Fecundability in reproductive aged women at risk of sexual dysfunction and associated risk factors: a prospective preconception cohort study

Holistic preconception care: Providing real-time guidance via a mobile app to optimise maternal and child health

Introduction

Preconception is a critical period to optimise gamete function and early placental development, essential for successful conception and long-term maternal-child health. However, there is a lack of preconception services and consequently, global fertility rates continue to fall and mothers embark on their pregnancy journey in poor health. There is an urgent need to implement a holistic community-level preconception care programme to optimise risk factors for poor fecundability and improve long-term maternal-child health.

Method

We reviewed current evidence on fecundability lifestyle risk factors, the efficacy of existing preconception interventions and the use of digital platforms for health optimisation, to create a new digital-based preconception intervention model that will be implemented via an app. We present the theory, content and mode of delivery of this holistic model targeting couples planning for pregnancy.

Results

We propose a new model featuring a user-friendly mobile app, which enables couples to self-assess fecundability risks through a personalised risk score that drives a tailored management plan. This tiered management provides anticipatory guidance supported by evidence-based recommen-dations, and promotes ongoing engagement for behavioural optimisation and specialist referrals as required. Based on the health belief model, this new model delivered with a mobile app seeks to shift couples' perceptions about their susceptibility and severity of subfertility, benefits of making a change and barriers to change.

Conclusion

Our proposed digital-based intervention model via a mobile app stands to enhance preconcep-tion care by providing personalised risk assessments, real-time feedback and tiered management to optimise preconception reproductive health of couples. This model forms a reference content framework for future preconception care intervention delivery.

Impact of Perceived Social Support and Depression in Married Turkish Women on the Sexual Quality of Life: An Online Survey

BACKGROUND

Sexual life is very important for people's physical health, psychological health, and reproductive health. Depression and social support are among the factors that affect the quality of sexual life.

AIM

The present study aimed to determine the impact of perceived social support on the sexual quality of life and depression in married women between the ages of 18 and 49.

MATERIALS AND METHODS

A total of 976 married women aged 18 to 49 were included in this cross-sectional study in which an online data collection method was used Sexual Life Quality Scale, Multidimensional Perceived Social Support Scale, and Beck Depression Scale, which were used as data collection tools. Statistical analysis used: Analyses were performed using SPSS version 26.0. Descriptive statistics were used for number, percentage, mean, and standard deviation, as well as independent group t-test, correlation, and regression analysis. The "Enter" model was used in the logistic regression analysis.

RESULTS

It was established that nearly one-third of married women aged 18-49 had low levels of perceived social support and sexual quality of life, and almost half of them experienced symptoms of depression. The quality of sexual life was 3.6 times (P = 0.001) lower in those with low social support and 1.6 times (P = 0.024) lower in those with depression.

CONCLUSION

Considering the fact that women's sexual problems, low social support and depression are important predictors of sexual quality of life, special attention should be paid to increasing social support to women, handling women's sexual problems more carefully, and detecting and treating such problems.

Association between body mass index, body image and self-esteem with sexual function: A survey of young women in Singapore

Introduction

Obesity is thought to be a negative predictor of sexual function, but the relationship between body mass index (BMI) and sexual function has been inconsistent. Other factors such as body image and self-esteem may mediate this relationship. This study examined the association of BMI, body image and self-esteem with sexual function in young women.

Method

A total of 514 sexually active women aged 21 to 35 years completed an anonymised online questionnaire that used 3 scales to assess body image, self-esteem and female sexual function: Body Image States Scale (BISS), Rosenberg Self-Esteem Scale (RSES) and Female Sexual Function Index (FSFI). Higher scores for BISS, RSES and FSFI indicate more positive body image, higher self-esteem and better sexual function, respectively. Spearman correlation assessed the association among BMI, BISS and RSES scores, and with FSFI scores. Linear and multivariable logistic regression identified risk factors associated with sexual dysfunction (FSFI <26.55).

Results

BISS and RSES scores significantly correlated with FSFI scores (r=0.27 and r=0.32, respectively; both P<0.001), indicating that better body image and self-esteem were associated with better sexual function. Risk factors for sexual dysfunction were lower BISS and RSES scores, being married (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.07-2.15), having 1 child (OR 2.45; 95% CI 1.26-4.77) and having a perceived mental condition (OR 3.02; 95% CI 1.44-6.33). Factors in lack of sexual dysfunction include being of Malay ethnicity (OR 0.38; 95% CI 0.21-0.71) and being overweight (OR 0.46; 95% CI 0.27-0.78).

Conclusion

Women with poorer body image and lower self-esteem were more likely to have sexual dysfunction. These perceptions and states did not correlate with being overweight, and were better predictors over BMI to identify the population at-risk.

Effects of physical activity and sleep duration on fertility: A systematic review and meta-analysis based on prospective cohort studies

Objective

Subfertility is a common problem for couples in modern society. Many studies have confirmed that lifestyle factors can affect fertility although there are conflicting conclusions relating to the effects of physical activity and sleep duration on fertility. In this study, we aimed to summarize and analyze the available evidence.

Methods

PubMed, Web of Science, Cochrane, and Embase databases (as of October 14, 2022) were systematically searched for eligible prospective cohort studies. Data were extracted and effect values were combined. We also performed methodological quality and bias risk assessments for all the included studies.

Results

A total of 10 eligible articles were included in our analysis; seven investigated the relationship between physical activity and fertility, and three investigated the effect of sleep duration on fertility. Compared with the lowest level of physical activity, high intensity physical activity (the highest levels of physical activity) was negatively correlated with fertility [odds ratio (OR) = 0.84; 95% confidence interval (CI): 0.70, 1.00, I ² = 64%]. However, we did not find an association between moderate intensity physical activity and fertility (OR = 1.09; 95% CI: 0.98, 1.22, I ² = 60%). We observed an inverse association between limited sleep duration (≤ 7 h) and fertility (OR = 0.92; 95% CI: 0.84, 1.00, I ² = 0%) compared with 8 h of sleep. The relationship between long sleep duration (≥9 h) and fertility was not statistically significant (OR = 0.85; 95% CI: 0.60, 1.21, I ² = 83%). According to the Newcastle-Ottawa Scale score, the overall quality of the research articles included was ranked as medium to high (6-9). Through GRADE system, the quality of evidence for the impact of high intensity physical activity and limited sleep duration on fertility was moderate, while the quality of evidence for the impact of moderate intensity physical activity and long sleep duration on fertility was low.

Conclusion

The current evidence shows that high intensity physical activity and limited sleep time are negatively related to fertility. But there was great heterogeneity among studies, and the quality of research evidence was low to median. Thus, further high-quality research is needed to confirm this conclusion.

PROSPERO registration number

CRD42022298137.

Sexual Function and Mood Disorders Among Menopausal Women: A Systematic Scoping Review

BACKGROUND

Changes in sex hormones during menopause may have detrimental effects on a woman's sexual function and cause mood disorders. The treatment of both conditions is a challenge in gynecology.

AIM

To review the published literature on sexual function and mood disorders among peri- and postmenopausal women.

METHODS

The review is based on the methodological framework of scoping reviews. We searched electronic databases including Medline (PubMed), Scopus, Embase, and Web of Science (WoS). Publications that reported data about the relationship between sexual function and mood disorders among menopausal women were included in the review. The search was not subject to any limitation in terms of time or method.

OUTCOMES

The main outcome measures used for the review were sexual dysfunction and mood disorders.

RESULTS

We found 106 total records. After a full-text screening we included 19 studies from 1986 to 2020 based on various methodologies; the majority of the studies16 were cross-sectional. Investigations that addressed the symptoms of mood disorders and some domains of sexual function showed a close relationship between sexual dysfunction and mood disorders among menopausal women.

CLINICAL IMPLICATIONS

In clinical practice, it would be appropriate to screen women for at least one mood disorder or sexual dysfunction. If a woman suffers from either, it will be necessary to assess for a further disorder as well.

STRENGTHS & LIMITATIONS

The review was based on a detailed search of the published literature concerning mood disorders and sexual dysfunction among menopausal women compared to women of reproductive age. Despite the clinical importance of the subject, the number of studies eligible for inclusion in the review are rather small. Further investigation of the topic is clearly warranted.

CONCLUSIONS

While the association between sexual dysfunction and mood disorders appears to be bidirectional, future studies will have to investigate the specific mechanisms by which sexual dysfunction could lead to mood disorders (or vice versa). Future studies should specifically address sexual dysfunctions and attitudes of partners, BMI, family support, sleep, and multiparity. Azam Rahmani, Elahe Afsharnia, Julia Fedotova, Shirin Shahbazi, Arezoo Fallahi, Leila Allahqoli, Reza GhaneipoklGheshlagh, Sarah Abboud, Ibrahim Alkatout. Sexual Function and Mood Disorders Among Menopausal Women: A Systematic Scoping Review. J Sex Med 2022;19:1098-1115.

Prepregnancy adherence to plant-based diet indices and exploratory dietary patterns in relation to fecundability

BACKGROUND

Modest associations have been reported between specific food groups or nutrients and fecundability [measured by time to pregnancy (TTP)]. Examining overall diets provides a more holistic approach towards understanding their associations with fecundability. It is not known whether plant-based diets indices or exploratory dietary patterns are associated with fecundability.

OBJECTIVES

We examine the associations between adherence to 1) plant-based diet indices; and 2) exploratory dietary patterns and fecundability among women planning pregnancy.

METHODS

Data were analyzed from the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) study. Prepregnancy diet was assessed using a semi-quantitative FFQ from which the overall, healthful, and unhealthful plant-based diet indices (oPDI, hPDI, and uPDI, respectively) were calculated. Exploratory dietary patterns were derived using factor analysis based on 44 predefined food groups. Participants were categorized into quintiles based on their dietary pattern scores. TTP (expressed in menstrual cycles) was ascertained within a year from the prepregnancy dietary assessment. Discrete-time proportional hazard models, adjusted for confounders, were used to estimate fecundability ratios (FRs) and 95% CIs, with FR > 1 indicating a shorter TTP.

RESULTS

Among 805 women, 383 pregnancies were confirmed by ultrasound scans. Compared with women in the lowest quintile, those in the highest quintile of the uPDI had reduced fecundability (FR of Q5 compared with Q1, 0.65; 95% CI, 0.46-0.91; P trend, 0.009). Conversely, greater adherence to the hPDI was associated with increased fecundability (1.46; 95% CI, 1.02-2.07; P trend, 0.036). The oPDI was not associated with fecundability. Among the 3 exploratory dietary patterns, only greater adherence to the Fast Food and Sweetened Beverages (FFSB) pattern was associated with reduced fecundability (0.61; 95% CI, 0.40-0.91; P trend, 0.018).

CONCLUSIONS

Greater adherence to the uPDI or the FFSB dietary pattern was associated with reduced fecundability among Asian women. Greater adherence to the hPDI may be beneficial for fecundability, though this requires confirmation by future studies.