Health and Care in preconception and reproductive life

Health conditions and risk factors can affect fertility and pregnancy outcome. Preconception health refers to the health of women and men during their reproductive years. It focuses on taking steps now to protect the health of a baby they might have sometime in the future.

Preconception care describe childbearing-related health care for women and men before pregnancy.

Sexual dysfunction and infertility-related stress among women and men with involuntary infertility

Sexuality has a central role in the health of individuals and a significant impact on several aspects of life. Involuntary childlessness is a common condition. Previous studies have reported that there is a possible interplay between involuntary childlessness and sexual function in women and men. However, the area is insufficiently studied and studies in a Swedish context are lacking. The purpose of the study is to investigate the prevalence of sexual dysfunction in women and men seeking treatment for infertility, to explore the relationship between perceived infertility-related stress and sexual dysfunction, and to investigate possible differences in the prevalence of sexual dysfunction and its relationship with infertility-related stress between genders and persons with different sexual orientations.

The study population will consist of women and men with infertility problems. Participants will be given web-based questionnaires to complete at the clinic or at home. Women and men participating in the study will be followed up with questionnaires after at least one fertility treatment, to evaluate possible changes over time and after fertility treatment.

Finans

ALF medel Region Uppsala, FPF

Ansvarig

Stavros Iliadis
PhD student: Lisa Lindgren, kurator

Completed projects

Sexual health and reproduction among women and young adults with intellectual disability

The aim of Berit Höglund’s thesis was to investigate pregnancy and childbirth in women with intellectual disability (ID), in Sweden, the health of their newborns and midwifery care. Mothers with ID had more complicated births and their newborns had a higher proportion of preterm births, were small for gestational age, stillborn or died in the perinatal period. The women with ID struggled to attain motherhood and feared to lose custody of the child. Midwives stated it was different to care for women with ID and requested additional knowledge. Women with ID and their children should be considered as risk groups and professionals need to elucidate their knowledge and skills for counselling and supporting this group of women. The project has continued with an investigation of health and health risks among children born to mothers with intellectual disability. The children have an increased risk for mental health problems as well as injuries, violence and child abuse early in childhood. Further work was focused by interview studies regarding sexual health and reproduction among staff’s experience and perceptions regarding sexual and reproductive health about young adults with ID. Interview studies regarding sexual health and reproduction among young adults with ID and their parents are also planned.

Collaborations

Berit Höglund
Margareta Larsson
Maria Wickström
Maria Lundgren

Funding

Sävstaholm Foundation and Uppsala University
European Society of Contraception and Reproductive Health

Responsible researcher/contact person

Berit Höglund, berit.hoglund@kbh.uu.se

Motherhood by medically assisted reproduction (MAR)

Reproductive health includes the individual's capability to reproduce and the ability to give birth to a child is fundamental to most women. Infertility is a reproductive failure affecting 10-15% of all couples. The main objective of the research was to determine the prevalence of mood and anxiety disorders and related risk factors in infertile women and men undergoing assisted reproductive technology (ART). Further research was to follow the same cohort five years after undergoing ART, results indicating that psychiatric disorders were less common than at baseline assessment. The majority of women and men were at five-year follow-up living with children, as a result from live birth after ART, spontaneous pregnancy and/or adoption. However, almost one out of five women had no live birth at follow-up.

After a new legislation in 2016, giving single mothers by choice access to medically assisted reproduction (MAR), a new study was conducted. The objective was to assess characteristics and motivations of single women as well as to explore the decision making to choose motherhood by assisted reproduction. Designs were both quantitative and qualitative and the studies are published.

Collaborators

Schmidt L. MD, PhD, Professor, Dept. of Public Health, University of Copenhagen, Denmark

Responsible researcher/contact person

Helena Volgsten helena.volgsten@kbh.uu.se

Publications

Helena Volgsten & Lone Schmidt (2021) Motherhood through medically assisted reproduction – characteristics and motivations of Swedish single mothers by choice, Human Fertility, 24:3, 219-225, https://DOI: 10.1080/14647273.2019.1606457

Helena Volgsten & Lone Schmidt (2021) Exploring Swedish single women’s decision to choose motherhood through medically assisted reproduction – a qualitative study, Human Fertility,DOI: 10.1080/14647273.2021.2017026

The effect of endometrial scratch and the role of microbiota and transcriptome in women with unexplained recurrent implantation failure

Despite the recent advances in assisted reproductive treatments, the success rate of in-vitro fertilization (IVF) is still low. This depends mainly on the limited implantation rate. Recurrent implantation failure (RIF) occurs in 5-10% of women undergoing IVF cycles. RIF can be defined as the failure to achieve a clinical pregnancy after transfer of at least four good quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40. In women with unexplained RIF, suboptimal endometrial receptivity is considered as a key factor in impaired implantation.

Studies have shown that endometrial scratch can improve clinical pregnancy rate and live birth rate in women undergoing IVF treatment, by causing endometrial injury possibly through improved endometrial receptivity.

Molecular studies analyzing endometrial gene expression among these women demonstrate aberrant endometrial regulation. There is, however, a new set of factors – microbial communities (i.e. microbiota) that could influence the gene expression and that seem to have an important role in endometrial function.

The aims of this project are:

To evaluate the benefits and the side effects of endometrial scratch in women with unexplained RIF.
To identify microorganisms from endometrium and other mucosal sites of the body (cervix, bladder, gut, mouth) that could be associated with RIF.
To identify transcription markers in women with unexplained RIF.

Collaborators

University of Granada, Spain.
Stanford University Medical Center, USA
Ludwig-Maximilians University Munich, Germany
University of Tartu Women’s Clinic, Estonia

Funding

Region Uppsalas riktade FoU medel
Gedeon Richter

Responsible researchers

Stavros Iliadis, MD, PhD, stavros.iliadis@kbh.uu.se
Pu Zhang, MD, PhD, pu.zhang@akademiska.se