Ann Thurin-Kjellberg

Obstetric outcome in singletons after in vitro fertilization with cryopreserved/thawed embryos

BACKGROUND There is increasing use of cryopreservation in IVF. This study compared singletons born after cryopreservation with singletons born after fresh IVF cycles and singletons born to women in the general population. METHODS Data were collected for Swedish IVF treatments during the years 2002-2006. All singletons from single embryo transfer (SET) and double embryo transfer (DET) after cryopreserved (n = 2348) and fresh cycles (n = 8944) were included and cross-linked with the Swedish Medical Birth Registry and compared with all singletons born after spontaneous conception (n = 571 914). Main outcomes were preterm and very preterm birth and low and very low birthweight (VLBW). Other outcomes were small for gestational age, large for gestational age (LGA), perinatal mortality and maternal outcomes. RESULTS Singletons from cryopreserved SET/DET or cryopreserved SET had increased rates of extreme preterm birth compared with singletons from the general population. A lower rate of LBW was found for cryopreserved SET/DET singletons compared with singletons from fresh cycles; however, a higher rate of perinatal mortality was detected. The rates of LGA and macrosomia were increased for cryopreserved SET/DET singletons when compared with those from fresh cycles and the general population. For maternal outcomes, a higher rate of pre-eclampsia was noted for pregnancies from cryopreserved cycles compared with those from fresh cycles or the general population, but the rate of placenta praevia was lower in pregnancies from cryopreserved cycles compared with those from fresh cycles. CONCLUSIONS The obstetric outcome of singletons after cryopreservation was slightly poorer when compared with the general population. In comparison with fresh cycles, the outcome varied. The finding of an increased rate of LGA after cryopreservation requires further study.

Obstetric outcome after in vitro fertilization with single or double embryo transfer

BACKGROUND IVF children, including singletons, are known to have a poorer obstetric outcome than children born after spontaneous conception. With a broad introduction of single embryo transfer (SET), this scenario might change. This study compares the obstetric outcome after IVF with SET, elective SET (eSET), non elective SET (non-eSET) and double embryo transfer (DET) with outcomes in the general population. METHODS All IVF children born in Sweden after IVF treatment during the years 2002-2006 (n = 13 544 children) were included and compared with all non-IVF children born during the same time period (n = 587 009 children). Data were collected from all 16 Swedish IVF clinics and cross-linked with the Swedish Medical Birth Registry. Main outcomes were preterm birth (<28, <32 and <37 w), very-low-birthweight (VLBW) and low-birthweight (LBW). Adjusted odds ratios were calculated. RESULTS In total, 7763 children were born after SET and 5724 children after DET. Comparing all SET children, irrespective of multiplicity, with all children in the general population, significantly higher rates of <28 w was found for the IVF children. Comparing IVF singletons, irrespective of SET and DET with non-IVF singletons from the general population, significantly higher rates of <28 w, <37 w, LBW and VLBW were found. eSET singletons, compared with singletons in the general population, had a significantly higher rate of <37 w and non-eSET singletons had significantly higher rates of <28 w and <2500 g births. CONCLUSIONS Children born after IVF had a poorer obstetric outcome compared with children from the general population. Singletons, when analysed as one group, irrespective of whether the children were born after eSET, non-eSET or DET, also had a poorer obstetric outcome with higher rates of preterm and LBW compared with singletons in the general population.

Distribution and hormonal regulation of membrane progesterone receptors β and γ in ciliated epithelial cells of mouse and human fallopian tubes

BackgroundThe controlled beating of cilia of the fallopian tube plays an important role in facilitating the meeting of gametes and subsequently transporting the fertilized egg to its implantation site. Rapid effects of progesterone on ciliary beat frequency have been reported in the fallopian tubes of cows, but the identity of the receptors mediating this non-genomic action of progesterone is not known. We recently identified a member of the non-genomic membrane progesterone receptor family, mPR gamma, as a candidate for mediating these actions of progesterone. Here, we investigated the possible presence of a related receptor, mPR beta, in the fallopian tubes of mice and women as well as the possible hormonal regulation of mPR beta and gamma.MethodsWestern blot and immunohistochemistry with specific antibodies were used to characterize the expression and cellular localization of the mPRs in mouse and human tissues. Taqman (Quantitative Polymerase Chain Reaction) assays were used to quantify mRNA levels in the fallopian tubes of two different mouse models after injections with different hormones and specific antagonists.ResultsIn the fallopian tubes of both mouse and human, the expression of mPR beta and mPR gamma proteins was exclusively found in the ciliated cells. Whereas mPR beta was found on the cilia, mPR gamma was localized at the base of the same ciliated cells, as previously reported. In gonadotropin-primed mice, both mPRs genes were down-regulated after an injection with progesterone. Treatment with estradiol rapidly down-regulated the level of mPR beta mRNA and protein in immature mice. The mPR gamma protein was down-regulated around the time of ovulation in cycling women, similar to the regulation observed in mice stimulated to ovulate via gonadotropin injections.ConclusionOur findings show the presence and hormonal regulation of two distinct mPRs associated with the cilia of the fallopian tubes in both mice and women. It is hypothesized that these receptors are involved in the control of ciliary movement and, thus, gamete transport in the fallopian tubes of mammals.

Use of metformin before and during assisted reproductive technology in non-obese young infertile women with polycystic ovary syndrome: a prospective, randomized, double-blind, multi-centre study

BACKGROUND To study the effect of metformin before and during assisted reproductive technology (ART) on the clinical pregnancy rate (CPR) in non-obese women with polycystic ovary syndrome (PCOS). METHODS A multi-centre, prospective, randomized, double-blind study was conducted in eight IVF clinics in four Nordic countries. We enrolled 150 PCOS women with a body mass index <28 kg/m(2), and treated them with 2000 mg/day metformin or identical placebo tablets for ≥ 12 weeks prior to and during long protocol IVF or ICSI and until the day of pregnancy testing. The primary outcome measure was CPR. Secondary outcome measures included spontaneous pregnancy rates during the pretreatment period, and the live birth rate (LBR). RESULTS Among IVF treated women (n = 112), biochemical pregnancy rates were identical in both groups (42.9%), and there were no significant differences in the metformin versus the placebo group in CPR [39.3 versus 30.4%; 95% confidence interval (CI): -8.6 to 26.5]. The LBR was 37.5 versus 28.6% (95% CI: -8.4 to 26.3). However, prior to IVF there were 15 (20.3%) spontaneous pregnancies in the metformin group and eight (10.7%) in the placebo group (95% CI: -1.9 to 21.1; P = 0.1047). According to intention to treat analyses (n = 149); significantly higher overall CPR were observed in the metformin versus placebo group (50.0 versus 33.3%; 95% CI: -1.1 to 32.3; P = 0.0391). LBR was also significantly higher with use of metformin versus placebo (48.6 versus 32.0; 95% CI: 1.1 to 32.2; P = 0.0383). No major unexpected safety issues or multiple births were reported. More gastrointestinal side effects occurred in the metformin group (41 versus 12%; 95% CI: 0.15 to 0.42; P < 0.001). CONCLUSIONS Metformin treatment for 12 weeks before and during IVF or ICSI in non-obese women with PCOS significantly increases pregnancy and LBRs compared with placebo. However, there was no effect on the outcome of ART per se. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00159575.

Ovarian tissue cryopreservation and transplantation among alternatives for fertility preservation in the Nordic countries - compilation of 20 years of multicenter experience.

The aim of this study is to report the current status of ovarian tissue cryopreservation among alternatives for fertility preservation in the Nordic countries.

Cumulative Live-Birth Rates in a Trial of Single-Embryo or Double-Embryo Transfer

The cumulative live-birth rates were 43.9% in the single-embryo-transfer group and 51.1% in the double-embryo-transfer group. The multiple-birth rate was significantly lower in the single-embryo-tr...

Who becomes a sperm donor: personality characteristics in a national sample of identifiable donors

Please cite this paper as: Sydsjö G, Lampic C, Brändström S, Gudmundsson J, Karlström P, Solensten N, Thurin‐Kjellberg A, Skoog Svanberg A. Who becomes a sperm donor: personality characteristics in a national sample of identifiable donors. BJOG 2012;119:33–39.

Personality characteristics in a Swedish national sample of identifiable oocyte donors

Please cite this paper as: Sydsjö G, Lampic C, Brändström S, Gudmundsson J, Karlström P, Solensten N, Thurin‐Kjellberg A, Svanberg A. Personality characteristics in a Swedish national sample of identifiable oocyte donors. BJOG 2011;118:1067–1072.

Patient preferences for characteristics differentiating ovarian stimulation treatments

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.

High risks of maternal and perinatal complications in singletons born after oocyte donation

Previous studies have shown an increased risk of obstetric complications in pregnancies after oocyte donation (OD). The present study includes all singletons born after OD over 10 years in Sweden.