Search

STUDY QUESTION Is embryo culture in a closed time-lapse system associated with any differences in perinatal and maternal outcomes in comparison to conventional culture and spontaneous conception? SUMMARY ANSWER There were no significant differences between time-lapse and conventional embryo culture in preterm birth (PTB, <37 weeks), low birth weight (LBW, >2500 g) and hypertensive disorders of pregnancy for singleton deliveries, the primary outcomes of this study. WHAT IS KNOWN ALREADY Evidence from prospective trials evaluating the safety of time-lapse incubation for clinical use show similar embryo development rates, implantation rates, and ongoing pregnancy and live birth rates when compared to conventional incubation. Few studies have investigated if uninterrupted culture can alter risks of adverse perinatal outcomes presently associated with IVF when compared to conventional culture and spontaneous conceptions. STUDY DESIGN, SIZE, DURATION This study is a Swedish population-based retrospective registry study, including 7379 singleton deliveries after fresh embryo transfer between 2013 and 2018 from selected IVF clinics. Perinatal outcomes of singletons born from time-lapse-cultured embryos were compared to singletons from embryos cultured in conventional incubators and 71 300 singletons from spontaneous conceptions. Main perinatal outcomes included PTB and LBW. Main maternal outcomes included hypertensive disorders of pregnancy (pregnancy hypertension and preeclampsia). PARTICIPANTS/MATERIALS, SETTING, METHODS From nine IVF clinics, 2683 singletons born after fresh embryo transfer in a time-lapse system were compared to 4696 singletons born after culture in a conventional incubator and 71 300 singletons born after spontaneous conception matched for year of birth, parity, and maternal age. Patient and treatment characteristics from IVF deliveries were cross-linked with the Swedish Medical Birth Register, Register of Birth Defects, National Patient Register and Statistics Sweden. Children born after sperm and oocyte donation cycles and after Preimplantation Genetic testing cycles were excluded. Odds ratio (OR) and adjusted OR were calculated, adjusting for relevant confounders. MAIN RESULTS AND THE ROLE OF CHANCE In the adjusted analyses, no significant differences were found for risk of PTB (adjusted OR 1.11, 95% CI 0.87–1.41) and LBW (adjusted OR 0.86, 95% CI 0.66–1.14) or hypertensive disorders of pregnancy; preeclampsia and hypertension (adjusted OR 0.99, 95% CI 0.67–1.45 and adjusted OR 0.98, 95% CI 0.62–1.53, respectively) between time-lapse and conventional incubation systems. A significantly increased risk of PTB (adjusted OR 1.31, 95% CI 1.08–1.60) and LBW (adjusted OR 1.36, 95% CI 1.08–1.72) was found for singletons born after time-lapse incubation compared to singletons born after spontaneous conceptions. In addition, a lower risk for pregnancy hypertension (adjusted OR 0.72 95% CI 0.53–0.99) but no significant difference for preeclampsia (adjusted OR 0.87, 95% CI 0.68–1.12) was found compared to spontaneous conceptions. Subgroup analyses showed that some risks were related to the day of embryo transfer, with more adverse outcomes after blastocyst transfer in comparison to cleavage stage transfer. LIMITATIONS, REASONS FOR CAUTION This study is retrospective in design and different clinical strategies may have been used to select specific patient groups for time-lapse versus conventional incubation. The number of patients is limited and larger datasets are required to obtain more precise estimates and adjust for possible effect of additional embryo culture variables. WIDER IMPLICATIONS OF THE FINDINGS Embryo culture in time-lapse systems is not associated with major differences in perinatal and maternal outcomes, compared to conventional embryo culture, suggesting that this technology is an acceptable alternative for embryo incubation. STUDY FUNDING/COMPETING INTEREST(S) The study was financed by a research grant from Gedeon Richter. There are no conflicts of interest for all authors to declare. TRIAL REGISTRATION NUMBER N/A [ABSTRACT FROM AUTHOR]

Background: In many fertility centres, intracytoplasmic sperm injection (ICSI) with epididymal or testicular spermatozoa is a routine treatment for men with azoospermia. In this prospective study, the physiological consequences after testicular sperm aspiration (TESA), using suction and a 19 gauge needle, were evaluated.Methods and Results: Thirty-five consecutive men with azoospermia underwent TESA. Testicular ultrasonography with Doppler flow imaging was performed and testicular volumes were evaluated pre-operatively and 3 months after aspiration. If focal testicular lesions were found, further examinations were performed 6 and 9 months after TESA. Serum FSH, testosterone and antisperm antibodies (ASA) were analysed. Focal testicular lesions were seen in four out of 61 testes (6.6%) at the 3 month investigation point. Three lesions were resolved after 6 months and all after 9 months. Testicular echogenicity remained unchanged in 50 cases (82%) 3 months after TESA. Four men (11.4%) reported severe subjective discomfort post-operatively, but only one had a medical consultation where an intratesticular haematoma was diagnosed. There were no significant changes in FSH and testosterone after surgery and testicular volumes were similar after 3 months. There were three borderline cases of ASA in serum, but none was classified as ASA-positive.Conclusions: The puncture method of testicular sperm aspiration seems to be a safe method for sperm retrieval, with minimal physiological consequences. [ABSTRACT FROM AUTHOR]

The aim of this study was to report the outcome of all clinical pregnancies obtained after intracytoplasmic sperm injection (ICSI) performed during a 5 year period at two fertility clinics, with special reference to delivery outcome associated with different sperm origin and quality and the transfer of fresh or frozen-thawed pre-embryos. A total of 1293 clinical pregnancies was analysed. Deliveries occurred in 75.9% (n = 982) and early spontaneous abortion, late spontaneous abortion and ectopic pregnancy in 21.4, 1.0 and 1.2% respectively. Multiple birth occurred in 21.3% (208 sets of twins and one set of triplets) of the deliveries, with the highest incidence in the epididymal sperm group (30.2%) and lowest in the cryopreserved group (13.7%). A total of 1192 infants was born. Preterm birth occurred in 15.7% of all deliveries. Preterm birth was not related to sperm origin or quality but was related to multiple birth. The prematurity rate was 8.4%, 42.3% and 100% for singletons, twins and triplets respectively. Singleton infants born after cryopreservation as embryos had a significantly higher birthweight than the ejaculated sperm group with fresh embryo transfer. The perinatal mortality rate was 11.7 per 1000 born infants. Eighty-seven of the 1192 infants (7.3%) had a malformation, 40 of which were minor. The perinatal mortality rate and the malformation rate were similar in the different subgroups. Prenatal karyotyping was performed on 149 fetuses (12.5%) and abnormal results were found in four cases (2.7%). In conclusion, obstetric outcome of ICSI pregnancies was similar to that of conventional IVF and was not influenced by sperm origin or quality. The high incidence of multiple births is still the major concern. [ABSTRACT FROM AUTHOR]

This paper concentrates on the scientific attempts to find psychological interpretations of pregnancy outcome. The author presents a critical discussion of the literature based on an extensive evaluation undertaken during 1988. The aim of the analysis was to clarify the state-of-the-art and choices of methodologies in studies exploring and identifying the non-medical factors behind pregnancy outcome. Three distinctive psychology based approaches are found which are based on personality theory, psychosocial theory and life-event theory. These bases argue for very different causal contexts of pregnancy outcome and are, therefore, according to the author's view, very imnportant to recognize, particularly when it comes to occupational health research on work environment and pregnancy outcome. [ABSTRACT FROM AUTHOR]

The effect on intestinal net transport of fluid and electrolytes of a reduced circulating blood volume was studied in the human jejunum with the triple lumen perfusion technique. The blood volume was reduced by changing the lower extremities from an elevated to a dependent position combined with a venous stasis. The tilting manoeuvre, probably resembling a bleeding of about 600-800 ml, significantly increased net absorption of fluid, sodium and chloride while glucose transport was unaffected. Concomitantly the blood flow decreased and vascular resistance increased in the forearm vascular bed. The results are consistent with the hypothesis that activity in the sympathetic nervous system initiated from unloading of the cardiopulmonary volume receptors enhances intestinal absorption of fluid and electrolytes. The results also indicate that the human intestines are an important target organ in the compensatory mechanisms activated during hypovolaemia due to - for example, haemorrhage. [ABSTRACT FROM PUBLISHER]

Men with testicular azoospermia (NOA) have impaired spermatogenesis, and surgical testicular procedures are required to retrieve sperm. If testicular sperm can be retrieved, men with NOA can become biological fathers via intracytoplasmic sperm injection (ICSI). Several techniques are available today, such as needle aspiration (TESA), percutaneous biopsies and open biopsies (conventional TESE/micro-TESE). The most recent technique is micro-TESE, a non-blind technique, where seminiferous tubules with the highest probability of containing sperm are selected using an operative microscope. Though clinical routines differ between fertility centres where micro-TESE is available, sperm recovery rates are high. Similar risk for adverse outcomes have been observed in offspring compared with standard IVF. New non-blind sperm recovery techniques, such as micro-TESE, are encouraging and may improve sperm retrieval outcome in men with NOA. However, they require surgical and embryologist skills as well as investment in an operative microscope.

Introduction: Vaginal progesterone supplementation is frequently given to patients receiving frozen embryo transfer (FET) in the natural cycle aiming to increase the chance of pregnancy and live birth. To date, only a few studies have investigated if progesterone supplementation is beneficial in these cycles and the level of evidence for progesterone supplementation is very low., Methods and Analysis: The ProFET trial is a multicentre, open-label, randomised controlled trial powered for this investigation, including 1800 women with regular menstrual cycles (24-35 days), aged 18-43 years planned for natural cycle-FET receiving a single blastocyst for transfer. Participants are randomised (1:1:1) to either luteal phase progesterone for 3 weeks, luteal phase progesterone for 7 weeks or no luteal phase progesterone. The participating study centres consist of 12 in vitro fertilisation-clinics in Sweden and 1 in Iceland. The primary outcome is to investigate if luteal phase support (LPS) by vaginal progesterone increases the chance of a live birth per randomised patient in a natural FET cycle compared with no LPS., Ethics and Dissemination: The trial was approved by the Swedish Ethical Review Authority (ID 2020-06774, 2021-02822 and 2022-01502-02) and the Swedish Medical Products Agency (ID nr 5.1-2020-102613). All participants are required to provide written informed consent. The outcome of this study will be disseminated to the public through broadcasts, newspapers and presentations at scientific congresses as well as publications in international scientific journals., Trial Registration Number: NCT04725864., Competing Interests: Competing interests: CB and ÅM declare support from Ferring Pharmaceuticals, Merck Sereno and Gedeon Richter. MB has 4 % stocks in EUGIN Sweden. None of the other authors hade conflicts of interest., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Study Question: Can use of a commercially available time-lapse algorithm for Day 5 blastocyst selection improve pregnancy rates compared with morphology alone?, Summary Answer: The use of a time-lapse selection model to choose blastocysts for fresh single embryo transfer on Day 5 did not improve ongoing pregnancy rate compared to morphology alone., What Is Known Already: Evidence from time-lapse monitoring suggests correlations between timing of key developmental events and embryo viability. No good quality evidence exists to support improved pregnancy rates following time-lapse selection., Study Design, Size, Duration: A prospective multicenter randomized controlled trial including 776 randomized patients was performed between 2018 and 2021. Patients with at least two good quality blastocysts on Day 5 were allocated by a computer randomization program in a proportion of 1:1 into either the control group, whereby single blastocysts were selected for transfer by morphology alone, or the intervention group whereby final selection was decided by a commercially available time-lapse model. The embryologists at the time of blastocyst morphological scoring were blinded to which study group the patients would be randomized, and the physician and patients were blind to which group they were allocated until after the primary outcome was known. The primary outcome was number of ongoing pregnancies in the two groups., Participants/materials, Setting, Methods: From 10 Nordic IVF clinics, 776 patients with a minimum of two good quality blastocysts on Day 5 (D5) were randomized into one of the two study groups. A commercial time-lapse model decided the final selection of blastocysts for 387 patients in the intervention (time-lapse) group, and blastocysts with the highest morphological score were transferred for 389 patients in the control group. Only single embryo transfers in fresh cycles were performed., Main Results and the Role of Chance: In the full analysis set, the ongoing pregnancy rate for the time-lapse group was 47.4% (175/369) and 48.1% (181/376) in the control group. No statistically significant difference was found between the two groups: mean difference -0.7% (95% CI -8.2, 6.7, P = 0.90). Pregnancy rate (60.2% versus 59.0%, mean difference 1.1%, 95% CI -6.2, 8.4, P = 0.81) and early pregnancy loss (21.2% versus 18.5%, mean difference 2.7%, 95% CI -5.2, 10.6, P = 0.55) were the same for the time-lapse and the control group. Subgroup analyses showed that patient and treatment characteristics did not significantly affect the commercial time-lapse model D5 performance. In the time-lapse group, the choice of best blastocyst changed on 42% of occasions (154/369, 95% CI 36.9, 47.2) after the algorithm was applied, and this rate was similar for most treatment clinics., Limitations, Reasons for Caution: During 2020, the patient recruitment rate slowed down at participating clinics owing to coronavirus disease-19 restrictions, so the target sample size was not achieved as planned and it was decided to stop the trial prematurely. The study only investigated embryo selection at the blastocyst stage on D5 in fresh IVF transfer cycles. In addition, only blastocysts of good morphological quality were considered for transfer, limiting the number of embryos for selection in both groups: also, it could be argued that this manual preselection of blastocysts limits the theoretical selection power of time-lapse, as well as restricting the results mainly to a good prognosis patient group. Most patients were aimed for blastocyst stage transfer when a minimum of five zygotes were available for extended culture. Finally, the primary clinical outcome evaluated was pregnancy to only 6-8 weeks., Wider Implications of the Findings: The study suggests that time-lapse selection with a commercially available time-lapse model does not increase chance of ongoing pregnancy after single blastocyst transfer on Day 5 compared to morphology alone., Study Funding/competing Interest(s): The study was financed by a grant from the Swedish state under the ALF-agreement between the Swedish government and the county councils (ALFGBG-723141). Vitrolife supported the study with embryo culture dishes and culture media. During the study period, T.H. changed his employment from Livio AB to Vitrolife AB. All other authors have no conflicts of interests to disclose., Trial Registration Number: ClinicalTrials.gov registration number NCT03445923., Trial Registration Date: 26 February 2018., Date of First Patient’s Enrolment: 11 June 2018., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The use of intracytoplasmic sperm injection (ICSI) has been a major breakthrough in the treatment of male infertility. Even patients with non-obstructive azoospermia (NOA) may benefit from the ICSI technique to father a child as long as spermatogenesis is present. There are several techniques to recover testicular sperm in patients with NOA. However, retrieval of spermatozoa is unfortunately still only successful in a subset of patients with NOA, and the most superior sperm retrieval method is still under debate. A more recent technique, microdissection testicular sperm extraction (MD-TESE) with an operative microscope collecting larger and more opaque seminiferous tubules, is a non-blind sperm retrieval technique with theoretical benefits. The MD-TESE procedure seems to be feasible, effective, and safe in NOA patients but also more technically demanding and time-consuming compared with conventional blind techniques. In the present report, we describe our clinical experience and results from our first 159 MD-TESE procedures. The probability to retrieve sperm with the MD-TESE technique is high in NOA cases where earlier sperm retrieval with blind methods such as needle aspiration, percutaneous needle biopsy, or conventional TESE has failed.

The most severe form of male infertility is non obstructive azoospermia (NOA), where spermatogenesis is impaired or absent. If testicular sperm can be retrieved, men with NOA can become biological fathers with IVF/ ICSI. In Sweden, testicular sperm aspiration (TESA) is the most common method used to retrieve sperm but is only successful in up to 34% of procedures. In 2013, our fertility center introduced MD-TESE, where an operating microscope is used to target the biopsies. We have performed more than 134 MD-TESE procedures, mainly in cases where TESA sperm recovery failed previously. Sperm sufficient for ICSI were recovered in 52 % and in these cases 75 % resulted in embryo transfer, resulting in a 34 % ongoing pregnancy rate/deliveries per transfer. Results are encouraging and hopefully more Swedish IVF centers will introduce this technique.

Background: Previous studies have shown a higher risk of birth defects and preterm birth (PTB) in singletons born after blastocyst transfer as compared to singletons born after cleavage-stage transfer. Few studies have investigated the maternal outcomes., Objective: We sought to analyze the neonatal and maternal outcome after blastocyst transfer (day 5-6) compared to transfer of cleavage-stage embryos (day 2-3) and spontaneous conception., Study Design: This was a population-based retrospective registry study including all singleton deliveries after blastocyst transfer in Sweden from 2002 through 2013. The in vitro fertilization register was cross-linked with the Swedish Medical Birth Register, the Register of Birth Defects, and the National Patient Register. Deliveries after blastocyst transfer were compared with deliveries after cleavage-stage transfer and deliveries after spontaneous conception. Outcome measures included birth defects, PTB, low birthweight, small for gestational age, large for gestational age, perinatal mortality, placenta previa, placental abruption, and preeclampsia. Crude and adjusted odds ratios (AOR) with 95% confidence interval (CI) were calculated. Adjustment was made for year of birth of child, maternal age, parity, smoking, body mass index, years of involuntary childlessness, and child's sex and, for cleavage stage, also for number of oocytes retrieved, number of embryos transferred, and fresh/frozen embryo transfer., Results: There were 4819 singletons born after blastocyst transfer, 25,747 after cleavage-stage transfer, and 1,196,394 after spontaneous conception. Singletons born after blastocyst transfer had no increased risk of birth defects compared to singletons born after cleavage-stage transfer (AOR, 0.94; 95% CI, 0.79-1.13) or spontaneous conception (AOR, 1.09; 95% CI, 0.92-1.28). Perinatal mortality was higher in the blastocyst vs the cleavage-stage group (AOR, 1.61; 95% CI, 1.14-2.29). When comparing singletons born after blastocyst transfer to singletons born after spontaneous conception, a higher risk of PTB (<37 weeks) was seen (AOR, 1.17; 95% CI, 1.05-1.31). Singletons born after blastocyst transfer had a lower rate of low birthweight (AOR, 0.83; 95% CI, 0.71-0.97) as compared to cleavage-stage transfer. The rate of being small for gestational age was lower in singletons born after blastocyst transfer as compared to both cleavage-stage and spontaneous conception (AOR, 0.71; 95% CI, 0.56-0.88 and AOR, 0.70; 95% CI, 0.57-0.87, respectively). The risk of placenta previa and placental abruption was higher in pregnancies after blastocyst transfer as compared to pregnancies after cleavage-stage (AOR, 2.08; 95% CI, 1.70-2.55 and AOR, 1.62; 95% CI, 1.15-2.29, respectively) and spontaneous conception (AOR, 6.38; 95% CI, 5.31-7.66 and AOR, 2.31; 95% CI, 1.70-3.13, respectively)., Conclusion: No increased risk of birth defects was found in singletons born after blastocyst transfer. Perinatal mortality and risk of placental complications were higher in the blastocyst group as compared to the cleavage-stage group, observations that need further investigations., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: A pre-ovarian block (POB) technique can be used for pain relief during oocyte retrieval in IVF. The local anaesthetic is deposited in the vaginal wall and between the vaginal wall and the peritoneal surface near the ovary using ultrasound guidance. The aim of this study was to test whether analgesia with POB resulted in improved pain relief compared to paracervical block (PCB)., Methods: A prospective, randomized, multicentre study of POB versus PCB (10 ml of 1% lidocaine each) with 183 patients randomized to POB (n = 96) or PCB (n = 87) was performed. Randomization (via a computer-generated list) was balanced for age, previously completed IVF cycles, degree of anxiety, estimated number of follicles, BMI, premedication and centre. Pain was measured using a visual analogue scale (VAS, 0-100 mm) and given as median values. The primary end-point of this study was overall VAS pain score for both sides during the oocyte retrieval procedure., Results: Overall pain during the entire oocyte retrieval was 22 (POB) and 16 (PCB) (P = 0.42). No differences were found in degree of anxiety, premedication, dose of alfentanil, fertilization rate, number of good-quality embryos or clinical pregnancy rate., Conclusions: No differences were found in overall pain experienced during the entire oocyte retrieval procedure with POB compared to PCB.

Context: The impact of progestins on exercise performance in women has not been previously studied., Objective: The objective of this study was to examine the effect of a synthetic progestin on aspects of exercise status in young women. DESIGN, PATIENTS, SETTING: Twenty-three young, healthy, habitually sedentary women participated in a single-blind, randomized, counterbalanced, cross-over study in a university-based laboratory setting., Intervention: Two monophasic oral contraceptive pills (OCPs) were administered in which the dose of the synthetic progestin, norethisterone, was 2-fold different but the dose of the synthetic estrogen, ethinyl estradiol, was constant. During each month of OCP aspects of exercise status were assessed during incremental exercise to exhaustion and steady-state submaximal exercise and with a performance test., Main Outcome Measures: The main outcome measures were peak oxygen uptake (VO(2peak)), respiratory exchange ratio (RER), time to exhaustion, lactate concentrations, and total work done., Results: Peak heart rates were approximately 95% of age-predicted values with both OCP preparations, whereas VO(2peak) was approximately 30% above age-predicted values. Peak postincremental exercise plasma lactate concentrations exceeded those reported for males and females, whereas the RER was below expected values throughout both incremental and steady-state exercise. The effects on VO(2peak) and RER were increased with the higher dose progestin OCP, as were exercise time to exhaustion and total work done., Conclusion: Synthetic progestins in OCP formulations can have a significant effect on the exercise status of young, sedentary women, possibly through an effect on stroke volume and a shift in the principal energy substrate used during exercise from carbohydrate to lipid.

Purpose: Klinefelter syndrome is the most common chromosomal aberration among azoospermic men. We wanted to compare testicular echogenicity and intratesticular arterial blood in men with this syndrome versus men with normal sperm parameters., Methods: Testicular sonography including Doppler imaging, was performed as part of the infertility workup in 26 men with Klinefelter syndrome as well as in 26 men with normal sperm parameters., Results: In men with Klinefelter syndrome, sonography of the testicular parenchyma revealed a heterogeneous irregular pattern with spread hyper- and hypoechoic foci. Doppler sonography resulted in waveforms of high impedance patterns, reflecting intratesticular blood flow of a high resistance. In men with normal sperm parameters testicular echogenicity was of an almost homogeneous regular pattern. In these men, intratesticular blood flow typically exhibited a pattern of low vascular resistance., Conclusions: The study demonstrates that testicular echogenicity as well as intratesticular blood flow are different in men with Klinefelter syndrome versus men with normal sperm parameters.

Purpose: To report the outcome of sperm retrieval and results after ICSI in up to six repeated testicular sperm aspiration procedures., Methods: Twenty-two men with obstructive and thirty-four men with nonobstructive azoospermia underwent 50 and 91 needle aspirations, respectively. Sufficiency of spermatozoa for ICSI and cryopreservation, fertilization rate, and pregnancy outcome was analyzed retrospectively., Results: No major differences were found in sperm recovery or pregnancy outcome in the repeated cycles. Testicular aspirate containing motile spermatozoa with maintained fertilizing capacity was obtained in up to six repeated procedures in the nonobstructive group. No postoperative complications were reported for any of the participants., Conclusions: Testicular sperm aspiration is a simple and effective method of sperm retrieval, which can be performed from the same testis up to several times with good recovery of motile spermatozoa for ICSI and maintaining high fertilization and pregnancy rates, in men with both obstructive and nonobstructive azoospermia.

Objectives: To evaluate attitudes of Swedish women towards oocyte donation and oocyte research., Methods: Five different groups of women, with approximately 50 patients in each, were asked anonymously about their attitudes to legislation, tentative roles as donors or recipients, anonymity, suitable donors or recipients, research on fetuses and cadavers as a source of oocytes, age limits and economic aspects. The groups were: 1. Women undergoing IVF treatment (IVF). 2. Infertile women during work-up (INF). 3. Recently delivered women attending a maternity unit (MAT). 4. Women attending a family planning center applying for therapeutic abortion (FPC). 5. Women with Turner's syndrome (TUR)., Results: More than 90% of women in all groups investigated advocated amendment of the law in order to permit oocyte donation. The women of infertile groups were more in favor of donating oocytes compared to women of fertile groups (p<0.05). A great majority would prefer anonymity both if they were donors and if they were recipients. If no anonymity was guaranteed, the acceptance of both the donor and recipient groups decreased but more than half of the women in all groups would still donate/accept oocytes. There was a significant difference in attitude towards non-anonymous oocyte donation, with the highest acceptance among Turner patients and the lowest among IVF patients (p<0.01). A majority in all groups were more motivated to donate/accept oocytes from a close relative, with the exception of Turner patients (p<0.01). All groups had a negative attitude to the use of donated fetuses and cadavers as sources of oocytes. IVF patients, close relatives and volunteers were all regarded as suitable donors by a majority of women in all groups. Women of fertile age, with ovarian failure or a genetic disorder, were accepted as recipients by all groups. Postmenopausal women were not accepted as recipients by a great majority in all groups. All groups preferred an age limit for recipients. More than 70% set the limit to the interval 40 to 45 years of age. A majority in all groups believed that donors should be paid to cover medication and loss of income. The recipients were expected, by a majority of women, to pay for some of the costs of the oocyte donation program., Conclusions: A great majority wanted a change in the Swedish legislation to permit oocyte donation. All groups had a generous attitude to donation of oocytes although anonymity would be preferred. Ovarian dysfunction and genetic disorders among women of fertile age were regarded as major indications for oocyte donation. IVF patients, close relatives and volunteers were all regarded as acceptable donors.

The study reports the results of a follow-up evaluation, conducted in 1994, of the impact of a training program for female unskilled metal workers that was implemented at the end of the 1970s. The program was designed to promote occupational skills development, and was first evaluated in 1979. On both occasions of evaluation the investment in training was examined from two perspectives, those of the training participants and management. Data were collected through semistructured personal interviews with key members of personnel management and through a group conversation session with a majority of the original course attendees. Supplementary background information was obtained from documents and records maintained by the organization. At some points, there was a convergence of views on the significance of the training program for occupational skills development, at others a divergence. These convergences and divergences are finally discussed and the findings of the study are related to other research on this particular kind of intervention.

This paper focuses on an intervention programme based on the concept of participatory ergonomics. The study was designed within the framework of a multidisciplinary project concerned with identifying the work conditions and problems necessary to improve the working life of VDT operators with routine data-entry and data-dialogue tasks. The intervention programme was evaluated in two follow-up studies. The evaluation criteria covered the proposals for improvement emerging from (1) the intervention programme's final joint decisions (of experts and employees) on measures needed, and (2) workers' views of the effectiveness of the programme itself. As the implementation period was marked by increasing turbulence caused by recession in many branches of the Swedish economy, attention was paid to the impact of the restructuring and rationalization effected by company management in the workplaces under study. To obtain a better understanding of the outcome of the intervention programme, the follow-up was extended systematically to explore the disturbing organizational factors operating during the implementation period. The results of the evaluation offer increased knowledge of organizational barriers to the implementation of ergonomics measures decided upon within the framework of intervention research.

A means-goals analysis requires a plan with some degree of distinctness, which is worked out beforehand and specifies reasonably clear goals and intended means. This article draws its material from a broadly designed strategy for organizational change that meets these criteria. A service division of Swedish Telecom underwent a program of comprehensive organizational change; major efforts were made to improve the occupational health of 300 telephone operators in manual service operations. Over a full three-year period, a number of specific problems were to be resolved. An independent research team evaluated the implementation of the program prospectively. The team followed an evaluation model in which stringent distinction was made between: (1) action areas, (2) intended specific means, (3) intended immediate goals, and (4) the longer-term favorable effects of achieving these immediate goals. In addition, an attempt was made to interpret and understand the findings of the means-goals evaluation by paying systematic attention to the implementation process and factors that might permit an understanding of the final outcomes of the program. Compared with other efforts to improve telephone operators' work conditions as reported in the research literature, this strategy for the promotion of change is broad and ambitious.

This paper provides information and analysis on the overall situation of women in Sweden with regard to computer based new technology. It is based on a survey of computer use in Sweden, carried out in June 1984 by Statistics Sweden. The aim of the study was to ascertain the knowledge base and experience with computers of the Swedish population. In order to study whether sex differences exist a special analysis of the data was carried out. Women are involved in new technology in Sweden to a very great extent, however, there is male dominance in both the initiation and development of the technology. This may be as much reflective of general male and female roles in the workplace as of the nature of new technology itself.

The focus of this article is the link between organizational change and individual working conditions. In some organizational development projects health aspects may be left to chance, in others they may be to some extent respected, and in still others they are the main theme of the process and direction of change. Along this line, the author presents and discusses a number of Swedish cases. The analysis aims at emphasizing a necessary characteristic of occupational health experts, namely, to be sensitive to the differences between the goals of various projects in organizational development. Preventive work must be based on a careful identification of the sort of health aspects that are overlooked in every effort at organizational change.

Peritonitis was induced in rats by exposing the peritoneal surface to 0.1 M hydrochloric acid (HCl). Peritonitis was quantified by extraction of Evans blue-bound albumin from the tissue exposed to HCl and analyzed by a spectrophotometric technique. In the first set of experiments, one group of rats had the peritoneal surface exposed to HCl following local pretreatment with isotonic saline; a second group of rats had the peritoneum exposed to HCl after topical pretreatment with an equal volume of lidocaine 1%, whereas in a third group the peritoneal surface was exposed only to saline without HCl. The experimental design in the second set of experiments was similar to that of the first set except that bupivacaine 0.5% was used instead of lidocaine in the second group. Results show a significant inhibition of peritonitis in the groups pretreated with lidocaine (P less than 0.01) and bupivacaine (P less than 0.05) compared with rats in the saline pretreated group. In the lidocaine-pretreated group Evans blue-albumin extravasation did not differ significantly from the rats not receiving HCl, whereas the bupivacaine-pretreated group showed a slightly but significantly (P less than 0.05) more pronounced peritonitis than control rats not exposed to HCl. In the third set of experiments the peritoneum was topically treated with either lidocaine 1%, bupivacaine 0.5%, or isotonic saline after first having exposed the peritoneal surface to HCl. A significant inhibition of albumin extravasation was seen following lidocaine (P less than 0.001) or bupivacaine (P less than 0.001) treatment compared with treatment with isotonic saline.(ABSTRACT TRUNCATED AT 250 WORDS)