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Optimizing natural fertility: a committee opinion. Fertil Steril 2021; 117:53-63. [PMID: 34815068 DOI: 10.1016/j.fertnstert.2021.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 01/08/2023]
Abstract
This committee opinion provides practitioners with suggestions for optimizing the likelihood of achieving pregnancy in couples or individuals attempting conception who have no evidence of infertility. This document replaces the document of the same name previously published in 2013 (Fertil Steril 2013;100:631-7).
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Affiliation(s)
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- The American Society for Reproductive Medicine, Birmingham, Alabama
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Mahalingaiah S, Cheng JJ, Winter MR, Rodriguez E, Fruh V, Williams A, Nguyen M, Madhavan R, Karanja P, MacRae J, Konanki SC, Lane KJ, Aschengrau A. Multimodal Recruitment to Study Ovulation and Menstruation Health: Internet-Based Survey Pilot Study. J Med Internet Res 2021; 23:e24716. [PMID: 33861203 PMCID: PMC8087968 DOI: 10.2196/24716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/30/2020] [Accepted: 03/11/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Multimodal recruitment strategies are a novel way to increase diversity in research populations. However, these methods have not been previously applied to understanding the prevalence of menstrual disorders such as polycystic ovary syndrome. OBJECTIVE The purpose of this study was to test the feasibility of recruiting a diverse cohort to complete a web-based survey on ovulation and menstruation health. METHODS We conducted the Ovulation and Menstruation Health Pilot Study using a REDCap web-based survey platform. We recruited 200 women from a clinical population, a community fair, and the internet. RESULTS We recruited 438 women over 29 weeks between September 2017 and March 2018. After consent and eligibility determination, 345 enrolled, 278 started (clinic: n=43; community fair: n=61; internet: n=174), and 247 completed (clinic: n=28; community fair: n=60; internet: n=159) the survey. Among all participants, the median age was 25.0 (SD 6.0) years, mean BMI was 26.1 kg/m2 (SD 6.6), 79.7% (216/271) had a college degree or higher, and 14.6% (37/254) reported a physician diagnosis of polycystic ovary syndrome. Race and ethnicity distributions were 64.7% (176/272) White, 11.8% (32/272) Black/African American, 7.7% (21/272) Latina/Hispanic, and 5.9% (16/272) Asian individuals; 9.9% (27/272) reported more than one race or ethnicity. The highest enrollment of Black/African American individuals was in clinic (17/42, 40.5%) compared to 1.6% (1/61) in the community fair and 8.3% (14/169) using the internet. Survey completion rates were highest among those who were recruited from the internet (159/174, 91.4%) and community fairs (60/61, 98.4%) compared to those recruited in clinic (28/43, 65.1%). CONCLUSIONS Multimodal recruitment achieved target recruitment in a short time period and established a racially diverse cohort to study ovulation and menstruation health. There were greater enrollment and completion rates among those recruited via the internet and community fair.
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Affiliation(s)
- Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - J Jojo Cheng
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States.,Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, United States
| | - Michael R Winter
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, United States
| | - Erika Rodriguez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Victoria Fruh
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Anna Williams
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - MyMy Nguyen
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Rashmi Madhavan
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Pascaline Karanja
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Jill MacRae
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA, United States
| | - Sai Charan Konanki
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kevin J Lane
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, United States
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
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Mahalingaiah S, Cosenza C, Cheng JJ, Rodriguez E, Aschengrau A. Cognitive testing of a survey instrument for self-assessed menstrual cycle characteristics and androgen excess. FERTILITY RESEARCH AND PRACTICE 2020; 6:19. [PMID: 33292647 PMCID: PMC7650203 DOI: 10.1186/s40738-020-00088-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022]
Abstract
Background In large population-based studies, there is a lack of existing survey instruments designed to ascertain menstrual cycle characteristics and androgen excess status including hirsutism, alopecia, and acne. Our objective was to cognitively test a survey instrument for self-assessed menstrual cycle characteristics androgen excess. Methods Questions to assess menstrual characteristics and health were designed using existing surveys and clinical experience. Pictorial self-assessment tools for androgen excess were also developed with an experienced medical illustrator to include the modified Ferrimen-Galway, acne and androgenic alopecia. These were combined into an online survey instrument using REDCap. Of the 219 questions, 120 were selected for cognitive testing to assess question comprehension in a population representative of the future study population. Results Cognitive testing identified questions and concepts not easily comprehended, recalled, or had problematic response choices. Comprehension examples included simplifying the definition for polycystic ovary syndrome and revising questions on historic menstrual regularity and bleeding duration. Recall and answer formation examples include issues with recalling waist size, beverage consumption, and interpretation of questions using symbols (> or <). The survey was revised based on feedback and subsequently used in the Ovulation and Menstruation (OM) Health Pilot study. Conclusion We present a cognitively tested, novel survey instrument to assess menstrual cycle characteristics and androgen excess.
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Affiliation(s)
- Shruthi Mahalingaiah
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Building 1 665 Huntington Avenue, Boston, MA, 02115, USA. .,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital , 55 Fruit Street Yawkey 10, Boston, MA, 02114, USA. .,Department of Obstetrics and Gynecology, Boston University School of Medicine, 85 East Concord Street, Boston, MA, 02118, USA.
| | - Carol Cosenza
- Center for Survey Research, UMass Boston, 100 Morrissey Blvd, Boston, MA, 02125, USA
| | - J Jojo Cheng
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, 53792, USA
| | - Erika Rodriguez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Massachusetts General Hospital , 55 Fruit Street Yawkey 10, Boston, MA, 02114, USA
| | - Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, Talbot 3E, 715 Albany Street, Boston, MA, 02118, USA
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Aschengrau A, Winter MR, Gallagher LG, Vieira VM, Butler LJ, Fabian MP, Carwile JL, Wesselink AK, Mahalingaiah S, Janulewicz PA, Weinberg JM, Webster TF, Ozonoff DM. Reproductive and developmental health effects of prenatal exposure to tetrachloroethylene-contaminated drinking water. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2020; 22:555-566. [PMID: 32051987 PMCID: PMC7937243 DOI: 10.1039/c9em00590k] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Tetrachloroethylene (PCE) is a common contaminant in both occupational and community settings. High exposure levels in the workplace have been shown to have adverse impacts on reproduction and development but few epidemiological studies have examined these effects at the lower levels commonly seen in community settings. We were presented with a unique opportunity to examine the reproductive and developmental effects of prenatal exposure to PCE-contaminated drinking water resulting from the installation of vinyl-lined water pipes in Massachusetts and Rhode Island from the late 1960s through 1980. This review describes the methods and findings of two community-based epidemiological studies, places their results in the context of the existing literature, and describes the strengths and challenges of conducting epidemiological research on a historical pollution episode. Our studies found that prenatal exposure to PCE-contaminated drinking water is associated with delayed time-to-pregnancy, and increased risks of placental abruption, stillbirths stemming from placental dysfunction, and certain birth defects. No associations were observed with pregnancy loss, birth weight, and gestational duration. Important strengths of this research included the availability of historical data on the affected water systems, a relatively high exposure prevalence and wide range of exposure levels, and little opportunity for recall bias and confounding. Challenges arose mainly from the retrospective nature of the exposure assessments. This research highlights the importance of considering pregnant women and their developing fetuses when monitoring, regulating, and remediating drinking water contaminants.
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Affiliation(s)
- Ann Aschengrau
- Department of Epidemiology, Boston University School of Public Health, 710 Albany Street, Boston, MA 02118, USA.
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Zhou J, Peng X, Mei S. Autophagy in Ovarian Follicular Development and Atresia. Int J Biol Sci 2019; 15:726-737. [PMID: 30906205 PMCID: PMC6429023 DOI: 10.7150/ijbs.30369] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/15/2018] [Indexed: 12/24/2022] Open
Abstract
Autophagy is a mechanism that exists in all eukaryotes under a variety of physiological and pathological conditions. In the mammalian ovaries, less than 1% of follicles ovulate, whereas the remaining 99% undergo follicular atresia. Autophagy and apoptosis have been previously found to be involved in the regulation of both primordial follicular development as well as atresia. The relationship between autophagy, follicular development, and atresia have been summarized in this review with the aim to obtain a more comprehensive understanding of the role played by autophagy in follicular development and atresia.
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Affiliation(s)
- Jiawei Zhou
- Institute of Animal Science and Veterinary Medicine, Hubei Academy of Agricultural Sciences, Wuhan 430064, China.,Hubei Key Lab for Animal Embryo Engineering and Molecular Breeding, Wuhan 430064, China
| | - Xianwen Peng
- Institute of Animal Science and Veterinary Medicine, Hubei Academy of Agricultural Sciences, Wuhan 430064, China.,Hubei Key Lab for Animal Embryo Engineering and Molecular Breeding, Wuhan 430064, China
| | - Shuqi Mei
- Institute of Animal Science and Veterinary Medicine, Hubei Academy of Agricultural Sciences, Wuhan 430064, China.,Hubei Key Lab for Animal Embryo Engineering and Molecular Breeding, Wuhan 430064, China
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Dai Y, Zhang X, Xue M, Zhou Y, Sun P, Leng J. Not Having Been Breastfed May Protect Chinese Women From Developing Deep Infiltrating Endometriosis: Results From Subgroup Analyses of the FEELING Study. Reprod Sci 2019; 26:1158-1167. [PMID: 30669944 PMCID: PMC6873220 DOI: 10.1177/1933719118820469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: This study aimed to investigate potential factors, especially early-life exposures,
associated with endometrioma (OMA) and/or deep infiltrating endometriosis (DIE) in
Chinese women. Methods: This is a subgroup analyses of the FEELING study, which was a case–control study that
investigated the clinical, lifestyle, and environmental factors associated with OMA
and/or DIE in China, Russia, and France. In this subgroup analysis, the data for the
Chinese participants were further analyzed using logistic regression model. Results: All women (N = 546) had fully completed the questionnaire. The mean age of the
participants was 31.8 (range: 18-41) years. Univariable analysis showed that noncyclic
chronic pelvic pain, dysmenorrhea intensity class, and whether breastfed during infancy
were distributed differently between patients with OMA or DIE and those with no
endometriosis (non-EM) or superficial peritoneal endometriosis (SUP; P
< .05). Multivariable analysis revealed that not having been breastfed was a
protective factor against OMA and DIE (odds ratio [OR] = 0.33, 95% confidence interval
[CI]: 0.16-0.69). Further analysis indicated not having been breastfed was a protective
factor for DIE compared with non-EM (OR = 0.13, 95% CI: 0.02-0.88) and with OMA + SUP
(OR = 0.19, 95% CI: 0.04-0.85) but was not a protective factor for OMA compared with
non-EM (OR = 0.66, 95% CI: 0.32-1.36) and with SUP (OR = 0.63, 95% CI: 0.31-1.30). Conclusion: This is the first study suggesting that not having been breastfed might protect against
DIE in Chinese women.
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Affiliation(s)
- Yi Dai
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinmei Zhang
- 2 Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Min Xue
- 3 The Third Xiangya Hospital of Central South University, Changsha, China
| | | | - Pengran Sun
- 5 Ipsen (Beijing) Pharmaceutical Science and Technology Development Co, Ltd, Beijing, China
| | - Jinhua Leng
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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