Social freezing of oocytes: a means to take control of your fertility.

In the last few decades, there have been tremendous developments of assisted reproductive technologies, but the outcome of in vitro fertilization is highly dependent on the age of the oocyte. The introduction of vitrification offers a possibility to freeze eggs proactively in younger years and use them at later ages, also called social egg freezing. Knowledge about age-related fertility decline is insufficient among many women, and there is an overoptimistic trust that in vitro fertilization can overcome this. The awareness of proactive egg freezing is limited, both among doctors and in the general population. This review aims at increasing the knowledge about proactive egg freezing and offers a means to advise women correctly. It deals with national guidelines, the best age and optimal number of eggs to freeze, and the chance to succeed. Creating more public awareness about age-linked fertility decline and elective egg freezing may help women reproduce at their own pace - to take control of their fertility.

Elective oocyte freezing for nonmedical reasons: a 6-year report on utilization and in vitro fertilization results from a Swedish center.

INTRODUCTION: Elective oocyte freezing started in Sweden in 2011, a few years after oocyte vitrification was introduced internationally as an effective method for cryopreservation of oocytes. The objective of this study is to describe the age of the women who choose to undergo this procedure, the subsequent utilization of cryopreserved oocytes and the results of autologous in vitro fertilization (IVF). MATERIAL AND METHODS: We conducted a descriptive follow-up study of a subset of women at a private IVF center. All women (n = 254) who electively vitrified oocytes at Nordic IVF Göteborg between 1 August 2011 and 31 August 2017 were included. Ages at oocyte vitrification and warming, number of vitrified oocytes and results of IVF are presented. RESULTS: A total of 254 women underwent elective oocyte freezing and 38 (15%) of these returned to use their cryopreserved oocytes for autologous IVF before November 2018. In the total cohort, the mean number of vitrified oocytes per woman, undergoing one or more oocyte retrievals, was 7.6 (range 1-37). Their mean age at first vitrification was 36.9 years (range 23-43 years). The mean ages for the subset of women that subsequently used their oocytes for IVF were 38.7 and 42.7 years at vitrification and oocyte warming, respectively. Forty-nine oocyte warming cycles resulting in 42 fresh and 16 frozen embryo transfers, have been performed. Cumulative live birth rate/ongoing pregnancy rates are 63%, 26% and 0% in women of ages 36-37, 38-39 and ≥40 years of age at vitrification, respectively. Five babies have been born and there are 5 ongoing pregnancies. CONCLUSIONS: Elective oocyte freezing has been offered in Sweden for >7 years. The utilization rate has so far been low. Pregnancy results after oocyte warming and IVF are encouraging when oocytes are cryopreserved at an age below 40 years.

Online Perceptions of Mothers About Breastfeeding and Introducing Formula: Qualitative Study.

BACKGROUND: Although the benefits of breastfeeding are well established for babies and their mothers, many women give formula to their infants. Whether to breastfeed or to give infant formula is a complex decision to make. Many parents use the Internet to find information and support that relate to infant feeding decisions. OBJECTIVE: The aim of this study was to analyze the perceptions of mothers, who are discussing the topic on Web forums, about introducing infant formula. METHODS: This is a qualitative, descriptive, and cross-sectional study on online data from parenting Web forums. The text was analyzed using qualitative content analysis. RESULTS: The analysis resulted in 1 main theme, "balancing between social expectations and confidence in your parental ability," which is further divided into 3 themes: "striving to be a good mother," "striving for your own well-being," and "striving to discover your own path." CONCLUSIONS: Breastfeeding is complex, and health care personnel can, with a more open approach toward formula, create better support for mothers by helping them to be more confident in their parental ability.

Effect of maternal age on maternal and neonatal outcomes after assisted reproductive technology.

OBJECTIVE: To compare the effect of maternal age on assisted reproductive technology (ART) and spontaneous conception (SC) pregnancies regarding maternal and neonatal complications. DESIGN: Nordic retrospective population-based cohort study. Data from national ART registries were cross-linked with national medical birth registries. SETTING: Not applicable. PATIENT(S): A total of 300,085 singleton deliveries: 39,919 after ART and 260,166 after SC. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Hypertensive disorders in pregnancy (HDP), placenta previa, cesarean delivery, preterm birth (PTB; <37 weeks), low birth weight (LBW; <2,500 g), small for gestational age (SGA), and perinatal mortality (≥28 weeks). Adjusted odds ratios (AORs) were calculated. Associations between maternal age and outcomes were analyzed. RESULT(S): The risk of placenta previa (AOR 4.11-6.05), cesarean delivery (AOR 1.18-1.50), PTB (AOR 1.23-2.19), and LBW (AOR 1.44-2.35) was significantly higher in ART than in SC pregnancies for most maternal ages. In both ART and SC pregnancies, the risk of HDP, placenta previa, cesarean delivery, PTB, LBW, and SGA changed significantly with age. The AORs for adverse neonatal outcomes at advanced maternal age (>35 years) showed a greater increase in SC than in ART. The change in risk with age did not differ between ART and SC for maternal outcomes at advanced maternal age. CONCLUSION(S): Having singleton conceptions after ART results in higher maternal and neonatal outcome risks overall, but the impact of age seems to be more pronounced in couples conceiving spontaneously.

Swedish women's food habits during pregnancy up to six months post-partum: A longitudinal study.

OBJECTIVES: Diet influences the health of the foetus and the woman during pregnancy and later in life. It is therefore important to investigate pregnant women's food habits. The aim of this study was to describe women's food habits during pregnancy and up to six months post-partum. STUDY DESIGN: A Food Frequency Questionnaire (VIP-FFQ) was distributed to 163 pregnant women on five occasions during and after pregnancy. Data were analysed using Friedman's ANOVA and a Bonferroni post-hoc test. MAIN OUTCOME MEASURES: Food habits in relation to the National Food Agency's (NFA) food index. RESULTS: The pregnant women's diets were inadequate according to the NFA food index. A tendency towards an even poorer diet after delivery was identified, something which was related to an increased intake of discretionary food, e.g. sweets, cakes, cookies, crisps, ice cream, and decreased intake of fruit and vegetable. The alcohol consumption was low throughout. CONCLUSIONS: The food habits during pregnancy were inadequate compared to recommendations and these habits became unhealthier after delivery. These suggest that dietary counselling needs to be more effective and continued into the lactating period. An increased focus should be given to healthy eating from the life course perspective, not just focus on effects on the foetus and pregnancy outcomes.

Attitudes towards new assisted reproductive technologies in Sweden: a survey in women 30-39 years of age.

INTRODUCTION: Novel pathways to parenthood [oocyte cryopreservation, allowance of surrogacy, uterus transplantation, and assisted reproductive treatments (ART) for single women] are currently being discussed. This study investigates women's attitudes towards oocyte cryopreservation and ART procedures that are not allowed or are still under investigation in Sweden, and whether the attitudes differ between urban women and women from a national cohort. MATERIALS AND METHODS: Two thousand randomly selected Swedish females aged 30-39 years, 1000 residents of Stockholm (urban cohort) and 1000 from the remainder of Sweden (national cohort), were invited to complete a postal questionnaire on attitudes about existing and novel ARTs. RESULTS: Response rates for the national and urban cohorts were 52.1% and 48.9%. Ninety-four per cent of women were positive towards oocyte cryopreservation for medical reasons. Seventy per cent considered that this treatment was also indicated for social reasons. Seventy-six per cent found it acceptable to offer ART to single women. Uterus transplantation was found to be more acceptable than surrogacy (80% vs. 47%). Urban women were more positive to both oocyte cryopreservation for social reasons and fertility treatment of single women than the national cohort. Urban women were also more tolerant regarding age limits for attempting pregnancy with cryopreserved gametes and regarding permission for a longer duration of maintaining cryopreserved gametes. CONCLUSIONS: Swedish women have a high acceptance of most new ARTs, with the exception of surrogacy. Urban women seem to have a greater acceptance for social egg-freezing, longer duration of cryopreservation of oocytes, and higher age limit for their use.

A questioned authority meets well-informed pregnant women--a qualitative study examining how midwives perceive their role in dietary counselling.

BACKGROUND: During pregnancy and afterward, a healthy diet is beneficial for the expecting mother and her foetus. Midwives in antenatal care have an ideal position for promoting healthy diets. Dietary counselling is however complex and recommendations can be controversial. While pregnant women struggle with dietary recommendations, midwives struggle with a lack of authority. The aim of the study was therefore to describe how midwives perceive their role and their significance in dietary counselling of pregnant women. METHODS: An interview study was conducted that involved twenty-one (21) experienced midwives, who worked in the Swedish prenatal health care. A qualitative content analysis was conducted. RESULTS: Pregnant women were perceived to be well informed, but they needed guidance to interpret information on the Internet. They were described as rigorous and eager information seekers who needed guidance to interpret information as they were worried and emotional. The midwives saw themselves as a questioned authority who lacked support. This meant being informative and directive though not always updated or listened to. Their impact was uncertain and they could also lack sufficient competence to counsel in delicate issues. CONCLUSION: The midwives' directive role may obstruct the women's needs to manage the dietary recommendations and risk evaluation in a women-centred dialogue. Midwives need to acknowledge pregnant women as both well informed and skilled if they are going to develop woman-centred antenatal care. Ongoing training and self-reflection will be needed to make this change.

Midwives' strategies in challenging dietary and weight counselling situations.

OBJECTIVE: By enhancing maternal nutritional status, midwives can help women lower the risks of pregnancy complications and adverse birth outcomes as well as improve maternal health during pregnancy and in the long run. Dietary counselling is, on the other hand, not reported to be effective. Poor communication and conflicting messages are identified as possible barriers to adherence with recommendations. Midwives' experiences of providing dietary advice and counselling during pregnancy are sparsely reported. The aim of this study was therefore to explore midwives' strategies when faced with challenging dietary counselling situations. METHODS: Seventeen midwives from different parts of Sweden and working within antenatal health care were interviewed by telephone. The interviews were analysed using qualitative content analysis. RESULTS: Challenges were commonly experienced when counselling women who were overweight, obese, had eating disorders or were from different cultures. The midwives talked in terms of "the problematic women" when addressing counselling problems. Strategies used in challenging counselling situations were Getting acquainted; Trying to support and motivate; Pressure to choose "correctly"; Controlling and mastering; and Resigning responsibility. CONCLUSIONS: The results indicate that Swedish midwives' counselling strategies are quite ambiguous and need to be questioned and that counselling of vulnerable groups of women should be highlighted. We could identify a need for education of practicing midwives to develop person-centred counselling skills.

Women's experiences of dietary advice and dietary changes during pregnancy.

OBJECTIVE: To describe women's experiences of dietary information and the change of dietary habits during pregnancy. DESIGN: A qualitative design was used. In 2007 we conducted six focus group interviews using open-ended questions. SETTINGS: five rural and city antenatal clinics in northern Sweden were included PARTICIPANTS: Twenty-three women in mid-pregnancy participated in groups of three to seven FINDINGS: Three domains were found 'Dietary information gain', 'Reactions to dietary information' and 'Dietary management'. The women had to discover dietary information by themselves, and only when health problems or symptoms occurred did they receive guidance from the midwife. Their reactions to the dietary information were 'being confused', 'feeling fear and guilt' and 'being monitored', summed up in 'being uncertain'. The diet was managed by 'checking food content', 'following bodily signals', 'using common sense', and 'making exceptions', summed up as 'being responsible but with a pinch of salt'. KEY CONCLUSIONS: The women expressed problems with dietary changes, but they could mostly manage them on their own. The pregnant women experienced that the midwives gave dietary information and advice first when problems arise. When struggling with diet, the women experienced confusion, and they had to seek information by themselves. IMPLICATIONS FOR PRACTICE: Sources of information about diet during pregnancy were experienced as inconsistent and contradictory. Midwives are important in motivation for healthy lifestyle during pregnancy and with sufficient dietary knowledge and counselling skills they can help pregnant women effect dietary changes by providing guidance and support in early pregnancy.

Genetic influences are important for most but not all lower urinary tract symptoms: a population-based survey in a cohort of adult Swedish twins.

BACKGROUND: The relative importance of genetic and environmental factors for the occurrence of lower urinary tract symptoms (LUTS) is poorly understood. OBJECTIVE: To (1) estimate the prevalence of urinary incontinence (UI), overactive bladder (OAB), and other LUTS and (2) to assess the heritability of these symptoms. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of LUTS in a national population-based cohort of Swedish twins 20-46 yr of age (n=42 582) from the Swedish Twin Registry. MEASUREMENTS: Prevalence rates were determined and heritability of LUTS (in female twins) was assessed using indicators of twin similarity. RESULTS AND LIMITATIONS: A total of 25 364 twins completed the questionnaire (response rate: 59.6%). LUTS were more common in women (UI: 7%; OAB: 9%; nocturia: 61%; micturition frequency: 18%) than in men (UI: 1%; OAB: 5%; nocturia: 40%; micturition frequency: 11%), and prevalence increased with age. The strongest genetic effects were observed for UI, frequency, and nocturia. The lowest estimate for genetic effects was observed for OAB where environmental effects dominated, and more specifically shared family environment accounted for a third or more of the total variation. For stress UI, a fifth of the total variation in susceptibility to the disorder could be attributed to shared environment. Nonshared environmental effects were seen in the range of 45-65% for the various LUTS. The prevalence of LUTS was low in the men, and there were too few male cases to compute measures of similarity or heritability estimates. CONCLUSIONS: This study provides robust evidence of a genetic influence for susceptibility to UI, frequency, and nocturia in women. In contrast, shared environmental factors seem more important for the predisposition to develop OAB, which may reflect familial patterns such as learning from parental behaviours.

Lower urinary tract symptoms: lack of change in prevalence and help-seeking behaviour in two population-based surveys of women in 1991 and 2007.

OBJECTIVES: To test the hypothesis that the overt prevalence and help-seeking pattern for lower urinary tract symptoms (LUTS) might have changed over time, by comparing the prevalence of urinary incontinence (UI), overactive bladder (OAB) and other LUTS (principally storage symptoms) and help-seeking pattern in two equivalent groups of women 16 years apart. SUBJECTS AND METHODS: We compared two cross-sectional studies; population-based random samples of women aged ≥20 years in the central district of Gothenburg in 1991 (2911) and 2007 (3158) were asked to complete similar self-administered postal questionnaires regarding UI and other LUTS. RESULTS: The mean (sd, range) age of the two groups was 48.1 (20.4, 20-98) years in 1991 and 46.2 (20.0, 20-101) years in 2007, respectively. When comparing the two study populations there were no significant differences in the reported prevalence of UI, OAB or nocturia (defined as two or more voids per night) over time. Nocturia according to the International Continence Society definition was significantly more prevalent in 2007 than 1991, as was daytime voiding frequency of eight or more times a day. OAB dry (i.e. with no incontinence) was more common in 1991, while OAB wet (i.e. with incontinence) was more prevalent in 2007. Of the women in 1991 and 2007, 6% and 7%, respectively, had sought help from the healthcare system due to UI. Significantly more women in 2007 than in 1991 stated that the presence of UI limited their social life (29% vs 13%, P < 0.001). CONCLUSION: LUTS are common in women and the prevalence rates of UI and OAB have not changed during the last 16 years. Many women still do not seek help from the healthcare system, and the help-seeking pattern has remained unchanged, despite effective treatment currently being offered.

A longitudinal population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in women.

BACKGROUND: Female urinary incontinence (UI), overactive bladder (OAB), and other lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on well-being and quality of life. There are a few studies describing progression as well as remission, in the short term, of UI in the general population as well as in selected groups; at present, there are very few population-based studies describing the natural course of other LUTS in the same women, and there are no long-term longitudinal studies. OBJECTIVE: To describe the prevalence of UI, OAB, and other LUTS in the same women studied prospectively over time and, thus, to assess possible progression or regression. DESIGN, SETTING, AND PARTICIPANTS: A longitudinal population-based study was performed in one primary health care district in the city of Gothenburg, Sweden. The participants were a sample of women aged > or = 20 yr who were randomly selected from the Swedish National Population Register, assessed in 1991 (n=2911), and available for reassessment in 2007 (n=1408). METHODS: A self-administered postal questionnaire regarding UI, OAB, and other LUTS was returned by 77% of the contacted women in 1991. The same women who responded in 1991 and who were still alive and available in the Swedish National Population Register 16 yr later were reassessed using a similar self-administered postal questionnaire. RESULTS AND LIMITATIONS: In 2007, 1081 of the available 1408 women responded to the questionnaire (77%). The overall prevalence of UI, OAB, nocturia, and daytime micturition frequency of eight or more times per day increased by 13%, 9%, 20% (p<0.001), and 3% (p<0.05), respectively, from 1991 to 2007. The incidence of UI and OAB were 21% and 20%, respectively, and the corresponding remission rates were 34% and 43%, respectively. Women with OAB symptoms were classified as OAB dry or OAB wet, depending on the presence or absence of concomitant UI. The prevalence of OAB dry did not differ between the two assessment occasions (11% and 10%, respectively), but the prevalence of OAB wet increased from 6% to 16% (p<0.001). CONCLUSIONS: UI and other LUTS constitute dynamic conditions. In this study, there was a marked overall increase in the prevalence of UI, OAB, and nocturia in the same women from 1991 to 2007. Both incidence and remission of most symptoms were considerable.

[8 out of 10 midwives informed about folic acid. Most of them considered their knowledge about folic acid not sufficient]. / 8 av 10 barnmorskor gav information om folsyra. De flesta ansåg sig ha otillräckliga kunskaper.

UNLABELLED: Deficiency of folic acid increases the risk for neural tube defects among newborn children and megaloblastic anaemia in the mother. The aim of this study was to make a survey of how midwives working in maternity health care, family planning guidance, and specialist prenatal care in a Swedish county inform women of childbearing age about folic acid. The questionnaire study showed that 79% of the midwives informed the women about folic acid. Usually, the women received information first when they asked for it and midwifes were less prone to inform young women about folic acid. 87% of the midwives felt that they did not know enough about folic acid. CONCLUSIONS: Midwives play an important role in information about the need of folic acid intake for women in childbearing age. Changes in local routines, guidelines and further education of midwifes would subsequently provide information about the importance of folic acid to women in childbearing age.

Stamey's abdominovaginal needle colposuspension for the correction of female genuine stress urinary incontinence--long-term results.

OBJECTIVES: To evaluate the long-term continence rate, subjective satisfaction and treatment-associated morbidity in a carefully selected group of patients undergoing Stamey bladder neck suspension. MATERIAL AND METHODS: We studied 24 women with objectively validated genuine stress urinary incontinence (GSI) who were treated using the Stamey needle colposuspension method. Follow-up was performed by means of a questionnaire, a urodynamic assessment and a new standardized quantification test. Time to follow-up ranged from 28 to 100 months (mean 63 months). RESULTS: Of the 24 patients, 20 (83%) reported an improvement in clinical symptoms for a mean of 37 (range 12-84) months at the evaluation and 10 (42%) were completely continent after the Stamey procedure. Four patients (17%) reported a poor outcome of the operation, but in only one case could this be related to recurrent GSI. Treatment-associated morbidity was low but the frequency of postoperative urgency symptoms was higher than that reported in other studies (21%). CONCLUSION: In a selected population of pure GSI patients with no demonstrable detrusor overactivity, the Stamey bladder neck suspension procedure appears a feasible therapeutic option with few complications.