Day-specific probabilities of conception in fertile cycles resulting in spontaneous pregnancies

Addendum to: The relationship between sperm nuclear DNA fragmentation, mitochondrial DNA fragmentation and copy number in normal and abnormal human ejaculates

BACKGROUND

While the kinetics of human sperm nuclear DNA fragmentation (SDF-nDNA) following ejaculation have been described, the dynamics and relationships of mitochondrial DNA copy number per spermatozoon (mtDNAcn) and fragmentation (SDF-mtDNA) remain unexplored.

OBJECTIVES

To compare post-ejaculatory kinetics of mtDNAcn, SDF-mtDNA and SDF-nDNA, global, single-strand DNA breaks (SDF-SSBs) and double-strand DNA breaks (SDF-DSBs) in normozoospermic and non-normozoospermic samples.

MATERIALS AND METHODS

28 normozoospermic and 43 non-normozoospermic ejaculates were evaluated at 0, 6, 24 and 48 h of incubation in vitro. SDF-nDNA was determined by sperm chromatin dispersion (SCD) assays. mtDNAcn and SDF-mtDNA were analysed by dPCR.

RESULTS

SDF-nDNA-global values increased as a consequence of quadratic SDF-SSBs and linear SDF-DSBs kinetics. Non-normozoospermic samples showed a slower SDF-global rate between 6-24 h, due to lesser SSBs production. Regarding SDF-DSBs, non-normozoospermic samples exhibited a faster initial increase rate, followed by a slower final increment. The mtDNAcn median value decreased linearly, being 3.2× higher in non-normozoospermics at all time points; mtDNAcn in both cohorts reduced to half of the baseline by 48 h. mtDNAcn was identified as a risk factor for discriminating non-normozoospermia, a finding that was further strengthen when combined with SDF-Global or SDF-DSBs values. SDF-mtDNA frequencies were identical, increasing over time correspondingly in both cohorts. The mtDNA fragmentation rate was initially fast, decreasing progressively with time for both cohorts; half of the initially unfragmented copies were fragmented after 48 h. Rates of mtDNAcn loss and SDF-mtDNA increase were only marginally correlated with the rates of nuclear fragmentation.

CONCLUSION

mtDNA fragmentation and loss occur post ejaculation. Their dynamics are likely to be associated with different and/or uncoupled mechanisms to that which cause nuclear DNA fragmentation. Our results indicate that while mtDNA fragmentation is not influenced by the sperm quality, the number of copies of sperm mtDNAcn can potentially serve as a risk factor for predicting non-normozoospermia.

Ovulatory cycle shifts in human motivational prioritisation of sex and food

Previous research on the endogenous effects of ovarian hormones on motivational states in women has focused on sexual motivation. The Motivational Priority Shifts Hypothesis has a broader scope. It predicts a shift from somatic to reproductive motivation when fertile. In a highly powered preregistered online diary study across 40 days, we tested whether 390 women report such an ovulatory shift in sexual and eating motivation and behaviour. We compared 209 naturally cycling women to 181 women taking hormonal contraceptives (HC) to rule out non-ovulatory changes across the cycle as confounders. We found robust ovulatory decreases in food intake and increases in general sexual desire, in-pair sexual desire and initiation of dyadic sexual behaviour. Extra-pair sexual desire increased mid-cycle, but the effect did not differ significantly in HC women, questioning an ovulatory effect. Descriptively, solitary sexual desire and behaviour, dyadic sexual behaviour, appetite, and satiety showed expected mid-cycle changes that were diminished in HC women, but these failed to reach our strict preregistered significance level. Our results provide insight into current theoretical debates about ovulatory cycle shifts while calling for future research to determine motivational mechanisms behind ovulatory changes in food intake and considering romantic partners' motivational states to explain the occurrence of dyadic sexual behaviour.

Alterations in sperm DNA methylation may as a mediator of paternal air pollution exposure and offspring birth outcomes: Insight from a birth cohort study

Paternal exposure to environmental risk factors influences the offspring health. This study aimed to evaluate the association between paternal air pollution exposure mediated by sperm DNA methylation and adverse birth outcomes in offspring. We recruited 1607 fertile men and their partners from 2014 to 2016 and collected semen samples to detect sperm DNA methylation. Multivariate linear regression and weighted quantile sum regression models were used to assess the associations between paternal air pollution exposure and offspring birth outcomes. A critical exposure window was identified. Reduced representation bisulfite sequencing was used to detect sperm DNA methylation. The results demonstrated that high paternal exposure to PM2.5 (β = -211.31, 95% CI: (-386.37, -36.24)), PM10 (β = -178.20, 95% CI: (-277.13, -79.27)), and NO2 (β = -84.22, 95% CI: (-165.86, -2.57)) was negatively associated with offspring's birthweight, especially in boys. Additionally, an early exposure window of 15-69 days before fertilization was recognized to be the key exposure window, which increased the risk of low birth weight and small for gestational age. Furthermore, paternal co-exposure to six air pollutants contributed to lower birthweight (β = -51.91, 95% CI: (-92.72, -11.10)) and shorter gestational age (β = -1.72, 95% CI: (-3.26, -0.17)) and PM2.5 was the most weighted pollutant. Paternal air pollution exposure resulted in 10,328 differentially methylated regions and the IGF2R gene was the key gene involved in the epigenetic process. These differentially methylated genes were predominantly associated with protein binding, transcriptional regulation, and DNA templating. These findings indicate that spermatogenesis is a susceptible window during which paternal exposure to air pollution affects sperm DNA methylation and the birth outcomes of offspring.

Toward an optimal contraception dosing strategy

Anovulation refers to a menstrual cycle characterized by the absence of ovulation. Exogenous hormones such as synthetic progesterone and estrogen have been used to attain this state to achieve contraception. However, large doses are associated with adverse effects such as increased risk for thrombosis and myocardial infarction. This study utilizes optimal control theory on a modified menstrual cycle model to determine the minimum total exogenous estrogen/progesterone dose, and timing of administration to induce anovulation. The mathematical model correctly predicts the mean daily levels of pituitary hormones LH and FSH, and ovarian hormones E2, P4, and Inh throughout a normal menstrual cycle and reflects the reduction in these hormone levels caused by exogenous estrogen and/or progesterone. Results show that it is possible to reduce the total dose by 92% in estrogen monotherapy, 43% in progesterone monotherapy, and that it is most effective to deliver the estrogen contraceptive in the mid follicular phase. Finally, we show that by combining estrogen and progesterone the dose can be lowered even more. These results may give clinicians insights into optimal formulations and schedule of therapy that can suppress ovulation.

Handsome or Rugged? : A Speed-Dating Study of Ovulatory Shifts in Women's Preferences for Masculinity in Men

We tested the good genes ovulatory shift hypothesis through speed-dating, an ecologically valid paradigm with real life consequences. Fifteen speed-dating sessions of 262 single Asian Americans were held. We analyzed 850 speed-dates involving 132 men and 100 normally ovulating women, finding ovulatory shifts in the desirability of men with more masculine facial measurements (smaller eye-mouth-eye angle, larger lower face to full face height ratio, and smaller facial width to lower face height ratio) in the predicted direction. However, there was no support for ovulatory shifts in preferences for men's self-reported height. In addition, the expected shifts were not found for women's second date offers to men. Therefore, with natural stimuli and in a competitive dating scenario, we partially replicated previously documented ovulatory shifts in women's preferences for men.

When fertile, women seek status via prestige but not dominance

Biological predictors of human dominance are hotly contested, with far-reaching implications for psychological sex differences and the placement of men and women in the social hierarchy. Most investigations have focused on dominance in men and testosterone, with diminished attention paid to dominance in women and other biological mechanisms. Investigating biological influences on other routes to status attainment popular among women-such as via prestige in addition to dominance-have also been neglected. Here, I examined whether status seeking via prestige and via dominance covaried with fertility probability in a citizen science project spanning 14 countries and 4 world regions. Across 4,179 observations, participants tracked their menstrual cycle characteristics, motivation for prestige and dominance, dominance contest outcomes, and three domains of self-esteem. Self-esteem is predicted by status within a group and helps individuals navigate social hierarchies. Bayesian mixed models controlling for menstruation indicated that the motivation to obtain status via prestige but not dominance peaked when conception was most likely, as did dominance contest losses and two self-esteem domains. Fertility appears to reorient female psychology toward prestige-based strategies to success, enhancing women's desire for social capital through influence and admiration but not through fear, coercion, or intimidation. These insights fundamentally advance the understanding of the biological correlates of status seeking among women. They further suggest that fertility motivates not only mating competition but gaining rank and positive regard in social hierarchies.

Ovarian hormones in relation to naturally cycling women's conception risk: Empirical evidence and implications for behavioral endocrinology

A substantial body of literature has examined how women's psychology and behavior vary as a function of conception risk across the ovarian cycle. These effects are widely believed to be outcomes of hormonal regulation, in particular effects of estrogens (E) and progesterone (P). Increasingly, researchers have sought to test predictions about how psychological processes or behavior vary as a function of conception risk by examining associations with estrogen (e.g., estradiol) and progesterone levels. Yet issues regarding how best to assess these associations arise. Should hormone levels be log-transformed? Do hormone ratios best capture their joint effects? How important are hormone interactions? How should outliers be treated? Across two large datasets, we examined hormonal predictors of conception risk, estimated from day of a luteinizing hormone (LH) surge. Log-transformed E and P levels predicted conception risk better than raw E and P levels did. The raw E/P ratio was a relatively poor predictor, whereas the log-transformed ratio (ln[E/P]) was a relatively good predictor. E × P interactions were detected but weak. Outliers were frequent, especially in distributions of raw hormone levels. Hormone measures predicted two psychological outcomes in these datasets-sexual desire and preferences for strength and muscularity-in parallel to how strongly they predicted conception risk. These results give rise to several recommendations regarding treatment of hormone measures and their use in analyses.

Fertility predicts self-development-oriented competitiveness in naturally cycling women but not hormonal contraceptive users

Objective

A growing body of research has begun investigating the relationship between hormones and female competitiveness. Many researchers have focused on the effect of the menstrual cycle and hormonal contraceptives. Despite many attempts at understanding hormone-behavior associations, contradictory findings have made it difficult to determine the existence of true effects. The aim of the current research was to use a robust methodological design to investigate the effect of fertility probability on four competitive orientations in naturally cycling women and hormonal contraceptive users.

Methods

Using a longitudinal diary study with over 3,900 observations from 21 countries, we explore the effect of fertility probability on four self-report competitive orientations after controlling for menstruation: self-developmental competition, hyper competitiveness, competition avoidance, and lack of interest toward competition.

Results

Using Bayesian estimation for ordinal mixed models, we found that fertility probability was associated with an increase in self-development competitiveness amongst naturally cycling women but not hormonal contraceptive users. We also found weak evidence that hormonal contraceptive users show reduced interest in competing compared to naturally cycling women. There were no other robust effects of fertility or hormonal contraceptive use.

Conclusions

These results suggest that fertility probability is associated with increased fluctuations in self-development competitive motivation and that hormonal contraceptives interfere with this effect. This research contributes to the growing body of literature suggesting that hormonal contraceptives may influence psychology and behavior by disrupting evolved hormonal mechanisms.

Men are not aware of and do not respond to their female partner's fertility status: Evidence from a dyadic diary study of 384 couples

Understanding how human mating psychology is affected by changes in female cyclic fertility is informative for comprehending the evolution of human reproductive behavior. Based on differential selection pressures between the sexes, men are assumed to have evolved adaptations to notice women's within-cycle cues to fertility and show corresponding mate retention tactics to secure access to their female partners when fertile. However, previous studies suffered from methodological shortcomings and yielded inconsistent results. In a large, preregistered online dyadic diary study (384 heterosexual couples), we found no compelling evidence that men notice women's fertility status (as potentially reflected in women's attractiveness, sexual desire, or wish for contact with others) or display mid-cycle increases in mate retention tactics (jealousy, attention, wish for contact or sexual desire towards female partners). These results extend our current understanding of the evolution of women's concealed ovulation and oestrus, and suggest that both might have evolved independently.

Hormonal contraceptives as disruptors of competitive behavior: Theoretical framing and review

Emerging evidence suggests that hormonal contraceptives (HCs) impact psychological outcomes through alterations in neurophysiology. In this review, we first introduce a theoretical framework for HCs as disruptors of steroid hormone modulation of socially competitive attitudes and behaviors. Then, we comprehensively examine prior research comparing HC users and non-users in outcomes related to competition for reproductive, social, and financial resources. Synthesis of 46 studies (n = 16,290) led to several key conclusions: HC users do not show the same menstrual cycle-related fluctuations in self-perceived attractiveness and some intrasexual competition seen in naturally-cycling women and, further, may show relatively reduced status- or achievement-oriented competitive motivation. However, there a lack of consistent or compelling evidence that HC users and non-users differ in competitive behavior or attitudes for mates or financial resources. These conclusions are tentative given the notable methodological limitations of the studies reviewed. Implications and recommendations for future research are discussed.

Menstrual Cycle Changes in Daily Sexual Motivation and Behavior Among Sexually Diverse Cisgender Women

We used a one-month daily diary assessment to measure menstrual cycle-related changes in same-gender and other-gender sexual motivation and behavior in 148 cisgender women (32% lesbian-identified, 35% bisexually identified, and 33% heterosexual-identified). Women with exclusive same-gender orientations reported increased motivation for same-gender sexual contact during the higher-fertility phase of the cycle, but women with exclusive other-gender orientations did not show a parallel increase in other-gender sexual motivation during the higher-fertility phase. Bisexually attracted women showed no phase-related changes in same-gender or other-gender sexual motivation, regardless of whether they generally preferred one gender versus the other. Rates of partnered sexual contact did not increase during the higher-fertility phase. During the 14 midcycle days during which we assayed salivary estrogen and testosterone, we found no significant associations between daily hormones and sexual motivation. However, daily estrogen levels were positively related to sexual behavior among women currently partnered with women, and negatively related to sexual behavior among women currently partnered with men. Our results suggest that traditional evolutionary models of menstrual cycle-related changes in sexual motivation do not adequately reflect the full range of cycle-related changes observed among sexually diverse women.

Women feel more attractive before ovulation: evidence from a large-scale online diary study

How attractive we find ourselves decides who we target as potential partners and influences our reproductive fitness. Self-perceptions on women's fertile days could be particularly important. However, results on how self-perceived attractiveness changes across women's ovulatory cycles are inconsistent and research has seldomly assessed multiple attractiveness-related constructs simultaneously. Here, we give an overview of ovulatory cycle shifts in self-perceived attractiveness, sexual desirability, grooming, self-esteem and positive mood. We addressed previous methodological shortcomings by conducting a large, preregistered online diary study of 872 women (580 naturally cycling) across 70 consecutive days, applying several robustness analyses and comparing naturally cycling women with women using hormonal contraceptives. As expected, we found robust evidence for ovulatory increases in self-perceived attractiveness and sexual desirability in naturally cycling women. Unexpectedly, we found moderately robust evidence for smaller ovulatory increases in self-esteem and positive mood. Although grooming showed an ovulatory increase descriptively, the effect was small, failed to reach our strict significance level of .01 and was not robust to model variations. We discuss how these results could follow an ovulatory increase in sexual motivation while calling for more theoretical and causally informative research to uncover the nature of ovulatory cycle shifts in the future.

The More Fertile, the More Creative: Changes in Women's Creative Potential across the Ovulatory Cycle

Creative thinking is a defining human feature. It provides novel solutions and as such undoubtedly has contributed to our survival. However, according to signaling theory, creativity could also have evolved through sexual selection as a potential fitness indicator. In our study, we tested one implication of this theory. Specifically, we hypothesized that if creativity can serve as a signal of women’s fitness, then we should observe an increase in creative thinking in the fertile phase of the ovulatory cycle compared to other non-fertile phases. In our study (N = 751), we tested creative potential throughout the ovulatory cycle. We found a positive correlation between the probability of conception and both creative originality and flexibility. Importantly, we also tested the mediating role of arousal in the relationship between the probability of conception and creative thinking. The results of our study are discussed in terms of signaling theory, through which women advertise their fitness with their creativity.

Post-conception heat exposure increases clinically unobserved pregnancy losses

Evidence of the relationship between temperature during pregnancy and human embryo mortality is limited. Most importantly, the literature lacks causal estimations and studies on early pregnancy losses. Here, we estimate the impact of early pregnancy temperature exposure on the clinically unobserved pregnancy loss rate. We use administrative data of clinically observed pregnancies from more than three decades for Hungary. We apply an empirical approach that allows us to infer the impact of temperature on the clinically unobserved pregnancy loss rate from the estimated effects on the clinically observed conception rate. The results show that exposure to hot temperatures during the first few weeks after the conception week increases the clinically unobserved pregnancy loss rate, whereas exposure to colder temperatures seems to decrease it. Importantly, the temperature-induced changes represent changes in the total number of pregnancy losses rather than a compositional change between clinically observed and clinically unobserved pregnancy losses.

Self-Deception about Fecundity in Women : Modeling the Burley Hypothesis

Concealed fecundity and extended female sexual receptivity have evolved in some primates, including humans, conferring advantages both within primarily monogamous relationships (e.g., benefits from paternity assurance) and from extrapair liaisons (e.g., better access to good genes). As humans evolved the intellectual capacity for decision-making, women became capable of altering their own fertility. In some circumstances, they may choose to ameliorate risks and responsibilities associated with pregnancy by reducing sexual motivation near the perceived most fecund time of their menstrual cycle. But three findings-a general inability of women to accurately recognize their own intervals of fecundity, high variability in ovulation timing, and unconscious transmission and reception of cues associated with fecundity-constitute a physiological and behavioral syndrome that can be considered self-deception. In this study, I develop a descriptive model to determine implications of the hypothesis that these features of female and male physiology and behavior have been shaped by natural selection in response to female decision-making. My analysis shows that consensus motivation for coitus between partners influences both the importance of variable ovulation date and the probability of conception, under the influence of self-deception. It also identifies priorities for future empirical work.

The effect of the menstrual cycle on dichotic listening

The purpose of this study was to determine the effect of the menstrual cycle on responses to a dichotic listening task. It was hypothesized that participants would exhibit a stronger right ear advantage during the menstrual cycle days when estrogen levels are at their peak. It was also hypothesized that the women not taking oral contraceptives would exhibit greater variations in ear advantage over the course of their menstrual cycle than those taking oral contraceptives. Finally, it was hypothesized that the error response rates would remain similar across different listening conditions and over the menstrual cycle. The participants were 30 women who took oral contraceptives and 15 who did not. They completed nine listening sessions comprised of three dichotic listening tasks: forced-left, forced-right, and open. The data were analyzed using a mixed effects models. The participants exhibited a reduction in right ear responses on the days that corresponded to when the level of estrogen would begin to increase. This response was different from what had been hypothesized. The analysis also indicated no response differences between the two groups of women. In addition, the women exhibited fewer errors over the course of the sessions, implying that they adapted to the task. The results indicate that the women’s hormone fluctuation across the menstrual cycle affected their responses to the forced-left, cognitive control, task only.

Couple Beads: An integrated method of natural family planning

Various fertility indicators are used by natural family planning methods to identify the fertile and infertile phases of a woman's menstrual cycle: mucus observations, cycle-day probabilities, basal body temperature readings, and hormonal measures of LH and estrogen. Simplified NFP methods generally make use of a single fertility indicator such as cycle-day probabilities (Standard Days Method) or mucus observations (Billings Ovulation Method). The Couple Bead Method integrates the two simplest fertility indicators, cycle-day probabilities and mucus observations, expanding its applicability to all women, regardless of cycle regularity and length. In determining cycle-day probabilities, the Couple Bead Method relies on a new data set from ultrasound-derived determinants of gestational age that more directly define the day of conception and the fertile window. By using a visual-based system of inexpensive colored beads, the Couple Bead Method can be used by couples of all educational and income levels. Lay Summary: Natural family planning methods provide education in regard to the signs of a woman's body which indicate if she is possibly fertile or not. Two important signs are the day of her menstrual cycle and her observations of bleeding and cervical mucus or dryness. The Couple Bead Method teaches a couple how to observe these signs and chart them with a system of colored beads. The Couple Bead Method can be used by women with regular or irregular cycles. The bead sets are inexpensive and consist of a length of plastic cord, colored "pony beads" and safety pins.

[Role of ultrasound in elective abortions]

Ultrasound plays a fundamental role in the management of elective abortions. Although it can improve the quality of post-abortion care, it must not be an obstacle to abortion access. We thus studied the role of ultrasound in pregnancy dating and possible alternatives and analyzed the literature to determine the role of ultrasound in post-abortion follow-up. During an ultrasound scan, the date of conception is estimated by measurement of the crown-rump length (CRL), defined by Robinson, or of the biparietal diameter (BPD), as defined by the French Center for Fetal Ultrasound (CFEF) after 11 weeks of gestation (Robinson and CFEF curves) (grade B). Updated curves have been developed in the INTERGROWTH study. In the context of abortion, the literature recommends the application of a safety margin of 5 days, especially when the CRL and/or BPD measurement indicates a term close to 14 weeks (that is equal or below 80 and 27mm, respectively) (best practice agreement). Accordingly, with the ultrasound measurement reliable to±5 days when its performance meets the relevant criteria, an abortion can take place when the CRL measurement is less than 90mm or the BPD less than 30mm (INTERGROWTH curves) (best practice agreement). While a dating ultrasound should be encouraged, its absence is not an obstacle to scheduling an abortion for women who report that they know the date of their last menstrual period and/or of the at-risk sexual relations and for whom a clinical examination by a healthcare professional is possible (best practice agreement). In cases of intrauterine pregnancy of uncertain viability or of a pregnancy of unknown location, without any particular symptoms, the patient must be able to have a transvaginal ultrasound to increase the precision of the diagnosis (grade B). Various reviews of the literature on post-abortion follow-up indicate that the routine use of ultrasound during instrumental abortions should be avoided (best practice agreement). If it becomes clear immediately after the procedure that the endometrial thickness exceeds 8mm, immediate reaspiration is necessary. Ultrasound examination of the endometrium several days after an instrumental elective abortion does not appear to be relevant (grade B). An analysis of the literature similarly shows that routine ultrasound scans after medical abortions should be avoided. If a transvaginal ultrasound is performed after a medical abortion, it should take place at least two weeks afterwards (best practice agreement). The only aim of an ultrasound examination during follow-up should be to determine whether a gestational sac is present (best practice agreement). Finally, if an ultrasound is performed at any point during pre- or post-abortion care, a report should be drafted, specifying any potential gynecologic abnormalities found, but its absence must not delay the scheduling of the abortion (best practice agreement).

Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort

STUDY QUESTION

What is the relationship between signs and symptoms of early pregnancy and pregnancy loss <20 weeks' gestation?

SUMMARY ANSWER

Vaginal bleeding is associated with increased incidence of early pregnancy loss, with more severe bleeding and bleeding accompanied by lower abdominal cramping associated with greater incidence of loss; conversely, vomiting is associated with decreased incidence of early pregnancy loss, even in the setting of vaginal bleeding, while nausea alone is not.

WHAT IS KNOWN ALREADY

Two previous cohort studies with preconception enrollment suggested that bleeding is associated with loss while nausea is inversely associated with loss though these studies were limited by small study size and reporting after loss ascertainment. No prior preconception cohort study has examined multiple signs and symptoms in relation to pregnancy loss.

STUDY DESIGN, SIZE, DURATION

Population-based preconception cohort of 501 couples discontinuing contraception to try for pregnancy in 16 counties in Michigan and Texas, USA. Participants were followed daily until positive home pregnancy test or 12 months of trying without an hCG pregnancy; women who became pregnant were followed daily from 2 to 7 weeks post-conception.

PARTICIPANTS, SETTING, METHODS

Three hundred and forty-seven women had a positive home pregnancy test denoting hCG pregnancy. Three hundred and forty-one women remained after excluding ineligible pregnancies. Women recorded daily from 2 to 7 weeks post-conception their signs and symptoms, including vaginal bleeding (none, spotting, light, moderate and heavy), lower abdominal cramping, nausea and vomiting. Pregnancy losses were ascertained by a subsequent negative home pregnancy test, clinical confirmation or onset of menses, depending on gestational age at loss; time-to-loss was measured in days post-conception. Cumulative incidence functions and 95% confidence intervals (CIs) were constructed for each sign or symptom, and hazard ratios (HRs) and 95% CIs for presence compared with absence of signs or symptoms were estimated using Cox proportional hazard models.

MAIN RESULTS AND THE ROLE OF CHANCE

Women experienced lower abdominal cramping (85%), nausea (48%), vomiting (46%) and light/moderate/heavy vaginal bleeding (24%) during early pregnancy. Ninety-five (28%) women experienced a loss. Cumulative incidence of pregnancy loss varied by symptomatology: 19% for vomiting, 27% for lower abdominal cramping, 35% for nausea only, 52% for vaginal bleeding, 81% for vaginal bleeding with lower abdominal cramping. Incidence of pregnancy loss was increased among women with vaginal bleeding (HR: 3.62, 95% CI: 2.29-5.74) and among women with vaginal bleeding and lower abdominal cramping (HR: 5.03, 95% CI: 2.07-12.20). Incidence of pregnancy loss was decreased for women with vomiting (HR: 0.51, 95% CI: 0.30-0.86). In the setting of vaginal bleeding with lower abdominal cramping, vomiting reduced the incidence of pregnancy loss (HR: 0.24, 95% CI: 0.11-0.56).

LIMITATIONS, REASONS FOR CAUTION

There were few losses beyond 14 weeks gestation; thus, the precision of our findings related to losses occurring after the first trimester is limited.

WIDER IMPLICATIONS OF THE FINDINGS

By using sensitive home pregnancy tests, we are able to document and characterize the cumulative incidence of the earliest pregnancy losses, which constitute the majority of losses. The use of daily, prospective capture of signs and symptoms relative to ascertainment of pregnancy loss minimizes potential biases associated with reporting after rather than before a loss, which could potentially distort the relationship between signs and symptoms and pregnancy loss. The findings of our study suggest that it may be useful to develop prognostic models for pregnancy loss based on signs and symptoms.

STUDY FUNDING/COMPETING INTERESTS

This study was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contract numbers N01-HD-3-3355; N01-HD-3-3356; N01-HD-3-3358). The authors have no conflict of interest to declare.

Hormonal predictors of women's extra-pair vs. in-pair sexual attraction in natural cycles: Implications for extended sexuality

In naturally cycling women, Roney and Simmons (2013) examined hormonal correlates of their desire for sexual contact. Estradiol was positively associated, and progesterone negatively associated, with self-reported desire. The current study extended these findings by examining, within a sample of 33 naturally cycling women involved in romantic relationships, hormonal correlates of sexual attraction to or interests in specific targets: women's own primary partner or men other than women's primary partner. Women's sexual interests and hormone (estradiol, progesterone, and testosterone) levels were assessed at two different time points. Whereas estradiol levels were associated with relatively greater extra-pair sexual interests than in-pair sexual interests, progesterone levels were associated with relatively greater in-pair sexual interests. Both hormones specifically predicted in-pair sexual desire, estradiol negatively and progesterone positively. These findings have implications for understanding the function of women's extended sexuality - their sexual proceptivity and receptivity outside the fertile phase, especially during the luteal phase.

Changes in Women's Facial Skin Color over the Ovulatory Cycle are Not Detectable by the Human Visual System

Human ovulation is not advertised, as it is in several primate species, by conspicuous sexual swellings. However, there is increasing evidence that the attractiveness of women's body odor, voice, and facial appearance peak during the fertile phase of their ovulatory cycle. Cycle effects on facial attractiveness may be underpinned by changes in facial skin color, but it is not clear if skin color varies cyclically in humans or if any changes are detectable. To test these questions we photographed women daily for at least one cycle. Changes in facial skin redness and luminance were then quantified by mapping the digital images to human long, medium, and shortwave visual receptors. We find cyclic variation in skin redness, but not luminance. Redness decreases rapidly after menstrual onset, increases in the days before ovulation, and remains high through the luteal phase. However, we also show that this variation is unlikely to be detectable by the human visual system. We conclude that changes in skin color are not responsible for the effects of the ovulatory cycle on women's attractiveness.

The human sex ratio from conception to birth

We describe the trajectory of the human sex ratio from conception to birth by analyzing data from (i) 3- to 6-d-old embryos, (ii) induced abortions, (iii) chorionic villus sampling, (iv) amniocentesis, and (v) fetal deaths and live births. Our dataset is the most comprehensive and largest ever assembled to estimate the sex ratio at conception and the sex ratio trajectory and is the first, to our knowledge, to include all of these types of data. Our estimate of the sex ratio at conception is 0.5 (proportion male), which contradicts the common claim that the sex ratio at conception is male-biased. The sex ratio among abnormal embryos is male-biased, and the sex ratio among normal embryos is female-biased. These biases are associated with the abnormal/normal state of the sex chromosomes and of chromosomes 15 and 17. The sex ratio may decrease in the first week or so after conception (due to excess male mortality); it then increases for at least 10-15 wk (due to excess female mortality), levels off after ∼20 wk, and declines slowly from 28 to 35 wk (due to excess male mortality). Total female mortality during pregnancy exceeds total male mortality. The unbiased sex ratio at conception, the increase in the sex ratio during the first trimester, and total mortality during pregnancy being greater for females are fundamental insights into early human development.

Reclaiming fertility awareness methods to inform timed intercourse for HIV serodiscordant couples attempting to conceive

INTRODUCTION

Increased life expectancy of HIV-positive individuals during recent years has drawn attention to their quality of life, which includes fulfillment of fertility desires. In particular, heterosexual HIV serodiscordant couples constitute a special group for whom the balance between desired pregnancy and the risk of viral transmission should be carefully considered and optimized. Although advanced assisted reproductive technologies are available, such treatments are expensive and are often unavailable. Moreover, standard viral load testing and antiretroviral therapy may not be accessible due to structural or individual barriers. To reduce the risk of HIV transmission, a lower cost alternative is timed condomless sex combined with other risk-reduction strategies. However, timed condomless sex requires specific knowledge of how to accurately predict the fertile window in a menstrual cycle. The aim of this study was to summarize inexpensive fertility awareness methods (FAMs) that predict the fertile window and may be useful for counselling HIV-positive couples on lower cost options to conceive.

METHODS

Original English-language research articles were identified by a detailed Medline and Embase search in July 2014. Relevant citations in the included articles were also retrieved.

RESULTS AND DISCUSSION

Calendar method, basal body temperature and cervicovaginal mucus secretions are the most accessible and sensitive FAMs, although poor specificity precludes their independent use in ovulation detection. In contrast, urinary luteinizing hormone testing is highly specific but less sensitive, and more expensive. To maximize the chance of conception per cycle, the likelihood of natural conception needs to be assessed with a basic fertility evaluation of both partners and a combination of FAMs should be offered. Adherence to other risk-reduction strategies should also be advised, and timely referral to reproductive medicine specialists is necessary when sub/infertility is suspected.

CONCLUSIONS

FAMs provide effective, economical and accessible options for HIV serodiscordant couples to conceive while minimizing unnecessary viral exposure. It is important for health care providers to initiate conversations about fertility desires in HIV-positive couples and to educate identified couples on safer conception strategies.