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Prenatal expectations are important for the future parent-child relationship. The authors examined how maternal and paternal prenatal expectations of the relationship with the child predicted 1st-year parenting stress and whether these expectations were violated over the transition to parenthood. They further examined how former infertility affected these associations. The participants were 745 Finnish couples, 367 having undergone a successful assisted reproductive treatment and 378 conceiving spontaneously. Couples completed a questionnaire of family representations during pregnancy and when the child was 2 and 12 months old and Abidin's Parenting Stress Index at 2 and 12 months postpartum. The hypothesis of moderately high expectations predicting the lowest level of parenting stress was substantiated only concerning paternal expectations of own autonomy with the child. Generally, however, negative expectations of own and spouse's relationship with the child were linearly associated with higher parenting stress. Postnatal representations were more positive or equal to expectations, except for negative violation occurring in maternal expectation of the father-child relationship, especially among normative mothers. The results are discussed in relation to family dynamic considerations and special features of formerly infertile couples.

Single embryo transfer (SET) has been the main embryo transfer strategy in the oocyte donation programme at the authors' clinic since 2000. The primary aim of this study was to evaluate the effect of SET on the clinical outcome in an unselected group of oocyte recipients. A retrospective analysis of the outcome in 142 recipient cycles (116 from anonymous donors; 26 from known donors) was performed. The oocytes from each anonymous donor were shared between two recipients if at least 10 oocytes were obtained. The proportion of SET of all fresh transfers was 77.3%. The clinical pregnancy rate (CPR) was 43.2% and the delivery rate 31.1% per embryo transfer. The outcome was similar in recipients undergoing anonymous and non-anonymous donation. The delivery rates were similar after SET (30.4%) or double embryo transfer (DET) (33.3%), whereas the twin rate was 0% after SET and 40% after DET. The implantation rate was significantly better (P < 0.01) with good-quality embryos (54.7%) compared with non-optimal embryos (27.1%). Of 152 frozen-thawed embryo transfer cycles, 78.9% were SET. The CPR was 28.3% and the twin rate was 7.1%. In fresh oocyte donation cycles, elective SET can be recommended if the embryo quality is considered good, and always if there is a contraindication for twin pregnancy.

The incidence of multiple births has increased parallel with the success of assisted reproduction treatments (ART) mainly because of the multiple embryo transfer. As a response to the increased multiple birth rate, the number of embryos transferred was reduced in 1992–1994 from three or more to two in many European countries. After that, a dramatic drop in the number of triplet and higher-order pregnancies was seen, but the twin rate still remained high. According to the European registers by ESHRE, in 2001 still 34.4% of children conceived with ART originated from multiple pregnancies, of which 94% were twin pregnancies. Obstetric and perinatal complications affect twins more often than singletons, contributing to increased health risk of the mother of twins and the children born as twins. In addition to the medical complications, twin families are at a greater risk for psychosocial burden. From the health-economic point of view, cost impact for twins is threefold to that of singletons. Recently, the standards of success of infertility treatment have been widely debated in journals of reproductive medicine. The general conclusion from this debate is that both the delivery rate per treatment and the final outcome of the pregnancy should be considered when the success of ART is reported. The high iatrogenic twin rate resulting from ART still offers the infertility treatment providers a challenge to strive for minimizing the number of ART-related twins. The most efficient way to reduce twin rate in ART is single embryo transfer (SET). However, the worry about impairment of delivery rate if only one embryo is transferred has hampered the acceptance of SET. The four randomised controlled trials and some retrospective cohort studies published until now have confirmed the effectiveness of elective single embryo transfer (eSET) in reducing the twin rate below 10%. In addition, highly acceptable delivery rate is achieved with eSET. The final results of eSET are most obviously further improved by transfer of frozen-thawed embryos. The experience of eSET until now encourages mowing towards an individualised embryo transfer policy, where eSET is performed in good prognosis patients at high risk for a twin pregnancy when two embryos would be transferred. The aim of this article is to review studies about eSET as a method to prevent ART-related twin pregnancies and the ways used in nationwide implementation of eSET in Finland, Belgium and Sweden.

Background. In vitro fertilization (IVF) surrogacy makes it possible for women who do not have a functional uterus to have their own genetic offspring. We describe here our experience of IVF surrogacy in Finland over a 10-year period. Methods. This retrospective study included 17 women who underwent ovarian stimulation in connection with surrogacy in 1991–2001 at four clinics. The surrogate mothers were unpaid volunteers: six sisters, three mothers, one husband's sister, one cousin, four friends and three other volunteers. Thorough counseling was given to the commissioning couples and to the surrogate mothers and their partners. The commissioning couples were prepared to adopt their biological children. Results. Twenty-eight surrogate IVF cycles were started in 17 women. One couple received donated oocytes. Trans-vaginal oocyte retrieval was feasible in every case, including those five women with congenital absence of the vagina and uterus. An average of 1.8 embryos was transferred at a time, and 11 pregnancies were achieved [50% per fresh embryo transfer (ET) and 16% per frozen-thawed ET]. Nine healthy singletons and one set of twins were born. One pregnancy ended in miscarriage. The mean birth weight of singleton infants was 3498 g (2270–4650 g). The birth weights of the twins were 2900 and 2400 g. In all cases the genetic parents took care of the infant immediately after birth. Two surrogate mothers had postpartum depression. Conclusions. Altruistic IVF surrogacy works well, but careful counseling of all parties involved is essential.

The outcome of 103 pregnancies in 64 women with constant hyperprolactinemia was evaluated. Seventy-eight pregnancies had been induced with bromocriptine and 25 occurred without any treatment. In all, 66% of the pregnancies ended in delivery, 17% in miscarriage, 10% in tubal pregnancy and 7% in induced abortion. The pregnancy of women with untreated hyperprolactinemia was more frequently ectopic when compared to those in women treated by bromocriptine. Obstetric complications as well as signs of tumoral enlargement during pregnancy were rare in hyperprolactinemic women treated or untreated with bromocriptine. Untreated hyperprolactinemia as a risk factor in tubal pregnancy is proposed.

To describe Finnish university students' childbearing histories, desires concerning childbearing, and awareness regarding the impact of age on female fertility.A national survey of Finnish university students in 2008. A questionnaire was sent to 9,967 Finnish undergraduate university students aged less than 35 years. Altogether, the questionnaire was answered by 1,864 men and 3,222 women. The overall response rate was 51% (42% for men and 59% for women). Students were asked about their number of children, desired childbearing, and awareness of the effect of age on female fertility.Of the respondents, 8.25% had children, and 94.0% wanted to have children in the future. Female students were more aware of the impact of age on female fertility than were male students. Over half of the men and approximately one-third of the women thought that the marked decrease in female fertility begins after the age of 45 years.A vast majority of Finnish university students wanted to have children in the future. Their awareness of the natural, age-related decline in female fertility was insufficient. Sexual health education in schools and health care personnel's family planning counselling, for both men and women, should include information about the age-related drop in fertility.

To review recent knowledge on mental health of parents of twins conceived via assisted reproductive technology (ART).Mental health of mothers and fathers of twins conceived via ART is impaired when compared with that of ART singletons.Existing studies are mainly cross-sectional and most of them focus on maternal mental health. It is evident that twin parenthood is the main factor impairing the mental health in parents with ART twins. This aspect should be taken into account when counseling the couples and deciding the number of embryos for transfer in ART. Well conducted prospective longitudinal studies are needed on both maternal and paternal mental health with twins conceived via ART from transition to parenthood to and beyond toddler age covering later life with school-aged and adolescent twins.

background: Although twin deliveries after assisted reproduction treatment (ART) are common, the mental health of the parents has scarcely been addressed. Therefore, we evaluated the psychological well-being of ART and spontaneously conceiving parents of twins and singletons. Furthermore, the impact of parity and children's health-related factors on mental health was evaluated. methods: We conducted a prospective longitudinal questionnaire study among ART parents of 91 pairs of twins and of 367 singletons and on control parents of 20 pairs of twins and of 379 singletons in the 2nd trimester of pregnancy (T1), and when the children were 2 months (T2) and 1-year old (T3). Symptoms of depression and anxiety, sleeping difficulties and social dysfunction were addressed via a ques- tionnaire. The effects of parity and child-related factors were assessed at T2. results: At T1, ART mothers of twins showed fewer symptoms of depression than control mothers of twins (P , 0.05). At T2, both ART and control mothers of twins had more symptoms of depression and anxiety than all mothers of singletons (F ¼ 5.20, P , 0.05 and F ¼ 3.93, P , 0.05, respectively). At T3, both ART and control mothers of twins continued to report more symptoms of depression than the mothers of singletons (F ¼ 10.01, P , 0.01), but a difference in anxiety symptoms was seen only in the control group. All fathers had similar mental health at T1. At T2, ART and control fathers of twins reported more symptoms of depression (F ¼ 4.15, P , 0.05) and social dys- function than fathers of singletons. At T3, both ART and control fathers of twins had more symptoms of depression (F ¼ 4.29, P , 0.05) and anxiety (F ¼ 5.40, P , 0.05) than fathers of singletons. Control fathers of twins had more sleeping difficulties than fathers of singletons (F ¼ 6.66, P , 0.01). Parity did not differently affect parental mental health at T2 in the study groups. Prematurity did not affect maternal mental health, but it had a negative impact on control fathers' social dysfunction (F ¼ 3.34, P , 0.05). conclusions: Twin parenthood, but not ART, has a negative impact on the mental health of mothers and fathers during the transition to parenthood. ART parents' mental health was not affected by parity or children's health-related factors.

BACKGROUND: The extremes of BMI are associated with an increased risk of miscarriage both in spontaneously conceived pregnancies and after fertility treatment. The aim of the present study was to study the effect of BMI on miscarriage rate (MR) in fresh IVF/ICSI, and in spontaneous and hormonally substituted frozen-thawed embryo (FET) cycles. METHODS: Analysis was carried out on 3330 first pregnancy cycles, performed during the years 1999–2004, of which 2198 were fresh, 666 were spontaneous and 466 were hormonally substituted FET cycles. A categorical, a linear and a quadratic models of the effect of BMI on miscarriage were studied by logistic regression. Factors related to patient characteristics, protocol and embryo parameters were also examined. RESULTS: MR was higher in hormonally substituted FET (23.0%), compared with the fresh cycles (13.8%) and spontaneous FET (11.4%, P< 0.0001). Multivariate logistic regression revealed that the relationship between BMI and the risk of miscarriage is not linear but quadratic (U-shaped) (P 5 0.01), indicating a higher risk of miscarriage in underweight and obese women. Hormonal substitution for FET was also associated with a 1.7-fold higher MR, compared with the fresh cycles (P 5 0.002, 95% confidence interval 1.2–2.3). CONCLUSIONS: Obese and underweight women have an increased risk of miscarriage, and hormonally substituted FET is associated with an even higher MR.

In this prospective controlled study, the authors examined (a) parenting experiences among couples with successful assisted reproduction treatment (ART; n = 367) and fertile spontaneously conceiving controls (n = 371) and (b) the impact of ante- and perinatal factors and child characteristics on parenting experiences. The results show that positive mothering experiences increased more during the 1st year of parenting and were generally higher among ART mothers than control mothers. No differences were found between ART fathers and controls in their fathering experience. Unpleasant birth experiences, low birth weight, and difficulty soothing the child were associated with high levels of parental stress in the control group, but this was not so among the ART parents. Psychosocial interventions in maternal care should take into account the various meanings that couples give to the history of infertility and conception and ante- and perinatal experiences.

BACKGROUND: The elective single embryo transfer policy is the only effective strategy known to minimize the risk of multiple pregnancy. However, little is known about its applicability to women older than 35 years. METHODS: Analysis was carried out on 1224 fresh IVF/ICSI cycles with embryo transfer and 828 frozen embryo transfer (FET) cycles of women aged 36-39 years. In the fresh cycles, 335 elective single top quality embryo (eSET), 110 elective single non top quality embryo (nt-eSET), 194 compulsory single embryo (cSET) and 585 double embryo transfers (DET) were carried out. RESULTS: Pregnancy rate/embryo transfer (33.1 versus 29.9%) and live birth rate (26.0 versus 21.9%) in fresh cycles did not differ significantly between the eSET and the DET groups. However, women in the eSET group had a higher cumulative pregnancy rate (54.0% versus 35.0%) and a higher cumulative live birth rate (41.8% versus 26.7%, P < 0.0001) compared with those in the DET group. The cumulative multiple birth rate in the eSET group was 1.7%, whereas in the DET group it was 16.6% (P < 0.0001). CONCLUSIONS: The eSET policy can be applied also to patients aged 36-39 years, reducing the risk of multiple birth and increasing the safety of assisted reproduction technique (ART) in this age group.

Background Transition to parenthood involves considerable psychological, social and physiological changes. We examined how prenatal and perinatal mental health and medical conditions predict infant's developmental and health status at 12 months, and whether former infertility and assisted reproduction treatment (ART) affect the predictor model. Methods The participants were 520 mothers who filled in questionnaires at the second trimester of pregnancy (T1), and when the child was 2 months (T2) and 12 months old (T3). Depressive and anxiety symptoms indicate reduced levels of mental health, and medical factors involve problems in pregnancy (e.g., high blood pressure and bleeding) and birth complications (pain and loss of blood). Neonatal health refers to, e.g., birth-weight and neurological status. At 12 months mothers reported infants’ verbal and motor development and general health status. Results First, it was shown that generally maternal prenatal anxiety and medical problems in pregnancy together predicted infant's developmental problems at 12 months through poor neonatal health, and medical problems alone also through increased level of birth complications. Second, the predictor models differed according to the history of infertility. In the ART group prenatal depression and anxiety and medical problems together predicted infant's developmental problems through maternal post-partum depression, and medical problems also through birth complications, whereas in the spontaneous conception group psychological and medical paths were separated and did not carry on developmental and health problems into 12 months. Conclusions Maternal health care should consider both psychological and medical risk paths across the whole transition to parenthood, and be aware of specific mediating paths in the risk groups.

BACKGROUND: High pregnancy rates have been noted after oocyte donation (OD). Multiple pregnancies should be avoided, because oocyte recipients have an increased risk of obstetric complications. METHODS: We analysed our OD results from 2000-2001 when elective single embryo transfer (eSET) was introduced as a recommended policy for all recipients if at least one good quality embryo was available. The results were compared with those achieved in 1998-1999, when usually two embryos were transferred (double embryo transfer, DET). Between 1998 and 2001, 100 healthy women donated oocytes and 135 fresh embryo transfers were carried out. The mean age of the donors was 31 years and that of the recipient women was 35 years. RESULTS: The proportion of eSET of all OD transfers was 17.1% in 1998-1999 and 61.0% in 2000-2001. There was no statistically significant difference in clinical pregnancy (36.8 versus 45.8%) and delivery rates (31.6 versus 33.9%) per embryo transfer between the two time periods. The proportion of twins declined from 29% (1998-1999) to 10% (2000-2001). The delivery rate was similar after eSET and DET (32.6 versus 32.1% respectively). CONCLUSIONS: By increasing the proportion of eSETs it is possible to reduce the number of twins without affecting delivery rates in oocyte recipients.

In vitro fertilization (IVF) surrogacy makes it possible for women who do not have a functional uterus to have their own genetic offspring. We describe here our experience of IVF surrogacy in Finland over a 10-year period.This retrospective study included 17 women who underwent ovarian stimulation in connection with surrogacy in 1991-2001 at four clinics. The surrogate mothers were unpaid volunteers: six sisters, three mothers, one husband's sister, one cousin, four friends and three other volunteers. Thorough counseling was given to the commissioning couples and to the surrogate mothers and their partners. The commissioning couples were prepared to adopt their biological children.Twenty-eight surrogate IVF cycles were started in 17 women. One couple received donated oocytes. Trans-vaginal oocyte retrieval was feasible in every case, including those five women with congenital absence of the vagina and uterus. An average of 1.8 embryos was transferred at a time, and 11 pregnancies were achieved [50% per fresh embryo transfer (ET) and 16% per frozen-thawed ET]. Nine healthy singletons and one set of twins were born. One pregnancy ended in miscarriage. The mean birth weight of singleton infants was 3498 g (2270-4650 g). The birth weights of the twins were 2900 and 2400 g. In all cases the genetic parents took care of the infant immediately after birth. Two surrogate mothers had postpartum depression.Altruistic IVF surrogacy works well, but careful counseling of all parties involved is essential.

Today many infertile couples become parents through assisted reproduction techniques (ART). A successful outcome improves emotional well-being in a majority of cases, but comparatively little is known about whether and how marital relations are affected during the transition to parenthood. The investigators studied the influence of ART on marital relations in 367 couples achieving singleton pregnancies by in vitro fertilization or intracytoplasmic sperm injection and 379 control couples who conceived spontaneously. The dyadic adjustment scale was used to assess parents' perceptions of their marriages when the child was 2 months (T2) and 12 months (T3) of age. Depression was rated during pregnancy using a short version of the Beck Depression Inventory. The ART and control couples did not differ significantly with regard to dyadic cohesion or marital satisfaction. Dyadic consensus deteriorated from T2 to T3 in control women but not those in the ART group. Men in the control group reported lower levels of sexual affection than did those in the ART group at T2, and stressful life events exaggerated this effect; no such difference was apparent at T3. Depression during pregnancy predicted worsened marital relations in control couples only. ART women experiencing several unsuccessful attempts at treatment exhibited good dyadic consensus and cohesion. Both spontaneous abortions and multiparity predicted relatively poor marital satisfaction in ART women. In ART men, a long duration of infertility and multiparity predicted poor marital relations. The investigators conclude from these findings that successful ART does not predispose to adverse marital adjustment. It is conceivable that the common stress of being infertile has the potential to stabilize marital relationships. This is only one example of how any life crisis may activate a couple's resources and strengthen their marriage.

Lymphocyte β 2 -adrenoceptor density was determined in 11 women during the normal menstrual cycle and 15 women during normal pregnancy. No significant difference in lymphocyte β 2 -adrenoceptor density was established in this follow-up study during the menstrual cycle or pregnancy. Lower lymphocyte β 2 -adrenoceptor density was established just after delivery and in puerperium compared with that during pregnancy. It is likely that the high catecholamine concentration during parturition together with the duration of labour and delivery caused down-regulation of the β 2 -adrenoceptors. In puerperium the irregular day-rhythm and the stress of caring for the newborn may also have an effect.