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1. Partnership and relationship happiness in endometriosis related chronic pelvic pain: a multicenter case–control study

Author

Samia el Hadad, Alexandra Sabrina Kohl Schwartz, Clarissa Gassner, Felix Haeberlin, Stephanie von Orelli, Patrick Imesch, and Brigitte Leeners

Subjects
endometriosis, chronic pain, dyspareunia, dysmenorrhea, partnership, separation, Psychology, BF1-990
Abstract

IntroductionPartnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved.MethodsThe study was designed as a multi-center matched case–control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas.ResultsQuality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness.ConclusionGiven the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support.Clinical trial registrationidentifier NCT 02511626.

Published
2024
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4. Dysmenorrhea in adolescents requires careful investigation of endometriosis—an analysis of early menstrual experiences in a large case-control study

Author

Samia El-Hadad, Daksha Lässer, Maike-Katja Sachs, Alexandra Sabrina Kohl Schwartz, Felix Haeberlin, Stephanie von Orelli, Markus Eberhard, and Brigitte Leeners

Subjects
adolescents, dysmenorrhea, endometriosis, maternal experiences, menarche, menstruation, Reproduction, QH471-489, Medicine (General), R5-920
Abstract

IntroductionRecent evidence shows that endometriosis, a significant cause of infertility, may already present in adolescents. Dysmenorrhea, often leading to school absences, is a key symptom of the maturing menstrual cycle but also of endometriosis. However, it is often perceived as “normal” and left untreated. In adolescents, laparoscopy, the standard procedure to diagnose endometriosis, is performed particularly cautiously. To improve reproductive health in adolescents, we evaluate associations between early menstrual experiences and endometriosis.MethodsRetrospective data on early menstrual experiences from 563 women with surgically/histologically verified endometriosis and from 563 age-matched controls were compared. Study participants were recruited in Switzerland, Germany, and Austria. Information on menstrual experiences was collected via a structured questionnaire.ResultsThe bivariate analysis showed that early menarche (p = 0.004), dysmenorrhea and negative memories of menarche (p 3 years after menarche ((p =

Published
2023
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6. Partnership and relationship happiness in endometriosis related chronic pelvic pain: a multicenter case-control study.

Author

el Hadad, Samia, Schwartz, Alexandra Sabrina Kohl, Gassner, Clarissa, Haeberlin, Felix, von Orelli, Stephanie, Imesch, Patrick, and Leeners, Brigitte

Subjects
SEXUAL excitement, PELVIC pain, CHRONIC pain, ENDOMETRIOSIS, CHRONIC diseases
Abstract

Introduction: Partnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved. Methods: The study was designed as a multi-center matched case-control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas. Results: Quality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness. Conclusion: Given the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Supplementary dydrogesterone is beneficial as luteal phase support in artificial frozen-thawed embryo transfer cycles compared to micronized progesterone alone

Author

Angela Vidal, Carolin Dhakal, Nathalie Werth, Jürgen Michael Weiss, Dirk Lehnick, and Alexandra Sabrina Kohl Schwartz

Subjects
dydrogesterone, micronized progesterone gel, luteal phase support, frozen embryo transfer, clinical pregnancy rate, live birth rate, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract

IntroductionThe number of frozen embryo transfers increased substantially in recent years. To increase the chances of implantation, endometrial receptivity and embryo competency must be synchronized. Maturation of the endometrium is facilitated by sequential administration of estrogens, followed by administration of progesterone prior to embryo transfer. The use of progesterone is crucial for pregnancy outcomes. This study compares the reproductive outcomes and tolerability of five different regimens of hormonal luteal phase support in artificial frozen embryo transfer cycles, with the objective of determining the best progesterone luteal phase support in this context.DesignThis is a single-center retrospective cohort study of all women undergoing frozen embryo transfers between 2013 and 2019. After sufficient endometrial thickness was achieved by estradiol, luteal phase support was initiated. The following five different progesterone applications were compared: 1) oral dydrogesterone (30 mg/day), 2) vaginal micronized progesterone gel (90 mg/day), 3) dydrogesterone (20 mg/day) plus micronized progesterone gel (90 mg/day) (dydrogesterone + micronized progesterone gel), 4) micronized progesterone capsules (600 mg/day), and (5) subcutaneous injection of progesterone 25 mg/day (subcutan-P4). The vaginal micronized progesterone gel application served as the reference group. Ultrasound was performed after 12-15 days of oral estrogen (≥4 mg/day) administration. If the endometrial thickness was ≥7 mm, luteal phase support was started, up to six days before frozen embryo transfer, depending on the development of the frozen embryo. The primary outcome was the clinical pregnancy rate. Secondary outcomes included live birth rate, ongoing pregnancy, and miscarriage and biochemical pregnancy rate.ResultsIn total, 391 cycles were included in the study (median age of study participants 35 years; IQR 32-38 years, range 26–46 years). The proportions of blastocysts and single transferred embryos were lower in the micronized progesterone gel group. Differences among the five groups in other baseline characteristics were not significant. Multiple logistic regression analysis, adjusting for pre-defined covariates, showed that the clinical pregnancy rates were higher in the oral dydrogesterone only group (OR = 2.87, 95% CI 1.38–6.00, p=0.005) and in the dydrogesterone + micronized progesterone gel group (OR = 5.19, 95% CI 1.76–15.36, p = 0.003) compared to micronized progesterone gel alone. The live birth rate was higher in the oral dydrogesterone-only group (OR = 2.58; 95% CI 1.11–6.00; p=0.028) and showed no difference in the smaller dydrogesterone + micronized progesterone gel group (OR = 2.49; 95% CI 0.74–8.38; p=0.14) compared with the reference group.ConclusionThe application of dydrogesterone in addition to micronized progesterone gel was associated with higher clinical pregnancy rate and live birth rate and then the use of micronized progesterone gel alone. DYD should be evaluated as a promising LPS option in FET Cycles.

Published
2023
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14. Dysmenorrhea in adolescents requires careful investigation of endometriosis—an analysis of early menstrual experiences in a large case-control study

Author

El-Hadad, Samia; https://orcid.org/0000-0001-8844-6709, Lässer, Daksha, Sachs, Maike-Katja, Schwartz, Alexandra Sabrina Kohl, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, Leeners, Brigitte; https://orcid.org/0000-0003-4027-6151, El-Hadad, Samia; https://orcid.org/0000-0001-8844-6709, Lässer, Daksha, Sachs, Maike-Katja, Schwartz, Alexandra Sabrina Kohl, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, and Leeners, Brigitte; https://orcid.org/0000-0003-4027-6151

Abstract

Introduction Recent evidence shows that endometriosis, a significant cause of infertility, may already present in adolescents. Dysmenorrhea, often leading to school absences, is a key symptom of the maturing menstrual cycle but also of endometriosis. However, it is often perceived as “normal” and left untreated. In adolescents, laparoscopy, the standard procedure to diagnose endometriosis, is performed particularly cautiously. To improve reproductive health in adolescents, we evaluate associations between early menstrual experiences and endometriosis. Methods Retrospective data on early menstrual experiences from 563 women with surgically/histologically verified endometriosis and from 563 age-matched controls were compared. Study participants were recruited in Switzerland, Germany, and Austria. Information on menstrual experiences was collected via a structured questionnaire. Results The bivariate analysis showed that early menarche (p = 0.004), dysmenorrhea and negative memories of menarche (p < 0.001) were significantly associated with a diagnosis of endometriosis. After controlling for confounders in bivariate regression analysis occurrence of dysmenorrhea (p = <0.001, OR 5,74, 95% CI 3.82–7.22) especially with onset >3 years after menarche ((p = <0.001, OR 3.42, 95% CI 2.09–5.64) remained statistically significant predictors for diagnosis of endometriosis. Dysmenorrhea in mothers and mothers' perceived attitude towards menstruation were not associated with the occurrence of Endometriosis. Conclusions Dysmenorrhea and onset of dysmenorrhea at menarche or several years after it are strongly associated with the development of endometriosis. As mothers perceived attitudes towards menstruation show no significant association with their daughters' experiences, physical symptoms accompanying menarche and menstrual period pain in adolescents seem to be very reliable predictors in diagnosis of endometriosis. Therefore, dysmenorrhea in adolescents requires car

Published
2023

15. Comparison of male and female perspective in couples involved in sexual relationships and facing endometriosis

Author

Helfenstein, Fabienne, Kohl Schwartz, Alexandra Sabrina; https://orcid.org/0000-0002-7558-1327, Imesch, Patrick; https://orcid.org/0000-0001-6322-6005, Rauchfuss, Martina, Wölfler, Monika M, Haeberlin, Felix, von Orelli, Stefanie, Leeners, Brigitte, Helfenstein, Fabienne, Kohl Schwartz, Alexandra Sabrina; https://orcid.org/0000-0002-7558-1327, Imesch, Patrick; https://orcid.org/0000-0001-6322-6005, Rauchfuss, Martina, Wölfler, Monika M, Haeberlin, Felix, von Orelli, Stefanie, and Leeners, Brigitte

Abstract

Background While the sexuality of patients with endometriosis is an established topic in research, the possible effect of endometriosis on partnership sexuality has come to the fore only recently. To improve counseling, more information is needed on how both partners experience sexuality in the context of endometriosis. Aim Previous research regarding endometriosis and sexuality normally focused on one partner to explore couples’ intimate relations, whereas this study provides a comparison on both partners’ perspectives on their common sexuality. Methods An overall 302 couples received a questionnaire based on the Brief Index of Sexual Functioning and Sexual History Form, which was modified by endometriosis specialists to better focus on endometriosis-specific aspects. To detect different perspectives on common sexuality within the couple, the Wilcoxon test and the Pearson chi-square test were performed. Outcomes Various aspects of couple sexuality were assessed by both partners to investigate divergent perspectives between the man and the woman within a couple. Results On one hand, male and female partners seem to have divergent perspectives on sexual satisfaction in general, desired frequency of sexual contacts, and the question of the female partner engaging in sexual activity despite discomfort. On the other, they have similar perspectives on who takes initiative in sexual contacts, satisfaction with variety in the sexual relationship, and the impact of sexual limitations on their satisfaction within the partnership. Clinical implications Endometriosis research addressing issues related to sexuality should include male partners; the same applies to consulting women with endometriosis in the context of their relationships rather than as individuals. Strengths and Limitations This is the first analysis conducted on a larger scale of data from both partners in couples dealing with endometriosis. As it provides quantitative information only, some qualitative informa

Published
2023

16. Physical Activity in Women with Endometriosis: Less or More Compared with a Healthy Control?

Author

Sachs, Maike Katja; https://orcid.org/0000-0002-1783-5915, Dedes, Ioannis; https://orcid.org/0000-0001-7265-4765, El-Hadad, Samia; https://orcid.org/0000-0001-8844-6709, Haufe, Annika, Rueff, Dalia, Kohl Schwartz, Alexandra Sabrina; https://orcid.org/0000-0002-7558-1327, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, Leeners, Brigitte; https://orcid.org/0000-0003-4027-6151, Sachs, Maike Katja; https://orcid.org/0000-0002-1783-5915, Dedes, Ioannis; https://orcid.org/0000-0001-7265-4765, El-Hadad, Samia; https://orcid.org/0000-0001-8844-6709, Haufe, Annika, Rueff, Dalia, Kohl Schwartz, Alexandra Sabrina; https://orcid.org/0000-0002-7558-1327, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, and Leeners, Brigitte; https://orcid.org/0000-0003-4027-6151

Abstract

Background: Endometriosis, i.e., endometrial-like tissue outside the uterus, is a chronic inflammatory condition affecting physical functioning. However, the specific levels of physical activity (PA) in the context of endometriosis and different disease symptoms remain unclear. Methods: This multi-center, cross-sectional study compared PA levels and influencing factors in endometriosis patients and non-endometriosis patients. Data were collected through questionnaires. Endometriosis was surgically confirmed. A statistical analysis was performed with appropriate tests. Results: The study included 460 women with endometriosis and 460 age-matched women without this condition. The two groups did not differ significantly in terms of age, education level, or stable partnership. Women with endometriosis exhibited lower PA levels, practicing fewer hours of sports weekly and climbing fewer stairs daily compared to the control group. These differences remained significant after controlling for confounding factors. Factors such as endometriosis, current dysmenorrhea, and depression were associated with decreased PA. Conclusions: These findings suggest that women with endometriosis engage in less PA compared to those without this condition. These results highlight the need for interventions to promote increased PA in endometriosis patients and harness the associated health benefits. Further research is warranted to explore the underlying mechanisms and develop tailored exercise therapies for this population.

Published
2023

19. Supplementary dydrogesterone is beneficial as luteal phase support in artificial frozen-thawed embryo transfer cycles compared to micronized progesterone alone

Author

Vidal, Angela, Dhakal, Carolin, Werth, Nathalie, Weiss, Jürgen Michael, Lehnick, Dirk, and Kohl Schwartz, Alexandra Sabrina

Subjects
Endocrinology, Diabetes and Metabolism, 610 Medicine & health, 610 Medizin und Gesundheit
Abstract

IntroductionThe number of frozen embryo transfers increased substantially in recent years. To increase the chances of implantation, endometrial receptivity and embryo competency must be synchronized. Maturation of the endometrium is facilitated by sequential administration of estrogens, followed by administration of progesterone prior to embryo transfer. The use of progesterone is crucial for pregnancy outcomes. This study compares the reproductive outcomes and tolerability of five different regimens of hormonal luteal phase support in artificial frozen embryo transfer cycles, with the objective of determining the best progesterone luteal phase support in this context.DesignThis is a single-center retrospective cohort study of all women undergoing frozen embryo transfers between 2013 and 2019. After sufficient endometrial thickness was achieved by estradiol, luteal phase support was initiated. The following five different progesterone applications were compared: 1) oral dydrogesterone (30 mg/day), 2) vaginal micronized progesterone gel (90 mg/day), 3) dydrogesterone (20 mg/day) plus micronized progesterone gel (90 mg/day) (dydrogesterone + micronized progesterone gel), 4) micronized progesterone capsules (600 mg/day), and (5) subcutaneous injection of progesterone 25 mg/day (subcutan-P4). The vaginal micronized progesterone gel application served as the reference group. Ultrasound was performed after 12-15 days of oral estrogen (≥4 mg/day) administration. If the endometrial thickness was ≥7 mm, luteal phase support was started, up to six days before frozen embryo transfer, depending on the development of the frozen embryo. The primary outcome was the clinical pregnancy rate. Secondary outcomes included live birth rate, ongoing pregnancy, and miscarriage and biochemical pregnancy rate.ResultsIn total, 391 cycles were included in the study (median age of study participants 35 years; IQR 32-38 years, range 26–46 years). The proportions of blastocysts and single transferred embryos were lower in the micronized progesterone gel group. Differences among the five groups in other baseline characteristics were not significant. Multiple logistic regression analysis, adjusting for pre-defined covariates, showed that the clinical pregnancy rates were higher in the oral dydrogesterone only group (OR = 2.87, 95% CI 1.38–6.00, p=0.005) and in the dydrogesterone + micronized progesterone gel group (OR = 5.19, 95% CI 1.76–15.36, p = 0.003) compared to micronized progesterone gel alone. The live birth rate was higher in the oral dydrogesterone-only group (OR = 2.58; 95% CI 1.11–6.00; p=0.028) and showed no difference in the smaller dydrogesterone + micronized progesterone gel group (OR = 2.49; 95% CI 0.74–8.38; p=0.14) compared with the reference group.ConclusionThe application of dydrogesterone in addition to micronized progesterone gel was associated with higher clinical pregnancy rate and live birth rate and then the use of micronized progesterone gel alone. DYD should be evaluated as a promising LPS option in FET Cycles.

Published
2023
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20. Low-dose clomiphene citrate does not reduce implantation and live birth rates in otherwise unstimulated modified natural cycle IVF-retrospective cohort study

Author

Grädel, Flavia, von Wolff, Michael, Kohl Schwartz, Alexandra Sabrina, and Mitter, Vera Ruth

Subjects
Obstetrics and Gynecology, General Medicine, 610 Medizin und Gesundheit
Abstract

Research question Does antioestrogen effect of clomiphene citrate (CC) on the endometrium reduce implantation and thereby decrease pregnancy and live birth rate per transferred embryo? Methods In this cohort, unstimulated IVF cycles modified with clomiphene citrate (CC-NC-IVF) and unstimulated, natural IVF cycles (NC-IVF) conducted between 2011 and 2016 were included. CC was applied in a dosage of 25mcg per day, starting on cycle day 7 until ovulation trigger day. Primary outcomes were clinical pregnancy rate, defined as amniotic sac visible in ultrasound, and live birth rate per transferred embryo. Miscarriage rate calculated as amniotic sac not ending in a live birth was secondary outcome. A modified mixed-effect Poisson regression model was applied, and adjustments were made for female age, parity, type and cause of infertility. Additionally, stratification by parity and age was performed. Results Four hundred and ninety-nine couples underwent a total of 1042 IVF cycles, 453 being NC-IVF and 589 being CC-NC-IVF cycles. Baseline characteristics of both groups did not differ. Addition of CC did neither decrease clinical pregnancy rate (aRR 0.86; 95% CI 0.67–1.12) nor live birth rate per transferred embryo (aRR 0.84; 95% CI 0.62–1.13) in comparison with NC-IVF. Miscarriage rate did not differ between CC-NC-IVF and NC-IVF (aRR 0.95; 95% CI 0.57–1.57). Conclusion Low-dose CC does not reduce pregnancy or live birth rate per transferred embryo. It can be used in infertility treatment without negatively affecting the endometrium and implantation.

Published
2022

22. Perinatal outcomes in singletons after fresh IVF/ICSI: results of two cohorts and the birth registry

Author

Vera Ruth Mitter, Pascale Fasel, Claudia Berlin, Sofia Amylidi-Mohr, Beatrice Mosimann, Marcel Zwahlen, Michael von Wolff, and Alexandra Sabrina Kohl Schwartz

Subjects
Fetal Growth Retardation, 360 Soziale Probleme, Sozialdienste, Infant, Newborn, Obstetrics and Gynecology, 610 Medicine & health, Fertilization in Vitro, Infant, Low Birth Weight, Cohort Studies, Reproductive Medicine, Pregnancy, 360 Social problems & social services, Humans, Female, Registries, Sperm Injections, Intracytoplasmic, 610 Medizin und Gesundheit, Child, Live Birth, reproductive and urinary physiology, Developmental Biology, Retrospective Studies
Abstract

RESEARCH QUESTION How are perinatal outcomes of live-born singletons after stimulated and unstimulated IVF different from perinatal outcomes in (i) children born in a tertiary centre and (ii) all children born in Switzerland? METHODS This cohort study compared the perinatal outcomes of two birth cohorts and the national live birth registry. Relative risks were calculated using modified Poisson regression and clustering for siblings and adjustment for maternal age, parity and childs sex. RESULTS Of the 636,639 live births, 311 were in the Bern IVF Cohort (144 stimulated, 167 unstimulated), 2332 in the tertiary centre and 633,996 in the Swiss Live Birth Registry (SLBR). Perinatal outcomes following IVF did not differ compared with births in the SLBR (adjusted relative risk [aRR]; 95% confidence interval [CI]), with the exception of the increased risk of small for gestational age (1.31; 1.01 to 1.70, P = 0.04; aRR 1.12; 0.87 to 1.45, P = 0.39). Children born following stimulated IVF had a higher risk of low birthweight (2.17; 1.27 to 3.69, P

Published
2022
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23. Living with endometriosis: Comorbid pain disorders, characteristics of pain and relevance for daily life

Author

Leuenberger, Janine, Kohl Schwartz, Alexandra Sabrina, Geraedts, Kirsten, Haeberlin, Felix, Eberhard, Markus, von Orellie, Stefanie, Imesch, Patrick, Leeners, Brigitte, Leuenberger, Janine, Kohl Schwartz, Alexandra Sabrina, Geraedts, Kirsten, Haeberlin, Felix, Eberhard, Markus, von Orellie, Stefanie, Imesch, Patrick, and Leeners, Brigitte

Abstract

Background: Pain plays a central role in endometriosis. The complex relationship among pain characteristics, comorbid pain disorders and daily life represents a challenge for medical support. This multicentre cross-sectional case-control study analysed the association between endometriosis-related chronic pain and functions of daily life in 510 women with endometriosis, 265 (52%) who experienced chronic pain, either from endometriosis alone (N = 134, 26.3%) or in association with additional pain disorders (N = 131, 25.7%). Methods: Self-administered questionnaires from the Brief Pain Inventory and the Pain Disability Index were used to investigate associations between pain characteristics (frequency, duration, intensity) and daily life. Also, associations between different endometriosis characteristics (rASRM stage, presence of adhesions, localisation of lesions) and pain were evaluated. Results: Chronic pain is negatively associated with almost all (12/14) aspects of daily life investigated, including standing, walking, sitting, defaecation, sleep, sports activities, family and domestic responsibilities, sexuality, social functioning, professional life, mood, and joy of life. Altogether, 33.7% of women with chronic pain reported moderate and 27.5% severe limitations. Comorbid pain disorders resulted in significantly more limitations. The length of pain episodes showed a particularly important influence, especially for family/domestic responsibilities (OR 22.94, p < 0.001), professional life (OR 16.56, p < 0.001) and social functioning (OR 41.03, p < 0.001). Conclusions: Our data confirm that despite treatment, about 50% of women experience pain. Pain was associated with at least moderate negative effects on almost all areas of daily life; additional pain comorbidities increased limitations. Improving pain management is essential for improving quality of life in women with endometriosis. Significance: The study provides an accurate overview of the impact of endometr

Published
2022

26. Gonadotropin Stimulation Reduces the Implantation and Live Birth Rate but Not the Miscarriage Rate of Embryos Transferred When Compared to Unstimulated In Vitro Fertilization

Author

Vera Ruth Mitter, Flavia Grädel, Alexandra Sabrina Kohl Schwartz, and Michael von Wolff

Subjects
Pregnancy Rate, Obstetrics and Gynecology, 610 Medicine & health, Fertilization in Vitro, Abortion, Spontaneous, Pregnancy, embryonic structures, Humans, Female, Embryo Implantation, Birth Rate, Live Birth, Gonadotropins, Retrospective Studies
Abstract

Research suggests that gonadotropin stimulation in in vitro fertilization (IVF) treatment affects embryo quality and the endometrium that might influence embryo implantation, placentation and establishment of a viable pregnancy. We assessed the impact of gonadotropin stimulation on implantation, live birth and miscarriage rates per transferred embryo by comparing stimulated and unstimulated IVF treatment. In a cohort of 728 couples, 1310 IVF cycles with successful embryo transfer were analysed; 857 cycles were stimulated with gonadotropins > 75 IU/day (333 poor responder p = 0.028; aRR 1.42; 95% CI 1.10–1.84; p = 0.008) and live birth rates (RR 1.33; 95% CI 0.95–1.86; p = 0.093; aRR 1.38; 95% CI 1.01–1.88; p = 0.044) were higher in NC-IVF compared to cIVF normal responders. Miscarriage did not differ (RR 0.99; 95% CI 0.59–1.65; p = 0.965; aRR 0.90; 95% CI 0.52–1.53 p = 0.698). Similar results were obtained in poor responders. The study suggests an impact of gonadotropin stimulation on the implantation potential of embryos.

Published
2021
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27. Supplementary dydrogesterone is beneficial as luteal phase support in artificial frozenthawed embryo transfer cycles compared to micronized progesterone alone.

Author

Vidal, Angela, Dhakal, Carolin, Werth, Nathalie, Weiss, Jürgen Michael, Lehnick, Dirk, and Schwartz, Alexandra Sabrina Kohl

Subjects
LUTEAL phase, EMBRYO transfer, PROGESTERONE, PREGNANCY outcomes, MULTIPLE regression analysis
Abstract

Introduction: The number of frozen embryo transfers increased substantially in recent years. To increase the chances of implantation, endometrial receptivity and embryo competency must be synchronized. Maturation of the endometrium is facilitated by sequential administration of estrogens, followed by administration of progesterone prior to embryo transfer. The use of progesterone is crucial for pregnancy outcomes. This study compares the reproductive outcomes and tolerability of five different regimens of hormonal luteal phase support in artificial frozen embryo transfer cycles, with the objective of determining the best progesterone luteal phase support in this context. Design: This is a single-center retrospective cohort study of all women undergoing frozen embryo transfers between 2013 and 2019. After sufficient endometrial thickness was achieved by estradiol, luteal phase support was initiated. The following five different progesterone applications were compared: 1) oral dydrogesterone (30 mg/day), 2) vaginal micronized progesterone gel (90 mg/day), 3) dydrogesterone (20 mg/day) plus micronized progesterone gel (90 mg/day) (dydrogesterone + micronized progesterone gel), 4) micronized progesterone capsules (600 mg/day), and (5) subcutaneous injection of progesterone 25 mg/day (subcutan-P4). The vaginal micronized progesterone gel application served as the reference group. Ultrasound was performed after 12-15 days of oral estrogen (=4 mg/day) administration. If the endometrial thickness was =7 mm, luteal phase support was started, up to six days before frozen embryo transfer, depending on the development of the frozen embryo. The primary outcome was the clinical pregnancy rate. Secondary outcomes included live birth rate, ongoing pregnancy, and miscarriage and biochemical pregnancy rate. Results: In total, 391 cycles were included in the study (median age of study participants 35 years; IQR 32-38 years, range 26-46 years). The proportions of blastocysts and single transferred embryos were lower in the micronized progesterone gel group. Differences among the five groups in other baseline characteristics were not significant. Multiple logistic regression analysis, adjusting for pre-defined covariates, showed that the clinical pregnancy rates were higher in the oral dydrogesterone only group (OR = 2.87, 95% CI 1.38-6.00, p=0.005) and in the dydrogesterone + micronized progesterone gel group (OR = 5.19, 95% CI 1.76-15.36, p = 0.003) compared to micronized progesterone gel alone. The live birth rate was higher in the oral dydrogesterone-only group (OR = 2.58; 95% CI 1.11-6.00; p=0.028) and showed no difference in the smaller dydrogesterone + micronized progesterone gel group (OR = 2.49; 95% CI 0.74-8.38; p=0.14) compared with the reference group. Conclusion: The application of dydrogesterone in addition to micronized progesterone gel was associated with higher clinical pregnancy rate and live birth rate and then the use of micronized progesterone gel alone. DYD should be evaluated as a promising LPS option in FET Cycles. [ABSTRACT FROM AUTHOR]

Published
2023
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28. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis

Author

Nirgianakis, Konstantinos, Kalaitzopoulos, Dimitrios R, Kohl Schwartz, Alexandra Sabrina, Spaanderman, Marc, Kramer, Boris W, Mueller, Michael D, Mueller, Martin, University of Zurich, and Nirgianakis, Konstantinos

Subjects
1309 Developmental Biology, Reproductive Medicine, 610 Medicine & health, 2729 Obstetrics and Gynecology, 2743 Reproductive Medicine, 10174 Clinic for Gynecology, Developmental Biology
Abstract

This study aimed to investigate the association of adenomyosis with fertility, pregnancy and neonatal outcomes. An electronic search was conducted using the MEDLINE, PubMed and Cochrane databases up to April 2020. Seventeen observational studies were included. Adenomyosis was significantly associated with a lower clinical pregnancy rate (odds ratio [OR] 0.69; 95% confidence interval [CI] 0.51-0.94) and higher miscarriage rate (OR 2.17; 95% CI 1.25-3.79) after treatment with assisted reproductive technology (ART). The lower clinical pregnancy rate was more significant in the subgroup of patients with short down-regulation protocols. Similar associations were recorded after age adjustment. Adenomyosis was also significantly associated with an increased risk of pre-eclampsia, preterm delivery, Caesarean section, fetal malpresentation, small for gestational age infancy and post-partum haemorrhage, which was confirmed after correction for age and mode of conception. In conclusion, adenomyosis is associated with negative effects on fertility after ART. The potentially protective role of the ultra-long down-regulation protocols needs further evaluation in randomized controlled studies. Adenomyosis is also associated (independently of the mode of conception) with adverse pregnancy and neonatal outcomes. Proper counselling prior to ART and close monitoring of pregnancy in patients with adenomyosis should be recommended.

Published
2021
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29. Fatigue - a symptom in endometriosis

Author

Ramin-Wright, Annika, Schwartz, Alexandra Sabrina Kohl, Geraedts, Kirsten, Rauchfuss, Martina, Wölfler, Monika Martina, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, Imthurn, Bruno, Imesch, Patrick, Fink, Daniel, Leeners, Brigitte, Ramin-Wright, Annika, Schwartz, Alexandra Sabrina Kohl, Geraedts, Kirsten, Rauchfuss, Martina, Wölfler, Monika Martina, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, Imthurn, Bruno, Imesch, Patrick, Fink, Daniel, and Leeners, Brigitte

Abstract

STUDY QUESTION Is fatigue a frequent symptom of endometriosis? SUMMARY ANSWER Fatigue is an underestimated symptom of endometriosis as it affects the majority of women with endometriosis, but it is not widely discussed in literature. WHAT IS KNOWN ALREADY Fatigue can be a symptom of endometriosis causing major distress impacting the daily activities and quality of life of women with endometriosis. However, few studies with large sample sizes have investigated fatigue as a symptom of endometriosis. STUDY DESIGN, SIZE, DURATION The study was designed as a multi-center matched case-control study. Recruitment took place at hospitals and private practices in Switzerland, Germany and Austria between 2010 and 2016. Data was collected from 1120 women, 560 of them with endometriosis. The women with endometriosis were matched to 560 control women in regard to age ±3 years and ethnic background. PARTICIPANTS/MATERIALS, SETTING, METHODS Diagnosis of women with endometriosis had to be surgically and histologically confirmed. Surgical exclusion or absence of any endometriosis-identifying symptoms was required for control subjects. Materials included surgical and histological reports as well as data retrieved from a self-administered questionnaire. This study focused on the symptom fatigue in endometriosis. Relationships of variables were established by regression analysis and associations were quantified as odds ratios. MAIN RESULTS AND THE ROLE OF CHANCE Frequent fatigue was experienced by a majority of women diagnosed with endometriosis (50.7% versus 22.4% in control women, P < 0.001). Fatigue in endometriosis was associated with insomnia (OR: 7.31, CI: 4.62-11.56, P < 0.001), depression (OR: 4.45, CI: 2.76-7.19, P < 0.001), pain (OR: 2.22, CI: 1.52-3.23, P < 0.001), and occupational stress (OR: 1.45, CI: 1.02-2.07, P = 0.037), but was independent of age, time since first diagnosis and stage of the disease. LIMITATIONS, REASONS FOR CAUTION Women with asymptomatic endom

Published
2021

30. Getting consent - challenges and difficulties for conducting research using health-related patient data

Author

Mitter, Vera Ruth, Krebs, Danielle, Paulsson, Maria, Mosimann, Beatrice, von Wolff, Michael, and Kohl Schwartz, Alexandra Sabrina

Subjects
ddc: 610, 610 Medical sciences, Medicine
Abstract

Background/research question: Informed consent is an important need to conduct medical research ethically correct. In Switzerland, since 2014 the human research act (HRA) [ref:1] regulates patient information and consent in research. Unique for a law on human research in Europe and within[for full text, please go to the a.m. URL], Nützliche patientenrelevante Forschung; 21. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin

Published
2020

32. Endometriose und Sexualität. Symptomatik und Bewältigungsstrategien

Author

Leeners, Brigitte, Kohl Schwartz, Alexandra Sabrina, Geraedts, Kirsten, Wölfler, Monika Martina, von Orelli, Stephanie, Häberlin, Felix, Eberhard, Markus, Imesch, Patrick, Fink, Daniel, Imthurn, Bruno, Rauchfuss, Martina, and University of Zurich

Subjects
610 Medicine & health, 10174 Clinic for Gynecology
Published
2018
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33. Breastfeeding following in vitro fertilisation in Switzerland—Does mode of conception affect breastfeeding behaviour?

Author

Purtschert, Livia Amanda, Mitter, Vera Ruth, Zdanowicz, Jarmila Anna, Minger, Mirja Amadea, Spaeth, Anna, Wolff, Michael, and Kohl Schwartz, Alexandra Sabrina

Subjects
BREASTFEEDING, DURATION of pregnancy, OPTIMAL stopping (Mathematical statistics), UNIVERSITY hospitals, CROSS-sectional method
Abstract

Aim: Breastfeeding has numerous advantages. Our aim was to investigate whether breastfeeding initiation and duration in women with pregnancies conceived through in vitro fertilisation differ from spontaneously conceived pregnancies. Methods: This is a comparative cross‐sectional study about breastfeeding behaviour performed at the Bern University Hospital including mothers of singletons conceived by in vitro fertilisation (n = 198) with or without gonadotropin stimulation between 2010 and 2016 (in vitro fertilisation group). They were compared to a population‐based control group (n = 1421) of a randomly selected sample of mothers in Switzerland who delivered in 2014. Results: A total of 1619 women were included in this analysis. Breastfeeding initiation rates were high, similar between the in vitro fertilisation group (93.4%) and the control group (94.8%). No increased risk of stopping breastfeeding earlier after in vitro fertilisation treatment compared to the control group could be found over the observational period of 12 months (HR = 1.00, 95% CI 0.83‐1.20, P =.984). There was no difference in breastfeeding initiation or duration after gonadotropin‐stimulated vs unstimulated in vitro fertilisation. Conclusion: In Switzerland, in vitro fertilisation treatments were not associated with earlier breastfeeding cessation. This result is reassuring for mothers undergoing in vitro fertilisation. [ABSTRACT FROM AUTHOR]

Published
2021
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34. Fatigue - a symptom in endometriosis

Author

Ramin-Wright, Annika, Kohl Schwartz, Alexandra Sabrina, Geraedts, Kirsten, Rauchfuss, Martina, Wölfler, Monika Martina, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, Imthurn, Bruno, Imesch, Patrick, Fink, Daniel, Leeners, Brigitte, Ramin-Wright, Annika, Kohl Schwartz, Alexandra Sabrina, Geraedts, Kirsten, Rauchfuss, Martina, Wölfler, Monika Martina, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, Imthurn, Bruno, Imesch, Patrick, Fink, Daniel, and Leeners, Brigitte

Abstract

STUDY QUESTION: Is fatigue a frequent symptom of endometriosis? SUMMARY ANSWER: Fatigue is an underestimated symptom of endometriosis as it affects the majority of women with endometriosis, but it is not widely discussed in literature. WHAT IS KNOWN ALREADY: Fatigue can be a symptom of endometriosis causing major distress impacting the daily activities and quality of life of women with endometriosis. However, few studies with large sample sizes have investigated fatigue as a symptom of endometriosis. STUDY DESIGN, SIZE, DURATION: The study was designed as a multi-center matched case-control study. Recruitment took place at hospitals and private practices in Switzerland, Germany and Austria between 2010 and 2016. Data was collected from 1120 women, 560 of them with endometriosis. The women with endometriosis were matched to 560 control women in regard to age ±3 years and ethnic background. PARTICIPANTS/MATERIALS, SETTING, METHODS: Diagnosis of women with endometriosis had to be surgically and histologically confirmed. Surgical exclusion or absence of any endometriosis-identifying symptoms was required for control subjects. Materials included surgical and histological reports as well as data retrieved from a self-administered questionnaire. This study focused on the symptom fatigue in endometriosis. Relationships of variables were established by regression analysis and associations were quantified as odds ratios. MAIN RESULTS AND THE ROLE OF CHANCE: Frequent fatigue was experienced by a majority of women diagnosed with endometriosis (50.7% versus 22.4% in control women, P < 0.001). Fatigue in endometriosis was associated with insomnia (OR: 7.31, CI: 4.62-11.56, P < 0.001), depression (OR: 4.45, CI: 2.76-7.19, P < 0.001), pain (OR: 2.22, CI: 1.52-3.23, P < 0.001), and occupational stress (OR: 1.45, CI: 1.02-2.07, P = 0.037), but was independent of age, time since first diagnosis and stage of the disease. LIMITATIONS, REASONS FOR CAUTION: Women with asymptomatic endomet

Published
2018

35. Fatigue – a symptom in endometriosis

Author

Ramin-Wright, Annika, primary, Schwartz, Alexandra Sabrina Kohl, additional, Geraedts, Kirsten, additional, Rauchfuss, Martina, additional, Wölfler, Monika Martina, additional, Haeberlin, Felix, additional, von Orelli, Stephanie, additional, Eberhard, Markus, additional, Imthurn, Bruno, additional, Imesch, Patrick, additional, Fink, Daniel, additional, and Leeners, Brigitte, additional

Published
2018
Full Text
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36. Fatigue - a symptom in endometriosis

Author

Ramin-Wright, Annika, Schwartz, Alexandra Sabrina Kohl, Geraedts, Kirsten, Rauchfuss, Martina, Wölfler, Monika Martina, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, Imthurn, Bruno, Imesch, Patrick, Fink, Daniel, Leeners, Brigitte, Ramin-Wright, Annika, Schwartz, Alexandra Sabrina Kohl, Geraedts, Kirsten, Rauchfuss, Martina, Wölfler, Monika Martina, Haeberlin, Felix, von Orelli, Stephanie, Eberhard, Markus, Imthurn, Bruno, Imesch, Patrick, Fink, Daniel, and Leeners, Brigitte

Abstract

STUDY QUESTION Is fatigue a frequent symptom of endometriosis? SUMMARY ANSWER Fatigue is an underestimated symptom of endometriosis as it affects the majority of women with endometriosis, but it is not widely discussed in literature. WHAT IS KNOWN ALREADY Fatigue can be a symptom of endometriosis causing major distress impacting the daily activities and quality of life of women with endometriosis. However, few studies with large sample sizes have investigated fatigue as a symptom of endometriosis. STUDY DESIGN, SIZE, DURATION The study was designed as a multi-center matched case-control study. Recruitment took place at hospitals and private practices in Switzerland, Germany and Austria between 2010 and 2016. Data was collected from 1120 women, 560 of them with endometriosis. The women with endometriosis were matched to 560 control women in regard to age ±3 years and ethnic background. PARTICIPANTS/MATERIALS, SETTING, METHODS Diagnosis of women with endometriosis had to be surgically and histologically confirmed. Surgical exclusion or absence of any endometriosis-identifying symptoms was required for control subjects. Materials included surgical and histological reports as well as data retrieved from a self-administered questionnaire. This study focused on the symptom fatigue in endometriosis. Relationships of variables were established by regression analysis and associations were quantified as odds ratios. MAIN RESULTS AND THE ROLE OF CHANCE Frequent fatigue was experienced by a majority of women diagnosed with endometriosis (50.7% versus 22.4% in control women, P < 0.001). Fatigue in endometriosis was associated with insomnia (OR: 7.31, CI: 4.62-11.56, P < 0.001), depression (OR: 4.45, CI: 2.76-7.19, P < 0.001), pain (OR: 2.22, CI: 1.52-3.23, P < 0.001), and occupational stress (OR: 1.45, CI: 1.02-2.07, P = 0.037), but was independent of age, time since first diagnosis and stage of the disease. LIMITATIONS, REASONS FOR CAUTION Women with asymptomatic endom

37. Endometriosis, especially mild disease: a risk factor for miscarriages

Author

Kohl Schwartz, Alexandra, Wölfler, Monika Martina, Mitter, Vera, Rauchfuss, Martina, Haeberlin, Felix, Eberhard, Markus, Von Orelli, Stephanie, Imthurn, Bruno, Imesch, Patrick, Fink, Daniel, Leeners, Brigitte, University of Zurich, and Kohl Schwartz, Alexandra Sabrina

Subjects
610 Medicine & health, 2729 Obstetrics and Gynecology, 10175 Clinic for Reproductive Endocrinology, 2743 Reproductive Medicine, 10174 Clinic for Gynecology
Abstract

OBJECTIVE To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW). DESIGN Cross-sectional analysis nested in a retrospective observational study (n = 940). SETTING Hospitals and associated private practices. PATIENT(S) Previously pregnant women (n = 268) within reproductive age in matched pairs. INTERVENTION(S) Retrospective analysis of surgical reports and self-administered questionnaires. MAIN OUTCOME MEASURE(S) Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis). RESULT(S) The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%-42.0%]) compared with CW (22.0% [16.7%-27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41-2.75). This remained significant in subfertile WwE (50.0% [40.7%-59.4%]) vs. CW (25.8% [8.5%-41.2%]) but not in fertile WwE (24.5% [16.3%-31.6%]) vs. CW (21.5% [15.9%-26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%-51.4%] vs. rASRM III/IV 30.8% [22.6%-38.7%], compared with 22.0% [16.7%-27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%-53.9%]) compared with ovarian endometriosis (28.6% [17.7%-38.7%]) and deep infiltrating endometriosis (33.9% [21.2%-46.0%]) compared with CW (22.0% [16.7%-27.0%]). CONCLUSION(S) Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage. CLINICAL TRIAL REGISTRATION NUMBER NCT02511626.

Published
2017

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