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La acuicultura contribuye de manera importante a la fuente de alimento destinado al consumo humano. La tilapia Oreochromis niloticus es uno de los peces principales de la producción acuícola, por lo que las fases de su reproducción son vitales para asegurar la calidad y cantidad de organismos disponibles para los sistemas de producción. Los parámetros reproductivos en actividades acuícolas de peces, como la fertilidad, fecundidad, diámetro de huevos, índice gonadosomático, tasa de supervivencia en larvas y alevines, entre otros, son de relevancia para una producción económicamente rentable y sostenible, y estos pueden variar según la dieta, condiciones ambientales, edad, características genéticas de los peces o la calidad del agua. Por lo anterior, este documento tiene como objetivo identificar los parámetros reproductivos que tengan una influencia en la producción de crías de tilapia presentar una descripción general de forma sencilla los diferentes parámetros reproductivos involucrados y de consideración en actividades de producción acuícola de crías de tilapia. Se realizó una búsqueda de la información en los últimos 20 años incorporada en diversas bases de datos especializadas. En esta investigación se recopila la información a la actualidad sobre los parámetros reproductivos en tilapia, y los resultados indican que no existe un parámetro reproductivo más importante que otro, ya que es un cúmulo de factores y sinergia que intervienen en la reproducción, por lo que resulta necesario establecer planes de manejo claro e investigación particular en los sistemas de producción para mejorar y potencializar su producción. El conocimiento de los parámetros reproductivos de la tilapia puede ayudar a disminuir los costos de producción para establecer planes de manejo claro e investigación particular en los sistemas de producción para mejorar y potencializar su producción. of the main fish in aquaculture production, so its reproduction phases are vital to ensure the quality, La acuicultura contribuye de manera importante a la fuente de alimento destinado al consumo humano. La tilapia Oreochromis niloticus es uno de los peces principales de la producción acuícola, por lo que las fases de su reproducción son vitales para asegurar la calidad y cantidad de organismos disponibles para los sistemas de producción. Los parámetros reproductivos en actividades acuícolas de peces, como la fertilidad, fecundidad, diámetro de huevos, índice gonadosomático, tasa de supervivencia en larvas y alevines, entre otros, son de relevancia para una producción económicamente rentable y sostenible, y estos pueden variar según la dieta, condiciones ambientales, edad, características genéticas de los peces o la calidad del agua. Por lo anterior, este documento tiene como objetivo identificar los parámetros reproductivos que tengan una influencia en la producción de crías de tilapia presentar una descripción general de forma sencilla los diferentes parámetros reproductivos involucrados y de consideración en actividades de producción acuícola de crías de tilapia. Se realizó una búsqueda de la información en los últimos 20 años incorporada en diversas bases de datos especializadas. En esta investigación se recopila la información a la actualidad sobre los parámetros reproductivos en tilapia, y los resultados indican que no existe un parámetro reproductivo más importante que otro, ya que es un cúmulo de factores y sinergia que intervienen en la reproducción, por lo que resulta necesario establecer planes de manejo claro e investigación particular en los sistemas de producción para mejorar y potencializar su producción. El conocimiento de los parámetros reproductivos de la tilapia puede ayudar a disminuir los costos de producción para establecer planes de manejo claro e investigación particular en los sistemas de producción para mejorar y potencializar su producción.

La acuicultura contribuye de manera importante a la fuente de alimento destinado al consumo humano. La tilapia Oreochromis niloticus es uno de los peces principales de la producción acuícola, por lo que las fases de su reproducción son vitales para asegurar la calidad y cantidad de organismos disponibles para los sistemas de producción. Los parámetros reproductivos en actividades acuícolas de peces, como la fertilidad, fecundidad, diámetro de huevos, índice gonadosomático, tasa de supervivencia en larvas y alevines, entre otros, son de relevancia para una producción económicamente rentable y sostenible, y estos pueden variar según la dieta, condiciones ambientales, edad, características genéticas de los peces o la calidad del agua. Por lo anterior, este documento tiene como objetivo identificar los parámetros reproductivos que tengan una influencia en la producción de crías de tilapia presentar una descripción general de forma sencilla los diferentes parámetros reproductivos involucrados y de consideración en actividades de producción acuícola de crías de tilapia. Se realizó una búsqueda de la información en los últimos 20 años incorporada en diversas bases de datos especializadas. En esta investigación se recopila la información a la actualidad sobre los parámetros reproductivos en tilapia, y los resultados indican que no existe un parámetro reproductivo más importante que otro, ya que es un cúmulo de factores y sinergia que intervienen en la reproducción, por lo que resulta necesario establecer planes de manejo claro e investigación particular en los sistemas de producción para mejorar y potencializar su producción. El conocimiento de los parámetros reproductivos de la tilapia puede ayudar a disminuir los costos de producción para establecer planes de manejo claro e investigación particular en los sistemas de producción para mejorar y potencializar su producción. of the main fish in aquaculture production, so its reproduction phases are vital to ensure the quality, La acuicultura contribuye de manera importante a la fuente de alimento destinado al consumo humano. La tilapia Oreochromis niloticus es uno de los peces principales de la producción acuícola, por lo que las fases de su reproducción son vitales para asegurar la calidad y cantidad de organismos disponibles para los sistemas de producción. Los parámetros reproductivos en actividades acuícolas de peces, como la fertilidad, fecundidad, diámetro de huevos, índice gonadosomático, tasa de supervivencia en larvas y alevines, entre otros, son de relevancia para una producción económicamente rentable y sostenible, y estos pueden variar según la dieta, condiciones ambientales, edad, características genéticas de los peces o la calidad del agua. Por lo anterior, este documento tiene como objetivo identificar los parámetros reproductivos que tengan una influencia en la producción de crías de tilapia presentar una descripción general de forma sencilla los diferentes parámetros reproductivos involucrados y de consideración en actividades de producción acuícola de crías de tilapia. Se realizó una búsqueda de la información en los últimos 20 años incorporada en diversas bases de datos especializadas. En esta investigación se recopila la información a la actualidad sobre los parámetros reproductivos en tilapia, y los resultados indican que no existe un parámetro reproductivo más importante que otro, ya que es un cúmulo de factores y sinergia que intervienen en la reproducción, por lo que resulta necesario establecer planes de manejo claro e investigación particular en los sistemas de producción para mejorar y potencializar su producción. El conocimiento de los parámetros reproductivos de la tilapia puede ayudar a disminuir los costos de producción para establecer planes de manejo claro e investigación particular en los sistemas de producción para mejorar y potencializar su producción.

Study question: What is the effect of a blended preconception lifestyle programme on reproductive and lifestyle outcomes of couples going through their first 12 months of IVF as compared to an attention control condition? Summery answer: This randomized controlled trial (RCT) was stopped prematurely because of the coronavirus disease 2019 (Covid-19) pandemic but the available data did not suggest that a blended preconception lifestyle programme could meaningfully affect time to ongoing pregnancy or other reproductive and lifestyle outcomes. What is know already: Increasing evidence shows associations between a healthy lifestyle and IVF success rates. Lifestyle programmes provided through a mobile phone application have yet to be evaluated by RCTs in couples undergoing IVF. Study design, size, duration: A multicentre RCT (1:1) was carried out. The RCT started in January 2019 and was prematurely stopped because of the Covid-19 pandemic, leading to a reduced sample size (211 couples initiating IVF) and change in primary outcome (cumulative ongoing pregnancy to time to ongoing pregnancy). Participants/materials, setting, methods: Heterosexual couples initiating IVF in five fertility clinics were randomized between an attention control arm and an intervention arm for 12 months. The attention control arm received treatment information by mobile phone in addition to standard care. The intervention arm received the blended preconception lifestyle (PreLiFe)-programme in addition to standard care. The PreLiFe-programme included a mobile application, offering tailored advice and skills training on diet, physical activity and mindfulness, in combination with motivational interviewing over the telephone. The primary outcome was 'time to ongoing pregnancy'. Secondary reproductive outcomes included the Core Outcome Measures for Infertility Trials and IVF discontinuation. Changes in the following secondary lifestyle outcomes

Recessive alleles have been shown to directly affect both human Mendelian disease phenotypes and complex traits. Pedigree studies also suggest that consanguinity results in increased childhood mortality and adverse health phenotypes, presumably through penetrance of recessive mutations. Here, we test whether the accumulation of homozygous, recessive alleles decreases reproductive success in a human population. We address this question among the Namibian Himba, an endogamous agro-pastoralist population, who until very recently practiced natural fertility. Using a sample of 681 individuals, we show that Himba exhibit elevated levels of inbreeding, calculated as the fraction of the genome in runs of homozygosity (FROH). Many individuals contain multiple long segments of ROH in their genomes, indicating that their parents had high kinship coefficients. However, we do not find evidence that this is explained by first-cousin consanguinity, despite a reported social preference for cross-cousin marriages. Rather, we show that elevated haplotype sharing in the Himba is due to a bottleneck, likely in the past 60 generations. We test whether increased recessive mutation load results in observed fitness consequences by assessing the effect of FROH on completed fertility in a cohort of postreproductive women (n = 69). We find that higher FROH is significantly associated with lower fertility. Our data suggest a multilocus genetic effect on fitness driven by the expression of deleterious recessive alleles, especially those in long ROH. However, these effects are not the result of consanguinity but rather elevated background identity by descent.

STUDY QUESTION: Do women with endometriosis have lower first live birth rate before surgical diagnosis than women without verified endometriosis? SUMMARY ANSWER: Compared to reference women, the incidence of first live birth was lower in women prior to surgical verification of endometriosis irrespective of the type of endometriosis. WHAT IS KNOWN ALREADY: Endometriosis is associated with pain and reduced fertility. The mechanism of infertility is partly explained by anatomical, endocrinological, and immunological changes. Over the past decades, the treatment of both endometriosis and infertility has evolved. Knowledge of fertility far before surgical diagnosis of endometriosis in large cohorts and of different types of endometriosis has been lacking. The diagnostic delay of endometriosis is long, 6–7 years. STUDY DESIGN, SIZE, DURATION: Retrospective population-based cohort study focused on the time period before the surgical verification of endometriosis. All women with surgical verification of endometriosis in 1998–2012 were identified from the Finnish Hospital Discharge Register and the reference cohort from the Central Population Register. Data on deliveries, gynecological care, and sociodemographic factors before the surgical diagnosis were gathered from Finnish national registers maintained by the Finnish Institute for Health and Welfare, the Digital and Population Data Services Agency, and Statistics Finland. PARTICIPANTS/MATERIALS, SETTING, METHODS: All women aged 15–49 years at the time of surgical verification of endometriosis (ICD-10: N80.1–N80.9) in Finland during 1998–2012 were identified (n = 21 620). Of them, we excluded women born in 1980–1999 due to the proximity of the surgical diagnosis (n = 3286) and women left without reference (n = 10) for the final endometriosis cohort of 18 324 women. From the final cohort, we selected sub-cohorts of women with isolated diagnosis of ovarian (n = 6384), peritoneal (n = 5789), and deep (n = 1267) endom

Inflammatory bowel diseases (IBD) often present in adolescence or early adulthood and is thus frequently diagnosed in men and women in their reproductive age. Previous population-based studies of fertility in patients with IBD are scarce. From the Swedish National Patient Register (NPR) all patients diagnosed with IBD of fertile age between 1964–2014 were identified. Statistics Sweden identified a matched reference cohort (ratio 1:5) from the general population matched for sex, age and place of birth. Children born were identified through the Medical Birth Register and the Swedish Multigeneration Register. For subgroup analyses information about medication was collected through Medical Drug Register and information about socioeconomic status from Longitudinal Integrated Database for Health Insurance and Labour Market Studies. From the SWedish Inflammatory Bowel disease quality REGister (SWIBREG) a cohort of women with UC who underwent colectomy 2000–2020 was identified. Demographic data from SWIBREG and information from a study specific questionnaire regarding reproductive history and voluntary childlessness were analysed. From the NPR 27,331 women and 29,104 men with IBD were identified, corresponding to 272,793 matched individuals. The fertility rate in women with IBD was 1.52 (standard deviation [SD] 1.22) births per 1000 person-years, compared with 1.62 (SD 1.28) (p <0.001) in the matched reference cohort. Fertility was negatively affected mainly in women with Crohn's disease (CD) and IBD-unclassified (IBD-U) and to a lesser extent in ulcerative colitis (UC). Disease activity, bowel resections and, in the case of CD, also perianal disease further adversely affected fertility. For women with UC and IBD-U, but not for women with CD, fertility improved throughout the study period. Contraceptive use was higher in female IBD patients, both before and after the diagnosis. In total 2,989 women underwent colectomy during the study period. Reconstruction with ileal po

Severe obesity influences sex hormone levels in women, which may result in subfertility, menstrual disturbances, anovulation and hyperandrogenism as well as increased risk for complications during pregnancy and birthing. Bariatric surgery leads to long-term weight loss and resolution of several comorbidities including hormone imbalance. However, the impact of altered sex hormones in women with obesity is insufficiently understood. Little is known concerning potential influences of changed sex hormone levels on women's function and quality of life following bariatric surgery and subsequent weight loss. This thesis aims to understand sex hormone balance in women with severe obesity and after bariatric surgery and to explore women’s experiences of changes in life after bariatric surgery and weight loss. Study I included 100 women and utilized blood assay to investigate changes in serum sex- hormone levels and questionnaires concerning sexual function and health-related quality of life (HRQoL) in women with severe obesity before and one year after bariatric surgery. Findings from Study I indicated that testosterone and sex hormone binding globulin normalized, and questionnaires showed improvements in several domains of sexual function, psychological well-being and general health in women one year after surgery. Study II used a qualitative method, specifically thematic analysis, to explore women's pre- and postoperative experiences, indicating that increased fertility and achieved motherhood were motivating factors to undergo bariatric surgery. Fourteen women were interviewed, and the themes of “Experiencing Motherhood and Femininity” and “Achieving a Normal Life” emerged from the data. Study III applied the qualitative method with Gadamer’s hermeneutic analysis to understand the lived experiences of premenopausal women with obesity before and after having undergone bariatric surgery. A focus was on influences of altered sex hormones and potential restoration o

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age, affecting many aspects of women’s health such as fertility, cardiovascular health and quality of life. However, less is known about later life stages, as well as the impact of hyperandrogenism and PCOS itself, apart from risks associated with excess body weight. The overall aim with this thesis was therefore to study how PCOS, and its hyperandrogenic phenotype, is associated with general health, with focus on diabetes, hypertension, dyslipidaemia and fertility at a longer span of time than during the fertile period. Studies I-III were register-based cohort studies, linking six Swedish national registers. In total, >50 000 women with PCOS and ≈ 250 000 controls were included and followed up for up to 20 years. Study IV was a clinical cross-sectional study including 124 women with PCOS and 74 controls. The main results were that PCOS has a great impact on women’s lives extending beyond the fertile period. While women with PCOS achieve a first childbirth as often as non-PCOS women, they have fewer children overall and give birth at a later age. In addition, PCOS is a moderate risk factor for type 2 diabetes, hypertension and dyslipidaemia, regardless of body weight. The risk appears to be more pronounced in those with the hyperandrogenic phenotype. Finally, hyperandrogenism persists largely in midlife for women with PCOS, both through ongoing symptoms such as hirsutism and by having a negative impact on the women’s quality of life. In conclusion, women with PCOS should be informed that they have a good chance of conceiving, but that some may need assisted reproduction. We suggest that PCOS in general and the hyperandrogenic phenotype in particular be included as independent risk factors when counselling women on their likelihood to suffer from cardiovascular disease and its risk factors in particular such as type 2 diabetes, hypertension and dyslipidaemia.

Inflammatory bowel diseases (IBD) often present in adolescence or early adulthood and is thus frequently diagnosed in men and women in their reproductive age. Previous population-based studies of fertility in patients with IBD are scarce. From the Swedish National Patient Register (NPR) all patients diagnosed with IBD of fertile age between 1964–2014 were identified. Statistics Sweden identified a matched reference cohort (ratio 1:5) from the general population matched for sex, age and place of birth. Children born were identified through the Medical Birth Register and the Swedish Multigeneration Register. For subgroup analyses information about medication was collected through Medical Drug Register and information about socioeconomic status from Longitudinal Integrated Database for Health Insurance and Labour Market Studies. From the SWedish Inflammatory Bowel disease quality REGister (SWIBREG) a cohort of women with UC who underwent colectomy 2000–2020 was identified. Demographic data from SWIBREG and information from a study specific questionnaire regarding reproductive history and voluntary childlessness were analysed. From the NPR 27,331 women and 29,104 men with IBD were identified, corresponding to 272,793 matched individuals. The fertility rate in women with IBD was 1.52 (standard deviation [SD] 1.22) births per 1000 person-years, compared with 1.62 (SD 1.28) (p <0.001) in the matched reference cohort. Fertility was negatively affected mainly in women with Crohn's disease (CD) and IBD-unclassified (IBD-U) and to a lesser extent in ulcerative colitis (UC). Disease activity, bowel resections and, in the case of CD, also perianal disease further adversely affected fertility. For women with UC and IBD-U, but not for women with CD, fertility improved throughout the study period. Contraceptive use was higher in female IBD patients, both before and after the diagnosis. In total 2,989 women underwent colectomy during the study period. Reconstruction with ileal po

Severe obesity influences sex hormone levels in women, which may result in subfertility, menstrual disturbances, anovulation and hyperandrogenism as well as increased risk for complications during pregnancy and birthing. Bariatric surgery leads to long-term weight loss and resolution of several comorbidities including hormone imbalance. However, the impact of altered sex hormones in women with obesity is insufficiently understood. Little is known concerning potential influences of changed sex hormone levels on women's function and quality of life following bariatric surgery and subsequent weight loss. This thesis aims to understand sex hormone balance in women with severe obesity and after bariatric surgery and to explore women’s experiences of changes in life after bariatric surgery and weight loss. Study I included 100 women and utilized blood assay to investigate changes in serum sex- hormone levels and questionnaires concerning sexual function and health-related quality of life (HRQoL) in women with severe obesity before and one year after bariatric surgery. Findings from Study I indicated that testosterone and sex hormone binding globulin normalized, and questionnaires showed improvements in several domains of sexual function, psychological well-being and general health in women one year after surgery. Study II used a qualitative method, specifically thematic analysis, to explore women's pre- and postoperative experiences, indicating that increased fertility and achieved motherhood were motivating factors to undergo bariatric surgery. Fourteen women were interviewed, and the themes of “Experiencing Motherhood and Femininity” and “Achieving a Normal Life” emerged from the data. Study III applied the qualitative method with Gadamer’s hermeneutic analysis to understand the lived experiences of premenopausal women with obesity before and after having undergone bariatric surgery. A focus was on influences of altered sex hormones and potential restoration o

Severe obesity influences sex hormone levels in women, which may result in subfertility, menstrual disturbances, anovulation and hyperandrogenism as well as increased risk for complications during pregnancy and birthing. Bariatric surgery leads to long-term weight loss and resolution of several comorbidities including hormone imbalance. However, the impact of altered sex hormones in women with obesity is insufficiently understood. Little is known concerning potential influences of changed sex hormone levels on women's function and quality of life following bariatric surgery and subsequent weight loss. This thesis aims to understand sex hormone balance in women with severe obesity and after bariatric surgery and to explore women’s experiences of changes in life after bariatric surgery and weight loss. Study I included 100 women and utilized blood assay to investigate changes in serum sex- hormone levels and questionnaires concerning sexual function and health-related quality of life (HRQoL) in women with severe obesity before and one year after bariatric surgery. Findings from Study I indicated that testosterone and sex hormone binding globulin normalized, and questionnaires showed improvements in several domains of sexual function, psychological well-being and general health in women one year after surgery. Study II used a qualitative method, specifically thematic analysis, to explore women's pre- and postoperative experiences, indicating that increased fertility and achieved motherhood were motivating factors to undergo bariatric surgery. Fourteen women were interviewed, and the themes of “Experiencing Motherhood and Femininity” and “Achieving a Normal Life” emerged from the data. Study III applied the qualitative method with Gadamer’s hermeneutic analysis to understand the lived experiences of premenopausal women with obesity before and after having undergone bariatric surgery. A focus was on influences of altered sex hormones and potential restoration o

BACKGROUND AND AIMS: Colectomy and reconstruction in patients with inflammatory bowel disease (IBD) may adversely affect fertility, but few population-based studies are available. METHODS: Fertility was assessed in 2,989 women and 3,771 men with IBD and prior colectomy 1964-2014, identified from the Swedish National Patient Register, and 35,092 matched individuals. RESULTS: Reconstruction with ileoanal pouch anastomosis (IPAA) was as common as ileorectal anastomosis (IRA) in ulcerative colitis (UC) and IBD-unclassified (IBD-U) while rare in Crohn's disease (CD). Compared with the matched reference cohort, women with IBD had lower fertility overall after colectomy (HR 0.65, CI 0.61-0.69), with least impact leaving the rectum intact (HR 0.79, CI 0.70-0.90). Compared with colectomy only, fertility in female patients remained unaffected after IRA (HR 0.86, CI 0.63-1.17 for UC, 0.86, CI 0.68-1.08 for IBD-U and 1.07, CI 0.70-1.63 for CD), but was impaired after IPAA, especially in UC (HR 0.67CI 0.50-0.88), and after completion proctectomy (HR 0.65, CI 0.49-0.85 for UC, 0.68, CI 0.55-0.85 for IBD-U and 0.61, CI 0.38-0.96 for CD). In men, fertility was marginally reduced post colectomy (HR 0.89, CI 0.85-0.94), regardless of reconstruction. CONCLUSIONS: Fertility was reduced in women after colectomy for IBD. The least impact was seen when a deviated rectum was left intact. IRA was associated with no further reduction in fertility, whereas proctectomy and IPAA were associated with the strongest impairment. IRA therefore seems to be the preferred reconstruction to preserve fertility in selected female patients. Fertility in men was only moderately reduced after colectomy., Funding agencies: FORSS—Medical Research Council of Southeast Sweden [Grant number: FORSS-570791], Futurum—Academy for Health and Care, Region Jönköping County, Sweden [Grant number: FUTURUM-962541]

Inflammatory bowel diseases (IBD) often present in adolescence or early adulthood and is thus frequently diagnosed in men and women in their reproductive age. Previous population-based studies of fertility in patients with IBD are scarce. From the Swedish National Patient Register (NPR) all patients diagnosed with IBD of fertile age between 1964–2014 were identified. Statistics Sweden identified a matched reference cohort (ratio 1:5) from the general population matched for sex, age and place of birth. Children born were identified through the Medical Birth Register and the Swedish Multigeneration Register. For subgroup analyses information about medication was collected through Medical Drug Register and information about socioeconomic status from Longitudinal Integrated Database for Health Insurance and Labour Market Studies. From the SWedish Inflammatory Bowel disease quality REGister (SWIBREG) a cohort of women with UC who underwent colectomy 2000–2020 was identified. Demographic data from SWIBREG and information from a study specific questionnaire regarding reproductive history and voluntary childlessness were analysed. From the NPR 27,331 women and 29,104 men with IBD were identified, corresponding to 272,793 matched individuals. The fertility rate in women with IBD was 1.52 (standard deviation [SD] 1.22) births per 1000 person-years, compared with 1.62 (SD 1.28) (p <0.001) in the matched reference cohort. Fertility was negatively affected mainly in women with Crohn's disease (CD) and IBD-unclassified (IBD-U) and to a lesser extent in ulcerative colitis (UC). Disease activity, bowel resections and, in the case of CD, also perianal disease further adversely affected fertility. For women with UC and IBD-U, but not for women with CD, fertility improved throughout the study period. Contraceptive use was higher in female IBD patients, both before and after the diagnosis. In total 2,989 women underwent colectomy during the study period. Reconstruction with ileal po

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age, affecting many aspects of women’s health such as fertility, cardiovascular health and quality of life. However, less is known about later life stages, as well as the impact of hyperandrogenism and PCOS itself, apart from risks associated with excess body weight. The overall aim with this thesis was therefore to study how PCOS, and its hyperandrogenic phenotype, is associated with general health, with focus on diabetes, hypertension, dyslipidaemia and fertility at a longer span of time than during the fertile period. Studies I-III were register-based cohort studies, linking six Swedish national registers. In total, >50 000 women with PCOS and ≈ 250 000 controls were included and followed up for up to 20 years. Study IV was a clinical cross-sectional study including 124 women with PCOS and 74 controls. The main results were that PCOS has a great impact on women’s lives extending beyond the fertile period. While women with PCOS achieve a first childbirth as often as non-PCOS women, they have fewer children overall and give birth at a later age. In addition, PCOS is a moderate risk factor for type 2 diabetes, hypertension and dyslipidaemia, regardless of body weight. The risk appears to be more pronounced in those with the hyperandrogenic phenotype. Finally, hyperandrogenism persists largely in midlife for women with PCOS, both through ongoing symptoms such as hirsutism and by having a negative impact on the women’s quality of life. In conclusion, women with PCOS should be informed that they have a good chance of conceiving, but that some may need assisted reproduction. We suggest that PCOS in general and the hyperandrogenic phenotype in particular be included as independent risk factors when counselling women on their likelihood to suffer from cardiovascular disease and its risk factors in particular such as type 2 diabetes, hypertension and dyslipidaemia.

Childbirth rates in classical Hodgkin lymphoma (cHL) survivors have historically been reduced compared to the general population. Understanding if contemporary treatment protocols are associated with reduced fertility is crucial as treatment guidelines shift toward more liberal use of intensive chemotherapy. We identified 2834 individuals aged 18-40 years with cHL in Swedish and Danish lymphoma registers, and in the clinical database at Oslo University Hospital diagnosed 1995-2018, who were linked to national medical birth registers. Cox regression adjusted for stage, performance status, year, and age at diagnosis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) contrasting time to first childbirth by treatment groups (ABVD, 2-4 BEACOPP, 6-8 BEACOPP) up to 10 years after diagnosis. Overall, 74.8% of patients were treated with ABVD, 3.1% with 2-4 BEACOPP and 11.2% with 6-8 BEACOPP. Adjusted HRs comparing childbirth rates in individuals treated with 6-8 BEACOPP, and 2-4 BEACOPP to ABVD were 0.53 (CI: 0.36-0.77) and 0.33 (CI: 0.12-0.91) for males, and 0.91 (CI: 0.61-1.34) and 0.38 (CI: 0.12-1.21) for females. Cumulative incidence of childbirths after 10 years was 19.8% (CI: 14.5%-27.0%) for males and 34.3% (CI: 25.8%-45.6%) for females treated with 6-8 BEACOPP. Proportions of children born after assisted reproductive technique (ART) treatments were 77.4% (CI: 60.2-88.6%) for males following 6-8 BEACOPP, and <11% for females. Among ABVD treated patients the corresponding proportions were 12.2% (CI: 8.5%-17.3%) and 10.6% (CI: 7.4%-14.9%). BEACOPP treatment is associated with decreased childbirth rates compared to ABVD in male, but not female, cHL patients, despite widespread access to ART in the Nordics.

Inflammatory bowel diseases (IBD) often present in adolescence or early adulthood and is thus frequently diagnosed in men and women in their reproductive age. Previous population-based studies of fertility in patients with IBD are scarce. From the Swedish National Patient Register (NPR) all patients diagnosed with IBD of fertile age between 1964–2014 were identified. Statistics Sweden identified a matched reference cohort (ratio 1:5) from the general population matched for sex, age and place of birth. Children born were identified through the Medical Birth Register and the Swedish Multigeneration Register. For subgroup analyses information about medication was collected through Medical Drug Register and information about socioeconomic status from Longitudinal Integrated Database for Health Insurance and Labour Market Studies. From the SWedish Inflammatory Bowel disease quality REGister (SWIBREG) a cohort of women with UC who underwent colectomy 2000–2020 was identified. Demographic data from SWIBREG and information from a study specific questionnaire regarding reproductive history and voluntary childlessness were analysed. From the NPR 27,331 women and 29,104 men with IBD were identified, corresponding to 272,793 matched individuals. The fertility rate in women with IBD was 1.52 (standard deviation [SD] 1.22) births per 1000 person-years, compared with 1.62 (SD 1.28) (p <0.001) in the matched reference cohort. Fertility was negatively affected mainly in women with Crohn's disease (CD) and IBD-unclassified (IBD-U) and to a lesser extent in ulcerative colitis (UC). Disease activity, bowel resections and, in the case of CD, also perianal disease further adversely affected fertility. For women with UC and IBD-U, but not for women with CD, fertility improved throughout the study period. Contraceptive use was higher in female IBD patients, both before and after the diagnosis. In total 2,989 women underwent colectomy during the study period. Reconstruction with ileal po

Severe obesity influences sex hormone levels in women, which may result in subfertility, menstrual disturbances, anovulation and hyperandrogenism as well as increased risk for complications during pregnancy and birthing. Bariatric surgery leads to long-term weight loss and resolution of several comorbidities including hormone imbalance. However, the impact of altered sex hormones in women with obesity is insufficiently understood. Little is known concerning potential influences of changed sex hormone levels on women's function and quality of life following bariatric surgery and subsequent weight loss. This thesis aims to understand sex hormone balance in women with severe obesity and after bariatric surgery and to explore women’s experiences of changes in life after bariatric surgery and weight loss. Study I included 100 women and utilized blood assay to investigate changes in serum sex- hormone levels and questionnaires concerning sexual function and health-related quality of life (HRQoL) in women with severe obesity before and one year after bariatric surgery. Findings from Study I indicated that testosterone and sex hormone binding globulin normalized, and questionnaires showed improvements in several domains of sexual function, psychological well-being and general health in women one year after surgery. Study II used a qualitative method, specifically thematic analysis, to explore women's pre- and postoperative experiences, indicating that increased fertility and achieved motherhood were motivating factors to undergo bariatric surgery. Fourteen women were interviewed, and the themes of “Experiencing Motherhood and Femininity” and “Achieving a Normal Life” emerged from the data. Study III applied the qualitative method with Gadamer’s hermeneutic analysis to understand the lived experiences of premenopausal women with obesity before and after having undergone bariatric surgery. A focus was on influences of altered sex hormones and potential restoration o

Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of reproductive age, affecting many aspects of women’s health such as fertility, cardiovascular health and quality of life. However, less is known about later life stages, as well as the impact of hyperandrogenism and PCOS itself, apart from risks associated with excess body weight. The overall aim with this thesis was therefore to study how PCOS, and its hyperandrogenic phenotype, is associated with general health, with focus on diabetes, hypertension, dyslipidaemia and fertility at a longer span of time than during the fertile period. Studies I-III were register-based cohort studies, linking six Swedish national registers. In total, >50 000 women with PCOS and ≈ 250 000 controls were included and followed up for up to 20 years. Study IV was a clinical cross-sectional study including 124 women with PCOS and 74 controls. The main results were that PCOS has a great impact on women’s lives extending beyond the fertile period. While women with PCOS achieve a first childbirth as often as non-PCOS women, they have fewer children overall and give birth at a later age. In addition, PCOS is a moderate risk factor for type 2 diabetes, hypertension and dyslipidaemia, regardless of body weight. The risk appears to be more pronounced in those with the hyperandrogenic phenotype. Finally, hyperandrogenism persists largely in midlife for women with PCOS, both through ongoing symptoms such as hirsutism and by having a negative impact on the women’s quality of life. In conclusion, women with PCOS should be informed that they have a good chance of conceiving, but that some may need assisted reproduction. We suggest that PCOS in general and the hyperandrogenic phenotype in particular be included as independent risk factors when counselling women on their likelihood to suffer from cardiovascular disease and its risk factors in particular such as type 2 diabetes, hypertension and dyslipidaemia.

Introduction: The growing proportion of overweight and obese people worldwide is of great concern as it affects the overall health of people and consequently also their reproductive health. The aim of this literature review is to examine how increased body mass index affects fertility and preconception health in men and women.Methods: A scoping literature review was conducted in February 2021 using PubMed and Medline databases, as well as the Google Scholar search engine. Inclusion criteria consisted of scientific literature, regardless of methodology, and articles published in Slovene and English.Results: The literature search yielded 9 reviews and 5 original quantitative studies published in English in the last 15 years. The results suggest that there is compelling evidence that obese individuals are at increased risk of various health problems in the pre-conception period that may affect their fertility and ability to conceive.Discussion and conclusion: The rising prevalence of high body mass index is changing the reproductive health of men and women. Growing obesity rates, particularly in the Western world, call for greater awareness of this metabolic syndrome and its impact on female and male reproduction. Health professionals working with couples in the pre-conception period should have sufficient knowledge to address the impact of high body mass index on reproductive health and promote a healthy lifestyle., Uvod: Naraščajoča stopnja prekomerne telesne mase in debelosti po vsem svetu ovira zdravje moških in žensk ter posledično vpliva na njihovo reproduktivno zdravje. Namen tega pregleda literature je raziskati, kako povečan indeks telesne mase vpliva na plodnost in zdravje moških in žensk pred spočetjem.Metode: Opravljen je bil pregled literature. Iskanje literature je potekalo februarja 2021 v podatkovnih bazah PubMed in Medline. Drugi iskalni zadetki so bili najdeni s pomočjo Google Učenjaka. Vključitveni kriteriji so zajemali znanstveno literaturo, ne glede na metodološki pristop, v slovenskem in angleškem jeziku.Rezultati: V pregled literature je bilo vključenih devet preglednih in pet izvirnih člankov kvantitativne metodologije. Ugotovitve raziskav kažejo, da imajo posamezniki s povišano telesno težo v predkoncepcijskemobdobju večje tveganje za številne zdravstvene težave, ki lahko vplivajo na njihovo plodnost in sposobnost zanositve.Diskusija in zaključek: Povišanje indeksa telesne mase vpliva na reproduktivno zdravje moških in žensk. Naraščajoča stopnja debelosti predvsem v zahodnem svetu zahteva večjo ozaveščenost o tem presnovnem sindromu in njegovem vplivu na reprodukcijo žensk in moških. Zdravstveni delavci, ki delajo s pari s prekomerno telesno maso v obdobju pred spočetjem, morajo imeti ustrezno znanje za njihovo obravnavo ter spodbujati zdrav način življenja.

De stofwisselingsziekte ketose veroorzaakt grote economische schade, met name door de indirecte effecten op de gezondheid en de vruchtbaarheid van koeien. Met het juiste management kunnen veel problemen worden voorkomen. Maar tussen koeien zijn er ook duidelijk genetische verschillen.

Childbirth rates in classical Hodgkin lymphoma (cHL) survivors have historically been reduced compared to the general population. Understanding if contemporary treatment protocols are associated with reduced fertility is crucial as treatment guidelines shift toward more liberal use of intensive chemotherapy. We identified 2834 individuals aged 18-40 years with cHL in Swedish and Danish lymphoma registers, and in the clinical database at Oslo University Hospital diagnosed 1995-2018, who were linked to national medical birth registers. Cox regression adjusted for stage, performance status, year, and age at diagnosis was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) contrasting time to first childbirth by treatment groups (ABVD, 2-4 BEACOPP, 6-8 BEACOPP) up to 10 years after diagnosis. Overall, 74.8% of patients were treated with ABVD, 3.1% with 2-4 BEACOPP and 11.2% with 6-8 BEACOPP. Adjusted HRs comparing childbirth rates in individuals treated with 6-8 BEACOPP, and 2-4 BEACOPP to ABVD were 0.53 (CI: 0.36-0.77) and 0.33 (CI: 0.12-0.91) for males, and 0.91 (CI: 0.61-1.34) and 0.38 (CI: 0.12-1.21) for females. Cumulative incidence of childbirths after 10 years was 19.8% (CI: 14.5%-27.0%) for males and 34.3% (CI: 25.8%-45.6%) for females treated with 6-8 BEACOPP. Proportions of children born after assisted reproductive technique (ART) treatments were 77.4% (CI: 60.2-88.6%) for males following 6-8 BEACOPP, and <11% for females. Among ABVD treated patients the corresponding proportions were 12.2% (CI: 8.5%-17.3%) and 10.6% (CI: 7.4%-14.9%). BEACOPP treatment is associated with decreased childbirth rates compared to ABVD in male, but not female, cHL patients, despite widespread access to ART in the Nordics.

This paper aims to better understand how contraceptive uptake is influenced by both individual and environmental factors, specifically in sub-Saharan Africa, by comparing Uganda and Kenya as examples of different policy environments. Implementing a literature review and statistical regression, this paper analyses how various factors (including indicators of gender equality, family planning exposure, and socioeconomic and -demographic status) influence differences in female and male use of family planning methods. The findings confirm the importance of socioeconomic status, parity, and education for all groups and find that age has a gendered effect on contraceptive use. Additionally, this study finds that family planning messaging is effective in encouraging contraceptive use, especially for men, and that both opinions on and experience of women’s equality have mixed effects on uptake. This study has potential implications not only for future research but also for policymakers who are concerned with expanding access to and use of contraceptives for all populations with need.

Introduction: This article aimed to study cross-sectional associations between the performance of dairy farms and their corresponding culling proportions under the herd size constraint as imposed in 2018 by the new phosphate regulation in the Netherlands. Methods: To this end, production data from 10,540 Dutch dairy farms were analyzed to capture the inflow and outflow of both primiparous and multiparous cows. Farm performance was measured by 10 indicators structured in four areas of longevity, production, reproduction, and udder health. Farm culling proportions were represented by the overall culling (OC) and the number of culled primiparous cows in relation to (i) the total number of producing cows (PC), (ii) the number of producing primiparous cows (PPC), and (iii) the number of culled producing cows (POC). Spearman's rank correlation and weighted logistic regression were adopted to study associations. Results: In 2018, on average, 28% of producing cows were culled (OC). The number of primiparous cows culled represented 4.5% of the total number of producing cows (PC) and the mean proportion of culled primiparous cows was 18.8% of the total number of producing primiparous cows (PPC), and, of the total number of producing culled cows, 15% were primiparous cows (POC). However, the variance around the mean, and among individual farms, was high (SD 4–15% for all four culling proportions). Results from rank correlation showed very low-rank conformity (<12%) between the areas of production, reproduction, and udder health to the culling proportions. Results from logistic regression showed that higher farm levels of production and higher percentages of cows with poor udder health were associated with more overall culling but with less primiparous culling. For reproduction indicators, the associations were similar for overall and primiparous culling. However, except for the average age of culled animals, the odds ratios for indicators were close to 1 (range: 0.92–1.07 and

Scientists are well aware of the major social, economic and cultural challenges brought about by population decline. However, we can often underestimate the more extreme interpretations of both the causes and the consequences of population decline in the popular discourse. In this commentary, I explore some of these toxic narratives, and speculate about how they may be linked to what appears to be a prevailing populist/ethno-nationalist view of population grounded in political tropes, rather than in scientific reality. Using Armitage’s (2021) concept of “demographic imaginaries”, I argue that much of this public discourse serves several vital purposes: to try to simplify a complex issue; to try to “unify”; to try to blame and scapegoat; and, ultimately, to try to negate the obligation to make tough, complex political and policy decisions. I also argue that scientists working in the field of population decline need to be more aware of these tropes, and should make more active efforts to ground the discourse of population decline in science and reality. I conclude that a bottom-up approach to responding to population decline may be the most fruitful avenue for progress in the future.

Ideal family sizes remain at or above two in most low-fertility settings, but sub-replacement fertility ideals have been reported for urban China. The presence of restrictive family planning policies has led to a debate as to whether such ideals are genuine. This study exploits the ending of the one-child policy and the beginning of a universal two-child policy in October 2015 to investigate whether relaxing the restrictions led to an increase in ideal family size. We apply difference-in-differences and individual-level fixed-effect models to longitudinal data from a near-nationwide survey. For married individuals aged 20-39, relaxing the restrictions from one to two children increased the mean ideal family size by around 0.2 and the proportion who desired two or more children by around 19 percentage points. Findings suggest that although reported ideal family sizes have been reduced by policy restrictions, sub-replacement ideal family sizes in urban China appear to be genuine.

Contemporary trends in low fertility can in part be explained by increasing incentives to invest in offspring’s embodied capital over offspring quantity in environments where education is a salient source of social mobility. However, studies on this subject often rely on homogenous populations, missing out on the opportunity to investigate how this relationship is impacted by structural factors that asymmetrically allocate economic opportunities between members of different groups. Using General Social Survey data from the US, I examine changes in the relationship between number of siblings and college attendance for White and Black respondents throughout the 1900s. Results showed that White individuals from larger families had a lower chance of completing at least four years of college education than individuals from smaller families, while the likelihood for Black individuals was more uniform across family sizes. Though results were not significant for every cohort, racial difference was generally larger in cohorts born in the early 1900s and converged in the later part of the century. These results explain variations in the timing of demographic transitions within subpopulations of a nation and suggest that the benefits of decreasing family size on educational outcomes may be conditional on the specific economic opportunities afforded to a family.

Not all sires have sperm suitable for chilled or frozen storage, and success in artificial insemination (AI) varies highly among individual dogs and breeds. Fertilizing potential is further complicated as sperm quality declines with the aging process. The overall objective of this work was to study the effects of age and mitochondrial function on sperm quality and bioenergetics using traditional methods assessed in the clinical setting, as well as emerging methods of investigating metabolic flexibility and the heterogenous nature of sperm. This dissertation explores the physiology and pathophysiology of canine sperm through the study of a breeding colony of highly fertile Labrador retrievers, and a rapidly aging purebred population of North American Great Danes. This was accomplished in three chapters. Chapter 1, Comparative Oxidative Metabolism in Mammalian Sperm, provides a review of the literature and current understanding of mitochondrial physiology and metabolic control of essential sperm functions in mammalian species of veterinary importance. We discuss the differences in fundamental oxygen and ATP substrate balance in stallions, bulls, and dogs, with an emphasis on the maintenance of sperm motility, electron transport chain (ETC) function, reactive oxygen species (ROS) production, and the balance of glycolytic and oxidative phosphorylation production of ATP in sperm. In Chapter 2, Sperm Parameters in the Great Dane: Influence of Age on Semen Quality, I characterized the distribution of sperm quality parameters within a purebred population of actively showing North American Great Danes, a rapidly aging breed currently suffering declining fertility. I identified progressive declines in sperm quality that accompany aging, detailed the relationship between ROS production and sperm motility and morphology, and distinguished sources of variation in sperm quality within the breed. Age was negatively associated with several sperm motility parameters associated with

Evolutionary success requires both production (acquisition of food, protection and warmth) and reproduction. We suggest that both may increase disproportionately as group size grows, reflecting 'increasing returns' or 'group augmentation benefits', raising fitness in groups that cooperate in production and limit reproduction to one or a few high fertility females supported by non-reproductives, with high reproductive skew. In our optimisation theory both Allee effects (when individual fitness increases with group size or density) and reproductive skew arise when increasing returns determine optimal group size and proportion of reproductive females. Depending on which of food or maternal time is more important for reproduction, evolutionary trajectories of lineages may (1) reach a boundary constraint where only one female reproduces in a period (as with African wild dogs) or (2) reach a boundary where all females reproduce during their lifetimes but only during an early life stage (human menopause) or a late life stage (birds with non-dispersing helpers), where stage length optimises the proportion of females that is reproductive at any time or (3) reach the intersection of these boundary constraints where a single reproductive female is fully specialised in reproduction (as with eusocial insects). We end with some testable hypotheses.

The core components of CRISPR-based gene drives, Cas9 and guide RNA (gRNA), either can be linked within a self-contained single cassette (full gene-drive, fGD) or be provided in two separate elements (split gene-drive, sGD), the latter offering greater control options. We previously engineered split systems that could be converted genetically into autonomous full drives. Here, we examine such dual systems inserted at the spo11 locus that are recoded to restore gene function and thus organismic fertility. Despite minimal differences in transmission efficiency of the sGD or fGD drive elements in single generation crosses, the reconstituted spo11 fGD cassette surprisingly exhibits slower initial drive kinetics than the unlinked sGD element in multigenerational cage studies, but then eventually catches up to achieve a similar level of final introduction. These unexpected kinetic behaviors most likely reflect differing transient fitness costs associated with individuals co-inheriting Cas9 and gRNA transgenes during the drive process.

BackgroundMindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making.MethodsIn 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired sample nonparametric tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically.ResultsSumadhur significantly impacted (p < .05) norms related to pregnancy spacing and timing, and sex preference of children, as well as knowledge about family planning benefits, pregnancy prevention methods, and abortion legality. Family planning intent also increased among newly married women. Qualitative findings revealed improved family dynamics and gender equity, and shed light on remaining challenges.ConclusionsEntrenched social norms surrounding fertility and family planning contrasted with participants' personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.

The pampiniform venous plexus is the system in charge of testicular blood drainage, which is found surrounding the spermatic cord; Varicocele is defined as tortuous varicose dilatation of the veins of the pampiniform plexus, particularly in the scrotal portion. It has been shown that this pathology occurs more frequently in the left testicle, while when it occurs in the right it is extremely important to ensure that an abdominal mass that increases vascular resistance is ruled out. Young people between the ages of 9 and 25 approximately are the ones who have the highest incidence of suffering from a varicocele. This disease is normally not associated with symptoms, but in some circumstances, it can cause pain and give the patient a feeling of heaviness in the testicle, mainly when exercising. Usually, an expectant treatment is carried out, except for those patients who if they suffer symptoms, surgical treatment is recommended., El plexo venoso pampiniforme es el sistema encargado del drenaje sanguíneo testicular, el cual se encuentra rodeando el cordón espermático. El varicocele se define como la dilatación tortuosa de carácter varicosa de las venas del plexo pampiniforme, particularmente en la porción escrotal. Se ha demostrado que esta patología se presenta con más frecuencia en el teste izquierdo. Cuando se presenta en el derecho es de suma importancia asegurarse de descartar una masa abdominal que aumente la resistencia vascular. Los jóvenes entre los 9 y 25 años, aproximadamente, son quienes poseen mayor incidencia a sufrir un varicocele. Esta enfermedad normalmente no está asociada a síntomas, pero en algunas circunstancias puede causar dolor y darle una sensación de pesadez en el teste para el paciente, principalmente al ejercitarse. Usualmente se lleva a cabo un tratamiento expectante, a excepción de aquellos pacientes que sí sufren síntomas, con quienes se recomienda el tratamiento quirúrgico.

Urszula Dudziak. Misterium ludzkiego życia: od poczęcia do umierania. Studium dla duszpasterzy i doradców życia rodzinnego. Lublin: Wydawnictwo KUL, 2021, ss. 197. The reviewed monograph by Urszula Dudziak, a theologian and psychologist from Lublin, is an interdisciplinary familiological and pastoral case study exploring three research areas of paramount importance for the pastoral care of families namely “gender and sexuality”, “fertility and procreation”, and “ageing and dying” of the human being. The aim of the literature research undertaken in the dissertation was to develop an integral anthropological synthesis of human biologism considered in close relation to other personal spheres. The author competently used the monographic method, utilising the methodology of theoretical-cognitive research and drawing extensively on the results of the auxiliary sciences of pastoral theology. The study as a whole is a remarkable example of pastoral personology which translates the assumptions of Christian personalist anthropology into the language of the pastoral practice of the Catholic Church aimed at the integral development of the human person at three particular stages of his or her life namely conception and birth, actualisation of procreative abilities as well aspassing on the gift of life, ageing and dying., Urszula Dudziak. Misterium ludzkiego życia: od poczęcia do umierania. Studium dla duszpasterzy i doradców życia rodzinnego. Lublin: Wydawnictwo KUL, 2021, ss. 197. Recenzowana monografia autorstwa lubelskiej teolog i psycholog, Urszuli Dudziak, stanowi interdyscyplinarne stadium familiologiczne i pastoralne eksplorujące trzy obszary badawcze o pryncypialnym znaczeniu dla duszpasterstwa rodzin: „płciowości i seksualności”, „płodności i prokreacji”, „starzenia się i umierania” człowieka. Celem podjętych w rozprawie badań literaturowych było wypracowanie integralnej syntezy antropologicznej ludzkiego biologizmu rozpatrywanego w ścisłym związku z pozostałymi sferami osobowymi. Autorka kompetentnie posłużyła się metodą monograficzną, wykorzystując metodologię badań teoretycznopoznawczych i szeroko czerpiąc z wyników nauk pomocniczych teologii pastoralnej. Całość opracowania jest dobrym przykładem personologii pastoralnej, która założenia chrześcijańskiej antropologii personalistycznej przekłada na język praktyki pastoralnej Kościoła katolickiego ukierunkowanej na integralny rozwój osoby ludzkiej w trzech szczególnych etapach jej życia: poczęcia i narodzin, aktualizacji zdolności prokreacyjnych i przekazywania daru życia, starzenia się i umierania.

Estrus synchronization (ES) is a valuable technology that can help beef cow-calf producers to overcome infertility caused by prolonged anestrus. Protocols for ES that use progesterone (P4) supplementation are of particular value to cows with prolonged postpartum anestrus as P4 triggers them to begin cycling and allows them to have fertility similar to that of cycling cows. Supplementation of P4 intravaginally with the use of a controlled internal drug release device (CIDR) improves cycle induction when compared to oral administration of P4. Vaginitis has been reported as a side effect to CIDR use in cattle, which raises concerns about its downstream effects on fertility. More specifically, the effects of CIDR use on the vaginal environment requires exploration, as no studies have explored the changes in vaginal microbiome in response to CIDR based ES protocols. In cattle, the vaginal microbiome has not been widely explored. On the contrary, the human vaginal microbiome is a well-defined environment, rich in bacteria from the genus Lactobacillus, which are responsible for promoting an environment of acidic pH. The dominance of Lactobacillus in the human vagina, however, fluctuates according to steroid hormone concentrations, and disruptions in the vaginal environment will cause depletion of Lactobacillus species, increase in vaginal pH and decreased fertility. Based on this data in humans, our objectives were to describe incidence of vaginitis caused by the CIDR in beef cows, as well as the vaginal microbiome changes in response to CIDR based protocols, and explore their relation to fertility. We found high incidences of vaginitis caused by CIDR use, yet CIDR-induced vaginitis did not negatively affect pregnancy outcomes. However, at CIDR withdrawal, there was decreased bacterial diversity, increased vaginal pH, increased bacterial abundance, and increased vaginal inflammation when compared to what was observed prior to CIDR insertion. Furthermore, abundance of bacte

OF THE THESISFraming Conversations Around Fertility: Experiences of People with Cystic Fibrosis, Their Parents, and Their Clinical TeamsByNicole Charlotte Nevitt Master of Science in Genetic Counseling University of California, Irvine, 2023 Professor Eliezer Nussbaum, ChairCystic fibrosis (CF) is an autosomal recessive genetic condition caused by biallelic pathogenic variants in the CFTR gene. The condition is characterized by thick mucus that progressively causes damage to the respiratory and digestive systems. CF also affects fertility in both males and females. Approximately 95% of males with CF experience infertility, largely due to complete or partial congenital bilateral absence of the vas deferens (CBAVD), and even those with biallelic CFTR gene variants without clinical CF features can have CBAVD. CBAVD prevents mature sperm from leaving the body, rendering these males infertile by natural conception methods. However, assisted reproductive technology can help them achieve fertility. About 35% of females with CF face infertility due to altered cervical mucus, ovulation issues, or nutritional problems. Those with significant lung disease must also weigh the medical risks of pregnancy. With highly effective modulator therapy, pregnancy rates in the CF population have risen dramatically, but there remains a knowledge gap regarding individual fertility capabilities, likely due to inadequate fertility education. Currently, no guidelines exist on discussing fertility with people with CF (pwCF), and it is unclear how well available resources are utilized. An anonymous survey was distributed to pwCF, parents of pwCF, and healthcare providers from CF care centers via Exchange Forums through the CF Foundation, on social media platforms including Facebook, Reddit, Instagram, and LinkedIn, and online support group forums including CysticFibrosis.com and HealingWell.com. Participants were at least 18 years old, could read/write in English, and lived in the United

Background: Many couples experience difficulties to become pregnant or carry a pregnancy to term due to unknown causes. Here we define pre-pregnancy complications as having prior recurrent pregnancy loss, prior late miscarriages, time to pregnancy more than one year, or the use of artificial reproductive technologies. We aim to identify factors associated with pre-pregnancy complications and poor well-being in early pregnancy. Methods: Online questionnaire data from 5330 unique pregnancies in Sweden were collected from November 2017 - February 2021. Multivariable logistic regression modelling was used to investigate potential risk factors for pre-pregnancy complications and differences in early pregnancy symptoms. Results: Pre-pregnancy complications were identified in 1142 participants (21%). Risk factors included diagnosed endometriosis, thyroid medication, opioids and other strong pain medication, body mass index > 25 kg/m(2) and age over 35 years. Different subgroups of pre-pregnancy complications had unique risk factors. The groups also experienced different pregnancy symptoms in early pregnancy, where women that had experienced recurrent pregnancy loss were at higher risk of depression in their current pregnancy. Conclusion: We report one of the largest pregnancy cohorts with high frequency of pre-pregnancy complications compared to the Swedish population. Prescribed drug use and body weight were the top potentially modifiable risk factors in all groups. Participants that experienced pre-pregnancy complications also had higher risk of depression and pregnancy problems in early pregnancy.

With the digitization of healthcare, there has been an increase in self-tracking technologies for health. One group of self-tracking technologies is FMTs, fertility- and menstruation technologies. By gathering information on users’ menstruation and fertility, these technologies have access to intimate and sensitive data that requires secure protection. Previous research has criticized FMTs for lacking in data security and several risks with this data being shared have been identified. Risks of lacking data security include discrimination against the user in the workplace, and being targeted by cyber-criminals. This thesis explores how users perceive trust and data privacy in fertility- and menstruation technologies by conducting a user study. Participants (n=18) were interviewed in pairs about their experiences of FMTs, data privacy, and trust. Based on the interview findings, seven design guidelines were created to enhance user trust and ensure data privacy. Additionally, an Android application was developed as a high-fidelity prototype to visualize and discuss the guidelines. The research contributes to the field by identifying design aspects that can be used by creators of FMTs to improve their privacy practices and generate trust among their users., Med digitalisering har det skett en ökning av självspårande teknologier inom hälsa. En typ av självspårande teknologier är FMT:er, fertilitet- och menstruationsteknologier. Genom att samla information om användares menstruation och fertilitet har de här teknologierna tillgång till intim och känslig data som kräver ordentligt skydd. Risker med bristande datasäkerhet inkluderar att användaren diskrimineras på sin arbetsplats, blir offer för cyberbrottslingar, och blir kontrollerad av en familjemedlem eller partner. Tidigare forskning har kritiserat FMT:er för bristande datasäkerhet och har identifierat flera risker med detta. Den här uppsatsen utforskar hur användare uppfattar tillit och datasäkerhet till fertilitet- och menstruationsteknologier genom en användarstudie. Deltagare (n=18) intervjuades parvis om deras erfarenhet av FMT:er, datasäkerhet och tillit. Utifrån intervjuresultaten har sju riktlinjer för design av FMT:er för ökad tillit och datasäkerhet tagits fram. Dessutom utvecklades en Android applikation som prototyp för att visualisera riktlinjerna. Denna uppsats bidrar till forskningsområdet genom att identifiera designaspekter som kan användas av FMT utvecklare för att förbättra deras sekretesspraxis och påverka deras användares tillit till deras produkt.

Background: Worldwide, there is limited knowledge regarding women’s views of future fertility in relation to contraceptive use. Few studies include material where women share their experiences at peer-written public domain websites, in spite of a larger portion of women discontinuing use of contraceptives. The objective of this study was to explore women’s experiences of contraceptive methods based on data gathered from individual blog posts. Methods: Explorative qualitative study including 123 individual blog posts as the data source analysed with inductive thematic analysis. Results: Two themes were identified. Theme 1, ‘Seeking control over reproduction and optimise fertility’ including the sub-themes; Having the possibility to decide if, and when, to become pregnant, The value of effective contraceptive methods and the impact of women’s sexuality, A wish to understand the body’s normal fertility function and Limited knowledge—sharing information about the menstrual cycle during counselling and Theme 2, ‘Making the complex decision on their own’ including the sub- themes; Limited or subpar guidance in counselling and need for information from social media, Relational and environmental factors influencing contraceptive decision making and Considering beneficial effects and fears of adverse health effects when using hormonal contraceptive methods. Conclusions: During counselling, women desired an extended dialogue regarding effectiveness, health effects of different methods and an increased understanding of their menstrual cycle. Insufficient understanding of contraceptive methods can lead to use of methods not providing the expected level of protection. Hormonal contraceptives, especially Long-acting reversible contraception (LARC) were believed to inhibit fertility long after ending treatment.

The fertility rates of Kazakhstan have reversed to levels not seen for several decades. The striking fertility increase poses questions regarding the extent to which this new development is shared across socio-demographic groups and the nature of fertility recuperation. The current study employs UNICEF Multiple Indicator Cluster Survey data and event-history modelling to analyse parity progressions to one, two, three, and four children. The results suggest a sustained fertility increase that is not merely associated with the recuperation of delayed first births, but a genuine increase across all birth orders. This pattern is evident for both main ethnicities in Kazakhstan and across educational groups. The gradual increase of higher-order births, especially among ethnic Kazakhs, indicates a reversed fertility transition and also that the previous fertility decline in the 1990s was not part of a general transition towards below-replacement fertility but rather a reflection of economic crisis after the collapse of the Soviet Union.

Bateman's principles heavily influence the understanding of human reproductive behaviour. Yet, few rigorous studies on Bateman's principles in contemporary industrialized populations exist. Most studies use small samples, exclude non-marital unions, and disregard recent insights on within-population heterogeneity in mating strategies. We assess mating success and reproductive success using population-wide Finnish register data on marital and non-marital cohabitations and fertility. We examine variability across social strata in the Bateman principles and analyse the mate count, the cumulated duration with a mate, and the association with reproductive success. Results support Bateman's first and second principles. Regarding Bateman's third principle, the number of mates is more positively associated with reproductive success for men than women, but this association is driven by ever having a mate. Having more than one mate is on average associated with lower reproductive success. However, for men in the lowest income quartile, having more than one mate positively predicts reproductive success. Longer union duration is associated with higher reproductive success, and more so for men. We note that sex differences in the relationship between mating success and reproductive success differ by social strata, and argue that mate duration may be an important component of mating success alongside mate count.

The link between personality and fertility is relatively underexplored. Moreover, there are only a few studies focusing on the prospective association between personality and childbearing. However, none of these studies considered the Five-Factor Model (FFM), which is the most widely accepted measurement of personality. The present study fills this gap by examining the prospective association between the FFM and the hazard ratio of the first and the second childbirth in Germany. Analyses are based on recent data (2005–2017) from the Socio-economic Panel Study. Cox proportional hazard models are applied. Findings demonstrate that personality traits are associated with fertility. Extraversion is positively linked with the first childbirth, but is negatively associated with the second childbirth. These findings are mainly driven by males. Agreeableness is positively linked with the first childbirth across the total sample. Again, this correlation is mainly based on the findings for men, among whom a positive association between agreeableness and the second childbirth is also found. Among women, personality does not seem to be linked with the first childbirth. However, the risk of having a second child is found to be negatively associated with conscientiousness. My study adds to the current understanding of the personality–fertility association by exploring the impact of personality trait scores from the FFM on subsequent fertility behavior. However, further research is needed on the association between personality and childbearing; on the mechanisms through which personality affects fertility; and on how these links differ across cultures, among higher parities, and for births after re-partnering.

Background: Many couples experience difficulties to become pregnant or carry a pregnancy to term due to unknown causes. Here we define pre-pregnancy complications as having prior recurrent pregnancy loss, prior late miscarriages, time to pregnancy more than one year, or the use of artificial reproductive technologies. We aim to identify factors associated with pre-pregnancy complications and poor well-being in early pregnancy. Methods: Online questionnaire data from 5330 unique pregnancies in Sweden were collected from November 2017 - February 2021. Multivariable logistic regression modelling was used to investigate potential risk factors for pre-pregnancy complications and differences in early pregnancy symptoms. Results: Pre-pregnancy complications were identified in 1142 participants (21%). Risk factors included diagnosed endometriosis, thyroid medication, opioids and other strong pain medication, body mass index > 25 kg/m(2) and age over 35 years. Different subgroups of pre-pregnancy complications had unique risk factors. The groups also experienced different pregnancy symptoms in early pregnancy, where women that had experienced recurrent pregnancy loss were at higher risk of depression in their current pregnancy. Conclusion: We report one of the largest pregnancy cohorts with high frequency of pre-pregnancy complications compared to the Swedish population. Prescribed drug use and body weight were the top potentially modifiable risk factors in all groups. Participants that experienced pre-pregnancy complications also had higher risk of depression and pregnancy problems in early pregnancy.

Background: Many couples experience difficulties to become pregnant or carry a pregnancy to term due to unknown causes. Here we define pre-pregnancy complications as having prior recurrent pregnancy loss, prior late miscarriages, time to pregnancy more than one year, or the use of artificial reproductive technologies. We aim to identify factors associated with pre-pregnancy complications and poor well-being in early pregnancy. Methods: Online questionnaire data from 5330 unique pregnancies in Sweden were collected from November 2017 - February 2021. Multivariable logistic regression modelling was used to investigate potential risk factors for pre-pregnancy complications and differences in early pregnancy symptoms. Results: Pre-pregnancy complications were identified in 1142 participants (21%). Risk factors included diagnosed endometriosis, thyroid medication, opioids and other strong pain medication, body mass index > 25 kg/m(2) and age over 35 years. Different subgroups of pre-pregnancy complications had unique risk factors. The groups also experienced different pregnancy symptoms in early pregnancy, where women that had experienced recurrent pregnancy loss were at higher risk of depression in their current pregnancy. Conclusion: We report one of the largest pregnancy cohorts with high frequency of pre-pregnancy complications compared to the Swedish population. Prescribed drug use and body weight were the top potentially modifiable risk factors in all groups. Participants that experienced pre-pregnancy complications also had higher risk of depression and pregnancy problems in early pregnancy.

Introduction: The growing proportion of overweight and obese people worldwide is of great concern as it affects the overall health of people and consequently also their reproductive health. The aim of this literature review is to examine how increased body mass index affects fertility and preconception health in men and women.Methods: A scoping literature review was conducted in February 2021 using PubMed and Medline databases, as well as the Google Scholar search engine. Inclusion criteria consisted of scientific literature, regardless of methodology, and articles published in Slovene and English.Results: The literature search yielded 9 reviews and 5 original quantitative studies published in English in the last 15 years. The results suggest that there is compelling evidence that obese individuals are at increased risk of various health problems in the pre-conception period that may affect their fertility and ability to conceive.Discussion and conclusion: The rising prevalence of high body mass index is changing the reproductive health of men and women. Growing obesity rates, particularly in the Western world, call for greater awareness of this metabolic syndrome and its impact on female and male reproduction. Health professionals working with couples in the pre-conception period should have sufficient knowledge to address the impact of high body mass index on reproductive health and promote a healthy lifestyle., Uvod: Naraščajoča stopnja prekomerne telesne mase in debelosti po vsem svetu ovira zdravje moških in žensk ter posledično vpliva na njihovo reproduktivno zdravje. Namen tega pregleda literature je raziskati, kako povečan indeks telesne mase vpliva na plodnost in zdravje moških in žensk pred spočetjem.Metode: Opravljen je bil pregled literature. Iskanje literature je potekalo februarja 2021 v podatkovnih bazah PubMed in Medline. Drugi iskalni zadetki so bili najdeni s pomočjo Google Učenjaka. Vključitveni kriteriji so zajemali znanstveno literaturo, ne glede na metodološki pristop, v slovenskem in angleškem jeziku.Rezultati: V pregled literature je bilo vključenih devet preglednih in pet izvirnih člankov kvantitativne metodologije. Ugotovitve raziskav kažejo, da imajo posamezniki s povišano telesno težo v predkoncepcijskemobdobju večje tveganje za številne zdravstvene težave, ki lahko vplivajo na njihovo plodnost in sposobnost zanositve.Diskusija in zaključek: Povišanje indeksa telesne mase vpliva na reproduktivno zdravje moških in žensk. Naraščajoča stopnja debelosti predvsem v zahodnem svetu zahteva večjo ozaveščenost o tem presnovnem sindromu in njegovem vplivu na reprodukcijo žensk in moških. Zdravstveni delavci, ki delajo s pari s prekomerno telesno maso v obdobju pred spočetjem, morajo imeti ustrezno znanje za njihovo obravnavo ter spodbujati zdrav način življenja.

Multiple sclerosis (MS) is the most frequent neurological disease in young adults, with the greatest incidence between age of 30 and 35 years. Sexual dysfunctions (SDs) are frequent, but are often underestimated in patients with MS, and can have a significantly high impact on patient's quality of life. Aim of this review is to summarize sexual dysfunctions in male and female MS patients and to illustrate current and emerging therapeutic options for treatment.

Soy beverage is a rich source of phytoestrogens isoflavones, with potential benefits on health. The effect of those compounds depends greatly on their bacterial metabolization into their aglycone forms. This study evaluated the health effects of two soy beverages, non-fermented (SB) and fermented with Bifidobacterium pseudocatenulatum INIA P815 (FSB), in acyclic and cyclic C57BL/6J aged female mice as a model of menopause and premenopause, respectively. SB and FSB treatments were administrated for 36 days and, subsequently, body weight, lipid and inflammatory profile and fertility were analyzed and compared. In addition, hepatic gene expression and faecal microbiota composition were also assessed. After fermentation, FSB presented a high content in the aglycones daidzein and genistein and a higher antioxidant activity. FSB treated cyclic mice showed a significant increase in the number of retrieved oocytes and zigotes. Differences in serum lipids were observed in triglycerides, which were lower in FSB than in SB groups. None of the treatments influenced the inflammatory profile or caused a dramatic change in the intestinal microbiota profile or hepatic gene expression in any of the groups. Our data showed that FSB provided greater health benefits than SB in lipid profile and fertility in cyclic mice. These beneficial effects could be attributed to the fermentation process, which produces more bioavailable and bioactive compounds, achieving a greater impact on health.

The low pregnancy rate by artificial insemination in sheep represents a fundamental challenge for breeding programs. In this species, oestrus synchronization is carried out by manipulating hormonal regimens through the insertion of progestogen intravaginal devices. This reproductive strategy may alter the vaginal microbiota affecting the artificial insemination outcome.

STUDY QUESTION Is maternal age at menarche associated with reproductive health in sons measured by semen quality, testes volume and reproductive hormone levels? SUMMARY ANSWER Later maternal age at menarche was associated with impaired semen characteristics, lower testes volume and altered levels of reproductive hormones, while earlier maternal age at menarche was not strongly associated with reproductive outcomes in sons. WHAT IS KNOWN ALREADY Both earlier and later maternal age at menarche may be associated with altered male reproductive health outcomes. This is the first study to investigate the potential association between maternal age at menarche and semen quality, testes volume and reproductive hormone levels in sons. STUDY DESIGN, SIZE, DURATION In this population-based cohort study, we used data from the Fetal Programming of Semen Quality Cohort nested within the Danish National Birth Cohort. In total, 5697 sons born in 1998-2000 were invited to participate in the cohort in 2017-2019. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 1043 (18% of the invited) young men with information on maternal age at menarche provided a semen and blood sample, measured their testes volume, and filled in a questionnaire on health behavior and pubertal development. Maternal age at menarche was reported by the mothers during pregnancy and examined categorically (as earlier, at the same time or later than their peers), continuously and modeled as splines. We estimated relative percentage differences in the reproductive outcomes using negative binomial regression models. Further, we did a mediation analysis to investigate the potential mediating role of timing of the sons' pubertal development. MAIN RESULTS AND THE ROLE OF CHANCE Sons whose mothers had age at menarche later than peers had 15% lower (95% CI: -27%; 0%) sperm concentration, 14% lower (95% CI: -28%; 1%) total sperm count, 7% higher (95% CI: 0%; 14%) proportion of nonprogressive or immotile spermatozoa, 6% lo

Probiotics are intended to improve gastrointestinal health when consumed. However, the probiotics marketed today only colonize the densely populated gut to a limited extent. Bacteriophages comprise the majority of viruses in the human gut virome and there are strong indications that they play important roles in shaping the gut microbiome. Here, we investigate the use of fecal virome transplantation (FVT, sterile filtrated feces) as a mean to alter the gut microbiome composition to lead the way for persistent colonization of two types of probiotics: Lacticaseibacillus rhamnosus GG (LGG) representing a well-established probiotic and Akkermansia muciniphila (AKM) representing a putative next-generation probiotic. Male and female C57BL/6NTac mice were cohoused in pairs from 4 weeks of age and received the following treatment by oral gavage at week 5 and 6: AKM+FVT, LGG+FVT, probiotic sham (Pro-sham)+FVT, LGG+Saline, AKM+Saline, and control (Pro-sham+Saline). The FVT donor material originated from mice with high relative abundance of A. muciniphila. All animals were terminated at age 9 weeks. The FVT treatment did not increase the relative abundance of the administered LGG or AKM in the recipient mice. Instead FVT significantly (p < 0.05) increased the abundance of naturally occurring A.muciniphila compared to the control. This highlights the potential of propagating the existing commensal “probiotics” that have already permanently colonized the gut. Being co-housed male and female, a fraction of the female mice became pregnant. Unexpectedly, the FVT treated mice were found to have a significantly (p < 0.05) higher fertility rate independent of probiotic administration. These preliminary observations urge for follow-up studies investigating interactions between the gut microbiome and fertility.

Because many involuntarily childless people have equal interests in benefitting from assisted reproductive technologies like in vitro fertilization as a mode of treatment, we have normative reasons to ensure inclusive access to such interventions for as many of these people as is reasonable and possible. However, the prevailing eligibility criterion for access to assisted reproductive technologies—'infertility'—is inadequate to serve the goal of inclusive access. This is because the prevailing frameworks of infertility, which include medical and social infertility, fail to precisely capture and unify the relevance of certain involuntarily childless experiences as warranting assisted reproductive technology (ART) treatment. I argue that the least we can do for those who have an interest in accessing ARTs is to conceptualize involuntarily childless experiences in dialogue with interactionist and ecological models of disability, to outline a unified and more inclusive eligibility criterion., Because many involuntarily childless people have equal interests in benefitting from assisted reproductive technologies like in vitro fertilization as a mode of treatment, we have normative reasons to ensure inclusive access to such interventions for as many of these people as is reasonable and possible. However, the prevailing eligibility criterion for access to assisted reproductive technologies-'infertility'-is inadequate to serve the goal of inclusive access. This is because the prevailing frameworks of infertility, which include medical and social infertility, fail to precisely capture and unify the relevance of certain involuntarily childless experiences as warranting assisted reproductive technology (ART) treatment. I argue that the least we can do for those who have an interest in accessing ARTs is to conceptualize involuntarily childless experiences in dialogue with interactionist and ecological models of disability, to outline a unified and more inclusive eligibility criterion.