Women's experience of pain and pain relief in assisted reproductive technology

The overall aim of this thesis was to evaluate and compare different methods for pain relief during oocyte retrieval and to study women’s expectations and experiences of pain during oocyte retrieval in conjunction with in vitro fertilization. Paper I, an open prospective randomized controlled trial, including 160 women had the primary aims of comparing the pain relieving effects of electro-acupuncture and conventional analgesia, comprising opiates, in conjunction with oocyte retrieval, and to compare post-operative well-being between groups. For measurements of pain the Visual Analogue Scale (VAS) was used and post-operative well-being was assessed using the State Trait Anxiety Inventory test. Our findings showed that women who used electro-acupuncture had significantly more pain during surgery than women who received conventional analgesia. Well-being between groups was comparable. In paper II, a prospective single blinded randomized multicentre study with a total of 183 women two techniques for local anesthesia were compared; pre-ovarian block and paracervical block, in combination with conscious sedation. VAS and the McGill Pain Questionnaire were used for pain ratings. No significant difference between paracervical block and pre-ovarian block was found in terms of pain relieving effects. No differences in fertilization and embryo development were observed. Study III, an observational two-centre study of 124 women, evaluated women’s expectations regarding pain before oocyte retrieval and whether their experienced pain was in accordance with the expected pain. VAS and multiple choice questions of our own construction were used for measurements. It was found that women experienced significantly less pain during oocyte retrieval than they expected before surgery. Study IV was a retrospective study evaluating the effects of analgesic drugs used at oocyte retrieval, in particular different doses of alfentanil, on fertilization rate and/or embryo quality. A total of 663 women were included. Data was collected from the clinical database at Reproductive Medicine, Sahlgrenska University Hospital and from the women’s hospital records. No differences in fertilization rate or embryo quality were observed in relation to the amount of drug used for analgesia. In conclusion, the results of these studies showed that electro-acupuncture cannot generally be recommended as a general pain relief method for oocyte retrieval, but might be used as an alternative for women desiring a non-pharmacological method (Paper I). One advantage of electro-acupuncture was significantly less tiredness and confusion compared with conventional analgesia. Both pre-ovarian block and paracervical block offered good pain relief and were considered safe methods with rapid recovery and ease of administration and monitoring (Paper II). Since women experienced significantly less pain in conjunction with oocyte retrieval than they expected before surgery, this is important information for women who are about to start IVF. It might reduce their apprehension about pain levels during the procedure (Paper III). High doses of alfentanil compared to low doses were not associated with any adverse effects on fertilization rate, embryo development or clinical pregnancy rate, assuring that women can be offered adequate pain relief (Paper IV)

A systematic review of the evidence for complementary and alternative medicine in infertility

BackgroundThe use of complementary and alternative medicine (CAM) by patients and physicians has increased markedly in recent years. Many case reports, case series, and uncontrolled trials of varying quality have been completed; however, there is now a slowly increasing number of randomized controlled trials (RCTs) examining the use of CAM.ObjectivesTo identify, survey, and review RCTs investigating the use of CAM for infertility treatment.Search strategyThe MEDLINE and Cochrane databases were electronically searched.Selection criteriaRCTs examining modalities for treatment or improvement of health status were reviewed.Data collection and analysisRCTs were included based on use of objective measures, articles written in English, availability through the University of Michigan database, and clear published clinical outcomes.Main resultsThirty‐seven articles assessing a variety of CAM modalities met inclusion criteria. Acupuncture, selenium supplementation, weight loss, and psychotherapeutic intervention had 3 or more studies demonstrating beneficial effect. Other interventions had been studied less and evidence for them was limited.ConclusionsAlthough there is preliminary evidence of the effectiveness of some CAM interventions among infertile patients, many of these interventions require further investigation before they can be considered for routine clinical use.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135426/1/ijgo202.pd

How might acupuncture work? A systematic review of physiologic rationales from clinical trials

BACKGROUND: Scientific interest in acupuncture has led numerous investigators to conduct clinical trials to test the efficacy of acupuncture for various conditions, but the mechanisms underlying acupuncture are poorly understood. METHODS: The author conducted a PubMed search to obtain a fair sample of acupuncture clinical trials published in English in 2005. Each article was reviewed for a physiologic rationale, as well as study objectives and outcomes, experimental and control interventions, country of origin, funding sources and journal type. RESULTS: Seventy-nine acupuncture clinical trials were identified. Twenty-six studies (33%) offered no physiologic rationale. Fifty-three studies (67%) posited a physiologic basis for acupuncture: 33 (62% of 53) proposed neurochemical mechanisms, 2 (4%) segmental nervous system effects, 6 (11%) autonomic nervous system regulation, 3 (6%) local effects, 5 (9%) effects on brain function and 5 (9%) other effects. No rationale was proposed for stroke; otherwise having a rationale was not associated with objective, positive or negative findings, means of intervention, country of origin, funding source or journal type. The dominant explanation for how acupuncture might work involves neurochemical responses and is not reported to be dependent on treatment objective, specific points, means or method of stimulation. CONCLUSION: Many acupuncture trials fail to offer a meaningful rationale, but proposing a rationale can help investigators to develop and test a causal hypothesis, choose an appropriate control and rule out placebo effects. Acupuncture may stimulate self-regulatory processes independent of the treatment objective, points, means or methods used; this would account for acupuncture's reported benefits in so many disparate pathologic conditions

"Jag skulle vilja påstå att det är väldigt personberoende" - En kvalitativ undersökning om fackets delaktighet vid en chefsrekrytering

Undersökningens syfte är att få en fördjupad kunskap om hur fackets roll/påverkan ser ut vid en chefsrekrytering i en privat verksamhet utifrån ett arbetsgivarperspektiv samt om det finns en problematik eller nytta med fackets delaktighet i en chefsrekrytering. Då den övervägande delen av den svenska arbetsmarknaden grundar sig i förhållandet mellan arbetsgivare och fackliga organisationer är det intressant att undersöka fackets påverkan i en chefsrekrytering. Förhållandet mellan arbetsgivare och fackliga organisationer är av betydelse för att de har en central roll på den svenska arbetsmarknaden. Undersökningen belyser endast arbetsgivarens perspektiv på fackets delaktighet vid en chefsrekrytering, men vi anser även att fackliga organisationer kan finna värde i de resultat som undersökningen presenterar. Den teoretiska referensramen ligger till grund för undersökningens insamling av kvalitativ data. Det empiriska materialet har samlats in genom sex stycken kvalitativa intervjuer med anställda inom ett av Sveriges största bolag. Undersökningen har genomförts i samarbete med det berörda svenska bolaget. Resultatet visar på att fackets roll/påverkan inte är av stor betydelse i en chefsrekrytering. Undersökningen visar också att det finns en problematik och en nytta med fackets delaktighet vid en chefsrekrytering. Problematiken med fackets delaktighet i en chefsrekrytering är att deras involvering är väldigt tidskrävande. Samtidigt är nyttan att de bidrar med ett medarbetarperspektiv. Vidare har undersökningen åskådliggjort att den generella inställningen till facket skiljer sig beroende på vilken geografisk region respondenterna tillhör. The aim with the research is to deepen the understanding and knowledge of the role and impact that trade union has from an employer perspective on recruitment of managers in a private sector and if there is a problem or benefit with the trade union’s participation in the process. As the major part of the Swedish labour market’s foundation is the relation between employers and trade unions it is of interest to investigate trade unions impact on recruitment of managers. The relation between employers and trade unions is of significance since it has a central role at the Swedish labour market. The research is solely focusing on the relation from the employer perspective, but we believe that the trade union also can find the value in the findings from the research. The theoretical framework creates the foundation for the collection of qualitative data. The empirical material has been collected through six qualitative interviews with employees in one of the largest Swedish companies. The research has been conducted in cooperation with the concerned Swedish company. The result show that the role and impact of the trade union in recruitment of managers is not of significant importance. The investigation also shows that there is a problem and benefit with the trade union participation at manager recruitment processes. The problem with the unions participation at a manager recruitment is that their involvement demands a lot of time. Simultaneously the benefit of the participation is that they contribute with an employee perspective. Furthermore the research gives that the general attitude to the trade union is dependent on which geographical region that the respondents belong to