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Zhang Y, Zhang H, Zhao J, Zhao Y, Zhang J, Jiang L, Wang Y, Peng Z, Zhang Y, Jiao K, He T, Wang Q, Shen H, Zhang Y, Yan D, Ma X. Gravidity modifies the associations of age and spousal age difference with couple's fecundability: a large cohort study from China. Hum Reprod 2024; 39:201-208. [PMID: 37823182 DOI: 10.1093/humrep/dead209] [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: 06/01/2023] [Revised: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
STUDY QUESTION Do couple's age ranges for optimal fecundability, and the associations with fecundability of couple's age combinations and age differences differ with gravidity? SUMMARY ANSWER The couple's age range of optimal fecundability and age combinations differed with gravidity, and gravidity might modify the associations of age and spousal age difference with couple's fecundability. WHAT IS KNOWN ALREADY Age is one of the strongest determinants of fecundability, but the existing studies have certain limitations in study population, couple's extreme age combinations and age differences, and have not explored whether the association between age and fecundability differs with gravidity. STUDY DESIGN, SIZE, DURATION Retrospective cohort study. 5 407 499 general reproductive-aged couples (not diagnosed with infertility) participated in the National Free Pre-conception Check-up Projects during 2015-2017. They were followed up for pregnancy outcomes through telephone interviews every 3 months until they became pregnant or were followed up for 1 year. PARTICIPANTS/MATERIALS, SETTING, METHODS The main outcome was time to pregnancy, and the fecundability odds ratios and 95% CIs were estimated using the Cox models for discrete survival time. The associations of age and spousal age difference with fecundability were evaluated by restricted cubic splines. MAIN RESULTS AND THE ROLE OF CHANCE In this large cohort of general reproductive-aged population, the age of optimal fecundability of multigravida couples was older than that of nulligravida couples, but their subsequent fecundability declined more sharply with age. The decline in female fecundability was more pronounced with age, with fecundability dropping by ∼30% in both nulligravida and multigravida couples whose female partners aged ≥35 years. In the nulligravida group, the fecundability of couples who were both ≤24 years with the same age was the highest, which decreased steadily with the increase of spousal age difference, and younger male partners did not seem to contribute to improving couple's fecundability. In the multigravida group, couples with female partners aged 25-34 years and a spousal age difference of -5 to 5 years showed higher fecundability, and the effect of spousal age difference on couple's fecundability became suddenly apparent when female partners aged around 40 years. Young male partners were unable to change the decisive effect of female partner's age over 40 years on couple's reduced fecundability, regardless of gravidity. LIMITATIONS, REASONS FOR CAUTION Lacking the time for couples to attempt pregnancy before enrollment, and some couples might suspend pregnancy plans during follow-up because of certain emergencies, which would misestimate the fecundability. Due to the lack of information on sperm quality and sexual frequency of couples, we could not adjust for these factors. Moreover, due to population characteristics, the extrapolation of our results required caution. WIDER IMPLICATIONS OF THE FINDINGS The couple's age range of optimal fecundability, age combinations, and spousal age difference on fecundability varied with gravidity. Female age-related decline in fecundability was more dominant in couple's fecundability. Targeted fertility guidance should be provided to couples with different age combinations and gravidities. STUDY FUNDING/COMPETING INTEREST(S) This research received funding from the Project of National Research Institute for Family Planning (Grant No. 2018NRIFPJ03), the National Key Research and Development Program of China (Grant No. 2016YFC1000307), and the National Human Genetic Resources Sharing Service Platform (Grant No. 2005DKA21300), People's Republic of China. The funders had no role in study design, analysis, decision to publish, or preparation of the manuscript. The authors report no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Yue Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Hongguang Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Jun Zhao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Yueshu Zhao
- The Third Affiliated Hospital of Zhengzhou University, Henan, China
| | - Junhui Zhang
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lifang Jiang
- Henan Institute of Reproductive Health Science and Technology, Henan, China
| | - Yuanyuan Wang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Zuoqi Peng
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Ya Zhang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Kailei Jiao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Tianyu He
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
| | - Qiaomei Wang
- Department of Maternal and Child Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Haiping Shen
- Department of Maternal and Child Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Yiping Zhang
- Department of Maternal and Child Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Donghai Yan
- Department of Maternal and Child Health, National Health Commission of the People's Republic of China, Beijing, China
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
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Cordova-Gomez A, Wong AP, Sims LB, Doncel GF, Dorflinger LJ. Potential biomarkers to predict return to fertility after discontinuation of female contraceptives-looking to the future. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1210083. [PMID: 37674657 PMCID: PMC10477712 DOI: 10.3389/frph.2023.1210083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/18/2023] [Indexed: 09/08/2023] Open
Abstract
Nowadays there are multiple types of contraceptive methods, from reversible to permanent, for those choosing to delay pregnancy. Misconceptions about contraception and infertility are a key factor for discontinuation or the uptake of family planning methods. Regaining fertility (the ability to conceive) after contraceptive discontinuation is therefore pivotal. Technical studies to date have evaluated return to fertility by assessing pregnancy as an outcome, with variable results, or return to ovulation as a surrogate measure by assessing hormone levels (such as progesterone, LH, FSH) with or without transvaginal ultrasound. In general, relying on time to pregnancy as an indicator of return to fertility following contraceptive method discontinuation can be problematic due to variable factors independent of contraceptive effects on fertility, hormone clearance, and fertility recovery. Since the ability to conceive after contraceptive method discontinuation is a critical factor influencing product uptake, it is important to have robust biomarkers that easily and accurately predict the timing of fertility return following contraception and isolate that recovery from extrinsic and circumstantial factors. The main aim of this review is to summarize the current approaches, existing knowledge, and gaps in methods of evaluating return-to-fertility as well as to provide insights into the potential of new biomarkers to more accurately predict fertility restoration after contraceptive discontinuation. Biomarker candidates proposed in this document include those associated with folliculogenesis, cumulus cell expansion, follicular rupture and ovulation, and endometrial transport and receptivity which have been selected and scored on predefined criteria meant to evaluate their probable viability for advancement. The review also describes limitations, regulatory requirements, and a potential path to clinically testing these selected biomarkers. It is important to understand fertility restoration after contraceptive method discontinuation to provide users and health providers with accurate evidence-based information. Predictive biomarkers, if easy and low-cost, have the potential to enable robust evaluation of RTF, and provide potential users the information they desire when selecting a contraceptive method. This could lead to expanded uptake and continuation of modern contraception and inform the development of new contraceptive methods to widen user's family planning choices.
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Affiliation(s)
- Amanda Cordova-Gomez
- Office of Population and Reproductive Health, USAID/Public Health Institute, Washington, DC, United States
| | - Andrew P. Wong
- CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Lee B. Sims
- Office of Population and Reproductive Health, USAID/Public Health Institute, Washington, DC, United States
| | - Gustavo F. Doncel
- CONRAD, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Laneta J. Dorflinger
- Department of Product Development and Introduction, FHI 360, Durham, NC, United States
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Jørgensen MD, Mikkelsen EM, Hatch EE, Rothman KJ, Wise LA, Sørensen HT, Laursen ASD. Socioeconomic status and fecundability in a Danish preconception cohort. Hum Reprod 2023; 38:1183-1193. [PMID: 37094974 PMCID: PMC10233268 DOI: 10.1093/humrep/dead077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/22/2023] [Indexed: 04/26/2023] Open
Abstract
STUDY QUESTION To what extent is socioeconomic status (SES), as measured by educational attainment and household income, associated with fecundability in a cohort of Danish couples trying to conceive? SUMMARY ANSWER In this preconception cohort, lower educational attainment and lower household income were associated with lower fecundability after adjusting for potential confounders. WHAT IS KNOWN ALREADY Approximately 15% of couples are affected by infertility. Socioeconomic disparities in health are well established. However, little is known about socioeconomic disparity and its relation to fertility. STUDY DESIGN, SIZE, DURATION This is a cohort study of Danish females aged 18-49 years who were trying to conceive between 2007 and 2021. Information was collected via baseline and bi-monthly follow-up questionnaires for 12 months or until reported pregnancy. PARTICIPANTS/MATERIALS, SETTING, METHODS Overall, 10 475 participants contributed 38 629 menstrual cycles and 6554 pregnancies during a maximum of 12 cycles of follow-up. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% CIs. MAIN RESULTS AND THE ROLE OF CHANCE Compared with upper tertiary education (highest level), fecundability was substantially lower for primary and secondary school (FR: 0.73, 95% CI: 0.62-0.85), upper secondary school (FR: 0.89, 95% CI: 0.79-1.00), vocational education (FR: 0.81, 95% CI: 0.75-0.89), and lower tertiary education (FR: 0.87, 95% CI: 0.80-0.95), but not for middle tertiary education (FR: 0.98, 95% CI: 0.93-1.03). Compared with a monthly household income of >65 000 DKK, fecundability was lower for household income <25 000 DKK (FR: 0.78, 95% CI: 0.72-0.85), 25 000-39 000 DKK (FR: 0.88, 95% CI: 0.82-0.94), and 40 000-65 000 DKK (FR: 0.94, 95% CI: 0.88-0.99). The results did not change appreciably after adjustment for potential confounders. LIMITATIONS, REASONS FOR CAUTION We used educational attainment and household income as indicators of SES. However, SES is a complex concept, and these indicators may not reflect all aspects of SES. The study recruited couples planning to conceive, including the full spectrum of fertility from less fertile to highly fertile individuals. Our results may generalize to most couples who are trying to conceive. WIDER IMPLICATIONS OF THE FINDINGS Our results are consistent with the literature indicating well-documented inequities in health across socioeconomic groups. The associations for income were surprisingly strong considering the Danish welfare state. These results indicate that the redistributive welfare system in Denmark does not suffice to eradicate inequities in reproductive health. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by the Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, and the National Institute of Child Health and Human Development (RO1-HD086742, R21-HD050264, and R01-HD060680). The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Marie Dahl Jørgensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- RTI Health Solutions, Research Triangle Institute, Research Triangle Park, NC, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Anne Sofie Dam Laursen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Loy SL, Ku CW, Tiong MMY, Ng CST, Cheung YB, Godfrey KM, Lim SX, Colega MT, Lai JS, Chong YS, Shek LPC, Tan KH, Chan SY, Chong MFF, Yap F, Chan JKY. Modifiable Risk Factor Score and Fecundability in a Preconception Cohort in Singapore. JAMA Netw Open 2023; 6:e2255001. [PMID: 36749588 PMCID: PMC10408273 DOI: 10.1001/jamanetworkopen.2022.55001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
IMPORTANCE Although multiple modifiable risk factors have been identified for reduced fecundability (defined as lower probability of conception within a menstrual cycle), no scoring system has been established to systematically evaluate fecundability among females who are attempting to conceive. OBJECTIVE To examine the association of a risk score based on 6 modifiable factors with fecundability, and to estimate the percentage reduction in incidence of nonconception if all study participants achieved a minimal risk score level. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study obtained data from the S-PRESTO (Singapore Preconception Study of Long-Term Maternal and Child Outcomes) prospective cohort study. Females of reproductive age who were trying to conceive were enrolled from February 2015 to October 2017 and followed for 1 year, ending in November 2018. Data were analyzed from March to May 2022. EXPOSURES A reduced fecundability risk score was derived by giving participants 1 point for each of the following factors: unhealthy body mass index, unhealthy diet, smoking, alcohol intake, folic acid supplement nonuser, and older maternal age. Total scores ranged from 0 to 6 and were classified into 5 levels: level 1 (score of 0 or 1), level 2 (score of 2), level 3 (score of 3), level 4 (score of 4), and level 5 (score of 5 or 6). MAIN OUTCOMES AND MEASURES Fecundability, measured by time to conception in cycles, was analyzed using discrete-time proportional hazards models with confounder adjustment. RESULTS A total of 937 females (mean [SD] age, 30.8 [3.8] years) were included, among whom 401 (42.8%) spontaneously conceived within 1 year of attempting conception; the median (IQR) number of cycles before conception was 4 (2-7). Compared with participants with a level 1 risk score, those with level 2, 3, 4, and 5 risk scores had reductions in fecundability of 31% (adjusted fecundability ratio [FR], 0.69; 95% CI, 0.54-0.88), 41% (FR, 0.59; 95% CI, 0.45-0.78), 54% (FR, 0.46; 95% CI, 0.31-0.69) and 77% (FR, 0.23; 95% CI, 0.07-0.73), respectively. Assessment of the population attributable fraction showed that all participants achieving a minimal (level 1) risk level would be associated with a reduction of 34% (95% CI, 30%-39%) in nonconception within a year. CONCLUSIONS AND RELEVANCE Results of this study revealed the co-occurrence of multiple modifiable risk factors for lowered fecundability and a substantially higher conception rate among participants with no or minimal risk factors. The risk assessment scoring system proposed is a simple and potentially useful public health tool for mitigating risks and guiding those who are trying to conceive.
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Affiliation(s)
- See Ling Loy
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Chee Wai Ku
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Carissa Shi Tong Ng
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Yin Bun Cheung
- Program in Health Services and Systems Research and Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Shan Xuan Lim
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Marjorelee T. Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jun Shi Lai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Yap-Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Wei M, An G, Fan L, Chen X, Li C, Chen J, Ma Q, Yang D, Wang J. Characteristics of menstrual cycle disorder and saliva metabolomics of young women in a high-temperature environment. Front Physiol 2023; 13:994990. [PMID: 36714308 PMCID: PMC9880290 DOI: 10.3389/fphys.2022.994990] [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: 07/15/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023] Open
Abstract
Objective: Menstrual disorders induced by high-temperature environments, can seriously damage women's reproductive health and workability. The regulation mechanism underlying it is not yet to be elucidated. Saliva is an information-rich biological fluid that can reflect systemic diseases. Here, we investigated the characteristics of menstrual cycle disorders and saliva metabolomics to provide a deeper insight of the regulation mechanism of young women in high-temperature environments. Methods: Women from high and normal temperature areas of China were selected and divided into two groups-high-temperature (H group) and control (C group). A questionnaire survey was conducted in summer (July) to investigate the incidence rate of menstrual disorders, characteristics of the disorders, and factors influencing the risk of these disorders in different regions. Metabolomics was applied to analyze the characteristics of the salivary metabolites and neurotransmitters in the two groups of women with menstrual disorders. Results: The incidence rate of menstrual disorders was significantly higher in the H group than that in the C group (p < 0.05). High-temperature environment, stress, and sleep quality were identified as critical factors associated with menstrual disorders. Non-targeted saliva metabolomics identified 64 significantly different metabolites between two groups, which mainly enriched in metabolic pathways such as carbohydrate metabolism, membrane transport, digestive system, and nucleotide metabolism (p < 0.05). N-acetylneuraminic acid, MYO, and tyramine may be candidate markers for early diagnosis of menstrual disorders in high temperature environments. Metabolites may be involving in the acute-phase response during an inflammatory process, to affecting the reproductive system by influencing the HPA axis loop. Regulations about oocyte membrane production and the luteal functions would be exerted in menstrual disorders. Targeted metabolomics of neurotransmitters revealed increased expression of histamine (HA) and glutamine and decreased expression of 5-hydroxyindole acetic acid (5-HIAA) (p < 0.05). Conclusion: Menstrual disorder characteristics induced by high temperature environments were specific. Anxiety, sleep quality and temperature feeling were the key factors to the menstrual disorder. endocrine regulation mechanism and inflammatory reactions might contribute to the development of menstrual disorders through influencing the formation of the follicular cell membrane.
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Affiliation(s)
- MengFan Wei
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China,Zhongguancun Hospital, Chinese Academy of Sciences, Beijing, China
| | - GaiHong An
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - LiJun Fan
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - XueWei Chen
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - Chao Li
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - JiaJun Chen
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China
| | - Qiang Ma
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China,*Correspondence: Qiang Ma, ; DanFeng Yang, ; Jing Wang,
| | - DanFeng Yang
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China,*Correspondence: Qiang Ma, ; DanFeng Yang, ; Jing Wang,
| | - Jing Wang
- Department of Operational Medicine, Tianjin Institute of Environmental and Operational Medicine, Tianjin, China,*Correspondence: Qiang Ma, ; DanFeng Yang, ; Jing Wang,
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Hong X, Yin J, Wang W, Zhao F, Yu H, Wang B. The current situation and future directions for the study on time-to-pregnancy: a scoping review. Reprod Health 2022; 19:150. [PMID: 35752834 PMCID: PMC9233796 DOI: 10.1186/s12978-022-01450-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/28/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction As problems associated with infertility and population aging increase, there is a growing interest in the factors that cause a decline in human fertility. Time-to-pregnancy (TTP) is a good indicator with which to reflect human fecundability. Here, we present a comprehensive overview of this topic. Methods Relevant qualitative and quantitative studies were identified by searching the Web of science and PubMed electronic databases. We included all literature, written in English, from inception to the 10th April 2021 providing the focus was on TTP. We conducted a narrative synthesis using thematic analysis. Results Traditional TTP-related study protocols include prospective and retrospective cohorts that provide a wealth of data to reveal potential influences on TTP. Thus far, a variety of factors have been shown to be associated with TTP in couples preparing for pregnancy, including basic demographic characteristics, menstrual status, chronic disease status, environmental endocrine disruptor exposure, and lifestyles. However, there are inevitable epidemiological bias in the existing studies, including recall bias, selection bias and measurement bias. Some methodological advances have brought new opportunities to TTP research, which make it possible to develop precision interventions for population fertility. Future TTP studies should take advantage of artificial intelligence, machine learning, and high-throughput sequencing technologies, and apply medical big data to fully consider and avoid possible bias in the design. Conclusion There are many opportunities and future challenges for TTP related studies which would provide a scientific basis for the “precise health management” of the population preparing for pregnancy. As the problems of infertility and population aging increase, there is a growing interest in the factors that cause a decline in human fertility. Time-to-pregnancy (TTP) is a good indicator with which to reflect human fecundability, and a longer TTP is known to reflect a reduction in fertility. Many original studies, with different designs, have used TTP to explore the factors that might influence fertility, including basic demographic characteristics, chronic disease status, environmental endocrine disruptor exposure, and lifestyles. However, much of the existing evidence is inconsistent and limited by various types of bias. This review provides a synopsis of recent TTP studies, and highlights new opportunities and future challenges.
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Affiliation(s)
- Xiang Hong
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No.87 Dingjiaqiao Rd, Gulou District, Nanjing, Jiangsu, China
| | - Jiechen Yin
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No.87 Dingjiaqiao Rd, Gulou District, Nanjing, Jiangsu, China
| | - Wei Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No.87 Dingjiaqiao Rd, Gulou District, Nanjing, Jiangsu, China
| | - Fanqi Zhao
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No.87 Dingjiaqiao Rd, Gulou District, Nanjing, Jiangsu, China
| | - Hong Yu
- Department of Obstetrics and Gynecology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Bei Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No.87 Dingjiaqiao Rd, Gulou District, Nanjing, Jiangsu, China.
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Anti-Müllerian hormone has limited ability to predict fecundability in Chinese women: a preconception cohort study. Reprod Biomed Online 2022; 44:1055-1063. [DOI: 10.1016/j.rbmo.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/18/2022]
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OUP accepted manuscript. Hum Reprod Update 2022; 28:435-454. [DOI: 10.1093/humupd/dmac007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/15/2021] [Indexed: 11/13/2022] Open
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Younis JS, Iskander R, Fauser BCJM, Izhaki I. Does an association exist between menstrual cycle length within the normal range and ovarian reserve biomarkers during the reproductive years? A systematic review and meta-analysis. Hum Reprod Update 2021; 26:904-928. [PMID: 32514566 DOI: 10.1093/humupd/dmaa013] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/05/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Regular menstrual cycling during the reproductive years is an indicator of spontaneous ovulation but sometimes falsely perceived as an indicator of preserved fertility. In contrast, menstrual cycle shortening, a physiologic occurrence preceding the menopausal transition, is not usually perceived as an indicator of decreased ovarian reserve in the general population. OBJECTIVE AND RATIONALE The individual decrease in menstrual cycle length (MCL) might represent a sensitive biomarker of diminishing ovarian reserve. The aim of this systematic review and meta-analysis is to examine the possible association between MCL in regularly cycling women (21-35 days) and ovarian reserve tests (ORT), fecundability in natural cycles and IVF outcomes. SEARCH METHODS An electronic database search employing PubMed, Web of Science, Trip, EBSCO, ClinicalTrials.gov and the Cochrane library was performed to identify research articles, only on human, published between January 1978 and August 2019. Search terms were pregnancy OR fertility OR fecundity OR fecundability, anti-Müllerian hormone OR AMH OR antral follicle count OR AFC OR ovarian reserve OR ovarian reserve test, in vitro fertilization OR ART OR assisted reproductive therapy OR assisted reproductive treatment OR assisted reproductive technology OR IVF OR ICSI, menstrual cycle length OR menstrual cycle characteristics. We combined these terms to complete the search. All prospective and retrospective studies exploring an association between MCL and proxies of ovarian reserve were included. The exclusions included studies of PCOS, ovarian failure, oral contraception treatment, prior chemotherapy and/or radiotherapy or ovarian surgery. The Newcastle-Ottawa scale was used to assess the quality of studies that were eligible for meta-analysis. OUTCOMES Eleven studies were eligible for meta-analysis, including 12 031 women. The included studies had a low risk of bias. Short MCL (21-27 days) was associated with lower ORT values as compared to normal (28-31 days), long (32-35 days) and all other (28-35 days) MCL sets. The estimated weighted mean difference (WMD) of AMH level was -1.3 ng/mL (95% CI: -1.75 to -0.86, P < 0.001) between the short and normal MCL sets. The estimated WMD of AFC values was -5.17 (95% CI: -5.96 to -4.37, P < 0.001) between the short and normal MCL sets. The weighted overall odds ratio (OR) of fecundability in natural cycles between women with short versus normal MCL sets was statistically significant (overall OR 0.81; 95% CI 0.72-0.91, P < 0.001). In the IVF setting, fewer oocytes were retrieved in short MCL in comparison to normal, long and all other MCL sets, with an estimated WMD of -1.8 oocytes (95% CI: -2.5 to -1.1, P < 0.001) in the short versus normal MCL sets. The weighted overall OR of clinical pregnancy rate between women with short versus all other MCL sets was statistically significant (overall OR 0.76; 95% CI: 0.60 to 0.96, P = 0.02). Low levels of heterogeneity were found in most meta-analyses of MCL and qualitative ovarian reserve biomarkers, while heterogeneity was high in meta-analyses performed for quantitative measures. WIDER IMPLICATIONS MCL in regularly cycling women is closely related to ovarian reserve biomarkers during the reproductive years. A short MCL, as compared to normal, is significantly associated with lower ORT values, reduced fecundability and inferior IVF outcomes, independent of age. The results imply that short MCL may be a sign of ovarian aging, combining the quantitative and qualitative facets of ovarian reserve. Educational efforts ought to be designed to guide women with short MCL at a young age, who desire children in the future, to seek professional counselling.
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Affiliation(s)
- Johnny S Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel.,Azrieili Faculty of Medicine, Galilee, Bar-Ilan University, Safed, Israel
| | - Rula Iskander
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya 15208, Israel
| | - Bart C J M Fauser
- Department of Reproductive Medicine and Gynecology, University of Utrecht and University Medical Center Utrecht, 3508 TC, Utrecht, The Netherlands
| | - Ido Izhaki
- Department of Evolutionary and Environmental Biology, University of Haifa, Haifa 3498838, Israel
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La X, Wang W, Zhang M, Liang L. Definition and Multiple Factors of Recurrent Spontaneous Abortion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1300:231-257. [PMID: 33523437 DOI: 10.1007/978-981-33-4187-6_11] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Recurrent spontaneous abortion (RSA) is usually defined as three or more spontaneous abortions prior to 20-28 weeks gestation. RSA affects approximately 2-5% of all women of childbearing age, and it brings tremendous psychological and psychiatric trauma to the women and also results in economic burden. The causes could be female age, anatomical and chromosomal abnormalities, genetic, endocrinological, placental anomalies, infection, smoking and alcohol consumption, psychological factor, exposure to environmental factors such as heavy metal, environment pollution, and radiation.
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Affiliation(s)
- Xiaolin La
- Reproductive Medicine Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Wenjuan Wang
- Reproductive Medical Center, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
| | - Meng Zhang
- Reproductive Medicine Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Liang
- Reproductive Medical Center, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, P.R. China
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11
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Sub-fecundity and associated factors among mothers with natural planned conception attending antenatal care service in Arba Minch Health Facilities. PLoS One 2020; 15:e0241995. [PMID: 33152037 PMCID: PMC7644055 DOI: 10.1371/journal.pone.0241995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/24/2020] [Indexed: 11/22/2022] Open
Abstract
Background Fecundity is a physiological ability to have children. The inability to get the desired child which was commonly caused by the prolonged time to conceive due to unwanted non-conception period increased from time to time. As a result, many couples are developing psychological, social, and economic problems and unstable life. However, information on fecundity status is limited in Ethiopia context. Therefore, this study aimed to assess the proportion of sub-fecundity and associated factors in Ethiopia context. Methods A health institution based cross-sectional study was conducted in Arba Minch health facilities from March 25 to April 25, 2020. By using a systematic sampling method, 539 mothers were selected for the study. Structured questionnaire was used for data collection. A binary logistic regression model was used to identify factors associated with the sub-fecundity. Variables with p-value <0.25 in the bi-variable logistic regression analysis were interred and checked for association in a multivariable logistic regression model. The level of statistical significance was declared at p-value <0.05. Result The proportion of sub-fecundity was 17.8% with 95%CI (14.8%-21.3%). Mothers’ age ≥ 30 (AOR = 2.54, 95%CI; 1.18–5.48), partners’ age ≥ 35 (AOR = 2.20, 95%CI; 1.01–4.75), coffee consumption of ≥ 4 cups/day (AOR = 2.93, 95%CI; 1.14–7.53), menses irregularity (AOR = 3.79 95%CI; 2.01–7.14) and coital frequency of 1day/week (AOR = 3.65, 95%CI; 1.47–9.05) were significantly associated with the sub-fecundity. Conclusion This study found that a substantial proportion of mothers were sub-fecund. Factors that contributed to the sub-fecundity were pre-pregnancy; mothers’ age, partners’ age, coffee drinking of ≥ 4 cups/day, coital frequency of 1day/week, and menses irregularity. Thus, efforts to prevent sub-fecundity should focus on awareness creation as to plan to conceive at early age, reducing coffee consumption, increasing days of coital frequency per week, and investigating and treating mothers with irregular menses.
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12
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Hu P, Cai C, Vinturache A, Hu Y, Gao Y, Zhang J, Lu M, Gu H, Qiao J, Tian Y, Ding G. Maternal preconception body mass index and time-to-pregnancy in Shanghai Women, China. Women Health 2020; 60:1014-1023. [PMID: 32605505 DOI: 10.1080/03630242.2020.1784369] [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: 10/23/2022]
Abstract
Previous studies suggested an association between female fertility and body size, but most of these studies were from Western countries and focused mainly on obesity. This study investigated the association between preconception body mass index (BMI) and time to pregnancy (TTP) in women planning to conceive from Shanghai, China. A total of 1,182 women aged 24-46 years were recruited from the Shanghai Birth Cohort between 2013 and 2015 and were followed up for 12 months. Preconception BMI was categorized as underweight, normal weight, and overweight/obesity according to the Chinese classification of BMI. Fecundability (FOR) and infertility (IOR) odds ratios were estimated using Cox (n = 1,092) and Logistic (n = 820) regression models, respectively. We found no differences in fecundability between underweight and overweight/obese women and normal-weight women. Furthermore, underweight and overweight/obese women did not have a higher risk of infertility compared with normal-weight women. Our findings suggest that non-optimal preconception BMI does not appear to influence female fecundability and infertility in Chinese women. These results should be interpreted with caution as they may be applicable only to women with demographic and anthropometric characteristics similar to our study population. Our findings need to be confirmed in other populations.
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Affiliation(s)
- Peipei Hu
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine , Shanghai, China
| | - Chen Cai
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine , Shanghai, China
| | - Angela Vinturache
- Department of Obstetrics & Gynecology, Queen Elizabeth II Hospital , Alberta, Canada
| | - Yi Hu
- Center for Medical Bioinformatics, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
| | - Yu Gao
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Min Lu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
| | - Haoxiang Gu
- Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
| | - Jing Qiao
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine , Shanghai, China
| | - Ying Tian
- Department of Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine , Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Guodong Ding
- Department of Pediatrics, Shanghai East Hospital, Tongji University School of Medicine , Shanghai, China.,Department of Respiratory Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University , Shanghai, China
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13
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Björvang RD, Gennings C, Lin PI, Hussein G, Kiviranta H, Rantakokko P, Ruokojärvi P, Lindh CH, Damdimopoulou P, Bornehag CG. Persistent organic pollutants, pre-pregnancy use of combined oral contraceptives, age, and time-to-pregnancy in the SELMA cohort. Environ Health 2020; 19:67. [PMID: 32539770 PMCID: PMC7294652 DOI: 10.1186/s12940-020-00608-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 05/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND We are exposed to several chemicals such as persistent organic pollutants (POPs) in our everyday lives. Prior evidence has suggested that POPs may have adverse effects on reproductive function by disrupting hormone synthesis and metabolism. While there is age-related decline of fertility, the use of hormonal combined oral contraceptives (COCs) and its association to return of fertility remains controversial. The goal of this study is to investigate the association between exposure to POPs, both individually and as a mixture, and fecundability measured as time-to-pregnancy (TTP) according to pre-pregnancy use of COCs and age. METHODS Using the SELMA (Swedish Environmental Longitudinal Mother and Child, Allergy and Asthma) study, we have identified 818 pregnant women aged 18-43 years (mean 29 years) with data on how long they tried to get pregnant and what was their most recently used contraceptive method. These data were collected at enrollment to the study (median week 10 of pregnancy). Concentrations of 22 POPs and cotinine were analyzed in the blood samples collected at the same time as the questions on TTP and pre-pregnancy use of contraceptive. Analyses were done on the association between POPs exposure and TTP measured as continuous (months) and binary (infertile for those with TTP > 12 months). To study the chemicals individually, Cox regression and logistic regression were used to estimate fecundability ratios (FRs) and odds ratios (ORs), respectively. Weighted quantile sum (WQS) regression was used to investigate the chemicals as a mixture where chemicals of concern were identified above the 7.6% threshold of equal weights. To perform the subgroup analysis, we stratified the sample according to use of COCs as the most recent pre-pregnancy contraception method and age (< 29 years, and ≥ 29 years). The models were adjusted for parity, regularity of menses, maternal body mass index (BMI) and smoking status, and stratified as described above. RESULTS Prior to stratification, none of the POPs were associated with fecundability while increased exposure to HCB, PCB 74 and 118 had higher odds of infertility. Upon stratification, POP exposure was significantly associated with longer TTP in women aged ≥29 years who did not use COC. Specifically, PCBs 156, 180, 183, and 187 were associated with reduced fecundability while PCBs 99, 153, 156, 180, 183, and 187 had higher odds of infertility. As a mixture, we identified the chemicals of concern for a longer TTP include PCBs 118, 156, 183, and 187. Moreover, chemicals of concern identified with increased odds of infertility were PCB 74, 156, 183, 187, and transnonachlor. CONCLUSION Serum concentrations of selected POPs, both as individual chemicals and as a mixture, were significantly associated with lower fecundability and increased odds of infertility in women aged 29 years and above not using COC as their most recent pre-pregnancy contraceptive. Our findings suggest that pre-pregnancy use of oral contraceptive and age may modify the link between POPs and fecundability. The differences of specific chemicals in the individual analysis and as a mixture support the need to study combination effects of chemicals when evaluating reproductive outcomes.
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Affiliation(s)
- Richelle D. Björvang
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Unit of Toxicology Sciences, Swetox, Karolinska Institute, Södertälje, Sweden
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ping-I Lin
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Ghada Hussein
- Department of Obstetrics and Gynecology, Karlstad Central Hospital, Karlstad, Sweden
| | - Hannu Kiviranta
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Panu Rantakokko
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Päivi Ruokojärvi
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Christian H. Lindh
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund, Sweden
| | - Pauliina Damdimopoulou
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Unit of Toxicology Sciences, Swetox, Karolinska Institute, Södertälje, Sweden
| | - Carl-Gustaf Bornehag
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
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14
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Impact of allergic diseases on fertility. Postepy Dermatol Alergol 2019; 36:507-512. [PMID: 31839765 PMCID: PMC6906954 DOI: 10.5114/ada.2019.89501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/10/2018] [Indexed: 01/24/2023] Open
Abstract
The incidence of allergic diseases has been increasing in recent decades, and currently, nearly 30% of the European population suffer from some type of allergy. Also, an increasing number of people are suffering from infertility. Both diseases are related to the hormonal and immune systems, which prompts the question as to whether there is a causal relationship between allergic disorders and the reproductive system. The purpose of this review is to evaluate whether there is a link between allergic diseases and infertility, using the available literature.
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15
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Berglund Scherwitzl E, Lundberg O, Kopp Kallner H, Rowland SP, Holte J, Trussell J, Gemzell Danielsson K, Scherwitzl R. Short- and long-term effect of contraceptive methods on fecundity. EUR J CONTRACEP REPR 2019; 24:260-265. [PMID: 31223036 DOI: 10.1080/13625187.2019.1621999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: The aim of the study was to compare the effect of previously used contraceptive methods on women's short- and long-term fecundity. Use of hormonal contraception (HC) was compared with the use of a contraceptive mobile application (app). Methods: This real-life prospective observational study comprised 2874 women who were attempting to become pregnant using the Natural Cycles mobile app to monitor their fertility. The women registered to use the app between August 2014 and June 2016 with the intention of planning a pregnancy and had previously either used the same app to prevent pregnancy or had recently discontinued HC use. We calculated the average time to pregnancy (TTP) for all women who became pregnant during the study and performed Kaplan-Meier life-table analysis to examine the cumulative probabilities of pregnancy for all women in the study. Results: The average TTP was 2.3 (95% confidence interval [CI] 2.1, 2.4) and 3.7 (95% CI 3.4, 3.9) cycles for women who had previously used Natural Cycles and HC, respectively. The time to reach 30% pregnancy probability for women previously on HC was 1.6 (95% CI 1.5, 1.8) times longer than for women previously using Natural Cycles. There was no significant difference in the 13 cycle cumulated pregnancy probability between the two groups. Conclusion: The results show that fertility awareness-based methods of contraception increase short-term pregnancy rates relative to HC, but have no effect on long-term pregnancy rates.
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Affiliation(s)
| | | | - Helena Kopp Kallner
- b Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden.,c Department of Women's and Children's Health , Karolinska Institutet and Karolinska University Hospital , Stockholm , Sweden
| | | | - Jan Holte
- d Carl von Linné Clinic , Uppsala , Sweden.,e Centre for Reproductive Biology in Uppsala , Uppsala , Sweden
| | - James Trussell
- f Office of Population Research , Princeton University , Princeton , NJ , USA
| | - Kristina Gemzell Danielsson
- c Department of Women's and Children's Health , Karolinska Institutet and Karolinska University Hospital , Stockholm , Sweden
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Bradley D, Landau E, Jesani N, Mowry B, Chui K, Baron A, Wolfberg A. Time to conception and the menstrual cycle: an observational study of fertility app users who conceived. HUM FERTIL 2019; 24:267-275. [PMID: 31094573 DOI: 10.1080/14647273.2019.1613680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this research was to evaluate the association between menstrual cycle characteristics (cycle length, cycle-length variability, and their interaction) and the amount of time it takes women to conceive using a robust multiple linear regression. Participants downloaded Ovia Fertility in 2015 indicated that they had just started trying to conceive, and reported conception within 12 months (n = 45,360, adjusted model n = 8835). The average time to conception among women in the adjusted model was 3.94 months (n = 8835). Women with normal cycle lengths (27-29 days) conceived more quickly than women with cycle lengths of 25-26 days (+0.41 months; p < 0.001), 30-31 days (+0.27 months; p < 0.01), 32-33 days (+0.44 months; p < 0.001), and 34+ days (+0.75 months; p < 0.001). Women with regular cycle-length variability (<9 days between cycles) conceived more quickly than women with irregular variability (+0.72 months; p < 0.001). Results of the interaction analysis indicated that, among women with regular cycle-length variability, those with normal cycle length had shorter time to conception than women with either short or long cycle length. The interaction between cycle length and cycle-length variability provided enhanced insights into the amount of time it takes to conceive, compared to either indicator alone.
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Affiliation(s)
| | - Erin Landau
- a Clinical Research , Ovia Health , Boston , MA , USA
| | - Noreen Jesani
- b Boston University School of Public Health , Boston , MA , USA
| | | | - Kenneth Chui
- d Public Health and Community Medicine , School of Medicine at Tufts University , Boston , MA , USA
| | - Alex Baron
- a Clinical Research , Ovia Health , Boston , MA , USA
| | - Adam Wolfberg
- a Clinical Research , Ovia Health , Boston , MA , USA.,e Newton Wellesley Hospital , Newton , MA , USA
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Johnson CY, Tanz LJ, Lawson CC, Howards PP, Bertone-Johnson ER, Eliassen AH, Schernhammer ES, Rich-Edwards JW. Anti-Müllerian hormone levels in nurses working night shifts. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2019; 75:136-143. [PMID: 30945620 PMCID: PMC6776712 DOI: 10.1080/19338244.2019.1577210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Our objective was to examine associations between night shift work and serum anti-Müllerian hormone (AMH) levels. We analyzed 1,537 blood samples from premenopausal female nurses in the Nurses' Health Study II, assayed for AMH. Rotating or permanent night shifts worked in the two weeks before blood collection and years of rotating night shift work were obtained via questionnaire. We found no associations between recent night shifts or rotating night shift work and AMH. The median difference in AMH was 0.3 (95% CI: -0.4, 0.8) ng/mL for ≥5 versus 0 recent night shifts and -0.1 (95% CI: -0.4, 0.3) ng/mL for ≥6 versus 0 years of rotating night shift work. Although we found no associations between night shift work and AMH, this does not preclude associations between night shift work and fertility operating through other mechanisms.
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Affiliation(s)
- Candice Y Johnson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Lauren J Tanz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Christina C Lawson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Connor Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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FSRH Guideline (January 2019) Combined Hormonal Contraception (Revision due by January 2024). BMJ SEXUAL & REPRODUCTIVE HEALTH 2019; 45:1-93. [PMID: 30665985 DOI: 10.1136/bmjsrh-2018-chc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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19
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Bach C, Matthiesen N, Olsen J, Henriksen T. Conditioning on Parity in Studies of Perfluoroalkyl Acids and Time to Pregnancy: An Example from the Danish National Birth Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:117003. [PMID: 30417653 PMCID: PMC6371644 DOI: 10.1289/ehp1493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Previous studies have investigated the associations between perfluoroalkyl acids (PFAAs) in women and time to pregnancy (TTP). Inconsistent results may be explained by differences in conditioning on parity. OBJECTIVES We used causal directed acyclic graphs to illustrate potential confounding related to previous pregnancies and exposure measurement error due to differences in the interpregnancy interval in pregnancy-based studies that include parous women. We exemplified the potential importance of these issues using data from the Danish National Birth Cohort. METHODS We used discrete time survival models to estimate associations between maternal plasma PFAAs in early pregnancy and TTP in 638 nulliparous and 613 parous women. RESULTS PFAA quartiles were not associated with the TTP in nulliparous women. In parous women, higher PFAA quartiles were associated with longer TTP. The strongest associations were estimated for perfluorohexane sulfonate and perfluorooctane sulfonate. PFAA concentrations were higher in women with longer interpregnancy intervals. Accounting for the interpregnancy interval attenuated the estimated associations. CONCLUSIONS Associations between PFAAs and TTP in parous women may be biased by confounders related to previous pregnancies and exposure measurement error. To avoid these biases, studies that include parous women may need to condition on a) common causes of PFAAs and the TTP in the index pregnancy, b) previous births (a descendant of a collider), c) PFAA levels or common causes of PFAA levels and the TTP in the previous pregnancy (to alleviate collider stratification bias caused by conditioning on previous births), and d) the interpregnancy interval (in pregnancy-based studies). Alternatives would be to restrict studies to nulliparous women or to use toxicokinetic modeling to correct exposure estimates in parous women. These recommendations may be extended to studies of other chemicals with similar toxicokinetic properties. https://doi.org/10.1289/EHP1493.
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Affiliation(s)
- Cathrine Bach
- Department of Pediatrics and Adolescent Medicine, Viborg Regional Hospital, Viborg, Denmark
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Matthiesen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Pediatrics and Adolescent Medicine, Randers Regional Hospital, Randers, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Henriksen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Perinatal Epidemiology Research Unit, Aarhus University Hospital, Aarhus, Denmark
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Oostingh EC, Hall J, Koster MPH, Grace B, Jauniaux E, Steegers-Theunissen RPM. The impact of maternal lifestyle factors on periconception outcomes: a systematic review of observational studies. Reprod Biomed Online 2018; 38:77-94. [PMID: 30424937 DOI: 10.1016/j.rbmo.2018.09.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022]
Abstract
The main risk factors for important reproductive health issues such as subfertility and perinatal mortality largely originate in the periconception period. To evaluate associations between modifiable maternal lifestyle factors and periconception outcomes, a systematic search was conducted for relevant studies published from 1990 to February 2017 on Embase, Medline, Web of Science, Cochrane database, PubMed and Google Scholar. The initial search identified 6166 articles, of which 49 studies were eligible for inclusion. Fecundity (the capacity to have a live birth) showed significant inverse associations with smoking, alcohol use and poor diet. Studies regarding time to pregnancy showed a decline in fecundity ratios (the monthly conception rate among exposed relative to unexposed couples) with increasing body mass index (BMI). Furthermore, risk of first-trimester miscarriage was found to be increased in smokers, alcohol and caffeine consumers, and with increasing BMI. Vitamin supplement use showed a decrease in this risk. This review demonstrates that maternal modifiable lifestyle factors affect periconception outcomes. If couples planning a pregnancy are more aware and supported to adopt healthy lifestyles during the periconceptional 'window of opportunity', short-term reproductive health as well as health in later life and even of future generations can be further improved.
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Affiliation(s)
- Elsje C Oostingh
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Jennifer Hall
- Research Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
| | - Maria P H Koster
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bola Grace
- Research Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
| | - Eric Jauniaux
- Research Department of Reproductive Health, EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
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Pre-pregnancy fast food and fruit intake is associated with time to pregnancy. Hum Reprod 2018; 33:1063-1070. [DOI: 10.1093/humrep/dey079] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Indexed: 11/14/2022] Open
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22
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Susko ML, Bloom MS, Neamtiu IA, Appleton AA, Surdu S, Pop C, Fitzgerald EF, Anastasiu D, Gurzau ES. Low-level arsenic exposure via drinking water consumption and female fecundity - A preliminary investigation. ENVIRONMENTAL RESEARCH 2017; 154:120-125. [PMID: 28061371 PMCID: PMC5328919 DOI: 10.1016/j.envres.2016.12.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/05/2016] [Accepted: 12/26/2016] [Indexed: 05/11/2023]
Abstract
High level arsenic exposure is associated with reproductive toxicity in experimental and observational studies; however, few data exist to assess risks at low levels. Even less data are available to evaluate the impact of low level arsenic exposure on human fecundity. Our aim in this pilot study was a preliminary evaluation of associations between low level drinking water arsenic contamination and female fecundity. This retrospective study was conducted among women previously recruited to a hospital-based case-control study of spontaneous pregnancy loss in Timiṣ County, Romania. Women (n=94) with planned pregnancies of 5-20 weeks gestation completed a comprehensive physician-administered study questionnaire and reported the number of menstrual cycles attempting to conceive as the time to pregnancy (TTP). Drinking water samples were collected from residential drinking water sources and we determined arsenic levels using hydride generation-atomic absorption spectrometry (HG-AAS). Multivariable Cox-proportional hazards regression with Efron approximation was employed to evaluate TTP as a function of drinking water arsenic concentrations among planned pregnancies, adjusted for covariates. There was no main effect for drinking water arsenic exposure, yet the conditional probability for pregnancy was modestly lower among arsenic exposed women with longer TTPs, relative to women with shorter TTPs, and relative to unexposed women. For example, 1µg/L average drinking water arsenic conferred 5%, 8%, and 10% lower likelihoods for pregnancy in the 6th, 9th, and 12th cycles, respectively (P=0.01). While preliminary, our results suggest that low level arsenic contamination in residential drinking water sources may further impair fecundity among women with longer waiting times; however, this hypothesis requires confirmation by a future, more definitive study.
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Affiliation(s)
- Michele L Susko
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Michael S Bloom
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States.
| | - Iulia A Neamtiu
- Health Department, Environmental Health Center, Cluj-Napoca, Romania; IMOGEN Research Institute, Cluj-Napoca, Romania
| | - Allison A Appleton
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Simona Surdu
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Cristian Pop
- Physico-chemical and Biotoxicological Analysis Laboratory, Environmental Health Center, Cluj-Napoca, Romania; Cluj School of Public Health - College of Political, Administrative and Communication Sciences, Babeṣ-Bolyai University, Cluj-Napoca, Romania; Faculty of Environmental Science and Engineering, Babeṣ-Bolyai University, Cluj-Napoca, Romania
| | - Edward F Fitzgerald
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York, United States; Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, New York, United States
| | - Doru Anastasiu
- University of Medicine and Pharmacy "Victor Babeṣ", Timiṣoara, Romania; Obstetrics and Gynecology Department of the Emergency County Hospital, Timiṣoara, Romania
| | - Eugen S Gurzau
- Health Department, Environmental Health Center, Cluj-Napoca, Romania; IMOGEN Research Institute, Cluj-Napoca, Romania; University of Medicine and Pharmacy "Iuliu Haṭieganu", Cluj-Napoca, Romania
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Zhang Q, Wang YY, Zhang Y, Zhang HG, Yang Y, He Y, Xu JH, Zhao J, Peng ZQ, Ma X. The influence of age at menarche, menstrual cycle length and bleeding duration on time to pregnancy: a large prospective cohort study among rural Chinese women. BJOG 2017; 124:1654-1662. [PMID: 28128508 DOI: 10.1111/1471-0528.14469] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the relations among age at menarche (AAM), menstrual cycle length, menstrual bleeding duration and time to pregnancy in a large cohort of rural Chinese women. DESIGN A prospective cohort study. SETTING Local family-planning service agencies and maternal/child care service centres. POPULATION A total of 391 320 rural women of reproductive age who participated in the National Free Pre-pregnancy Checkups and were planning to conceive were enrolled. METHODS Menstrual characteristics were collected via face-to-face interviews. The Cox proportional hazards model were used to estimate the fecundability ratios (FRs) and 95% confidence intervals for each measure relative to its reference category. MAIN OUTCOME MEASURES Time to pregnancy. RESULTS Women with an AAM later than 14 years of age were less likely become pregnant compared with women with AAM at 13-14 years of age (FR 0.93, 95% CI 0.92-0.94). Those with menstrual cycle lengths >29 days were less likely to come pregnant (FR 0.91, 95% CI 0.90-0.92) compared with the reference cycle length of 27-29 days. Women with bleeding durations of <4 (FR 0.88; 95% CI 0.86-0.91) or >5 days (FR 0.91; 95% CI 0.90-0.91) showed lower FRs compared with those reporting 4-5 days of bleeding. The associations were independent of maternal age, ethnicity, education level, occupation, tobacco use, alcohol use and body mass index. CONCLUSION A later onset of menarche, longer menstrual cycle length, both shorter (<4 days) and longer (>5 days) bleeding duration were associated with a lower FR and longer time to pregnancy in rural Chinese women. TWEETABLE ABSTRACT A later menarche, longer cycle, shorter or longer bleeding duration were associated with lower fecundity.
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Affiliation(s)
- Q Zhang
- Section of Genetics, National Research Institute for Family Planning, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
| | - Y Y Wang
- Section of Genetics, National Research Institute for Family Planning, Beijing, China
| | - Y Zhang
- Section of Genetics, National Research Institute for Family Planning, Beijing, China
| | - H G Zhang
- Section of Genetics, National Research Institute for Family Planning, Beijing, China
| | - Y Yang
- Section of Genetics, National Research Institute for Family Planning, Beijing, China
| | - Y He
- Section of Genetics, National Research Institute for Family Planning, Beijing, China
| | - J H Xu
- Section of Genetics, National Research Institute for Family Planning, Beijing, China
| | - J Zhao
- Section of Genetics, National Research Institute for Family Planning, Beijing, China
| | - Z Q Peng
- Section of Genetics, National Research Institute for Family Planning, Beijing, China
| | - X Ma
- Section of Genetics, National Research Institute for Family Planning, Beijing, China.,Graduate School of Peking Union Medical College, Beijing, China
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Bloom MS, Fujimoto VY, Storm R, Zhang L, Butts CD, Sollohub D, Jansing RL. Persistent organic pollutants (POPs) in human follicular fluid and in vitro fertilization outcomes, a pilot study. Reprod Toxicol 2017; 67:165-173. [PMID: 28089717 DOI: 10.1016/j.reprotox.2017.01.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/06/2016] [Accepted: 01/05/2017] [Indexed: 11/25/2022]
Abstract
Persistent organic pollutants (POPs) are ubiquitously distributed among the U.S. population and adversely impact human reproduction. These compounds have been detected in human ovarian follicular fluid (FF), where they directly contact a developing oocyte. As a pilot investigation, we measured 43 polychlorinated biphenyl (PCB) congeners, p,p'-dichlorodiphenyltrichloroethane (DDT), and its persistent metabolite p,p'-dichlorodiphenyldichloroethylene (DDE) in residual FF collected from 32 women undergoing in vitro fertilization (IVF). We identified significant inverse associations between higher levels of PCB congeners and indicators of ovarian reserve (e.g., antral follicle count), follicular response to administered gonadotropins (e.g., peak estradiol, number of oocytes retrieved, endometrial thickness), intermediate IVF endpoints (e.g., oocyte fertilization and embryo quality), and clinical IVF outcomes (e.g., embryo implantation and live birth), after adjusting for body mass index, cigarette smoking, race, and age. Our results suggest that ongoing exposure to POPs impacts IVF and merit confirmation in a larger and more definitive future study.
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Affiliation(s)
- Michael S Bloom
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA.
| | - Victor Y Fujimoto
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, CA, USA
| | - Robin Storm
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Li Zhang
- Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Celeste D Butts
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Diana Sollohub
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Robert L Jansing
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA; Wadsworth Center, New York State Department of Health, Albany, NY, USA
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Zare N, Nouri B, Moradi F, Parvareh M. The study of waiting time to first pregnancy in the south of Iran: A parametric frailty model approach. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.1.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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26
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The relationship between age at menarche and infertility among Chinese rural women. Eur J Obstet Gynecol Reprod Biol 2015; 194:68-72. [DOI: 10.1016/j.ejogrb.2015.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 07/07/2015] [Accepted: 08/13/2015] [Indexed: 11/17/2022]
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Jensen ET, Daniels JL, Stürmer T, Robinson WR, Williams CJ, Vejrup K, Magnus P, Longnecker MP. Hormonal contraceptive use before and after conception in relation to preterm birth and small for gestational age: an observational cohort study. BJOG 2015; 122:1349-61. [PMID: 25318662 PMCID: PMC4400183 DOI: 10.1111/1471-0528.13114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate whether hormonal contraceptives, used before or in early pregnancy, confer increased risk of preterm birth or reduced fetal growth. DESIGN Population-based cohort study conducted by the Norwegian Institute of Public Health (Mother and Child Cohort Study, 1998-2008) with linkage to the Norwegian Prescription Registry and to the Medical Birth Registry of Norway. SETTING Norway. POPULATION Of the 48,615 pregnancies meeting study inclusion criteria, 44,734 pregnancies were included in the complete case analysis. METHODS We characterised hormonal contraception by type (combination oral, progestin-only oral, vaginal ring, transdermal, and injectable) and specific progestin component. We used generalised estimating equations to estimate the odds of adverse outcome according to formulation used. Several sensitivity analyses were conducted. MAIN OUTCOME MEASURES Preterm birth, small for gestational age. RESULTS We observed a positive association between use of a combination oral contraceptive and preterm birth for all exposure periods (e.g. adjusted odds ratio 1.21, 95% confidence interval 1.04-1.41 for last use 12 to >4 months before conception); combination contraceptives containing the progestin norethisterone were consistently related to risk. Other types of hormonal contraception were generally not associated with preterm birth; none were related to small for gestational age. Observed associations were robust to sensitivity analyses. CONCLUSION Hormonally active agents may exert dose-, agent-, and timing-specific effects on growth and development. We found that the particular progestin component is important when assessing the potential for adverse effects among former users of hormonal contraceptives.
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Affiliation(s)
- Elizabeth T. Jensen
- National Institutes of Health, National Institute of Environmental Health Sciences, University of North Carolina, Chapel Hill, North Carolina
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Julie L. Daniels
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Whitney R. Robinson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Carmen J. Williams
- National Institutes of Health, National Institute of Environmental Health Sciences, University of North Carolina, Chapel Hill, North Carolina
| | | | - Per Magnus
- National Institute of Public Health, Oslo, Norway
| | - Matthew P. Longnecker
- National Institutes of Health, National Institute of Environmental Health Sciences, University of North Carolina, Chapel Hill, North Carolina
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Incidence of infertility and risk factors of impaired fecundity among newly married couples in a Chinese population. Reprod Biomed Online 2015; 30:92-100. [DOI: 10.1016/j.rbmo.2014.10.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 10/06/2014] [Accepted: 10/07/2014] [Indexed: 11/20/2022]
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Jensen ET, Longnecker MP. Pharmacologic sex hormones in pregnancy in relation to offspring obesity. Obesity (Silver Spring) 2014; 22:2406-12. [PMID: 24760473 PMCID: PMC4209008 DOI: 10.1002/oby.20778] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/14/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To assess the association between in utero exposure to either diethylstilbestrol (DES) or an oral contraceptive in pregnancy and offspring obesity. METHODS Using data from the Collaborative Perinatal Project (1959-1974), a multicenter prospective study of pregnant women and their offspring, we examined overweight or obesity among 34,419 children with height and weight data at age 7 years. Generalized linear models to estimate the adjusted odds ratio (aOR) for overweight or obesity (≥85th percentile) or obesity (≥95th percentile) in the offspring according to exposure during different months of pregnancy were used. RESULTS Oral contraceptive use during pregnancy was positively associated with offspring overweight or obesity and obesity. The magnitude of association was strongest in the first 2 months of pregnancy for obesity (aOR 2.0, 95% CI: 1.1, 3.7). DES use was also associated with offspring overweight or obesity and obesity, with the association being strongest for exposure beginning between months 3 and 5 (e.g., for exposure beginning in months 3-4, the aOR for obesity was 2.8, 95% CI: 1.3, 6.3). CONCLUSIONS Pharmacologic sex hormone use in pregnancy may be associated with childhood obesity. Whether contemporary, lower dose oral contraceptive formulations are similarly associated with increased risk of childhood obesity is unclear.
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Affiliation(s)
- Elizabeth T Jensen
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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Tehrani HG, Allameh ZS, Mehrabi AK. Relation between time to pregnancy and pregnancy outcome. Adv Biomed Res 2014; 3:175. [PMID: 25250289 PMCID: PMC4166062 DOI: 10.4103/2277-9175.139411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 08/13/2014] [Indexed: 11/30/2022] Open
Abstract
Background: Studies have shown significant correlation between time to pregnancy (TTP) and pregnancy outcomes. But understanding of these mechanisms may not be facilitated. The aim of this study was to determine the relation between TTP and pregnancy outcome. Materials and Methods: This study was a case cohort study that was done in Shahid Beheshti Educational Hospital during 2006-2007. Women aged 18-35 years, who had only one pregnancy without using any contraception method before pregnancy and delivered their first child, were enrolled in this study. Thus, 801 women were selected and followed up for pregnancy outcome and TTP until the end of pregnancy. All the participants filled in a special questionnaire. Finally the collected data were entered into computer and analyzed by SPSS ver. 20 software. Results: The frequency distribution of TTP-based pregnancy outcome showed that TTP >48 weeks was higher in normal delivery than in abnormal delivery (5.6% vs. 19.4%). According to Chi-square test, the frequency distribution of pregnancy outcome was related to TTP (P < 0.001). Conclusion: According to the results of this study, there is a significant relationship between TTP and pregnancy outcome, and TTP may lead to unwanted complications such as ectopic pregnancy, preterm labor, and abortion. Thus, all women with a long time of contraception, especially in the rural areas, mast be controlled.
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Affiliation(s)
- Hatave Ghasemi Tehrani
- Department of Obstetrics and Gynecology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Sadat Allameh
- Department of Obstetrics and Gynecology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Koushki Mehrabi
- Department of Biostatistics, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Buck Louis GM. Persistent environmental pollutants and couple fecundity: an overview. Reproduction 2014; 147:R97-R104. [PMID: 24310101 DOI: 10.1530/rep-13-0472] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Speculation has arisen that human fecundity may be declining, possibly a function of exposure to persistent environmental chemicals that resist degradation resulting in various pathways for human exposure. In contrast to considerable animal evidence suggesting adverse effects of such chemicals on reproduction, limited human research has been undertaken. To date, available data stem largely from ten unique study cohorts that have quantified individual chemical exposures in relation to time-to-pregnancy (TTP), which is a measure of couple fecundity. Diminished fecundability odds ratios indicative of longer TTP were observed in all but two studies, although not all findings achieved statistical significance. Persistent chemicals associated with reduced couple fecundity as measured by a longer TTP included βHCH, cadmium, lead, mercury, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene, TCCD dioxin, and select polybrominated diethers, polychlorinated biphenyls, and perfluorochemicals. Important methodologic limitations need to be considered in weighing the evidence: i) reliance on pregnant women, which may exclude women with the highest exposures if related to the inability to conceive; ii) retrospectively reported TTP, which may be associated with bidirectional reporting errors; and iii) limited attention to male partners or couples' exposures. While current evidence is not inconsistent with animal evidence, concerted efforts to address lingering data gaps should include novel strategies for recruiting couples, the longitudinal measurement of TTP, and the continued enrollment of couples across successive pregnancies. This latter strategy will provide a more complete understanding of the toxicokinetics of chemicals during sensitive windows and their implications for fecundity and its related impairments.
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Affiliation(s)
- Germaine M Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd., Room 7B03, Rockville, Maryland 20852, USA
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Buck Louis GM, Sundaram R, Sweeney AM, Schisterman EF, Maisog J, Kannan K. Urinary bisphenol A, phthalates, and couple fecundity: the Longitudinal Investigation of Fertility and the Environment (LIFE) Study. Fertil Steril 2014; 101:1359-66. [PMID: 24534276 DOI: 10.1016/j.fertnstert.2014.01.022] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the relationship between environmental chemicals and couple fecundity or time to pregnancy (TTP). DESIGN Prospective cohort. SETTING Communities of targeted populations with reported exposure. PATIENT(S) 501 couples recruited upon discontinuing contraception to become pregnant, 2005-2009. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Fecundability odds ratios (FORs) and 95% confidence intervals (CIs) estimated for each partner's chemical concentrations adjusted for age, body mass index, cotinine, creatinine, and research site while accounting for time off contraception. RESULT(S) Couples completed interviews and anthropometric assessments and provided the urine specimens for quantification of bisphenol A (BPA) and 14 phthalate metabolites, which were measured using high-performance liquid chromatography with electrospray triple-quadrupole mass spectrometer. Women recorded menstruation and pregnancy test results in daily journals. Couples were evaluated until a positive human-chorionic gonadotropin pregnancy test or 12 cycles without pregnancy. Neither female nor male BPA concentration was associated with TTP (FOR 0.98; 95% CI, 0.86, 1.13 and FOR 1.04; 95% CI, 0.91, 1.18, respectively). Men's urinary concentrations of monomethyl, mono-n-butyl, and monobenzyl phthalates were associated with a longer TTP (FOR 0.80; 95% CI, 0.70, 0.93; FOR 0.82, 95% CI, 0.70, 0.97; and FOR 0.77, 95% CI, 0.65 0.92, respectively). CONCLUSION(S) Select male but not female phthalate exposures were associated with an approximately 20% reduction in fecundity, underscoring the importance of assessing both partners' exposure to minimize erroneous conclusions.
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Affiliation(s)
- Germaine M Buck Louis
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland.
| | - Rajeshwari Sundaram
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Anne M Sweeney
- Department of Epidemiology and Biostatistics, Texas A&M Rural School of Public Health, College Station, Texas
| | - Enrique F Schisterman
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - José Maisog
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
| | - Kurunthachalam Kannan
- Division of Environmental Health Sciences, Wadsworth Center, New York State Department of Health and the Department of Environmental Health Sciences, The University at Albany, Albany, New York
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Garlantézec R, Warembourg C, Monfort C, Labat L, Pulkkinen J, Bonvallot N, Multigner L, Chevrier C, Cordier S. Urinary glycol ether metabolites in women and time to pregnancy: the PELAGIE cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:1167-73. [PMID: 23838187 PMCID: PMC3801453 DOI: 10.1289/ehp.1206103] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 07/08/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Glycol ethers are present in a wide range of occupational and domestic products. Animal studies have suggested that some of them may affect ovarian function. OBJECTIVE We examined the relation between women's exposure to glycol ethers and time to pregnancy. METHODS We used chromatography coupled to mass spectrometry to measure eight glycol ether metabolites in urine samples from randomly selected women in the PELAGIE mother-child cohort who had samples collected before 19 weeks of gestation. Using time to pregnancy information collected at the beginning of the pregnancy (women were asked how many months it took for them to conceive), we estimated associations between metabolite levels and time to pregnancy in 519 women with complete data using discrete-time Cox proportional hazards models to adjust for potential confounders. RESULTS We detected glycol ether metabolites in 6% (for ethoxyacetic acid) to 93% (for phenoxyacetic and butoxyacetic acids) of urine samples. Phenoxyacetic acid was the only metabolite with a statistically significant association with longer time to pregnancy [fecundability OR = 0.82; 95% CI: 0.63, 1.06 for the second and third quartile combined; fecundability OR = 0.70; 95% CI: 0.52, 0.95 for a fourth-quartile (≥ 1.38 mg/L) vs. first-quartile concentration (< 0.14 mg/L)]. This association remained stable after multiple sensitivity analyses. CONCLUSION Phenoxyacetic acid, which was present in most of the urine samples tested in our study, was associated with increased time to pregnancy. This metabolite and its main parent compound, 2-phenoxyethanol, are plausible causes of decreased fecundability, but they may also be surrogates for potential coexposures to compounds frequently present in cosmetics.
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Affiliation(s)
- Ronan Garlantézec
- INSERM (Institut national de la santé et de la recherche médicale), U1085 IRSET (Institut de Recherche en Santé, Environnement et Travail), Rennes, France
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Attarchi M, Darkhi H, Khodarahmian M, Dolati M, Kashanian M, Ghaffari M, Mirzamohammadi E, Mohammadi S. Characteristics of menstrual cycle in shift workers. Glob J Health Sci 2013; 5:163-72. [PMID: 23618486 PMCID: PMC4776814 DOI: 10.5539/gjhs.v5n3p163] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 02/28/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In this study, the characteristics of menstrual cycle in shift workers employed in the pharmaceutical industry are investigated. METHOD This study was conducted in a pharmaceutical industrial complex in Tehran in 2012. 406 female workers in packaging units were studied on the menstrual cycle characteristics. The studied workers were divided into two groups of shift workers and non-shift workers and were compared in terms of the frequency of menstrual disorder (short-term cycle, long-term cycle, irregular cycle and bleeding during menstrual cycle) as well as hormonal values (FSH, LH, TSH, and Prolactin). RESULTS The odds ratio (OR) for menstrual disorder in the shift workers was 5.54 (95% CI=2.78-11.02) compared to the non-shift workers. The mean difference of hormonal values (except prolactin) between shift workers and non-shift workers was not significant (P>0.05). CONCLUSION This study suggests that shift work may disrupt the menstrual cycle.
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Affiliation(s)
- Mirsaeed Attarchi
- Occupational Medicine Department- School of Medicine- Tehran University of Medical Sciences, Terhan, Iran.
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Mikkelsen EM, Riis AH, Wise LA, Hatch EE, Rothman KJ, Sørensen HT. Pre-gravid oral contraceptive use and time to pregnancy: a Danish prospective cohort study. Hum Reprod 2013; 28:1398-405. [PMID: 23427234 DOI: 10.1093/humrep/det023] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Is there an association between oral contraceptive (OC) use (age at the start of use, duration of use, ethinylestradiol dose and generation) and time to pregnancy (TTP)? SUMMARY ANSWER Although OC use was associated with a transient delay in the return of fertility, we found no evidence that long-term OC use deleteriously affects fecundability. WHAT IS KNOWN ALREADY Studies using retrospective data on TTP have reported a short-term delay in the return of fertility after OC use. However, little is known about the long-term OC use and TTP. STUDY DESIGN, SIZE, DURATION Data were derived from 'Snart Gravid.dk', a prospective cohort study that enrolled participants from 1 June 2007 to 31 May 2010. The final study population consisted of 3727 women. PARTICIPANTS, SETTING, METHODS Eligible women were Danish pregnancy planners, aged 18-40 years, who completed a baseline questionnaire and bimonthly follow-up questionnaires until conception or for 12 months, whichever came first. Cohort retention was 80%. We used proportional probability regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), with adjustment for potential confounders. MAIN RESULTS AND ROLE OF CHANCE Compared with barrier methods, the use of OCs as the last contraception method before attempting to conceive was associated with a short-term delay in return of fertility (FR = 0.87, 95% CI: 0.79-0.96). Longer term OC use was associated with higher fecundability: compared with OC use for less than 2 years; FRs were 0.98 (95% CI: 0.83-1.15) for 2-3 years, 1.16 (95% CI: 0.98-1.37) for 4-5 years, 1.10 (95% CI: 0.93-1.29) for 6-7 years, 1.17 (95% CI: 0.99-1.38) for 8-9 years, 1.23 (95% CI: 1.04-1.46) for 10-11 years and 1.28 (95% CI: 1.07-1.53) for ≥12 years of OC use. LIMITATIONS, REASONS FOR CAUTION Because this was a non-experimental study, where study volunteers provided information about their history of contraceptive use at baseline and were followed prospectively to assess their waiting times to pregnancy, there was some potential for error in the reporting of OC use and TTP. Nevertheless, participants reported data on OC use before the occurrence of pregnancy, thereby reducing the potential for systematic bias. WIDER IMPLICATIONS OF THE FINDINGS Women who have used OCs for many years should be reassured as there was no evidence that long-term OC use has a deleterious affects on fecundability. Both short- and long-term OC users are likely to experience a transient delay in conception compared with those discontinuing barrier methods. STUDY FUNDING This study was supported by the National Institute of Child Health and Human Development (R21050264) and the Danish Medical Research Council (271-07-0338). The authors declare that there are no conflicts of interest.
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Affiliation(s)
- Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N 8200, Denmark.
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Steiner AZ, Long DL, Herring AH, Kesner JS, Meadows JW, Baird DD. Urinary follicle-stimulating hormone as a measure of natural fertility in a community cohort. Reprod Sci 2012; 20:549-56. [PMID: 23171685 DOI: 10.1177/1933719112459226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High serum follicle-stimulating hormone (FSH) levels have been associated with diminished ovarian reserve; however, the association between high urinary FSH and reduced natural fertility has yet to be established. We sought to characterize the relationship between a single or multiple measurements of early follicular phase urinary FSH and fertility. Women (n = 209), 30 to 44 years old with no history of infertility, who had been trying to conceive for less than 3 months, provided early follicular phase urine. Participants subsequently kept a diary to record bleeding and intercourse and conducted standardized pregnancy testing for up to 6 months. A subset of women (N = 95) collected urine on cycle day 3 for up to 6 cycles. Urine was analyzed for FSH and creatinine (cr) corrected. Proportional hazard models were used to calculate fecundability ratios (FRs). Urinary FSH levels across cycles from the same woman were highly correlated (adjusted intraclass correlation = .77); within-woman variance was 3-fold lower than variance among women. Women with an initial urinary FSH level <7 mIU/mg cr exhibited a nonsignificant reduction in the probability of pregnancy (adjusted FR 0.71, 95% confidence interval [CI]: 0.45-1.13), as did women with elevated urinary FSH (≥12 mIU/mg cr; adjusted FR 0.78, 95% CI: 0.46-1.32). Using the most recent or maximum urinary FSH value did not strengthen the association. In the general population, urinary FSH levels appear to be nonlinearly associated with fertility; however, broad CIs indicate a lack of statistical significance. Repetitive testing appears to be of little benefit.
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Affiliation(s)
- Anne Z Steiner
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
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Buck Louis GM, Sundaram R, Schisterman EF, Sweeney AM, Lynch CD, Gore-Langton RE, Chen Z, Kim S, Caldwell K, Barr DB. Heavy metals and couple fecundity, the LIFE Study. CHEMOSPHERE 2012; 87:1201-7. [PMID: 22309709 PMCID: PMC3327819 DOI: 10.1016/j.chemosphere.2012.01.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 01/02/2012] [Accepted: 01/03/2012] [Indexed: 05/19/2023]
Abstract
The effect of heavy metals at environmentally relevant concentrations on couple fecundity has received limited study despite ubiquitous exposure. In 2005-2009, couples (n=501) desiring pregnancy and discontinuing contraception were recruited and asked to complete interviews and to provide blood specimens for the quantification of cadmium (μg L(-1)), lead (μg dL(-1)) and mercury (μg L(-1)) using inductively coupled plasma-mass spectrometry. Couples completed daily journals on lifestyle and intercourse along with menstruation and pregnancy testing for women. Couples were followed for 12 months or until pregnant. Fecundability odds ratios (FORs) and 95% confidence intervals (CIs) were estimated adjusting for age, body mass index, cotinine, and serum lipids in relation to female then male exposures. FORs <1 denote a longer time to pregnancy. In adjusted models, reduced FORs were observed for both female cadmium (0.78; 95% CI 0.63-0.97) and male lead (0.85; 95% CI 0.73-0.98) concentrations. When jointly modeling couples' exposures, only male lead concentration significantly reduced the FOR (0.82; 95% CI 0.68, 0.97), though the FOR remained <1 for female cadmium (0.80; 95% CI 0.64, 1.00). This prospective couple based cohort with longitudinal capture of time to pregnancy is suggestive of cadmium and lead's reproductive toxicity at environmentally relevant concentrations.
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Affiliation(s)
- Germaine M. Buck Louis
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Rajeshwari Sundaram
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Enrique F. Schisterman
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Anne M. Sweeney
- Texas A & M Health Science Center, School of Rural Public Health
| | - Courtney D. Lynch
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine
| | | | - Zhen Chen
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Sungduk Kim
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd., Room 7B05, Rockville, Maryland 20852
| | - Kathleen Caldwell
- Division of Laboratory Science, National Center for Environmental Health, Centers for Disease Control and Prevention
| | - Dana Boyd Barr
- Department of Environmental and Occupational Health, Rollins School of Public Health of Emory University
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Snijder CA, te Velde E, Roeleveld N, Burdorf A. Occupational exposure to chemical substances and time to pregnancy: a systematic review. Hum Reprod Update 2012; 18:284-300. [DOI: 10.1093/humupd/dms005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McLain AC, Sundaram R, Buck Louis GM. Modeling fecundity in the presence of a sterile fraction using a semi-parametric transformation model for grouped survival data. Stat Methods Med Res 2012; 25:22-36. [PMID: 22374340 DOI: 10.1177/0962280212438646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The analysis of fecundity data is challenging and requires consideration of both highly timed and interrelated biologic processes in the context of essential behaviors such as sexual intercourse during the fertile window. Understanding human fecundity is further complicated by presence of a sterile population, i.e. couples unable to achieve pregnancy. Modeling techniques conducted to date have largely relied upon discrete time-to-pregnancy survival or day-specific probability models to estimate the determinants of time-to-pregnancy or acute effects, respectively. We developed a class of semi-parametric grouped transformation cure models that capture day-level variates purported to affect the cycle-level hazards of conception and, possibly, sterility. Our model's performance is assessed using simulation and longitudinal data from one of the few prospective cohort studies with preconception enrollment of women followed for 12 menstrual cycles at risk for pregnancy.
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Affiliation(s)
- Alexander C McLain
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA
| | - Rajeshwari Sundaram
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA
| | - Germaine M Buck Louis
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA
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Møller UK, Streym S, Heickendorff L, Mosekilde L, Rejnmark L. Effects of 25OHD concentrations on chances of pregnancy and pregnancy outcomes: a cohort study in healthy Danish women. Eur J Clin Nutr 2012; 66:862-8. [PMID: 22378226 DOI: 10.1038/ejcn.2012.18] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND/OBJECTIVES Plasma 25-hydroxyvitamin D (P-25OHD) concentrations may affect pregnancy outcomes. To elucidate this further, we studied the effects of pre-conception P-25OHD concentrations on chances for pregnancy as well as the effects of P-25OHD during pregnancy on the risk of miscarriage, birth weight and length, Apgar score and head circumference. Moreover, we studied whether pregnancy and breastfeeding patterns affect maternal P-25OHD concentrations. SUBJECTS/METHODS A total of 153 healthy Caucasian women with pregnancy plans were followed with measurements performed before pregnancy, at pregnancy weeks 11±2, 22±1 and 35±2 as well as 15±7, 129±12 and 280±15 days postpartum. Furthermore, 75 non-pregnant, age-matched women were followed in parallel as controls. RESULTS The 203 women were aged 29 (25-35) years. At baseline, median P-25OHD was 59 nmol/l. Of these women, 31% had P-25OHD <50 nmol/l, whereas 12% had levels above 80 nmol/l. Within ∼6 months after inclusion, 63% conceived. P-25OHD was not associated with chances of conceiving or overall risk of miscarriage. However, women with a miscarriage in their second trimester (n=3) had lower P-25OHD concentrations at measurements performed in the first trimester compared with women without a miscarriage (P=0.03). P-25OHD before or during pregnancy was not associated with gestational length or infant parameters. Adjustments for possible confounders did not change the result. During pregnancy, P-25OHD changed significant over time, but similar changes occurred within the control group, indicating no effect of pregnancy per se (P=0.59). Overall, P-25OHD did not differ according to length of breastfeeding at 2 weeks, and 4 and 9 months postpartum, although women breastfeeding for >9 months had lower P-25OHD levels at the last visit compared with the controls. CONCLUSION P-25OHD concentrations did not affect fertility or pregnancy outcomes, although low P-25OHD may be associated with an increased risk of late miscarriage.
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Affiliation(s)
- U K Møller
- Department of Internal Medicine and Endocrinology, THG, Aarhus University Hospital, Aarhus, Denmark.
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Abstract
BACKGROUND Shift workers who experience sleep disturbances and exposure to light at night could be at increased risk for alterations in physiologic functions that are circadian in nature. METHODS We investigated rotating shift work and menstrual cycle patterns in the Nurses' Health Study II using cross-sectional data collected in 1993 from 71,077 nurses aged 28-45 years who were having menstrual periods and were not using oral contraceptives. Log-binomial regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs). RESULTS Eight percent of participants reported working rotating night shifts for 1-9 months, 4% for 10-19 months, and 7% for 20+ months during the previous 2 years. Irregular cycles (>7 days variability) were reported by 10% of participants. Seventy percent of women reported menstrual cycles of 26-31 days, 1% less than 21 days, 16% 21-25 days, 11% 32-39 days, and 1% 40+ days. Women with 20+ months of rotating shift work were more likely to have irregular cycles (adjusted RR = 1.23 [CI = 1.14-1.33]); they were also more likely to have cycle length <21 days (1.27 [0.99-1.62]) or 40+ days (1.49 [1.19-1.87]) (both compared with 26-31 days). For irregular patterns and for 40+ day cycles, there was evidence of a dose response with increasing months of rotating shift work. Moderately short (21-25 days) or long (32-39 days) cycle lengths were not associated with rotating shift work. CONCLUSIONS Shift work was modestly associated with menstrual function, with possible implications for fertility and other cycle-related aspects of women's health.
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Louis GMB, Lum KJ, Sundaram R, Chen Z, Kim S, Lynch CD, Schisterman EF, Pyper C. Stress reduces conception probabilities across the fertile window: evidence in support of relaxation. Fertil Steril 2011; 95:2184-9. [PMID: 20688324 PMCID: PMC2975045 DOI: 10.1016/j.fertnstert.2010.06.078] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 06/21/2010] [Accepted: 06/22/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess salivary stress biomarkers (cortisol and α-amylase) and female fecundity. DESIGN Prospective cohort design. SETTING United Kingdom. PATIENT(S) 274 women aged 18 to 40 years who were attempting pregnancy. INTERVENTION(S) Observation for six cycles or until pregnancy: women collected basal saliva samples on day 6 of each cycle, and used fertility monitors to identify ovulation and pregnancy test kits for pregnancy detection. MAIN OUTCOME MEASURE(S) Salivary cortisol (μg/dL) and α-amylase (U/mL) concentration measurements; fecundity measured by time-to-pregnancy and the probability of pregnancy during the fertile window as estimated from discrete-time survival and Bayesian modeling techniques, respectively. RESULT(S) Alpha-amylase but not cortisol concentrations were negatively associated with fecundity in the first cycle (fecundity odds ratio=0.85; 95% confidence interval 0.67, 1.09) after adjusting for the couples' ages, intercourse frequency, and alcohol consumption. Statistically significant reductions in the probability of conception across the fertile window during the first cycle attempting pregnancy were observed for women whose salivary concentrations of α-amylase were in the upper quartiles in comparison with women in the lower quartiles (highest posterior density: -0.284; 95% interval -0.540, -0.029). CONCLUSION(S) Stress significantly reduced the probability of conception each day during the fertile window, possibly exerting its effect through the sympathetic medullar pathway.
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Affiliation(s)
- Germaine M Buck Louis
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland 20852, USA.
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Tough SC, Siever JE, Jack M. Reproductive Assistance, Emotional Health, Obesity, and Time to Pregnancy Among Women Under 35 Years of Age. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:1153-1162. [DOI: 10.1016/s1701-2163(16)34739-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE Increasing use of infertility treatment and a decline in demographic fertility in some countries have raised concern whether human fecundity is declining or has declined over time. A dramatic decline in semen quality over the past half-century has been proposed and widely discussed, but none of the existing studies provide data good enough for coming to any firm conclusion. RESULTS Results from 19 articles published during the last 5 years on semen quality and fecundity, covering data from the Nordic countries since the year 2000, do not indicate an ongoing decline in fertility. CONCLUSION We will probably never know, whether semen quality and fecundity has declined over time, but we may be able to monitor biological fecundity and semen quality over time from now on. There are both research initiatives and interest from official channels that could provide more funding for infertility research.
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Affiliation(s)
- Jørn Olsen
- Department of Epidemiology, Institute of Public Health, University of Aarhus, Aarhus, Denmark
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Ganaba R, Marshall T, Sombié I, Baggaley RF, Ouédraogo TW, Filippi V. Women's sexual health and contraceptive needs after a severe obstetric complication ("near-miss"): a cohort study in Burkina Faso. Reprod Health 2010; 7:22. [PMID: 20799964 PMCID: PMC2939513 DOI: 10.1186/1742-4755-7-22] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 08/27/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the reproductive health of women who survive obstetric complications in poor countries. Our aim was to determine how severe obstetric complications in Burkina Faso affect reproductive events in the first year postpartum. METHODS Data were collected from a prospective cohort of women who either experienced life threatening (near-miss) pregnancy-related complications or an uncomplicated childbirth, followed from the end of pregnancy to one year postpartum or post-abortum. Documented outcomes include menses resumption, sexual activity resumption, dyspareunia, uptake of contraceptives, unmet needs for contraception and women's reproductive intentions.Participants were recruited in seven hospitals between December 2004 and March 2005 in six towns in Burkina Faso. RESULTS Reproductive events were associated with pregnancy outcome. The frequency of contraceptive use was low in all groups and the method used varied according to the presence or not of a live baby. The proportion with unmet need for contraception was high and varied according to the time since end of pregnancy. Desire for another pregnancy was highest among near-miss women with perinatal death or natural abortion. Women in the near-miss group with induced abortion, perinatal death and natural abortion had significantly higher odds of subsequent pregnancy. Unintended pregnancies were observed mainly in women in the near-miss group with live birth and the uncomplicated delivery group. CONCLUSIONS Considering the potential deleterious impact (on health and socio-economic life) of new pregnancies in near-miss women, it is important to ensure family planning coverage includes those who survive a severe complication.
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Affiliation(s)
- Rasmané Ganaba
- Agence de Formation, de Recherche et d'Expertise en Santé pour l'Afrique (AFRICSanté), 01 BP 298 Bobo-Dioulasso, Burkina Faso.
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Raatikainen K, Harju M, Hippeläinen M, Heinonen S. Prolonged time to pregnancy is associated with a greater risk of adverse outcomes. Fertil Steril 2010; 94:1148-51. [DOI: 10.1016/j.fertnstert.2009.10.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 10/27/2009] [Accepted: 10/30/2009] [Indexed: 10/20/2022]
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Bunting L, Boivin J. Development and preliminary validation of the fertility status awareness tool: FertiSTAT. Hum Reprod 2010; 25:1722-33. [PMID: 20410218 DOI: 10.1093/humrep/deq087] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of our research was to create a fertility status awareness tool (FertiSTAT) that would enable women to gain personalized guidance about reducing risks to their fertility and seeking timely fertility medical advice based on their own lifestyle and reproductive profile. METHODS Independent risk factors associated with female fertility impairment were identified. Associations between risk indicator and fertility status were examined in 1073 women who completed the Fertility Risk Factors Survey (FRFS) online or in pregnancy termination, antenatal or infertility clinics in the UK, consisting of the FertiSTAT indicators; 49.58% (n = 532) were currently pregnant (78.82% > or = 12 weeks pregnant) and 15.66% (n = 168) were currently infertile (trying to conceive >12 or 6 months if >34 years of age). RESULTS Twenty-two risk factors were identified from the literature review and expert Delphi consultation. Prevalence of risk factors in the validation sample was similar to general population. Most risks were independently associated with fertility status in logistic regressions and in the expected direction. Discriminant analysis demonstrated that the set of FertiSTAT indicators could correctly classify whether women were currently pregnant or infertile [chi(2)(19) = 204.209, P < 0.001] with a correct classification rate for the overall sample of 85.8% (326/380), 91.0% (n = 243/267) for the currently pregnant and 73.5% (n = 83/113) for the currently infertile. CONCLUSIONS The main result was the generation of a self-administered, multifactorial tool that can enable women to get personalized fertility guidance. This research and the FertiSTAT provide foundational work for public health campaigns to increase awareness about fertility health.
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Affiliation(s)
- L Bunting
- School of Psychology, Cardiff University, Tower Building, Park Place, Wales CF10 3AT, UK
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Sanin LH, Carrasquilla G, Solomon KR, Cole DC, Marshall EJP. Regional differences in time to pregnancy among fertile women from five Colombian regions with different use of glyphosate. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2009; 72:949-60. [PMID: 19672763 DOI: 10.1080/15287390902929691] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The objective of this study was to test whether there was an association between the use of glyphosate when applied by aerial spray for the eradication of illicit crops (cocaine and poppy) and time to pregnancy (TTP) among fertile women. A retrospective cohort study (with an ecological exposure index) of first pregnancies was undertaken in 2592 fertile Colombian women from 5 regions with different uses of glyphosate. Women were interviewed regarding potential reproductive, lifestyle, and work history predictors of TTP, which was measured in months. Fecundability odds ratios (fOR) were estimated using a discrete time analogue of Cox's proportional hazard model. There were differences in TTP between regions. In the final multivariate model, the main predictor was the region adjusted by irregular relationship with partner, maternal age at first pregnancy, and, marginally, coffee consumption and self-perception of water pollution. Boyaca, a region with traditional crops and. recently, illicit crops without glyphosate eradication spraying (manual eradication), displayed minimal risk and was the reference region. Other regions, including Sierra Nevada (control area, organic agriculture), Putumayo and Narino (illicit crops and intensive eradication spray program), and Valle del Cauca, demonstrated greater risk of longer TTP, with the highest risk for Valle del Cauca (fOR 0.15, 95% CI 0.12, 0.18), a sugar-cane region with a history of use of glyphosate and others chemicals for more than 30 yr. The reduced fecundability in some regions was not associated with the use of glyphosate for eradication spraying. The observed ecological differences remain unexplained and may be produced by varying exposures to environmental factors, history of contraceptive programs in the region, or psychological distress. Future studies examining these or other possible causes are needed.
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Buck Louis GM, Dmochowski J, Lynch C, Kostyniak P, McGuinness BM, Vena JE. Polychlorinated biphenyl serum concentrations, lifestyle and time-to-pregnancy. Hum Reprod 2008; 24:451-8. [PMID: 18940895 DOI: 10.1093/humrep/den373] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Consumption of fish contaminated with polychlorinated biphenyls (PCBs) and prenatal PCB serum concentrations have been associated with a longer time-to-pregnancy (TTP). However, the relationship between preconception serum PCBs concentrations and TTP has not been previously studied. METHODS Eighty-three women (contributing 442 menstrual cycles) planning pregnancies completed daily diaries regarding menstruation, intercourse, home pregnancy test results, and reported use of alcohol and cigarettes. TTP denoted the number of observed menstrual cycles required for pregnancy. Preconception blood specimens underwent toxicologic analysis for 76 PCB congeners via gas chromatography with electron capture; serum lipids were quantified with enzymatic methods. A priori, PCB congeners were summed into a total and three groupings-estrogenic, anti-estrogenic and other-and entered into discrete analogs of Cox models with time-varying covariates to estimate fecundability odds ratios (FOR) and corresponding 95% confidence intervals (CIs). RESULTS Estrogenic and anti-estrogenic PCB concentrations (ng/g serum) conferred reduced FORs in fully adjusted models (0.32; 95% CI 0.03, 3.90 and 0.01: 95% CI < 0.00, 1.99, respectively). Reduced FORs (0.96) were observed for alcohol consumption standardized to a 28-day menstrual cycle in the same adjusted model (FOR = 0.96; 95% CI 0.93, 1.00). CONCLUSIONS These data suggest that environmental exposures including those amenable to change, such as alcohol consumption, may impact female fecundity. The findings are sensitive to model specification and PCB groupings, underscoring the need to further assess the impact of chemical mixtures on sensitive reproductive outcomes, such as TTP, especially in the context of lifestyle factors which are amenable to change, thereby improving reproductive health.
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Affiliation(s)
- G M Buck Louis
- Epidemiology Branch, Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health & Human Development, 6100 Executive Blvd, Rm. 7B03, Rockville, MD 20852, USA
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Abstract
BACKGROUND Laboratory evidence suggests tap water disinfection by-products (DBPs) could have an effect very early in pregnancy, typically before clinical detectability. Undetected early losses would be expected to increase the reported number of cycles to clinical pregnancy. METHODS We investigated the association between specific DBPs (trihalomethanes, haloacetic acids, brominated-trihalomethanes, brominated-haloacetic acids, total organic halides, and bromodichloromethane) and time to pregnancy among women who enrolled in a study of drinking water and reproductive outcomes. We quantified exposure to DBPs through concentrations in tap water, quantity ingested through drinking, quantity inhaled or absorbed while showering or bathing, and total integrated exposure. The effect of DBPs on time to pregnancy was estimated using a discrete time hazard model. RESULTS Overall, we found no evidence of an increased time to pregnancy among women who were exposed to higher levels of DBPs. A modestly decreased time to pregnancy (ie, increased fecundability) was seen among those exposed to the highest level of ingested DBPs, but not for tap water concentration, the amount absorbed while showering or bathing, or the integrated exposure. CONCLUSIONS Our findings extend those of a recently published study suggesting a lack of association between DBPs and pregnancy loss.
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