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Previous studies concerning reproductive patterns among non-Hodgkin lymphoma (NHL) survivors are scarce and those available have reported conflicting results. Treatment regimens vary considerably between aggressive and indolent NHL and studies of reproductive patterns by subtypes are warranted. In this matched cohort study, we identified all NHL patients aged 18-40 years and diagnosed between 2000 and 2018 from the Swedish and Danish lymphoma registers, and the clinical database at Oslo University Hospital (n = 2090). Population comparators were matched on sex, birth year and country (n = 19 427). Hazard ratios (HRs) were estimated using Cox regression. Males and females diagnosed with aggressive lymphoma subtypes had lower childbirth rates (HRfemale: 0.43, 95% CI: 0.31-0.59, HRmale: 0.61, 95% CI: 0.47-0.78) than comparators during the first 3 years after diagnosis. For indolent lymphomas, childbirth rates were not significantly different from comparators (HRfemale: 0.71, 95% CI: 0.48-1.04, HRmale: 0.94, 95% CI: 0.70-1.27) during the same period. Childbirth rates reached those of comparators for all subtypes after 3 years but the cumulative incidence of childbirths was decreased throughout the 10-year follow-up for aggressive NHL. Children of NHL patients were more likely to be born following assisted reproductive technology than those of comparators, except for male indolent lymphoma patients. In conclusion, fertility counselling is particularly important for patients with aggressive NHL.

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.

Previous studies concerning reproductive patterns among non-Hodgkin lymphoma (NHL) survivors are scarce and those available have reported conflicting results. Treatment regimens vary considerably between aggressive and indolent NHL and studies of reproductive patterns by subtypes are warranted. In this matched cohort study, we identified all NHL patients aged 18-40 years and diagnosed between 2000 and 2018 from the Swedish and Danish lymphoma registers, and the clinical database at Oslo University Hospital (n = 2090). Population comparators were matched on sex, birth year and country (n = 19 427). Hazard ratios (HRs) were estimated using Cox regression. Males and females diagnosed with aggressive lymphoma subtypes had lower childbirth rates (HRfemale: 0.43, 95% CI: 0.31-0.59, HRmale: 0.61, 95% CI: 0.47-0.78) than comparators during the first 3 years after diagnosis. For indolent lymphomas, childbirth rates were not significantly different from comparators (HRfemale: 0.71, 95% CI: 0.48-1.04, HRmale: 0.94, 95% CI: 0.70-1.27) during the same period. Childbirth rates reached those of comparators for all subtypes after 3 years but the cumulative incidence of childbirths was decreased throughout the 10-year follow-up for aggressive NHL. Children of NHL patients were more likely to be born following assisted reproductive technology than those of comparators, except for male indolent lymphoma patients. In conclusion, fertility counselling is particularly important for patients with aggressive NHL.

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.

Previous studies concerning reproductive patterns among non-Hodgkin lymphoma (NHL) survivors are scarce and those available have reported conflicting results. Treatment regimens vary considerably between aggressive and indolent NHL and studies of reproductive patterns by subtypes are warranted. In this matched cohort study, we identified all NHL patients aged 18-40 years and diagnosed between 2000 and 2018 from the Swedish and Danish lymphoma registers, and the clinical database at Oslo University Hospital (n = 2090). Population comparators were matched on sex, birth year and country (n = 19 427). Hazard ratios (HRs) were estimated using Cox regression. Males and females diagnosed with aggressive lymphoma subtypes had lower childbirth rates (HRfemale: 0.43, 95% CI: 0.31-0.59, HRmale: 0.61, 95% CI: 0.47-0.78) than comparators during the first 3 years after diagnosis. For indolent lymphomas, childbirth rates were not significantly different from comparators (HRfemale: 0.71, 95% CI: 0.48-1.04, HRmale: 0.94, 95% CI: 0.70-1.27) during the same period. Childbirth rates reached those of comparators for all subtypes after 3 years but the cumulative incidence of childbirths was decreased throughout the 10-year follow-up for aggressive NHL. Children of NHL patients were more likely to be born following assisted reproductive technology than those of comparators, except for male indolent lymphoma patients. In conclusion, fertility counselling is particularly important for patients with aggressive NHL.

Previous studies concerning reproductive patterns among non-Hodgkin lymphoma (NHL) survivors are scarce and those available have reported conflicting results. Treatment regimens vary considerably between aggressive and indolent NHL and studies of reproductive patterns by subtypes are warranted. In this matched cohort study, we identified all NHL patients aged 18-40 years and diagnosed between 2000 and 2018 from the Swedish and Danish lymphoma registers, and the clinical database at Oslo University Hospital (n = 2090). Population comparators were matched on sex, birth year and country (n = 19 427). Hazard ratios (HRs) were estimated using Cox regression. Males and females diagnosed with aggressive lymphoma subtypes had lower childbirth rates (HRfemale: 0.43, 95% CI: 0.31-0.59, HRmale: 0.61, 95% CI: 0.47-0.78) than comparators during the first 3 years after diagnosis. For indolent lymphomas, childbirth rates were not significantly different from comparators (HRfemale: 0.71, 95% CI: 0.48-1.04, HRmale: 0.94, 95% CI: 0.70-1.27) during the same period. Childbirth rates reached those of comparators for all subtypes after 3 years but the cumulative incidence of childbirths was decreased throughout the 10-year follow-up for aggressive NHL. Children of NHL patients were more likely to be born following assisted reproductive technology than those of comparators, except for male indolent lymphoma patients. In conclusion, fertility counselling is particularly important for patients with aggressive NHL.

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.

I Sverige omfattas alla elever från förskoleklass till årskurs nio av skolplikt, men ändå har många elever hög frånvaro. Problematisk skolfrånvaro är ett globalt samhällsproblem som kan ge allvarliga konsekvenser för eleven både nu och i framtiden, vilket dessutom leder till stora samhällskostnader. Syftet med denna studie är att undersöka hur yrkesverksamma inom skolan beskriver och upplever utmaningar och möjligheter i arbetet med problematisk skolfrånvaro. Detta har gjorts genom semistrukturerade intervjuer med olika aktörer i skolan som aktivt arbetar med frågan: rektor, specialpedagog och socionom i skolan. Intervjuerna har analyserats med hjälp av innehållsanalys och Bronfenbrenners ekologiska systemteori. De huvudsakliga utmaningarna som beskrevs vid intervjuerna var brist på ekonomiska och materiella resurser, organisatoriska hinder, tid och svårigheter att bygga en god relation till elev och vårdnadshavare. De övergripande förutsättningarna och möjligheterna som beskrevs var tidig kartläggning och insatser, god relation och allians med elev och vårdnadshavare, helhetsperspektiv, samverkan med socialtjänst samt närvarokultur på skolan. Resultatet av studien visade dessutom att de skolor med professionen “socionom i skolan” hade större utrymme för att arbeta uppsökande med elever med problematisk skolfrånvaro, något som de skolor utan denna resurs beskrev som något de saknade. Utifrån Bronfenbrenners ekologiska systemteori är det tydligt att arbetet med problematisk skolfrånvaro är komplext och gränsöverskridande samt behöver förstås ur ett större perspektiv än skolans fyra väggar. Teorin tydliggör hur elevens olika nätverk, miljöer, skeenden och samhälleliga kontext påverkar dennes skolsituation och attityd gentemot den. Slutligen relateras studiens resultat till teorin samt tidigare forskning som tillsammans pekar på att problematisk skolfrånvaro är ett växande problem, att det kan leda till allvarliga konsekvenser samt att arbetet är relationellt och behöv

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.

Previous studies concerning reproductive patterns among non-Hodgkin lymphoma (NHL) survivors are scarce and those available have reported conflicting results. Treatment regimens vary considerably between aggressive and indolent NHL and studies of reproductive patterns by subtypes are warranted. In this matched cohort study, we identified all NHL patients aged 18-40 years and diagnosed between 2000 and 2018 from the Swedish and Danish lymphoma registers, and the clinical database at Oslo University Hospital (n = 2090). Population comparators were matched on sex, birth year and country (n = 19 427). Hazard ratios (HRs) were estimated using Cox regression. Males and females diagnosed with aggressive lymphoma subtypes had lower childbirth rates (HRfemale: 0.43, 95% CI: 0.31-0.59, HRmale: 0.61, 95% CI: 0.47-0.78) than comparators during the first 3 years after diagnosis. For indolent lymphomas, childbirth rates were not significantly different from comparators (HRfemale: 0.71, 95% CI: 0.48-1.04, HRmale: 0.94, 95% CI: 0.70-1.27) during the same period. Childbirth rates reached those of comparators for all subtypes after 3 years but the cumulative incidence of childbirths was decreased throughout the 10-year follow-up for aggressive NHL. Children of NHL patients were more likely to be born following assisted reproductive technology than those of comparators, except for male indolent lymphoma patients. In conclusion, fertility counselling is particularly important for patients with aggressive NHL.

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.

I Sverige omfattas alla elever från förskoleklass till årskurs nio av skolplikt, men ändå har många elever hög frånvaro. Problematisk skolfrånvaro är ett globalt samhällsproblem som kan ge allvarliga konsekvenser för eleven både nu och i framtiden, vilket dessutom leder till stora samhällskostnader. Syftet med denna studie är att undersöka hur yrkesverksamma inom skolan beskriver och upplever utmaningar och möjligheter i arbetet med problematisk skolfrånvaro. Detta har gjorts genom semistrukturerade intervjuer med olika aktörer i skolan som aktivt arbetar med frågan: rektor, specialpedagog och socionom i skolan. Intervjuerna har analyserats med hjälp av innehållsanalys och Bronfenbrenners ekologiska systemteori. De huvudsakliga utmaningarna som beskrevs vid intervjuerna var brist på ekonomiska och materiella resurser, organisatoriska hinder, tid och svårigheter att bygga en god relation till elev och vårdnadshavare. De övergripande förutsättningarna och möjligheterna som beskrevs var tidig kartläggning och insatser, god relation och allians med elev och vårdnadshavare, helhetsperspektiv, samverkan med socialtjänst samt närvarokultur på skolan. Resultatet av studien visade dessutom att de skolor med professionen “socionom i skolan” hade större utrymme för att arbeta uppsökande med elever med problematisk skolfrånvaro, något som de skolor utan denna resurs beskrev som något de saknade. Utifrån Bronfenbrenners ekologiska systemteori är det tydligt att arbetet med problematisk skolfrånvaro är komplext och gränsöverskridande samt behöver förstås ur ett större perspektiv än skolans fyra väggar. Teorin tydliggör hur elevens olika nätverk, miljöer, skeenden och samhälleliga kontext påverkar dennes skolsituation och attityd gentemot den. Slutligen relateras studiens resultat till teorin samt tidigare forskning som tillsammans pekar på att problematisk skolfrånvaro är ett växande problem, att det kan leda till allvarliga konsekvenser samt att arbetet är relationellt och behöv

Loss of fertility as a potential side effect of anti-neoplastic treatments may have a significant negative impact on the survivors’ quality of life. Assisted reproductive technologies (ART) have been adapted and further developed for fertility preservation (FP) and fertility treatments in young women with cancer. The last three decades have seen impressive achievements in this field, with the rapid introduction and development of methods in clinical practice. Still, the data on outcomes and safety of FP are scarce, and numerous questions await answering. The four studies included in this thesis aimed to investigate: if a history of cancer may increase the risk of adverse perinatal outcomes in pregnancies achieved with donor oocytes (Study I), if return rates and utilization rates differ in patients with oncologic and nononcologic indications for FP, and if the trends in decisions regarding preferred FP-methods have changed over time (Study II), if current approaches to controlled ovarian stimulation aimed at FP in women with breast cancer are efficacious and safe (Study III) and if longterm reproductive outcomes after breast cancer differ in women with and without FP (Study IV). Study I was a single-center cohort study, including 25 live births in 20 women with a history of cancer and 244 live births in 212 women without a history of cancer, all after treatments with donor oocytes. Higher rates of pre-eclampsia (adjusted odds ratio (aOR) 2.79, 95% CI 1.07-7.34) and preterm birth (aOR 5.54, 95% CI 2.01-15.31) were observed in women with a history of cancer. Study II included data on 1254 women that underwent FP counseling due to oncologic and non-oncologic indications at Karolinska University Hospital during a 20-year long period (1998-2018). Oncologic indication for FP was associated with a slightly lower likelihood of returning for counseling (OR 0.72, 95% CI 0.51-1.0) and a significantly lower likelihood of returning for pregnancy attempt (OR 0.41, 95%CI 0.27-0.62

Loss of fertility as a potential side effect of anti-neoplastic treatments may have a significant negative impact on the survivors’ quality of life. Assisted reproductive technologies (ART) have been adapted and further developed for fertility preservation (FP) and fertility treatments in young women with cancer. The last three decades have seen impressive achievements in this field, with the rapid introduction and development of methods in clinical practice. Still, the data on outcomes and safety of FP are scarce, and numerous questions await answering. The four studies included in this thesis aimed to investigate: if a history of cancer may increase the risk of adverse perinatal outcomes in pregnancies achieved with donor oocytes (Study I), if return rates and utilization rates differ in patients with oncologic and nononcologic indications for FP, and if the trends in decisions regarding preferred FP-methods have changed over time (Study II), if current approaches to controlled ovarian stimulation aimed at FP in women with breast cancer are efficacious and safe (Study III) and if longterm reproductive outcomes after breast cancer differ in women with and without FP (Study IV). Study I was a single-center cohort study, including 25 live births in 20 women with a history of cancer and 244 live births in 212 women without a history of cancer, all after treatments with donor oocytes. Higher rates of pre-eclampsia (adjusted odds ratio (aOR) 2.79, 95% CI 1.07-7.34) and preterm birth (aOR 5.54, 95% CI 2.01-15.31) were observed in women with a history of cancer. Study II included data on 1254 women that underwent FP counseling due to oncologic and non-oncologic indications at Karolinska University Hospital during a 20-year long period (1998-2018). Oncologic indication for FP was associated with a slightly lower likelihood of returning for counseling (OR 0.72, 95% CI 0.51-1.0) and a significantly lower likelihood of returning for pregnancy attempt (OR 0.41, 95%CI 0.27-0.62

STUDY QUESTION: How efficacious and safe are the current approaches to controlled ovarian stimulation (COS) aimed at fertility preservation (FP) in women with breast cancer (BC)? SUMMARY ANSWER: In women with BC undergoing COS aiming at egg/embryo cryopreservation, letrozole-based protocols and those randomly started were equally effective compared with conventional COS, and the overall survival was similar between the women that proceeded to FP and those who did not. WHAT IS KNOWN ALREADY: Cryopreservation of oocytes and embryos is an established method for FP in women with BC. Recent improvements to COS protocols include concomitant use of letrozole, random-cycle start day of stimulation and the use of GnRHa for the egg maturation trigger. To date, limited sample size of the available studies has not allowed investigation of differences in the efficacy of the different approaches to COS for FP in this patient population. STUDY DESIGN, SIZE, DURATION: A prospective multicenter study with national coverage including 610 women with BC counseled between 1 January 1995 and 30 June 2017 at six Swedish FP regional programs. PARTICIPANTS/MATERIALS, SETTING, METHODS: After counseling, 401 women elected to undergo COS. Treatments differed in the use or not of concomitant letrozole, a conventional or random-cycle day COS initiation and the use of hCG versus GnRHa trigger for oocyte maturation. Numbers of cryopreserved oocytes and embryos were defined as primary outcome. Pregnancy attempts, reproductive outcomes and long-term survival, investigated by the linking of individuals of the cohort to the total population register of the Swedish Tax Agency (up to 25 November 2018), were evaluated. MAIN RESULTS AND THE ROLE OF CHANCE: Using letrozole or not resulted in similar numbers of oocytes and embryos cryopreserved (mean(oocytes)=9.7 versus 10 and mean(embryos) 4.0 versus 5.3, respectively), similar to COS with random versus conventional start (mean(oocytes) 9.0 versus 10.6 and, Funding Agencies|Swedish Cancer SocietySwedish Cancer Society; Stockholm County CouncilStockholm County Council; Percy Falk Stiftelsen; Radiumhemmets Forskningsfonder; Swedish Breast Cancer Association; Karolinska InstitutetKarolinska Institutet

STUDY QUESTION: How efficacious and safe are the current approaches to controlled ovarian stimulation (COS) aimed at fertility preservation (FP) in women with breast cancer (BC)? SUMMARY ANSWER: In women with BC undergoing COS aiming at egg/embryo cryopreservation, letrozole-based protocols and those randomly started were equally effective compared with conventional COS, and the overall survival was similar between the women that proceeded to FP and those who did not. WHAT IS KNOWN ALREADY: Cryopreservation of oocytes and embryos is an established method for FP in women with BC. Recent improvements to COS protocols include concomitant use of letrozole, random-cycle start day of stimulation and the use of GnRHa for the egg maturation trigger. To date, limited sample size of the available studies has not allowed investigation of differences in the efficacy of the different approaches to COS for FP in this patient population. STUDY DESIGN, SIZE, DURATION: A prospective multicenter study with national coverage including 610 women with BC counseled between 1 January 1995 and 30 June 2017 at six Swedish FP regional programs. PARTICIPANTS/MATERIALS, SETTING, METHODS: After counseling, 401 women elected to undergo COS. Treatments differed in the use or not of concomitant letrozole, a conventional or random-cycle day COS initiation and the use of hCG versus GnRHa trigger for oocyte maturation. Numbers of cryopreserved oocytes and embryos were defined as primary outcome. Pregnancy attempts, reproductive outcomes and long-term survival, investigated by the linking of individuals of the cohort to the total population register of the Swedish Tax Agency (up to 25 November 2018), were evaluated. MAIN RESULTS AND THE ROLE OF CHANCE: Using letrozole or not resulted in similar numbers of oocytes and embryos cryopreserved (mean(oocytes)=9.7 versus 10 and mean(embryos) 4.0 versus 5.3, respectively), similar to COS with random versus conventional start (mean(oocytes) 9.0 versus 10.6 and, Funding Agencies|Swedish Cancer SocietySwedish Cancer Society; Stockholm County CouncilStockholm County Council; Percy Falk Stiftelsen; Radiumhemmets Forskningsfonder; Swedish Breast Cancer Association; Karolinska InstitutetKarolinska Institutet

Synen på sex kan se väldigt olika ut beroende på dess kontext, och för att kunna förstå sex och sexualitet i sin helhet krävs det att det ses ur sitt sociala, historiska, kulturella och politiska sammanhang. Studien utgår från en komparativ ansats, då den avser att identifiera eventuella samband och skillnader mellan Sverige och Nederländerna kring synen på sex, samt vad som kan vara orsaken till dessa. Som jämförande länder valdes Sverige och Nederländerna då de kan ses som varandras motpoler när det kommer till konservativa och liberala värderingar. Studien undersöker sex utifrån unga kvinnors perspektiv, och material har samlats in med hjälp av semistrukturerade intervjuer i respektive land. Således är syftet med studien att undersöka unga kvinnors syn på sex i Sverige samt Nederländerna. Resultaten visade att trots olika värderingar och politiska åsikter i länderna så har unga kvinnor liknande tankar och upplevelser när det kommer till synen på sex. Den främsta förklaringen till de liknande åsikterna kopplas till feminismens utveckling samt internet som informationskälla. Den största skillnaden i åsikter hos kvinnorna var kring sexuellt arbete såsom prostitution, där kvinnorna i Sverige var negativa medan kvinnorna i Nederländerna var positiva, men med en viss skepticism. En möjlig förklaring till att kvinnorna i Nederländerna var mer positiva till prostitution var på grund av normaliseringen som skett genom inflytande från politiken.

STUDY QUESTION: How efficacious and safe are the current approaches to controlled ovarian stimulation (COS) aimed at fertility preservation (FP) in women with breast cancer (BC)? SUMMARY ANSWER: In women with BC undergoing COS aiming at egg/embryo cryopreservation, letrozole-based protocols and those randomly started were equally effective compared with conventional COS, and the overall survival was similar between the women that proceeded to FP and those who did not. WHAT IS KNOWN ALREADY: Cryopreservation of oocytes and embryos is an established method for FP in women with BC. Recent improvements to COS protocols include concomitant use of letrozole, random-cycle start day of stimulation and the use of GnRHa for the egg maturation trigger. To date, limited sample size of the available studies has not allowed investigation of differences in the efficacy of the different approaches to COS for FP in this patient population. STUDY DESIGN, SIZE, DURATION: A prospective multicenter study with national coverage including 610 women with BC counseled between 1 January 1995 and 30 June 2017 at six Swedish FP regional programs. PARTICIPANTS/MATERIALS, SETTING, METHODS: After counseling, 401 women elected to undergo COS. Treatments differed in the use or not of concomitant letrozole, a conventional or random-cycle day COS initiation and the use of hCG versus GnRHa trigger for oocyte maturation. Numbers of cryopreserved oocytes and embryos were defined as primary outcome. Pregnancy attempts, reproductive outcomes and long-term survival, investigated by the linking of individuals of the cohort to the total population register of the Swedish Tax Agency (up to 25 November 2018), were evaluated. MAIN RESULTS AND THE ROLE OF CHANCE: Using letrozole or not resulted in similar numbers of oocytes and embryos cryopreserved (mean(oocytes)=9.7 versus 10 and mean(embryos) 4.0 versus 5.3, respectively), similar to COS with random versus conventional start (mean(oocytes) 9.0 versus 10.6 and, Funding Agencies|Swedish Cancer SocietySwedish Cancer Society; Stockholm County CouncilStockholm County Council; Percy Falk Stiftelsen; Radiumhemmets Forskningsfonder; Swedish Breast Cancer Association; Karolinska InstitutetKarolinska Institutet

STUDY QUESTION: How efficacious and safe are the current approaches to controlled ovarian stimulation (COS) aimed at fertility preservation (FP) in women with breast cancer (BC)? SUMMARY ANSWER: In women with BC undergoing COS aiming at egg/embryo cryopreservation, letrozole-based protocols and those randomly started were equally effective compared with conventional COS, and the overall survival was similar between the women that proceeded to FP and those who did not. WHAT IS KNOWN ALREADY: Cryopreservation of oocytes and embryos is an established method for FP in women with BC. Recent improvements to COS protocols include concomitant use of letrozole, random-cycle start day of stimulation and the use of GnRHa for the egg maturation trigger. To date, limited sample size of the available studies has not allowed investigation of differences in the efficacy of the different approaches to COS for FP in this patient population. STUDY DESIGN, SIZE, DURATION: A prospective multicenter study with national coverage including 610 women with BC counseled between 1 January 1995 and 30 June 2017 at six Swedish FP regional programs. PARTICIPANTS/MATERIALS, SETTING, METHODS: After counseling, 401 women elected to undergo COS. Treatments differed in the use or not of concomitant letrozole, a conventional or random-cycle day COS initiation and the use of hCG versus GnRHa trigger for oocyte maturation. Numbers of cryopreserved oocytes and embryos were defined as primary outcome. Pregnancy attempts, reproductive outcomes and long-term survival, investigated by the linking of individuals of the cohort to the total population register of the Swedish Tax Agency (up to 25 November 2018), were evaluated. MAIN RESULTS AND THE ROLE OF CHANCE: Using letrozole or not resulted in similar numbers of oocytes and embryos cryopreserved (mean(oocytes)=9.7 versus 10 and mean(embryos) 4.0 versus 5.3, respectively), similar to COS with random versus conventional start (mean(oocytes) 9.0 versus 10.6 and, Funding Agencies|Swedish Cancer SocietySwedish Cancer Society; Stockholm County CouncilStockholm County Council; Percy Falk Stiftelsen; Radiumhemmets Forskningsfonder; Swedish Breast Cancer Association; Karolinska InstitutetKarolinska Institutet

STUDY QUESTION: How efficacious and safe are the current approaches to controlled ovarian stimulation (COS) aimed at fertility preservation (FP) in women with breast cancer (BC)? SUMMARY ANSWER: In women with BC undergoing COS aiming at egg/embryo cryopreservation, letrozole-based protocols and those randomly started were equally effective compared with conventional COS, and the overall survival was similar between the women that proceeded to FP and those who did not. WHAT IS KNOWN ALREADY: Cryopreservation of oocytes and embryos is an established method for FP in women with BC. Recent improvements to COS protocols include concomitant use of letrozole, random-cycle start day of stimulation and the use of GnRHa for the egg maturation trigger. To date, limited sample size of the available studies has not allowed investigation of differences in the efficacy of the different approaches to COS for FP in this patient population. STUDY DESIGN, SIZE, DURATION: A prospective multicenter study with national coverage including 610 women with BC counseled between 1 January 1995 and 30 June 2017 at six Swedish FP regional programs. PARTICIPANTS/MATERIALS, SETTING, METHODS: After counseling, 401 women elected to undergo COS. Treatments differed in the use or not of concomitant letrozole, a conventional or random-cycle day COS initiation and the use of hCG versus GnRHa trigger for oocyte maturation. Numbers of cryopreserved oocytes and embryos were defined as primary outcome. Pregnancy attempts, reproductive outcomes and long-term survival, investigated by the linking of individuals of the cohort to the total population register of the Swedish Tax Agency (up to 25 November 2018), were evaluated. MAIN RESULTS AND THE ROLE OF CHANCE: Using letrozole or not resulted in similar numbers of oocytes and embryos cryopreserved (mean(oocytes)=9.7 versus 10 and mean(embryos) 4.0 versus 5.3, respectively), similar to COS with random versus conventional start (mean(oocytes) 9.0 versus 10.6 and, Funding Agencies|Swedish Cancer SocietySwedish Cancer Society; Stockholm County CouncilStockholm County Council; Percy Falk Stiftelsen; Radiumhemmets Forskningsfonder; Swedish Breast Cancer Association; Karolinska InstitutetKarolinska Institutet

Loss of fertility as a potential side effect of anti-neoplastic treatments may have a significant negative impact on the survivors’ quality of life. Assisted reproductive technologies (ART) have been adapted and further developed for fertility preservation (FP) and fertility treatments in young women with cancer. The last three decades have seen impressive achievements in this field, with the rapid introduction and development of methods in clinical practice. Still, the data on outcomes and safety of FP are scarce, and numerous questions await answering. The four studies included in this thesis aimed to investigate: if a history of cancer may increase the risk of adverse perinatal outcomes in pregnancies achieved with donor oocytes (Study I), if return rates and utilization rates differ in patients with oncologic and nononcologic indications for FP, and if the trends in decisions regarding preferred FP-methods have changed over time (Study II), if current approaches to controlled ovarian stimulation aimed at FP in women with breast cancer are efficacious and safe (Study III) and if longterm reproductive outcomes after breast cancer differ in women with and without FP (Study IV). Study I was a single-center cohort study, including 25 live births in 20 women with a history of cancer and 244 live births in 212 women without a history of cancer, all after treatments with donor oocytes. Higher rates of pre-eclampsia (adjusted odds ratio (aOR) 2.79, 95% CI 1.07-7.34) and preterm birth (aOR 5.54, 95% CI 2.01-15.31) were observed in women with a history of cancer. Study II included data on 1254 women that underwent FP counseling due to oncologic and non-oncologic indications at Karolinska University Hospital during a 20-year long period (1998-2018). Oncologic indication for FP was associated with a slightly lower likelihood of returning for counseling (OR 0.72, 95% CI 0.51-1.0) and a significantly lower likelihood of returning for pregnancy attempt (OR 0.41, 95%CI 0.27-0.62

Loss of fertility as a potential side effect of anti-neoplastic treatments may have a significant negative impact on the survivors’ quality of life. Assisted reproductive technologies (ART) have been adapted and further developed for fertility preservation (FP) and fertility treatments in young women with cancer. The last three decades have seen impressive achievements in this field, with the rapid introduction and development of methods in clinical practice. Still, the data on outcomes and safety of FP are scarce, and numerous questions await answering. The four studies included in this thesis aimed to investigate: if a history of cancer may increase the risk of adverse perinatal outcomes in pregnancies achieved with donor oocytes (Study I), if return rates and utilization rates differ in patients with oncologic and nononcologic indications for FP, and if the trends in decisions regarding preferred FP-methods have changed over time (Study II), if current approaches to controlled ovarian stimulation aimed at FP in women with breast cancer are efficacious and safe (Study III) and if longterm reproductive outcomes after breast cancer differ in women with and without FP (Study IV). Study I was a single-center cohort study, including 25 live births in 20 women with a history of cancer and 244 live births in 212 women without a history of cancer, all after treatments with donor oocytes. Higher rates of pre-eclampsia (adjusted odds ratio (aOR) 2.79, 95% CI 1.07-7.34) and preterm birth (aOR 5.54, 95% CI 2.01-15.31) were observed in women with a history of cancer. Study II included data on 1254 women that underwent FP counseling due to oncologic and non-oncologic indications at Karolinska University Hospital during a 20-year long period (1998-2018). Oncologic indication for FP was associated with a slightly lower likelihood of returning for counseling (OR 0.72, 95% CI 0.51-1.0) and a significantly lower likelihood of returning for pregnancy attempt (OR 0.41, 95%CI 0.27-0.62

Loss of fertility as a potential side effect of anti-neoplastic treatments may have a significant negative impact on the survivors’ quality of life. Assisted reproductive technologies (ART) have been adapted and further developed for fertility preservation (FP) and fertility treatments in young women with cancer. The last three decades have seen impressive achievements in this field, with the rapid introduction and development of methods in clinical practice. Still, the data on outcomes and safety of FP are scarce, and numerous questions await answering. The four studies included in this thesis aimed to investigate: if a history of cancer may increase the risk of adverse perinatal outcomes in pregnancies achieved with donor oocytes (Study I), if return rates and utilization rates differ in patients with oncologic and nononcologic indications for FP, and if the trends in decisions regarding preferred FP-methods have changed over time (Study II), if current approaches to controlled ovarian stimulation aimed at FP in women with breast cancer are efficacious and safe (Study III) and if longterm reproductive outcomes after breast cancer differ in women with and without FP (Study IV). Study I was a single-center cohort study, including 25 live births in 20 women with a history of cancer and 244 live births in 212 women without a history of cancer, all after treatments with donor oocytes. Higher rates of pre-eclampsia (adjusted odds ratio (aOR) 2.79, 95% CI 1.07-7.34) and preterm birth (aOR 5.54, 95% CI 2.01-15.31) were observed in women with a history of cancer. Study II included data on 1254 women that underwent FP counseling due to oncologic and non-oncologic indications at Karolinska University Hospital during a 20-year long period (1998-2018). Oncologic indication for FP was associated with a slightly lower likelihood of returning for counseling (OR 0.72, 95% CI 0.51-1.0) and a significantly lower likelihood of returning for pregnancy attempt (OR 0.41, 95%CI 0.27-0.62

Loss of fertility as a potential side effect of anti-neoplastic treatments may have a significant negative impact on the survivors’ quality of life. Assisted reproductive technologies (ART) have been adapted and further developed for fertility preservation (FP) and fertility treatments in young women with cancer. The last three decades have seen impressive achievements in this field, with the rapid introduction and development of methods in clinical practice. Still, the data on outcomes and safety of FP are scarce, and numerous questions await answering. The four studies included in this thesis aimed to investigate: if a history of cancer may increase the risk of adverse perinatal outcomes in pregnancies achieved with donor oocytes (Study I), if return rates and utilization rates differ in patients with oncologic and nononcologic indications for FP, and if the trends in decisions regarding preferred FP-methods have changed over time (Study II), if current approaches to controlled ovarian stimulation aimed at FP in women with breast cancer are efficacious and safe (Study III) and if longterm reproductive outcomes after breast cancer differ in women with and without FP (Study IV). Study I was a single-center cohort study, including 25 live births in 20 women with a history of cancer and 244 live births in 212 women without a history of cancer, all after treatments with donor oocytes. Higher rates of pre-eclampsia (adjusted odds ratio (aOR) 2.79, 95% CI 1.07-7.34) and preterm birth (aOR 5.54, 95% CI 2.01-15.31) were observed in women with a history of cancer. Study II included data on 1254 women that underwent FP counseling due to oncologic and non-oncologic indications at Karolinska University Hospital during a 20-year long period (1998-2018). Oncologic indication for FP was associated with a slightly lower likelihood of returning for counseling (OR 0.72, 95% CI 0.51-1.0) and a significantly lower likelihood of returning for pregnancy attempt (OR 0.41, 95%CI 0.27-0.62

Synen på sex kan se väldigt olika ut beroende på dess kontext, och för att kunna förstå sex och sexualitet i sin helhet krävs det att det ses ur sitt sociala, historiska, kulturella och politiska sammanhang. Studien utgår från en komparativ ansats, då den avser att identifiera eventuella samband och skillnader mellan Sverige och Nederländerna kring synen på sex, samt vad som kan vara orsaken till dessa. Som jämförande länder valdes Sverige och Nederländerna då de kan ses som varandras motpoler när det kommer till konservativa och liberala värderingar. Studien undersöker sex utifrån unga kvinnors perspektiv, och material har samlats in med hjälp av semistrukturerade intervjuer i respektive land. Således är syftet med studien att undersöka unga kvinnors syn på sex i Sverige samt Nederländerna. Resultaten visade att trots olika värderingar och politiska åsikter i länderna så har unga kvinnor liknande tankar och upplevelser när det kommer till synen på sex. Den främsta förklaringen till de liknande åsikterna kopplas till feminismens utveckling samt internet som informationskälla. Den största skillnaden i åsikter hos kvinnorna var kring sexuellt arbete såsom prostitution, där kvinnorna i Sverige var negativa medan kvinnorna i Nederländerna var positiva, men med en viss skepticism. En möjlig förklaring till att kvinnorna i Nederländerna var mer positiva till prostitution var på grund av normaliseringen som skett genom inflytande från politiken.

STUDY QUESTION: How efficacious and safe are the current approaches to controlled ovarian stimulation (COS) aimed at fertility preservation (FP) in women with breast cancer (BC)? SUMMARY ANSWER: In women with BC undergoing COS aiming at egg/embryo cryopreservation, letrozole-based protocols and those randomly started were equally effective compared with conventional COS, and the overall survival was similar between the women that proceeded to FP and those who did not. WHAT IS KNOWN ALREADY: Cryopreservation of oocytes and embryos is an established method for FP in women with BC. Recent improvements to COS protocols include concomitant use of letrozole, random-cycle start day of stimulation and the use of GnRHa for the egg maturation trigger. To date, limited sample size of the available studies has not allowed investigation of differences in the efficacy of the different approaches to COS for FP in this patient population. STUDY DESIGN, SIZE, DURATION: A prospective multicenter study with national coverage including 610 women with BC counseled between 1 January 1995 and 30 June 2017 at six Swedish FP regional programs. PARTICIPANTS/MATERIALS, SETTING, METHODS: After counseling, 401 women elected to undergo COS. Treatments differed in the use or not of concomitant letrozole, a conventional or random-cycle day COS initiation and the use of hCG versus GnRHa trigger for oocyte maturation. Numbers of cryopreserved oocytes and embryos were defined as primary outcome. Pregnancy attempts, reproductive outcomes and long-term survival, investigated by the linking of individuals of the cohort to the total population register of the Swedish Tax Agency (up to 25 November 2018), were evaluated. MAIN RESULTS AND THE ROLE OF CHANCE: Using letrozole or not resulted in similar numbers of oocytes and embryos cryopreserved (mean(oocytes)=9.7 versus 10 and mean(embryos) 4.0 versus 5.3, respectively), similar to COS with random versus conventional start (mean(oocytes) 9.0 versus 10.6 and, Funding Agencies|Swedish Cancer SocietySwedish Cancer Society; Stockholm County CouncilStockholm County Council; Percy Falk Stiftelsen; Radiumhemmets Forskningsfonder; Swedish Breast Cancer Association; Karolinska InstitutetKarolinska Institutet

Våld i nära relation är ett stort samhälleligt problem. Både kvinnor och män utsätts för våld men kvinnor drabbas i större utsträckning av våld av allvarlig karaktär. En av mannens strategier för att kontrollera kvinnan är att isolera henne från omvärlden. Denna studie handlar om det sociala nätverket och vilken betydelse det kan ha för en våldsutsatt kvinna. Studien bygger på intervjuer med fem yrkesverksamma inom kvinnojour samt kommunal verksamhet som arbetar mot våld. Det insamlade datamaterialet har analyserats med hjälp av konventionell innehållsanalys. Resultatet av vår studie visar att det sociala nätverket på olika sätt är av stor betydelse för en våldsutsatt kvinna. Det som var tydligt återkommande var att kvinnor i regel blir väldigt isolerade och upplever en stor ensamhet samt att barnen kan påverka huruvida kvinnan väljer att lämna eller stanna kvar i relationen. Kvinnor som inte har något arbete, lever i ett missbruk eller invandrat till Sverige upplevs enligt yrkesverksamma befinna sig i en extra utsatt och sårbar situation.

Våld i nära relation är ett stort samhälleligt problem. Både kvinnor och män utsätts för våld men kvinnor drabbas i större utsträckning av våld av allvarlig karaktär. En av mannens strategier för att kontrollera kvinnan är att isolera henne från omvärlden. Denna studie handlar om det sociala nätverket och vilken betydelse det kan ha för en våldsutsatt kvinna. Studien bygger på intervjuer med fem yrkesverksamma inom kvinnojour samt kommunal verksamhet som arbetar mot våld. Det insamlade datamaterialet har analyserats med hjälp av konventionell innehållsanalys. Resultatet av vår studie visar att det sociala nätverket på olika sätt är av stor betydelse för en våldsutsatt kvinna. Det som var tydligt återkommande var att kvinnor i regel blir väldigt isolerade och upplever en stor ensamhet samt att barnen kan påverka huruvida kvinnan väljer att lämna eller stanna kvar i relationen. Kvinnor som inte har något arbete, lever i ett missbruk eller invandrat till Sverige upplevs enligt yrkesverksamma befinna sig i en extra utsatt och sårbar situation.