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Resumé Baggrund og problemformulering Infertilitet er et globalt sundhedsproblem og mange lande har faldende fertilitetsrater. En del af forklaringen kan skyldes sociodemografiske ændringer (finansiel sikkerhed, uddannelse, karriere) og biologiske årsager (f. eks lav sædkvalitet), men en medvirkende faktor kan også være mangel på viden om fertilitet. Hensigten med dette litteraturstudie er at undersøge hvilke interventioner der er udført for at øge viden og bevidsthed om fertilitet, samt deres betydning for familiedannelsen. Materiale og metode Dette speciale er et litteraturstudie baseret på 24 artikler identificeret gennem en struktureret søgning i PubMed og ESHRE med assistance fra Afdeling for Social Medicin ved Institut for Folkesundhedsvidenskab, Københavns Universitet. Studierne havde udført flere typer af interventioner, ved hjælp af video, individuel rådgivning, skriftlig information, samt en sidste gruppe med diverse andre metoder. Resultater De fleste af interventionerne, uafhængig af metode, viste en øgning i viden om diverse emner indenfor fertilitet og infertilitet. Imidlertid viste opfølgningsstudier generelt et fald i viden på lang sigt, hvilket antyder, at forbedringerne målt lige efter interventionerne ikke blev opretholdt. Derudover observerede få studier adfærdsændringer som følge af interventionen. Generelt havde kvinder højere vidensniveauer ved baseline og opfølgning sammenlignet med mænd. De kvalitative studier viste, at individuel fertilitetsrådgivning havde været en katalysator for forandring og ”a cue to action”. Konklusion Dette strukturerede litteraturstudie sammenligner både kvalitative og kvantitative data, og de kvantitative data blev målt med forskellige metoder. Derfor er en sammenligning ikke ligetil. Ikke desto mindre viste resultaterne generelle tendenser, såsom øget viden og fertilitetsbevidsthed efter en intervention. Der var dog mangel på langsigtede opfølgningsstudier, og, Background Infertility is a global health issue and decreasing fertility rates are present in many countries. Although a partial explanation is sociodemographic changes (financial security, education, career) and biological causes (e.g. low semen quality), a contributing factor could be lack of fertility knowledge. The purpose of this review is to examine the variety of interventions performed to increase fertility awareness and knowledge, as well as having an impact on family building. Materials and method This thesis is a literature study based on 24 articles identified through a structured search of PubMed, ESHRE, and with assistance from The Section of Social Medicine at The Department of Public Health, University of Copenhagen. The studies performed interventions using different methods, such as videos, individual counselling and written information. Results Most interventions showed an increase in knowledge of various topics regarding fertility and infertility. The increase was observed with all types of intervention methods. Even so, long-term follow-ups largely showed decreases in knowledge, implying that the improvements immediately after the interventions were not maintained. In addition, few studies observed behavioral change as a result of the intervention. In general, women had greater knowledge levels at baseline and follow-up compared to men. The qualitative studies found that individual fertility counselling had been a catalyst for change and a cue to action. Conclusion This structured literature study compares both qualitative and quantitative data, and the quantitative data was measured in various ways. Therefore, a comparison is not straightforward. Nevertheless, the results presented general trends, showing increased fertility awareness and knowledge after an educational intervention. However, there was a lack of long-term follow-ups, and in the long-term, knowledge levels generally d

Problem There has been an increase in the number of single women deciding to have children through the use of medically assisted reproduction (MAR). These women are referred to as ‘single mothers by choice’ (SMC). Background: Previous studies have shown how SMC can feel stigmatised. Aim: Explore if single women seeking fertility treatment in Denmark feel stigmatised. Methods Six single women undergoing MAR at a public fertility clinic in Denmark were interviewed. The interviews were audiotaped, anonymised, and transcribed in full, after provided written consent by the participants to take part in the study. Data were analysed using qualitative content analysis. Findings The women would have preferred to have a child in a relationship with a partner. Despite their dream of the nuclear family meaning a family group consisting of two parents and their children (one or more), the women choose to become SMC because motherhood was of such importance, and they feared they would otherwise become too old to have children. The participants did not experience stigma or negative responses to their decision, but they all had an awareness of the prejudices other people might have towards SMC. Conclusion This study contributes to the understanding of the experiences of single women seeking fertility treatment in a welfare state where there are no differences in the possibilities for different social classes to seek MAR., Problem: There has been an increase in the number of single women deciding to have children through the use of medically assisted reproduction (MAR). These women are referred to as ‘single mothers by choice’ (SMC). Background: Previous studies have shown how SMC can feel stigmatised. Aim: Explore if single women seeking fertility treatment in Denmark feel stigmatised. Methods: Six single women undergoing MAR at a public fertility clinic in Denmark were interviewed. The interviews were audiotaped, anonymised, and transcribed in full, after provided written consent by the participants to take part in the study. Data were analysed using qualitative content analysis. Findings: The women would have preferred to have a child in a relationship with a partner. Despite their dream of the nuclear family meaning a family group consisting of two parents and their children (one or more), the women choose to become SMC because motherhood was of such importance, and they feared they would otherwise become too old to have children. The participants did not experience stigma or negative responses to their decision, but they all had an awareness of the prejudices other people might have towards SMC. Conclusion: This study contributes to the understanding of the experiences of single women seeking fertility treatment in a welfare state where there are no differences in the possibilities for different social classes to seek MAR.

BackgroundStudies report that it can be challenging to assess and treat side-effects and symptoms among children who have impairments and difficulties in expressing their needs. Children with Down syndrome have an increased vulnerability and an increased risk for contracting leukaemia. There is sparse knowledge about the parental experience of how treatment and side-effects affect children with Down syndrome with leukaemia, as well as the role of participation during treatment.PurposeThis study aimed to explore the perceptions of parents of children with Down syndrome and leukaemia regarding their childs treatment, side effects and participation during hospital care.MethodsA qualitative study design was used, and interviews were conducted with a semi-structured interview-guide. Fourteen parents of 10 children with Down syndrome and acute lymphoblastic leukaemia from Sweden and Denmark, 1-18 years of age, participated. All children had completed therapy or had a few months left before the end of treatment. Data was analysed according to qualitative content analysis.ResultsFour sub-themes were identified: (1) Continuously dealing with the childs potential susceptibility; (2) Confidence and worries regarding decisions related to treatment regulation; (3) Challenges in communication, interpretation, and participation; and (4) Facilitating participation by adapting to the childs behavioural and cognitive needs. The sub-themes were bound together in an overarching theme, which expressed the core perception "Being the childs spokesperson to facilitate the childs participation during treatment". The parents expressed this role as self-evident to facilitate communication regarding the needs of the child, but also regarding how the cytotoxic treatment affected the vulnerable child. Parents conveyed the struggle to ensure the childs right to receive optimal treatment.ConclusionThe study results highlight parental challenges regarding childhood disabilities and severe health co, Funding Agencies|The research was supported by funding from the Danish Childhood Cancer Foundation. The funding source was by no means involved in the study.; Danish Childhood Cancer Foundation

New legislation was introduced in Sweden in 2016, giving single women access to medically assisted reproduction (MAR). While Swedish single women's characteristics and motivations for choosing motherhood through MAR were assessed in our previous pilot survey, their experience of considering and making the decision to undergo MAR has not been assessed through a qualitative approach. Thus, the aim of this study was to explore Swedish single women´s experience of making the decision to choose motherhood through MAR. The study design was a qualitative method with a semi-structured interview guide used for individual face-to-face interviews. Sixteen single women accepted for MAR were interviewed individually during their waiting time to start treatment. Qualitative content analysis was used to analyse the data. The data analyses resulted in three main categories: (i) longing and belonging; (ii) social exclusion and support; and (iii) evaluation and encounter. The overarching theme reflects the decision to become a single mother by choice: motherhood through MAR - an emotional and ambivalent decision to make on your own. In conclusion, to reach motherhood, by giving birth to one's child and not deviating from the norm as childless, was considered important among these women when making the decision to become a single mother by choice.

Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.

Background: Studies report that it can be challenging to assess and treat side-effects and symptoms among children who have impairments and difficulties in expressing their needs. Children with Down syndrome have an increased vulnerability and an increased risk for contracting leukaemia. There is sparse knowledge about the parental experience of how treatment and side-effects affect children with Down syndrome with leukaemia, as well as the role of participation during treatment. Purpose: This study aimed to explore the perceptions of parents of children with Down syndrome and leukaemia regarding their child's treatment, side effects and participation during hospital care. Methods: A qualitative study design was used, and interviews were conducted with a semi-structured interview-guide. Fourteen parents of 10 children with Down syndrome and acute lymphoblastic leukaemia from Sweden and Denmark, 1–18 years of age, participated. All children had completed therapy or had a few months left before the end of treatment. Data was analysed according to qualitative content analysis. Results: Four sub-themes were identified: (1) Continuously dealing with the child's potential susceptibility; (2) Confidence and worries regarding decisions related to treatment regulation; (3) Challenges in communication, interpretation, and participation; and (4) Facilitating participation by adapting to the child's behavioural and cognitive needs. The sub-themes were bound together in an overarching theme, which expressed the core perception “Being the child's spokesperson to facilitate the child's participation during treatment”. The parents expressed this role as self-evident to facilitate communication regarding the needs of the child, but also regarding how the cytotoxic treatment affected the vulnerable child. Parents conveyed the struggle to ensure the child's right to receive optimal treatment. Conclusion: The study results highlight parental challeng, BACKGROUND: Studies report that it can be challenging to assess and treat side-effects and symptoms among children who have impairments and difficulties in expressing their needs. Children with Down syndrome have an increased vulnerability and an increased risk for contracting leukaemia. There is sparse knowledge about the parental experience of how treatment and side-effects affect children with Down syndrome with leukaemia, as well as the role of participation during treatment.PURPOSE: This study aimed to explore the perceptions of parents of children with Down syndrome and leukaemia regarding their child's treatment, side effects and participation during hospital care.METHODS: A qualitative study design was used, and interviews were conducted with a semi-structured interview-guide. Fourteen parents of 10 children with Down syndrome and acute lymphoblastic leukaemia from Sweden and Denmark, 1-18 years of age, participated. All children had completed therapy or had a few months left before the end of treatment. Data was analysed according to qualitative content analysis.RESULTS: Four sub-themes were identified: (1) Continuously dealing with the child's potential susceptibility; (2) Confidence and worries regarding decisions related to treatment regulation; (3) Challenges in communication, interpretation, and participation; and (4) Facilitating participation by adapting to the child's behavioural and cognitive needs. The sub-themes were bound together in an overarching theme, which expressed the core perception "Being the child's spokesperson to facilitate the child's participation during treatment". The parents expressed this role as self-evident to facilitate communication regarding the needs of the child, but also regarding how the cytotoxic treatment affected the vulnerable child. Parents conveyed the struggle to ensure the child's right to receive optimal treatment.CONCLUSION: The study results highlight parental challenges regard

Being aware of factors that affect fertility can help people make informed decisions about their reproductive futures. To some, however, fertility information leads to worry and self-blame. In this paper, we explore how people from different generations discuss fertility and reproductive decision-making, along with their perceptions of fertility information. The study was conducted in southern Sweden with 26 focus-group discussions that included a total of 110 participants aged 17-90 years. The material was analysed thematically. Our results show that fertility knowledge and openness to talking about fertility problems have increased over generations. Participants who were assigned female at birth were more often concerned about their fertility than those who were not, and fertility concerns were transferred from mothers to daughters. While age-related fertility concerns had been uncommon in older generations, participants aged 25-40 often expressed these concerns. Young adults appreciated being knowledgeable about fertility but simultaneously expressed how fertility information could lead to distress. Our conclusion is that fertility information was best received by high-school students, and efforts to improve fertility education in schools are therefore recommended.

Specialets indhold: Indeværende kandidatspeciale (”specialet”) beskriver et forskningsprojekt (Interpretation of clinical trial REsults PRESENTed with Bayesian versus frequentist statistics - ”RE-PRESENT”). RE-PRESENT er færdigudviklet som projektdesign, herunder infrastruktur, godkendelser, prædefinerede analyser og overordnet strategi for datapræsentation. I specialet præsenteres analyser af simulerede data, da dataindsamlingen ikke er fuldført. Specialet indeholder foruden dette resume: - Dansksproget udvidet beskrivelse af RE-PRESENT’s tilblivelse, baggrund og metode - Uddrag fra RE-PRESENT spørgeskemaet - Eksempel på analyse og fortolkning af simulerede data - Endelig protokol (på engelsk) Kort om RE-PRESENT: Baggrund: Tolkning af kliniske forsøgsresultater kan være en vanskelig opgave. Det er blevet foreslået, at kliniske forskere i højere grad benytter sig af bayesianske (fremfor for de dominerende frekventistiske) analysemetoder, da disse angiveligt er mere intuitive og derfor lettere at fortolke. Vi ser af samme årsag flere eksempler på post-hoc bayesianske analyser af allerede publicerede forsøg, men vi har ringe forståelse for om disse alternative analyser rent faktisk påvirker beslutningstagernes fortolkning af forsøgene. Formål: RE-PRESENT har til formål at belyse læger og medicinstuderendes fortolkning af kliniske forsøgsresultater, og mere specifikt om fortolkningen lader sig påvirke af den anvendte analysemodel (bayesiansk mod frekventistisk) for de kliniske forsøgsresultater. Metode: RE-PRESENT er et randomiseret kontrolleret forsøg, hvor forsøgsdeltagere (læger og medicinstuderende) i et online spørgeskema skal fortolke styrken og implikationerne af seks fiktive kliniske forsøgsresultater. Forsøgsdeltagerne randomiseres til at få forsøgsresultaterne præsenteret sammen ved hhv. bayesiansk eller frekventistisk analysemetode. Vi sammenlig

Background: One in four pregnancies end in a pregnancy loss. Although the effect on couples is well documented, evidence-based treatments and prediction models are absent. Fetal aneuploidy is associated with a higher chance of a next successful pregnancy compared with euploid pregnancy loss in which underlying maternal conditions might be causal. Ploidy diagnostics are therefore advantageous but challenging as they require collection of the pregnancy tissue. Cell-free fetal DNA (cffDNA) from maternal blood has the potential for evaluation of fetal ploidy status, but no large-scale validation of the method has been done. Methods: In this prospective cohort study, women with a pregnancy loss were recruited as a part of the Copenhagen Pregnancy Loss (COPL) study from three gynaecological clinics at public hospitals in Denmark. Women were eligible for inclusion if older than 18 years with a pregnancy loss before gestational age 22 weeks (ie, 154 days) and with an intrauterine pregnancy confirmed by ultrasound (including anembryonic sac), and women with pregnancies of unknown location or molar pregnancies were excluded. Maternal blood was collected while pregnancy tissue was still in situ or within 24 h after pregnancy tissue had passed and was analysed by genome-wide sequencing of cffDNA. Direct sequencing of the pregnancy tissue was done as reference. Findings: We included 1000 consecutive women, at the time of a pregnancy loss diagnosis, between Nov 12, 2020, and May 1, 2022. Results from the first 333 women with a pregnancy loss (recruited between Nov 12, 2020, and Aug 14, 2021) were used to evaluate the validity of cffDNA-based testing. Results from the other 667 women were included to evaluate cffDNA performance and result distribution in a larger cohort of 1000 women in total. Gestational age of fetus ranged from 35–149 days (mean of 70·5 days [SD 16·5], or 10 weeks plus 1 day). The cffDNA-based test had a sensitivity for aneuploidy detection of 85% (95% CI 79–

How are educational level, labor market attachment and income associated with receiving a first ART treatment in either the public or private healthcare sector among women in Denmark?, STUDY QUESTION How are educational level, labor market attachment and income associated with receiving a first ART treatment in either the public or private healthcare sector among women in Denmark? SUMMARY ANSWER Higher educational level and income as well as labor market attachment were associated with higher probability of initiating ART treatment at public and private fertility clinics among women in Denmark. WHAT IS KNOWN ALREADY Infertility is common in populations worldwide, and the approach to this issue differs between societies and healthcare systems. In the public Danish healthcare system, ART treatment is free of charge, and the direct cost for patients is therefore low. In the private healthcare sector in Denmark, ART treatment is self-financed. There is limited knowledge about the association between socioeconomic factors and seeking ART treatment, although previous studies have indicated that higher socioeconomic status is associated with seeking ART treatment. STUDY DESIGN, SIZE, DURATION Women undergoing ART treatment during 1994-2016 registered in the Danish IVF register were individually linked with data from sociodemographic population registers using the Danish Personal Identification number. The study population consisted of 69 018 women treated with ART and 670 713 age-matched comparison women from the background population with no previous history of ART treatment. PARTICIPANTS/MATERIALS, SETTING, METHODS The women included in the analyses were aged 18-45 years. The associations between attained educational level, labor market attachment and income and receiving a first ART treatment attempt were investigated for women either initiating treatment in the public sector or in the private sector, respectively. Information on age and origin was included as potential confounders, and odds ratios (ORs) were estimated in logistic regression models. In addition, analyses were stratified by age group to investigate potential differences across the a

STUDY QUESTION Are there any differences in physical and psychosocial well-being among women undergoing modified natural cycle frozen embryo transfer (mNC-FET) with or without vaginal progesterone as luteal phase support (LPS)? SUMMARY ANSWER Women undergoing mNC-FET with vaginal progesterone supplementation were more likely to experience physical discomfort but there was no difference in psychosocial well-being between the two groups. WHAT IS KNOWN ALREADY mNC-FET can be carried out with or without vaginal progesterone as LPS, which has several side-effects. It is commonly known that fertility treatment can cause stress and psychosocial strain, however, most studies on this subject are conducted in fresh cycle regimes, which differ from NC-FET and results may not be comparable. STUDY DESIGN, SIZE, DURATION This is a sub-study of an ongoing RCT investigating whether progesterone supplementation has a positive effect on live birth rate in mNC-FET. The RCT is conducted at eight fertility clinics in Denmark from 2019 and is planned to end primo 2024. The sub-study is based on two questionnaires on physical and psychosocial well-being added to the RCT in August 2019. On the time of data extraction 286 women had answered both questionnaires. PARTICIPANTS/MATERIALS, SETTING, METHODS Women who had answered both questionnaires were included in the sub-study. Participants were equally distributed, with 143 in each of the two groups. Participants in both groups received the same questionnaires at two time-points: on cycle day 2–5 (baseline) and after blastocyst transfer. Participants in the progesterone group had administered progesterone for 7 days upon answering the second questionnaire. All items in the questionnaires were validated. Items on psychosocial well-being originate from the Copenhagen Multi-Centre Psychosocial Infertility—Fertility Problem Stress Scale (COMPI-FPSS) and from the Mental Health Inventory-5., STUDY QUESTION: Are there any differences in physical and psychosocial well-being among women undergoing modified natural cycle frozen embryo transfer (mNC-FET) with or without vaginal progesterone as luteal phase support (LPS)? SUMMARY ANSWER: Women undergoing mNC-FET with vaginal progesterone supplementation were more likely to experience physical discomfort but there was no difference in psychosocial well-being between the two groups. WHAT IS KNOWN ALREADY: mNC-FET can be carried out with or without vaginal progesterone as LPS, which has several side-effects. It is commonly known that fertility treatment can cause stress and psychosocial strain, however, most studies on this subject are conducted in fresh cycle regimes, which differ from NC-FET and results may not be comparable. STUDY DESIGN, SIZE, DURATION: This is a sub-study of an ongoing RCT investigating whether progesterone supplementation has a positive effect on live birth rate in mNC-FET. The RCT is conducted at eight fertility clinics in Denmark from 2019 and is planned to end primo 2024. The sub-study is based on two questionnaires on physical and psychosocial well-being added to the RCT in August 2019. On the time of data extraction 286 women had answered both questionnaires. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women who had answered both questionnaires were included in the sub-study. Participants were equally distributed, with 143 in each of the two groups. Participants in both groups received the same questionnaires at two time-points: on cycle day 2-5 (baseline) and after blastocyst transfer. Participants in the progesterone group had administered progesterone for 7 days upon answering the second questionnaire. All items in the questionnaires were validated. Items on psychosocial well-being originate from the Copenhagen Multi-Centre Psychosocial Infertility - Fertility Problem Stress Scale (COMPI-FPSS) and from the Mental Health Inventory-5. MAIN RESULTS AND THE ROLE OF CHANCE: Women recei

STUDY QUESTION: Is the psychosocial wellbeing affected in women and men shortly after allocation to a freeze-all strategy with postponement of embryo transfer compared to a fresh transfer strategy?SUMMARY ANSWER: In general, psychosocial wellbeing (i.e. emotional reactions to the treatment, quality-of-life, infertility-related stress, and marital benefit) was similar in women and men allocated to a freeze-all versus those allocated to a fresh-transfer strategy 6 days after disclosure of treatment strategy (i.e. 4 days after oocyte retrieval), although women in the freeze-all group reported a slightly higher degree of depressive symptoms and mood swings compared to women in the fresh transfer group.WHAT IS KNOWN ALREADY: The use of a freeze-all strategy, i.e. freezing of the entire embryo cohort followed by elective frozen embryo transfer in subsequent cycles has increased steadily over the past decade in assisted reproductive technology (ART). This strategy essentially eliminates the risk of ovarian hyperstimulation syndrome and has proven beneficial regarding some reproductive outcomes in subgroups of women. However, patients experience a longer time interval between oocyte retrieval and embryo transfer, hence a longer time to pregnancy, possibly adding additional stress to the ART treatment. So far, little focus has been on the possible psychosocial strains caused by postponement of embryo transfer.STUDY DESIGN, SIZE, DURATION: This is a self-reported questionnaire based sub-study of a multicentre randomized controlled trial (RCT) including 460 women and 396 male partners initiating their first, second, or third treatment cycle of invitro fertilisation or intracytoplasmic sperm injection (ICSI) from May 2016 to September 2018. This sub-study was included in the primary project protocol and project plan for the RCT, as psychosocial wellbeing was considered a secondary outcome.PARTICIPANTS/MATERIALS, SETTING, METHODS: Women from eight

This study explored young Danish men's perceptions and attitudes towards two fertility awareness (FA) interventions (a podcast episode and an informational poster) and their preferences for how fertility awareness and prevention efforts should be targeted and communicated to young men in the future. Focus groups were held with 13 young men who were between the ages of 25-35 and in a committed relationship over Zoom in January 2021. Data were analysed using qualitative content analysis. Young men preferred FA interventions to be factual as in the informational poster and to include personal stories that could serve as conversation starters as in the podcast. According to the young men, FA interventions should communicate using positive language and humour and not be negative or shaming. They preferred intervention formats like TV-programmes, podcasts, and social media. The participants also suggested fertility information should be included in sexual education in high school and vocational education. This research suggests that future FA campaigns should be developed in cooperation with the target group together with clinicians, and concurrent studies using different intervention formats should be performed. In all probability, a mix of different interventions is necessary to attain the desired effect to ensure long-lasting fertility awareness.