Background: Due to the “flare effect” associated with the flare protocol, variation in the degree of follicular maturation during stimulation may result in differences in follicle response as compared to the luteal protocol which is based on maximal pituitary suppression and synchronization of follicular maturation. In this study, besides other methods, Anti-Mullerian Hormone (AMH), a novel marker for ovarian reserve, was used as a tool to evaluate the ovarian responsiveness to stimulation. Methods: Women undergoing IVF/ICSI treatment in the UBC IVF Program from January to December 2006 using luteal and flare protocols were retrospectively selected for a total of 40 treatment cycles, 20 cycles in each protocol matched by age, weight, and indication for IVF/ICSI. Serial serum Estradiol (E₂) levels and follicle data were obtained from the clinic chart. Follicle stimulating hormone (FSH), Luteinizing Hormone (LH), progesterone (P), androstenedione (D₄) and AMH levels were measured from aliquots of frozen serum samples. Hormone responses were evaluated by Area Under the Curve (AUC). Data were analyzed using the t-test and statistical significance was considered present at P<0.05. Results are reported as the mean ± SEM. Results: For flare versus luteal protocol, there was a significant difference in the number of total follicles (14.5 ± 1.8 vs 21.3 ± 2.3), medium follicles (3.7 ± 0.6 vs 8.4 ± 1.3), eggs retrieved (8 ± 0.8 vs 14 ± 1.4) and oocytes fertilized (4.4 ± 0.5 vs 8.4 ± 0.7), AMH AUC (62 ± 12 vs 111 ± 13), LH AUC (67 ± 21 vs 20 ± 9), FSH AUC (171 ± 59 vs 112 ± 29), respectively. Mean number of embryos transferred in both groups was similar. Number of pregnancies conceived (5 for flare and 10 for luteal protocol) was not significantly different. Although E₂ AUC in luteal protocol was higher than that in flare protocol, the difference was not statistically significant (28,339 ± 2,669 vs 26,905 ± 2,790). Differences in P and D₄ AUC between the two protocols were not statistically significant. Correlations with ovarian follicles and eggs retrieved were better for AMH than E₂. Conclusions: The luteal protocol exhibited a better ovarian response to stimulation as compared to the flare protocol. As compared to E₂, AMH had a better correlation with the number of follicles and eggs retrieved. / Medicine, Faculty of / Obstetrics and Gynaecology, Department of / Graduate

<p>Varje år föds barn runt om i världen som ett resultat av ägg- och spermiedonation. I Sverige är äggdonation laglig sedan 2003. Spermiedonation är reglerat i lag sedan 1984. Syftet med denna studie var att undersöka graden av oro och nedstämdhet som rapporteras från heterosexuella par som genomgår behandling med ägg- eller spermiedonation. Deltagarna i studien var män och kvinnor som genomgått ägg- eller spermiedonation vid ett av de sju infertilitetscentra som finns i Sverige. Det var totalt 348 män och kvinnor som besvarade två enkäter, den första vid behandlingens början och den andra ca 10 veckor efter avslutad behandlingen. Bortfallet var 16 %. Datainsamlingen gjordes med HADS – Hospital Anxiety and Depression scale. Efter att datan bearbetats statistiskt visade resultaten följande signifikanta skillnader. 1. Kvinnorna rapporterade högre grad av oro än männen både före och efter behandlingen samt högre grad av nedstämdhet efter behandlingen. 2. Både kvinnornas och männens grad av nedstämdhet var högre hos de par där behandlingen inte resulterade i graviditet jämfört med de par som blev gravida. 3. De kvinnor som inte blev gravida visade mer oro efter ett negativt behandlingsresultat än de kvinnor som blev gravida.</p><p>Slutsatsen från föreliggande studie är att kvinnor som genomgår behandlingar med ägg- eller spermiedonation känner mer oro och nedstämdhet än sina partners. Känslorna är av övergående natur och minskar då behandlingarna resulterar i graviditet.</p> / <p>Every year children all over the world are born as a result of gamete donation. In Sweden oocyte donation has been legally used since 2003 and sperm donation has been regulated in law since 1984. The aim of this study was to investigate the extent of anxiety and depression in couples going through treatments with oocyte- or sperm donation. Participants of the study were men and women who received treatment with oocyte- and sperm donation at one of the seven fertility centers in Sweden. A total of 348 men and women answered two questioners, the first one at the beginning of the treatment and the second one around 10 weeks after the end of the treatment. The drop-out rate was 16 percent. Data collection was made with the HADS – Hospital Anxiety and Depression scale. When the data had been statistically processed the results showed following significant differences: 1.The women reported a higher degree of anxiety than the men before as well as after the treatment and a higher degree of depression after the treatment. 2. The extent of depression was higher among those women and men who didn´t become pregnant compared to those who did. 3. The women who didn´t become pregnant were more anxious after failed treatment than the women who became pregnant. The conclusion is that women who receive treatment with oocyte- or sperm donation are more anxious and depressed than their partners. The feelings are temporary and seem to decrease when the treatment results in pregnancy.</p>

Varje år föds barn runt om i världen som ett resultat av ägg- och spermiedonation. I Sverige är äggdonation laglig sedan 2003. Spermiedonation är reglerat i lag sedan 1984. Syftet med denna studie var att undersöka graden av oro och nedstämdhet som rapporteras från heterosexuella par som genomgår behandling med ägg- eller spermiedonation. Deltagarna i studien var män och kvinnor som genomgått ägg- eller spermiedonation vid ett av de sju infertilitetscentra som finns i Sverige. Det var totalt 348 män och kvinnor som besvarade två enkäter, den första vid behandlingens början och den andra ca 10 veckor efter avslutad behandlingen. Bortfallet var 16 %. Datainsamlingen gjordes med HADS – Hospital Anxiety and Depression scale. Efter att datan bearbetats statistiskt visade resultaten följande signifikanta skillnader. 1. Kvinnorna rapporterade högre grad av oro än männen både före och efter behandlingen samt högre grad av nedstämdhet efter behandlingen. 2. Både kvinnornas och männens grad av nedstämdhet var högre hos de par där behandlingen inte resulterade i graviditet jämfört med de par som blev gravida. 3. De kvinnor som inte blev gravida visade mer oro efter ett negativt behandlingsresultat än de kvinnor som blev gravida. Slutsatsen från föreliggande studie är att kvinnor som genomgår behandlingar med ägg- eller spermiedonation känner mer oro och nedstämdhet än sina partners. Känslorna är av övergående natur och minskar då behandlingarna resulterar i graviditet. / Every year children all over the world are born as a result of gamete donation. In Sweden oocyte donation has been legally used since 2003 and sperm donation has been regulated in law since 1984. The aim of this study was to investigate the extent of anxiety and depression in couples going through treatments with oocyte- or sperm donation. Participants of the study were men and women who received treatment with oocyte- and sperm donation at one of the seven fertility centers in Sweden. A total of 348 men and women answered two questioners, the first one at the beginning of the treatment and the second one around 10 weeks after the end of the treatment. The drop-out rate was 16 percent. Data collection was made with the HADS – Hospital Anxiety and Depression scale. When the data had been statistically processed the results showed following significant differences: 1.The women reported a higher degree of anxiety than the men before as well as after the treatment and a higher degree of depression after the treatment. 2. The extent of depression was higher among those women and men who didn´t become pregnant compared to those who did. 3. The women who didn´t become pregnant were more anxious after failed treatment than the women who became pregnant. The conclusion is that women who receive treatment with oocyte- or sperm donation are more anxious and depressed than their partners. The feelings are temporary and seem to decrease when the treatment results in pregnancy.

Bakgrund: IVF-behandlingen är en hormonell behandling som medför både psykiskt och fysiskt lidande för paren som genomgår behandlingen. 10–15% av alla heterosexuella par lider av oönskad infertilitet. Vårdpersonal ska kunna bemöta känslor och lidande hos patienter, vilket gör det möjligt att lindra lidandet och möjliggöra en personcentrerad vård utifrån patienternas livssammanhang och miljö. Syfte: Beskriva patienters erfarenheter under pågående behandling vid ofrivillig barnlöshet. Metod: Studien har skett genom en kvalitativ innehållsanalys där 4 bloggar har analyserats. Resultat: Under IVFbehandlingen kastas paren mellan hopp och förtvivlan samt känslor som ångest, sorg och frustration, samtidigt som hoppet om ett barn är ständigt närvarande. Paren beskriver en ovisshet och att väntan på ett positivt besked om lyckat resultat men vågar inte hoppas för mycket. Konklusion: Studien ökar sjuksköterskans förståelse kring parens erfarenheter under pågående behandling mot ofrivillig barnlöshet. Ta steget in i IVF-behandling är ett stort steg för paren där livsvärlden förändras och de utsätts för ett lidande. / Background: IVF treatment is a hormonal treatment that causes both mental physical suffering for couples. 10-15% of all heterosexual couples suffer from unwanted infertility during their lifetime. Being able to respond to emotions and suffering in patient care as a nurse makes it possibly to alleviate suffering in vulnerable situations and enable personcentered care based on the patient’s life context and environment. Aim: Describe experiences during ongoing treatment for involuntary infertility. Method: The study has been done through a qualitative content analysis where 4 blogs have been analyzed. Findings: During IVF treatment, the couple is tossed between hope and despair and emotions such as anxiety, sadness and despair and emotions such as anxiety, sadness and frustration fights against the hope of having a child. The couples describe uncertainty and waiting for the positive news of successful results, but douse note dare to hope too much. Conclusion: This study increases the nurse’s understanding of patient experiences during ongoing treatment for involuntary infertility. To take the step into IVF-treatment is a big step for the couples where the entire patient's world of life changes and they are exposed to suffering.

O Brasil é o país que mais realiza aspiração folicular de oócitos guiada por ultrasonografia (OPU) para fins de produção in vitro de embriões bovinos. Com isso é possível aumentar consideravelmente o número de progênies por fêmea por ano. O objetivo desse trabalho foi identificar polimorfismos em genes envolvidos na foliculogênese e associar alterações gênicas com o número de folículos pré-antrais recrutados em bovinos, estimados pelo número de oócitos recuperados por OPU. Dados de aspiração folicular feitas a campo em fêmeas Nelore (Bos taurus indicus) foram obtidos de duas empresas diferentes, sendo que 30 fêmeas foram utilizadas para a prospecção de polimorfismos de nucleotídeos únicos (SNPs), 218 para estudos populacionais e dados de 193 fêmeas foram utilizados para a análise de efeitos das variações genéticas com o número de oócitos viáveis colhidos por OPU. Vinte fêmeas da raça Holandesa (Bos taurus taurus) foram genotipadas para a identificação de alelos taurinos ou zebuínos específicos. Regiões dos genes Gdf9, Fgf8, Fgf10 e BmprII foram amplificadas por meio da reação em cadeia da polimerase (PCR) e seqüenciadas para prospecção de SNPs. Quatro polimorfismos foram genotipados por meio de restrição enzimática de DNA, (PCR-RFLP; genes: Gdf9, Fgf8, Lhr e DNA mitocondrial-mtDNA) ou PCR em tempo real utilizando sondas específicas para cada alelo (BmprII). A avaliação de efeitos dos marcadores sobre a característica foi realizada por análise de variância utilizando modelos mistos com dados repetidos, em que o número de oócitos viáveis foi considerado variável dependente, as fêmeas foram consideradas variável aleatória, e local de aspiração, ano de aspiração e o SNP foram efeitos fixos. O mesmo modelo foi utilizado para estimar efeito médio de substituição alélica, em que o marcador foi substituído por uma co-variável numérica. A diferença entre médias de quadrados mínimos foram estimadas por meio de contrastes e a significância avaliada por teste t. Os efeitos ou as diferenças entre as médias foram consideradas significativas quando P<0,05. Foram identificados 19 SNPs sendo que 10 polimórficos entre as fêmeas Nelore, 04 causadores de substituição de aminoácidos na proteína. Entre os marcadores nucleares genotipados (Gdf9, A318C; Fgf8, C1027G; BmprII, A40048G; Lhr C62478T), todos apresentaram equilíbrio de segregação alélica dentro do marcador e genotípica entre os marcadores (P>0,05). Os SNPs nos genes Gdf9, BmprII e Lhr genotipados em fêmeas Nelore e Holandesas apresentaram-se fixados na segunda raça. Foram identificados efeitos dos polimorfismos dos genes Gdf9, Fgf8, BmprII e Lhr (P<0,05), entretanto os variantes de mtDNA não foram significativos. As diferenças entre médias confirmaram os resultados da ANOVA. Para os polimorfismos no gene Gdf9, BmprII e Lhr, observou-se a tendência de os indivíduos heterozigotos terem menores médias de oócitos viáveis quando comparados aos homozigotos, já o polimorfismo no gene Fgf8, observou-se a tendência de interação aditiva entre os alelos, em que foi estimado um efeito médio de 1,13±0,01 oócitos viáveis por troca de alelo C por G. Conclui-se que variações genéticas são causas de variabilidade do número de folículos presentes nos ovários, estimados por OPU. / Brazil is the country with the biggest number of ovum pick up (OPU) collection for bovine in vitro embryo production. This strategy is used to increase the number of calves born per cow per year. The objective of this work was to identify polymorphisms in genes related in folliculogenesis and associate some of the resulted gene variants with the number of pre antral follicle recruited in bovines, estimated by the number of oocytes collected by OPU. Records of open filed OPUs performed in Nelore cows (Bos taurus indicus) were obtained from two independent enterprises, and 30 females were used for single nucleotide polymorphism (SNP) prospection, 218 females for genotype and allelic population analysis and 193 females used for identification of genetic variation effects over the number of viable oocytes collected by OPU. Twenty Holstein cows (Bos taurus taurus) were also genotyped for identification of taurine and zebuine specific alleles. Segments of genes Gdf9, Fgf8, Fgf10 and BmprII were amplified by polymerase chain reaction (PCR) and sequenced for SNP prospection. Four polymorphisms were genotyped by means of enzymatic DNA digestion (PCR-RFLP, genes: Gdf9, Fgf8, Lhr and mitochondrial DNA - mtDNA) or real time PCR using allelic specific probes (Gene: BmprII). Genetic marker effect over the analyzed characteristic was realized by analysis of variance using mixed models with repeated data, in which the number of viable oocytes were set as dependent variable, the females were considered random variable, OPU place, OPU year and SNP were fixed effects. The same model was used for average allelic substitution effect estimation, where the genetic marker class was changed by a numeric covariant. The least square means (LSM) differences were estimated by contrasts and the significance evaluated by t test. Fixed effects or LSMs differences were considered significant when P<0.05. Nineteen SNPs were identified, from which ten were polymorphic among Nelore cows, four were expected to cause amino acid changes in protein. Among the nuclear genome markers genotyped (Gdf9, A318C; Fgf8, C1027G; BmprII, A40048G; Lhr C62478T, all resulted in allelic segregation equilibrium within marker and genotypic segregation equilibrium between markers (P>0.05). The SNPs in genes Gdf9, BmprII and Lhr genotyped in Nelore and Holstein cows were fixed in the last breed. SNPs in genes Gdf9, Fgf8, BmprII and Lhr affected the characteristic (P<0.05), however the mtDNA variants did not. The LSMs differences confirmed the ANOVA results. Heterozygote females for SNPs in genes Gdf9, BmprII and Lhr tend to have smaller LSMs than homozygous ones. On the other hand, there is indication of additive allelic interaction between alleles of SNP in gene Fgf8, for which an average allele substitution was estimated in 1.13±0.01 viable oocytes for a C/G change. We concluded that genetic variations were responsible for variable number of follicles present in ovaries, estimated by OPU.

In Deutschland unterliegt die Reproduktionsmedizin umfassenden gesetzlichen Regelungen. Fertilisierte Oozyten müssen im Pronukleus-Stadium selektiert werden, hierbei darf maximal eine Anzahl von drei Embryonen kultiviert werden. Studien der vergangenen Jahre zielten vornehmlich auf die Entwicklung eines detaillierten Scoring-Systemes (Zygoten Screening im Pronukleus Stadium), um jeweils die Embryonen mit dem größten Entwicklungspotenzial zu selektieren. 99 Patientinnen wurden inkludiert und durchliefen entweder eine IVF oder ICSI Prozedur. Die fertilisierten Oozyten wurden im Pronukleus-Stadium beurteilt. TNF alpha und LIF, beides in der Reproduktionsmedizin bekannte Zytokine, wurden in gepoolten Kulturmedien an den Tagen 3 und 5 gemessen. 865 Oozyten wurden hierbei gewonnen, 438 zeigten positive Fertilisations-Zeichen, es fand sich eine Fertilisationsrate von 62,6%. Die Schwangerschaftsrate betrug 24,7%. Die mittlere PN Scores zeigten sich signifikant niedriger bei nicht konzipierenden Frauen (15.8 versus 17.2). Die mittlere TNF alpha Konzentration zeigte sich sowohl an Tag 3 als auch an Tag 5 signifikant erniedrigt in schwangeren Frauen gegenüber denen, welche nicht konzipierten (0.43pg/ml versus 0.59pg/ml). Die mittlere LIF Konzentration hingegen war signifikant erhöht bei schwangeren Frauen (56.2pg/ml versus 22.2pg/ml an Tag 3). Zusammenfassung: Das PN-Scoring bleibt eine gute Methode zur prognostischen Einschätzung des weiteren Entwicklungspotenziales von Präimplantationsembryonen. Höhere Konzentrationen von LIF und niedrigere Konzentrationen von TNF alpha in Kulturmedien scheinen eine favorable Rolle in der Embryogenese zu spielen. / German law comprehensively regulates IVF procedures and the selection of embryos for further cultivation. By law, fertilized oocytes have to be selected at the pronucleus-stadium, and a maximum of three embryos are allowed to be cultivated. Studies of the past years therefore aimed to elaborate a detailed scoring system (zygote scoring system at the pronucleus stage) in order to select those embryos with the highest potential for further favorable development. METHODS: 99 patients were included in our prospective trial and underwent either IVF or ICSI procedure. Fertilized oocytes were assessed at the pronucleus stage (day 1). TNF alpha and LIF, both cytokines known to be involved in embryonic development, were measured in pooled culture media on day 3 and 5. RESULTS: A total of 865 oocytes were collected, 438 showed positive signs of fertilisation, a fertilisation-rate of 62.6 % was achieved. Pregnancy rate per embryo transfer was 24.7 %. Mean PN-scores were significantly lower in women conceiving (15.8) than in those not conceiving (17.2). Mean TNF alpha concentration in culture media on day 3 was 0,54pg/ml and 0.37pg/ml on day 5 and was significantly lower in women conceiving (0.43pg/ml versus 0.59pg/ml on day 3). Mean LIF concentration on day 3 was 31.5pg/ml and 35.5pg/ml on day 5 and was significantly higher in women conceiving (56.2pg/ml versus 22.2pg/ml on day 3). CONCLUSION: PN-scoring remains a valuable tool for assessing fertilized oocytes for their further developmental potential at the pronucleus stage. Higher concentrations of LIF and lower concentrations of TNF alpha in culture media seem to play a putative favorable role in embryogenesis.

Broad societal and cultural changes since the 1970s have provided incentives for young people to postpone parenthood. The greater access to and longer pursuit of higher education, the greater involvement of women in the labour market, and changes in family behaviour have contributed to a long-term increase in age at parenthood. The spread of effective contraception and wider access to abortion have also played a part, helping women and couples better plan the timing of births. Using data from the Human Fertility Database, we document a rise in fertility rates among women aged 40 and older in low-fertility countries of Europe, East Asia, North America, and Australia.

We aimed to prospectively investigate the paternal antigen-induced cytokine secretion by peripheral blood mononuclear cells (PBMCs) in response to hormone treatment in women undergoing in vitro fertilisation (IVF) and to examine the predictive value of the cytokine secretion profile in the outcome of IVF treatment, in a pilot study. Twenty-five women were included and IVF treatment was successful for six and unsuccessful for 19 women. Blood samples were collected before IVF treatment, on four occasions during IVF and four weeks after embryo transfer. The numbers of Th1-, Th2- and Th17-associated cytokine-secreting cells and cytokine levels in cell supernatants were analysed by enzyme-linked immunospot-forming (ELISpot), enzyme-linked immune-sorbent (ELISA) or Luminex assay. None of the cytokines (IFN-γ, IL-4, IL-5, IL-10, IL-12, IL-13, IL-17, TNF and GM-CSF) had any predictive value regarding IVF outcome. The majority of the cytokines reached their peak levels at ovum pick-up, suggesting an enhancing influence of the hormonal stimulation. Pregnancy was associated with a high number of IL-4-, IL-5- and IL-13-secreting cells four weeks after ET. In conclusion, the results do not support our hypothesis of a more pronounced peripheral Th1 and Th17 deviation towards paternal antigens in infertile women with an unsuccessful IVF outcome, although this is based on a small number of observations. A larger study is required to confirm this conclusion. Higher numbers of Th2-associated cytokine-secreting cells in pregnant women four weeks after ET do corroborate the hypothesis of a Th2 deviation during pregnancy.

This project examines how Nadya Suleman and Kate Gosselin were represented in the media following the births of their higher order multiples by conducting a critical textual analysis of newspaper and entertainment magazine articles to answer the following questions: How were Suleman and Gosselin portrayed as mothers? And how were they portrayed as recipients of reproductive technology? The findings illustrate that race and class combined with gender to play an important role in determining who has a right to be a mother and what that mother should look like. Traditional stereotypes within media coverage about good mothers and bad mothers reinforced prejudices about who deserves access to reproductive technology and who does not.

Introduktion: Ofrivillig barnlöshet, infertilitet, är ett vanligt problem som uppträder i alla kulturer. I Sverige är ungefär 10-15 % av alla par drabbade och det samma gäller i övriga Västeuropa och Nordamerika. Det är ungefär lika vanligt med manlig som kvinnlig infertilitet och relativt ofta i kombination. Hos 10-15 % av alla infertila återfinns ingen orsak till infertiliteten. Idag är in vitro fertilisering, IVF, den vanligaste behandlingsmetoden vid alla typer av infertilitet. Syfte: Syftet var att beskriva kvinnor och mäns upplevelse av att genomgå IVF-behandling. Metod: Studien genomfördes som en systematisk litteraturstudie som analyserades genom kvalitativ innehållsanalys. Resultat: Deltagarna upplevde att IVF-behandlingen förändrade och tog över livet. Behandlingen inverkade på parrelationen på olika sätt. IVF medförde också en påtaglig psykisk och känslomässig påfrestning. Hur deltagarna valde att förhålla sig till behandlingen påverkade upplevelsen. Barn och gravida skapade reaktioner som gav blandade känslor som följd. En bristande information inom vården och betydelsen av stöd var framträdande. Slutsats: IVF-upplevelsen påverkar livets alla delar och är en påfrestande upplevelse. Tydligt är behovet av information och stöd under behandlingen samt en individualiserad vård.