Fertilitetsbehandling

Hensikt Både antallet barn og andelen barn som blir født etter fertilitetsbehandling i Norge er økende. Hensikten med denne artikkelen er å gi en oversikt over de vanligste formene for medikamentell fertilitetsbehandling hos kvinner. Kunnskapsgrunnlag Artikkelen er basert på et skjønnsmessig utvalg av artikler etter litteratursøk i PubMed. Relevante internasjonale og nasjonale veiledere er gjennomgått. Informasjon fra flere offentlige norske nettsteder er innhentet. Resultater Det finnes tre hovedtyper medikamentell fertilitetsbehandling: 1) Ovulasjonsinduksjon er en metode som brukes særlig hos kvinner som ikke har eggløsninger regelmessig. 2) Intrauterin inseminasjon innebærer innsprøyting av preparert sæd i livmoren og brukes ved lett redusert sædkvalitet, uforklarlig infertilitet, eller til lesbiske par og enslige kvinner. 3) In vitro-fertilisering (IVF) er den mest omfattende behandlingsmetoden, men også den vanligste formen for medikamentell fertilitetsbehandling. Hovedprinsippet i behandlingene er farmakologisk manipulasjon av den endokrine aksen mellom hypothalamus, hypofyse og eggstokker. Bivirkninger på grunn av medisineringen forekommer, men det er sjelden de fører til at man må avbryte behandlingen. Konklusjon Medikamentell fertilitetsbehandling inne-bærer at man forsøker å forsterke, hemme eller støtte de hormonelle variasjoner som skjer under menstruasjonssyklus. Behandlingen er effektiv ettersom cirka 70 % av pasientene som er til fertilitetsbehandling ved offentlige sykehus i Norge blir foreldre

The demographics of assisted reproductive technology births in a Nordic country

Study question: What are the socio-demographic characteristics of families in Norway who have children after assisted reproductive technology (ART), and have these characteristics changed over time? Summary answer: Parents who conceive through ART in Norway tend to be advantaged families, and their socio-demographic profile has not changed considerably over the period 1985-2014. What is known already: A small number of studies show that couples who conceive through ART tend to be socio-economically advantaged. Study design, size, duration: Norwegian Population Register, the Medical Birth Register and the national data bases were linked to study all live births in Norway between 1985 and 2014. Participants/materials, setting, methods: The sample consisted of 1 757 768 live births. Simple bivariate analyses were performed to describe the socio-demographic characteristics of parents who conceived through ART and changes in these characteristics over the time period 1985-2014. We used linear probability models to estimate the association between parental income and giving birth after ART from 2000 to 2014, before and after adjustment for maternal age at delivery, education and area of residence. Main results and the role of chance: Parents conceiving through ART were more likely to be older, with the highest levels of income and education, and married. Their socio-demographic profiles did not change considerably during the period 1985-2014. In the unadjusted model, parents belonging to the top income quartile were 4.2 percentage points more likely (95% CI: 4.1 to 4.3) to have conceived through ART than parents who belonged to the bottom income quartile. Adjustment for maternal age only partially reduced the income disparities (for the top income quartile by 35% (β = 2.7 with 95% CI: 2.5 to 2.8)). Additional adjustment for maternal education, marital status and area of residence did not further attenuate the associations. Limitations, reasons for caution: The data does not enable us to tell whether the lower numbers of children conceived through ART amongst more disadvantaged individuals is caused by lower success rates with ART treatment, lower demand of ART services or barriers faced in access to ART. The study focuses on Norway, a context characterised by high subsidisation of ART services. Wider implications of the findings: Even though in Norway access to ART services is highly subsidised, the results highlight important and persisting social inequities in use of ART. The results also indicate that children born after ART grow up in resourceful environments, which will benefit their development and well-being

Body Mass Index Is Associated with Impaired Semen Characteristics and Reduced Levels of Anti-Müllerian Hormone across a Wide Weight Range

There is still controversy as to how body mass index (BMI) affects male reproduction. We investigated how BMI is associated with semen quality and reproductive hormones in 166 men, including 38 severely obese men. Standard semen analysis and sperm DNA integrity analysis were performed, and blood samples were analysed for reproductive hormones. Adjusted for age and time of abstinence, BMI was negatively associated with sperm concentration (B = -0.088, P = 0.009), total sperm count (B = -0.223, P = 0.001), progressive sperm motility (B = -0.675, P = 0.007), normal sperm morphology (B = -0.078, P = 0.001), and percentage of vital spermatozoa (B = -0.006, P = 0.027). A negative relationship was observed between BMI and total testosterone (B = -0.378, P < 0.001), sex hormone binding globulin (B = -0.572, P < 0.001), inhibin B (B = -3.120, P < 0.001) and anti-Müllerian hormone (AMH) (B = -0.009, P < 0.001). Our findings suggest that high BMI is negatively associated with semen characteristics and serum levels of AMH

Associations between epigenetic age acceleration and infertility

Study question: Is the use of ART, a proxy for infertility, associated with epigenetic age acceleration? Summary answer: The epigenetic age acceleration measured by Dunedin Pace of Aging methylation (DunedinPoAm) differed significantly between non-ART and ART mothers. What is known already: Among mothers who used ART, epigenetic age acceleration may be associated with low oocyte yield and poor ovarian response. However, the difference in epigenetic age acceleration between non-ART and ART mothers (or even fathers) has not been examined. Study design, size, duration: The Norwegian Mother, Father and Child Cohort Study (MoBa) recruited pregnant women and their partners across Norway at around 18 gestational weeks between 1999 and 2008. Approximately 95 000 mothers, 75 000 fathers and 114 000 children were included. Peripheral blood samples were taken from mothers and fathers at ultrasound appointments or from mothers at childbirth, and umbilical cord blood samples were collected from the newborns at birth. Participants/materials, setting, methods: Among the MoBa participants, we selected 1000 couples who conceived by coitus and 894 couples who conceived by IVF (n = 525) or ICSI (n = 369). We measured their DNA methylation (DNAm) levels using the Illumina MethylationEPIC array and calculated epigenetic age acceleration. A linear mixed model was used to examine the differences in five different epigenetic age accelerations between non-ART and ART parents. Main results and the role of chance: We found a significant difference in the epigenetic age acceleration calculated by DunedinPoAm between IVF and non-ART mothers (0.021 years, P-value = 2.89E-06) after adjustment for potential confounders. Further, we detected elevated DunedinPoAm in mothers with tubal factor infertility (0.030 years, P-value = 1.34E-05), ovulation factor (0.023 years, P-value = 0.0018) and unexplained infertility (0.023 years, P-value = 1.39E-04) compared with non-ART mothers. No differences in epigenetic age accelerations between non-ART and ICSI fathers were found. DunedinPoAm also showed stronger associations with smoking, education and parity than the other four epigenetic age accelerations. Limitations, reasons for caution: We were not able to determine the directionality of the causal pathway between the epigenetic age accelerations and infertility. Since parents' peripheral blood samples were collected after conception, we cannot rule out the possibility that the epigenetic profile of ART mothers was influenced by the ART treatment. Hence, the results should be interpreted with caution, and our results might not be generalizable to non-pregnant women. Wider implications of the findings: A plausible biological mechanism behind the reported association is that IVF mothers could be closer to menopause than non-ART mothers. The pace of decline of the ovarian reserve that eventually leads to menopause varies between females yet, in general, accelerates after the age of 30, and some studies show an increased risk of infertility in females with low ovarian reserve. Study funding/competing interest(s): This study was partly funded by the Research Council of Norway (Women's fertility, project no. 320656) and through its Centres of Excellence Funding Scheme (project no. 262700). M.C.M. has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement number 947684). The authors declare no conflict of interest.publishedVersio

Characteristics of reproductive hormones according to BMI group, and associations between BMI and serum hormone levels by multiple linear regression.

<p>T, testosterone; FAI, free androgen index; SHBG, sex hormone binding globulin; FSH, follicle stimulating hormone; LH, luteinizing hormone; AMH, anti-Müllerian hormone; B, regression coefficient; CI, confidence interval.</p><p>Associations tested by multiple linear regression were adjusted for age. All variables in the regression analyses were continuous variables.</p><p>^a, log transformed data.</p><p>Characteristics of reproductive hormones according to BMI group, and associations between BMI and serum hormone levels by multiple linear regression.</p

Characteristics of semen parameters according to BMI groups, comparison between group 1 and group 4, and associations between BMI and semen parameters by multiple linear regression.

<p>BMI, body mass index; DFI, DNA fragmentation index; B, regression coefficient; CI, confidence interval.</p><p>P-values for differences between group 1 and group 4 were calculated by Mann-Whitney U test. Associations tested by multiple linear regression were adjusted for age and time of abstinence. All variables in the regression analyses were continuous.</p><p>^a, log transformed data</p><p>^b, square root transformed data</p><p>Characteristics of semen parameters according to BMI groups, comparison between group 1 and group 4, and associations between BMI and semen parameters by multiple linear regression.</p

Characteristics of the participants according to BMI groups.

<p>BMI, body mass index.</p><p>Characteristics of the participants according to BMI groups.</p

Proportions of normal weight and severely obese men with semen parameters below the WHO lower reference limits [38].

<p>χ², Chi-square value; df, degrees of freedom.</p><p>n (%), number (percentage) of participants with sperm characteristics below WHO lower reference limit/ group total.</p><p>Associations were tested by Chi-square test with Yates’ correction for continuity.</p><p>Proportions of normal weight and severely obese men with semen parameters below the WHO lower reference limits [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0130210#pone.0130210.ref038" target="_blank">38</a>].</p