Fertilitetsbevarande

Projekt

Vi driver rikstäckande studier baserade på patientunderlaget hos de sju stora universitetssjukhusen. 

Våra pågående projekt är både prospektiva och retrospektiva. Under 2021 öppnar vår första kliniska läkemedelsstudie för inklusion. 

 

 

Evaluating the protective effect of GnRHa, a randomized clinical study

We will conduct a Swedish multicentric randomized clinical trial and a Nordic population-based registry study to investigate if co-treatment with GnRH agonist drugs during systemic chemotherapy treatment can prevent ovarian follicle loss and protect the fertility of young women and girls undergoing cancer treatment. For this new project (see project outline in the next pages) funding has been granted by the Swedish Research Council and by the Swedish Cancer Society. The debate on ovarian protection using GnRHa has gone on for over 35 years and we would like to provide with an answer by performing a well-designed multicentric, randomized-controlled, double-blind study including appropriate clinical outcomes for fertility and modern biochemical markers of ovarian reserve and also by using the data collected in the population-based Nordic registries. If GnRHa co-treatment can be associated with increased fertility, such treatment would be particularly suitable for very young patients that require immediate cancer therapy and do not have the opportunity to perform any established and time-demanding fertility preservation treatments. However, if the GnRHa co-treatment doesn’t show any protective effects, research should move on attempting to finding therapies that can prevent infertility in our youngest cancer patient population.

Fertility in female cancer survivors after ART

A project to follow survivors of cancer who become pregnant using assisted reproductive treatments including oocyte donation has been completed by doctoral student Anna Marklund, MD and gyn/ob specialist at Södersjukhuset. Her project has special focus on women with breast cancer. This project will encompass the prospective investigation of fertility aspects of female cancer survivors and including the performance of fertility preservation, as well as their obstetrical and perinatal otucomes. Colleagues from all university hospitals in Sweden have joined the network and our project is multicentric with national coverage, including all centers in Sweden that have developed programs for fertility preservation. Our national research collaboration has been successful and effective, and now we plan to use the  model for the investigation of women and men with lymphoma (Postdoc project Frida Lundberg), women and men with sarcoma (PhD project Tobias Lekberg) and women with gynecologic cancer (Oncologist Hanna Röjlar). 

Risks and long term outcomes of ART

In our epidemiological research, large databases using medical population-based registries are being used for identification of risks of ART procedures in specific patient groups including pregnancy complications and long-term outcomes of the mothers and the children. We have recently submitted our manuscript on childhood mortality after ART vs natural conceptions, a study that analysed data from 2.847.815 children born in Sweden and registered in the Medical Birth Registry (Rodriguez-Wallberg et al, 2020). We are currently conducting a long-term follow-up study on the growth and development of children born in Stockholm after ART treatments.

Reproductive outcomes after ovarian cancer

The clinical and reproductive outcomes in women with early ovarian cancer that undergo fertility-sparing surgery are being investigated by doctoral candidate Gry Johansen, MD, gyn/ob specialist at Karolinska Hospital. The project is running nationwide, with collaboration from all 7 centers located at University Hospitals and will collect data prospectively for 3-years.

Publikationer

Reproductive outcome after breast cancer in women with and withour fertility preservation: A Swedish population-based nationwide cohort study.

Marklund A, Lundberg FE, Eloranta S, Hedayati E, Pettersson K & Rodriguez-Wallberg KA. JAMA Oncology 2020, Nov 19. https://pubmed-ncbi-nlm-nih-gov.proxy.kib.ki.se/33211089/

Nationwide Prospective study of Oncological and Reproductive Outcome following Fertility-Sparing Surgery for Treatment of Early Stage Epithelial Ovarian Cancer in Young Women.

Johansen G, Dahm-Kähler P, Staf C, Flöter Rådestad A & Rodriguez-Wallberg KABMC Cancer 2020, Oct 19;20(1):1009. doi: 10.1186/s12885-020-07511-y. https://pubmed-ncbi-nlm-nih-gov.proxy.kib.ki.se/33076846/

Reproductive and obstetric outcomes with the overall survival of fertile aged women treated with fertility-sparing surgery for ovarian borderline tumors in Sweden: A prospective Nationwide population-based study.

Johansen G, Dahm-Kähler P, Staf C, Flöter-Rådestad A & Rodriguez-Wallberg KA. Fertility and Sterility, 2020 Sep 22;S0015-0282(20)30696-8. https://pubmed-ncbi-nlm-nih-gov.proxy.kib.ki.se/32977941/

A prospective study of women and girls undergoing fertility preservation due to oncologic and non-oncologic indications in Sweden – Trends in patients’ choices and benefit of the chosen methods after long-term follow-up.

Rodriguez-Wallberg KA, Marklund A, Lundberg F, Wikander I, Milenkovic M, Anastacio A, Sergouniotis F, Wånggren K, Ekengren J, Lind T & Borgström B. Acta Obstetricia Gynecologica Scandinavica, 2019 May;98(5):604-615. https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/30723910

The risk of breast and gynecological cancer in women with a diagnosis of infertility: a nationwide population-based study.

Lundberg FE, Iliadou AN, Rodriguez-Wallberg KA, Gemzell-Danielsson K, Johansson ALV. European Journal of Epidemiology 2019 May;34(5):499-507. https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/30623293

Efficacy and safety of controlled ovarian stimulation using GnRH antagonist protocols for emergency fertility preservation in young women with breast cancer - A prospective nationwide Swedish multicenter study.

Marklund A, Eloranta S, Wikander I, Laczna Kitlinski M, Lood M, Nedstrand E, Thurin-Kjellberg A, Zhang P, Bergh J & Rodriguez-Wallberg KA. Human Reproduction 2020, Apr 28;35(4):929-938. https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/32313940

Mortality from infancy to adolescence in singleton children conceived from assisted reproductive techniques versus naturally conceived singletons in Sweden.

Rodriguez-Wallberg KA, Lundberg FE, Ekberg S, Johansson ALV, Ludvigsson JF, Almqvist C, Cnattingius S and Iliadou AN. Fertility and Sterility 2020 Mar;113(3):524-532. https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/32081362

Fertility-Sparing Surgery for treatment of Non-Epithelial Ovarian Cancer: Oncological and Reproductive Outcomes in a Prospective Nationwide Population-Based Cohort Study.

Johansen G, Dahm-Kähler P, Staf C, Flöter Rådestad A & Rodriguez-Wallberg KA. Gynecological Oncology, 2019 Nov;155(2):287-293. https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/31493900

Cohort Profile: The Uppsala-Stockholm Assisted Reproductive Techniques (UppStART) study.

Anastasia N Iliadou, Anna Sara Öberg, Jessica Pege, Kenny A. Rodriguez-Wallberg, Jan I Olofsson, Jan Holte, Håkan Wramsby, Margaretha Wramsby, Sven Cnattingius, Carolyn E Cesta.  BMJ Open 2019 aug 28; 9(8):e028866. https://www-ncbi-nlm-nih-gov.proxy.kib.ki.se/pubmed/31467051

For those who deeply want children and are denied them, those missing babies hover like silent ephemeral shadows over their lives. Who can describe the feel of a tiny hand that is never held?

/Laura Bush

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