Synnytysiän ja hedelmällisyyden pulmallinen ristiriita

Monella on ylioptimistinen kuva hedelmöityshoitojen tehokkuudesta

Hedelmöityshoitojen mahdollisuudet

Vertaisarvioitu. Teema : hedelmällisyys. English abstract.Hedelmöityshoidot suunnitellaan hedelmättömyyden syyn ja keston sekä naisen iän mukaan. ¬Niistä saa avun 80 % pareista, kun naisen ikä on korkeintaan 35 vuotta. Koeputkihedelmöityksessä joka neljäs yhden alkion siirto johtaa lapsen syntymään. Lasten perinataali¬tuloksissa on pieniä eroja spontaanisti hedelmöityneiden lasten tilanteeseen. Suomessa hedelmöityshoitoja saa sekä omilla että luovutetuilla sukusoluilla julkisilla ja yksityisillä klinikoilla.Peer reviewe

Turnerin oireyhtymä aikuisiässä : hoito ja seuranta

Vertaisarvioitu. English summary.Turnerin oireyhtymä on monimuotoinen sairaus, johon liittyy ennenaikaisen munasarjojen vajaatoiminnan ja lyhytkasvuisuuden lisäksi useiden eri elimien sairauksien kehittymisen riski. Synnynnäiset sydämen ja munuaisten rakennepoikkeavuudet ovat yleisiä ja vaativat elinikäistä seurantaa. Lisäksi potilaiden verenpainetaudin, hyperkolesterolemian, tyypin 2 diabeteksen, keliakian, kilpirauhasen vajaatoiminnan, maksan toimintahäiriöiden ja sensorineuraalisen kuulovian riski on suurentunut. Myös neuropsykiatriset ongelmat ovat yleisiä. Hedelmättömyys on Turner-naisille suuri surun aihe, ja hedelmöityshoito luovutetuilla munasoluilla on osalle varteenotettava vaihtoehto saada oma lapsi. Monimuotoisen taudinkuvan vuoksi kokonaisvaltainen terveyden seuranta on tärkeää. Siirtyminen lasten erikoissairaanhoidosta aikuispuolelle on seurannan jatkuvuuden kannalta kriittinen vaihe. Gynekologit ovat avainasemassa seurannan koordinoinnissa.Peer reviewe

The Association Between High Birth Weight and Long-Term Outcomes—Implications for Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis

Background: Studies have shown that the prevalence of children born with high birth weight or large for gestational age (LGA) is increasing. This is true for spontaneous pregnancies; however, children born after frozen embryo transfer (FET) as part of assisted reproductive technology (ART) also have an elevated risk. In recent years, the practice of FET has increased rapidly and while the perinatal and obstetric risks are well-studied, less is known about the long-term health consequences.Objective: The aim of this systematic review was to describe the association between high birth weight and LGA on long-term child outcomes.Data Sources: PubMed, Scopus, and Web of Science were searched up to January 2021. Exposure included high birth weight and LGA. Long-term outcome variables included malignancies, psychiatric disorders, cardiovascular disease, and diabetes.Study Selection: Original studies published in English or Scandinavian languages were included. Studies with a control group were included while studies published as abstracts and case reports were excluded.Data Extraction: The methodological quality, in terms of risk of bias, was assessed by pairs of reviewers. Robins-I (www.methods.cochrane.org) was used for risk of bias assessment in original articles. For systematic reviews, AMSTAR (www.amstar.ca) was used. For certainty of evidence, we used the GRADE system. The systematic review followed PRISMA guidelines. When possible, meta-analyses were performed.Results: The search included 11,767 articles out of which 173 met the inclusion criteria and were included in the qualitative analysis, while 63 were included in quantitative synthesis (meta-analyses). High birth weight and/or LGA was associated with low to moderately elevated risks for certain malignancies in childhood, breast cancer, several psychiatric disorders, hypertension in childhood, and type 1 and 2 diabetes.Conclusions: Although the increased risks for adverse outcome in offspring associated with high birth weight and LGA represent serious health effects in childhood and in adulthood, the size of these effects seems moderate. The identified risk association should, however, be taken into account in decisions concerning fresh and frozen ART cycles and is of general importance in view of the increasing prevalence in high birthweight babies

In vitro fertilization does not increase the incidence of de novo copy number alterations in fetal and placental lineages

Although chromosomal instability (CIN) is a common phenomenon in cleavage-stage embryogenesis following in vitro fertilization (IVF)1,2,3, its rate in naturally conceived human embryos is unknown. CIN leads to mosaic embryos that contain a combination of genetically normal and abnormal cells, and is significantly higher in in vitro-produced preimplantation embryos as compared to in vivo-conceived preimplantation embryos4. Even though embryos with CIN-derived complex aneuploidies may arrest between the cleavage and blastocyst stages of embryogenesis5,6, a high number of embryos containing abnormal cells can pass this strong selection barrier7,8. However, neither the prevalence nor extent of CIN during prenatal development and at birth, following IVF treatment, is well understood. Here we profiled the genomic landscape of fetal and placental tissues postpartum from both IVF and naturally conceived children, to investigate the prevalence and persistence of large genetic aberrations that probably arose from IVF-related CIN. We demonstrate that CIN is not preserved at later stages of prenatal development, and that de novo numerical aberrations or large structural DNA imbalances occur at similar rates in IVF and naturally conceived live-born neonates. Our findings affirm that human IVF treatment has no detrimental effect on the chromosomal constitution of fetal and placental lineages

The Association Between High Birth Weight and Long-Term Outcomes-Implications for Assisted Reproductive Technologies : A Systematic Review and Meta-Analysis

Background: Studies have shown that the prevalence of children born with high birth weight or large for gestational age (LGA) is increasing. This is true for spontaneous pregnancies; however, children born after frozen embryo transfer (FET) as part of assisted reproductive technology (ART) also have an elevated risk. In recent years, the practice of FET has increased rapidly and while the perinatal and obstetric risks are well-studied, less is known about the long-term health consequences. Objective: The aim of this systematic review was to describe the association between high birth weight and LGA on long-term child outcomes. Data Sources: PubMed, Scopus, and Web of Science were searched up to January 2021. Exposure included high birth weight and LGA. Long-term outcome variables included malignancies, psychiatric disorders, cardiovascular disease, and diabetes. Study Selection: Original studies published in English or Scandinavian languages were included. Studies with a control group were included while studies published as abstracts and case reports were excluded. Data Extraction: The methodological quality, in terms of risk of bias, was assessed by pairs of reviewers. Robins-I (www.methods.cochrane.org) was used for risk of bias assessment in original articles. For systematic reviews, AMSTAR (www.amstar.ca) was used. For certainty of evidence, we used the GRADE system. The systematic review followed PRISMA guidelines. When possible, meta-analyses were performed. Results: The search included 11,767 articles out of which 173 met the inclusion criteria and were included in the qualitative analysis, while 63 were included in quantitative synthesis (meta-analyses). High birth weight and/or LGA was associated with low to moderately elevated risks for certain malignancies in childhood, breast cancer, several psychiatric disorders, hypertension in childhood, and type 1 and 2 diabetes. Conclusions: Although the increased risks for adverse outcome in offspring associated with high birth weight and LGA represent serious health effects in childhood and in adulthood, the size of these effects seems moderate. The identified risk association should, however, be taken into account in decisions concerning fresh and frozen ART cycles and is of general importance in view of the increasing prevalence in high birthweight babies.Peer reviewe