| 1. |
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| 2. |
- Ahlström, Aisling, 1976, et al.
(författare)
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Cross-validation and predictive value of near-infrared spectroscopy algorithms for day-5 blastocyst transfer.
- 2011
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Ingår i: Reproductive biomedicine online. - : Elsevier BV. - 1472-6491 .- 1472-6483.
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Tidskriftsartikel (refereegranskat)abstract
- Near-infrared (NIR) spectroscopic metabolomic profiling of spent embryo-culture media has been used to calculate a viability score for individual embryos. These scores have been found to correlate to the reproductive potential of cleavage-stage embryos. In this study, 137 spent blastocyst media samples were collected after single-embryo transfer and analysed by NIR spectroscopy to generate an algorithm and calculate viability scores. To blindly validate the algorithm development process, another algorithm was trained on 47 preselected samples from clinic 1 and then used to predict the outcome of 42 samples from clinic 2. The overall pregnancy rate from the two clinical sites was 50.4%. A positive correlation (R(2)=0.82, P=0.03) was observed with the increasing viability score quintiles and their associated implantation rates. Cross-validation of an algorithm generated from NIR analysis of media samples at one clinical setting blindly was shown to predict implantation potential of blastocysts cultured at another clinic in a different culture media and culture volume. This study demonstrates that metabolomic profiling by NIR spectroscopic analysis of day-5 spent embryo-culture media can predict the implantation potential of blastocysts. Furthermore, this method may not be restricted to a specific set of culturing conditions. The successes of IVF treatment cycles are in part limited by the ability to select the best single embryo from a cohort of patient embryos for transfer back to the woman. Routine procedures of embryo selection are based on morphology, including cell number and size, and the timing of cell division. These methods are favoured because they are quick and easy to assess. Human embryos are grown in culture solutions, which are specific for their stage of development. Recent studies analysing the culture solution in which the embryo are grown, by near infrared (NIR) spectroscopic analysis, have been able to predict if an embryo will implant or not. As culture conditions often vary between IVF laboratories the questions remained if the NIR technique could be used to independently predict the implantation potential of an embryo cultured at one laboratory using an algorithm trained on embryos at a second clinic, a so-called cross-validation. The results of this study show that NIR spectroscopy can predict the ability of embryos to implant even when grown in different IVF laboratories and in two different culture solutions. This information supports the idea that NIR spectroscopy can be used globally not relying on specific culture conditions or media.
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| 3. |
- Ahlström, Aisling, 1976, et al.
(författare)
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Prediction of live birth in frozen-thawed single blastocyst transfer cycles by pre-freeze and post-thaw morphology.
- 2013
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 28:5, s. 1199-209
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Tidskriftsartikel (refereegranskat)abstract
- What pre-freeze and post-thaw morphological parameters can be used to predict live birth outcomes after frozen-thawed blastocyst transfer cycles? SUMMARY ANSWER: Pre-freeze blastocoele expansion and trophectoderm (TE) grade and post-thaw degree of re-expansion are the most significant predictors of live birth in frozen-thawed blastocyst transfer cycles. WHAT IS KNOWN ALREADY: Currently, blastocoele re-expansion after thawing is used to indicate blastocyst cryosurvival and reproductive potential. The predictive roles of other pre-freeze and post-thaw morphological parameters are neglected. STUDY DESIGN, SIZE, DURATION: This was a retrospective study of all the patients who received a frozen-thawed single blastocyst transfer (n = 1089) at our clinic between March 2008 and October 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS: Pre-freeze morphological parameters analyzed for all blastocysts included grade of blastocoele expansion, inner cell mass and TE. A group of blastocysts (n = 243) were also graded for post-thaw parameters: degree of blastocoele re-expansion, viability and cell contour. Univariate and multivariate generalized estimating equations (GEEs) models were used to identify the confounders that statistically significantly affected live birth outcomes and to investigate the independent effect of significant pre-freeze and post-thaw morphological parameters. Stepwise logistic regression analysis was used to select the best independent morphological predictors of live birth. Pearson correlations and linear regression analyses were performed to determine the relationship between morphological parameters and possible covariates. MAIN RESULTS AND THE ROLE OF CHANCE: Multivariate GEE models estimated that the odds of live birth increased by ∼36% for each grade of expansion (P = 0.0061) and decreased by 29% for blastocysts with grade B TE compared with grade A TE (P = 0.0099). Furthermore, the odds of live birth increased by ∼39% (P = 0.0042) for each 10% increase in degree of re-expansion. Blastocoele expansion and TE grade were selected as the most significant pre-freeze morphological predictors of live birth and degree of re-expansion was selected as the best post-thaw parameter for prediction of live birth. LIMITATIONS, REASONS FOR CAUTION: Blastocysts with poorer grades of morphology were not cryopreserved or transferred, limiting the ability to generalize our findings for grades of morphology not included in this study. WIDER IMPLICATIONS OF THE FINDINGS: Blastocysts with higher pre-freeze grades of expansion and TE, irrespective of day of cryopreservation, should be given priority when thawing. Subsequently, re-expanding blastocysts, assessed within 2-4 h, with >60% viability should be transferred. STUDY FUNDING/COMPETING INTEREST(S): No external funding was obtained for this study. There was no competing interest.
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| 4. |
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| 5. |
- Bergh, Christina, 1953, et al.
(författare)
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Chromosomal abnormality rate in human pre-embryos derived from in vitro fertilization cycles cultured in the presence of Follicular-Fluid Meiosis Activating Sterol (FF-MAS)
- 2004
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Ingår i: Hum Reprod. ; 19:9, s. 2109-17
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The objective of the study was to investigate the effect of Follicular-Fluid Meiosis Activating Sterol (FF-MAS) when added to the culture media on the incidence of chromosomal abnormalities and pre-embryo development in human pre-embryos. METHODS: 243 women undergoing IVF/ICSI treatment donated 353 oocytes in a multicentre, prospective, randomized, double blind, four-arm, controlled trial performed at Danish and Swedish public and private IVF centers. Metaphase II oocytes were randomly assigned to: FF-MAS 5 microM, FF-MAS 20 microM, ethanol 0.2% (vehicle control) or water for injection (inert control). The exposure regimen of FF-MAS to the human oocytes was 4 h prior to fertilization by ICSI and 20 h exposure post ICSI. The primary endpoint was the incidence of numerical chromosomal abnormalities. Secondary endpoints were cleavage rate and pre-embryo quality. RESULT: On the pre-embryo level, no significant differences in chromosomal abnormality rate were observed among the four groups. However, the percentage of uniformly normal pre-embryos was significantly lower in the pooled FF-MAS group (5 microM: 12% and 20 microM: 17%) than in the pooled control group (inert control 32% and vehicle control 42%). A high level of mosaicism (41-60%) was found in all groups. At the blastomere level, the percentage of blastomeres categorized as normal was significantly lower in the FF-MAS 5 microM group (41%) and the FF-MAS 20 microM (29%) group versus the inert (52%) and the vehicle (61%) groups. Significantly reduced cleavage and good quality pre-embryo rates were found in both FF-MAS groups. CONCLUSION: FF-MAS increased the rate of aneuploidy and had detrimental effects on cleavage and pre-embryo development, when exposed both before and after fertilization.
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| 6. |
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| 7. |
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| 8. |
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| 9. |
- Hamberger, Lars, 1939, et al.
(författare)
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Nobel prize to Robert Edwards.
- 2010
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 89:12, s. 1502-3
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Hanson, Charles, 1958, et al.
(författare)
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Re-analysis of 166 embryos not transferred after PGS with advanced reproductive maternal age as indication.
- 2009
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 24:11, s. 2960-4
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Tidskriftsartikel (refereegranskat)abstract
- In a randomized controlled study aiming to test the effectiveness of preimplantation genetic screening (PGS) in women of advanced maternal age, embryos diagnosed as chromosomally abnormal and those with no diagnosis were fixed for reanalysis. The aim of this study was to determine how well the chromosomal constitution of one biopsied blastomere reflects the status of the entire embryo.
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| 11. |
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| 12. |
- Holter, Herborg, 1960, et al.
(författare)
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In vitro fertilization health care professionals generally underestimate patients’ satisfaction with quality of care
- 2017
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 96:3, s. 302-312
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Previous studies have mainly compared professionals' and patient's ratings of the importance of different care aspects, finding poor agreement between the groups concerning patient-centered quality of care. There is still little known about the professionals' knowledge of how patients' experience the quality of care they receive during in vitro fertilization (IVF) treatments. The aim of this study was to investigate how IVF health care professionals estimate patients' experience of patient-centered quality of care and if certain factors influenced the IVF professionals' perceptions and IVF patients' experience of quality of care.MATERIAL AND METHODS: All 16 IVF public and private clinics in Sweden participated in this cross sectional study. A total of 268 IVF health care professionals and 3298 patients (women and men) undergoing IVF treatment between January and May 2015 participated by answering the validated questionnaire "Quality from the patient's perspective of in vitro fertilization treatment" (QPP-IVF).RESULTS: Healthcare professionals significantly underestimated patients' satisfaction with the patient-centered quality of care they received in all aspects measured. Both patients and professionals rated the most deficient factors to be 'responsibility/continuity', 'participation' and 'availability'. Healthcare professionals and patients belonging to private clinics evaluated patient-centered care as significantly better than professionals and patients at public clinics in almost all aspects measured.CONCLUSION: The results of this study will increase the professionals understanding of the patients' experiences during IVF treatment and provide additional knowledge when identifying areas to prioritize in order to improve quality of care.
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| 13. |
- Holter, Herborg, 1960, et al.
(författare)
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Patient-centred quality of care in an IVF programme evaluated by men and women.
- 2014
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 29:12, s. 2695-2703
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Tidskriftsartikel (refereegranskat)abstract
- Do men and women value the same aspects of quality of care during IVF treatment when measuring rates of importance by the validated instrument, quality from the patient's perspective of in vitro fertilization (QPP-IVF)?
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| 14. |
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| 15. |
- Karlsson, Bengt, et al.
(författare)
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Transvaginal ultrasonography of the endometrium in women with postmenopausal bleeding--a Nordic multicenter study
- 1995
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 1097-6868 .- 0002-9378. ; 172:5, s. 1488-1494
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The purpose of this study was to use transvaginal ultrasonographic measurements to find the thickness of the endometrium below which the risk of endometrial abnormality in women with postmenopausal bleeding is low. STUDY DESIGN: This multicenter study was carried out at eight clinics in four Nordic countries. The study included 1168 women with postmenopausal bleeding scheduled for curettage Before the curettage was performed, the thickness of the endometrium was measured with transvaginal ultrasonography. The measurement included both endometrial layers (double-layer technique). The transvaginal ultrasonographic measurement was compared with the histopathologic diagnosis of the curettage specimens. RESULTS: In women with atrophic endometrium the mean endometrial thickness (+/- SD) was 3.9 +/- 2.5 mm. The corresponding figures for women with endometrial cancer were 21.1 +/- 11.8 mm. No malignant endometrium was thinner than 5 mm. In 30 women (2.8%) it was not possible to measure the thickness of the endometrium; one of these women had endometrial cancer. The 95% confidence limit for the probability of excluding endometrial abnormality was 5.5% when the endometrial thickness was < or = 4 mm as measured by transvaginal ultrasonography. CONCLUSION: The risk of finding pathologic endometrium at curettage when the endometrium is < or = 4 mm as measured by transvaginal ultrasonography is 5.5%. Thus in women with postmenopausal bleeding and an endometrium < or = 4 mm it would seem justified to refrain from curettage.
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| 16. |
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| 17. |
- Niederberger, C., et al.
(författare)
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Forty years of IVF
- 2018
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Ingår i: Fertility and Sterility. - : Elsevier BV. - 0015-0282. ; 110:2
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Tidskriftsartikel (refereegranskat)abstract
- This monograph, written by the pioneers of IVF and reproductive medicine, celebrates the history, achievements, and medical advancements made over the last 40 years in this rapidly growing field.
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| 18. |
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| 19. |
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| 20. |
- Sjögren, Anita, 0, et al.
(författare)
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Human blastocysts for the development of embryonic stem cells
- 2004
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Ingår i: Reproductive BioMedicine Online. - 1472-6483 .- 1472-6491. ; 9:3, s. 326-9
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Tidskriftsartikel (refereegranskat)abstract
- Establishment of human embryonic stem cells (hES) from surplus human IVF embryos has been successful when both fresh and frozen-thawed cleavage stage embryos have been cultured to the blastocyst stage. This study reports the characteristics of the starting material, the blastocysts, for hES cell lines that were first derived at the University of Gothenburg, Sahlgrenska University Hospital in 1999. Twenty-two hES cell lines were derived by Cellartis AB from 114 blastocysts, giving an overall success rate of 19.3%. The blastocysts from which the hES cell lines were established were of varying morphological quality, both fresh and frozen-thawed. Two techniques of hES establishment were applied, i.e. direct application of the blastocysts on feeder cells or the standard immunosurgery method. It was further found that the efficiency by which frozen-thawed embryos gave rise to new hES cell lines was 3.7 times better than with fresh surplus embryos. These findings suggest that frozen-thawed embryos are superior to fresh surplus human embryos in hES cell establishment, which also avoids specific ethical problems associated with embryo donation in a fresh IVF cycle.
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| 21. |
- Sol Olafsdottir, Helga, et al.
(författare)
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Access to artificial reproduction technology in the Nordic countries in 2004.
- 2009
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Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 88:3, s. 301-7
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Tidskriftsartikel (refereegranskat)abstract
- To survey access to Artificial Reproduction Technology (ART) treatments in 2004 with regard to legislation, geographical location, financing and the kind of ART treatments provided in the Nordic countries.
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| 22. |
- Stener-Victorin, Elisabet, 1964, et al.
(författare)
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Alternative treatments in reproductive medicine: much ado about nothing. Acupuncture-a method of treatment in reproductive medicine: lack of evidence of an effect does not equal evidence of the lack of an effect.
- 2002
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 17:8, s. 1942-6
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Forskningsöversikt (refereegranskat)abstract
- The increasing popularity of alternative treatments-methods of treatment that are not generally established in Western medicine-demands a serious debate about scientific documentation, efficacy and safety. It has been argued that there is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data, and we agree. Different methods of treatment, referred to as alternative treatments, are used by millions of patients every day which generates billions of dollars in health care expenditure each year. Therefore, it is important that physicians become more knowledgeable about different methods of treatment and increase their understanding of the possible benefits and limitations of each therapy. This article is intended to illustrate acupuncture in reproductive medicine today, as an example of a method of treatment that has become more established in Western medicine over the last decade. Discussed are the scientific documentation and aspects of acupuncture research, the physiological basis for the use of acupuncture, and evidence for the use of acupuncture in reproductive medicine. We are well aware that there are few well-designed papers on the effectiveness of different treatments in this field. However, we need to adhere to these principles, as we hope, do the readers of the present debate article.
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| 23. |
- Stener-Victorin, Elisabet, 1964, et al.
(författare)
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Electro-acupuncture as a peroperative analgesic method and its effects on implantation rate and neuropeptide Y concentrations in follicular fluid.
- 2003
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 18:7, s. 1454-60
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In a previous study on the effect of electro-acupuncture (EA) in combination with a paracervical block (PCB) as an analgesic method during oocyte aspiration in IVF treatment, EA appeared to increase the pregnancy rate. This study was designed to test the hypothesis that EA as an analgesic during oocyte aspiration would result in: (i) a better IVF pregnancy rate than with alfentanil; (ii) peroperative analgesia that was as good as that produced by alfentanil; (iii) less postoperative abdominal pain, nausea and stress; and (iv) a reduction in the use of additional analgesics. Neuropeptide Y (NPY) concentrations in follicular fluid (FF) were analysed when possible. METHODS AND RESULTS: In this prospective, randomized, multicentre clinical trial, 286 women undergoing oocyte aspiration were randomly allocated to the EA group (EA plus a PCB) or to the alfentanil group (alfentanil plus a PCB). No significant differences were found between the EA and alfentanil groups in any of the IVF variables. NPY concentrations in FF were significantly higher in the EA group compared with the alfentanil group. No correlation between pregnancy rate and NPY concentrations was found in either analgesic group. Both EA plus a PCB and alfentanil plus a PCB induced adequate peroperative analgesia during oocyte aspiration evaluated using the visual analogue scale. After 2 h, the EA group reported significantly less abdominal pain, other pain, nausea and stress than the alfentanil group. In addition, the EA group received significantly lower amounts of additional alfentanil than the alfentanil group. CONCLUSION: EA does not improve pregnancy rate in the present clinical situation. The observation that NPY concentrations in FF were higher in the EA group may be important for human ovarian steroidogenesis. The analgesic effects produced by EA are as good as those produced by conventional analgesics, and the use of opiate analgesics with EA is lower than when conventional analgesics alone are used.
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| 24. |
- Stener-Victorin, Elisabet, 1964, et al.
(författare)
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Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture.
- 1996
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Ingår i: Human reproduction (Oxford, England). - 0268-1161. ; 11:6, s. 1314-7
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Tidskriftsartikel (refereegranskat)abstract
- In order to assess whether electro-acupuncture (EA) can reduce a high uterine artery blood flow impedance, 10 infertile but otherwise healthy women with a pulsatility index (PI) >=3.0 in the uterine arteries were treated with EA in a prospective, non-randomized study. Before inclusion in the study and throughout the entire study period, the women were down-regulated with a gonadotrophin-releasing hormone analogue (GnRHa) in order to exclude any fluctuating endogenous hormone effects on the PI. The baseline PI was measured when the serum oestradiol was <=0.1 nmol/l, and thereafter the women were given EA eight times, twice a week for 4 weeks. The PI was measured again closely after the eighth EA treatment, and once more 10-14 days after the EA period. Skin temperature on the forehead (STFH) and in the lumbrosacral area (STLS) was measured during the first, fifth and eighth EA treatments. Compared to the mean baseline PI, the mean PI was significantly reduced both shortly after the eighth EA treatment (P < 0.0001) and 10-14 days after the EA period (P < 0.0001). STFH increased significantly during the EA treatments. It is suggested that both of these effects are due to a central inhibition of the sympathetic activity.
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| 29. |
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| 30. |
- 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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| 31. |
- Wikland, Matts, et al.
(författare)
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Monitoring ovarian response in IVF cycles.
- 2012
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Ingår i: Textbook of Assisted Reproductive Techniques, Volume Two: Clinical Perspectives, eds: Gardner D, Weissman A, Howles C and Shoham Z. Fourth edition. - London , UK : Taylor&Francis. - 9781841849720
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 32. |
- Wikland, Matts, et al.
(författare)
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Obstetric outcomes after transfer of vitrified blastocysts.
- 2010
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Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 25:7, s. 1699-707
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Tidskriftsartikel (refereegranskat)abstract
- It has been claimed that the risks to the child resulting from vitrification as compared with the slow-freezing technique, may be higher owing to the high concentrations of potentially toxic cryoprotectants. We therefore retrospectively compared the obstetric and neonatal outcomes in a cohort of children born after transfer of vitrified blastocysts, fresh blastocysts and slow-frozen early cleavage stage embryos.
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| 34. |
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