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Fedder J, Fagerberg C, Jørgensen MW, Gravholt CH, Berglund A, Knudsen UB, Skakkebæk A. Correction: Complete or partial loss of the Y chromosome in an unselected cohort of 865 non-vasectomized, azoospermic men. Basic Clin Androl 2024; 34:1. [PMID: 38182976 PMCID: PMC10768135 DOI: 10.1186/s12610-023-00218-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Affiliation(s)
- J Fedder
- Centre of Andrology & Fertility Clinic, Odense University Hospital, Kløvervænget 23, 5000, Odense, Denmark.
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark.
- Fertility Clinic, Horsens Hospital, Horsens, Denmark.
| | - C Fagerberg
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - M W Jørgensen
- Department of Clinical Genetics, Lillebaelt Hospital, Vejle, Denmark
| | - C H Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Berglund
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - U B Knudsen
- Fertility Clinic, Horsens Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Skakkebæk
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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Fedder J, Fagerberg C, Jørgensen MW, Gravholt CH, Berglund A, Knudsen UB, Skakkebæk A. Complete or partial loss of the Y chromosome in an unselected cohort of 865 non-vasectomized, azoospermic men. Basic Clin Androl 2023; 33:37. [PMID: 38093178 PMCID: PMC10720143 DOI: 10.1186/s12610-023-00212-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Structural abnormalities as well as minor variations of the Y chromosome may cause disorders of sex differentiation or, more frequently, azoospermia. This study aimed to determine the prevalence of loss of Y chromosome material within the spectrum ranging from small microdeletions in the azoospermia factor region (AZF) to complete loss of the Y chromosome in azoospermic men. RESULTS Eleven of 865 azoospermic men (1.3%) collected from 1997 to 2022 were found to have a karyotype including a 45,X cell line. Two had a pure 45,X karyotype and nine had a 45,X/46,XY mosaic karyotype. The AZF region, or part of it, was deleted in eight of the nine men with a structural abnormal Y-chromosome. Seven men had a karyotype with a structural abnormal Y chromosome in a non-mosaic form. In addition, Y chromosome microdeletions were found in 34 men with a structural normal Y chromosome. No congenital malformations were detected by echocardiography and ultrasonography of the kidneys of the 11 men with a 45,X mosaic or non-mosaic cell line. CONCLUSIONS In men with azoospermia, Y chromosome loss ranging from small microdeletions to complete loss of the Y chromosome was found in 6.1% (53/865). Partial AZFb microdeletions may give a milder testicular phenotype compared to complete AZFb microdeletions.
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Affiliation(s)
- J Fedder
- Centre of Andrology & Fertility Clinic, Odense University Hospital, Kløvervænget 23, DK-5000, Odense, Denmark.
- Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark.
- Fertility Clinic, Horsens Hospital, Horsens, Denmark.
| | - C Fagerberg
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - M W Jørgensen
- Department of Clinical Genetics, Lillebaelt Hospital, Vejle, Denmark
| | - C H Gravholt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Berglund
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - U B Knudsen
- Fertility Clinic, Horsens Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A Skakkebæk
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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Colombo C, Pistoljevic-Kristiansen N, Saupstad M, Bergenheim SJ, Spangmose AL, Klajnbard A, la Cour Freiesleben N, Løkkegaard EC, Englund AL, Husth M, Breth Knudsen U, Alsbjerg B, Prætorius L, Løssl K, Schmidt L, Pinborg A. Does luteal phase progesterone supplementation affect physical and psychosocial well-being among women undergoing modified natural cycle-FET? A sub-study of a randomized controlled trial. Hum Reprod 2023; 38:1970-1980. [PMID: 37634089 DOI: 10.1093/humrep/dead171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/27/2023] [Indexed: 08/28/2023] Open
Abstract
STUDY QUESTION Are there any differences in physical and psychosocial well-being among women undergoing modified natural cycle frozen embryo transfer (mNC-FET) with or without vaginal progesterone as luteal phase support (LPS)? SUMMARY ANSWER Women undergoing mNC-FET with vaginal progesterone supplementation were more likely to experience physical discomfort but there was no difference in psychosocial well-being between the two groups. WHAT IS KNOWN ALREADY mNC-FET can be carried out with or without vaginal progesterone as LPS, which has several side-effects. It is commonly known that fertility treatment can cause stress and psychosocial strain, however, most studies on this subject are conducted in fresh cycle regimes, which differ from NC-FET and results may not be comparable. STUDY DESIGN, SIZE, DURATION This is a sub-study of an ongoing RCT investigating whether progesterone supplementation has a positive effect on live birth rate in mNC-FET. The RCT is conducted at eight fertility clinics in Denmark from 2019 and is planned to end primo 2024. The sub-study is based on two questionnaires on physical and psychosocial well-being added to the RCT in August 2019. On the time of data extraction 286 women had answered both questionnaires. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who had answered both questionnaires were included in the sub-study. Participants were equally distributed, with 143 in each of the two groups. Participants in both groups received the same questionnaires at two time-points: on cycle day 2-5 (baseline) and after blastocyst transfer. Participants in the progesterone group had administered progesterone for 7 days upon answering the second questionnaire. All items in the questionnaires were validated. Items on psychosocial well-being originate from the Copenhagen Multi-Centre Psychosocial Infertility-Fertility Problem Stress Scale (COMPI-FPSS) and from the Mental Health Inventory-5. MAIN RESULTS AND THE ROLE OF CHANCE Women receiving progesterone experienced more vaginal itching and/or burning than women in the non-progesterone group (P < 0.001). Women in the progesterone group also experienced more self-reported vaginal yeast infection, this was, however, not significant after adjustment for multiple testing (P/adjusted P = 0.049/0.881). No differences regarding psychosocial well-being were found between the two groups. Within the progesterone group, a shift toward feeling less 'downhearted and blue' was found when comparing response distribution at baseline and after blastocyst transfer (P < 0.001). LIMITATIONS, REASONS FOR CAUTION All items on physical symptoms were self-reported. The item on vaginal yeast infection was therefore not diagnosed by a doctor. Inclusion in the study required a few extra visits to the clinic, participants who felt more burdened by fertility treatment might have been more likely to decline participation. Women who experienced a lot of side-effects to progesterone prior to this FET cycle, might be less likely to participate. WIDER IMPLICATIONS OF THE FINDINGS Our results are in line with previous known side-effects to progesterone. Physical side-effects of progesterone should be considered before administration. STUDY FUNDING/COMPETING INTEREST(S) The RCT is fully supported by Rigshospitalet's Research Foundation and a grant from Gedeon Richter. Gedeon Richter were not involved in the design of protocol nor in the conduction of the study or analysis of results. A.P., L.P., and N.I.-C.F. report grants from Gedeon Richter, Ferring and Merck with no relations to this study. N.I.-C.F. has received travel support from Ferring, Merck A/S, & Gideon Richter, and is the head of the steering committee for the Danish Fertility Guidelines made by the members of from the Danish Fertility Society. A.P. reports consulting fees from Preglem, Novo Nordisk, Ferring, Gedeon Richter, Cryos, & Merck A/S, honoraria from Gedeon Richter, Ferring, Merck A/S, Theramex, and Organon, has received travel support from Gedeon Richter (payment to institution), participated on an advisory board for Preglem and was loaned an embryoscope from Gedeon Richter to their institution. A.L.S. has stock options for Novo Nordisk B A/S. B.A. have received unrestricted grant from Gedeon Richter Nordic and Merck and honoraria for lectures from Gedeon Richter, Merck, IBSA, and Marckyrl Pharma. TRIAL REGISTRATION NUMBER The RCT is registered on ClinicalTrials. gov (NCT03795220) and in EudraCT (2018-002207-34).
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Affiliation(s)
- Clara Colombo
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Nina Pistoljevic-Kristiansen
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Marte Saupstad
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Sara Johanna Bergenheim
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Anne Lærke Spangmose
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Anna Klajnbard
- Fertility Clinic, Copenhagen University Hospital-Herlev and Gentofte Hospital, Herlev, Denmark
| | - Nina la Cour Freiesleben
- Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Christine Løkkegaard
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Fertility Clinic, Copenhagen University Hospital-North Zealand, Hillerød, Denmark
| | | | - Merete Husth
- Fertility Unit and Centre for Preimplantation Genetic Test, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Breth Knudsen
- Fertility Clinic, Horsens Regional Hospital and Institute of Clinical Medicine, Aarhus University, Horsens, Denmark
| | | | - Lisbeth Prætorius
- Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kristine Løssl
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Faculty of Health and Medicine, The Fertility Department, Section 4071, The Juliane Marie Centre for Women, Children and Reproduction, University Hospital of Copenhagen, University of Copenhagen, Rigshospitalet, Copenhagen N, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Sangild J, Faldborg A, Schousboe C, Fedder MDK, Christensen LP, Lausdahl AK, Arnspang EC, Gregersen S, Jakobsen HB, Knudsen UB, Fedder J. Effects of Chokeberries ( Aronia spp.) on Cytoprotective and Cardiometabolic Markers and Semen Quality in 109 Mildly Hypercholesterolemic Danish Men: A Prospective, Double-Blinded, Randomized, Crossover Trial. J Clin Med 2023; 12:jcm12010373. [PMID: 36615174 PMCID: PMC9821700 DOI: 10.3390/jcm12010373] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
Background: Chokeberries (Aronia spp.) are known to exhibit both direct and indirect antioxidant properties and have been associated with beneficial effects on human health, including cardiovascular risk factors (inflammation, serum lipids, sugars, blood pressure), oxidative stress, and semen quality. This prospective, double-blinded, randomized, crossover clinical trial was conducted to elucidate the effects of Aronia supplementation on these health targets in mildly hypercholesterolemic men. Methods: The standardized Aronia supplementation comprised three wild Aronia spp. (A. arbutifolia, A prunifolia and A. melanocarpa) and the Aronia hybrid × Sorbaronia mitschurinii (standardized to 150 mg anthocyanins daily). Participants (n = 109) were healthy men with respect to all outcome targets except for the total cholesterol level (5.0−7.0 mM). Participants were randomized to supplementation with either Aronia or placebo for 90 days, followed by a wash-out period and lastly the complementary supplementation. Effects on the health parameters were compared among both the whole group of men and in subgroups according to age, body mass index (BMI), lifestyle, dietary habits, and serum glutathione levels at baseline. The study is registered in ClinicalTrials.gov.: NCT03405753. Results: Glutathione levels were significantly improved after 90 days intake of Aronia supplementation compared to placebo in the subgroup of men with a low level of glutathione at baseline (p = 0.038) and a high coffee intake (p = 0.045). A significant decrease in levels of sperm DNA fragmentation and an increase in the percentage of motile sperm were observed in men aged >40 and in men with BMI > 25. Further, these parameters were significantly improved in the dietary subgroup defined by a high level of coffee intake. Total cholesterol and low-density lipoprotein-cholesterol levels decreased significantly in men <40 years after Aronia supplementation. No statistically significant effects were observed regarding blood pressure, markers of blood sugar regulation, hemoglobin A1c, superoxide dismutase, catalase, isoprostane levels, high sensitivity C reactive protein, or other semen parameters. Conclusions: This study demonstrated a significant increase in glutathione levels and improvement of cytoprotective targets following Aronia supplementation in specific subgroups of men >40 years of age and BMI > 25 but did not demonstrate a significant effect in the overall analysis. The observed concurrent increase in glutathione levels and improvement of cytoprotective targets following Aronia supplementation in subgroups of men, suggests that the endogenous phase II antioxidant glutathione is involved in the modulation of the observed cytoprotective effects. This study is a good foundation for further investigation of these cytoprotective effects in groups with oxidative stress in a dose−response study.
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Affiliation(s)
- Julie Sangild
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
| | - Anne Faldborg
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
| | - Cecilie Schousboe
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
| | | | - Lars Porskjær Christensen
- Department of Physics, Chemistry and Pharmacy, Faculty of Science, University of Southern Denmark, DK-5230 Odense, Denmark
| | - Astrid Komal Lausdahl
- Department of Green Technology, Faculty of Engineering, University of Southern Denmark, DK-5230 Odense, Denmark
| | - Eva Christensen Arnspang
- Department of Green Technology, Faculty of Engineering, University of Southern Denmark, DK-5230 Odense, Denmark
| | - Søren Gregersen
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
- Steno Diabetes Center Aarhus, DK-8200 Aarhus, Denmark
| | | | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, DK-8200 Aarhus, Denmark
- Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, DK-8700 Horsens, Denmark
| | - Jens Fedder
- Centre of Andrology, Fertility Clinic, Department D, Odense University Hospital, DK-5000 Odense, Denmark
- Department of Clinical Medicine, University of Southern Denmark, DK-5000 Odense, Denmark
- Correspondence:
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Ebdrup NH, Schullehner J, Knudsen UB, Liew Z, Thomsen AML, Lyngsø J, Bay B, Arendt LH, Clemmensen PJ, Sigsgaard T, Hansen B, Ramlau-Hansen CH. Drinking water nitrate and risk of pregnancy loss: a nationwide cohort study. Environ Health 2022; 21:87. [PMID: 36114546 PMCID: PMC9479399 DOI: 10.1186/s12940-022-00897-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/01/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Nitrate contamination is seen in drinking water worldwide. Nitrate may pass the placental barrier. Despite suggestive evidence of fetal harm, the potential association between nitrate exposure from drinking water and pregnancy loss remains to be studied. We aimed to investigate if nitrate in drinking water was associated with the risk of pregnancy loss. METHODS We conducted a nationwide cohort study of 100,410 pregnancies (enrolled around gestational week 11) in the Danish National Birth Cohort (DNBC) during 1996-2002. Spontaneous pregnancy losses before gestational week 22 were ascertained from the Danish National Patient Registry and DNBC pregnancy interviews. Using the national drinking water quality-monitoring database Jupiter, we estimated the individual and time-specific nitrate exposure by linking geocoded maternal residential addresses with water supply areas. The nitrate exposure was analyzed in spline models using a log-transformed continuous level or classified into five categories. We used Cox proportional hazards models to estimate associations between nitrate and pregnancy loss and used gestational age (days) as the time scale, adjusting for demographic, health, and lifestyle variables. RESULTS No consistent associations were found when investigating the exposure as a categorical variable and null findings were also found in trimester specific analyses. In the spline model using the continuous exposure variable, a modestly increased hazard of pregnancy loss was observed for the first trimester at nitrate exposures between 1 and 10 mg/L, with the highest. adjusted hazard ratio at 5 mg/L of nitrate of 1.16 (95% CI: 1.01, 1.34). This trend was attenuated in the higher exposure ranges. CONCLUSION No association was seen between drinking water nitrate and the risk of pregnancy loss when investigating the exposure as a categorical variable. When we modelled the exposure as a continuous variable, a dose-dependent association was found between drinking water nitrate exposure in the first trimester and the risk of pregnancy loss. Very early pregnancy losses were not considered in this study, and whether survival bias influenced the results should be further explored.
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Affiliation(s)
- Ninna Hinchely Ebdrup
- Department of Obstetrics and Gynecology, Horsens Fertility Clinic, Horsens, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Geological Survey of Denmark and Greenland, Aarhus, Denmark
| | - Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Horsens Fertility Clinic, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Anne Marie Ladehoff Thomsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Julie Lyngsø
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjørn Bay
- Department of Obstetrics and Gynecology, Horsens Fertility Clinic, Horsens, Denmark
- Maigaard Fertility Clinic, Aarhus, Denmark
| | - Linn Håkonsen Arendt
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Torben Sigsgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research Aarhus University, Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
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Ebdrup NH, Riis AH, Ramlau-Hansen CH, Bay B, Lyngsø J, Rytter D, Jørgensen MJ, Knudsen UB. Healthcare Use in the Five Years Before a First Infertility Diagnosis: A Danish Register-Based Case–Control Study in the CROSS-TRACKS Cohort. Clin Epidemiol 2022; 14:677-688. [PMID: 35586868 PMCID: PMC9109896 DOI: 10.2147/clep.s360292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Infertility may affect somatic and mental health later in life. Nevertheless, health status before diagnosed infertility is sparsely studied in women. We aimed to describe healthcare use in primary and secondary care before a first infertility diagnosis and compare use between cases and controls. Materials and Methods The case–control study was based on register data and used incidence density sampling. From the CROSS-TRACKS Cohort, we included women residing in the Horsens area in Denmark in 2012–2018 (n = 54,175). Eligible women were aged 18–40 years, nulliparous, and living in heterosexual relationships. Cases were women with a first infertility diagnosis in the Danish National Patient Registry (index date). Five controls were matched on age, birth year, and calendar time. Through linkage to Danish national health registries, we identified general practitioner (GP) attendance, paraclinical examinations, hospital contacts, diagnoses, and redeemed prescriptions. Healthcare use from one year to five years before index date was compared with conditional logistic regression. Results We identified 711 cases and 3555 controls. At one year before index date, cases consulted their GP (odds ratio (OR) = 5.2, 95% confidence interval (CI): 3.2, 8.3) and visited hospital (OR = 1.2, 95% CI: 1.0, 1.4) and redeemed prescriptions (OR = 2.3 95% CI: 1.9, 2.7) more often compared to controls. Cases more often had blood and hemoglobin tests performed, redeemed more drugs related to genitourinary and hormonal diseases, and were more often diagnosed with endocrine and genitourinary diseases in the year before a first infertility diagnosis compared to controls. Cases and controls had comparable healthcare use from five years to one year before a first infertility diagnosis. Conclusion Cases and controls had similar healthcare use from five years to one year before a first infertility diagnosis. However, cases had a higher healthcare use in the year preceding a first infertility diagnosis compared to controls.
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Affiliation(s)
- Ninna Hinchely Ebdrup
- Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Correspondence: Ninna Hinchely Ebdrup, Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, Sundvej 30, Horsens, 8700, Denmark, Tel +45 28 47 21 11, Email
| | - Anders Hammerich Riis
- Department of Research, Regional Hospital Horsens, Horsens, Denmark
- Enversion A/S, Aarhus, Denmark
| | | | - Bjørn Bay
- Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
- Maigaard Fertility Clinic, Aarhus, Denmark
| | - Julie Lyngsø
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte Rytter
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Raos M, Roman H, Seyer-Hansen M, Kesmodel US, Knudsen UB. EFFORT study: Comparing impact of operation and assisted reproductive technologies on fertility for women with deep infiltrating endometriosis - study protocol for a multicentre randomised trial. BMJ Open 2022; 12:e052877. [PMID: 35410921 PMCID: PMC9003604 DOI: 10.1136/bmjopen-2021-052877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Deep infiltrating endometriosis (DIE) affecting the rectum or sigmoid colon is associated with infertility, severe pain and decreased quality of life. As most women with DIE are young, many have a pregnancy intention. Treatment possibilities of endometriosis-associated infertility are surgery or assisted reproductive technologies (ART). However, no studies have compared the two interventions directly. Therefore, this study aims to determine the cumulative pregnancy rate (CPR) and the live birth rate (LBR) after first-line surgery compared with first-line ART for women with rectosigmoid DIE and a pregnancy intention. METHODS AND ANALYSIS Multicentre, parallel-group, randomised trial of women with rectosigmoid DIE and a pregnancy intention for at least 6 months in Aarhus, Denmark and Bordeaux, France. 352 women aged 18-38 years are randomised 1:1 to either surgical management (shaving, disc excision or segmental resection) or ART management (at least two in vitro fertilisation or intracytoplasmic sperm injection procedures if not pregnant after the first cycle). Women in the surgical intervention group will attempt to get pregnant by either spontaneous conception or ART, depending on the endometriosis fertility index score. Primary outcome measures are CPR and LBR at 18 months' follow-up. Secondary outcomes are: Non-viable pregnancies, time to pregnancy, pain score, quality of life, complication rate, bowel and bladder function, endocrine and inflammatory profile, number of oocytes, blastocysts, frozen embryos and blastocyst morphology score within 18 months after either intervention. ETHICS AND DISSEMINATION Conduct of this study is approved by the Danish National Committee on Health Research Ethics and Comité de Protection des Personnes Ile de France VIII. Study participants must sign an informed consent form. The results will be presented at national and international conferences and published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER This trial is registered at ClinicalTrials.gov (no. NCT04610710). PROTOCOL VERSION The Danish National Committee on Health Research Ethics: Fifth protocol version approved 7 September 2020 (no. 1-10-72-96-20). Comité de Protection des Personnes Ile de France VIII: Version 1.1 22JAN2021 the 9 March 2021.
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Affiliation(s)
- Maja Raos
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Fertility Clinic, Regional Hospital Horsens, Horsens, Denmark
| | - Horace Roman
- Endometriosis Center, Clinique Tivoli-Ducos, Bordeaux, France
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Mikkel Seyer-Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus N, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- Fertility Clinic, Regional Hospital Horsens, Horsens, Denmark
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Ebdrup NH, Knudsen UB, Schullehner J, Arendt LH, Liew Z, Lyngsø J, Bay B, Clemmensen PJ, Sigsgaard T, Hansen B, Ramlau-Hansen CH. Nitrate in Drinking Water and Time to Pregnancy or Medically Assisted Reproduction in Women and Men: A Nationwide Cohort Study in the Danish National Birth Cohort. Clin Epidemiol 2022; 14:475-487. [PMID: 35444467 PMCID: PMC9014114 DOI: 10.2147/clep.s354926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose No studies have investigated if drinking water nitrate affects human fecundity. Experimental studies point at detrimental effects on fetal development and on female and male reproduction. This cohort study aimed to explore if female and male preconception and long-term exposure to nitrate in drinking water was associated with fecundability measured as time to pregnancy (TTP) or use of medically assisted reproduction (MAR) treatment. Methods The study population consisted of pregnant women recruited in their first trimester in 1996–2002 to the Danish National Birth Cohort. Preconception drinking-water nitrate exposure was estimated for the pregnant women (89,109 pregnancies), and long-term drinking water nitrate exposure was estimated from adolescence to conception for the pregnant women (77,474 pregnancies) and their male partners (62,000 pregnancies) by linkage to the national drinking water quality-monitoring database Jupiter. Difference in risk of TTP >12 months or use of MAR treatment between five exposure categories and log-transformed continuous models of preconception and long-term nitrate in drinking water were estimated. Binominal regression models for risk ratios (RR) were adjusted for age, occupation, education, population density, and lifestyle factors. Results Nitrate in drinking water (median preconception exposure: 1.9 mg/L; median long-term exposure: 3.3 mg/L) was not associated with TTP >12 months or use of MAR treatment, neither in the categorical nor in the continuous models. Conclusion We found no association between preconception or long-term exposure to drinking water nitrate and fecundability.
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Affiliation(s)
- Ninna Hinchely Ebdrup
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Correspondence: Ninna Hinchely Ebdrup, Department of Obstetrics and Gynecology, Horsens Regional Hospital, Regionshospitalet Horsens, Sundvej 30, Horsens, 8700, Denmark, Tel +4528472111, Email
| | - Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Geological Survey of Denmark and Greenland, Aarhus, Denmark
| | - Linn Håkonsen Arendt
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Julie Lyngsø
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjørn Bay
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
- Maigaard Fertility Clinic, Aarhus, Denmark
| | | | - Torben Sigsgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
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Sloth A, Kjølhede M, Sarmon KG, Knudsen UB. Effect of dual trigger on reproductive outcome in low responders: a systematic PRISMA review and meta-analysis. Gynecol Endocrinol 2022; 38:213-221. [PMID: 34779694 DOI: 10.1080/09513590.2021.2000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Poor ovarian responders (PORs) pose a great challenge for fertility clinics worldwide. The aim of this study was to examine whether 'dual trigger' consisting of human chorionic gonadotropin (hCG) plus gonadotropin-releasing hormone agonist (GnRHa) is beneficial or not regarding implantation rate, pregnancy rate, and live birth rate for POR. METHODS This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Risk of bias was evaluated by the Newcastle-Ottawa scale or version 2 (NOS) of the Cochrane risk-of-bias tool for randomized trials (ROB2) independently by two authors. Furthermore, RevMan version 5.4 was used to analyze the extracted data and to create an inverse-weighted summary-odds ratio (OR). RESULTS A total of 1390 studies were screened. Seven studies containing a total of 2474 POR were included. The pooled meta-analysis revealed a 1.62-fold increase in clinical pregnancy rate (OR = 1.62 [1.00, 2.62], p = .05) and a 2.65-fold increase in live birth rate (OR = 2.65 [1.66, 4.24], p < .0001) in the dual trigger group compared to hCG trigger. The pooled analysis showed no significant difference between the two groups regarding implantation rate (OR = 1.14 [0.93, 1.39], p = .21). CONCLUSIONS The meta-analysis of this study indicates that dual trigger as finale oocyte maturation is advantageous compared to hCG trigger among POR. However, large-scale, high-quality, randomized controlled trials (RCT) are required to confirm this conclusion and fully address the magnitude of this effect.
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Affiliation(s)
- Amalie Sloth
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark
| | - Maria Kjølhede
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
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10
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Borgstrøm MB, Kesmodel US, Klausen TW, Danielsen AK, Thomsen T, Gabrielsen A, Englund ALM, Zedeler A, Povlsen BB, Troest B, Almind GJ, Fedder J, Kirk J, Hindkjær J, Lemmen JG, Petersen K, Haahr K, Petersen MR, Laursen S, Knudsen UB, Bentin-Ley U, Larsen T, Grøndahl MI. Developmental stage and morphology of the competent blastocyst are associated with sex of the child but not with other obstetric outcomes: a multicenter cohort study. Hum Reprod 2021; 37:119-128. [PMID: 34986219 DOI: 10.1093/humrep/deab242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/13/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Are transfer day, developmental stage and morphology of the competent blastocyst in pregnancies leading to live birth associated with preterm birth, birthweight, length at birth and sex of the child? SUMMARY ANSWER A high score in blastocyst developmental stage and in trophectoderm (TE) showed a significant association with the sex of the child, while no other associations with obstetric outcomes were observed. WHAT IS KNOWN ALREADY The association between blastocyst assessment scores and obstetric outcomes have been reported in small single-center studies and the results are conflicting. STUDY DESIGN, SIZE, DURATION Multicenter historical cohort study based on exposure data (transfer day (blastocyst developmental stage reached by Day 5 or Day 6)) blastocyst developmental stage (1-6) and morphology (TE and inner cell mass (ICM): A, B, C)) and outcome data (preterm birth, birthweight, length at birth, and sex of the child) from women undergoing single blastocyst transfer resulting in a singleton pregnancy and live birth. PARTICIPANTS/MATERIALS, SETTING, METHODS Data from 16 private and university-based facilities for clinical services and research were used. A total of 7246 women, who in 2014-2018 underwent fresh-embryo transfer with a single blastocyst or frozen-thawed embryo transfer (FET) with a single blastocyst resulting in a singleton pregnancy were identified. Linking to the Danish Medical Birth Registry resulted in a total of 4842 women with a live birth being included. Cycles with pre-implantation genetic testing and donated gametes were excluded. The analyses were adjusted for female age (n = 4842), female BMI (n = 4302), female smoking (n = 4290), parity (n = 4365), infertility diagnosis (n = 4765), type of treatment (n = 4842) and center (n = 4842); some analyses additionally included gestational age (n = 4368) and sex of the child (n = 4833). MAIN RESULTS AND THE ROLE OF CHANCE No statistically significant associations between blastocyst assessment scores (transfer day, developmental stage, TE, ICM) and preterm birth (8.3%) or birthweight (mean 3461.7 g) were found. The adjusted association between blastocysts with a TE score of C and a TE score of A and length at birth (mean 51.6 cm) were statistically significant (adjusted mean difference 0.4 cm (95% CI: 0.02; 0.77)). Blastocysts transferred with developmental stage score 5 compared to blastocysts transferred with score 3 had a 34% increased probability of being a boy (odds ratio (OR) 1.34 (95% CI: 1.09; 1.64). Further, TE score B blastocysts compared to TE score A blastocysts had a 31% reduced probability of being a boy (OR 0.69 (95% CI: 0.60; 0.80)). LIMITATIONS, REASONS FOR CAUTION It is possible that some residual confounding remains. WIDER IMPLICATIONS OF THE FINDINGS Blastocyst selection during ART does not appear to introduce any negative effects on obstetric outcome. Therefore, clinicians and patients can be reassured that the assessment scores of the selected blastocyst will not in themselves pose a risk of preterm birth or affect birthweight and the length at birth. STUDY FUNDING/COMPETING INTEREST(S) Unrestricted grant from Gedeon Richter Nordics AB, Sweden. None of the authors have any competing interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M B Borgstrøm
- Department of Obstetrics and Gynecology, The Fertility Clinic, Copenhagen University Hospital Herlev, Aalborg University, Herlev, Denmark
| | - U S Kesmodel
- The Fertility Unit, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - T W Klausen
- Department of Hematology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - A K Danielsen
- Department of Gastroenterology, Copenhagen University Hospital Herlev, University of Copenhagen, Herlev, Denmark
| | - T Thomsen
- Department of Anaesthesiology, Copenhagen University Hospital Herlev, University of Copenhagen, Herlev, Denmark
| | - A Gabrielsen
- The Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
| | - A L M Englund
- The Fertility Clinic, Zealand University Hospital Køge, Køge, Denmark
| | - A Zedeler
- Department of Obstetrics and Gynecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - B B Povlsen
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - B Troest
- The Fertility Unit, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - G J Almind
- Copenhagen Fertility Center, Copenhagen, Denmark
| | - J Fedder
- The Fertility Clinic, Odense University Hospital, Odense, Denmark
| | - J Kirk
- Maigaard Fertility Clinic, Aarhus N, Denmark
| | - J Hindkjær
- Aagaard Fertility Clinic, Aarhus N, Denmark
| | - J G Lemmen
- Vitanova Fertility Center, Copenhagen, Denmark
| | - K Petersen
- VivaNeo Ciconia Fertility Clinic, Højbjerg, Denmark
| | - K Haahr
- Stork IVF Clinic, Copenhagen K, Denmark
| | - M R Petersen
- Department of Obstetrics and Gynecology, The Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - S Laursen
- The Fertility Clinic IVF-syd, Fredericia, Denmark
| | - U B Knudsen
- The Fertility Clinic at Horsens Regional Hospital, Aarhus University, Horsens, Denmark
| | - U Bentin-Ley
- Danish Fertility Clinic, The Fertility Partnership Denmark, Frederiksberg, Denmark
| | - T Larsen
- Danish Medical Data Center, Vallensbæk, Denmark
| | - M I Grøndahl
- Department of Obstetrics and Gynecology, The Fertility Clinic, Copenhagen University Hospital Herlev, Herlev, Denmark
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Philipsen MT, Knudsen UB, Zachariae R, Ingerslev HJ, Hvidt JEM, Frederiksen Y. Sleep, psychological distress, and clinical pregnancy outcome in women and their partners undergoing in vitro or intracytoplasmic sperm injection fertility treatment. Sleep Health 2021; 8:242-248. [PMID: 34949542 DOI: 10.1016/j.sleh.2021.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the prevalence of poor sleep quality in couples undergoing fertility treatment and study possible associations. PARTICIPANTS 163 women and 132 partners receiving in vitro (IVF) or intracytoplasmic sperm injection (ICSI) fertility treatment. SETTING Three public Danish fertility clinics. DESIGN AND MEASUREMENTS Participants completed the Pittsburgh Sleep Quality Index (PSQI) at three time-points as part of a larger RCT. Additional data from patient records and questionnaires were included to evaluate possible associations with treatment protocol type, psychological distress, and pregnancy outcome. RESULTS Mean PSQI global scores before treatment were 8.1 (standard deviation = 2.3), with 91% of participants having PSQI scores > 5, indicating poor sleep quality. Scores did not differ between women and their partners and did not change during treatment. Statistically significant associations were found between sleep quality and depressive symptoms and state anxiety (p < .001). No difference in PSQI scores was found between protocol types. While there was a trend towards higher clinical pregnancy rates among women with good sleep quality (PSQI ≤ 5 = 72.7%, PSQI 6-10 = 52.6% and PSQI ≥ 11 = 42.3%), the differences did not reach statistical significance (p = .10-.21). CONCLUSIONS Poor sleep quality is a prevalent problem among couples undergoing fertility treatment and is associated with psychological distress and possibly with pregnancy outcomes. Success rates after fertility treatment remain moderate, and poor sleep quality, a potentially modifiable factor, could be relevant to screen for and treat among couples undergoing fertility treatment. The high prevalence of poor sleep quality calls for further investigation.
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Affiliation(s)
- Marie Tholstrup Philipsen
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Ulla Breth Knudsen
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Horsens Fertility Clinic, Horsens Hospital, Horsens, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Jakob Ingerslev
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Julius Edward Miller Hvidt
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Yoon Frederiksen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark; The Sexology Unit, Department of Affective Disorders, Aarhus University Hospital, Aarhus, Denmark
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Dalsgaard TH, Hvas AM, Kirkegaard KS, Jensen MV, Knudsen UB. Impact of frozen thawed embryo transfer in hormone substituted cycles on thrombotic risk markers. Thromb Res 2021; 209:23-32. [PMID: 34847404 DOI: 10.1016/j.thromres.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Fertility treatment with frozen thawed embryo transfer (FET) is widely used. Women treated in artificial cycles (AC-FET) receive high doses of estrogen in contrast to natural cycles (NC-FET), where no estrogen is administered. Estrogen substitution may be associated with increased risk of thromboembolism. Our aim is therefore to characterize changes in blood coagulation parameters defined as surrogate thrombotic risk markers in women undergoing estrogen substitution during AC-FET. MATERIALS In our prospective cohort study, we enrolled 34 women in either: AC-FET (n = 19) or NC-FET (n = 15). Women were recruited at the Department of Obstetrics and Gynaecology, Horsens Fertility Clinic, Denmark, from August 2019 - November 2020. Blood samples were obtained at four timepoints. Thrombin generation, platelet aggregation and fibrinolysis were evaluated as thrombotic risk markers. RESULTS Within the AC-FET group, we found a significantly shorter lagtime (p < 0.05) and time to peak (TTP) (p < 0.001) after hormone substitution compared to baseline. Furthermore, a significantly higher mean peak (p < 0.0001) and larger endogenous thrombin potential (ETP) (p < 0.0001) was observed. When compared to the NC-FET group, women receiving AC-FET had a significantly shorter mean TTP (p < 0.005), higher mean peak (p < 0.0001) and larger ETP (p < 0.05). Additionally, we demonstrated a significantly prolonged lysis time within the AC-FET group (p < 0.001). CONCLUSION Our results indicate that women receiving AC-FET have a significantly increased thrombin generation which may increase the thromboembolic risk in women being estrogen substituted.
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Affiliation(s)
- Trine Holm Dalsgaard
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Gynaecology and Obstetrics, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Anne-Mette Hvas
- Thrombosis and Haemostasis Research Unit, Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
| | | | - Maria Vestergaard Jensen
- Department of Gynaecology and Obstetrics, Horsens Regional Hospital, 8700 Horsens, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Ulla Breth Knudsen
- Department of Gynaecology and Obstetrics, Horsens Regional Hospital, 8700 Horsens, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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13
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Mejlhede MAB, Jepsen JB, Knudsen UB. Oral melatonin supplementation during in vitro fertilization treatment: a systematic PRISMA review and meta-analysis of randomized controlled trials. Gynecol Endocrinol 2021; 37:1079-1085. [PMID: 34494508 DOI: 10.1080/09513590.2021.1974378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE High levels of reactive oxygen species (ROS) have been suspected of reducing the success rate of assisted reproductive technology (ART). Melatonin has anti-oxidative properties and could therefore be of interest as a supplement in in vitro-fertilization (IVF) protocols. The objective of this study was to evaluate if a melatonin supplementation given in vivo to women undergoing IVF-treatment can improve the outcome. METHODS A systematic literature search was performed on PubMed, Embase and Cochrane. The methodological quality of the included studies was assessed using the version 2 of the Cochrane risk-of-bias tool (RoB2). Primary outcome was clinical pregnancy rate (CPR). Secondary outcomes were total number of oocytes, number of mature oocytes, embryo quality, biochemical pregnancy rate, miscarriage rate and live birth rate (LBR). RESULTS Seven randomized controlled trials (RCT) were included. The meta-analysis demonstrated a significantly higher mature oocyte count when melatonin was used (Mean Diff. = 1,82; 95% CI 0.37-3.27; p = .01). All seven studies showed a trend for increase in CPR, although not significant. No other measured outcomes showed a significant improvement. Two studies had 'low risk', three 'some concerns' and two studies had 'high risk' of bias. CONCLUSION This meta-analysis including RCT indicates that an oral melatonin supplement during IVF-treatment can increase the number of mature oocytes, and a trend for increase CPR, albeit not significant. Most of the included studies were small. The methodological quality in three of the seven studies was moderate and two were low. Further investigations are needed to support the positive findings.
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Affiliation(s)
| | | | - Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital & Aarhus University, Denmark
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14
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Larsen EC, Bentin-Ley U, Knudsen UB. [Oocyt donation]. Ugeskr Laeger 2021; 183:V04210368. [PMID: 34852907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The number of treatments with donated oocytes has risen markedly in Denmark during the latest decade due to changes in legislation and because female age is increasingly advanced when fertility treatment is warranted. Today, oocyte donation is a standard procedure offering the otherwise untreatable a high chance of achieving a pregnancy. Live birth rates as high as 35% per treatment are being reported. It is, however, important to be aware of increased risks of hypertensive disorders and bleeding complications in these pregnancies. As pointed out in this review, continuous research in the field is therefore highly needed.
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15
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Soegaard A, Knudsen UB. Complementary and alternative medicine among women and men prior to and during fertility treatment. Dan Med J 2021; 68:A05210433. [PMID: 34851254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The use of complementary and alternative medicine (CAM) is generally increasing. CAM use in relation to fertility treatment is sparsely studied. Thus, the aim of this study was to assess the use prevalence and patterns of CAM among Danish women and men initiating or receiving fertility treatment. Additionally, we aimed to establish whether several fertility treatment attempts influenced CAM use prevalence. METHODS A cross-sectional survey was conducted at the second largest fertility clinic in Denmark in the period from April to June 2018. The CAM use prevalence was reported for two groups of patients. Specifically, CAM use prior to or during fertility treatment was compared between groups, and various general patterns were reported. RESULTS Among the 411 patients approached, 277 responded (67.4%). Among these patients, 142 participants had not previously received fertility treatment, whereas 135 participants had received treatment at least once previously. We found that 52.5% of the patients initiating and undergoing fertility treatment had used CAM. Furthermore, previous fertility treatment was related to a higher CAM use. Surprisingly, only 53.4% of the participating women used folic acid. CONCLUSIONS More than half of the women and men initiating or undergoing fertility treatment had been using the investigated CAM. Of notice, folic acid compliance was low. The frequency of CAM use increased during fertility treatment. FUNDING none. TRIAL REGISTRATION not relevant.
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Hoejris NF, Frederiksen Y, Nielsen SH, Brand SL, Holt M, Amidi A, Knudsen UB. P–041 Reproductive concerns and sexual health in men with newly diagnosed testicular cancer prior to orchiectomy: preliminary results from an on-going study. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What is the prevalence of reproductive concerns among patients with newly diagnosed testicular cancer (TC), and how do they rate their sexual health (SH).
Summary answer
Of 20 patients, 75% (n = 15) were moderate to highly concerned about decreased reproductive functioning. Twenty-four percent exhibited overall low SH.
What is known already
Currently, only little is known about reproductive concerns among TC patients. Furthermore, these concerns have not been investigated in a TC population prior to orchiectomy. One study among post-surgery TC patients two years after diagnosis, reported that 28% had high degree of reproductive concern. The literature indicates that TC patients’ sexual health is negatively affected due to altered body image and sexual dysfunction. However, studies regarding sexual health have primarily been performed on long term survivors of TC. Thus, little is known about SH in this population prior to treatment.
Study design, size, duration
The present cross-sectional study included patients from the fertility clinic in Horsens, Denmark. Patients were approached at their pre-scheduled appointment for cryopreservation of semen prior to orchiectomy. Enrolment started March, 2019 and is still on-going. Preliminary data is included from 21 enrolled patients.
Participants/materials, setting, methods
Patients newly diagnosed with TC, who were referred to the fertility clinic for semen cryopreservation prior to orchiectomy and other treatment modalities were invited. The patients responded to a questionnaire package of which reproductive concerns were assessed with seven questions with Likert scale response options ranging from 0 (not concerned) to 5 (highly concerned). SH was assessed with the validated 22-item questionnaire European Organization for Research and Treatment of Cancer Sexual health questionnaire (EORTC-SHQ).
Main results and the role of chance
A total of 37 patients met the inclusion criteria and of these 21 were enrolled in the study. Due to technical issues, only 20 out of 21 patients completed the full questionnaire package. Patients were asked about concerns regarding the ability to father children. Nine patients (45%) were moderately concerned, and six patients (30%) were highly concerned. When asked about their concerns of not being able to father children without fertility treatment, the answers were mostly unaffected with eight patients (40%) being moderately concerned, and seven patients (35%) highly concerned.
Four patients (20%) were highly concerned that decreased semen quality would affect future or present relationships. Patients were also asked if they felt sufficiently informed regarding the chance of fathering children without help from a fertility clinic following cancer treatment. Three patients (15%) reported that they were insufficiently informed, while four patients (20%) responded only to a little extend. Five patients (23,8%) scored ≤ 50 on the EORTC SHQ indicating that they had low SH. Eleven patients (52,3%) felt less masculine due to their disease. Furthermore, one patient (4,8%) scored ≤ 50 on the symptomatic scale, indicating that he had symptomatic sexual problems as fatigue and sexual pain.
Limitations, reasons for caution
The relatively low participant number is a limitation, making the results less generalizable. Furthermore, there is a risk of selection bias due to the moderate inclusion rate. Also, the questionnaire examining fertility related concerns were non validated, and focused mainly on the fertility-related aspects of reproductive concerns.
Wider implications of the findings: A considerable number of patients with newly diagnosed TC show substantial reproductive concerns as well as lowered sexual health. These worries could possibly be alleviated by more sufficient information from the health professionals already in the beginning of the treatment phase, reducing further emotional distress during the remaining treatment period.
Trial registration number
ClinicalTrials.gov ID:NCT03880994
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Affiliation(s)
- N F Hoejris
- Aarhus University, Institute of Clinical Medicine, Aarhus, Denmark
| | - Y Frederiksen
- Aarhus University and Aarhus University Hospital- Psychiatry, Department of Clinical Medicine and the Sexology Unit, Aarhus, Denmark
| | - S H Nielsen
- Regional Hospital of Horsens, Fertility Clinic, Horsens, Denmark
| | - S L Brand
- Aarhus University, Department of Psychology & Behavioural Sciences, Aarhus, Denmark
| | - M Holt
- Aarhus University, Department of Psychology & Behavioural Sciences, Aarhus, Denmark
| | - A Amidi
- Aarhus University, Department of Psychology & Behavioural Sciences, Aarhus, Denmark
| | - U B Knudsen
- Institute of Clinical Medicine- Aarhus University, Gynecology & Obstetrics, Aarhus, Denmark
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Pistoljevic N, Saupstad M, Mizrak I, Andersen LF, Englund AL, Cou. Freiesleben NL, Husth M, Klajnbard A, Knudsen UB, Løssl K, Schmidt L, Pinborg A. P–484 Progesterone supplementation in modified natural frozen embryo transfer (mNC-FET) does not cause mental health adverse effects - A sub-study of a multicenter RCT. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Do women undergoing mNC-FET with progesterone supplementation experience mental health adverse effects at a greater rate compared to a control group.
Summary answer
Progesterone supplementation does not affect mental wellbeing in women undergoing mNC-FET.
What is known already
Women and men undergoing assisted reproductive treatment more likely to experience stress and other adverse psychological effects than the background population. Various factors such as parental age, cause of infertility and treatment method have been shown to affect patient well-being. Progesterone supplementation is known to cause various physical adverse effects, yet few studies have investigated the potential mental health adverse effects of progesterone supplementation in FET.
Study design, size, duration
This is a sub-study of an ongoing RCT investigating the effect of luteal phase progesterone supplementation in mNC-FET. The aim is to investigate possible mental health adverse effects of progesterone. From 2019–2021 a total of 164 women were included (n = 84 and n = 82 in the progesterone and control group, respectively). The health and wellbeing self-reporting survey was fulfilled after randomization on hCG trigger + 11 days.
Participants/materials, setting, methods
A validated, electronic questionnaire in Danish was used to measure mental wellbeing in women aged 18–41 years undergoing mNC-FET with and without use of progesterone supplementation in the luteal phase at seven Danish public hospitals. Women were randomized to either progesterone treatment or no progesterone by a computerized randomization algorithm with minimization for female age > =37 years, previous oocyte retrievals and previous FET. Comparisons of survey responses were performed by chi-square tests.
Main results and the role of chance
The survey response rate was 68%. We observed no significant differences in any of the three items between the progesterone group and the control group. On the first item “to which degree have you felt sensitive due to treatment”, 56% and 52% responded “to a large degree” or “to some degree” sensitive in the progesterone vs. control group, while 25% and 34% vs. 19% and 13% responded “to a lesser extent” or “not at all” sensitive in progesterone vs. controls (P = 0.35).
On the second item, “to which degree have you felt aggressive due to treatment”, 10% and 9% responded “to a large degree” or “to some degree”, 29% and 22% answered “to a lesser degree” and 62% and 70% responded “not at all” in the progesterone vs control group (P = 0.57).
On the third item “to which degree have you cried unexpectedly due to treatment” 25% and 18% responded “to a large degree” or “to some degree” in the progesterone vs control group, 20% and 27% answered “to a lesser extent”, while 55% in both groups answered “not at all” (P = 0.44).
Limitations, reasons for caution
In a self-reported survey selection bias, due to a less than 100% response rate, and reporting bias cannot be excluded. However with the possibility to answer the survey online at leisure, the risk of reporting bias is minimized.
Wider implications of the findings: A large concern for clinicians working with ART is patient wellbeing. Our study suggests that luteal phase support does not cause extra emotional distress, though further research is needed.
Trial registration number
NCT03795220
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Affiliation(s)
- N Pistoljevic
- Copenhagen University Hospital- Rigshospitalet, Fertility Department, Copenhagen, Denmark
| | - M Saupstad
- Copenhagen University Hospital- Rigshospitalet, Fertility Department, Copenhagen, Denmark
| | - I Mizrak
- Copenhagen University Hospital- Rigshospitalet, Fertility Department, Copenhagen, Denmark
| | - L F Andersen
- Copenhagen University Hospital- Nordsjællands Hospital Hillerød, Fertility Clinic, Hillerød, Denmark
| | - A L Englund
- Zealand University Hospital, Fertility Clinic, Køge, Denmark
| | - N L Cou. Freiesleben
- Copenhagen University Hospital Hvidovre, Department of Obstetrics and Gynaecology- The Fertility Clinic, Hvidovre, Denmark
| | - M Husth
- Aalborg University Hospital, Fertility Unit and Centre for Preimplantation Genetic Test, Aalborg, Denmark
| | - A Klajnbard
- Herlev-Gentofte Hospital, Fertility Clinic, Herlev, Denmark
| | - U B Knudsen
- Horsens Regional Hospital and Institute of Clinical Medicine- Aarhus University, Fertility Clinic, Horsens, Denmark
| | - K Løssl
- Copenhagen University Hospital- Rigshospitalet, Fertility Department, Copenhagen, Denmark
| | - L Schmidt
- University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - A Pinborg
- Copenhagen University Hospital- Rigshospitalet, Fertility Department, Copenhagen, Denmark
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18
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Bick L, Nielsen AS, Knudsen UB. Embryo Culture Media Influence on Live Birth Rate and Birthweight after IVF/ICSI: A Systematic Review Comparing Vitrolife G5 Media to Other Common Culture Media. JBRA Assist Reprod 2021; 25:480-492. [PMID: 33710837 PMCID: PMC8312284 DOI: 10.5935/1518-0557.20200099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/20/2020] [Indexed: 12/02/2022] Open
Abstract
Previous studies have indicated that culture media vary in efficiency and outcomes, such as live birth rate, birthweight and embryo quality. Does Vitrolife G5 series culture media result in higher live birth rates and birthweight compared to other common culture media? This study is a systematic review based on the PRISMA criteria. Relevant search terms, mesh terms (PubMed and Cochrane) and Emtree terms (Embase) were identified. We searched the literature using PubMed, Embase and Cochrane, on November 10, 2019. The inclusion criteria involved published articles in English comparing Vitrolife G5 to other common culture media. We included randomized controlled trials (RCTs) and cohort studies. The quality of the studies was assessed using the Cochrane Risk of Bias tool 2.0 and the Newcastle-Ottawa Scale. Primary outcomes were live birth rate and birthweight. Secondary outcomes were fertilization rate, implantation rate, biochemical pregnancy rate, clinical pregnancy rate, miscarriage rate, multiple pregnancies and congenital malformations. Of 187 articles screened, 11 studies fulfilled the inclusion criteria: Five RCTs and six retrospective cohort studies. Only one study reported live birth rate, showing a non-significantly higher live birth rate for Vitrolife G5 media. Birthweight had equivocal results with three of six studies, showing significantly lower (2)/higher (1) birthweights, whereas the others were non-significant. Overall, there were no significant differences concerning secondary outcomes. The results are equivocal, and we need more studies to evaluate culture media and their effect on short- and long-term health.
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Affiliation(s)
- Lena Bick
- Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Denmark
| | - Anja Schulz Nielsen
- Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Denmark
| | - Ulla Breth Knudsen
- Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus, Denmark
- Department of Obstetrics & Gynecology, Regional Hospital Horsens, Sundvej 30, 8700 Horsens, Denmark
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19
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Berntsen S, Nøhr B, Grøndahl ML, Petersen MR, Andersen LF, Englund AL, Knudsen UB, Prætorius L, Zedeler A, Nielsen HS, Pinborg A, Freiesleben NLC. In vitro fertilisation (IVF) versus intracytoplasmic sperm injection (ICSI) in patients without severe male factor infertility: study protocol for the randomised, controlled, multicentre trial INVICSI. BMJ Open 2021; 11:e051058. [PMID: 34168037 PMCID: PMC8231059 DOI: 10.1136/bmjopen-2021-051058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Over the last decades, the use of intracytoplasmic sperm injection (ICSI) has increased, even among patients without male factor infertility. The increase has happened even though there is no evidence to support that ICSI results in higher live birth rates compared with conventional in vitro fertilisation (IVF) in cases with nonmale factor infertility. The lack of robust evidence on an advantage of using ICSI over conventional IVF in these patients is problematic since ICSI is more invasive, complex and requires additional resources, time and effort. Therefore, the primary objective of the IVF versus ICSI (INVICSI) study is to determine whether ICSI is superior to standard IVF in patients without severe male factor infertility. The primary outcome measure is first live birth from fresh and frozen-thawed transfers after one stimulated cycle. Secondary outcomes include fertilisation rate, ongoing pregnancy rate, birth weight and congenital anomalies. METHODS AND ANALYSIS This is a two-armed, multicentre, randomised, controlled trial. In total, 824 couples/women with infertility without severe male factor will be recruited and allocated randomly into two groups (IVF or ICSI) in a 1:1 ratio. Participants will be randomised in variable block sizes and stratified by trial site and age. The main inclusion criteria are (1) no prior IVF/ICSI treatment, (2) male partner sperm with an expected count of minimum 2 million progressive motile spermatozoa following density gradient purification on the day of oocyte pick up and (3) age of the woman between 18 and 42 years. ETHICS AND DISSEMINATION The study will be performed in accordance with the ethical principles in the Helsinki Declaration. The study is approved by the Scientific Ethical Committee of the Capital Region of Denmark. Study findings will be presented, irrespectively of results at international conferences and submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04128904. Pre-results.
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Affiliation(s)
- Sine Berntsen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre Hospital, Hvidovre, Denmark
| | - Bugge Nøhr
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Herlev, Herlev Hospital, Herlev, Denmark
| | - Marie Louise Grøndahl
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Herlev, Herlev Hospital, Herlev, Denmark
| | - Morten Rønn Petersen
- The Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Rigshospitalet, Copenhagen, Denmark
| | - Lars Franch Andersen
- Department of Obstetrics and Gynaecology, Copenhagen University Hospital North Zealand, North Zealand Hospital, Hilleroed, Denmark
| | - Anne Lis Englund
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Zealand University Hospital Koege, Zealand University Hospital Koge, Koege, Denmark
| | - Ulla Breth Knudsen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, The Regional Hospital Horsens, Regional Hospital Horsens, Horsens, Denmark
| | - Lisbeth Prætorius
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre Hospital, Hvidovre, Denmark
| | - Anne Zedeler
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre Hospital, Hvidovre, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Anja Pinborg
- The Fertility Clinic, Copenhagen University Hospital Rigshospitalet, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Nina La Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital Hvidovre, Hvidovre Hospital, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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20
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Hinchely Ebdrup N, Hohwü L, Bay B, Obel C, Knudsen UB, Kesmodel US. Long-term growth in offspring of infertile parents: A 20-year follow-up study. Acta Obstet Gynecol Scand 2021; 100:1849-1857. [PMID: 34157129 DOI: 10.1111/aogs.14215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Long-term growth has been poorly investigated in boys and girls born to parents receiving fertility treatment. This study aimed to investigate the growth of children born following fertility treatment up to adulthood hypothesizing comparable growth in children born to parents receiving fertility treatment or to subfertile parents conceiving spontaneously to that in children spontaneously conceived by fertile parents. MATERIAL AND METHODS In this historical long-term follow-up study the study population consisted of 4151 singletons born at term in the Aarhus Birth Cohort between 1990 and 1992. Parental lifestyle and sociodemographic characteristics together with multiple measurements of weight and height were collected up to 20 years of age (6.1% of children contributed with at least one measurement for height or weight at age 20 years). The main outcome was difference in z-score for height (m) and weight (kg) between children conceived spontaneously (reference) and children conceived following fertility treatment, children conceived spontaneously by subfertile parents, or unplanned. Results were adjusted for pre-pregnancy maternal and paternal body mass index, maternal educational level, smoking during pregnancy, maternal age, and parity. RESULTS Singletons conceived following fertility treatment (n = 164; 4.0%) or by subfertile parents (n = 271; 6.5%) had comparable magnitude of weight estimates to children conceived spontaneously (difference in z-score per year 0.0148 [95% CI 0.0026-0.0270] and 0.0069 [95% CI -0.0028 to 0.0165], respectively). Height estimates were also comparable between groups of children conceived following fertility treatment or by subfertile parents (difference in z-score per year 0.0022 [95% CI -0.0075 to 0.0119]) compared with children conceived spontaneously (difference in z-score per year -0.0026 (95% CI -0.0103 to 0.0052). From the beginning of adolescence, we found lower weight for children born to subfertile parents and to parents receiving fertility treatment compared with spontaneously conceived children. CONCLUSIONS The main finding was equal long-term growth for children born at term by parents who received fertility treatment or parents waiting more than 12 months to conceive compared with spontaneously conceived children.
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Affiliation(s)
| | - Lena Hohwü
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bjørn Bay
- Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
| | - Carsten Obel
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ulla Breth Knudsen
- Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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21
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Christensen M, Petersen JL, Sivanandam P, Kronborg CS, Knudsen UB, Martensen PM. Reduction of serum-induced endothelial STAT3(Y705) activation is associated with preeclampsia. Pregnancy Hypertens 2021; 25:103-109. [PMID: 34098522 DOI: 10.1016/j.preghy.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Preeclampsia is associated with maternal morbidity and mortality during pregnancy, and also an increased cardiovascular disease (CVD) risk later in life. During preeclampsia, alterations in secreted placental factors leading to systemic maternal endothelial dysfunction are evident. However, little is known about the associated endothelial intracellular signaling. STAT3 is a latent cytoplasmic transcription factor involved in endothelial cell differentiation, survival, and angiogenesis. We aimed to test if preeclampsia and preeclampsia-related placental factors could alter serum-induced STAT3(Y705) activation in endothelial cells. Furthermore, if altered serum-induced endothelial STAT3 (Y705) activation is related to post-preeclamptic CVD risk. STUDY DESIGN HUVECs were used as a model of maternal endothelium. Experiments entailed addition of 20% human pregnancy serum as well as addition of recombinant PlGF, sFLT1 and VEGF-A165a to the cells. MAIN OUTCOME MEASURES Levels of pSTAT3(Y705) related to STAT3 levels were evaluated by immunoblotting analysis. RESULTS Our results show that preeclamptic serum induces significantly lower STAT3(Y705) phosphorylation compared with uncomplicated pregnancy serum (P = 0.0089) in endothelial cells. Furthermore, STAT3(Y705) phosphorylation was not changed upon addition of PlGF, sFLT1, or VEGF-A165a together with pregnancy sera compared with sera alone. Finally, sera from women with previous preeclampsia and current hypertension and carotid atherosclerotic plaques show significantly lower STAT3(Y705) phosphorylation capabilities compared with healthy women with previous uncomplicated pregnancies 8-18 years after deliveries (P = 0.029). CONCLUSIONS Reduction in serum-induced endothelial STAT3(Y705) activation may play an important role in the preeclampsia-associated endothelial dysfunction. Additionally, reduced endothelial STAT3(Y705) phosphorylation may contribute to increased post-preeclamptic CVD risk 8-18 years after delivery.
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Affiliation(s)
- M Christensen
- Clinical Research Unit, Randers Regional Hospital, 8930 Randers NOE, Denmark; Institute of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
| | - J L Petersen
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
| | - P Sivanandam
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark
| | - C S Kronborg
- Department of Oncology, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - U B Knudsen
- Institute of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; Department of Gynaecology and Obstetrics, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - P M Martensen
- Department of Molecular Biology and Genetics, Aarhus University, 8000 Aarhus C, Denmark.
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22
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Sarmon KG, Eliasen T, Knudsen UB, Bay B. Assisted reproductive technologies and the risk of stillbirth in singleton pregnancies: a systematic review and meta-analysis. Fertil Steril 2021; 116:784-792. [PMID: 34023069 DOI: 10.1016/j.fertnstert.2021.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the risk of stillbirth from in vitro types of assisted reproductive technologies compared with spontaneous conception (SC), limited to singleton births. DESIGN Systematic literature search and search chaining on online databases: PubMed, Embase, and Scopus. SETTING Not applicable. PATIENT(S) Singleton pregnancies from in vitro fertilization (IVF) or fertilization by IVF and intracytoplasmic sperm injection (IVF-ICSI). INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Adjusted odds ratio for stillbirth or prevalence of stillbirth in case-control groups of IVF/IVF-ICSI singletons and SCs, respectively, in matched studies. RESULT(S) A total of 19 studies were included, and study quality was mixed. Ten studies qualified for inclusion to the meta-analysis, which revealed a significantly increased risk of stillbirth in IVF/IVF-ICSI compared with that in SC (odds ratio [95% confidence interval]: 1.82 [1.37-2.42]), and there was no evidence of publication bias. CONCLUSION(S) In vitro fertilization and IVF-ICSI treatment increases the risk of stillbirth compared with natural conception. CLINICAL TRIAL REGISTRATION NUMBER PROSPERO 216768.
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Affiliation(s)
| | - Troels Eliasen
- Institute of Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Ulla Breth Knudsen
- Institute of Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; The Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark; The Fertility Clinic, Aarhus University Hospital, Aarhus, Denmark
| | - Bjørn Bay
- Bay Gynækologisk Klinik, Aarhus, Denmark
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23
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Katyal N, Poulsen CM, Knudsen UB, Frederiksen Y. The association between psychosocial interventions and fertility treatment outcome: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 259:125-132. [PMID: 33677371 DOI: 10.1016/j.ejogrb.2021.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/28/2021] [Accepted: 02/13/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Does psychosocial intervention affect pregnancy outcomes in women and couples undergoing assisted reproductive technology (ART) treatment?. DESIGN A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) evaluating the efficacy of psychosocial intervention on pregnancy outcomes in women and couples undergoing ART treatment. The primary outcome was Pregnancy Rates. Secondary outcomes were Live Birth Rate (LBR) and Abortion Rate (AR). MATERIALS AND METHODS Databases searched were Pubmed, PsycINFO, Embase, CINAHL and The Cochrane Library. 1439 records were screened, 15 were eligible and included in the meta-analyses (N = 2434). Data was extracted using the Covidence software. Effect sizes were reported as relative risks with 95% confidence-intervals and p-values. RESULTS A positive association was found between psychosocial intervention and pregnancy rates (RR = 1.12 CI=(1.01;1.24), p = 0.033). Long-duration interventions and mind-body intervention types were found to be associated with increased pregnancy rates (RR 1.21, CI= (1.04;1.43), p = 0.017) and (RR = 1.25, CI= (1.00;1.55), p = 0.046) respectively. Q and I2tests suggested no to low heterogeneity. Funnel plots, Trim and Fill analyses and Fail-safe numbers were applied to adjust for possible publication bias. CONCLUSIONS Our findings suggest a positive association between psychosocial interventions, particularly long-duration interventions, and pregnancy rate in infertile women and couples in ART treatment. The findings are in line with findings from other reviews and meta-analyses exploring the same topic. More good quality RCTs need to be performed to increase the quality of guidance for infertile women and couples. The effect of psychosocial interventions on LBR and AR remain to be examined.
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Affiliation(s)
- Nitasha Katyal
- Department of Health, Aarhus University, 8000 Aarhus C, Denmark.
| | | | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus C, Denmark; The Fertility Clinic, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Yoon Frederiksen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark; the Sexology Unit, Aarhus University Hospital Psychiatry, 8200 Aarhus N, Denmark
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24
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Kirkegaard K, Yan Y, Sørensen BS, Hardarson T, Hanson C, Ingerslev HJ, Knudsen UB, Kjems J, Lundin K, Ahlström A. Comprehensive analysis of soluble RNAs in human embryo culture media and blastocoel fluid. J Assist Reprod Genet 2020; 37:2199-2209. [PMID: 32681282 DOI: 10.1007/s10815-020-01891-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/13/2020] [Indexed: 01/01/2023] Open
Abstract
PURPOSE miRNAs have been suggested as biomarkers of embryo viability; however, findings from preliminary studies are divergent. Furthermore, the presence of other types of small RNA molecules remains to be investigated. The purpose of this study was to perform a comprehensive analysis of small non-coding RNA levels in spent and unconditioned embryo culture media, along with miRNA levels in blastocoelic fluid samples from human embryos. METHODS miRNAs in unconditioned culture medium from 3 different manufacturers, along with miRNA from day 5 conditioned culture medium, control medium, and corresponding blastocoel fluid from 10 human blastocysts were analyzed with array-based q-PCR analysis. Subsequently, deep sequencing of total and small RNA in day 5 spent culture medium from 5 human blastocysts and corresponding controls was performed. RESULTS In spite of using state-of-the-art sensitive detection methods, no miRNAs were found to be reliably present in the spent culture medium or the blastocoel fluid. Ct values were above the recommended limit for detection in the array-based analysis, a finding that was confirmed by deep sequencing. The majority of miRNAs identified by deep sequencing were expressed in all samples including control media and seem to originate from sources other than conditioned IVF media. CONCLUSIONS Our findings question the use of miRNAs as a reliable biomarker and highlight the need for a critical methodological approach in miRNA studies. Interestingly, tiRNA fragments appear to be overexpressed in conditioned IVF media samples and could potentially be a novel biomarker worthy of investigation.
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Affiliation(s)
- Kirstine Kirkegaard
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200, Aarhus N, Denmark. .,Department of Gynecology and Obstetrics, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200, Aarhus N, Denmark.
| | - Yan Yan
- Interdisciplinary Nanoscience Center (iNANO) and Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - Boe S Sørensen
- Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200, Aarhus N, Denmark
| | - Thorir Hardarson
- Livio Fertilitetscentrum Gothenburg, Carlandersparken 24, 402 29, Gothenburg, Sweden
| | - Charles Hanson
- Unit of Reproductive Medicine, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - Hans J Ingerslev
- Fertility Unit and Centre for Preimplantation diagnosis, Aalborg University Hospital, Søndre Skovvej 3, 9000, Aalborg, Denmark
| | - Ulla Breth Knudsen
- Fertility Clinic, Regional Hospital Horsens, Sundvej 30, 8700, Horsens, Denmark.,Inst. Clin. Medicine, Aarhus University, Palle Juul-Jensens Boulevard 88, 8200, Aarhus N, Denmark
| | - Jørgen Kjems
- Interdisciplinary Nanoscience Center (iNANO) and Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark
| | - Kersti Lundin
- Unit of Reproductive Medicine, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
| | - Aisling Ahlström
- Unit of Reproductive Medicine, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
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25
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Clemmensen TS, Christensen M, Løgstrup BB, Kronborg CJS, Knudsen UB. Reduced coronary flow velocity reserve in women with previous pre-eclampsia: link to increased cardiovascular disease risk. Ultrasound Obstet Gynecol 2020; 55:786-792. [PMID: 31343097 DOI: 10.1002/uog.20407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/26/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate differences in coronary microvascular function approximately 12 years after delivery between women who had had early- (EO-PE) or late- (LO-PE) onset pre-eclampsia and those who had had a normotensive pregnancy, and to assess the relationship between microvascular function and myocardial deformation at follow-up in these women. METHODS This was a case-control study of 88 women who had delivered at the Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark, between 1998 and 2008. Coronary flow velocity reserve (CFVR) was assessed by Doppler echocardiography approximately 12 years after delivery. Women were grouped according to whether the pregnancy had been complicated by EO-PE (n = 29) or LO-PE (n = 20), or had been normotensive (controls) (n = 39). Study groups were matched for maternal age and time since delivery. CFVR at follow-up was compared between the study groups. Regression analysis was used to assess the association between gestational age at onset of PE and CFVR. The association between left ventricular global longitudinal strain (LV-GLS) and CFVR at follow-up was also evaluated. RESULTS Resting coronary flow velocity assessed 12 years after delivery was comparable between the study groups (P = 0.55), whereas peak hyperemic flow velocity was significantly lower in the EO-PE group than in the LO-PE group (P < 0.01) and controls (P < 0.0001). As such, mean CFVR at follow-up was significantly lower in the EO-PE group than in the LO-PE group (P < 0.01) and controls (P < 0.0001). CFVR was < 2.5 in 48% of women in the EO-PE group, 25% of those in the LO-PE group and 8% of controls (P < 0.01). There was a significant positive association between gestational age at diagnosis of PE and CFVR at 12-year follow-up (β1 = 1.8 (95% CI, 0.8-2.9); P < 0.01). This relationship remained significant after adjustment for cardiovascular risk factors, namely mean arterial blood pressure, glycated hemoglobin level, body mass index, low-density lipoprotein cholesterol level and smoking status (P < 0.05). There was a significant association between LV-GLS and CFVR in women who had had PE (β1 = -1.5 (95% CI, -2.2 to -0.9); R2 = 0.33, P < 0.0001). CONCLUSIONS Low gestational age at onset of PE, both as a continuous variable and when categorized as early onset, was associated with decreased CFVR 12 years after delivery. Nearly 50% of women who had had EO-PE had CFVR < 2.5 at follow-up. Reduced CFVR in women who had had PE was associated with subclinical myocardial dysfunction in terms of reduced LV-GLS. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T S Clemmensen
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - M Christensen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark
| | - B B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - C J S Kronborg
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - U B Knudsen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Gynecology and Obstetrics, Horsens Regional Hospital, Horsens, Denmark
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Hvidt JEM, Knudsen UB, Zachariae R, Ingerslev HJ, Philipsen MT, Frederiksen Y. Associations of bedtime, sleep duration, and sleep quality with semen quality in males seeking fertility treatment: a preliminary study. Basic Clin Androl 2020; 30:5. [PMID: 32341784 PMCID: PMC7181488 DOI: 10.1186/s12610-020-00103-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/03/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Poor sleep has been linked to a number of adverse health outcomes. Recent studies suggest that late bedtimes, short or long sleep durations, and poor sleep quality may impair semen quality. No study has previously explored all three factors in relation to semen quality. RESULTS One hundred and four men and their partners treated at three fertility clinics in Denmark between 2010 and 2012 completed an online-version of the Pittsburgh Sleep Quality Index (PSQI). The results of the semen analyses conducted at the fertility clinics were self-reported and categorised as normal or reduced.Early bedtime (< 10:30 PM) was more often associated with normal semen quality compared with both regular (10:30 PM-11:29 PM) and late (≥11:30 PM) bedtime (OR: 2.75, 95%CI: 1.1-7.1, p = 0.04 and OR: 3.97, 95%CI: 1.2-13.5, p = 0.03). Conventional sleep duration (7.5-7.99 h) was more often associated with normal semen quality than both short (7.0-7.49 h) and very short (< 7.0 h) sleep duration (OR: 1.36, 95% CI: 1.2-12.9, p = 0.03 and OR: 6.18, 95%CI: 1.6-24.2, p = 0.01). Although poor sleep quality was associated with reduced semen quality in the descriptive statistics (p = 0.04), no differences were found between optimal (PSQI ≤6) and either borderline (PSQI 7-8) or poor (PSQI ≥9) sleep quality (OR: 1.19, 95%CI: 0.4-3.4, p = 0.75 and OR: 2.43, 95%CI: 0.8-7.1, p = 0.11) in multivariate regression models. CONCLUSION Early bedtimes (< 10:30 PM) and conventional sleep duration (7.5-7.99 h) were associated with self-reported normal semen quality. The role of subjective sleep quality remains uncertain.
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Affiliation(s)
| | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
- Horsens Fertility Clinic, Horsens Regional Hospital, 8700 Horsens, Denmark
| | - Robert Zachariae
- Department of Psychology and Behavioural Sciences, Aarhus University, 8000 Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Hans Jakob Ingerslev
- Fertility Unit, Aalborg University Hospital, Søndre Skovvej 3, 9000 Aalborg, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | | | - Yoon Frederiksen
- Department of Clinical Medicine, Aarhus University, 8000 Aarhus, Denmark
- The Unit for Clinical Sexology, the Department of Affective Disorders, Aarhus University Hospital, Psychiatry, Palle-Juul Jensens Boulevard 175, 8200 Aarhus N, Denmark
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Saupstad M, Freiesleben NLC, Skouby SO, Andersen LF, Knudsen UB, Petersen KB, Husth M, Egeberg A, Petersen MR, Ziebe S, Andersen AN, Løssl K, Pinborg A. Preparation of the endometrium and timing of blastocyst transfer in modified natural cycle frozen-thawed embryo transfers (mNC-FET): a study protocol for a randomised controlled multicentre trial. BMJ Open 2019; 9:e031811. [PMID: 31843833 PMCID: PMC6924851 DOI: 10.1136/bmjopen-2019-031811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/01/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Despite the high number of frozen embryo transfer (FET) cycles being conducted (190 000 cycles/year) in Europe, the timing of blastocyst transfer and the use of luteal phase progesterone support in modified natural cycle FET (mNC-FET) in assisted reproductive technologies are controversial. In mNC-FET, the timing of blastocyst warming and transfer is determined according to the time of implantation in a natural cycle, aiming to reach blastocyst endometrial synchronicity. However, the optimal day of blastocyst transfer following ovulation trigger is not determined. In addition, the value of luteal phase support to maintain the endometrium remains uncertain. Thus, there is a need to identify the optimal timing of blastocyst warming and transfer and the effect of luteal phase support in a randomised controlled trial design. The aim of this randomised controlled trial is to investigate if progesterone supplementation from the early luteal phase until gestational age 8 weeks is superior to no progesterone supplementation and to assess if blastocyst warming and transfer 6 days after ovulation trigger is superior to 7 days after ovulation trigger in mNC-FET with live birth rates as the primary outcome. METHODS AND ANALYSIS Multicentre, randomised, controlled, single-blinded trial including 604 normo-ovulatory women aged 18-41 years undergoing mNC-FET with a high-quality blastocyst originating from their first to third in vitro fertilisation/intracytoplasmic sperm injection cycle. Participants are randomised (1:1:1:1) to either luteal phase progesterone or no luteal phase progesterone and to blastocyst warming and transfer on day 6 or 7 after human chorionic gonadotropin trigger. Only single blastocyst transfers will be performed. ETHICS AND DISSEMINATION The study is approved by the Danish Committee on Health Research Ethics (H-18025839), the Danish Medicines Agency (2018061319) and the Danish Data Protection Agency (VD-2018-381). The results of the study will be publicly disseminated. TRIAL REGISTRATION NUMBER The study is registered in EudraCT (2018-002207-34) and on ClinicalTrials.gov (NCT03795220); Pre-results.
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Affiliation(s)
- Marte Saupstad
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nina La Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Copenhagen, Denmark
| | - Sven Olaf Skouby
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Herlev Hospital, Copenhagen, Denmark
| | - Lars Franch Andersen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Nordsjællands Hospital, Hillerød, Denmark
| | - Ulla Breth Knudsen
- Kvindeafdelingen, Aarhus University Hospital, Horsens Hospital and the Institute of Clinical Medicine, Horsens, Denmark
| | - Kathrine Birch Petersen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Zealands University Hospital, Køge Hospital, Køge, Denmark
| | - Merete Husth
- Fertilitetsenheden og Center for Præimplantationsdiagnostik, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Egeberg
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Rønn Petersen
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Ziebe
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anders Nyboe Andersen
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristine Løssl
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anja Pinborg
- The Fertility Clinic, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Falsig AML, Gleerup CS, Knudsen UB. The influence of omega-3 fatty acids on semen quality markers: a systematic PRISMA review. Andrology 2019; 7:794-803. [PMID: 31116515 DOI: 10.1111/andr.12649] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Infertility affects about 15% of all couples worldwide. Male factors such as decreased semen quality contribute to around 40% of the cases. Recent reviews have shown that different foods and nutrients may improve semen quality. OBJECTIVES We conducted a systematic review in order to investigate whether intake of omega-3 fatty acids can improve semen quality markers. MATERIALS AND METHODS A systematic search of PubMed, Embase, and Cochrane was conducted in adherence with the PRISMA guideline from the earliest available online indexing year to October 2018. Keywords related to male fertility or infertility was combined with words describing omega-3 fatty acids and dietary fish intake. RCTs and observational studies on infertile and fertile men were included. Studies were considered eligible if they met the inclusion criteria, evaluated either the effect of omega-3 fatty acids or dietary fish intake and had semen quality as primary outcome. RESULTS Thousand and seventy four records were screened, and sixteen studies were ultimately included. Fourteen of the included studies found an improvement or association between omega-3 and at least one semen quality marker. As the studies were very inhomogeneous in participants (fertile/infertile, age, BMI, ethnicity etc), no meta-analysis was performed. DISCUSSION The findings in this review are limited by the few available RCTs. Furthermore, RCTs were very heterogenetic according to study population, sample size, dosage of omega-3, and durations of follow up. Results from the observational studies might have been affected by recall bias and confounded by lifestyle factors. CONCLUSION Based on the findings in this review, omega-3 supplements and dietary intake of omega-3 might improve semen quality parameters in infertile men and men from couples seeking fertility treatment. However, more research is required in order to fully clarify the effect of omega-3 on semen quality and research with fecundity as end point is needed.
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Affiliation(s)
- A-M L Falsig
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - C S Gleerup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - U B Knudsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Horsens Regional Hospital, Horsens, Denmark
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Clemmensen TS, Christensen M, Kronborg CJS, Knudsen UB, Løgstrup BB. Long-term follow-up of women with early onset pre-eclampsia shows subclinical impairment of the left ventricular function by two-dimensional speckle tracking echocardiography. Pregnancy Hypertens 2018; 14:9-14. [DOI: 10.1016/j.preghy.2018.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/21/2018] [Accepted: 07/05/2018] [Indexed: 01/15/2023]
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Hansen AT, Juul S, Knudsen UB, Hvas AM. Low risk of venous thromboembolism following early pregnancy loss in pregnancies conceived by IVF. Hum Reprod 2018; 33:1968-1972. [DOI: 10.1093/humrep/dey271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/28/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- A T Hansen
- Department of Clinical Biochemistry, Aalborg University Hospital, Hobrovej 18-22, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
| | - S Juul
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, Denmark
| | - U B Knudsen
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
- Department of Obstetrics and Gynaecology, Horsens Regional Hospital, Sundvej 30C, Horsens, Denmark
| | - A M Hvas
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
- Center of Haemophilia and Thrombosis, Department of Clinical Biochemistry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, Denmark
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Bro Schmidt G, Christensen M, Breth Knudsen U. Preeclampsia and later cardiovascular disease - What do national guidelines recommend? Pregnancy Hypertens 2017; 10:14-17. [PMID: 29153667 DOI: 10.1016/j.preghy.2017.07.139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/17/2017] [Accepted: 07/22/2017] [Indexed: 11/17/2022]
Abstract
Preeclamptic women have an increased risk of hypertension and cardiovascular disease (CVD) later in life. The aim was to compare the latest clinical recommendations on post-preeclamptic prevention of hypertension and CVD published by eight National Associations of Gynecologists and Obstetricians. Definitions of preeclampsia differ internationally. Recommendations on when, how and who to screen to reduce post-preeclamptic CVD risk also show substantial variation. The diverging preeclampsia definitions make CVD prevention strategies difficult to compare. The variations in clinical recommendations are in line with the lacking evidence of cost-efficient follow-up strategies and stress the need for further research to optimize prevention strategies.
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Affiliation(s)
- Gitte Bro Schmidt
- Department of Surgery - Woman and Child, Regional Hospital of Northern Denmark, Hjoerring, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Martin Christensen
- Clinical Research Unit, Randers Regional Hospital, Randers, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulla Breth Knudsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Obstetrics and Gynaecology, Horsens Regional Hospital, Horsens, Denmark
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Christensen M, Kronborg CS, Carlsen RK, Eldrup N, Knudsen UB. Early gestational age at preeclampsia onset is associated with subclinical atherosclerosis 12 years after delivery. Acta Obstet Gynecol Scand 2017; 96:1084-1092. [PMID: 28542803 DOI: 10.1111/aogs.13173] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/17/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Women with a history of preeclampsia have increased risk of cardiovascular disease later in life. However, it is unclear whether early gestational age at preeclampsia onset is associated with higher cardiovascular disease risk. This study aimed to test the association between gestational age at preeclampsia onset (including the early-onset/late-onset preeclampsia distinction) and subclinical atherosclerosis and arterial stiffness in age-matched women 12 years after index pregnancy. MATERIAL AND METHODS Eligible participants were identified in two Danish registries. Main outcome measures were carotid plaque presence, carotid intima-media thickness, aortic pulse wave velocity, and augmentation index adjusted for heart rate. RESULTS Twenty-four women with previous early-onset preeclampsia, 24 with previous late-onset preeclampsia and 24 with previous normotensive pregnancies were included after matching on age (±2 years) and time since delivery (±1 year). In all outcome measures, the early-onset group had the highest percentage or mean value. In the adjusted analysis, the early-onset group significantly differed from the late-onset group in all outcome measures except aortic pulse wave velocity. The early-onset group also had significantly higher carotid intima-media thickness (average and left) compared with the normotensive group. Gestational age at preeclampsia onset as a continuous variable was significantly associated to both carotid plaque presence and carotid intima-media thickness (average and right). CONCLUSIONS Gestational age at preeclampsia onset is negatively associated with markers of subclinical atherosclerosis 12 years after delivery. Potentially, gestational age at preeclampsia onset might be helpful in directing cardiovascular disease prevention after preeclampsia.
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Affiliation(s)
- Martin Christensen
- Clinical Research Unit, Randers Regional Hospital, Randers, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Nikolaj Eldrup
- Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ulla Breth Knudsen
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Gynecology and Obstetrics, Horsens Regional Hospital, Horsens, Denmark
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Knudsen UB. [Not Available]. Ugeskr Laeger 2017; 179:V69086. [PMID: 28606291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Schmidt GB, Christensen M, Knudsen UB. 113 Preeclampsia and prevention of cardiovascular disease – What do the national guidelines recommend? Pregnancy Hypertens 2016. [DOI: 10.1016/j.preghy.2016.08.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Christensen M, Kronborg CS, Knudsen UB. 76 The cardiovascular disease risk 10 years after early-onset or late-onset preeclampsia – Are there any difference? Pregnancy Hypertens 2016. [DOI: 10.1016/j.preghy.2016.08.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Christensen M, Kronborg CS, Eldrup N, Rossen NB, Knudsen UB. Preeclampsia and cardiovascular disease risk assessment - Do arterial stiffness and atherosclerosis uncover increased risk ten years after delivery? Pregnancy Hypertens 2016; 6:110-4. [PMID: 27155337 DOI: 10.1016/j.preghy.2016.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/06/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Epidemiological studies associate preeclampsia with increased risk of premature cardiovascular disease (CVD) later in life. This study aims to make a comprehensive CVD risk assessment comparing women with previous preeclamptic pregnancies to women with previous normotensive pregnancies 10years after index pregnancy. STUDY DESIGN A nested, matched, observational cohort study. MAIN OUTCOME MEASURES Markers of arterial stiffness, aortic pulse wave velocity (aPWV) and augmentation index (AIx-75), and markers of atherosclerosis, carotid intima-media thickness (cIMT) and carotid plaque presence. Traditional CVD risk factors and 10-year and 30-year Framingham CVD risk scores were also assessed. RESULTS Women were included from April 2014 to October 2014 at a tertiary referral hospital in Denmark. Twenty-one exposed women with a history of preeclampsia and 21 unexposed with a history of normotensive pregnancies were included. Ten years after delivery, significantly more exposed women suffered from hypertension and received antihypertensive treatment and significantly more fulfilled the hypertension-definition at screening. Previously preeclamptic women also tended to have more unfavorable CVD risk estimates. The Framingham risk scores seemed to extend the unfavorable CVD risk. The exposed women tended to have a higher aPWV compared to unexposed women, (P=0.057). No differences were shown in the other examined arteriosclerotic or atherosclerotic variables. CONCLUSIONS Ten years after delivery, we found increased risk of hypertension and trend toward unfavorable CVD risk profile in 40-year-old previously preeclamptic women. However, arterial stiffness and atherosclerosis did not uncover any additional CVD risk information at this time point.
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Affiliation(s)
- Martin Christensen
- Clinical Research Unit, Randers Regional Hospital, Skovlyvej 1, 8930 Randers NO, Denmark; Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
| | | | - Nikolaj Eldrup
- Department of Cardio-Thoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Niklas Blach Rossen
- Diagnostic Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600 Silkeborg, Denmark; Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark.
| | - Ulla Breth Knudsen
- Department of Gynecology and Obstetrics, Horsens Regional Hospital, Sundsvej 30, 8700 Horsens, Denmark.
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Bungum HF, Nygaard U, Vestergaard C, Martensen PM, Knudsen UB. Increased IL-25 levels in the peritoneal fluid of patients with endometriosis. J Reprod Immunol 2016; 114:6-9. [PMID: 26852387 DOI: 10.1016/j.jri.2016.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/01/2016] [Accepted: 01/19/2016] [Indexed: 01/10/2023]
Abstract
Previous studies have indicated a higher prevalence of allergic disease among women with endometriosis. It is already well established that type 1 allergies develop in a Th2 cytokine environment. Recent studies have shown, however, that IL-25 induces a Th2 development of naive T lymphocytes and is central in the Th2 response. The aim of this case-control study was to investigate the presence of IL-25 in the peritoneal fluid of women suffering from endometriosis. PF was obtained both from women undergoing laparoscopic surgery due to endometriosis (25 cases) and from women wanting sterilisation (19 controls). IL-25 levels were then investigated by ELISA. Women with endometriosis showed significantly higher levels of IL-25 in their PF (p=0.019) compared to controls. IL-25 levels did not correlate with the stage of endometriosis. Both Th2-cells and mast cells express IL-25, which could favor the development of allergies by perpetuating a hypersensitivity reaction. Further, IL-25 may also hold a role as a diagnostic tool.
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Affiliation(s)
- Helle Folge Bungum
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Uffe Nygaard
- Department of Dermatology, Aarhus University Hospital, P.P.Ørumsgade 11, 8000 Aarhus C, Denmark; Department of Clinical medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Christian Vestergaard
- Department of Dermatology, Aarhus University Hospital, P.P.Ørumsgade 11, 8000 Aarhus C, Denmark
| | - Pia M Martensen
- Department of Molecular Biology and Genetics, Aarhus University, C.F. Møllers Allé, 8000 Aarhus C, Denmark
| | - Ulla Breth Knudsen
- Department of Gynaecology and Obstetrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Kirkegaard K, Sundvall L, Erlandsen M, Hindkjær JJ, Knudsen UB, Ingerslev HJ. Timing of human preimplantation embryonic development is confounded by embryo origin. Hum Reprod 2015; 31:324-31. [PMID: 26637491 PMCID: PMC4716807 DOI: 10.1093/humrep/dev296] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/04/2015] [Indexed: 02/07/2023] Open
Abstract
STUDY QUESTION To what extent do patient- and treatment-related factors explain the variation in morphokinetic parameters proposed as embryo viability markers? SUMMARY ANSWER Up to 31% of the observed variation in timing of embryo development can be explained by embryo origin, but no single factor elicits a systematic influence. WHAT IS KNOWN ALREADY Several studies report that culture conditions, patient characteristics and treatment influence timing of embryo development, which have promoted the perception that each clinic must develop individual models. Most of the studies have, however, treated embryos from one patient as independent observations, and only very few studies that evaluate the influence from patient- and treatment-related factors on timing of development or time-lapse parameters as predictors of viability have controlled for confounding, which implies a high risk of overestimating the statistical significance of potential correlations. STUDY DESIGN, SIZE, DURATION Infertile patients were prospectively recruited to a cohort study at a hospital fertility clinic from February 2011 to May 2013. Patients aged <38 years without endometriosis were eligible if ≥8 oocytes were retrieved. Patients were included only once. All embryos were monitored for 6 days in a time-lapse incubator. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 1507 embryos from 243 patients were included. The influence of fertilization method, BMI, maternal age, FSH dose and number of previous cycles on timing of t2-t5, duration of the 2- and 3-cell stage, and development of a blastocoel (tEB) and full blastocoel (tFB) was tested in multivariate, multilevel linear regression analysis. Predictive parameters for live birth were tested in a logistic regression analysis for 223 single transferred blastocysts, where time-lapse parameters were investigated along with patient and embryo characteristics. MAIN RESULTS AND THE ROLE OF CHANCE Moderate intra-class correlation coefficients (0.16-0.31) were observed for all parameters except duration of the 3-cell stage, which demonstrates that embryos from one patient elicit clustering at a patient level. No single patient- and treatment-related factor was found to systematically influence the timing from cleavage to blastocyst stage, which indicates that no individual patient-related factor can be identified that separately explains the clustering throughout the entire developmental stages. The blastocyst parameters were more affected by patient-related factors than cleavage stage parameters, as tEB occurred significantly later with older age (0.29 h/year (95% confidence interval: CI 0.03; 0.56)), while both tEB and tFB occurred significantly later with increasing dose of FSH (tEB: 0.12 h/100 IU FSH (95% CI 0.01;0.24); tFB 0.14 h/100 IU FSH (95% CI 0.03;0.27)) and with more previous attempts (tEB: 1.2 h/attempt (95% CI 0.01;2.5); tFB 1.4 h/attempt (0.10;2.7)). Fertilization method affected timing of the first division, with ICSI embryos cleaving significantly faster than IVF embryos (-3.6% (95% CI -6.4; -0.77)), whereas no difference was found in the subsequent divisions. The univariable regression analysis identified female age, cumulative FSH dose, degree of blastocyst expansion, score of the inner cell mass and timing of full blastocyst formation as predictors of live birth. The timing of full blastocyst formation (tFB) did not remain significant when adjusting for age, number of previous cycles and cumulative FSH dose, which were the parameters shown to influence tFB in the mixed regression model. LIMITATIONS, REASONS FOR CAUTION Only good prognosis patients were enrolled, so these results may not be generalized to all infertile women. Not all patient-related factors were investigated. WIDER IMPLICATIONS OF THE FINDINGS Our findings underline the importance of treating embryos as dependent observations and suggest a high risk of patient-based confounding in retrospective studies. The impact of confounders and the embryo origin needs to be addressed in order to apply appropriate statistical models in observational studies. Furthermore, this observation emphasizes the need for RCTs for evaluating use of time-lapse parameters for embryo selection. STUDY FUNDING/COMPETING INTERESTS Funding for the cohort study was provided by the Lippert Foundation, the Toyota Foundation, the Aase og Einar Danielsen foundation and NordicInfu Care research grant. Research at the Fertility Clinic, Aarhus University Hospital is supported by an unrestricted grant from MSD and Ferring. K.K. is funded by a grant from the Danish Council for Independent Research Medical Sciences. The authors declare no competing interest.
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Affiliation(s)
- K Kirkegaard
- Department of Clinical Biochemistry, Aarhus University Hospital, Nørrebrogade 44, DK-8000 Aarhus C, Denmark Clinical institute, Health, Aarhus University, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - L Sundvall
- Clinical institute, Health, Aarhus University, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark Centre for Preimplantation Genetic Diagnosis/The Fertility Clinic, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - M Erlandsen
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
| | - J J Hindkjær
- Centre for Preimplantation Genetic Diagnosis/The Fertility Clinic, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - U B Knudsen
- Clinical institute, Health, Aarhus University, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark Centre for Preimplantation Genetic Diagnosis/The Fertility Clinic, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
| | - H J Ingerslev
- Clinical institute, Health, Aarhus University, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark Centre for Preimplantation Genetic Diagnosis/The Fertility Clinic, Aarhus University Hospital, Palle Juul Jensens Boulevard, 8200 Aarhus N, Denmark
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Bungum HF, Vestergaard C, Knudsen UB. Endometriosis and type 1 allergies/immediate type hypersensitivity: a systematic review. Eur J Obstet Gynecol Reprod Biol 2014; 179:209-15. [DOI: 10.1016/j.ejogrb.2014.04.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/09/2014] [Accepted: 04/15/2014] [Indexed: 11/30/2022]
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Abstract
STUDY QUESTION How consistent is the time-lapse annotation of dynamic and static morphologic parameters of embryo development, within and between observers? SUMMARY ANSWER The assessment of dynamic parameters is characterized by almost perfect agreement within and between observers. WHAT IS KNOWN ALREADY The commonly employed method used to assess embryos in IVF treatments is based on static evaluation of morphology in a microscope, but this is limited by substantial intra- and inter-observer variation. Time-lapse imaging has been proposed as a method to refine embryo selection by adding new dynamic predictors of viability to the assessment. Yet, there are no data regarding the consistency of estimates of the time-lapse parameters. STUDY DESIGN, SIZE, DURATION Infertile patients were recruited at the Fertility Clinic, Arhus University Hospital from February 2011 to June 2012. All embryos were cultured for 6 days in a time-lapse incubator (EmbryoScope(™)). Automated image recording was performed every 20 min. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 158 fertilized embryos from 20 different patients were annotated. Three observers made independent annotations on time-lapse recordings. One observer performed the assessment twice. Twenty-five parameters were annotated and the inter- and intra-observer agreement was assessed by calculating intra-class correlation coefficients (ICCs). MAIN RESULTS AND THE ROLE OF CHANCE Extremely close agreement (ICC 0.99) was found for dynamic parameters including the timing of the following: pronuclei breakdown, completion of blastocyst hatching and the appearance and disappearance of the first nucleus after the first division. Observations of cleavage divisions were strongly correlated (ICC > 0.8), indicating close agreement. Measurements of the static morphologic parameters, i.e. multi-nucleation and evenness of blastomeres at 2-cell stage showed fair-to-moderate agreement (ICC ≤ 0.5). LIMITATIONS, REASON FOR CAUTION The study was conducted at a single clinic. Only embryos with a good prognosis were included. The influence of training sessions was not measured. WIDER IMPLICATIONS OF THE FINDINGS Consistency is crucial to the validity of embryo scoring and selection. All of the time-lapse parameters suggested by the literature showed in our study high intra- and inter-observer correlation, thus validating the precision of time-lapse annotations. This provides the basis for further investigation of embryo assessment and selection by time-lapse imaging in prospective trials. STUDY FUNDING/COMPETING INTEREST(S) Research at the Fertility Clinic was funded by an unrestricted grant from Ferring and MSD. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER NCT01139268.
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Affiliation(s)
- Linda Sundvall
- Fertility Clinic, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus, Denmark
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Kløverpris S, Gaidamauskas E, Rasmussen LCV, Overgaard MT, Kronborg C, Knudsen UB, Christiansen M, Kumar A, Oxvig C. A robust immunoassay for pregnancy-associated plasma protein-A2 based on analysis of circulating antigen: establishment of normal ranges in pregnancy. Mol Hum Reprod 2013; 19:756-63. [PMID: 23804707 DOI: 10.1093/molehr/gat047] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Pregnancy-associated plasma protein-A (PAPP-A) and PAPP-A2, two homologous metzincin metalloproteases, are both tightly linked to regulation within the insulin-like growth factor (IGF) system because of their specific cleavage of IGF binding proteins. Recent studies suggest that PAPP-A may be involved in clinical conditions related to unwanted cellular growth, and the circulating levels of PAPP-A is an established biomarker in prenatal screening for chromosomal abnormalities. Microarray data indicate that PAPP-A2 has potential as a biomarker for pre-eclampsia. However, well-characterized immunological methods of quantification are not available. We therefore developed monoclonal antibodies against recombinant PAPP-A2. The antibodies were epitope mapped against recombinantly expressed chimeras between PAPP-A2 and PAPP-A. Furthermore, circulating PAPP-A2 was immunoaffinity purified and characterized by sequence analysis and mass spectrometry. Unlike PAPP-A, PAPP-A2 is a noncovalent dimer in which each subunit of 1558 amino acids originates from all of the 22 predicted coding exons. A previously hypothesized variant (PAPP-E) does not exist, but low amounts of a C-terminally truncated PAPP-A2 variant was detected. A sensitive and robust ELISA for full-length PAPP-A2 was developed and used to establish normal ranges of PAPP-A2 through pregnancy. The functional sensitivity of this ELISA at 20% CV was 0.08 ng/ml, and the serum concentration of PAPP-A2 was found to increase during pregnancy in agreement with placental synthesis. The existence of this assay will enable an assessment of the biomarker potential of PAPP-A2 in pre-eclampsia as well as other clinical conditions.
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Affiliation(s)
- S Kløverpris
- Department of Molecular Biology and Genetics, Aarhus University, Gustav Wieds Vej 10C, Aarhus C DK-8000, Denmark
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Hansen SO, Knudsen UB. Endometriosis, dysmenorrhoea and diet. Eur J Obstet Gynecol Reprod Biol 2013; 169:162-71. [PMID: 23642910 DOI: 10.1016/j.ejogrb.2013.03.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 01/20/2013] [Accepted: 03/28/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To review the literature on the effects of diet on endometriosis and dysmenorrhoea. STUDY DESIGN A systematic search for trials investigating a relationship between diet and endometriosis/dysmenorrhoea was undertaken, and 23 studies were included in this review. RESULTS Data on the relationship between diet and endometriosis were limited to 12 trials, three of which were animal studies, resulting in a total of 74,708 women. One large study (n=70,709) found a relatively strong association between endometriosis and trans-fatty acid consumption, and a lower risk of endometriosis with increased consumption of long-chain omega-3 fatty acids. The latter finding was also supported by smaller studies. No further dietary recommendations for reducing the risk of endometriosis were possible, and results for intake of vegetable, fibre and fruit were equivocal. The relationship between diet and dysmenorrhoea was investigated in 11 trials with different designs, including a total of 1433 women. Intake of fish oil seemed to reduce dysmenorrhoea. CONCLUSION The literature on endometriosis and dysmenorrhoea in relation to diet is sparse, yielding equivocal results on specific elements. Overall, however, the literature suggests that specific types of dietary fats are associated with endometriosis and/or dysmenorrhoea, thereby indicating that there may be modifiable risk factors. Further research is recommended on both subjects.
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Affiliation(s)
- S O Hansen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
BACKGROUND Postmenopausal endometriosis is rare. The purpose of this presentation is to give a review of the topic based on existing literature. METHODS A Medline search concerning postmenopausal endometriosis was carried out. Hormone therapy and risk of malignancy in these patients are discussed. RESULTS Some 32 case reports on postmenopausal endometriosis were found. The most common location is in the ovaries. Estrogens stimulate endometriosis. There is a risk of recurrence or de novo occurrence of endometriosis after the menopause in patients who take hormone therapy (HT); especially estrogen only therapy (ET). So far, treatment has primarily been surgery (hysterectomy (TAH) and bilateral oophorectomy (BSO)).There is little experience with medical treatment (aromatase inhibitors). The risk of malignant transformation of premenopausal endometriosis is around 1%. Furthermore, patients with endometriosis have an increased risk of ovarian cancer, and, apparently, other malignancies. The risk of malignant transformation appears to be further elevated in patients who take ET, although this subject is not fully elucidated. CONCLUSIONS Although the condition is rare, it is important to be aware of endometriosis after the menopause. Postmenopausal endometriosis infers a risk of recurrence and malignant transformation. Although solid evidence is lacking, the risk of malignant transformation appears to be lower during combined HT compared to ET. Thus, hormone replacement therapy should generally be reserved for patients with severe climacteric complaints, and if indicated, combined therapy should be used.
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Affiliation(s)
- Dorthe Oxholm
- Department of Gynaecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Denmark.
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Abstract
METHODS A retrospective 2-year cohort study of 127 women, with gestation between 13 and 24 weeks and a live fetus, seeking induced abortion. The aim was to compare the effect of a 1-day and a 2-day interval between oral mifepristone (200 mg) and vaginal misoprostol (400 microg) every 3 h. RESULTS The time to fetal expulsion was longer (9.8 versus 7.5 h; p<0.01) in the 1-day than in the 2-day group, but the median number of applications were identical and abortion occurred in 98% within 24 h in both groups The time to abortion was longer in women with a gestation of 17-22 weeks compared to women with lower gestation (10.2 versus 6.8 h; p<0.001), and longer in nulliparae than in parous women (10.0 versus 6.7 h; p<0.001). CONCLUSION The combined regimen of mifepristone and misoprostol is effective in the second trimester, and the interval between the drugs can be reduced allowing individualised patient care.
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Affiliation(s)
- Lisbeth Nilas
- Department of Obstetrics and Gynecology, Hvidovre Hospital, Denmark.
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Kronborg CS, Knudsen UB, Moestrup SK, Allen J, Vittinghus E, Møller HJ. Serum markers of macrophage activation in pre-eclampsia: no predictive value of soluble CD163 and neopterin. Acta Obstet Gynecol Scand 2007; 86:1041-6. [PMID: 17712642 DOI: 10.1080/00016340701415236] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Alternatively activated macrophages expressing the CD163 and CD206 surface receptors are the dominant immune-cell type found in the placenta. The placental number and distribution of macrophages is altered in pre-eclampsia, and the generalised inflammatory reaction associated with pre-eclampsia might lead to shedding of soluble CD163 into the circulation. METHODS Serum samples from 18 women with pre-eclampsia and 90 normal pregnancies were obtained from a longitudinal study of 955 pregnant women at Randers County Hospital, Denmark. sCD163 and Neopterin were measured by ELISA on samples collected in weeks 18, 28, 32, and 38 of pregnancy. RESULTS sCD163 levels in pregnancy (2-3 mg/l) were similar to previously measured levels in non-pregnant women, and did not increase from week 18 to 38. There was a tendency towards higher sCD163 in week 38 in pre-eclamptic women compared to healthy women. Neopterin increased throughout pregnancy in both healthy (from median 5.4 to 6.7 nmol/l, p<0.0001) and pre-eclamptic women (from 5.0 to 8.0 nmol/l, p<0.0001), but there were no differences between groups at any time-point. sCD163 correlated to neopterin in both the control (r=0.25, p<0.0001) and in the pre-eclampsia group (r=0.32, p=0.011). C-reactive protein was higher in pre-eclampsia than in healthy pregnancies by week 38 (159 versus 91 nmol/l, p=0.0189). CONCLUSIONS The macrophage serum-markers sCD163 and neopterin are not pre-symptomatic nor prognostic markers for pre-eclampsia.
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Affiliation(s)
- Camilla S Kronborg
- Department of Gynaecology and Obstetrics, Randers County Hospital, Randers, Denmark.
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Abstract
BACKGROUND Although the pre-eclamptic pathogenesis begins at least around the 18th week of pregnancy, clinically evident disease often does not appear until the third trimester. This long pre-symptomatic latency period has led to intensive research for early markers of evolving disease. We evaluated urine excretion and plasma levels of orosomucoid and albumin longitudinally in healthy and pre-eclamptic pregnancies. Orosomucoid is an acute phase protein involved in inflammation and protection of the endothelium. METHODS From a prospective, longitudinal cohort study consisting of 1,631 women, 32 women developed pre-eclampsia, and 5 controls for every case of pre-eclampsia were found. Blood samples were collected 4 times and urine samples 6 times from the 18/19th week and throughout pregnancy. Orosomucoid and albumin in plasma were analysed by standard methods, and in urine by sandwich ELISA. RESULTS Orosomucoid/creatinin excretion ratio was significantly higher early in pre-eclamptic pregnancies (from the 20th week of pregnancy, p=0.0053) compared with healthy pregnancies, the difference increased throughout pregnancy. Albumin/creatinin ratio increased subsequent to the increase in orosomucoid. In the plasma samples, orosomucoid was significantly higher late in pre-eclamptic pregnancies (>or=36th week, p=0.0275). CONCLUSIONS Pre-eclampsia is associated with a pre-symptomatic increase in the urine excretion of orosomucoid, and orosomucoid excretion precedes that of albumin. Orosomucoid excretion can probably be used as a prognostic tool in combination with other screening methods, and seems to be a more sensitive marker for evolving pre-eclampsia than albumin. Plasma orosomucoid is significantly increased late in pre-eclampsia. Thus, the increased excretion of orosomucoid must primarily originate from altered renal processing of orosomucoid.
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Affiliation(s)
- Camilla S Kronborg
- Department of Gynecology and Obstetrics, Randers County Hospital, Randers, Denmark.
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Ravn P, Rasmussen A, Knudsen UB, Kristiansen FV. An outpatient regimen of combined oral mifepristone 400 mg and misoprostol 400 microg for first-trimester legal medical abortion. Acta Obstet Gynecol Scand 2005; 84:1098-102. [PMID: 16232179 DOI: 10.1111/j.0001-6349.2005.00868.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the success rate of medical abortion using an outpatient regimen of oral mifepristone 400 mg and oral misoprostol 400 microg for legal abortion in women < 56 days pregnant. METHODS Successful abortion was defined as an endometrial thickness < 20 mm evaluated by transvaginal ultrasound and minimal vaginal bleeding at a control examination performed 14 days after administration of misoprostol. Over a 6-month period in 2003, a questionnaire (completion rate 70%) was used for a spot check of the patients' evaluation of the method. RESULTS Six hundred and sixty women underwent the procedure over a 3-year period and 606 (92%) experienced successful medical abortion. The remaining 8% had vacuum aspiration performed mainly due to uterine retention (70%). Other reasons were vaginal bleeding (25%), vomiting (2%), or pelvic infection (4%). Most women reported no days with severe pain (67%), 0--1 days with moderate pain (82%), and 0--1 days with light pain (62%). In terms of gastrointestinal side effects, 68% reported nausea, 33% vomiting, and 27% diarrhea. Most women (90%) felt that the information given at the hospital prior to the abortion was sufficient, 74% would prefer medical abortion again in case of a future unwanted pregnancy, and 85% would prefer to abort at home again. CONCLUSION A high acceptance and success rate was seen using this outpatient oral regimen of mifepristone and misoprostol.
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Affiliation(s)
- Pernille Ravn
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense C, Denmark.
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Ravn P, Rasmussen A, Knudsen UB, Kristiansen FV. An outpatient regimen of combined oral mifepristone 400 mg and misoprostol 400 |ag for first-trimester legal medical abortion. Acta Obstet Gynecol Scand 2005. [DOI: 10.1080/j.0001-6349.2005.00868.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
BACKGROUND The treatment of an ovarian cyst relies on its nature, and accurate preoperative discrimination of benign and malignant cysts is therefore of crucial importance. This study was undertaken to review the literature concerning the preoperative diagnosis and treatment of ovarian cysts. METHODS Articles concerning ovarian cysts from a medline literature search during the period 1985-2003 were included in addition to articles found as references in the initial publications. RESULTS Different methods for discriminating between benign and malignant ovarian cysts are discussed. The diagnosis and the treatment are assessed in relation to age, menopausal status, pregnancy, and whether the cyst is presumed to be benign or malignant. In general, expectant management is the choice in premenopausal and pregnant women with non-suspicious cysts and normal levels of CA-125. In postmenopausal women, unilocular, anechoic cysts less than 5 cm in diameter together with a normal CA-125 may be followed up. Operation is recommended in women with cysts larger than 5 cm and/or elevated levels of CA-125. Women with symptoms should be operated regardless of age, menopausal status, or ultrasound findings. CONCLUSIONS The preoperative discrimination between benign and malignant ovarian cysts is a challenge. Multimodal methods improve the results of single modalities, but we still need improved preoperative diagnostic tools. Furthermore, these methods should be validated in consecutive patient populations large enough to give a reliable estimate of the method's sensitivity and specificity.
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Affiliation(s)
- Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Odense University Hospital, Denmark.
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Knudsen UB, Glavind-Kristensen M, Jørgensen HS, Ottesen BS. [Clinical guidelines for hysterectomy in Denmark]. Ugeskr Laeger 2004; 166:1213-5. [PMID: 15088480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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