| 1. |
- Edelstam, Greta, et al.
(author)
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Pertubation with lidocaine - a non-hormonal, long-term treatment of dysmenorrhea due to endometriosis
- 2012
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In: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 3:2, s. 93-94
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Journal article (peer-reviewed)abstract
- The major symptoms of endometriosis are dysmenorrhea and infertility. Pertubations with lidocaine have been shown to reduce dysmenorrhea and have an enhancing effect on fertility. Different concentrations of lidocaine were evaluated in a randomized, double-blind study of pre-ovulatory pertubations with lidocaine solutions in women with dysmenorrhea. The patients had laparoscopically diagnosed endometriosis and normal fallopian tubes. Ninety pertubations were carried out without complications on 26 patients during up to six cycles. The effect was evaluated by means of questionnaires where a clinically significant reduction of dysmenorrhea was reported. Pertubation with lidocaine can be a non-hormonal treatment option for dysmenorrhea. (C) 2012 Elsevier B.V. All rights reserved.
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| 2. |
- Jablonowska, Barbara, 1948-, et al.
(author)
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Blocking antibodies in blood from patients with recurrent spontaneous abortion in relation to pregnancy outcome and intravenous immunoglobulin treatment
- 2001
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In: American Journal of Reproductive Immunology. - : Wiley. - 1046-7408 .- 1600-0897 .- 8755-8920. ; 45:4, s. 226-231
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Journal article (peer-reviewed)abstract
- PROBLEM: To study whether the occurrence of mixed lymphocyte culture (MLC) blocking antibodies is associated with pregnancy outcome in women with unexplained recurrent spontaneous abortion (RSA) and the in vivo effect of intravenous immunoglobulin (IVIG) treatment on MLC blocking effect.METHOD OF STUDY: Blood samples from 41 RSA patients were obtained before and after pregnancy, and blocking antibodies were estimated by one-way MLC assay. The patients received IVIG or placebo (saline) during pregnancy. Additionally, pre-pregnancy blood samples from 31 RSA women and 10 controls were obtained.RESULTS: We found no correlation between blocking antibodies before pregnancy and the pregnancy outcome. The occurrence of blocking antibodies was not affected by pregnancy or IVIG treatment.CONCLUSIONS: Blocking antibodies have no predictive value for the pregnancy outcome in RSA patients, and their production seems not to be affected by IVIG.
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| 3. |
- Jablonowska, Barbara, 1948-, et al.
(author)
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Prevention of recurrent spontaneous abortion by intravenous immunoglobulin : a double-blind placebo-controlled study
- 1999
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In: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 14:3, s. 838-841
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Journal article (peer-reviewed)abstract
- The aim of this study was to evaluate the therapeutic efficacy of intravenous immunoglobulin (IVIG) in the prevention of recurrent spontaneous abortion (RSA). In a double-blind, randomized, placebo-controlled study, 41 women with a history of unexplained recurrent spontaneous abortion were treated with IVIG or saline infusions during pregnancy. The birth of a child was considered a successful outcome. The overall success rate was 77% in the IVIG group compared with 79% in the placebo group. For women with primary RSA the success rates were 82 (IVIG) and 89% (placebo), and for women with secondary RSA the rates were 73 (IVIG) and 70% (placebo). We found no statistically significant difference in treatment results between IVIG and placebo.
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| 4. |
- Jablonowska, Barbara, 1948-
(author)
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Recurrent spontaneous abortion : a clinical, immunological and genetic study
- 2003
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Doctoral thesis (other academic/artistic)abstract
- Recurrent spontaneous abortion (RSA) is defined as the loss of three or more consecutive pregnancies before 20 completed gestational weeks. The condition affects 0.5-1% of all women. In the majority of women with RSA, the cause remains unexplained after genetic, endocrine, immunological and anatomical investigations of the couple. However, there is increasing evidence that immunological mechanisms might contribute in the pathogenesis of RSA. Therefore high doses of intravenous immunoglobulin (IVIG), known to modulate immune responses, has been suggested as a treatment of RSA. The aim of this study was to evaluate IVIG in the treatment of RSA, and to elucidate immunological and genetic mechanisms behind this condition. In a prospective, double blind, placebo-controlled IVIG study we investigated 41 women with a history of unexplained RSA. They received 20g IVIG or placebo-saline every 3 weeks on five occasions from 6-7 gestational weeks. The overall success rate was 77% in the IVIG group compared with 79% in the placebo group, indicating that IVIG was not better than placebo and that both groups had better results than the predicted outcome.We also investigated the presence of blocking effect of maternal serum in a mixed leukocyte culture (MLC). Blood samples were obtained before and after pregnancy in the IVIG/placebo groups. As RSA controls we used 31 RSA women who did not achieve pregnancy during this study and were not enrolled in the IVIG study. As normal controls we used 10 non-pregnant women without a history of spontaneous abortions. Blocking antibodies were present in 20% of women with unexplained RSA and in 30% of the control group. The blocking effect before pregnancy was the same for IVIG-, placebo-, and untreated RSA controls as well as in the normal controls. We found no significant differences in blocking effect before compared with after IVIG or placebo treatment.We measured lymphocyte subset distributions in blood samples obtained in the first trimester and after pregnancy in 39 RSA women in the IVIG study and compared them with previous results from pregnant and non-pregnant controls. In the first trimester of pregnancy, the RSA women had significantly increased proportions ofB-cells (CD19), T cells subsets including activated HLA-DR expressing T cells (CD3+HLA-DR+), and T killer/effector cells (CD+S6F1+). The proportion of T suppressor/inducer cells (CD4+CD45RA+) was significantly decreased. Thus, in early pregnancy the immune system seems to be activated in RSA patients in contrast to the suppression noted in normal pregnancy. These changes in subpopulations do, however, not correlate to the outcome of pregnancy.We studied the compatibility of HLA-DRB1 alleles in the couples with unexplained RSA and the frequency of HLA-DRB1 and HLA-G alleles in these couples compared with fertile controls. We did not find significantly increased sharing of HLA-DRB1 alleles between partners. We found no significant differences for HLA-DRB1 and HLA-G allele frequencies in RSA couples compared with fertile controls.In conclusion, RSA patients have no genetic differences, their immune reaction during pregnancy is altered, their levels of blocking antibodies is of no use to predict pregnancy outcome and intravenously given high dose IVIG does not effect their pregnancy outcome.
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| 5. |
- Jablonowska, Barbara, 1948-, et al.
(author)
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T and B lymphocyte subsets in patients with unexplained recurrent spontaneous abortion : IVIG versus placebo treatment
- 2002
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In: American Journal of Reproductive Immunology. - : Wiley. - 1046-7408 .- 1600-0897. ; 48:5, s. 312-318
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Journal article (peer-reviewed)abstract
- Jablonowska B, Palfi M, Matthiesen L, Selbing A, Kjellberg S, Ernerudh J. T and B Lymphocyte subsets in patients with unexplained recurrent spontaneous abortion: IVIG versus placebo treatment. AJRI 2002; 48:312–318 © Blackwell Munksgaard, 2002PROBLEM: To investigate circulating lymphocyte subsets in women with recurrent spontaneous abortion (RSA) in relation to pregnancy outcome and to treatment with intravenous immunoglobulin (IVIG).METHOD OF STUDY: Forty-one women with a history of unexplained RSA were examined during first trimester of pregnancy before IVIG or placebo treatment and after pregnancy. The results were compared with five healthy, non-pregnant women and five women in the first trimester of normal pregnancy. Circulating lymphocyte subsets with focus on T-cell subpopulations were determined by flow cytometry.RESULTS: The proportions of human leukocyte antigen (HLA)-DR positive T cells (CD3+ HLA-DR+), T-killer/effector cells (CD8+ S6F1+) and B cells (CD19+) were increased, whereas the proportion of T-suppressor/inducer cells (CD4+ CD45RA+) was decreased during first trimester pregnancy of RSA women compared with pregnant normal controls. T and B lymphocyte subsets did not correlate with pregnancy outcome on either IVIG or placebo group.CONCLUSIONS: In RSA patients, the immune system seems to be activated in contrast to the suppression noted in normal pregnancy.
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| 6. |
- Landfeldt, Erik, et al.
(author)
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Patient preferences for characteristics differentiating ovarian stimulation treatments
- 2012
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In: Human Reproduction. - : Oxford University Press (OUP): Policy B1. - 0268-1161 .- 1460-2350. ; 27:3, s. 760-769
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Journal article (peer-reviewed)abstract
- BACKGROUND Little is known concerning patient preferences for IVF treatments. The objective of this study was to elicit patient preferences for characteristics differentiating ovarian stimulation treatments. METHODS Women undergoing IVF were recruited from six clinics in Sweden between May 2010 and December 2010. Included patients completed a study questionnaire consisting of one contingent valuation (CV) question (with six different bids) and 16 conjoint analysis (CA) questions formulated as discrete choices between two hypothetical ovarian stimulation treatments (defined in terms of manufacturing method, method of administration, time required for administration, dose variability and hypothetical price). Patient preferences were derived using multinomial logit modelling. RESULTS The final study population consisted of 294 women (mean age of 35). Respondents were willing to pay €360 [95% confidence interval (CI): €340-€390] to receive FSH derived from DNA technology instead of highly purified extract from urine from post-menopausal women, €300 (95% CI: €280-€320) to administer the FSH using a prefilled injection pen instead of a conventional syringe, €30 (95% CI: €20-€40) per saved minute required for administration and €530 (95% CI: €500-€570) to reduce the dose variability from 10-20% to 1-2%(P< 0.001 for all estimates). The result from the CV was similar to the CA. CONCLUSIONS Women undergoing IVF place significant value on characteristics differentiating ovarian stimulation treatments. Product-specific aspects should be taken into account by decision-makers when discriminating between commercial gonadotrophins in clinical practice to align health-care decision-making with patient preferences and potentially improve the effectiveness of IVF interventions through enhanced patient satisfaction and treatment compliance. Preferences for treatment characteristics should also be considered in evaluations of ovarian stimulation products to capture their true value from a patient perspective.
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| 7. |
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| 8. |
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| 9. |
- Persson, Marie, et al.
(author)
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Immunological status in patients undergoing in vitro fertilisation : responses to hormone treatment and relationship to outcome
- 2012
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In: Journal of Reproductive Immunology. - : Elsevier. - 0165-0378 .- 1872-7603. ; 96:1-2, s. 58-67
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Journal article (peer-reviewed)abstract
- We aimed to prospectively investigate the paternal antigen-induced cytokine secretion by peripheral blood mononuclear cells (PBMCs) in response to hormone treatment in women undergoing in vitro fertilisation (IVF) and to examine the predictive value of the cytokine secretion profile in the outcome of IVF treatment, in a pilot study. Twenty-five women were included and IVF treatment was successful for six and unsuccessful for 19 women. Blood samples were collected before IVF treatment, on four occasions during IVF and four weeks after embryo transfer. The numbers of Th1-, Th2- and Th17-associated cytokine-secreting cells and cytokine levels in cell supernatants were analysed by enzyme-linked immunospot-forming (ELISpot), enzyme-linked immune-sorbent (ELISA) or Luminex assay. None of the cytokines (IFN-γ, IL-4, IL-5, IL-10, IL-12, IL-13, IL-17, TNF and GM-CSF) had any predictive value regarding IVF outcome. The majority of the cytokines reached their peak levels at ovum pick-up, suggesting an enhancing influence of the hormonal stimulation. Pregnancy was associated with a high number of IL-4-, IL-5- and IL-13-secreting cells four weeks after ET. In conclusion, the results do not support our hypothesis of a more pronounced peripheral Th1 and Th17 deviation towards paternal antigens in infertile women with an unsuccessful IVF outcome, although this is based on a small number of observations. A larger study is required to confirm this conclusion. Higher numbers of Th2-associated cytokine-secreting cells in pregnant women four weeks after ET do corroborate the hypothesis of a Th2 deviation during pregnancy.
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| 10. |
- Persson, Marie, et al.
(author)
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Leukocyte populations in patients undergoing in vitro fertilization: responses to hormone treatment and relation to outcome
- 2012
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Other publication (other academic/artistic)abstract
- We aimed to prospectively investigate circulating leukocyte populations in infertile women undergoing IVF treatment and to determine whether any differences in cell proportions were associated with the IVF outcome. We also assessed the effect of IVF-based ovarian stimulation on the leukocyte populations. Twenty-five women were included and IVF treatment was successful in six and unsuccessful in 19 women. Blood samples were collected before IVF treatment, at the time of embryo transfer and four weeks after embryo transfer. The numbers and proportions of lymphocytes, T cells, NK cells, monocytes and granulocytes were analysed by flow cytometry, as well as the following lymphocyte subpopulations: CD3+HLA-DR+, CD4+CD45RA+, CD4+CD45R0+, CD8+CD45RA+, CD8+CD45R0+, CD4+CD25+, CD4dimCD25bright regulatory T cells, CD3-CD56bright and CD3-CD56dim NK cells. The proportions and numbers of leukocytes during IVF treatment were not related to the IVF outcome, although pregnant women (four weeks after ET) had a lower proportion of lymphocytes than the non-pregnant women. The absolute counts of lymphocytes, T cells, granulocytes and monocytes, as well as the proportions of granulocytes and T cells, increased at the time of ET, coinciding with high FSH and hCG levels. In conclusion, the proportions and numbers of leukocyte populations were not associated with the IVF outcome, although a larger study should be conducted to confirm this conclusion. Changes in both proportions and numbers of several leukocyte populations were observed during the course of IVF treatment, suggesting a stimulatory effect of the hormonal influence.
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