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De Larochelambert Q, Hamri I, Chassard T, Meignié A, Storme F, Dupuit M, Diry A, Toussaint JF, Louis PY, Coulmy N, Antero JDS. Exploring the effect of the menstrual cycle or oral contraception on elite athletes' training responses when workload is not objectively quantifiable: the MILS approach and findings from female Olympians. BMJ Open Sport Exerc Med 2024; 10:e001810. [PMID: 38882205 PMCID: PMC11177701 DOI: 10.1136/bmjsem-2023-001810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives Develop the Markov Index Load State (MILS) model, based on hidden Markov chains, to assess athletes' workload responses and investigate the effects of menstrual cycle (MC)/oral contraception (OC), sex steroids hormones and wellness on elite athletes' training. Methods On a 7-month longitudinal follow-up, daily training (volume and perceived effort, n=2200) and wellness (reported sleep quality and quantity, fitness, mood, menstrual symptoms, n=2509) data were collected from 24 female rowers and skiers preparing for the Olympics. 51 MC and 54 OC full cycles relying on 214 salivary hormone samples were analysed. MC/OC cycles were normalised, converted in % from 0% (first bleeding/pill withdrawal day) to 100% (end). Results MILS identified three chronic workload response states: 'easy', 'moderate' and 'hard'. A cyclic training response linked to MC or OC (95% CI) was observed, primarily related to progesterone level (p=8.23e-03 and 5.72e-03 for the easy and hard state, respectively). MC athletes predominantly exhibited the 'easy' state during the cycle's first half (8%-53%), transitioning to the 'hard' state post-estimated ovulation (63%-96%). OC users had an increased 'hard' state (4%-32%) during pill withdrawal, transitioning to 'easy' (50%-60%) when on the pill. Wellness metrics influenced the training load response: better sleep quality (p=5.20e-04), mood (p=8.94e-06) and fitness (p=6.29e-03) increased the likelihood of the 'easy' state. Menstrual symptoms increased the 'hard' state probability (p=5.92e-02). Conclusion The MILS model, leveraging hidden Markov chains, effectively analyses cumulative training load responses. The model identified cyclic training responses linked to MC/OC in elite female athletes.
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Affiliation(s)
- Quentin De Larochelambert
- Institut de Recherche bioMédicale et d'Epidemiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
- French Rowing Federation, Nogent-sur-Marne, France
- Scientific Department, Fédération Française de Ski, Annecy, France
- Institut de Mathématiques de Bourgogne, UMR 5584, CNRS & Université de Bourgogne, F-21000 Dijon, France, Dijon, France
| | - Imad Hamri
- Institut de Recherche bioMédicale et d'Epidemiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
| | - Tom Chassard
- Institut de Recherche bioMédicale et d'Epidemiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
| | - Alice Meignié
- Institut de Recherche bioMédicale et d'Epidemiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
| | - Florent Storme
- Institut de Recherche bioMédicale et d'Epidemiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
| | - Marine Dupuit
- Institut de Recherche bioMédicale et d'Epidemiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
| | - Allison Diry
- French Rowing Federation, Nogent-sur-Marne, France
| | - Jean-François Toussaint
- Institut de Recherche bioMédicale et d'Epidemiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
- CIMS, Hôtel-Dieu, AP-HP, Paris, France
| | - Pierre Yves Louis
- Institut de Mathématiques de Bourgogne, UMR 5584, CNRS & Université de Bourgogne, F-21000 Dijon, France, Dijon, France
- Université Bourgogne Franche-Comté, Institut Agro, Université de Bourgogne, INRAE, UMR PAM 1517, 21000 Dijon, France
| | - Nicolas Coulmy
- Scientific Department, Fédération Française de Ski, Annecy, France
| | - Juliana da Silva Antero
- Institut de Recherche bioMédicale et d'Epidemiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
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Bradshaw L, Buniam J, Betts JA, Gonzalez JT. Are there sex differences in the variability of fasting metabolism? J Appl Physiol (1985) 2024; 136:1450-1459. [PMID: 38634507 DOI: 10.1152/japplphysiol.00053.2024] [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: 01/18/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024] Open
Abstract
There is evidence across species and across many traits that males display greater between-individual variance. In contrast, (premenopausal) females display large within-individual variance in sex hormone concentrations, which can increase within-individual variance in many other parameters. The latter may contribute to the lower representation of females in metabolic research. This study is a pooled secondary analysis of data from seven crossover studies to investigate the between-individual and the within-individual variance in fasting plasma metabolites, resting metabolic rate (RMR), and body mass. Females demonstrated higher within-individual variability of plasma 17β-estradiol [coefficient of variation (CV): 15 ± 15% for males vs. 38 ± 34% for females, P < 0.001] and progesterone concentrations (CV: 13 ± 11% for males vs. 52 ± 51% for females, P < 0.001) but there were no meaningful differences in the variability of plasma glucose (CV: 4 ± 3% for males vs. 5 ± 5% for females), insulin, lactate, triglycerides (CV: 15 ± 9% for males vs. 15 ± 10% for females), and esterified fatty acid concentrations or in RMR and body mass (CV: 0.43 ± 0.34% for males vs. for 0.42 ± 0.33% females; P > 0.05 for all outcomes). Males displayed higher between-individual variance in RMR compared with females (SD: 224 kcal·day-1 for males vs. 151 kcal·day-1 for females). In conclusion, these data do not provide evidence that females show greater within-individual variability in many fasting metabolic variables, RMR, or body mass compared with males. We conclude that including females in metabolic research is unlikely to introduce greater within-individual variance when using the recruitment and control procedures described in these studies.NEW & NOTEWORTHY To investigate the within-individual variability in metabolic parameters in males and females, we performed a pooled secondary analysis of fasting blood samples, resting metabolic rate, and body mass from seven crossover studies. We found a greater day-to-day variation in 17β-estradiol and progesterone in females compared with males but no meaningful difference in within-individual variability of fasting plasma glucose, insulin, lactate, triglycerides, NEFA, resting metabolic rate, or body mass between females and males.
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Affiliation(s)
- Louise Bradshaw
- Centre for Nutrition, Exercise and Metabolism, University of Bath, Bath, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Jariya Buniam
- Centre for Nutrition, Exercise and Metabolism, University of Bath, Bath, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - James A Betts
- Centre for Nutrition, Exercise and Metabolism, University of Bath, Bath, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
| | - Javier T Gonzalez
- Centre for Nutrition, Exercise and Metabolism, University of Bath, Bath, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
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Carlin H, Dupuit M, Storme F, Chassard T, Meignié A, Sachet I, Brunet E, Toussaint JF, Antero J. Impact of menstrual cycle or combined oral contraception on elite female cyclists' training responses through a clustering analysis of training sessions. Front Sports Act Living 2024; 6:1307436. [PMID: 38487254 PMCID: PMC10937518 DOI: 10.3389/fspor.2024.1307436] [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: 10/04/2023] [Accepted: 02/01/2024] [Indexed: 03/17/2024] Open
Abstract
Objectives (i) To classify training sessions of elite female cyclists according to an intensity index based on a longitudinal follow-up using multiparametric data collected in situ (ii) to measure the effect of estimated menstrual cycle (MC) phases and oral contraceptive pills (OC) phases on the athletes' training responses on each type of training identified. Method Thirteen elite French cyclists were followed up over 30 months and 5,190 training sessions were collected and 81 MC/OCs full cycles analyzed. Power sensors and position devices captured training data in situ, which was summarized into 14 external load variables. Principal Component Analysis and K-means clustering were used to identify cycling sessions according to an intensity load index. The clusters were then verified and categorized through the analysis of heart rate and rate of perceived effort. A calendar method was used to estimate 3 phases of the MC: menstruation, mid-cycle phase (MP) and late-cycle phase (LP). Two phases were defined among monophasic OC users: pills' taking/withdrawal. Results Four main types of training effort were identified: Intensive, Long, Medium and Light. In the MC group (n = 7; 52 cycles), the intensity index is 8% higher during the mid-cycle (vs. menstrual phase, p = 0.032) in the Intensive effort sessions. No differences were observed in Long, Medium or Light effort, nor between the phases of pills' taking/withdrawal among OC users. Conclusion The clustering analyses developed allows a training classification and a robust method to investigate the influence of the MC/OC in situ. A better training response during the mid-cycle when the sessions are the most intense suggest an impact of the MC when the athletes approach their maximal capacity.
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Affiliation(s)
- Hugo Carlin
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES, UPR7329), INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Marine Dupuit
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES, UPR7329), INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Florent Storme
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES, UPR7329), INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Tom Chassard
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES, UPR7329), INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Alice Meignié
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES, UPR7329), INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Iris Sachet
- Fédération Française de Cyclisme (FFC), Saint Quentin en Yvelines, France
| | - Emanuel Brunet
- Fédération Française de Cyclisme (FFC), Saint Quentin en Yvelines, France
| | - Jean-François Toussaint
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES, UPR7329), INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
- Centre d'Investigations en Médecine du Sport—CIMS, Hôpital Hôtel-Dieu, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - Juliana Antero
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES, UPR7329), INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
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Jones BP, L'Heveder A, Bishop C, Kasaven L, Saso S, Davies S, Chakraverty R, Brown J, Pollock N. Menstrual cycles and the impact upon performance in elite British track and field athletes: a longitudinal study. Front Sports Act Living 2024; 6:1296189. [PMID: 38445211 PMCID: PMC10912517 DOI: 10.3389/fspor.2024.1296189] [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: 09/24/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Objective To assess the prevalence of menstrual disorders and the perceived effect of menstrual cycles upon performance in elite athletes. Methodology A longitudinal survey in the form of a questionnaire was sent to female track and field athletes at British Athletics every 6 months, over a five-year period between 1st October 2014 and 1st October 2019 in the United Kingdom (UK). Results 128 athletes completed an average of 4.2 ± 2.9 questionnaires across the study period. The mean age of menarche was 14.2 ± 1.4 years, 13.4 ± 1.3 years and 12.8 ± 1.4 years in endurance, power, and thrower athletes respectively (p < 0.05). Two-thirds (66%; n = 82) reported consistently regular cycles, 30% (n = 37) irregular at some point during the period of observation and 4% (n = 5) were amenorrhoeic. 87 athletes (68%) reported dysmenorrhoea and 40 (31%) menorrhagia. More than three quarters (76.8%; n = 96) described their cycle negatively affected performance. Amongst those who reported when the negative impact occurred (n = 91), 40% (n = 36) reported this in the late luteal phase and 35% (n = 32) during the early follicular phase. 79% (n = 100) of athletes reported at least one cyclical symptom, of which bloating, lower back and pelvic pain were most frequently experienced. Conclusion This data highlights the complex interrelationship between women's health and elite athletic performance. Athletes perceive a negative impact from their menstrual cycles upon performance with a desire to manage these more effectively, particularly during competition. Female reproductive health expertise in the multi-disciplinary management of elite athletes is required.
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Affiliation(s)
- Benjamin P. Jones
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Lister Fertility Clinic, The Lister Hospital, HCA Healthcare, London, United Kingdom
| | - Ariadne L'Heveder
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Department of Cutrale and Perioperative Ageing Group, Imperial College London, London, United Kingdom
| | - Charlotte Bishop
- Women's Health, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, United Kingdom
| | - Lorraine Kasaven
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
- Department of Cutrale and Perioperative Ageing Group, Imperial College London, London, United Kingdom
| | - Srdjan Saso
- Department of Gynaecology, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Sarah Davies
- National Performance Institute, British Athletics, Loughborough, United Kingdom
- Institute of Sport, Exercise and Health, University College London, London, United Kingdom
| | - Robin Chakraverty
- National Performance Institute, British Athletics, Loughborough, United Kingdom
| | - James Brown
- National Performance Institute, British Athletics, Loughborough, United Kingdom
| | - Noel Pollock
- National Performance Institute, British Athletics, Loughborough, United Kingdom
- Institute of Sport, Exercise and Health, University College London, London, United Kingdom
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Hosseinzadeh P, Peck JD, Burks HR, Souter I, Xing A, Craig LB, Diamond MP, Hansen KR. Follicular phase length is not related to live birth outcome in women with unexplained infertility undergoing ovarian stimulation with intrauterine insemination cycles in a multicenter trial. F S Rep 2023; 4:361-366. [PMID: 38204957 PMCID: PMC10774873 DOI: 10.1016/j.xfre.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 01/12/2024] Open
Abstract
Objective To evaluate the effect of follicular phase length (FPL) on pregnancy outcomes and endometrial thickness (ET) among women with unexplained infertility undergoing ovarian stimulation with intrauterine insemination (OS-IUI) with clomiphene citrate, letrozole, or gonadotropins. Design Cohort analysis of the Reproductive Medicine Network's Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation randomized controlled trial. Setting Multicenter randomized controlled trial. Patients A total of 869 couples with unexplained infertility who underwent OS-IUI treatment cycles as part of the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation study. Interventions FPL was evaluated as a categorical variable defined by quintiles (q1: ≤11 days, q2: 12 days, q3: 13 days, q4: 14-15 days, and q5: ≥16 days). Main outcome measures Clinical pregnancy, live birth rates, and ET. Results Decreasing FPL quintiles did not reduce clinical pregnancy or live birth rates in unadjusted or adjusted models with all treatment groups combined or when stratified by the ovarian stimulation medication. All FPL categories had significantly thinner ET compared with the 5th quintile (≥16 days) among women treated with clomiphene citrate or letrozole. Similar but diminished associations were observed among women who underwent ovarian stimulation with gonadotropins, but the observed differences were limited to those with FPL of 12 days or shorter when compared with FPL ≥16 days. Conclusions Although shorter FPL was associated with reduced ET, it was not associated with the outcomes of clinical pregnancy or live birth in women with unexplained infertility undergoing OS-IUI in all treatment groups combined. Similar patterns existed when analyses of clinical pregnancy and live birth rates were stratified by treatment. Clinical trial registration NCT01044862.
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Affiliation(s)
- Pardis Hosseinzadeh
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Jennifer D. Peck
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
- Department of Biostatistics and Epidemiology, University of Oklahoma College of Public Health, Oklahoma City, Oklahoma
| | - Heather R. Burks
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Irene Souter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital Fertility Center, Boston, Massachusetts
| | - Angela Xing
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - LaTasha B. Craig
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Michael P. Diamond
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia
| | - Karl R. Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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Pereira TJ, Bouakkar J, Johnston H, Pakosh M, Drake JD, Edgell H. The effects of oral contraceptives on resting autonomic function and the autonomic response to physiological stressors: a systematic review. Clin Auton Res 2023; 33:859-892. [PMID: 37971640 DOI: 10.1007/s10286-023-00996-0] [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] [Received: 06/14/2023] [Accepted: 10/15/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE This systematic review aimed to summarize how oral contraceptives (OC) affect resting autonomic function and the autonomic response to a variety of physiological stressors. METHODS A search strategy was created to retrieve citations investigating physiological responses comparing OC users to non-users (NOC) in response to autonomic reflex activation. RESULTS A total of 6148 citations were identified across databases from inception to June 2, 2022, and 3870 citations were screened at the abstract level after deduplication. Then, 133 texts were assessed at full-text level, and only 40 studies met eligibility requirements. Included citations were grouped by the aspect of autonomic function assessed, including autonomic reflex (i.e., baroreflex, chemoreflex, mechanoreflex, metaboreflex, and venoarterial reflex), or indicators (i.e., heart rate variability, pulse wave velocity, and sympathetic electrodermal activity), and physiological stressors that may alter autonomic function (i.e., auditory, exercise, mental or orthostatic stress, altitude, cold pressor test, sweat test, and vasodilatory infusions). CONCLUSION OC influence the physiological responses to chemoreflex, mechanoreflex, and metaboreflex activation. In terms of autonomic indices and physiological stressors, there are more inconsistencies within the OC literature, which may be due to estrogen dosage within the OC formulation (i.e., heart rate variability) or the intensity of the stressor (exercise intensity/duration or orthostatic stress). Further research is required to elucidate the effects of OC on these aspects of autonomic function because of the relatively small amount of available research. Furthermore, researchers should more clearly define or stratify OC use by duration, dose, and/or hormone cycling to further elucidate the effects of OC.
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Affiliation(s)
- T J Pereira
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - J Bouakkar
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - H Johnston
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - M Pakosh
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - J D Drake
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
- Muscle Health Research Centre, York University, Toronto, ON, Canada
| | - H Edgell
- School of Kinesiology and Health Science, York University, 355 Bethune College, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
- Library & Information Services, University Health Network, Toronto, ON, Canada.
- Muscle Health Research Centre, York University, Toronto, ON, Canada.
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Teh WT, Chung J, Holdsworth-Carson SJ, Donoghue JF, Healey M, Rees HC, Bittinger S, Obers V, Sloggett C, Kendarsari R, Fung JN, Mortlock S, Montgomery GW, Girling JE, Rogers PAW. A molecular staging model for accurately dating the endometrial biopsy. Nat Commun 2023; 14:6222. [PMID: 37798294 PMCID: PMC10556104 DOI: 10.1038/s41467-023-41979-z] [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: 07/15/2022] [Accepted: 09/26/2023] [Indexed: 10/07/2023] Open
Abstract
Natural variability in menstrual cycle length, coupled with rapid changes in endometrial gene expression, makes it difficult to accurately define and compare different stages of the endometrial cycle. Here we develop and validate a method for precisely determining endometrial cycle stage based on global gene expression. Our 'molecular staging model' reveals significant and remarkably synchronised daily changes in expression for over 3400 endometrial genes throughout the cycle, with the most dramatic changes occurring during the secretory phase. Our study significantly extends existing data on the endometrial transcriptome, and for the first time enables identification of differentially expressed endometrial genes with increasing age and different ethnicities. It also allows reinterpretation of all endometrial RNA-seq and array data that has been published to date. Our molecular staging model will significantly advance understanding of endometrial-related disorders that affect nearly all women at some stage of their lives, such as heavy menstrual bleeding, endometriosis, adenomyosis, and recurrent implantation failure.
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Affiliation(s)
- W T Teh
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Melbourne IVF, Melbourne, Victoria, Australia
| | - J Chung
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Melbourne Bioinformatics, University of Melbourne, Melbourne, Victoria, Australia
| | - S J Holdsworth-Carson
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Julia Argyrou Endometriosis Centre, Epworth HealthCare, Richmond, Victoria, Australia
| | - J F Donoghue
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - M Healey
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - H C Rees
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - S Bittinger
- Royal Women's Hospital, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - V Obers
- Melbourne Pathology, Collingwood, Victoria, Australia
| | - C Sloggett
- Melbourne Bioinformatics, University of Melbourne, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute, Melbourne, Victoria, Australia
| | - R Kendarsari
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia
- Illumina Inc. 11 Biopolis Way, Singapore, 138667, Singapore
| | - J N Fung
- School of Biomedical Sciences, University of Queensland, St Lucia, Queensland, Australia
| | - S Mortlock
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia
| | - G W Montgomery
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia
| | - J E Girling
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Aotearoa, New Zealand
| | - P A W Rogers
- University of Melbourne Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia.
- Royal Women's Hospital, Melbourne, Victoria, Australia.
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Dupuit M, Meignié A, Chassard T, Blanquet L, LeHeran J, Delaunay T, Bernardeau E, Toussaint JF, Duclos M, Antero J. On-Field Methodological Approach to Monitor the Menstrual Cycle and Hormonal Phases in Elite Female Athletes. Int J Sports Physiol Perform 2023; 18:1169-1178. [PMID: 37666497 DOI: 10.1123/ijspp.2022-0287] [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] [Received: 07/12/2022] [Revised: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Currently, there are no guidelines for implementing the monitoring of menstrual status, including the natural menstrual cycle (NC) or oral contraception (OC), in a sport setting. We aimed to provide a feasible, on-field methodological approach for monitoring NC and OC in female athletes. METHODS We developed a smartphone app with daily questionnaires to monitor both NC and OC phases in 19 elite female soccer players (23.7 [4.4] y) over 7 months. Adherence and compliance were evaluated. The NC and OC phases were based on calendar data to establish an individual menstrual profile for each athlete. RESULTS The initial questionnaire revealed that the vast majority of female players (80%) were interested in monitoring their menstrual status. The online monitoring yielded high athlete adherence (87.0% [14.2%]) with a slight decrease over the winter break and at the end of the championship, which necessitated adaptations to promote compliance. Monitoring identified the specific menstrual pattern of each athlete and highlighted large interindividual variability. CONCLUSION This study assesses, for the first time, the interest of female players in monitoring their menstrual status. It provides a new methodological approach, as well as guidelines for optimizing on-field monitoring. It also anticipates some obstacles sport staff may encounter when trying to implement such follow-up. It is essential to better understand the menstrual profile of athletes and determine its potential impacts on well-being and performance.
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Affiliation(s)
- Marine Dupuit
- Laboratory of Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne (UCA), Clermont-Ferrand, France
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Alice Meignié
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Tom Chassard
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Ludivine Blanquet
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | | | | | | | - Jean-François Toussaint
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
- CIMS, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Martine Duclos
- Sport Medicine and Functional Explorations, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
- Unité de Nutrition Humaine (UNH), Université Clermont Auvergne (UCA), INRA, Clermont-Ferrand, France
| | - Juliana Antero
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
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9
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Gibbons T, Reavey J, Georgiou EX, Becker CM. Timed intercourse for couples trying to conceive. Cochrane Database Syst Rev 2023; 9:CD011345. [PMID: 37709293 PMCID: PMC10501857 DOI: 10.1002/14651858.cd011345.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
BACKGROUND Many factors influence fertility, one being the timing of intercourse. The 'fertile window' describes a stage in the cycle when conception can occur and is approximately five days before to several hours after ovulation. 'Timed intercourse' is the practice of prospectively identifying ovulation and, thus, the fertile window to increase the likelihood of conception. Methods of predicting ovulation include urinary hormone measurement (luteinising hormone (LH) and oestrogen), fertility awareness-based methods (FABM) (including tracking basal body temperatures, cervical mucus monitoring, calendar charting/tracking apps), and ultrasonography. However, there are potentially negative aspects associated with ovulation prediction, including stress, time consumption, and cost implications of purchasing ovulation kits and app subscriptions. This review considered the evidence from randomised controlled trials (RCTs) evaluating the use of timed intercourse (using ovulation prediction) on pregnancy outcomes. OBJECTIVES To evaluate the benefits and risks of ovulation prediction methods for timing intercourse on conception in couples trying to conceive. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group Specialised Register, CENTRAL, MEDLINE, and Embase in January 2023. We also checked the reference lists of relevant studies and searched trial registries for any additional trials. SELECTION CRITERIA We included RCTs that compared methods of timed intercourse using ovulation prediction to other forms of ovulation prediction or intercourse without ovulation prediction in couples trying to conceive. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane to select and analyse studies in this review. The primary review outcomes were live birth and adverse events (such as depression and stress). Secondary outcomes were clinical pregnancy, pregnancy (clinical or positive urinary pregnancy test not yet confirmed by ultrasound), time to pregnancy, and quality of life. We assessed the overall quality of the evidence for the main comparisons using GRADE methods. MAIN RESULTS This review update included seven RCTs involving 2464 women or couples. Four of the five studies from the previous review were included in this update, and three new studies were added. We assessed the quality of the evidence as moderate to very low, the main limitations being imprecision, indirectness, and risk of bias. Urinary ovulation tests versus intercourse without ovulation prediction Compared to intercourse without ovulation prediction, urinary ovulation detection probably increases the chance of live birth in couples trying to conceive (risk ratio (RR) 1.36, 95% confidence interval (CI) 1.02 to 1.81, 1 RCT, n = 844, moderate-quality evidence). This suggests that if the chance of a live birth without urine ovulation prediction is 16%, the chance of a live birth with urine ovulation prediction is 16% to 28%. However, we are uncertain whether timed intercourse using urinary ovulation detection resulted in a difference in stress (mean difference (MD) 1.98, 95% CI -0.87 to 4.83, I² = 0%, P = 0.17, 1 RCT, n = 77, very low-quality evidence) or clinical pregnancy (RR 1.09, 95% CI 0.51 to 2.31, I² = 0%, 1 RCT, n = 148, low-quality evidence). Similar to the live birth result, timed intercourse using urinary ovulation detection probably increases the chances of clinical pregnancy or positive urine pregnancy test (RR 1.28, 95% CI 1.09 to 1.50, I² = 0, 4 RCTs, n = 2202, moderate-quality evidence). This suggests that if the chance of a clinical pregnancy or positive urine pregnancy test without ovulation prediction is assumed to be 18%, the chance following timed intercourse with urinary ovulation detection would be 20% to 28%. Evidence was insufficient to determine the effect of urine ovulation tests on time to pregnancy or quality of life. Fertility awareness-based methods (FABM) versus intercourse without ovulation prediction Due to insufficient evidence, we are uncertain whether timed intercourse using FABM resulted in a difference in live birth rate compared to intercourse without ovulation prediction (RR 0.95, 95% CI 0.76 to 1.20, I² = 0%, 2 RCTs, n = 157, low-quality evidence). We are also uncertain whether FABM affects stress (MD -1.10, 95% CI -3.88 to 1.68, 1 RCT, n = 183, very low-quality evidence). Similarly, we are uncertain of the effect of timed intercourse using FABM on anxiety (MD 0.5, 95% CI -0.52 to 1.52, P = 0.33, 1 RCT, n = 183, very low-quality evidence); depression (MD 0.4, 95% CI -0.28 to 1.08, P = 0.25, 1 RCT, n = 183, very low-quality evidence); or erectile dysfunction (MD 1.2, 95% CI -0.38 to 2.78, P = 0.14, 1 RCT, n = 183, very low-quality evidence). Evidence was insufficient to detect a benefit of timed intercourse using FABM on clinical pregnancy (RR 1.13, 95% CI 0.31 to 4.07, 1 RCT, n = 17, very low-quality evidence) or clinical or positive pregnancy test rates (RR 1.08, 95% CI 0.89 to 1.30, 3 RCTs, n = 262, very low-quality evidence). Finally, we are uncertain whether timed intercourse using FABM affects the time to pregnancy (hazard ratio 0.86, 95% CI 0.53 to 1.38, 1 RCT, n = 140, low-quality evidence) or quality of life. No studies assessed the use of timed intercourse with pelvic ultrasonography. AUTHORS' CONCLUSIONS The new evidence presented in this review update shows that timed intercourse using urine ovulation tests probably improves live birth and pregnancy rates (clinical or positive urine pregnancy tests but not yet confirmed by ultrasound) in women under 40, trying to conceive for less than 12 months, compared to intercourse without ovulation prediction. However, there are insufficient data to determine the effects of urine ovulation tests on adverse events, clinical pregnancy, time to pregnancy, and quality of life. Similarly, due to limited data, we are uncertain of the effect of FABM on pregnancy outcomes, adverse effects, and quality of life. Further research is therefore required to fully understand the safety and effectiveness of timed intercourse for couples trying to conceive. This research should include studies reporting clinically relevant outcomes such as live birth and adverse effects in fertile and infertile couples and utilise various methods to determine ovulation. Only with a comprehensive understanding of the risks and benefits of timed intercourse can recommendations be made for all couples trying to conceive.
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Affiliation(s)
- Tatjana Gibbons
- Nuffield Department of Women's and Reproductive Health, University of Oxford , Oxford, UK
| | - Jane Reavey
- Department of Obstetrics and Gynaecology, Royal Berkshire Hospital, Reading, UK
| | | | - Christian M Becker
- Nuffield Department of Women's and Reproductive Health, University of Oxford , Oxford, UK
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10
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Ledesma BR, Suarez Arbelaez MC, Grewal M, Marquez K, Palmerola K, Ghomeshi A, Ramasamy R. The Impact of Ovulation Calculators on the Stress Levels of Fertility-Seeking Couples: An Evaluation Study. Cureus 2023; 15:e43972. [PMID: 37746350 PMCID: PMC10515671 DOI: 10.7759/cureus.43972] [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: 05/21/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Infertility affects a significant portion of couples seeking pregnancy, leading to stress and emotional strain. Ovulation calculators, widely used as a tool to predict fertile days, may play a role in the stress experienced by couples undergoing fertility treatments. The aim of this study was to evaluate the impact of ovulation calculators on the stress levels of couples seeking fertility. Methods Participants were recruited from the University of Miami Health System Clinics. Fifty couples consulting for infertility were asked to participate in the study and complete anonymous self-reported surveys. The surveys consisted of validated questions related to stress levels and the use of ovulation calculators. The completed surveys were collected and analyzed using descriptive statistics. The data collected included age, number of years trying to conceive, and answers to questions related to stress levels and the use of ovulation calculators. Responses from 50 couples who met the inclusion criteria were included in the final analysis. Results A total of 50 couples who were attempting conception and who completed all the questionnaires were included in the study. Whether or not they were using ovulation calculators, females scored similarly in the four variables of the Female Sexual Function Index (FSFI), including arousal, orgasm, satisfaction, and lubrication. When evaluating International Index of Erectile Function (IIEF) scores for male erectile function, the average score of males tracking ovulation was 12.0 ± 4.8, compared to 11.5 ± 5.4 in male patients who were not (P = 0.81). The results showed no statistically significant difference in stress levels between couples who used ovulation calculators and those who did not. However, in couples experiencing higher stress levels due to infertility, both male and female participants reported higher levels of sexual dysfunction. Fertility-related stress was also found to be significantly associated with mental health implications, with increased anxiety and depression reported by couples undergoing fertility treatments. Conclusion The findings suggest that the use of ovulation calculators did not significantly influence the stress experienced by couples seeking fertility treatment. However, the study highlights the significant impact of infertility-related stress on sexual function and mental health in both male and female partners. These results emphasize the importance of addressing the psychological aspects of infertility and providing comprehensive support to couples undergoing fertility treatments. Further research is warranted to explore the complex interplay between ovulation calculator usage, infertility-related stress, sexual dysfunction, and mental health implications in couples seeking to conceive. Healthcare providers should consider incorporating mental health support into fertility treatment programs to optimize patient outcomes and overall well-being.
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Affiliation(s)
- Braian R Ledesma
- Urology, Desai Sethi Urology Institute, University of Miami, Miami, USA
| | | | - Meghan Grewal
- Urology, Desai Sethi Urology Institute, University of Miami, Miami, USA
| | - Kyara Marquez
- Urology, Jackson Health System, University of Miami, Miami, USA
| | | | - Armin Ghomeshi
- Urology, Florida International University Herbert Wertheim College of Medicine, Miami, USA
| | - Ranjith Ramasamy
- Urology, Desai Sethi Urology Institute, University of Miami, Miami, USA
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11
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Hills E, Woodland MB, Divaraniya A. Using Hormone Data and Age to Pinpoint Cycle Day within the Menstrual Cycle. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1348. [PMID: 37512159 PMCID: PMC10384168 DOI: 10.3390/medicina59071348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Menstrual cycle tracking is essential for reproductive health and overall well-being. However, there is still an over-reliance on estimations that standard cycles are 28 days long, divided evenly between the follicular and luteal phases. Due to the variability of cycle length and cycle phase lengths, common methods of identifying where an individual is in their cycle are often inaccurate. This study used daily hormone monitoring obtained through a remote hormone-monitoring platform to evaluate hormone levels across a menstrual cycle to identify nuances in the follicular and luteal phases in individuals of different age groups. Materials and Methods: This study used a remote fertility testing system that quantitatively tracks luteinizing hormone (LH) and pregnanediol-3-glucuronide (PdG) through urine tests read by an AI-powered smartphone app. The study analyzed cycle data from 1233 users with a total of 4123 evaluated cycles. Daily levels for LH and PdG were monitored across multiple cycles. Results: This study determined that calculated cycle lengths tended to be shorter than user-reported cycle lengths. Significant differences were observed in cycle phase lengths between age groups, indicating that follicular phase length declines with age while luteal phase length increases. Finally, the study found that if an individual's age, first cycle day, and current hormone levels are known, population-level hormone data can be used to pinpoint which cycle phase and cycle day they are in with 95% confidence. Conclusions: At-home hormone monitoring technologies can allow patients and clinicians to track their cycles with greater precision than when relying on textbook estimations. The study's findings have implications for fertility planning, clinical management, and general health monitoring. Prior to this study, no standard existed for pinpointing where a person was in their cycle through only one measure of LH and PdG. These findings have the potential to fill significant gaps within reproductive healthcare and beyond.
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Affiliation(s)
- Elinor Hills
- Oova, Inc., 335 Madison Avenue, New York, NY 10017, USA
| | - Mark B Woodland
- Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA 19129, USA
- Department of Obstetrics and Gynecology, Reading Hospital-/Tower Health, West Reading, PA 19611, USA
- Pennsylvania State Board of Medicine, Harrisburg, PA 17110, USA
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12
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Hamidovic A, Davis J, Wardle M, Naveed A, Soumare F. Periovulatory Subphase of the Menstrual Cycle Is Marked by a Significant Decrease in Heart Rate Variability. BIOLOGY 2023; 12:785. [PMID: 37372070 DOI: 10.3390/biology12060785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/12/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
(1) Background: High-frequency heart rate variability (HF-HRV) is an essential ultradian rhythm that reflects the activity of the PNS to decelerate the heart. It is unknown how HF-HRV varies across the menstrual cycle (MC), and whether progesterone mediates this potential variation. (2) Methods: We enrolled 33 women in the study to attend eight clinic visits across the MC, during which we measured their resting HF-HRV and collected samples for the analysis of luteinizing hormone (LH) and progesterone. We realigned the study data according to the serum LH surge to the early follicular, mid-follicular, periovulatory, early luteal, mid-luteal and late luteal subphases. (3) Results: Pairwise comparisons between all the subphases showed significant differences between the early follicular and periovulatory subphases (β = 0.9302; p ≤ 0.001) and between the periovulatory and early luteal subphases (β = -0.6955; p ≤ 0.05). Progesterone was positively associated with HF-HRV in the early follicular subphase but not the periovulatory subphase (p ≤ 0.05). (4) Conclusions: The present study shows a significant drop in HF-HRV in the anticipation of ovulation. Further research in this area is critical given the marked cardiovascular disease mortality in women.
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Affiliation(s)
- Ajna Hamidovic
- Department of Pharmacy, University of Illinois at Chicago, 833 S. Wood St., Chicago, IL 60612, USA
| | - John Davis
- Department of Psychiatry, University of Illinois at Chicago, 1601 W. Taylor St., Chicago, IL 60612, USA
| | - Margaret Wardle
- Department of Psychology, University of Illinois at Chicago, 1007 W. Harrison St., Chicago, IL 60607, USA
| | - Aamina Naveed
- Department of Pharmacy, University of Illinois at Chicago, 833 S. Wood St., Chicago, IL 60612, USA
| | - Fatimata Soumare
- Department of Pharmacy, University of Illinois at Chicago, 833 S. Wood St., Chicago, IL 60612, USA
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13
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Access to Ovulation Tests and Strategic Timing of Intercourse in a Low Fertility Context. POPULATION RESEARCH AND POLICY REVIEW 2023. [DOI: 10.1007/s11113-023-09769-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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14
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James JJ, Leach OK, Young AM, Newman AN, Mpongo KL, Quirante JM, Wardell DB, Ahmadi M, Gifford JR. The exercise power-duration relationship is equally reproducible in eumenorrheic female and male humans. J Appl Physiol (1985) 2023; 134:230-241. [PMID: 36548510 DOI: 10.1152/japplphysiol.00416.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study aims to investigate the effect of the menstrual cycle (MC) on exercise performance across the power-duration relationship (PDR). We hypothesized females would exhibit greater variability in the PDR across the MC than males across a similar timespan, with critical power (CP) and work-prime (W') being lower during the early follicular phase than the late follicular and midluteal phases. Seven eumenorrheic, endurance-trained female adults performed multiple constant-load-to-task-failure and maximum-power tests at three timepoints across the MC (early follicular, late follicular, and midluteal phases). Ten endurance-trained male adults performed the same tests approximately 10 days apart. No differences across the PDR were observed between MC phases (CP: 186.74 ± 31.00 W, P = 0.955, CV = 0.81 ± 0.65%) (W': 7,961.81 ± 2,537.68 J, P = 0.476, CV = 10.48 ± 3.06%). CP was similar for male and female subjects (11.82 ± 1.42 W·kg-1 vs. 11.56 ± 1.51 W·kg-1, respectively) when controlling for leg lean mass. However, W' was larger (P = 0.047) for male subjects (617.28 ± 130.10 J·kg-1) than female subjects (490.03 ± 136.70 J·kg-1) when controlling for leg lean mass. MC phase does not need to be controlled when conducting aerobic endurance performance research on eumenorrheic female subjects without menstrual dysfunction. Nevertheless, several sex differences in the power-duration relationship exist, even after normalizing for body composition. Therefore, previous studies describing the physiology of exercise performance in male subjects may not perfectly describe that of female subjects.NEW & NOTEWORTHY Females are often excluded from exercise performance research due to experimental challenges in controlling for the menstrual cycle (MC), causing uncertainty regarding how the MC impacts female performance. The present study examined the influences that biological sex and the MC have on the power-duration relationship (PDR) by comparing critical power (CP), Work-prime (W'), and maximum power output (PMAX) in males and females. Our data provide evidence that the MC does not influence the PDR and that females exhibit similar reproducibility as males. Thus, when conducting aerobic endurance exercise research on eumenorrheic females without menstrual dysfunction, the phase of the MC does not need to be controlled. Although differences in body composition account for some differences between the sexes, sex differences in W' and PMAX persisted even after normalizing for different metrics of body composition. These data highlight the necessity and feasibility of examining sex differences in performance, as previously generated male-only data within the literature may not apply to female subjects.
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Affiliation(s)
- Jessica J James
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Olivia K Leach
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Arianna M Young
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Audrey N Newman
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Kiese L Mpongo
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Jaron M Quirante
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Devon B Wardell
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Mohadeseh Ahmadi
- Department of Exercise Sciences, Brigham Young University, Provo, Utah
| | - Jayson R Gifford
- Department of Exercise Sciences, Brigham Young University, Provo, Utah.,Program of Gerontology, Brigham Young University, Provo, Utah
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15
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Antero J, Golovkine S, Niffoi L, Meignié A, Chassard T, Delarochelambert Q, Duclos M, Maitre C, Maciejewski H, Diry A, Toussaint JF. Menstrual cycle and hormonal contraceptive phases' effect on elite rowers' training, performance and wellness. Front Physiol 2023; 14:1110526. [PMID: 36875020 PMCID: PMC9981658 DOI: 10.3389/fphys.2023.1110526] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
Objectives: To investigate the effect of menstrual cycle (MC) and hormonal contraception (HC) phases in elite rowers training, performance and wellness monitoring. Methods: Twelve French elite rowers were follow-up for 4,2 cycles on average in their final preparation for the Olympics and Paralympics Games in Tokyo 2021 through an on-site longitudinal study based on repeated measures. Daily self-reported evaluation using Likert rating scales of wellness (sleep quality, fitness, mood, injuries' pain), menstrual symptoms and training parameters (perceived exertion and self-assessment of performance) were collected (n = 1,281) in parallel to a coach evaluation of rowers' performance (n = 136), blinded to theirs MC and HC phases. Salivary samples of estradiol and progesterone were collected in each cycle to help to classify the MC into 6 phases and HC into 2-3 phases depending on the pills' hormone concentration. A chi-square test normalized by each rower was used to compare the upper quintile scores of each studied variable across phases. A Bayesian ordinal logistic regression was applied to model the rowers' self-reported performance. Results: Rowers with a natural cycle, n = 6 ( + 1 amenorrhea) evaluate their performance and wellness with significant higher score indices at the middle of their cycle. Top assessments are rarer at the premenstrual and menses phases, when they more frequently experience menstrual symptoms which are negatively correlated with their performance. The HC rowers, n = 5, also better evaluate their performance when taking the pills and more frequently experience menstrual symptoms during the pill withdrawal. The athletes self-reported performance is correlated with their coach's evaluation. Conclusion: It seems important to integrate MC and HC data in the wellness and training monitoring of female athletes since these parameters vary across hormonal phases affecting training perception of both athlete and coach.
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Affiliation(s)
- Juliana Antero
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Steven Golovkine
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Louis Niffoi
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Alice Meignié
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Tom Chassard
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Quentin Delarochelambert
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Martine Duclos
- Department of Sport Medicine and Functional Exploration, University Hospital CHU G. Montpied, INRAE, UNH, CRNH Auvergne, Clermont Auvergne University, Clermont-Ferrand, France
| | - Carole Maitre
- Medical Department at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | | | - Allison Diry
- French Rowing Federation, Nogent-sur-Marne, France
| | - Jean-François Toussaint
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France.,URP 7329, Université Paris Cité, Paris, France.,Center for Investigation in Sport Medicine, CIMS Hôtel-Dieu, Assistance Publique-Hopitaux de Paris, Paris, France
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16
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Nichols JH, Ali M, Anetor JI, Chen LS, Chen Y, Collins S, Das S, Devaraj S, Fu L, Karon BS, Kary H, Nerenz RD, Rai AJ, Shajani-Yi Z, Thakur V, Wang S, Yu HYE, Zamora LE. AACC Guidance Document on the Use of Point-of-Care Testing in Fertility and Reproduction. J Appl Lab Med 2022; 7:1202-1236. [DOI: 10.1093/jalm/jfac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/11/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The AACC Academy revised the reproductive testing section of the Laboratory Medicine Practice Guidelines: Evidence-Based Practice for Point-of-Care Testing (POCT) published in 2007.
Methods
A panel of Academy members with expertise in POCT and laboratory medicine was formed to develop guidance for the use of POCT in reproductive health, specifically ovulation, pregnancy, premature rupture of membranes (PROM), and high-risk deliveries. The committee was supplemented with clinicians having Emergency Medicine and Obstetrics/Gynecology training.
Results
Key recommendations include the following. First, urine luteinizing hormone (LH) tests are accurate and reliable predictors of ovulation. Studies have shown that the use of ovulation predicting kits may improve the likelihood of conception among healthy fertile women seeking pregnancy. Urinary LH point-of-care testing demonstrates a comparable performance among other ovulation monitoring methods for timing intrauterine insemination and confirming sufficient ovulation induction before oocyte retrieval during in vitro fertilization. Second, pregnancy POCT should be considered in clinical situations where rapid diagnosis of pregnancy is needed for treatment decisions, and laboratory analysis cannot meet the required turnaround time. Third, PROM testing using commercial kits alone is not recommended without clinical signs of rupture of membranes, such as leakage of amniotic fluid from the cervical opening. Finally, fetal scalp lactate is used more than fetal scalp pH for fetal acidosis due to higher success rate and low volume of sample required.
Conclusions
This revision of the AACC Academy POCT guidelines provides recommendations for best practice use of POCT in fertility and reproduction.
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Affiliation(s)
| | | | | | | | - Yu Chen
- Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Dalhousie University, and Memorial University , Fredericton, NB , Canada
| | - Sean Collins
- Vanderbilt University Medical Center , Nashville, TN , USA
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System , Nashville, TN , USA
| | - Saswati Das
- Dr. Ram Manohar Lohia Hospital, Atal Bihari Vajpayee Institute of Medical Sciences , New Delhi , India
| | - Sridevi Devaraj
- Texas Children’s Hospital and Baylor College of Medicine , Houston, TX , USA
| | - Lei Fu
- Sunnybrook Health Sciences Center , Toronto, ON , Canada
| | | | - Heba Kary
- King Fahd Armed Forces Hospital , Jeddah , Saudi Arabia
| | | | - Alex J Rai
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital , New York, NY , USA
| | - Zahra Shajani-Yi
- Laboratory Corporation of America (LabCorp) , San Diego, CA, USA
| | - Vinita Thakur
- Eastern Health Authority, Health Science Center and Memorial University , St. John’s, NL , Canada
| | - Sihe Wang
- Akron Children’s Hospital , Akron, OH , USA
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Koşar ŞN, Güzel Y, Köse MG, Kin İşler A, Hazır T. Whole and segmental body composition changes during mid-follicular and mid-luteal phases of the menstrual cycle in recreationally active young women. Ann Hum Biol 2022; 49:124-132. [PMID: 35696275 DOI: 10.1080/03014460.2022.2088857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Changes in oestradiol and progesterone hormones and associated fluid retention during the menstrual cycle phases might affect body composition (BC) in women. AIM The main objectives of this study were to determine the changes in whole and segmental BC by dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance (BIA) during the mid-follicular (MFP) and mid-luteal (MLP) phases. SUBJECTS AND METHODS Thirty recreationally active young women participated in this study. BC was measured by DXA and BIA during MFP and MLP. A mixed linear model for repeated measures analysis was used to determine the differences between the two phases. RESULTS Body mass was higher during MLP than MFP, while total body water, total and segmental fat mass and fat percentages measured by both BIA and DXA were similar during the two phases. DXA-derived fat-free mass and soft lean mass in the android region were higher during MLP than MFP. Large variability in individual responses was evident. CONCLUSION On average, whole and segmental BC variables do not change significantly between MFP and MLP. However, given the large variability among the individual responses, it is suggested to perform repeated BC measurements during the same phase of the menstrual cycle.
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Affiliation(s)
- Şükran Nazan Koşar
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Yasemin Güzel
- Division of Exercise Nutrition and Metabolism, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Mehmet Gören Köse
- Division of Training and Movement Sciences, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Ayşe Kin İşler
- Division of Training and Movement Sciences, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
| | - Tahir Hazır
- Division of Training and Movement Sciences, Faculty of Sport Sciences, Hacettepe University, Ankara, Turkey
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Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. The ABC of reproductive intentions: a mixed-methods study exploring the spectrum of attitudes towards family building. HUMAN REPRODUCTION (OXFORD, ENGLAND) 2022. [PMID: 35238351 DOI: 10.1093/humrep/deac036/6541644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people's reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18-45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one 'other' group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as 'Desirers' or 'Flexers' for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future-whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK.,SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
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Timing of progesterone luteal support in natural frozen-thawed embryo transfer cycles - Back to basics. Reprod Biomed Online 2022; 45:63-68. [DOI: 10.1016/j.rbmo.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022]
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Écochard R, Leiva R, Bouchard T, Boehringer H, Iwaz J, Plotton I. Descriptive analysis of the relationship between progesterone and basal body temperature across the menstrual cycle. Steroids 2022; 178:108964. [PMID: 35065994 DOI: 10.1016/j.steroids.2022.108964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/14/2021] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Describe the relationship between basal body temperature (BBT) and pregnanediol-3 alpha-glucuronide (PDG, the urine metabolite of progesterone) across the menstrual cycle. DESIGN Observational study. SETTING Study carried out from 1996 to 1997 in eight European family planning clinics. PARTICIPANT(S) One hundred and seven normally fertile and cycling women. MAIN OUTCOME MEASURE(S) BBT and PDG level on each day of 283 cycles and ultrasound determination of the day of ovulation. RESULT (s): In comparison with previous end-of-cycle levels, decreases in PDG and BBT on the first day of menses were seen in nearly 90% and 80% of cycles, respectively. In a non-negligible percentage of cycles, luteolysis would continue during menses: between the second and the third day after menses, small but significant decreases in PDG and BBT were seen in 76% and 48% of cycles, respectively. During the peri-ovulatory phase, between the third and the second day before ovulation, PDG and BBT began to rise in 56% and 41% of cycles, respectively. There was a medium degree of correlation between PDG levels and BBT (r = 0.53; 7,279 days with available measurements). The relationship between PDG levels and BBT was linear at low PDG levels but BBT increased no longer when PDG levels continued to rise above a threshold of nearly 10 mcg/mg Cr. CONCLUSION (s): PDG and BBT had parallel increases at low PDG rates but diverged at higher rates.
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Affiliation(s)
- René Écochard
- Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique-Bioinformatique, Lyon, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France.
| | - René Leiva
- Bruyère Research Institute, CT Lamont Primary Health Care Research Centre, Ottawa, Ontario, Canada; University of Ottawa, Department of Family Medicine, Ottawa, Ontario, Canada
| | - Thomas Bouchard
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Jean Iwaz
- Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique-Bioinformatique, Lyon, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Ingrid Plotton
- Université Lyon 1, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique-Bioinformatique, Lyon, France; Hospices Civils de Lyon, Service de Biochimie et Biologie Moléculaire, Lyon, France
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Lipecki J, Mitchell AE, Muter J, Lucas ES, Makwana K, Fishwick K, Odendaal J, Hawkes A, Vrljicak P, Brosens JJ, Ott S. OUP accepted manuscript. Hum Reprod 2022; 37:747-761. [PMID: 35092277 PMCID: PMC8971653 DOI: 10.1093/humrep/deac006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/09/2021] [Indexed: 11/18/2022] Open
Abstract
STUDY QUESTION Can the accuracy of timing of luteal phase endometrial biopsies based on urinary ovulation testing be improved by measuring the expression of a small number of genes and a continuous, non-categorical modelling approach? SUMMARY ANSWER Measuring the expression levels of six genes (IL2RB, IGFBP1, CXCL14, DPP4, GPX3 and SLC15A2) is sufficient to obtain substantially more accurate timing estimates and to assess the reliability of timing estimates for each sample. WHAT IS KNOWN ALREADY Commercially available endometrial timing approaches based on gene expression require large gene sets and use a categorical approach that classifies samples as pre-receptive, receptive or post-receptive. STUDY DESIGN, SIZE, DURATION Gene expression was measured by RTq-PCR in different sample sets, comprising a total of 664 endometrial biopsies obtained 4–12 days after a self-reported positive home ovulation test. A further 36 endometrial samples were profiled by RTq-PCR as well as RNA-sequencing. PARTICIPANTS/MATERIALS, SETTING, METHODS A computational procedure, named ‘EndoTime’, was established that models the temporal profile of each gene and estimates the timing of each sample. Iterating these steps, temporal profiles are gradually refined as sample timings are being updated, and confidence in timing estimates is increased. After convergence, the method reports updated timing estimates for each sample while preserving the overall distribution of time points. MAIN RESULTS AND THE ROLE OF CHANCE The Wilcoxon rank-sum test was used to confirm that ordering samples by EndoTime estimates yields sharper temporal expression profiles for held-out genes (not used when determining sample timings) than ordering the same expression values by patient-reported times (GPX3: P < 0.005; CXCL14: P < 2.7e−6; DPP4: P < 3.7e−13). Pearson correlation between EndoTime estimates for the same sample set but based on RTq-PCR or RNA-sequencing data showed a high degree of congruency between the two (P = 8.6e−10, R2 = 0.687). Estimated timings did not differ significantly between control subjects and patients with recurrent pregnancy loss or recurrent implantation failure (P > 0.05). LARGE SCALE DATA The RTq-PCR data files are available via the GitHub repository for the EndoTime software at https://github.com/AE-Mitchell/EndoTime, as is the code used for pre-processing of RTq-PCR data. The RNA-sequencing data are available on GEO (accession GSE180485). LIMITATIONS, REASONS FOR CAUTION Timing estimates are informed by glandular gene expression and will only represent the temporal state of other endometrial cell types if in synchrony with the epithelium. Methods that estimate the day of ovulation are still required as these data are essential inputs in our method. Our approach, in its current iteration, performs batch correction such that larger sample batches impart greater accuracy to timing estimations. In theory, our method requires endometrial samples obtained at different days in the luteal phase. In practice, however, this is not a concern as timings based on urinary ovulation testing are associated with a sufficient level of noise to ensure that a variety of time points will be sampled. WIDER IMPLICATIONS OF THE FINDINGS Our method is the first to assay the temporal state of luteal-phase endometrial samples on a continuous domain. It is freely available with fully shared data and open-source software. EndoTime enables accurate temporal profiling of any gene in luteal endometrial samples for a wide range of research applications and, potentially, clinical use. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by a Wellcome Trust Investigator Award (Grant/Award Number: 212233/Z/18/Z) and the Tommy's National Miscarriage Research Centre. None of the authors have any competing interests. J.L. was funded by the Biotechnology and Biological Sciences Research Council (UK) through the Midlands Integrative Biology Training Partnership (MIBTP, BB/M01116X/1).
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Affiliation(s)
- Julia Lipecki
- School of Life Sciences, University of Warwick, Coventry, UK
| | | | - Joanne Muter
- Warwick Medical School, University of Warwick, Coventry, UK
- Tommy’s National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
| | - Emma S Lucas
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Komal Makwana
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Amelia Hawkes
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Pavle Vrljicak
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jan J Brosens
- Warwick Medical School, University of Warwick, Coventry, UK
- Tommy’s National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, UK
| | - Sascha Ott
- Warwick Medical School, University of Warwick, Coventry, UK
- Bioinformatics RTP, Research Technology Platforms, University of Warwick, Coventry, UK
- Correspondence address. E-mail: https://orcid.org/0000-0002-5411-8114
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22
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Grace B, Shawe J, Johnson S, Usman NO, Stephenson J. OUP accepted manuscript. Hum Reprod 2022; 37:988-996. [PMID: 35238351 PMCID: PMC9071225 DOI: 10.1093/humrep/deac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/02/2022] [Indexed: 11/26/2022] Open
Abstract
STUDY QUESTION What are the intentions of men and women of reproductive age in the UK regarding reproduction and family building? SUMMARY ANSWER We identified six main categories of people; Avoiders, Betweeners, Completers, Desirers, Expectants and Flexers, for whom reproduction education strategies should be tailored differently to suit intentions. WHAT IS KNOWN ALREADY Several studies have highlighted poor fertility awareness across men and women of reproductive age. As the average age of first-time parents continues to rise, there has been a concerted effort from educators, healthcare professionals, charities, reproductive health groups and government policymakers, to improve fertility awareness. In order to ensure that these messages are effective and to deploy the best strategies, it is important to understand people’s reproductive health needs. This study therefore aimed to explore different reproductive intentions to aid tailoring of information to help individuals and couples achieve their family building desires. STUDY DESIGN, SIZE, DURATION We conducted a mixed-method study via a UK-wide cross-sectional survey with 1082 participants and semi-structured interviews of 20 women and 15 men who agreed to follow-up interviews. Interviews lasted an hour on average. Ethics approval from UCL Research Ethics Committee. PARTICIPANTS/MATERIALS, SETTING, METHODS Survey participants were recruited nationwide via online newspaper and social media adverts. Interviewees were purposely sampled to include men and women from the reproductive age range (18–45 years), varying ethnicity and education background. Survey data were analysed using the Minitab statistical software package. Interview data were transcribed and analysed using the framework method. MAIN RESULTS AND THE ROLE OF CHANCE From the survey and interviews, we identified six key categories of people, grouped alphabetically, in a user-friendly manner to highlight a spectrum of reproductive intentions: Avoiders describes respondents who have no children and do not want to have children in the future; Betweeners describes those who already have child(ren) and want more in the future but are not actively trying to conceive; Completers describes those who have child(ren) but do not want more; Desirers describes those who are actively trying to conceive or plan to have child(ren) in the future; Expectants describes those who were pregnant at the time of the study; and Flexers describes those who may or may not already have and are unsure but or open to having child(ren) in the future. Analysis of survey data identified the following proportions in our study: Avoiders, 4.7%; Betweeners, 11.3%; Completers, 13.6%; Desirers, 36.9%; Expectants, 4.1%; and Flexers 28.4% and 2.4% preferring not to answer. There was one ‘other’ group from qualitative analysis, who would like to have children in the future but were unsure whether they could or had changing views. We recommend classifying as ‘Desirers’ or ‘Flexers’ for the purposes of fertility education. A majority of the survey population were trying to get pregnant; were pregnant; or planning to have a child in the future—whether actively, passively or simply open to the idea, with interviews providing deep insights into their family building decision-making. LIMITATIONS, REASONS FOR CAUTION Due to the online recruitment method, there may be a bias towards more educated respondents. WIDER IMPLICATIONS OF THE FINDINGS We developed a user-friendly, alphabetical categorization of reproductive intentions, which may be used by individuals, healthcare professionals, educators, special interest groups, charities and policymakers to support and enable individuals and couples in making informed choices to achieve their desired intentions, if and when they choose to start a family. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. The authors report no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- B Grace
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
- Correspondence address. UCL EGA Institute for Women’s Health, Faculty of Population Health Sciences, Room 236 Medical School Building, University College London, 74 Huntley Street, London WC1E 6AU, UK. E-mail:
| | - J Shawe
- Faculty of Health, University of Plymouth, Devon, UK
- SW Clinical School, Royal Cornwall Hospital, Truro, UK
| | - S Johnson
- QIAGEN Manchester Ltd, Manchester, UK
| | - N O Usman
- Department of Community Medicine, Kaduna State University, Kaduna, Nigeria
| | - J Stephenson
- Department of Sexual and Reproductive Health, UCL Institute for Women’s Health, Faculty of Population Health Sciences, University College London, London, UK
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Li K, Urteaga I, Shea A, Vitzthum VJ, Wiggins CH, Elhadad N. A predictive model for next cycle start date that accounts for adherence in menstrual self-tracking. J Am Med Inform Assoc 2021; 29:3-11. [PMID: 34534312 PMCID: PMC8714275 DOI: 10.1093/jamia/ocab182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/05/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The study sought to build predictive models of next menstrual cycle start date based on mobile health self-tracked cycle data. Because app users may skip tracking, disentangling physiological patterns of menstruation from tracking behaviors is necessary for the development of predictive models. MATERIALS AND METHODS We use data from a popular menstrual tracker (186 000 menstruators with over 2 million tracked cycles) to learn a predictive model, which (1) accounts explicitly for self-tracking adherence; (2) updates predictions as a given cycle evolves, allowing for interpretable insight into how these predictions change over time; and (3) enables modeling of an individual's cycle length history while incorporating population-level information. RESULTS Compared with 5 baselines (mean, median, convolutional neural network, recurrent neural network, and long short-term memory network), the model yields better predictions and consistently outperforms them as the cycle evolves. The model also provides predictions of skipped tracking probabilities. DISCUSSION Mobile health apps such as menstrual trackers provide a rich source of self-tracked observations, but these data have questionable reliability, as they hinge on user adherence to the app. By taking a machine learning approach to modeling self-tracked cycle lengths, we can separate true cycle behavior from user adherence, allowing for more informed predictions and insights into the underlying observed data structure. CONCLUSIONS Disentangling physiological patterns of menstruation from adherence allows for accurate and informative predictions of menstrual cycle start date and is necessary for mobile tracking apps. The proposed predictive model can support app users in being more aware of their self-tracking behavior and in better understanding their cycle dynamics.
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Affiliation(s)
- Kathy Li
- Department of Applied Physics and Applied Mathematics/Data Science Institute, Columbia University, New York, USA
| | - Iñigo Urteaga
- Department of Applied Physics and Applied Mathematics/Data Science Institute, Columbia University, New York, USA
| | | | - Virginia J Vitzthum
- Clue by BioWink, Berlin, Germany
- Kinsey Institute and Department of Anthropology, Indiana University, Bloomington, Indiana, USA
| | - Chris H Wiggins
- Department of Applied Physics and Applied Mathematics/Data Science Institute, Columbia University, New York, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, USA
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Adnan T, Coull BA, Jukic AM, Mahalingaiah S. The real-world applications of the symptom tracking functionality available to menstrual health tracking apps. Curr Opin Endocrinol Diabetes Obes 2021; 28:574-586. [PMID: 34560714 PMCID: PMC8631160 DOI: 10.1097/med.0000000000000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The goal of this review was to evaluate whether the fields available in iOS mobile phone apps for recording menstrual cycle symptoms are able to be harmonized across platforms for potential use in research, such as aggregated data analysis. RECENT FINDINGS Symptom tracking capabilities are a common feature among menstrual health apps but have been the subject of limited investigations. Apps differ with respect to which symptoms are included and the rationale for these differences is unclear. Epidemiologic studies are poised to incorporate these data; however, a thorough exploration of symptom tracking functionality across apps is required. SUMMARY Our review finds that the language used to describe symptoms and the specificity with which symptoms are collected varies greatly across the most used iOS tracking apps. Although some apps allow numerical and qualitative description of symptoms, such as sleep and mood, most simply record the presence or absence of a symptom. Collaborative efforts between clinicians and researchers to guide what and how data is collected may allow tracking apps to realize their potential diagnostic applicability. Regardless, with the increasing use of menstrual health tracking apps, it is imperative that data retrieved from such apps can realize its potential in the research and clinical ecosystems.
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Affiliation(s)
| | - Brent A. Coull
- Department of Environmental Health
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anne Marie Jukic
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina
| | - Shruthi Mahalingaiah
- Department of Environmental Health
- Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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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: 18] [Impact Index Per Article: 6.0] [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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Urteaga I, Li K, Shea A, Vitzthum VJ, Wiggins CH, Elhadad N. A Generative Modeling Approach to Calibrated Predictions: A Use Case on Menstrual Cycle Length Prediction. PROCEEDINGS OF MACHINE LEARNING RESEARCH 2021; 149:535-566. [PMID: 35072087 PMCID: PMC8782440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We explore how to quantify uncertainty when designing predictive models for healthcare to provide well-calibrated results. Uncertainty quantification and calibration are critical in medicine, as one must not only accommodate the variability of the underlying physiology, but adjust to the uncertain data collection and reporting process. This occurs not only on the context of electronic health records (i.e., the clinical documentation process), but on mobile health as well (i.e., user specific self-tracking patterns must be accounted for). In this work, we show that accurate uncertainty estimation is directly relevant to an important health application: the prediction of menstrual cycle length, based on self-tracked information. We take advantage of a flexible generative model that accommodates under-dispersed distributions via two degrees of freedom to fit the mean and variance of the observed cycle lengths. From a machine learning perspective, our work showcases how flexible generative models can not only provide state-of-the art predictive accuracy, but enable well-calibrated predictions. From a healthcare perspective, we demonstrate that with flexible generative models, not only can we accommodate the idiosyncrasies of mobile health data, but we can also adjust the predictive uncertainty to per-user cycle length patterns. We evaluate the proposed model in real-world cycle length data collected by one of the most popular menstrual trackers worldwide, and demonstrate how the proposed generative model provides accurate and well-calibrated cycle length predictions. Providing meaningful, less uncertain cycle length predictions is beneficial for menstrual health researchers, mobile health users and developers, as it may help design more usable mobile health solutions.
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Affiliation(s)
- Iñigo Urteaga
- Department of Applied Physics and Applied Mathematics, Data Science Institute Columbia University, New York, NY, USA
| | - Kathy Li
- Department of Applied Physics and Applied Mathematics, Data Science Institute Columbia University, New York, NY, USA
| | - Amanda Shea
- Clue by BioWink, Adalbertstraße 7-8, 10999 Berlin, Germany
| | - Virginia J Vitzthum
- Kinsey Institute & Department of Anthropology Indiana University, Bloomington, IN, USA
| | - Chris H Wiggins
- Department of Applied Physics and Applied Mathematics, Data Science Institute Columbia University, New York, NY, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Data Science Institute Columbia University, New York, NY, USA
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Natural cycle versus hormone replacement cycle for transferring vitrified-warmed embryos in eumenorrhoeic women. A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2021; 263:94-99. [PMID: 34171636 DOI: 10.1016/j.ejogrb.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare pregnancy, miscarriage and live birth rates and cycle monitoring parameters between Natural Cycle (NC-FET) and Hormone replacement cycle (HRC-FET) in eumenorrhoeic women undergoing vitrified-warmed autologous embryo transfer. STUDY DESIGN Single-centre retrospective cohort study analyzed 173 NC-FET and 507 HRC-FET cycles with transfer of day2/3/5/6 embryos. Natural cycle monitoring occurred with serial ultrasound with the first day of the scan determined by the shortest cycle frequency. Serum progesterone was ordered when ultrasound was ambiguous in ascertaining ovulation. For HRC-FET oral estradiol valerate was used in fixed or escalating doses with maximum daily dose of 12 mg. Transdermal estradiol gel was added when desired endometrial thickness was not achieved. Vaginal progesterone was introduced with Endometrial thickness(ET)> = 7 mm. Embryos were transferred after stage-appropriate progesterone exposure. Luteal support was given with vaginal progesterone in NC-FET and vaginal and oral progesterone in HRC-FET. Primary outcome was live-birth-rate. Secondary outcomes were ET, length-of-estrogenic-phase, numbers-of-ultrasounds&hormone-monitoring, pregnancy&miscarriage rate. The odds ratio for live-birth was adjusted for age, embryo number, previous-live-births, previous-losses, past-negative-ET-cycles, IVF-indication and embryo-developmental-stage. Quantitative variables were compared using unpaired-t-test and qualitative variables with chi-square test. Two tailed p-value < 0.05 was considered significant. Binary logistic regression was used to calculate adjusted odds for live-births. RESULTS The two cohorts were comparable in age, infertility-duration, previous-live-births, previous-losses, past-negative-ET-cycles, IVF-indication and embryo-developmental-stage. Length-of-estrogenic-phase was significantly shorter for NC-FET than HRC-FET 14.32 ± 2.83vs.18.18 ± 4.48; p = 0.0001) as was mean ultrasound-monitoring-scans (2.73 ± 0.95vs. 3.3 ± 1.04; p = 0.0001). Mean-endometrial-thickness (8.75 ± 1.83vs. 8.5 ± 1.25; p = 0.25) and mean-hormonal-tests (1.75 ± 1.28 vs. 1.88 ± 0.69; p = 0.09) did not differ significantly between NC-FET vs HRC-FET. Significantly higher live births took place in NC-FET vs. HRC-FET (87/173 = 50.3%vs.204/507 = 40.2%;p = 0.026). No significant difference was found in pregnancy rate (66.5% vs. 58%; p = 0.058) or in the pregnancy loss rate (24.3%vs30.6%; p = 0.23). The odds ratio for live-births adjusted for relevant variables was 1.48 (1.03-2.13) in NC-FET compared to HRC-FET. CONCLUSIONS NC-FET is a superior method of endometrial preparation compared to HRC-FET in eumenorrhoeic women since it has a shorter estrogenic phase, reduces patient visits to the hospital and improves live birth rates. Future adequately powered studies should look at antenatal and perinatal outcomes, patient satisfaction rates and cost-effectiveness in the two endometrial preparation regimes.
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Schantz JS, Fernandez CS, Anne Marie ZJ. Menstrual Cycle Tracking Applications and the Potential for Epidemiological Research: A Comprehensive Review of the Literature. CURR EPIDEMIOL REP 2021; 8:9-19. [PMID: 34055569 PMCID: PMC8162175 DOI: 10.1007/s40471-020-00260-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW We reviewed published studies on menstrual cycle tracking applications (MCTAs) in order to describe the potential of MCTAs for epidemiologic research. RECENT FINDINGS A search of PubMed, Web of Science, and Scopus for MCTA literature yielded 150 articles. After exclusions, there were 49 articles that addressed the primary interest areas: 1) characteristics of MCTA users in research, 2) reasons women use or continue using MCTAs, 3) accuracy of identifying ovulation and utility at promoting and preventing pregnancy, and 4) quality assessments of MCTAs across several domains. SUMMARY MCTAs are an important tool for the advancement of epidemiologic research on menstruation. MCTA studies should describe the characteristics of their user-base and missing data patterns. Describing the motivation for using MCTAs throughout a user's life and validating the data collected should be prioritized in future research.
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Affiliation(s)
- Joelle S. Schantz
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Claudia S.P. Fernandez
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Z. Jukic Anne Marie
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC 27709
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Carmichael MA, Thomson RL, Moran LJ, Wycherley TP. The Impact of Menstrual Cycle Phase on Athletes' Performance: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1667. [PMID: 33572406 PMCID: PMC7916245 DOI: 10.3390/ijerph18041667] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
The effect of the menstrual cycle on physical performance is being increasingly recognised as a key consideration for women's sport and a critical field for further research. This narrative review explores the findings of studies investigating the effects of menstrual cycle phase on perceived and objectively measured performance in an athletic population. Studies examining perceived performance consistently report that female athletes identify their performance to be relatively worse during the early follicular and late luteal phases. Studies examining objective performance (using anaerobic, aerobic or strength-related tests) do not report clear, consistent effects of the impact of menstrual cycle phase on physical performance. Overall sport performance can be influenced by both perceived and physical factors. Hence, to optimise performance and management of eumenorrheic female athletes, there is a need for further research to quantify the impact of menstrual cycle phase on perceived and physical performance outcomes and to identify factors affecting variability in objective performance outcomes between studies.
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Affiliation(s)
- Mikaeli Anne Carmichael
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.L.T.); (T.P.W.)
| | - Rebecca Louise Thomson
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.L.T.); (T.P.W.)
- Adelaide Medical School and Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia;
| | - Lisa Jane Moran
- Adelaide Medical School and Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia;
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC 3168, Australia
| | - Thomas Philip Wycherley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia; (R.L.T.); (T.P.W.)
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Worsfold L, Marriott L, Johnson S, Harper JC. Period tracker applications: What menstrual cycle information are they giving women? WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211049905. [PMID: 34629005 PMCID: PMC8504278 DOI: 10.1177/17455065211049905] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Period tracking applications (apps) allow women to track their menstrual cycles and receive a prediction for their period dates. The majority of apps also provide predictions of ovulation day and the fertile window. Research indicates apps are basing predictions on assuming women undergo a textbook 28-day cycle with ovulation occurring on day 14 and a fertile window between days 10 and 16. OBJECTIVE To determine how the information period tracker apps give women on their period dates, ovulation day and fertile window compares to expected results from big data. METHODS Five women's profiles for 6 menstrual cycles were created and entered into 10 apps. Cycle length and ovulation day for the sixth cycle were Woman 1-Constant 28 day cycle length, ovulation day 16; Woman 2-Average 23 day cycle length, ovulation day 13; Woman 3-Average 28 day cycle length, ovulation day 17; Woman 4-Average 33 day cycle length, ovulation day 20; and Woman 5-Irregular, average 31 day cycle length, ovulation day 14. RESULTS The 10 period tracker apps examined gave conflicting information on period dates, ovulation day and the fertile window. For cycle length, the apps all predicted woman 1's cycles correctly but for women 2-5, the apps predicted 0 to 8 days shorter or longer than expected. For day of ovulation, for women 1-4, of the 36 predictions, 3 (8%) were exactly correct, 9 predicted 1 day too early (25%) and 67% of predictions were 2-9 days early. For woman 5, most of the apps predicted a later day of ovulation. CONCLUSION Period tracker apps should ensure they only give women accurate information, especially for the day of ovulation and the fertile window which can only be predicted if using a marker of ovulation, such as basal body temperature, ovulation sticks or cervical mucus.
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Affiliation(s)
- Lauren Worsfold
- Institute for Women's Health, University College London, London, UK
| | - Lorrae Marriott
- Statistics and Data Management, SPD Development Company Ltd, Bedford, UK
| | - Sarah Johnson
- Clinical and Regulatory Affairs, SPD Development Company Ltd, Bedford, UK
| | - Joyce C Harper
- Institute for Women's Health, University College London, London, UK
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Ahn SH, Lee I, Cho S, Kim HI, Baek HW, Lee JH, Park YJ, Kim H, Yun BH, Seo SK, Park JH, Choi YS, Lee BS. Predictive Factors of Conception and the Cumulative Pregnancy Rate in Subfertile Couples Undergoing Timed Intercourse With Ultrasound. Front Endocrinol (Lausanne) 2021; 12:650883. [PMID: 33935968 PMCID: PMC8082069 DOI: 10.3389/fendo.2021.650883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/24/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine predictive factors for pregnancy and assess the cumulative pregnancy rate (CPR) and live birth rate (CLBR) in subfertile couples undergoing timed intercourse (TI) using ultrasound. This retrospective cohort study included 285 women (854 cycles) who started TI with ultrasound between January 2017 and October 2019. The overall clinical pregnancy rate was 28.1% (80/285) per couple and 9.4% (80/854) per cycle. Pregnant women had a higher body mass index (BMI), higher percentage of irregular menstrual cycles, a shorter duration of subfertility, lower serum follicle-stimulating hormone levels, and higher anti-Müllerian hormone levels than non-pregnant women. A longer duration of subfertility (≥24 months vs. <12 months; odds ratio: 0.193; 95% confidence interval: 0.043-0.859) and endometriosis (vs. ovulatory factors; odds ratio: 0.282; 95% confidence interval: 0.106-0.746) as causes of subfertility were unfavorable factors that independently affected clinical pregnancy. In subgroup analysis, old age ≥ 35 years [vs. < 35 years; odds ratio: 0.279; 95% confidence interval: 0.083-0.938), a longer duration of infertility ≥24 months (vs. <24 months; odds ratio: 0.182; 95% confidence interval: 0.036-0.913) and a higher BMI ≥ 25 kg/m2(vs. >25 kg/m2; odds ratio: 3.202; 95% confidence interval: 1.020-10.046) in couples with ovulatory factor and a longer duration of infertility ≥24 months (vs. <24 months; odds ratio: 0.185; 95% confidence interval: 0.042-0.819) in couples with non-ovulatory factors were significant independent predictive factors for pregnancy. No significant differences were found in the cycle characteristics between pregnant and non-pregnant women. The CPR substantially increased during the first three cycles and significantly increased until the sixth cycle. No significant increase was observed in the CPR after the sixth cycle. The CLBRs substantially increased during the first three cycles and significantly increased until the fourth cycle. No significant increase was observed in the CLBRs after the fifth cycle. When comparing CPRs and CLBRs according to subfertile causes, CRPs was significantly different and CLBRs was different with borderline significance. Our findings may indicate that women with a longer duration of subfertility or subfertility due to endometriosis have poor outcomes during TI with ultrasound. Women who failed to achieve conception by the fourth or fifth cycle of TI with ultrasound may be encouraged to consider advancing to the next treatment strategy.
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Affiliation(s)
- So Hyun Ahn
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Inha Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - SiHyun Cho
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye In Kim
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Won Baek
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Jeong Park
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Heeyon Kim
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Joo Hyun Park
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Young Sik Choi,
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
- Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
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