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Moholdt T, Sujan MAJ, Ashby ER, Beetham K. Interval training and cardiometabolic health in reproductive-aged females. Appl Physiol Nutr Metab 2024; 49:993-1001. [PMID: 38478956 DOI: 10.1139/apnm-2023-0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
Physical activity and exercise training are especially important for reproductive-aged females as exercise-induced health benefits can also affect their infants. However, levels of physical inactivity remain high among females in this age group, before, during, and after pregnancy. There is a great need for practical and feasible exercise modes to increase adherence to exercise in this population, and interval training may be a time-efficient training modality. Interval training is a form of exercise involving intermittent bouts of intense effort interspersed with recovery periods of rest or lower-intensity exercise. A substantial amount of research indicates that interval training induces superior cardiometabolic health benefits compared with iso-energetic moderate-intensity continuous exercise. This review provides a comprehensive overview of research on interval training interventions in reproductive-aged females across various life stages, focusing on the cardiometabolic health benefits. We discuss the potential role of interval training in premenopausal females with overweight/obesity, polycystic ovary syndrome, and subfertility, as well as the potential influence of oral contraceptives on cardiometabolic adaptations to interval training. Furthermore, this review also highlights recent findings supporting the beneficial role of high-intensity interval training for cardiometabolic health outcomes during pregnancy. In summary, the existing evidence suggests that interval training can improve several cardiometabolic and reproductive outcomes in females spanning different life stages. However, more research is needed to further strengthen the evidence-base for physical activity recommendations for females in their reproductive years of life.
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Affiliation(s)
- T Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women's Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M A J Sujan
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women's Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - E R Ashby
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Beetham
- School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
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Wang W, Yang F, Bai Y, Lu Y, Mao X. Association between domain-specific physical activity and mental health status after embryo transfer in IVF-ET-assisted pregnancy patients. Sci Rep 2024; 14:4928. [PMID: 38418518 PMCID: PMC10902343 DOI: 10.1038/s41598-024-55097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/20/2024] [Indexed: 03/01/2024] Open
Abstract
Physical activity has been shown to impact mental health in in vitro fertilization-embryo transfer (IVF-ET) patients, but the relationship between domain-specific physical activity and mental health in this population remains unclear. In a cross-sectional observational study, 208 patients undergoing IVF-ET with long-term ovulation induction cycles were recruited from a reproductive center. The International Physical Activity Questionnaire and the symptom checklist 90 (SCL-90) were used to assess physical activity levels and mental health status, respectively. Analyses of variance and linear regression analyses were conducted to identify the relationship between physical activity and mental health. There were differences between different physical activity level in times of transfers, years of infertility, and times of abortions. Patients with high levels of physical activity had fewer symptoms than those with low levels of physical activity. Occupation, transport and household physical activity had significant negative correlations with the respective SCL-90 factor scores. Linear regression analysis revealed that occupation physical activity was associated with lower depression and anxiety, and transport physical activity and household physical activity were associated with lower obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and psychoticism scores. The study indicates that increased engagement in physical activity, specifically activities related to occupation, transportation, and household, may be associated with improved mental health among IVF-ET patients.
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Affiliation(s)
- Wei Wang
- Department of Psychology, Qilu Hospital of Shandong University, Wenhuaxi Road 107, Jinan, 250012, Shandong, China
| | - Fang Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Yunfeng Bai
- Department of Anesthesiology, Linyi People's Hospital, Linyi, China
| | - Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
| | - Xueqin Mao
- Department of Psychology, Qilu Hospital of Shandong University, Wenhuaxi Road 107, Jinan, 250012, Shandong, China.
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Mínguez-Alarcón L, Williams PL, Souter I, Ford JB, Hauser R, Chavarro JE. Women's preconception psychological stress and birth outcomes in a fertility clinic: the EARTH study. Front Glob Womens Health 2024; 5:1293255. [PMID: 38379838 PMCID: PMC10877713 DOI: 10.3389/fgwh.2024.1293255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
Background The epidemiologic literature on women's perceived stress in relation to perinatal outcomes has been inconclusive and does not consider the preconception window of exposure. Objective To evaluate whether women's preconception perceived stress is related to live birth, gestational age, and birthweight in a cohort receiving fertility treatment. Methods This observational study included women seeking fertility care at the Massachusetts General Hospital (2004-2019). During preconception, women provided information on their psychological stress using the short version of the validated Perceived Stress Scale 4 (PSS-4). We used regression models to evaluate the associations of stress with live birth (N = 768 attempting to conceive) and perinatal outcomes (N = 413 live births) while adjusting for confounders. Stratified analyses by mode of conception [natural, intrauterine insemination (IUI), and IVF (in vitro fertilization)] and selected socioeconomic factors (race, education, and income) were also conducted. Results Higher psychological stress was negatively associated with the overall probability of live birth (adjusted RR = 0.95, 95% CI: 0.92, 0.98), particularly among women conceiving using IVF. However, we found no association between women's psychological stress and gestational age and birth weight in the overall analyses and also stratified by mode of conception. Similarly, we observed no differences in women's psychological stress with any of the measured outcomes by socioeconomic factors. Discussion These results highlight the importance of considering the preconception window and mode of conception when evaluating the relationship between women's preconception stress and live birth.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women’s Hospital, Boston, MA, United States
- Departments of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Paige L. Williams
- Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jennifer B. Ford
- Departments of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Russ Hauser
- Departments of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, United States
| | - Jorge E. Chavarro
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women’s Hospital, Boston, MA, United States
- Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Génard-Walton M, McGee G, Williams PL, Souter I, Ford JB, Chavarro JE, Calafat AM, Hauser R, Mínguez-Alarcón L. Mixtures of urinary concentrations of phenols and phthalate biomarkers in relation to the ovarian reserve among women attending a fertility clinic. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 898:165536. [PMID: 37453702 DOI: 10.1016/j.scitotenv.2023.165536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/18/2023]
Abstract
Although prior studies have found associations of the ovarian reserve with urinary concentrations of some individual phenols and phthalate metabolites, little is known about the potential associations of these chemicals as a mixture with the ovarian reserve. We investigated whether mixtures of four urinary phenols (bisphenol A, butylparaben, methylparaben, propylparaben) and eight metabolites of five phthalate diesters including di(2-ethylhexyl) phthalate were associated with markers of the ovarian reserve among 271 women attending a fertility center who enrolled in the Environment and Reproductive Health study (2004-2017). The analysis was restricted to one outcome per study participant using the earliest outcome after the last exposure assessment. Ovarian reserve markers included lower antral follicle count (AFC) defined as AFC < 7, circulating serum levels of day 3 follicle stimulating hormone (FSH) assessed by immunoassays, and diminished ovarian reserve (DOR) defined as either AFC < 7, FSH > 10 UI/L or primary infertility diagnosis of DOR. We applied Bayesian Kernel Machine Regression (BKMR) and quantile g-computation to estimate the joint associations and assess the interactions between chemical exposure biomarkers on the markers of the ovarian reserve while adjusting for confounders. Among all 271 women, 738 urine samples were collected. In quantile g-computation models, a quartile increase in the exposure biomarkers mixture was not significantly associated with lower AFC (OR = 1.10, 95 % CI = 0.52, 2.30), day 3 FSH levels (Beta = 0.30, 95 % CI = -0.32, 0.93) or DOR (OR = 1.02, 95 % CI = 0.52, 2.05). Similarly, BKMR did not show any evidence of associations between the mixture and any of the studied outcomes, or interactions between chemicals. Despite the lack of associations, these results need to be explored among women in other study cohorts.
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Affiliation(s)
- Maximilien Génard-Walton
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France.
| | - Glen McGee
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer B Ford
- Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Russ Hauser
- Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA; Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, USA
| | - Lidia Mínguez-Alarcón
- Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, USA
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Prémusz V, Makai A, Ács P, Derkács E, Laczkó T. Association of Outdoor Physical Activity and Sports with Life Satisfaction among Women of Reproductive Age According to a European Representative Sample-A Longitudinal Analysis. Eur J Investig Health Psychol Educ 2023; 13:1859-1879. [PMID: 37754474 PMCID: PMC10528805 DOI: 10.3390/ejihpe13090135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
(1) Background: Low life satisfaction (LS) is associated with impaired mental and physical health. Outdoor physical activity (PA) has diverse somatic and psychological benefits. This study aimed to analyse the associations between sports settings and LS in women of reproductive age. (2) Methods: Special Eurobarometer on Sport and Physical Activity (2022, 2018, 2013) data on regularity and settings of sports/PA, LS and sociodemographic variables were analysed. The representative sample consisted of 18,489 women (34.60 ± 9.36 years). Pearson χ2 test and multivariate logistic regression analysis were conducted, using IBM SPSS version 28.0 according to the STROBE guidelines. The significance level was set at p < 0.05. (3) There was a significant difference in LS based on sports settings (χ2 = 409.696, p < 0.001). In the outdoor group, a 21.4% higher probability of being "very satisfied" compared to the non-outdoor, 30.0% higher compared to the inactive group, was found (R2N = 0.151). Dividing the sample by age, a significant effect remained in middle adulthood (35-44 years p = 0.002 and 45-49 years p = 0.033). (4) Conclusions: Our results underline the importance of the promotion of outdoor, green exercise and the development of special interventions to maintain or improve the psychological well-being of women in reproductive age.
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Affiliation(s)
- Viktória Prémusz
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (A.M.); (P.Á.); (E.D.); (T.L.)
- Physical Activity Research Group, Szentágothai Research Centre, 7624 Pécs, Hungary
- MTA-PTE Human Reproduction Scientific Research Group, University of Pécs, 7624 Pécs, Hungary
- National Laboratory on Human Reproduction, University of Pécs, 7624 Pécs, Hungary
| | - Alexandra Makai
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (A.M.); (P.Á.); (E.D.); (T.L.)
- Physical Activity Research Group, Szentágothai Research Centre, 7624 Pécs, Hungary
| | - Pongrác Ács
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (A.M.); (P.Á.); (E.D.); (T.L.)
- Physical Activity Research Group, Szentágothai Research Centre, 7624 Pécs, Hungary
| | - Evelin Derkács
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (A.M.); (P.Á.); (E.D.); (T.L.)
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary
| | - Tamás Laczkó
- Faculty of Health Sciences, University of Pécs, 7621 Pécs, Hungary; (A.M.); (P.Á.); (E.D.); (T.L.)
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Salas-Huetos A, Mitsunami M, Wang S, Mínguez-Alarcón L, Ribas-Maynou J, Yeste M, Souter I, Chavarro JE. Women's Adherence to Healthy Dietary Patterns and Outcomes of Infertility Treatment. JAMA Netw Open 2023; 6:e2329982. [PMID: 37594758 PMCID: PMC10439476 DOI: 10.1001/jamanetworkopen.2023.29982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/28/2023] [Indexed: 08/19/2023] Open
Abstract
Importance Increasing evidence suggests that specific foods and nutrients may improve infertility treatment outcomes in women. However, less is known about the role of dietary patterns. Objective To investigate whether women's adherence to a priori-defined dietary patterns promoted for the prevention of chronic conditions is associated with outcomes of infertility treatment. Design, Setting, and Participants This prospective cohort study was conducted at a fertility center at an academic medical center in Boston, Massachusetts. Women undergoing infertility treatment cycles, including intrauterine insemination cycles and in vitro fertilization with or without intracytoplasmic sperm injection were included. Data were collected from January 2007 to October 2019, and data were analyzed from February to December 2022. Exposures Women's pretreatment diet was assessed with a validated food frequency questionnaire from which 8 a priori-defined scores were calculated (higher score indicates greater adherence): (1) Trichopoulou Mediterranean diet, (2) alternate Mediterranean diet, (3) Panagiotakos Mediterranean diet, (4) Healthy Eating Index, (5) Alternate Healthy Eating Index, (6) American Heart Association (AHA) index, (7) Dietary Approaches to Stop Hypertension index, and (8) plant-based diet. Main Outcomes and Measures The adjusted probability of clinically relevant outcomes (live birth as a primary outcome and clinical pregnancy and pregnancy loss as secondary outcomes) was evaluated across quartiles of adherence to each dietary pattern using multivariable generalized linear mixed models to account for repeated cycles. Results This analysis included 612 women with a median (IQR) age of 35.0 (32.0-38.0) years. There was no association between women's adherence to the 8 a priori dietary patterns and probability of clinical pregnancy or live birth following in vitro fertilization or intrauterine insemination. However, an inverse association was found between adherence to AHA dietary pattern and risks of total and clinical pregnancy loss. Among women who became pregnant during the course of infertility treatment, the adjusted probabilities of pregnancy loss in the lowest and highest quartile of the AHA dietary pattern were 0.41 (95% CI, 0.33-0.50) and 0.28 (95% CI, 0.21-0.36), respectively (P for trend = .02). The corresponding adjusted probabilities of clinical pregnancy loss were 0.30 (95% CI, 0.22-0.39) and 0.15 (95% CI, 0.10-0.23) (P for trend = .007). A similar pattern was observed for all other dietary patterns, with the exception of the plant-based diet pattern. Conclusions and Relevance Findings of this cohort study suggest that preconception adherence to the AHA diet may be associated with a lower likelihood of pregnancy loss during the course of infertility treatment.
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Affiliation(s)
- Albert Salas-Huetos
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Unit of Preventive Medicine and Public Health, Alimentació, Nutrició, Desenvolupament i Salut Mental, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
- Consorcio Centro de Investigación Biomédica en Red, M.P. Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Makiko Mitsunami
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Siwen Wang
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jordi Ribas-Maynou
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain
- Unit of Cell Biology, Faculty of Sciences, Department of Biology, University of Girona, Girona, Spain
| | - Marc Yeste
- Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain
- Unit of Cell Biology, Faculty of Sciences, Department of Biology, University of Girona, Girona, Spain
| | - Irene Souter
- Massachusetts General Hospital Fertility Center and Harvard Medical School, Boston
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Malekpour P, Hasanzadeh R, Javedani Masroor M, Chaman R, Motaghi Z. Effectiveness of a mixed lifestyle program in couples undergoing assisted reproductive technology: a study protocol. Reprod Health 2023; 20:112. [PMID: 37528465 PMCID: PMC10394976 DOI: 10.1186/s12978-023-01652-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND The desire for fertility is the manifestation of yearning for immortality. Infertility and assisted reproductive technology (ART) expose couples to great affective, anxiety, stress, and financial burden. Increasing evidence emphasize the impact of lifestyle on infertility. One of the most crucial factors affecting the fertility process is the nutrition patterns, the amount and quality of physical activities, emotional problems management; modulate stressors, relief from anxiety, and the living conditions of couples. Most ART treatment interventions in Iran are not integrated into lifestyle programs. Therefore, this research will investigate the impact of mixed fertility health-promoting programs in couples who use ARTs. METHODOLOGY/DESIGN This study entails three steps. The first step includes the systematic review of literature on a health-promoting lifestyle in infertile couples undergoing ARTs, a systematic review of observational studies and interventions in couple's lifestyle, then, a systematic review of qualitative studies on infertility in couples and their lifestyle, and in the final step couple's life style literature systematically will evaluate in Iran. In case of failure to obtain the required results from systematic reviews, cross-sectional studies will be carried out to determine the lifestyle of infertile couples receiving ARTs. In the second stage, by holding a panel of experts, an intervention is planned based on the results of the previous stages in order to improve the lifestyle of couples. In the final step, the designed intervention will be administered as a random clinical trial-on ART candidates, in intervention or control groups in one of Iran University of Medical Sciences hospitals. Afterward, the data's will be evaluated by using standard questionnaires, that include health-promoting lifestyle questionnaire (HPLII), Beck's depression inventory (BDI), international physical activity questionnaire-short form (IPAQ-SF), and food frequency questionnaire (FFQ). The statistical analysis will be carried out in SPSS software. During the study, subjects meeting the inclusion criteria were randomly selected and randomized into the intervention and control groups. The health-promoting lifestyle training program will be executed for the intervention group while the standard care program is administered to the control group. The content of this program will be obtained from the consensus opinions of the expert panel. The program includes diet recommendations, physical activity, and stress management. Appropriate time, frequency, duration and number of activities will be considered. Communication with subjects will be possible through private meeting special comfort room. Support to the participants will also be through clinical visits social media, SMS and phone calls. Nutritional changes, physical activity amount, anxiety and stress level, abdominal circumference (AC), and body mass index (BMI) will be measured after the completion of the specified time interval. The initial outcome includes examining chemical pregnancy (2 weeks after the transmission) and clinical pregnancy by ultrasound (6 weeks after). The secondary outcome will be live birth rate. Retrieved oocyte and embryo numbers will also be reported. DISCUSSION Health-promoting lifestyle programs are essential in assisted reproductive technologies to improve pregnancy results and live birth. These programs in association with in-vitro fertilization (IVF) influence the outcome of fertilization. In addition, enhancing parental health leads to healthy pregnancy outcome. Despite the frequency of lifestyle risk factors, employing proper methods helps reduce anxiety and stress, modify dietary patterns, and perform qualitatively and quantitatively balanced physical activities. In addition, having coping skills and mental health management methods, in nowadays modern world challenges seems crucial and effective in solving fertility problems and reducing them before pregnancy.
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Affiliation(s)
| | - Robab Hasanzadeh
- Department of Midwifery, Bonab Branch, Islamic Azad University, Bonab, Iran
| | - Mojgan Javedani Masroor
- School of Medicine, Shahid Akbar-Abadi Clinical Research Development Unit (Sh A C R D U), Iran University of Medical Sciences, Tehran, Iran
| | - Reza Chaman
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Motaghi
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran.
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Jiménez-Cardozo N, Mitsunami M, Mínguez-Alarcón L, Ortiz-Panozo E, Wang S, Souter I, Hauser R, Chavarro JE. Iron intake in relation to ovarian reserve among women seeking infertility treatment. Hum Reprod 2023; 38:1613-1620. [PMID: 37329261 PMCID: PMC10391310 DOI: 10.1093/humrep/dead118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/09/2023] [Indexed: 06/19/2023] Open
Abstract
STUDY QUESTION Is there an association between iron intake and ovarian reserve among women seeking fertility care? SUMMARY ANSWER Supplemental iron intake above 45 mg/day is associated with lower ovarian reserve among women seeking fertility care. WHAT IS KNOWN ALREADY Although the literature regarding iron intake in relation to ovarian reserve is scant and inconsistent, some evidence suggests that iron may have gonadotoxic effects. STUDY DESIGN, SIZE, DURATION This observational study included 582 female participants attending the Massachusetts General Hospital Fertility Center (2007-2019) enrolled in the Environment and Reproductive Health (EARTH) Study. PARTICIPANTS/MATERIALS, SETTING, METHODS Iron intake was estimated using a validated food frequency questionnaire. Markers of ovarian reserve included antral follicle count (AFC) (assessed via transvaginal ultrasound) and Day 3 FSH, both obtained during the course of an infertility evaluation. MAIN RESULTS AND THE ROLE OF CHANCE Participants had a median age of 35 years and median total iron intake of 29 mg/day. Total iron intake was inversely related to AFC and this association was driven by intake of supplemental iron. Compared to women with a supplemental iron intake of ≤20 mg/day, women consuming 45-64 mg/day of supplemental iron had a 17% (-35%, 0.3%) lower AFC and women consuming ≥65 mg/day of supplemental iron had a 32% (-54%, -11%) lower AFC after adjusting for potential confounders (P, linear trend = 0.003). Similarly, in a multivariable-adjusted analysis, Day 3 FSH levels were 0.9 (0.5, 1.3) IU/ml higher among women with a supplemental iron intake of ≥65 mg/day when compared to women with a supplemental iron intake of ≤20 mg/day (P, linear trend = 0.02). LIMITATIONS, REASONS FOR CAUTION Iron intake was estimated using a method that relies on self-report and we had no biomarkers of iron status in our participants; only 36 women consumed ≥45 mg/day of supplemental iron. WIDER IMPLICATIONS OF THE FINDINGS Since all study participants were seeking fertility treatment, our findings may not apply to women in the general population. Although our findings are consistent with studies of women with iron overload, given the paucity of literature on this topic, it is essential that this question is revisited in studies designed to better understand the dose-response relation of this association across the entire distribution of ovarian reserve and the risk-benefit balance of pre-conceptional iron supplementation given its many positive effects on pregnancy outcomes. STUDY FUNDING/COMPETING INTEREST(S) The project was funded by Grants R01ES022955, R01ES033651, R01ES009718, P30ES000002, and P30DK046200 from the National Institutes of Health. N.J.-C. was supported by a Fulbright Scholarship. N.J.-C., M.M., L.M.-A., E.O.-P., S.W., I.S., and J.E.C. declare no conflict of interest related to the work in the manuscript. R.H. has received grants from the National Institute of Environmental Health Sciences. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- N Jiménez-Cardozo
- Grupo de Investigación en Ciencias Básicas y Clínicas de la Salud, Pontificia Universidad Javeriana, Cali, Colombia
- Universidad del Valle, Cali, Colombia
| | - M Mitsunami
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - L Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - E Ortiz-Panozo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico
| | - S Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - I Souter
- Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - R Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Fertility Center, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - J E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Mínguez-Alarcón L, Williams PL, Souter I, Ford JB, Hauser R, Chavarro JE. Perceived stress and markers of ovarian reserve among subfertile women. Reprod Biomed Online 2023; 46:956-964. [PMID: 37085427 PMCID: PMC10247401 DOI: 10.1016/j.rbmo.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Abstract
RESEARCH QUESTION Is self-reported psychological stress associated with markers of ovarian reserve among subfertile women? DESIGN Observational study of women (n = 520) seeking fertility care at the Massachusetts General Hospital who enrolled in the Environment and Reproductive Health study between 2005 and 2019. Women completed the short version of the validated PSS4, which assesses psychological stress. Ovarian reserve markers included AFC and circulating serum levels of day-3 FSH, with AMH assessed in a subset of participants (n = 185). RESULTS Higher total PSS4 scores were negatively associated with AFC and serum AMH levels. Analyses adjusted for age, BMI, race, smoking, education, physical activity and type of infertility diagnosis. Women in the second and third tertiles of stress had lower AFC (13.3, 95% CI 12.7 to 13.8; and 13.5, 95% CI 13.0 to 14.1) compared with women in the lowest tertile of psychological stress score (14.3, 95% CI 13.8 to 14.9, both P < 0.05). Women in the second and third tertiles of total PSS4 scores also had lower mean serum AMH compared with women in the lowest tertile (2.99, 95% CI 2.24 to 3.74), and (2.99 95% CI 2.22 to 3.76) versus (3.94 95% CI 3.23 to 4.64). These associations varied by several socioeconomic factors, and were observed among women who were younger, belonging to minority races, with a college degree or with annual household income less than $100,000. CONCLUSIONS Higher perceived stress was negatively associated with AFC and serum AMH levels. These associations varied by several socioeconomic factors.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA.
| | - Paige L Williams
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, USA
| | - Irene Souter
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA; Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
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Mussawar M, Balsom AA, Totosy de Zepetnek JO, Gordon JL. The effect of physical activity on fertility: a mini-review. F S Rep 2023; 4:150-158. [PMID: 37398617 PMCID: PMC10310950 DOI: 10.1016/j.xfre.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/15/2023] [Accepted: 04/08/2023] [Indexed: 07/04/2023] Open
Abstract
Although lifestyle factors such as diet, cigarette smoking, and alcohol consumption are increasingly recognized as important contributors to the risk of subfertility, the role of exercise in fertility remains less clear. As such, it is challenging for healthcare providers to deliver clear, evidence-based recommendations to patients regarding the optimal frequency and intensity with which they should exercise to maximize their chances of conception. Therefore, this review provides a critical overview of the available research for various patient populations.
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Affiliation(s)
- Minhal Mussawar
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Ashley A. Balsom
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | | | - Jennifer L. Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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11
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Kakargia E, Mamalakis E, Frountzas M, Anagnostou E, Siristatidis C. The role of maternal physical activity on in vitro fertilization outcomes: a systematic review and meta-analysis. Arch Gynecol Obstet 2022; 307:1667-1676. [PMID: 35596747 DOI: 10.1007/s00404-022-06606-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/01/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This systematic review is designed to summarize the evidence concerning the impact of maternal physical activity on the reproductive outcomes following assisted reproduction techniques (ART), namely in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). METHODS We searched for eligible studies on PubMed, EMBASE databases and the Cochrane Library from their inception until September 2021. Our primary outcomes were live birth rate and miscarriage, while secondary ones included clinical pregnancy and implantation rates. The quality of the evidence was evaluated using a study-specific adaptation of the Robins I tool. RESULTS Quantitative data from 10 cohort studies (CS) and 2 randomized control trials (RCT), involving 3431 women undergoing ART treatments, were included in the analyses. The pooled results exhibited uncertainty regarding the effect of physical activity on live birth rate per woman (OR 1.15, 95% CI 0.92-1.43, p = 0.23, I2 = 61%, 9 studies) and miscarriage rates (OR 0.79, 95% CI 0.44-1.43, p = 0.43, I2 = 44%, 6 studies). However, physical activity was associated with significantly improved clinical pregnancy rate after ART (OR 1.39, 95% CI 1.08-1.79, p = 0.0009, I2 = 68%, 10 studies), whereas implantation rate after ART almost reached statistical significance (OR = 1.95, 95% CI 0.99-3.82, p = 0.05, I2 = 77%). CONCLUSION The current evidence is still insufficient to firmly conclude on the effect of maternal physical activity on live birth, miscarriage and implantation rates. Although clinical pregnancy rates favored physical activity in this group of patients, these results must be undertaken with caution due to the low quality and the high heterogeneity of the studies included.
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Affiliation(s)
- Eleftheria Kakargia
- First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, 401 General Military Hospital of Athens, Athens, Greece.
| | - Eleftherios Mamalakis
- Physiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maximos Frountzas
- First Propaedeutic Department of Surgery, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens, Greece
| | - Evangelos Anagnostou
- Neurosurgery Department, Medical School, National and Kapodistrian University of Athens, 401 General Military Hospital of Athens, Athens, Greece
| | - Charalampos Siristatidis
- Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Aretaieio" University Hospital, Athens, Greece
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12
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Women's and men's intake of omega-3 fatty acids and their food sources and assisted reproductive technology outcomes. Am J Obstet Gynecol 2022; 227:246.e1-246.e11. [PMID: 35364062 PMCID: PMC9308672 DOI: 10.1016/j.ajog.2022.03.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/12/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Long-chain omega-3 fatty acids and their food sources have garnered interest as a potential nutrient with wide-range health benefits, including fertility. OBJECTIVE This study aimed to investigate the association of women's and men's intake of omega-3 fatty acids and omega-3 rich-foods with semen quality and outcomes of infertility treatment with assisted reproductive technologies. STUDY DESIGN Couples presenting to the Massachusetts General Hospital were invited to enroll in a prospective cohort study (2007-2020). Male and female diets were assessed using a validated 131-item food frequency questionnaire. The primary outcomes were implantation, clinical pregnancy, and live birth probabilities. The secondary outcomes included total and clinical pregnancy loss and conventional semen parameters, for males only. We estimated the relationship between intakes of omega-3 fatty acids, nuts, and fish and the probability (95% confidence interval) of study outcomes using generalized linear mixed models to account for repeated treatment cycles per participant while simultaneously adjusting for age, body mass index, smoking status, education, dietary patterns, total energy intake, and male partner diet. RESULTS A total of 229 couples and 410 assisted reproductive technology cycles were analyzed for primary and secondary outcomes. Of note, 343 men contributing 896 semen samples were included in analyses for semen quality measures. Women's docosahexaenoic acid + eicosapentaenoic acid intake was positively associated with live birth. The multivariable-adjusted probabilities of live birth for women in the bottom and top quartiles of eicosapentaenoic acid + docosahexaenoic acid intake were 0.36 (95% confidence interval, 0.26-0.48) and 0.54 (95% confidence interval, 0.42-0.66) (P trend=.02). Eicosapentaenoic acid + docosahexaenoic acid intake was inversely related to the risk of pregnancy loss, which was 0.53 among women in the lowest quartile of eicosapentaenoic acid + docosahexaenoic acid intake and 0.05 among women in the highest quartile (P trend=.01). Men's intake of total omega-3 fatty acids was positively related to sperm count, concentration, and motility, but unrelated to any assisted reproductive technology outcomes. Similar associations were observed when evaluating the intake of primary food sources of these fatty acids. CONCLUSION Women's consumption of omega-3 fatty acids and omega-3-rich foods may improve the probability of conception by decreasing the risk of pregnancy loss. In addition, men's intake of omega-3 fatty acids may influence semen quality.
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Kadir M, Hood RB, Minguez-Alarcon L, Maldonado-Cárceles AB, Ford JB, Souter I, Chavarro JE, Gaskins AJ. Folate intake and ovarian reserve among women attending a fertility center. Fertil Steril 2022; 117:171-180. [PMID: 34809974 PMCID: PMC8714696 DOI: 10.1016/j.fertnstert.2021.09.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the association between dietary folate intake and antral follicle count (AFC) among women seeing treatment for infertility. DESIGN Cohort study. SETTING Academic fertility center. PATIENTS A total of 552 women attending the Massachusetts General Hospital Fertility Center (2007-2019) who participated in the Environment and Reproductive Health Study. INTERVENTIONS None. Folate intake was measured with a validated food frequency questionnaire at study entry. Multivariable Poisson regression models with robust standard errors were used to estimate the association of folate intake with AFC adjusting for calorie intake, age, body mass index, physical activity, education, smoking status, year of AFC, and intakes of vitamin B12, iron, and vitamin D. Nonlinearity was assessed with restricted cubic splines. MAIN OUTCOME MEASURE AFC as measured by transvaginal ultrasonography as part of routine care. RESULTS Among the 552 women (median age, 35.0 years; median folate intake, 1,005 μg/d), total and supplemental folate intake had a significant nonlinear relationship with AFC. There was a positive linear association with AFC up to approximately 1,200 μg/d for total folate intake and up to 800 μg/d for supplemental folate intake; however, there was no additional benefit of higher folate intakes. The magnitude of the association was modest; for example, the predicted adjusted difference in AFC between a woman consuming 400 vs. 800 μg/d of supplemental folate was approximately 1.5 follicles. CONCLUSION Higher intake of folate, particularly from supplements, was associated with modestly higher ovarian reserve as measured by AFC among women attending a fertility center. CLINICAL TRIAL REGISTRATION NUMBER This trial was registered at clinicaltrials.gov as NCT00011713.
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Affiliation(s)
- Mumta Kadir
- Department of Epidemiology, Rollins School of Public
Health, Emory University, Atlanta, GA, 30322, USA
| | - Robert B. Hood
- Department of Epidemiology, Rollins School of Public
Health, Emory University, Atlanta, GA, 30322, USA
| | - Lidia Minguez-Alarcon
- Department of Environmental Health, Harvard T.H. Chan
School of Public Health, Boston, MA, 02115, USA
| | | | - Jennifer B. Ford
- Department of Environmental Health, Harvard T.H. Chan
School of Public Health, Boston, MA, 02115, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center and Harvard
Medical School, Boston, MA, 02114, USA
| | - Jorge E. Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public
Health, Boston, MA, 02115, USA,Department of Epidemiology, Harvard T.H. Chan School of
Public Health, Boston, MA, 02115, USA,Channing Division of Network Medicine, Department of
Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston,
MA, 02115, USA
| | - Audrey J. Gaskins
- Department of Epidemiology, Rollins School of Public
Health, Emory University, Atlanta, GA, 30322, USA
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Läänelaid S, Ortega FB, Kunovac Kallak T, Joelsson L, Ruiz JR, Hreinsson J, Wånggren K, Stavreus-Evers A, Kalda R, Salumets A, Altmäe S. Physical and Sedentary Activities in Association with Reproductive Outcomes among Couples Seeking Infertility Treatment: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2718. [PMID: 33800259 PMCID: PMC7967443 DOI: 10.3390/ijerph18052718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to investigate the association of physical activity (PA) with assisted reproductive technology (ART) treatment and pregnancy outcomes among couples seeking infertility treatment. METHODS This prospective cohort study was carried out among 128 infertile individuals (64 couples), entering the infertility clinic for ART procedures. Baseline PA (before entering any treatment) was assessed using accelerometry for both women and men. For every couple the infertility treatment outcomes were recorded. RESULTS The couples that required invasive ART procedures such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) spent less time in vigorous PA (-73 min/week per couple, woman + man) than those couples who became spontaneously pregnant after entering the study (p = 0.001). We observed no significant associations between the time spent in physical activities and positive pregnancy test or live birth. CONCLUSIONS Our results do not support a positive nor negative relation between the time the couples spent in physical activities and the chances of getting pregnant or having a baby among patients seeking infertility treatment. However, couples undergoing invasive ART procedures did less vigorous PA than couples that became spontaneously pregnant, suggesting that PA may interfere with their reproductive health.
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Affiliation(s)
- Siret Läänelaid
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia; (S.L.); (R.K.)
- Department of Nursing and Midwifery, Tartu Health Care College, Nooruse 5, 50411 Tartu, Estonia
| | - Francisco B. Ortega
- Department of Physical Education and Sports, University of Granada, Carretera de Alfacar, S/N CP, 18071 Granada, Spain; (F.B.O.); (J.R.R.)
- Department of Biosciences and Nutrition, Karolinska Institutet, NEO, SE-14183 Huddinge, Sweden
| | - Theodora Kunovac Kallak
- Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden; (T.K.K.); (L.J.); (K.W.); (A.S.-E.)
| | - Lana Joelsson
- Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden; (T.K.K.); (L.J.); (K.W.); (A.S.-E.)
| | - Jonatan R. Ruiz
- Department of Physical Education and Sports, University of Granada, Carretera de Alfacar, S/N CP, 18071 Granada, Spain; (F.B.O.); (J.R.R.)
- Department of Biosciences and Nutrition, Karolinska Institutet, NEO, SE-14183 Huddinge, Sweden
| | - Julius Hreinsson
- Minerva Fertility Clinic, Kålsängsgränd 10 d, 753 19 Uppsala, Sweden;
| | - Kjell Wånggren
- Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden; (T.K.K.); (L.J.); (K.W.); (A.S.-E.)
| | - Anneli Stavreus-Evers
- Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden; (T.K.K.); (L.J.); (K.W.); (A.S.-E.)
| | - Ruth Kalda
- Institute of Family Medicine and Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia; (S.L.); (R.K.)
| | - Andres Salumets
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 50406 Tartu, Estonia;
- Competence Centre on Health Technologies, Teaduspargi 13, 50411 Tartu, Estonia
- Institute of Genomics, University of Tartu, Riia 23b, 51010 Tartu, Estonia
| | - Signe Altmäe
- Competence Centre on Health Technologies, Teaduspargi 13, 50411 Tartu, Estonia
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Avenida de la Fuente Nueva S/N, 18071 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Parque Tecnológico de la Salud, 18016 Granada, Spain
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Maternal Physical Activity During Pregnancy and the Effect on the Mother and Newborn: A Systematic Review. J Phys Act Health 2020; 18:130-147. [PMID: 33361475 DOI: 10.1123/jpah.2019-0348] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/29/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The practice of physical exercise during pregnancy has benefits for both the mother and baby. Currently, there is scientific evidence that supports the inclusion of a monitored physical activity program in the daily activities of pregnant women. The objective of this study is to provide an overview of the current status of the association between physical activity during pregnancy and the effects on the mother and the newborn. METHODS A systematic review of the literature, assessing each study using the Scottish Intercollegiate Guidelines Network, from different databases PubMed, Embase, or ScienceDirect, on the association between maternal physical activity and its effects on the mother and the newborn published from 2010 until 2018 was conducted. RESULTS About 25 studies were identified and divided into categories according to the health problems affecting the mother or newborn. It was found that 8% of all the studies received a grade B, 68% obtained a grade C, and the remaining 24% obtained less than a grade C. Improved cardiovascular function, decreased risk of gestational diabetes mellitus, hypertension, and the limitation of weight gain are among the benefits to the mother with lower percentage of body fat, increased gestational age, and potentially improved neurodevelopment as benefits for the child. CONCLUSIONS The realization of physical activity during pregnancy is supported by most of the studies reviewed. However, given the vulnerability of the studied populations, more studies on the association between physical activity and pregnancy are necessary.
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Ricci E, Noli S, Ferrari S, La Vecchia I, De Cosmi V, Castiglioni M, Somigliana E, Agostoni C, Cipriani S, Mauri PA, Parazzini F. Pretreatment maternal lifestyle and outcomes of assisted reproduction: an Italian cohort study. BMJ Open 2020; 10:e038837. [PMID: 33243794 PMCID: PMC7692844 DOI: 10.1136/bmjopen-2020-038837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE We investigated whether lifestyle affects assisted reproduction technology (ART) outcomes. DESIGN Cohort study. SETTING Italian fertility unit. PARTICIPANTS From September 2014 to December 2016, women from couples presenting for evaluation and eligible for ART were invited to participate. Information on alcohol intake, current smoking and leisure physical activity (PA) during the year before the interview was collected, using a structured questionnaire. We considered the ART outcomes of the cycle immediately following the interview. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was cumulative pregnancy rate per retrieval. Secondary measures were number of retrieved oocytes, embryo transfer and live birth. RESULTS In 492 women undergoing an ART cycle, 427 (86.8%) underwent embryo transfer, 157 (31.9%) had at least one clinical pregnancy and 121 (24.6%) had live birth. The cumulative pregnancy rate per retrieval was 33.3% (95% CI 28.5% to 38.7%). In women in the third tertile of alcohol intake, adjusted relative risk was 0.97 (95% CI 0.87 to 1.08), 0.90 (95% CI 0.62 to 1.30) and 0.89 (95% CI 0.57 to 1.37) for embryo transfer, clinical pregnancy and live birth, respectively. The corresponding figures in women currently smoking more than 5 cigarettes/day were 1.00 (95% CI 0.88 to 1.16), 0.94 (95% CI 0.60 to 1.48) and 1.14 (95% CI 0.68 to 1.90), and in women with PA ≥5 hours/week were 0.93 (95% CI 0.79 to 1.08), 0.44 (95% CI 0.22 to 0.90) and 0.48 (95% CI 0.22 to 1.05), respectively. CONCLUSION There were no significant differences in in vitro fertilisation outcomes among women who used alcohol or tobacco in the year prior to treatment. Conservatively, all women should be advised to limit substance abuse. Moreover, our study suggested that maintaining a moderate, but not high, level of PA could be beneficial.
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Affiliation(s)
- Elena Ricci
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Noli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefania Ferrari
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Irene La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Valentina De Cosmi
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry, and Epidemiology "G. A. Maccacaro", Università di Milano, Milan, Italy
| | - Marta Castiglioni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Edgardo Somigliana
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Pediatric Intermediate Care Unit, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonia Cipriani
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Agnese Mauri
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Parazzini
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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The association of types, intensities and frequencies of physical activity with primary infertility among females in Gaza Strip, Palestine: A case-control study. PLoS One 2020; 15:e0241043. [PMID: 33095804 PMCID: PMC7584224 DOI: 10.1371/journal.pone.0241043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Physical activity and energy state balance have fundamentally been related to reproductive system and health. This study explored the relationship between different types, intensities and frequencies of physical activity with primary infertility among women in Gaza Strip, Palestine. METHODS A case-control study was conducted in Gaza Strip with the participation of 320 married couples. 160 infertile couples were chosen from five fertility centers registries from 2016 to 2018 and matched residentially with 160 fertile couples. Cases were selected through systematic stratified sampling of five lists categorized according to residency and the determined percentage selected from each list was proportional. Data were collected through a self-administered questionnaire extended by the short form of international physical activity questionnaire and analyzed through SPSS program version 22 by using descriptive analysis, independent T-test, cross-tabulation, and binary logistic regression. RESULTS Low frequency, intensity and duration of physical activity were associated with 3.1 risk of primary infertility (95% CI, 1.60-5.99, P < 0.001). Adjustment for age, marital age, age of menarche, refugee status and monthly income provided 3.2 risk (95% CI, 1.55-6.60, P = 0.002). Women spending more than 300 minutes a day sedentarily were 2.3 times more likely to have fertility problems than physically active females. Measuring energy expenditure in MET-min/w (Metabolic Equivalent) showed vigorous MET-min/w as negatively associated with the infertility status of females (Interquartile range IQR: 480 for cases and 720 for controls, P = 0.010). On the basis of energy expended in kilocalories in relation to weight, results showed the same association (IQR: 564 for case and 864 for controls, P = 0.011). No associations were found between moderate activity levels and primary infertility. CONCLUSION Low levels of physical activity and sedentary lifestyle endanger the fertility status of females in Gaza Strip. This may offer the need for endorsing and formalizing adequate physical activity education and awareness protocols in the national reproductive health guidelines and empowering environmental capacity building to alter physical activity-related cultural norms.
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Alliance of COVID 19 with pandemic of sedentary lifestyle & physical inactivity: Impact on reproductive health. Taiwan J Obstet Gynecol 2020; 59:790. [PMID: 32917342 PMCID: PMC7362860 DOI: 10.1016/j.tjog.2020.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/03/2022] Open
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Sõritsa D, Mäestu E, Nuut M, Mäestu J, Migueles JH, Läänelaid S, Ehrenberg A, Sekavin A, Sõritsa A, Salumets A, Ortega FB, Altmäe S. Maternal physical activity and sedentary behaviour before and during in vitro fertilization treatment: a longitudinal study exploring the associations with controlled ovarian stimulation and pregnancy outcomes. J Assist Reprod Genet 2020; 37:1869-1881. [PMID: 32578030 DOI: 10.1007/s10815-020-01864-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/16/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To evaluate the association of objectively measured physical activity (PA) and sedentary behaviour before and during in vitro fertilization (IVF) with controlled ovarian stimulation (COS) and pregnancy outcomes. METHODS This longitudinal study involved 107 infertile women undergoing IVF treatment. PA and sedentary behaviour were measured for 14 consecutive days using accelerometry as follows: (1) before IVF treatment, (2) during IVF at the implantation time, immediately after embryo transfer, and (3) after positive pregnancy test. Total screen time was assessed by questionnaires. COS results were measured as the number of oocytes and embryos obtained, and the study outcomes included positive hCG, clinical pregnancy, and live birth. RESULTS Compared with baseline activity levels, women significantly reduced their PA and increased sedentary behaviour during IVF (p ≤ 0.001). Higher average PA, light PA, and ratio between breaks in every ≥ 30-min blocks of sedentary time showed positive associations, while sedentary time, number, and time accumulated in blocks of ≥ 30 min of sedentary time associated negatively with oocyte and embryo counts (all p < 0.05). Women with high total screen time during non-work days (≥ 7 h) obtained 4.7 oocytes (p = 0.005) and 2.8 embryos (p = 0.008) less in COS. PA and sedentary behaviour before and during IVF did not affect the positive hCG, clinical pregnancy, and live birth outcomes. CONCLUSION Our study results suggest that higher time spent in PA and lower time spent in sedentary behaviour before entering assisted reproduction is associated with better COS outcomes, while activity levels before and during IVF do not affect the implantation, pregnancy, and live birth outcomes.
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Affiliation(s)
- Deniss Sõritsa
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, 51014, Tartu, Estonia
- Elite Clinic, 50407, Tartu, Estonia
| | - Evelin Mäestu
- Faculty of Medicine, Institute of Sport Sciences and Physiotherapy, University of Tartu, 51014, Tartu, Estonia
| | - Margit Nuut
- Tartu University Hospital's Women's Clinic, 51014, Tartu, Estonia
| | - Jarek Mäestu
- Faculty of Medicine, Institute of Sport Sciences and Physiotherapy, University of Tartu, 51014, Tartu, Estonia
| | - Jairo H Migueles
- PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
| | - Siret Läänelaid
- Department of Family Medicine, Faculty of Medicine, University of Tartu, 50411, Tartu, Estonia
- Tartu Health Care College, 50411, Tartu, Estonia
| | - Aivar Ehrenberg
- Tartu University Hospital's Women's Clinic, 51014, Tartu, Estonia
| | - Aire Sekavin
- Tartu University Hospital's Women's Clinic, 51014, Tartu, Estonia
| | | | - Andres Salumets
- Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, 51014, Tartu, Estonia
- Competence Centre on Health Technologies, 50410, Tartu, Estonia
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, FI-00029 HUS, Helsinki, Finland
| | - Francisco B Ortega
- PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
- Department of Biosciences and Nutrition, NOVUM, Karolinska Institutet, 14183, Huddinge, Sweden
| | - Signe Altmäe
- Competence Centre on Health Technologies, 50410, Tartu, Estonia.
- Department of Biochemistry and Molecular Biology, Faculty of Sciences, University of Granada, Avda. Fuente Nueva S/N, 18071, Granada, Spain.
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
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20
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Dupont C, Aegerter P, Foucaut AM, Reyre A, Lhuissier FJ, Bourgain M, Chabbert-Buffet N, Cédrin-Durnerin I, Selleret L, Cosson E, Lévy R. Effectiveness of a therapeutic multiple-lifestyle intervention taking into account the periconceptional environment in the management of infertile couples: study design of a randomized controlled trial - the PEPCI study. BMC Pregnancy Childbirth 2020; 20:322. [PMID: 32456614 PMCID: PMC7251692 DOI: 10.1186/s12884-020-2855-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. It affects approximately one in six couples seeking pregnancy in France or western countries. Many lifestyle factors of the couples' pre and peri-conceptional environment (weight, diet, alcohol, tobacco, coffee, drugs, physical activity, stress, sleep…) have been identified as risk factors for infertility in both males and females. The high prevalence rates of unhealthy diets and lifestyles in the reproductive population of industrialized countries are worrisome. Nevertheless, adoption of a healthy lifestyle may improve fertility but lifestyle changes are difficult to achieve and to maintain due notably to behavioral factors. METHODS Consequently, we decided to propose an interventional study aimed at improving the quality of life of infertile couples before the start of assisted reproductive technology treatment. It is a randomized controlled multicentre trial. Both members of the couples are involved in an integrated global care program (PEPCI for "Parcours Environnement PériConceptionnel en Infertilité") vs. usual care. This global intervention not only considers diet and/or physical activity but follows a holistic approach, including a multidisciplinary assessment to address complete physical, psychological and social well-being. According to patient needs, this includes interventions on weight, exercise, diet, alcohol and drugs, mental and social health. DISCUSSION The main objective of trial is to demonstrate that periconceptional multidisciplinary care has a positive impact on reproductive functions. We will also focus on feasibility, acceptance, compliance and conditions of success of a multifaceted lifestyle intervention. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov, Identifier: NCT02961907 on November 11, 2016.
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Affiliation(s)
- Charlotte Dupont
- Saint Antoine Research Center, INSERM équipe Lipodystrophies génétiques et acquises, Service de biologie de la reproduction-CECOS, AP-HP, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, F-75020, Paris, France.
| | - Philippe Aegerter
- Unité de Recherche Clinique et Département de Santé Publique, Assistance Publique - Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne, France.,UVSQ, UMR-S 1168 Université de Versailles Saint Quentin Paris Saclay, INSERM VIMA Aging and Chronic diseases, Epidemiological and Public Health approaches, Paris, France
| | - Aude-Marie Foucaut
- Université Sorbonne Paris Nord, Laboratoire Educations et Pratiques de Santé, LEPS, UR 3412, F-93017, Bobigny, France.,Département STAPS, Université Sorbonne Paris Nord, Bobigny, France
| | - Aymeric Reyre
- Department of Addiction Medicine and Psychiatry, APHP Avicenne University Hospital, Bobigny, France.,CESP-INSERM U1178, Villejuif, France
| | - François J Lhuissier
- Université Sorbonne Paris Nord, UMR INSERM 1272 Hypoxie et poumon, Bobigny, France.,Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Jean Verdier, Médecine de l'exercice et du sport, Bondy, France
| | - Marie Bourgain
- Department of Addiction Medicine and Psychiatry, APHP Avicenne University Hospital, Bobigny, France
| | - Nathalie Chabbert-Buffet
- Service de Gynécologie-Obstétrique et Médecine de La Reproduction, APHP Hôpital Tenon, 4 Rue de La Chine, 75020, Paris, France
| | - Isabelle Cédrin-Durnerin
- APHP Hôpital Jean verdier Service de médecine de la reproduction et préservation de la fertilité, avenue du 14-Juillet, 93143, Bondy, France
| | - Lise Selleret
- Service de Gynécologie-Obstétrique et Médecine de La Reproduction, APHP Hôpital Tenon, 4 Rue de La Chine, 75020, Paris, France
| | - Emmanuel Cosson
- Paris 13 University, Sorbonne Paris Cité, Assistance Publique - Hôpitaux de Paris, Avicenne Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France.,Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRA/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Rachel Lévy
- Saint Antoine Research Center, INSERM équipe Lipodystrophies génétiques et acquises, Service de biologie de la reproduction-CECOS, AP-HP, Hôpital Tenon, Sorbonne Université, 4 rue de la Chine, F-75020, Paris, France
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21
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Mínguez-Alarcón L, Chiu YH, Nassan FL, Williams PL, Petrozza J, Ford JB, Calafat AM, Hauser R, Chavarro JE. Urinary concentrations of benzophenone-3 and reproductive outcomes among women undergoing infertility treatment with assisted reproductive technologies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 678:390-398. [PMID: 31077917 PMCID: PMC6550292 DOI: 10.1016/j.scitotenv.2019.04.452] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 05/20/2023]
Abstract
Benzophenone-3 is used in a variety of cosmetic products as a sunscreen, and has shown weak estrogenic and antiandrogenic activity in animal and in vitro studies. Few studies have evaluated whether benzophenone-3 is associated with reproductive outcomes among women. We studied 304 women undergoing infertility treatment (2007-2017) in the prospective Environment and Reproductive Health cohort study and who underwent 449 treatment cycles (n = 788 urines). Generalized linear mixed models were used with random intercepts to account for multiple cycles, and adjusting for confounders including physical activity. Analyses were also stratified by self-reported moderate/heavy outdoor work. The cycle-specific median (IQR) urinary benzophenone-3 concentration was 147 (58, 462) μg/L, and 98% samples had detectable concentrations. Self-reported sunscreen use, physical activity, and time spent on moderate/heavy outdoor work were positively associated with urinary benzophenone-3. Adjusted probabilities of implantation, clinical pregnancy and live birth were higher in increasing quartiles of benzophenone-3, but these associations were restricted to women who reported spending time outdoors performing moderate/heavy work. Specifically, among these women, those in the highest quartile of benzophenone-3 concentrations had 51% higher implantation (p,trend = 0.02), 68% higher clinical pregnancy (p,trend = 0.01) and 75% higher live birth (p,trend = 0.02) adjusted probabilities than women in the lowest quartile. Benzophenone-3 was unrelated to these outcomes among women who did not report doing moderate/heavy work outdoors. These results confirm that sunscreen use is a source of benzophenone-3 exposure, and show positive associations between benzophenone-3 and pregnancy outcomes, especially among women who reported engaging in outdoor work. Since these associations may be subject to important residual confounding by lifestyle factors, further research is needed to confirm these novel results in other populations, and to investigate whether other factors may be affecting the relation of benzophenone-3 with fertility and other health outcomes.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, United States of America.
| | - Yu-Han Chiu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, United States of America; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - Feiby L Nassan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, United States of America; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States of America; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - John Petrozza
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, United States of America; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States of America; Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, United States of America; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, United States of America; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States of America
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22
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Gaskins AJ, Nassan FL, Chiu YH, Arvizu M, Williams PL, Keller MG, Souter I, Hauser R, Chavarro JE. Dietary patterns and outcomes of assisted reproduction. Am J Obstet Gynecol 2019; 220:567.e1-567.e18. [PMID: 30742825 PMCID: PMC6545142 DOI: 10.1016/j.ajog.2019.02.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/08/2019] [Accepted: 02/03/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is growing acceptance that nutrition may be related to fertility and specifically to assisted reproductive technologies success in women; however, there is still no specific dietary guidance. OBJECTIVE The objective of the study was to evaluate the relationship between pretreatment adherence to various dietary patterns and outcomes of assisted reproductive technologies. STUDY DESIGN We followed up 357 women enrolled in the prospective Environment and Reproductive Health (EARTH) study, who underwent 608 assisted reproductive technologies cycles (2007-2017). Using a validated food frequency questionnaire completed prior to treatment, we assessed adherence to the Mediterranean diet, the alternate Healthy Eating Index 2010, the Fertility Diet (developed based on risk factors for anovulatory infertility), and a profertility diet we developed based on factors previously related to assisted reproductive technologies outcomes (higher intake of supplemental folic acid, vitamin B12, vitamin D, low- rather than high-pesticide residue produce, whole grains, dairy, soy foods, and seafood rather than other meats). RESULTS Higher adherence to the alternate Healthy Eating Index 2010 and Fertility Diet was not related to live birth following assisted reproductive technologies. Women in the second through the fourth quartiles of Mediterranean diet adherence had significantly higher probability of live birth (0.44, 95% confidence interval, 0.39-0.49) compared with women in the first quartile (0.31, 95% confidence interval, 0.25-0.39); however, there was no additional benefit of adherence to the Mediterranean diet above the second quartile. Increased adherence to the profertility diet was linearly associated with assisted reproductive technologies outcomes. The adjusted odds (95% confidence interval) of implantation, clinical pregnancy, and live birth were higher by 47% (21%, 77%), 43% (19%, 72%), and 53% (26%, 85%), respectively, per SD increase. The adjusted difference in the proportion of cycles resulting in live birth for women in the fourth vs first quartile of adherence to the profertility diet was 0.28 (95% confidence interval, 0.16-0.38). While the profertility diet was not related to estradiol levels, oocyte counts, or endometrial thickness, it was inversely associated with clinical pregnancy loss (odds ratio, 0.69, 95% confidence interval, 0.53-0.90 per SD increase). CONCLUSION Higher pretreatment adherence to the profertility diet was associated with an increased probability of live birth among women undergoing assisted reproductive technologies. Commonly recommended dietary advice such as adhering to the Mediterranean diet may not provide the most appropriate guidance for women undergoing infertility treatment in the United States.
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Affiliation(s)
- Audrey J Gaskins
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston.
| | - Feiby L Nassan
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston
| | - Yu-Han Chiu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Mariel Arvizu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston
| | - Paige L Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston; Department of Biostatisticsr, Harvard T. H. Chan School of Public Health, Boston
| | - Myra G Keller
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston; Massachusetts General Hospital Fertility Center and Harvard Medical School, Boston
| | - Irene Souter
- Massachusetts General Hospital Fertility Center and Harvard Medical School, Boston
| | - Russ Hauser
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston; Massachusetts General Hospital Fertility Center and Harvard Medical School, Boston
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
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23
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Foucaut AM, Faure C, Julia C, Czernichow S, Levy R, Dupont C. Sedentary behavior, physical inactivity and body composition in relation to idiopathic infertility among men and women. PLoS One 2019; 14:e0210770. [PMID: 31017887 PMCID: PMC6481765 DOI: 10.1371/journal.pone.0210770] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Physical activity (PA) and sedentary behavior have inconsistent effects on fertility. High body mass index is associated with infertility but to our knowledge, very few studies have explored body composition in association to fertility. OBJECTIVE To assess the association between physical inactivity, sedentary behavior, body composition and idiopathic infertility in French men and women. DESIGN We conducted a case-control multicentric observational study. 159 infertile (79 men and 80 women) and 143 fertile (72 men and 71 women) were recorded in four fertility centers. MAIN OUTCOME MEASURES Participants completed self-administered questionnaires on sociodemographic and lifestyle characteristics, dietary intake, physical activity and sedentary behavior. Anthropometrics were measured, and bioelectrical impedance analysis was used to estimate body composition. Multivariable logistic regression was used to analyze the association of fertility with PA level and sedentary behavior. RESULTS In men, being physically inactive (Odd ratio [OR] 2.20; 95% confidence interval [CI], 1.06, 4.58) and having fat mass greater than the reference values for their age (OR 2.83; 95%CI, 1.31, 6.10) were positively associated with infertility. Sedentary behavior and fat-free mass were not related to infertility in men. In women, sedentary behavior (OR 3.61; 95%CI, 1.58, 8.24), high body fat (OR 3.16; 95%CI, 1.36, 7.37) and low fat-free mass (OR 2.65; 95%CI, 1.10, 6.37) were associated with infertility. PA level was not associated with fertility in women. CONCLUSIONS This study suggests that sedentary behavior and physical inactivity would represent two independent risk factors associated with infertility. The various elements that make up physical activity (frequency, intensity, time, and type of exercise) and the interrupting time spent sitting should be considered. Body composition variation should be explored further in relation to the biological pathways involved in idiopathic infertility. Moreover, the improvement of lifestyle factors should be considered in infertility treatment.
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Affiliation(s)
- Aude-Marie Foucaut
- Université Paris 13, Sorbonne Paris Cité, Laboratoire Educations et Pratiques de Santé (LEPS) EA 3412, UFR SMBH, Bobigny, France
| | - Céline Faure
- AP-HP, Hôpital Tenon, service de biologie de la reproduction CECOS, Paris, France
| | - Chantal Julia
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidemiologie et Biostatistiques Sorbonne Paris Cité (CRESS), Inserm U1153, Inra U1125, Cnam, COMUE Sorbonne-Paris-Cité, Bobigny, France
- Département de Santé Publique, Hôpital Avicenne, AP-HP, Bobigny, France
| | - Sébastien Czernichow
- Service de nutrition (Centre Spécialisé Obésité IdF), Hôpital européen Georges Pompidou, AP-HP, Paris, France
- Université Paris Descartes, Paris, France
| | - Rachel Levy
- Sorbonne Université, Saint Antoine Research center, INSERM équipe Lipodystrophies génétiques et acquises. Service de biologie de la reproduction-CECOS, AP-HP, Hôpital Tenon, Paris, France
| | - Charlotte Dupont
- Sorbonne Université, Saint Antoine Research center, INSERM équipe Lipodystrophies génétiques et acquises. Service de biologie de la reproduction-CECOS, AP-HP, Hôpital Tenon, Paris, France
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Nassan FL, Chiu YH, Vanegas JC, Gaskins AJ, Williams PL, Ford JB, Attaman J, Hauser R, Chavarro JE. Intake of protein-rich foods in relation to outcomes of infertility treatment with assisted reproductive technologies. Am J Clin Nutr 2018; 108:1104-1112. [PMID: 30475972 PMCID: PMC6692709 DOI: 10.1093/ajcn/nqy185] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/13/2018] [Indexed: 01/04/2023] Open
Abstract
Background Some dietary factors have been linked to outcomes of infertility treatment with assisted reproductive technology (ART), but the role of intake of meats and other protein-rich foods remains unclear. Objective The aim of this manuscript was to study the relation between preconception intake of meat and other protein-rich foods and outcomes of infertility treatment with ART. Design A total of 351 women enrolled in a prospective cohort at the Massachusetts General Hospital Fertility Center and underwent 598 ART cycles for infertility treatment. Meat intake was assessed with a validated food-frequency questionnaire, and ART outcomes were abstracted from electronic medical records. We estimated the associations between intake of protein-rich foods (meats, eggs, beans, nuts, and soy) and the outcome of live birth per initiated cycle using generalized linear mixed models. Results The average total meat intake was 1.2 servings/d, with most coming from poultry (35%), fish (25%), processed meat (22%), and red meat (17%). Fish intake was positively related to the proportion of cycles resulting in live birth. The multivariable-adjusted probabilities of live birth for women in increasing quartiles of fish intake were 34.2% (95% CI: 26.5%, 42.9%), 38.4% (95% CI: 30.3%, 47.3%), 44.7% (95% CI: 36.3%, 53.4%), and 47.7% (95% CI: 38.3%, 57.3%), respectively (P-trend = 0.04). In the estimated substitution analyses, the ORs of live birth associated with increasing fish intake by 2 servings/wk were 1.54 (95% CI: 1.14, 2.07) when fish replaced any other meat, 1.50 (95% CI: 1.13, 1.98) when fish replaced any other protein-rich food, and 1.64 (95% CI: 1.14, 2.35) when fish replaced processed meat. Conclusions Fish consumption is related to a higher probability of live birth following infertility treatment with ART. This trial was registered at clinicaltrials.gov as NCT00011713.
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Affiliation(s)
- Feiby L Nassan
- Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
- Environmental Health, Harvard TH Chan School of Public Health, Boston, MA
| | - Yu-Han Chiu
- Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
| | - Jose C Vanegas
- Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
| | - Audrey J Gaskins
- Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Paige L Williams
- Epidemiology, Harvard TH Chan School of Public Health, Boston, MA
- Biostatistics, Harvard TH Chan School of Public Health, Boston, MA
| | - Jennifer B Ford
- Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
| | - Jill Attaman
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Russ Hauser
- Environmental Health, Harvard TH Chan School of Public Health, Boston, MA
- Epidemiology, Harvard TH Chan School of Public Health, Boston, MA
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jorge E Chavarro
- Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, MA
- Epidemiology, Harvard TH Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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25
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Kiel IA, Lundgren KM, Mørkved S, Kjøtrød SB, Salvesen Ø, Romundstad LB, Moholdt T. Women undergoing assisted fertilisation and high-intensity interval training: a pilot randomised controlled trial. BMJ Open Sport Exerc Med 2018; 4:e000387. [PMID: 30057778 PMCID: PMC6059324 DOI: 10.1136/bmjsem-2018-000387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Overweight and obese women often seek assisted fertilisation. In the obese population, pregnancy rates are 30%-75% below that of normal weight women who undergo assisted fertilisation. We hypothesised that high-intensity interval training (HIT) would improve fertility by improving insulin sensitivity and thus affect the hypothalamic-pituitary-ovarian axis and ovarian androgen production. Our aim was to assess whether HIT prior to assisted fertilisation would increase pregnancy rate. METHODS Eighteen overweight and obese women (body mass index>25.0 kg/m2) were randomised to HIT (n=8) or usual care (control, n=10) before assisted fertilisation. HIT was undertaken three times weekly for 10 weeks; two sessions of 4×4 min HIT and one session of 10×1 min HIT. Primary outcome was ongoing pregnancy. Secondary outcomes included insulin sensitivity, reproductive hormones, oxygen uptake and body composition. RESULTS Four women got pregnant in both the HIT group (50%) and in the control group (44%), no between-group difference (p=0.6). Insulin sensitivity (glucose infusion rate) improved significantly after HIT, from 264.1 mg/m2/min (95% CI 193.9 to 334.4) at baseline to 324.7 mg/m2/min (95% CI 247.2 to 402.2) after 10 weeks (between-group difference, p=0.04). Fasting glucose, visceral fat, waist circumference and VO2peak were significantly improved in the group that undertook HIT. CONCLUSIONS HIT significantly improved insulin sensitivity, VO2peak and abdominal fat. Low statistical power makes it difficult to conclude on whether HIT prior to assisted fertilisation could increase pregnancy rate. Larger trials are needed to determine if improvements in insulin sensitivity are clinically relevant for assisted fertilisation success rates in this population.
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Affiliation(s)
- Ida Almenning Kiel
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Magrethe Lundgren
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siv Mørkved
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrun Beate Kjøtrød
- Department of Public Health and General Practice, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
- Research Department, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Fertility, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Laboratory Medicine, Children’s and Women’s Health, Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Liv Bente Romundstad
- Department of Public Health and General Practice, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Women's Health, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Messerlian C, Williams PL, Ford JB, Chavarro JE, Mínguez-Alarcón L, Dadd R, Braun JM, Gaskins AJ, Meeker JD, James-Todd T, Chiu YH, Nassan FL, Souter I, Petrozza J, Keller M, Toth TL, Calafat AM, Hauser R. The Environment and Reproductive Health (EARTH) Study: A Prospective Preconception Cohort. Hum Reprod Open 2018; 2018. [PMID: 29888739 PMCID: PMC5990043 DOI: 10.1093/hropen/hoy001] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Do environmental exposures, diet and lifestyle factors impact reproductive and pregnancy outcomes among subfertile couples attending a fertility clinic? SUMMARY ANSWER Environmental chemicals exposure in men and women were associated with reduced fertility and a higher risk of adverse outcomes, whereas some dietary factors improved the probability of successful reproductive outcomes. WHAT IS KNOWN ALREADY Accumulating epidemiologic evidence has shown associations of environmental chemicals and nutritional factors with reproductive and pregnancy outcomes. However, few studies have been designed to assess these factors simultaneously, and even fewer have collected such data among both men and women in the preconception period. Furthermore, early and sensitive reproductive endpoints (e.g. fertilization, implantation, biochemical pregnancy loss) are largely unobservable in population-based designs. STUDY DESIGN SIZE, DURATION The Environment and Reproductive Health (EARTH) Study is an ongoing prospective preconception cohort designed to investigate the impact of environmental, nutritional and lifestyle factors in both women and men on fertility and pregnancy outcomes. The study has been ongoing since 2004 and has recruited 799 women and 487 men (447 couples; 40 men joined without female partners) as of June 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS The study recruits women aged 18–45 years and men aged 18–55 years seeking fertility evaluation and treatment at a large academic hospital fertility center. Women and men are eligible to join either independently or as a couple. Participants are followed from study entry throughout each fertility treatment cycle, once per trimester of pregnancy (for those achieving pregnancy), and up to labor and delivery, or until they discontinue treatment or withdraw from the study. The study prospectively collects a combination of biological samples (e.g. blood, urine, semen), self-reported questionnaire data (including a validated food frequency questionnaire) and medical information abstracted from fertility clinic and hospital records. MAIN RESULTS AND THE ROLE OF CHANCE Among women in this cohort, higher urinary concentrations of some phthalate metabolites were associated with reduced oocyte yields, lower likelihood of clinical pregnancy, increased risk of pregnancy loss and lower likelihood of live birth following infertility treatment. Certain urinary phthalate metabolite concentrations among men was also associated with decreased odds of implantation and live birth. Maternal soy and folate intake significantly modified the association between bisphenol A (BPA) and IVF outcomes in women. While the EARTH Study has tested many a priori hypotheses, multiple comparisons were undertaken, and we cannot rule out the possibility that some of findings may be spurious or due to chance. LIMITATIONS REASONS FOR CAUTION While the fertility clinic setting provides the opportunity to measure environmental exposures, diet and lifestyle factors across different windows of vulnerability and to evaluate their potential effect on critical early fertility, pregnancy and delivery outcomes, the findings may be less generalizable to naturally conceived pregnancies. WIDER IMPLICATIONS OF THE FINDINGS The EARTH Study is one of the few cohorts designed to examine multiple windows of vulnerability, including the paternal and maternal preconception windows and the periconception and prenatal windows, in pregnancy. It is also one of the few human studies that has assessed potential interactions between environmental exposures and dietary factors. STUDY FUNDING/COMPETING INTEREST(S) The EARTH Study has been funded by the National Institute of Environmental Health Sciences since its inception in 2004. The authors declare no competing interests. TRIAL REGISTRATION NUMBER n/a.
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Affiliation(s)
- Carmen Messerlian
- Department of Environmental Health, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Jorge E Chavarro
- Department of Epidemiology, Harvard T.H. Chan School of Public Health Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Ramace Dadd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Audrey J Gaskins
- Department of Nutrition, Harvard T.H. Chan School of Public Health Boston, MA, USA.,Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston, MA, USA
| | - John D Meeker
- Department of Environmental Health Science, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Yu-Han Chiu
- Department of Nutrition, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Feiby L Nassan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Irene Souter
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, USA
| | - John Petrozza
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, USA
| | - Myra Keller
- Department of Environmental Health, Harvard T.H. Chan School of Public Health Boston, MA, USA
| | - Thomas L Toth
- Massachusetts General Hospital Fertility Center, Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, USA
| | - Antonia M Calafat
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health Boston, MA, USA.,Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston
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Rao M, Zeng Z, Tang L. Maternal physical activity before IVF/ICSI cycles improves clinical pregnancy rate and live birth rate: a systematic review and meta-analysis. Reprod Biol Endocrinol 2018; 16:11. [PMID: 29415732 PMCID: PMC5803901 DOI: 10.1186/s12958-018-0328-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/29/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This meta-analysis was aimed to evaluate the association between maternal physical activity before IVF/ICSI cycles and reproductive outcomes. METHODS We searched databases of PubMed, EMBASE and Web of Science electronic databases, and ongoing trials up to November 2017 to identify studies that focused on the relationship between maternal physical activity before IVF/ICSI cycles and reproductive outcomes, including implantation rate, clinical pregnancy rate, miscarriage rate and live birth rate. Odds ratio (OR) with 95% confidence intervals, were calculated to assess the results of each outcome. RESULTS Eight published studies encompassing 3683 infertile couples undergoing IVF/ICSI treatment were included into the analysis. There was an increasing, but not statistically significant, trend in implantation rate for physically active women when compared with physically inactive women (OR = 1.95, 95% CI 0.99-3.83, I2 = 77%). No significant difference was found in miscarriage rate between physically active women and physically inactive women (OR = 0.76, 95% CI 0.41-1.44, I2 = 49%). However, rates of clinical pregnancy and live births in physically active women were significantly higher than those in physically inactive women (OR = 1.96, 95% CI 1.40, 2.73, I2 = 42% and OR = 1.95, 95% CI 1.06-3.59, I2 = 82%, respectively). Subgroup analysis helped to confirm these results. CONCLUSIONS Female physical activity before IVF/ICSI cycles was associated with increased rates of clinical pregnancy and live births, whereas only a small but not statistically significant increase was found in implantation rate, and no effect was shown on miscarriage rate.
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Affiliation(s)
- Meng Rao
- Department of reproduction and genetics, the First Affiliated Hospital of Kunming Medical University, No. 295 Xi Chang road, Kunming, 650032, China
| | - Zhengyan Zeng
- Department of Neurology, the First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
| | - Li Tang
- Department of reproduction and genetics, the First Affiliated Hospital of Kunming Medical University, No. 295 Xi Chang road, Kunming, 650032, China.
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