These are the first results from this longitudinal follow-up cohort study. Female adolescent and young adult survivors of pediatric cancer in Western Sweden were included from January 2016 to December 2018, a total of 54 participants. Median age at inclusion was 21 (15-29) years and median age at cancer diagnosis was 10 (1-17) years. AMH levels, antral follicle count, and data on fertility were recorded at inclusion and will be prospectively followed up. The study includes questionnaires and interviews concerning quality of life. This study is planned to continue until the participants reach the age of 40years.Eighteen of 54 (33%) participants had AMH levels below 1.0µg/L and were considered to have high or very high risk of infertility. Median AMH level was 2.50µg/L. Six women had immediate need of oocyte cryopreservation. Psychological assessment showed that more than one-third of participants (n=20) had elevated anxiety scores.One-third of female survivors of pediatric cancer in the study had high risk of low ovarian reserve, measured by a combination of AMH and antral follicle count, and many had signs of anxiety. The longitudinal study could contribute to better knowledge in the changes of AMH over time for this patient group. Psychological follow-up with questionnaires and interviews evaluating signs of depression and anxiety may serve as a model for future screening programs.
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| 37. |
- Nilsson, Sofia, et al.
(författare)
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EXPERIENCES OF COMMUNICATION AND INFORMATION FROM HEALTH CARE STAFF REGARDING REPRODUCTIVE HEALTH: A QUALITATIVE STUDY OF FEMALE CHILDHOOD CANCER SURVIVORS IN SWEDEN
- 2024
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Ingår i: Journal of Cancer Rehabilitation. - 2704-6494. ; 7, s. 53-56
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Tidskriftsartikel (refereegranskat)abstract
- Background With increasing number of childhood cancer survivors, there is a growing population of adult survivors that reach reproductive age. Long-term side effects of cancer treatment can include damage to the reproductive organs and lead to premature ovarian failure. The purpose of the study was to examine female childhood cancer survivors’, participating in long-term follow-up, experiences of communication and information regarding fertility and reproductive health outcomes. We also aimed to investigate how they experienced the transition from pediatric to adult health services. Methods Participants for the study were all part of a longitudinal project, identified through the Long-Term Follow-Up Clinic at the Oncology Department at Sahlgrenska University Hospital, Sweden. Fifty-four female childhood cancer survivors treated with chemotherapy and/or radiotherapy before 18 years of age were included between 2016 and 2018. During the years 20182022, twenty-five of the participants reached the age of 25 and were invited to conduct a semi-structured interview. Twenty-two agreed to participate. The interview includes questions about fertility, collaboration with healthcare and communication regarding reproductive options when diagnosed with cancer. Interview data was analysed inductively using a thematic analysis. Results The analysis of the data resulted in three main themes; (1) Communication challenges, (2) Information about potential infertility and (3) Follow-up – a broader perspective, with a total of 9 subthemes. Many of the women expressed lack of information regarding reproductive health and a disappointment in their follow-up. Conclusion It is evident that the young women have felt a lack of information regarding fertility, reproductive health outcomes and options after their cancer treatment. The results of our study also indicate that transition from pediatric health care to adult health care needs to be facilitated and supported.
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